Predictors of Recurrent AKI.

Recurrent AKI is common among patients after hospitalized AKI and is associated with progressive CKD. In this study, we identified clinical risk factors for recurrent AKI present during index AKI hospitalizations that occurred between 2003 and 2010 using a regional Veterans Administration database in the United States. AKI was defined as a 0.

The National Neurosurgery Quality and Outcomes Database (N2QOD): a collaborative North American outcomes registry to advance value-based spine care.

Study Design: National Prospective Observational Registry.

Objective: Describe our preliminary experience with the National Neurosurgery Quality and Outcomes Database (NQOD), a national collaborative registry of quality and outcomes reporting after low back surgery.

Summary Of Background Data: All major health care stakeholders are now requiring objective data regarding the value of medical services.

Operating room clinicians' ratings of workload: a vignette simulation study.

Objectives: Increased clinician workload is associated with medical errors and patient harm. The Quality and Workload Assessment Tool (QWAT) measures anticipated (pre-case) and perceived (post-case) clinical workload during actual surgical procedures using ratings of individual and team case difficulty from every operating room (OR) team member. The purpose of this study was to examine the QWAT ratings of OR clinicians who were not present in the OR but who read vignettes compiled from actual case documentation to assess interrater reliability and agreement with ratings made by clinicians involved in the actual cases.

Who said it? Establishing professional attribution among authors of Veterans' Electronic Health Records.

Background: A practical data point for assessing information quality and value in the Electronic Health Record (EHR) is the professional category of the EHR author. We evaluated and compared free form electronic signatures against LOINC note titles in categorizing the profession of EHR authors.

Methods: A random 1000 clinical document sample was selected and divided into 500 document sets for training and testing.

Secondary use of clinical data.

Clinicians involved in clinical care generate daily volumes of important data. This data is important for continuity of care, referrals to specialists and back to the patient's medical home. The same data can be used to generate alerts to improve the practice and to generate care activities to ensure that all appropriate care services are provided for the patient given their known medical histories using electronic quality (eQuality) monitoring.

eQuality for all: Extending automated quality measurement of free text clinical narratives.

Introduction: Electronic quality monitoring(eQuality) from clinical narratives may advance current manual quality measurement techniques.We evaluated automated eQuality measurement tools on clinical narratives of veterans' disability examinations.

Methods: We used a general purpose indexing engine to encode clinical concepts with SNOMED CT.

Using quality improvement methods to improve door-to-balloon time at an academic medical center.

Objectives: 1) Describe a quality improvement (QI) process to decrease door-to-balloon time (D2B); 2) Explain implementation of evidence-based strategies to improve D2B.

Background: The ACC/AHA 2006 guideline target for ST-elevation myocardial infarction (STEMI) is a D2B of 90 minutes (min). QI methods can be used to identify areas for improvement, measure current processes, and provide rapid-cycle feedback about which strategies are effective.

Prolonged QTc intervals on admission electrocardiograms: prevalence and correspondence with admission electrolyte abnormalities.

Background: Prolonged QTc (corrected QT) interval and torsades de pointes (TDP) are associated with hypocalcemia, hypomagnesemia, hypokalemia, possibly alkalosis and may result in syncope and sudden cardiac death.

Hypothesis: The purpose of this study was to determine the prevalence of prolonged QTc intervals on admission electrocardiograms (ECGs) and its correspondence with simultaneous admission electrolyte values, adjusted for admission diagnoses, comorbidities, other ECG abnormalities, and medications potentially associated with QTc prolongation.

Methods: Consecutive patients (N=258) admitted to a general medical service with the admission electrolytes and ECGs.

The effect of standardized, computer-guided templates on quality of VA disability exams.

Background: The costs and limitations of clinical encounter documentation using dictation/transcription have provided impetus for increased use of computerized structured data entry to enforce standardization and improve quality. The purpose of the present study is to compare exam report quality of Veterans Affairs (VA) disability exams documented by computerized protocol-guided templates with exams documented in the usual fashion (dictation).

Methods: Exam report quality for 17,490 VA compensation and pension (C&P) disability exams reviewed in 2005 was compared for exam reports completed by template and exam reports completed in routine fashion (dictation).

Optimizing choledocholithiasis management: a cost-effectiveness analysis.

Hypothesis: Endoscopic retrograde cholangiopancreatography (ERCP) is more cost-effective for managing incidental choledocholithiasis (CDL) after laparoscopic cholecystectomy and intraoperative cholangiogram (LC/IOC) than laparoscopic common bile duct exploration (LCBDE).

Design: A cost-effectiveness analysis was performed to compare ERCP with LCBDE. Sensitivity analyses were performed to determine the key contributors to cost-effectiveness between the 2 treatment options.

Evaluation of the content coverage of SNOMED CT: ability of SNOMED clinical terms to represent clinical problem lists.

Objective: To evaluate the ability of SNOMED CT (Systematized Nomenclature of Medicine Clinical Terms) version 1.0 to represent the most common problems seen at the Mayo Clinic in Rochester, Minn.

Material And Methods: We selected the 4996 most common nonduplicated text strings from the Mayo Master Sheet Index that describe patient problems associated with inpatient and outpatient episodes of care.

Adequacy of representation of the National Drug File Reference Terminology Physiologic Effects reference hierarchy for commonly prescribed medications.

The National Drug File Reference Terminology contains a novel reference hierarchy to describe physiologic effects (PE) of drugs. The PE reference hierarchy contains 1697 concepts arranged into two broad categories; organ specific and generalized systemic effects. This investigation evaluated the appropriateness of the PE concepts for classifying a random selection of commonly prescribed medications.

The economic benefit of organizational restructuring of the cardiothoracic intensive care unit.

Objectives: Compare cost/benefits of organizational restructuring of the cardiac intensive care unit (CICU).

Design: Prospective, with a retrospective control period.

Setting: Academic medical center.

Initializing the VA medication reference terminology using UMLS metathesaurus co-occurrences.

We developed and evaluated a UMLS Metathesaurus Co-occurrence mining algorithm to connect medications and diseases they may treat. Based on 16 years of co-occurrence data, we created 977 candidate drug-disease pairs for a sample of 100 ingredients (50 commonly prescribed and 50 selected at random). Our evaluation showed that more than 80% of the candidate drug-disease pairs were rated "APPROPRIATE" by physician raters.