Computable Phenotype Implementation for a National, Multicenter Pragmatic Clinical Trial: Lessons Learned From ADAPTABLE.

Background: Many large-scale cardiovascular clinical trials are plagued with escalating costs and low enrollment. Implementing a computable phenotype, which is a set of executable algorithms, to identify a group of clinical characteristics derivable from electronic health records or administrative claims records, is essential to successful recruitment in large-scale pragmatic clinical trials. This methods paper provides an overview of the development and implementation of a computable phenotype in ADAPTABLE (Aspirin Dosing: a Patient-Centric Trial Assessing Benefits and Long-Term Effectiveness)-a pragmatic, randomized, open-label clinical trial testing the optimal dose of aspirin for secondary prevention of atherosclerotic cardiovascular disease events.

Neuropathy and Other Risk Factors for Lower Extremity Amputation in People with Diabetes Using a Clinical Data Repository System.

Aims: The purpose of the study was to identify the frequency of a prior diagnosis of neuropathy, peripheral vascular disease (PVD), and foot ulceration in patients with diabetes who subsequently underwent lower extremity amputation (LEA).

Methods: We performed a retrospective electronic review of de-identified charts from a tertiary medical health center of patients who had the diagnosis codes of diabetes and the procedure codes of LEA. For this query, neuropathy, PVD, and foot ulcer diagnosis codes were selected as the variables of interest.

The Building Blocks of Interoperability. A Multisite Analysis of Patient Demographic Attributes Available for Matching.

Background: Patient matching is a key barrier to achieving interoperability. Patient demographic elements must be consistently collected over time and region to be valuable elements for patient matching.

Objectives: We sought to determine what patient demographic attributes are collected at multiple institutions in the United States and see how their availability changes over time and across clinical sites.

The effect of computerized provider order entry (CPOE) on ordering patterns for chest pain patients in the emergency department.

This study addressed the effect of CPOE implementation on chest pain ordering patterns for patients in the emergency department. Retrospective order data was collected to assess the implementation. 300 randomly selected, time matched patients with a chief complaint of chest pain were selected in a before/after study.

Prospective evaluation of a closed-loop, computerized reminder system for pneumococcal vaccination in the emergency department.

The Emergency Department is a suitable but challenging environment to implement a sustainable pneumococcal vaccination program. To increase vaccination rates for patients > or equal to 65 years old, we prospectively evaluated a closed-loop informatics approach over a 6-week study period. Among the 572 candidate patients, 284 were up-to-date with vaccination, 187 patients refused vaccination, 65 physicians declined to order the vaccine, and 28 patients received the vaccine during the ED visit.