Application of Human Factors Methods to Understand Missed Follow-up of Abnormal Test Results.

Objective: This study demonstrates application of human factors methods for understanding causes for lack of timely follow-up of abnormal test results ("missed results") in outpatient settings.

Methods: We identified 30 cases of missed test results by querying electronic health record data, developed a critical decision method (CDM)-based interview guide to understand decision-making processes, and interviewed physicians who ordered these tests. We analyzed transcribed responses using a contextual inquiry (CI)-based methodology to identify contextual factors contributing to missed results.

Pediatric clinician perspectives on communicating diagnostic uncertainty.

Objective: Diagnosis often evolves over time, involves uncertainty, and is vulnerable to errors. We examined pediatric clinicians' perspectives on communicating diagnostic uncertainty to patients' parents and how this occurs.

Design: We conducted semi-structured interviews, which were audiotaped, transcribed, and analyzed using content analysis.

National trend of utilization, clinical and economic outcomes of transcatheter aortic valve replacement among patients with chronic obstructive pulmonary disease.

We aimed to trend the utilization of transcatheter aortic valve replacement (TAVR) among COPD patients, compare its outcomes to surgical aortic valve replacement (SAVR) and assess any social disparities in its outcomes. Patients with chronic obstructive pulmonary disease (COPD) have been increasingly undergoing TAVR, but studies to evaluate the national trend of TAVR utilization and outcomes are still lacking. We conducted a retrospective observational study using a nationally representative database, the National Inpatient Sample (NIS).

National Trends in Smoking Cessation Medication Prescriptions for Smokers With Chronic Obstructive Pulmonary Disease in the United States, 2007-2012.

Objectives: Smoking cessation decreases morbidity and mortality due to chronic obstructive pulmonary disease (COPD). Pharmacotherapy for smoking cessation is highly effective. However, the optimal prescription rate of smoking cessation medications among smokers with COPD has not been systemically studied.

Electronic health record reviews to measure diagnostic uncertainty in primary care.

Rationale, Aims And Objectives: Diagnostic uncertainty is common in primary care. Because it is challenging to measure, there is inadequate scientific understanding of diagnostic decision-making during uncertainty. Our objective was to understand how diagnostic uncertainty was documented in the electronic health record (EHR) and explore a strategy to retrospectively identify it using clinician documentation.

Patient perspectives on how physicians communicate diagnostic uncertainty: An experimental vignette study.

Objective: We evaluated the effects of three different strategies for communicating diagnostic uncertainty on patient perceptions of physician competence and visit satisfaction.

Design/setting: Experimental vignette-based study design involving pediatric cases presented to a convenience sample of parents living in a large US city.

Participants/intervention(s): Three vignettes were developed, each describing one of three different ways physicians communicated diagnostic uncertainty to parents-(i) explicit expression of uncertainty ('not sure' about diagnosis), (ii) implicit expression of uncertainty using broad differential diagnoses and (iii) implicit expression of uncertainty using 'most likely' diagnoses.

Defining and Measuring Diagnostic Uncertainty in Medicine: A Systematic Review.

Background: Physicians routinely encounter diagnostic uncertainty in practice. Despite its impact on health care utilization, costs and error, measurement of diagnostic uncertainty is poorly understood. We conducted a systematic review to describe how diagnostic uncertainty is defined and measured in medical practice.

Sex-Specific Associations of Oral Anticoagulant Use and Cardiovascular Outcomes in Patients With Atrial Fibrillation.

Background: Sex-specific effectiveness of rivaroxaban (RIVA), dabigatran (DABI), and warfarin in reducing myocardial infarction (MI), heart failure (HF), and all-cause mortality among patients with atrial fibrillation are not known. We assessed sex-specific associations of RIVA, DABI, or warfarin use with the risk of MI, HF, and all-cause mortality among patients with atrial fibrillation.

Methods And Results: Medicare beneficiaries (men: 65 734 [44.

Outcomes and readmissions after transcatheter and surgical aortic valve replacement in patients with cirrhosis: A propensity matched analysis.

Background: The data on the comparative outcomes and readmissions after transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) in patients with cirrhosis are limited. We compared mortality, complications, discharge disposition, 30-day readmission rates, length of stay, and cost of hospitalization in cirrhotic patients undergoing TAVR and SAVR.

Methods: The National Inpatient Sample (NIS) and the National Readmission Database (NRD) were used for the study.

Gender Differences in the Trends of Hospitalizations for Acute Stroke Among Patients With Atrial Fibrillation in the United States: 2005 to 2014.

Female gender was included in stroke prediction algorithms in an attempt to improve anticoagulation rates in women with atrial fibrillation (AF). It is unclear if these efforts reduced stroke burden in women with AF. To bridge this literature gap, using the Nationwide Inpatient Sample, we assessed gender differences in the trends of hospitalizations for stroke among patients with AF in the United States in 2005 to 2014.

Errors in Diagnosis of Spinal Epidural Abscesses in the Era of Electronic Health Records.

Purpose: With this study, we set out to identify missed opportunities in diagnosis of spinal epidural abscesses to outline areas for process improvement.

Methods: Using a large national clinical data repository, we identified all patients with a new diagnosis of spinal epidural abscess in the Department of Veterans Affairs (VA) during 2013. Two physicians independently conducted retrospective chart reviews on 250 randomly selected patients and evaluated their records for red flags (eg, unexplained weight loss, neurological deficits, and fever) 90 days prior to diagnosis.

Early readmissions after transcatheter and surgical aortic valve replacement.

Objectives: We aimed to determine and compare the prevalence, and predictors of readmissions after the transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR).

Background: There are limited data on the readmission rates after TAVR in comparison with SAVR.

Methods: We analyzed the data from 2013 National Readmission Database.

Computerized Triggers of Big Data to Detect Delays in Follow-up of Chest Imaging Results.

Background: A "trigger" algorithm was used to identify delays in follow-up of abnormal chest imaging results in a large national clinical data warehouse of electronic health record (EHR) data.

Methods: We applied a trigger in a repository hosting EHR data from all Department of Veterans Affairs health-care facilities and analyzed data from seven facilities. Using literature reviews and expert input, we refined previously developed trigger criteria designed to identify patients potentially experiencing delays in diagnostic evaluation of chest imaging flagged as "suspicious for malignancy.

Patient-Reported Attributions for Missed Colonoscopy Appointments in Two Large Healthcare Systems.

Background: Missed colonoscopy appointments (no-shows) can lead to wasted resources and delays in colorectal cancer diagnosis, an area of special concern in public health systems that often provide care for vulnerable patients. Our objective was to identify reasons for missed colonoscopy appointments in patients seeking care at two large public health systems in Houston, TX.

Methods: We conducted a telephone survey of patients who missed their colonoscopy appointments at two tertiary care health systems.

The use of a tablet computer platform to optimize the care of patients receiving peritoneal dialysis: a pilot study.

Background: Peritoneal dialysis (PD) affords patients increased independence and improved quality of life. However, the lack of more frequent monitoring may compromise outcomes and decrease wider uptake of this modality. This study uses a novel tablet computer-based interface to allow real-time monitoring and two-way communication to better link PD patients with a dialysis center and care providers.

Screening for latent tuberculosis in refugees with renal failure.

Refugee camps are prone for easy spread of infections of various kinds and tuberculosis (TB) is no exception. Refugees with renal failure are often a vulnerable group because they are immunocompromised due to reasons such as poor nutrition, overcrowding and immune suppression due to renal failure. Latent pulmonary TB is a particular problem in this patient population as it is not easily diagnosed and has immense potential for spread.

Prevalence of Subclinical Hypothyroidism in Patients with End-Stage Renal Disease and the Role of Serum Albumin: A Cross-Sectional Study from South India.

BACKGROUND/AIM: Subclinical hypothyroidism (SCH) and end-stage renal disease (ESRD) are independent risk factors for cardiovascular mortality. We aimed to study the prevalence of SCH in ESRD patients and assessed its associated risk factors. METHODS: This cross-sectional study was conducted at 2 tertiary-care centers in Chennai, India, over a 3-year period.