@article{aarone.carrollUseComputerizedDecision2013,
  title = {Use of a {{Computerized Decision Aid}} for {{ADHD Diagnosis}}: {{A Randomized Controlled Trial}}},
  author = {{Aaron E. Carroll} and {Nerissa S. Bauer} and {Tamara M. Dugan} and {Vibha Anand} and {Chandan Saha} and {Stephen M. Downs}},
  year = {2013},
  month = sep,
  journal = {Pediatrics},
  volume = {132},
  number = {3},
  pages = {e623-e629},
  publisher = {American Academy of Pediatrics},
  issn = {0031-4005},
  doi = {10.1542/peds.2013-0933},
  abstract = {To determine if implementing attention-deficit/hyperactivity disorder (ADHD) diagnosis and treatment guidelines in a clinical decision support system would result in better care, including higher rates of adherence to clinical care guidelines.We conducted a cluster randomized controlled trial in which we compared diagnosis and management of ADHD in 6- to 12-year-olds after implementation of a computer decision support system in 4 practices.Eighty-four charts were reviewed. In the control group, the use of structured diagnostic assessments dropped from 50\% in the baseline period to 38\% in the intervention period. In the intervention group, however, it rose from 60\% to 81\%. This difference was statistically significant, even after controlling for age, gender, and race (odds ratio of structured diagnostic assessment in intervention group versus control group = 8.0, 95\% confidence interval 1.6-40.6). Significant differences were also seen in the number of ADHD core symptoms noted at the time of diagnosis. Our study was not powered to detect changes in care and management, but the percent of patients who had documented medication adjustments, mental health referrals, and visits to mental health specialists were higher in the intervention group than the control.The introduction of a clinical decision support module resulted in higher quality of care with respect to ADHD diagnosis including a prospect for higher quality of ADHD management in children. Future work will examine how to further develop the ADHD module and add support for other chronic conditions.}
}

@article{alexandram.rochAutomatedPancreaticCyst2015,
  title = {Automated Pancreatic Cyst Screening Using Natural Language Processing: A New Tool in the Early Detection of Pancreatic Cancer},
  author = {{Alexandra M. Roch} and {Saeed Mehrabi} and {Anand Krishnan} and {Heidi Schmidt} and {Joe Kesterson} and {Chris Beesley} and {Paul Dexter} and {Mathew Palakal} and {C. Max Schmidt}},
  year = {2015},
  month = may,
  journal = {Hpb},
  volume = {17},
  number = {5},
  pages = {447--453},
  publisher = {Elsevier BV},
  issn = {1365-182X},
  doi = {10.1111/hpb.12375},
  abstract = {IntroductionAs many as 3\% of computed tomography (CT) scans detect pancreatic cysts. Because pancreatic cysts are incidental, ubiquitous and poorly understood, followup is often not performed. Pancreatic cysts may have a significant malignant potential and their identification represents a `window of opportunity' for the early detection of pancreatic cancer. The purpose of this study was to implement an automated Natural Language Processing (NLP)based pancreatic cyst identification system.MethodA multidisciplinary team was assembled. NLPbased identification algorithms were developed based on key words commonly used by physicians to describe pancreatic cysts and programmed for automated search of electronic medical records. A pilot study was conducted prospectively in a single institution.ResultsFrom March to September 2013, 566 233 reports belonging to 50 669 patients were analysed. The mean number of patients reported with a pancreatic cyst was 88/month (range 78--98). The mean sensitivity and specificity were 99.9\% and 98.8\%, respectively.ConclusionNLP is an effective tool to automatically identify patients with pancreatic cysts based on electronic medical records (EMR). This highly accurate system can help capture patients `atrisk' of pancreatic cancer in a registry.}
}

@article{allisond.heldPharmacistsFamiliarityUtilization2014,
  title = {Pharmacists' Familiarity, Utilization, and Beliefs about {{Health Information Exchange}}: {{A}} Survey of Pharmacists in an {{Indiana}} Pharmacy Organization},
  author = {{Allison D. Held} and {Lacie J. Woodall} and {John B. Hertig}},
  year = {2014},
  month = nov,
  journal = {Journal of the American Pharmacists Association},
  volume = {54},
  number = {6},
  pages = {625--629},
  publisher = {Elsevier BV},
  issn = {1544-3191},
  doi = {10.1331/japha.2014.14080},
  abstract = {Objective To gauge pharmacists' familiarity, utilization, and beliefs about Health Information Exchange (HIE). Methods A survey questionnaire was developed by the authors in Qualtrics (Provo, UT) and administered to 358 Indiana Pharmacists Alliance (IPA) members via e-mail listserv in May and August 2013. The questionnaire consisted of 18 questions on familiarity, utilization, and beliefs about HIE. Results The response rate was 19\% (67/358). Pharmacy practice experience of respondents ranged from 0 to 5 years (18\%, n = 12) to more than 20 years (61\%, n = 41). More than one-half (70\%) of respondents practiced in hospital settings. Many respondents (75\%) were familiar with the concept of HIE; 54\% currently use some type of HIE technology. Nearly all respondents felt that data in electronic health records (EHRs) should be shared between pharmacists and other health care providers. Respondents identified improved coordination of care as the greatest potential benefit, and difficulty implementing and maintaining technology as the greatest barrier of HIE. Conclusion Many respondents were familiar with HIE and in favor of sharing patient records between providers. Respondents agreed that HIE has the potential to improve coordination of care but were concerned about implementing and maintaining technology. Larger pharmacy samples should be studied to determine how the results of this study compare to pharmacy populations at state and national levels. To gauge pharmacists' familiarity, utilization, and beliefs about Health Information Exchange (HIE). A survey questionnaire was developed by the authors in Qualtrics (Provo, UT) and administered to 358 Indiana Pharmacists Alliance (IPA) members via e-mail listserv in May and August 2013. The questionnaire consisted of 18 questions on familiarity, utilization, and beliefs about HIE. The response rate was 19\% (67/358). Pharmacy practice experience of respondents ranged from 0 to 5 years (18\%, n = 12) to more than 20 years (61\%, n = 41). More than one-half (70\%) of respondents practiced in hospital settings. Many respondents (75\%) were familiar with the concept of HIE; 54\% currently use some type of HIE technology. Nearly all respondents felt that data in electronic health records (EHRs) should be shared between pharmacists and other health care providers. Respondents identified improved coordination of care as the greatest potential benefit, and difficulty implementing and maintaining technology as the greatest barrier of HIE. Many respondents were familiar with HIE and in favor of sharing patient records between providers. Respondents agreed that HIE has the potential to improve coordination of care but were concerned about implementing and maintaining technology. Larger pharmacy samples should be studied to determine how the results of this study compare to pharmacy populations at state and national levels.}
}

@article{ameesanganiEvaluationConsultationNotes2020,
  title = {Evaluation of {{Consultation Notes Within}} and {{Across Institutions}}: {{A Preliminary Study}}},
  author = {{Amee Sangani} and {April Savoy}},
  year = {2020},
  month = dec,
  journal = {Proceedings of IMPRS},
  volume = {NA},
  number = {NA},
  pages = {NA-NA},
  publisher = {Indiana University School of Medicine},
  issn = {2641-2470},
  doi = {10.18060/24750},
  abstract = {Background/Objective: Patients with multiple chronic conditions require specialty consultations both within and across institutions for effective co-management of comorbidities. Poor communication during the referral process increases physician workload, patient burden and risks. Successful co-management relies on bi-directional information flow that supports interpersonal communication and establishment of clear tasks and responsibilities among physicians. However, flow of health information is often limited to specific health network access, phone calls, or faxes. Interpersonal communication is dependent on limited encounter notes. In this preliminary study, our objective was to understand how consultants' notes support physician collaboration within and across health care institutions. \&\#x0D; \&\#x0D; Project Methods: To assess consultants' notes, outpatient charts were randomly selected from the Indiana Network for Patient Care database representing consultations with five different specialties within the IU Health network, including referrals from within and outside of IU Health. The Quality of Consult Assessment tool was adapted to assess content of notes, emphasizing clinical recommendations, distribution of tasks and responsibilities, and communication plans. \&\#x0D; \&\#x0D; Results: Our sample included ten charts for patients who had comorbidities. All notes contained clinical recommendations that included an assessment and plan. 70\% of notes contained explicit responsibilities of the consultants. Conversely, only one contained explicit responsibilities for referrers. Charts denoted reliance on support staff to send messages between referrers, consultants, and patients via phone and fax. Phone calls and faxes were more prominent in referrals across institutions. \&\#x0D; \&\#x0D; Conclusion and Impact: Our preliminary findings indicate that current clinical documentation supports specialty referrals for transitions of care rather than co-management of care. Difficulties in accessing patient charts across institutions leads to a lack of clinical context and workflow inefficiencies when attempting to co-manage care. These findings demonstrate negative implications in health outcomes for patients with multiple comorbidities that require more care coordination within and across institutions.}
}

@article{annem.weaverEffectsSmokefreeAir2018,
  title = {Effects of Smoke-Free Air Law on Acute Myocardial Infarction Hospitalization in {{Indianapolis}} and {{Marion County}}, {{Indiana}}},
  author = {{Anne M. Weaver} and {Yi Wang} and {Katelin Rupp} and {Dennis P. Watson}},
  year = {2018},
  month = feb,
  journal = {BMC Public Health},
  volume = {18},
  number = {1},
  pages = {NA-NA},
  publisher = {BioMed Central},
  issn = {1471-2458},
  doi = {10.1186/s12889-018-5153-y},
  abstract = {A comprehensive smoke-free air law was enacted on June 1, 2012 in most of Marion County, Indiana, including all of the City of Indianapolis. We evaluated changes in acute myocardial infarction (AMI) admission rates in Indianapolis and Marion County before compared to after the law. We collected AMI admissions from five Marion County hospitals between May 2007 and December 2014. We used Poisson regression to evaluate the overall effects of the law on monthly AMI hospitalizations, adjusting for month, seasonality, meteorology, air pollution, and hospital utilization. We tested the interactions between the law and AMI risk factors on monthly AMI admission rates to identify subpopulations for which the effects might be stronger. Monthly AMI admissions declined 20\% (95\% CI 14--25\%) in Marion County and 25\% (95\% CI 20--29\%) in Indianapolis after the law was implemented. We observed decreases among never (21\%, 95\% CI 13--29\%), former (28\%, 95\% CI 21--34\%), and current smokers (26\%, 95\% CI 11--38\%); Medicaid beneficiaries (19\%, 95\% CI 9--29\%) and non-beneficiaries (26\%, 95\% CI 20--31\%). We observed decreases among those with a history of diabetes (Yes: 22\%, 95\% CI 14--29\%; No: 25\%, 95\% CI 18--31\%), congestive heart failure (Yes: 23\%, 95\% CI 16--30\%; No: 24\%, 95\% CI 17--31\%), and hypertension (Yes: 23\%, 95\% CI 17--28\%: No: 26\%, 95\% CI 15--36\%). We observed decreases in AMI admissions comparable with previous studies. We identified subpopulations who benefitted from the law, such as former and current smokers, and those without comorbidities such as congestive heart failure and hypertension.}
}

@article{anqizhuEstimatingCausalLogodds2018,
  title = {Estimating Causal Log-Odds Ratio Using the Case-Control Sample and Its Application in the Pharmaco-Epidemiology Study},
  author = {{Anqi Zhu} and {Donglin Zeng} and {Pengyue Zhang} and {Lang Li}},
  year = {2018},
  month = jan,
  journal = {Statistical Methods in Medical Research},
  volume = {28},
  number = {7},
  pages = {2165--2178},
  publisher = {SAGE Publishing},
  issn = {0962-2802},
  doi = {10.1177/0962280217750175},
  abstract = {One important goal in pharmaco-epidemiology studies is to understand the causal relationship between drug exposures and their clinical outcomes, including adverse drug events. In order to achieve this goal, however, we need to resolve several challenges. Most of pharmaco-epidemiology data are observational and confounding is largely present due to many co-medications. The pharmaco-epidemiology study data set is often sampled from large medical record databases using a matched case-control design, and it may not be representative of the original patient population in the medical record databases. Data analysis method needs to handle a large sample size that cannot be handled using existing statistical analysis packages. In this paper, we tackle these challenges both methodologically and computationally. We propose a conditional causal log-odds ratio (OR) definition to characterize causal effects of drug exposures on a binary adverse drug event adjusting for individual level confounders. Using a case-control design, we present a propensity score estimation using only case samples and we provide sufficient conditions for the consistency of the estimation of the causal log-odds ratio using case-based propensity scores. Computationally, we implement a principle component analysis to reduce high-dimensional confounders. Extensive simulation studies are performed to demonstrate superior performance of our method to existing methods. Finally, we apply the proposed method to analyze drug-induced myopathy data sampled from a de-identified subset of medical record database (close to 5 million patient records), The Indiana Network for Patient Care. Our method identified 70 drug-induced myopathy ( p \< 0.05) out 72 drugs, which have myoathy side effects on their FDA drug labels. These 70 drugs include three statins who are known for their myopathy side effects.}
}

@article{aprilsavoy50048ClosingCrossinstitutional2021,
  title = {50048 {{Closing}} the Cross-Institutional Referral Loop: {{Assessment}} of Consultation Note Quality},
  author = {{April Savoy} and {Richard L. Roudebush} and {Amee Sangani} and {Michael Weiner} and {Richard L. Roudebush}},
  year = {2021},
  month = mar,
  journal = {Journal of clinical and translational science},
  volume = {5},
  number = {s1},
  pages = {70--71},
  publisher = {Cambridge University Press},
  issn = {2059-8661},
  doi = {10.1017/cts.2021.584},
  abstract = {ABSTRACT IMPACT: Results will inform the design of health information technologies that assess and improve clinicians' interpersonal communication supporting co-management of care across health institutions. OBJECTIVES/GOALS: Poor communication and co-management of comorbidities during the referral process increase physician workload, patient burden, and safety risks. In this preliminary study, our objective was to understand how consultants' notes support physician collaboration within and across health care institutions. METHODS/STUDY POPULATION: We reviewed medical records. Accessing the Indiana Network for Patient Care database, consultation notes were randomly selected from four specialties: cardiothoracic surgery, neurology, rheumatology, and oncology. These specialties were identified, in advance, as challenging in interprofessional communication. The notes reviewed were associated with in-person consultations at a medical network in the Midwest from 2016 to 2019, including internal and cross-institutional (i.e., external) referrals. The Quality of Consult Assessment tool was adapted to assess note quality and co-management facilitation. Two researchers reviewed all records independently. A consensus meeting was then held to discuss and resolve discrepancies. RESULTS/ANTICIPATED RESULTS: Medical records of ten patients with comorbidities were reviewed. The mean age was 67 (SD= 12 years); one patient was a child. All consultation notes contained clinical recommendations. Seventy percent of notes referred to explicit consultant responsibilities. Conversely, only one contained explicit responsibilities for referrers. Medical records denoted reliance on support staff to send messages among referrers, consultants, and patients via phone calls and facsimile. The use of fax machines to send medical records to referrers was more prominent after cross-institutional consultations. DISCUSSION/SIGNIFICANCE OF FINDINGS: Clinical documentation supported specialty referrals for transitions of care rather than co-management of care. Accessing medical records across institutions contributed to a lack of clinical context, and workflow inefficiencies, when attempting to co-manage clinical care.}
}

@article{arifnazirInteractionCognitiveImpairment2013,
  title = {Interaction {{Between Cognitive Impairment}} and {{Discharge Destination}} and {{Its Effect}} on {{Rehospitalization}}},
  author = {{Arif Nazir} and {Michael A. LaMantia} and {Joshua Chodosh} and {Babar Khan} and {Noll L. Campbell} and {Siu L. Hui} and {Malaz Boustani}},
  year = {2013},
  month = oct,
  journal = {Journal of the American Geriatrics Society},
  volume = {61},
  number = {11},
  pages = {1958--1963},
  publisher = {Wiley-Blackwell},
  issn = {0002-8614},
  doi = {10.1111/jgs.12501},
  abstract = {Objectives To evaluate the effect of cognitive impairment on rehospitalization in older adults. Design One-year longitudinal study. Setting Medical service of an urban, 340-bed public hospital in Indianapolis between July 2006 and March 2008. Participants Individuals aged 65 and older admitted to the medical service (N = 976). Measurements Rehospitalization was defined as any hospital admission after the index admission. Participant demographics, discharge destination, Charlson Comorbidity Index, Acute Physiology Score, and prior hospitalizations were measured as the confounders. Participants were considered to have cognitive impairment if they had two or more errors on the Short Portable Mental Status Questionnaire. Results After adjusting for confounders, a significant interaction between cognitive impairment and discharge location was found to predict rehospitalization rate (P = .008) and time to 1-year rehospitalization (P = .03). Participants with cognitive impairment discharged to a facility had a longer time to rehospitalization (median 142 days) than participants with no cognitive impairment (median 98 days) (hazard ratio (HR) = 0.77, 95\% confidence interval (CI) = 0.58--1.02, P = .07), whereas participants with cognitive impairment discharged to home had a slightly shorter time to rehospitalization (median 182 days) than those without cognitive impairment (median 224 days) (HR = 1.15, 95\% CI = 0.92--1.43, P = .23). These two nonsignificant HRs in opposite directions were significantly different from each other (P = .03). Conclusion Discharge destination modifies the association between cognitive impairment and rehospitalization. Of participants discharged to a facility, those without cognitive impairment had higher rehospitalization rates, whereas the rates were similar between cognitively impaired and intact participants discharged to the community.}
}

@article{benrichterDriversBarriersUse2020,
  title = {Drivers and {{Barriers}} to the {{Use}} of {{Health Information Exchange Amongst Clinicians}} in the {{Emergency Department}}},
  author = {{Ben Richter} and {Brian E. Dixon}},
  year = {2020},
  month = dec,
  journal = {Proceedings of IMPRS},
  volume = {NA},
  number = {NA},
  pages = {NA-NA},
  publisher = {Indiana University School of Medicine},
  issn = {2641-2470},
  doi = {10.18060/24739},
  abstract = {Background: \&\#x0D; Health Information Exchange (HIE) describes the exchange of medical data between various health care organizations. Though research is limited, widespread use of HIE may improve patient outcomes while improving efficiency and thus lowering health care costs for patients. The paucity of existing research necessitates further study into the effects of HIE use in the clinical setting. The Indiana Network for Patient Care (INPC) is one of the most comprehensive HIE networks in the country, and provides an ideal environment for conducting research regarding factors that influence HIE use. \&\#x0D; Methods: \&\#x0D; A group of 20 clinicians from the Emergency Department were chosen to answer a set of questions regarding their HIE use. This group included physicians, nurse practitioners, physician assistants, and registered nurses from various health care organizations across the state of Indiana. Interview questions were centered around four main themes: Performance Expectancy, Effort Expectancy, Social Influence, and Facilitating Conditions. Interviews were recorded and transcribed, then subject to qualitative analysis using NVivo software. \&\#x0D; Results: \&\#x0D; The Single Sign-On and EHR Button were the most commonly discussed features in terms of facilitating HIE use. Providers used HIE most often when the patient reported previous admission at a different hospital, or when the patient was incapacitated and could not provide information. Although clinicians had unanimous social support for using HIE, inadequate training regarding HIE was apparent, and served as the most common barrier to its use. \&\#x0D; Conclusion/Impact: \&\#x0D; The implementation of Single Sign-On and access to the INPC via a button integrated into the user's EHR are critical for widespread use of HIE, while lack of physician training serves as a major barrier to its use. Implementing SSO and EHR button features while improving HIE training may spurn additional use of HIE and thus lower costs for both hospitals and patients.}
}

@article{blessingogbemudiaAssessingOutpatientFollowup2019,
  title = {Assessing Outpatient Follow-up Care Compliance, Complications, and Sequelae in Children Hospitalized for Isolated Traumatic Abdominal Injuries},
  author = {{Blessing Ogbemudia} and {Jodi Raymond} and {La Ranna S. Hatcher} and {Ashley Vetor} and {Thomas M. Rouse} and {Aaron E. Carroll} and {Teresa M. Bell}},
  year = {2019},
  month = aug,
  journal = {Journal of Pediatric Surgery},
  volume = {54},
  number = {8},
  pages = {1617--1620},
  publisher = {Elsevier BV},
  issn = {0022-3468},
  doi = {10.1016/j.jpedsurg.2018.09.001},
  abstract = {Abstract Background Currently there is limited knowledge on compliance with follow-up care in pediatric patients after abdominal trauma. The Indiana Network for Patient Care (INPC) is a large regional health information exchange with both structured clinical data (e.g., diagnosis codes) and unstructured data (e.g., provider notes). The objective of this study is to determine if regional health information exchanges can be used to evaluate whether patients receive all follow-up care recommended by providers. Methods We identified 61 patients treated at a Pediatric Level I Trauma Center who were admitted for isolated abdominal injuries. We analyzed medical records for two years following initial hospital discharge for injury using the INPC. The encounters were classified by the type of encounter: outpatient, emergency department, unplanned readmission, surgery, imaging studies, and inpatient admission; then further categorized into injury- and non-injury-related care, based on provider notes. We determined compliance with follow-up care instructions given at discharge and subsequent outpatient visits, as well as the prevalence of complications and sequelae. Results After reviewing patient records, we found that 78.7\% of patients received all recommended follow-up care, 6.6\% received partial follow-up care, and 11.5\% did not receive follow-up care. We found that 4.9\% of patients developed complications after abdominal trauma and 9.8\% developed sequelae in the two years following their initial hospitalization. Conclusions Our findings suggest that health information exchanges such as the INPC are useful in evaluation of follow-up care compliance and prevalence of complications/sequelae after abdominal trauma in pediatric patients. Level of evidence Level IV.}
}

@article{briane.dixonElectronicHealthInformation2013,
  title = {Electronic {{Health Information Quality Challenges}} and {{Interventions}} to {{Improve Public Health Surveillance Data}} and {{Practice}}},
  author = {{Brian E. Dixon} and {Jason A. Siegel} and {Tanya V. Oemig} and {Shaun J. Grannis}},
  year = {2013},
  month = nov,
  journal = {Public Health Reports},
  volume = {128},
  number = {6},
  pages = {546--553},
  publisher = {SAGE Publishing},
  issn = {0033-3549},
  doi = {10.1177/003335491312800614},
  abstract = {Objective. We examined completeness, an attribute of data quality, in the context of electronic laboratory reporting (ELR) of notifiable disease information to public health agencies. Methods. We extracted more than seven million ELR messages from multiple clinical information systems in two states We calculated and compared the completeness of various data fields within the messages that were identified to be important to public health reporting processes We compared unaltered, original messages from source systems with similar messages from another state as well as messages enriched by a health information exchange (HIE). Our analysis focused on calculating completeness (i e, the number of nonmissing values) for fields deemed important for inclusion in notifiable disease case reports. Results. The completeness of data fields for laboratory transactions varied across clinical information systems and jurisdictions. Fields identifying the patient and test results were usually complete (97\%--100\%). Fields containing patient demographics, patient contact information, and provider contact information were suboptimal (6\%--89\%). Transactions enhanced by the HIE were found to be more complete (increases ranged from 2\% to 25\%) than the original messages. Conclusion. ELR data from clinical information systems can be of suboptimal quality. Public health monitoring of data sources and augmentation of ELR message content using HIE services can improve data quality.}
}

@article{briane.dixonIdentifyingHealthFacilities2014,
  title = {Identifying Health Facilities Outside the Enterprise: Challenges and Strategies for Supporting Health Reform and Meaningful Use},
  author = {{Brian E. Dixon} and {Cyril Colvard} and {William M. Tierney}},
  year = {2014},
  month = jun,
  journal = {Informatics for Health \& Social Care},
  volume = {40},
  number = {4},
  pages = {319--333},
  publisher = {Taylor \& Francis},
  issn = {1753-8157},
  doi = {10.3109/17538157.2014.924949},
  abstract = {Objective: To support collation of data for disability determination, we sought to accurately identify facilities where care was delivered across multiple, independent hospitals and clinics. Methods: Data from various institutions' electronic health records were merged and delivered as continuity of care documents to the United States Social Security Administration (SSA). Results: Electronic records for nearly 8000 disability claimants were exchanged with SSA. Due to the lack of standard nomenclature for identifying the facilities in which patients received the care documented in the electronic records, SSA could not match the information received with information provided by disability claimants. Facility identifiers were generated arbitrarily by health care systems and therefore could not be mapped to the existing international standards. Discussion: We propose strategies for improving facility identification in electronic health records to support improved tracking of a patient's care between providers to better serve clinical care delivery, disability determination, health reform and meaningful use. Conclusion: Accurately identifying the facilities where health care is delivered to patients is important to a number of major health reform and improvement efforts underway in many nations. A standardized nomenclature for identifying health care facilities is needed to improve tracking of care and linking of electronic health records.}
}

@article{briane.dixonInformaticsApproachMedication2014,
  title = {An Informatics Approach to Medication Adherence Assessment and Improvement Using Clinical, Billing, and Patient-Entered Data},
  author = {{Brian E. Dixon} and {Abdulrahman Jabour} and {Erin O'Kelly Phillips} and {David G. Marrero}},
  year = {2014},
  month = may,
  journal = {Journal of the American Medical Informatics Association},
  volume = {21},
  number = {3},
  pages = {517--521},
  publisher = {Oxford University Press},
  issn = {1067-5027},
  doi = {10.1136/amiajnl-2013-001959},
  abstract = {The aim of this study was to describe an integrated informatics approach to aggregating and displaying clinically relevant data that can identify problems with medication adherence and facilitate patient--provider communication about strategies to improve medication use. We developed a clinical dashboard within an electronic health record (EHR) system that uses data from three sources: the medical record, pharmacy claims, and a personal health record. The data are integrated to inform clinician--patient discussions about medication adherence. Whereas prior research on assessing patterns of medication adherence focused on a single approach using the EHR, pharmacy data, or patient-entered data, we present an approach that integrates multiple electronic data sources increasingly found in practice. Medication adherence is a complex challenge that requires patient and provider team input, necessitating an integrated approach using advanced EHR, clinical decision support, and patient-controlled technologies. Future research should focus on integrated strategies to provide patients and providers with the right combination of informatics tools to help them adequately address the challenge of adherence to complex medication therapies.}
}

@article{briane.dixonLongRoadSemantic2014,
  title = {The Long Road to Semantic Interoperability in Support of Public Health: {{Experiences}} from Two States},
  author = {{Brian E. Dixon} and {Daniel J. Vreeman} and {Shaun J. Grannis}},
  year = {2014},
  month = jun,
  journal = {Journal of Biomedical Informatics},
  volume = {49},
  number = {NA},
  pages = {3--8},
  publisher = {Elsevier BV},
  issn = {1532-0464},
  doi = {10.1016/j.jbi.2014.03.011},
  abstract = {Proliferation of health information technologies creates opportunities to improve clinical and public health, including high quality, safer care and lower costs. To maximize such potential benefits, health information technologies must readily and reliably exchange information with other systems. However, evidence from public health surveillance programs in two states suggests that operational clinical information systems often fail to use available standards, a barrier to semantic interoperability. Furthermore, analysis of existing policies incentivizing semantic interoperability suggests they have limited impact and are fragmented. In this essay, we discuss three approaches for increasing semantic interoperability to support national goals for using health information technologies. A clear, comprehensive strategy requiring collaborative efforts by clinical and public health stakeholders is suggested as a guide for the long road towards better population health data and outcomes.}
}

@article{briane.dixonMeasuringImpactHealth2013,
  title = {Measuring the Impact of a Health Information Exchange Intervention on Provider-Based Notifiable Disease Reporting Using Mixed Methods: A Study Protocol},
  author = {{Brian E. Dixon} and {Shaun J. Grannis} and {Debra Revere}},
  year = {2013},
  month = oct,
  journal = {BMC Medical Informatics and Decision Making},
  volume = {13},
  number = {1},
  pages = {NA-NA},
  publisher = {BioMed Central},
  issn = {1472-6947},
  doi = {10.1186/1472-6947-13-121},
  abstract = {Health information exchange (HIE) is the electronic sharing of data and information between clinical care and public health entities. Previous research has shown that using HIE to electronically report laboratory results to public health can improve surveillance practice, yet there has been little utilization of HIE for improving provider-based disease reporting. This article describes a study protocol that uses mixed methods to evaluate an intervention to electronically pre-populate provider-based notifiable disease case reporting forms with clinical, laboratory and patient data available through an operational HIE. The evaluation seeks to: (1) identify barriers and facilitators to implementation, adoption and utilization of the intervention; (2) measure impacts on workflow, provider awareness, and end-user satisfaction; and (3) describe the contextual factors that impact the effectiveness of the intervention within heterogeneous clinical settings and the HIE.The intervention will be implemented over a staggered schedule in one of the largest and oldest HIE infrastructures in the U.S., the Indiana Network for Patient Care. Evaluation will be conducted utilizing a concurrent design mixed methods framework in which qualitative methods are embedded within the quantitative methods. Quantitative data will include reporting rates, timeliness and burden and report completeness and accuracy, analyzed using interrupted time-series and other pre-post comparisons. Qualitative data regarding pre-post provider perceptions of report completeness, accuracy, and timeliness, reporting burden, data quality, benefits, utility, adoption, utilization and impact on reporting workflow will be collected using semi-structured interviews and open-ended survey items. Data will be triangulated to find convergence or agreement by cross-validating results to produce a contextualized portrayal of the facilitators and barriers to implementation and use of the intervention.By applying mixed research methods and measuring context, facilitators and barriers, and individual, organizational and data quality factors that may impact adoption and utilization of the intervention, we will document whether and how the intervention streamlines provider-based manual reporting workflows, lowers barriers to reporting, increases data completeness, improves reporting timeliness and captures a greater portion of communicable disease burden in the community.}
}

@article{briane.dixonSurveillanceStillbirthSyphilis2018,
  title = {Surveillance of {{Stillbirth}} and {{Syphilis Screening Using Electronic Health Records}}},
  author = {{Brian E. Dixon} and {Jane wang} and {Timothy E. O'Connor} and {Janet N. Arno}},
  year = {2018},
  month = may,
  journal = {Online Journal of Public Health Informatics},
  volume = {10},
  number = {1},
  pages = {NA-NA},
  publisher = {University of Illinois at Chicago},
  issn = {1947-2579},
  doi = {10.5210/ojphi.v10i1.8967},
  abstract = {Objective: To measure stillbirth delivery rates and syphilis screening rates among women with a stillbirth delivery using electronic health record data available in a health information exchange.Introduction: Reports of infants born with congenital syphilis have increased in the United States every year since 2012. Prevention depends on high performing surveillance systems and compliance with the U.S. Centers for Disease Control and Prevention (CDC) recommendations to perform syphilis testing early in pregnancy, in the third trimester and at delivery if a woman is at high risk, and following a stillbirth delivery. These guidelines exist, because untreated syphilis is associated with adverse fetal outcomes including central nervous system infection and death.Surveillance of congenital syphilis and stillbirth is challenging because available data sources are limited. Assessment of compliance with testing guidelines is particularly challenging, since public health agencies often lack access to comprehensive cohorts of tested individuals as most public health laws only require reporting of positive disease case information.Methods: Using integrated electronic health records available in a community-based health information exchange, we examined syphilis testing patterns for women with a stillbirth delivery in Indiana between 2010-2016. The cohort was examined to determine whether the women received syphilis testing in accordance with the CDC recommendations. During this time period, Indiana recorded around 84,000 live births per year.Data were extracted from electronic health records, including encounter data, laboratory test results and procedure data, captured by the Indiana Network for Patient Care (INPC), one of the largest community-based HIE networks in the United States. The INPC connects over 90 health care facilities, including hospitals, physicians' practices, pharmacy networks, long-term post-acute care facilities, laboratories, and radiology centers. In addition to clinical care, the INPC supports surveillance of STIs1.Women with a stillbirth delivery were identified using International Classification of Disease (ICD) Clinical Modification (CM) codes from the 9thand 10th editions (ICD-CM-9 and ICD-CM-10). Inclusion codes: ICD-CM-9 codes 656.4, 779.9, V27.1, V27.3, V27.4, V27.6, V27.7, V32.01, V32.1, V32.2, V36.1; and ICD-CM-10 codes P95, P96.9, O36.4, Z37.1, Z37.3, Z37.4, Z37.9.Using the master person index for the INPC, we linked stillbirth deliveries with pregnancy encounters and laboratory testing data. We analyzed documentation of syphilis testing during the pregnancy (up to 270 days prior to the stillbirth delivery) as well as after the stillbirth delivery (up to 30 days). Broad time ranges were utilized to account for potential delays in reporting of either the stillbirth delivery or the syphilis test results. Documentation could include either presence of a result from a laboratory test for syphilis or a CPT code (80055, 86780, 86781, 86592, 86593) indicating performance of a syphilis test.Results: A total of 4,361 stillbirth deliveries attributable to 4,265 unique women were identified in the INPC between 2010-2016; representing a rate of 7.44 stillbirths per 1,000 live births during the same time period. Of the stillbirth deliveries, syphilis testing occurred within 270 days prior to or 30 days after delivery for 2,763 (63.4\%) cases. Figure 1 displays the number of stillbirth cases observed each year and the number of cases in which syphilis testing occurred during the pregnancy or after delivery.Conclusions: Using integrated electronic health records data, we discovered that fetal deaths occurred more frequently (7.44 versus 4.09 per 1,000) than previously estimated2 through fetal death reporting mechanisms in Indiana. Furthermore, we observed increasing rates of stillbirth within Indiana in recent years. Integrated data further enabled measurement of syphilis testing rates for stillbirth cases, which were similar to those reported by Patel et al.3using a large, national administrative data set. Testing rates in Indiana are well below the targets set by national and international public health organizations. Accessing more complete data on populations using a health information exchange is valuable, although doing so may uncover a more negative picture of health in one's community. Deeper analysis of these trends is warranted to explore factors related to increasing rates as well as limited testing in this population.}
}

@article{briane.dixonUtilizingIntegratedInfrastructure2015,
  title = {Utilizing an Integrated Infrastructure for Outcomes Research: A Systematic Review},
  author = {{Brian E. Dixon} and {Elizabeth C. Whipple} and {John M. Lajiness} and {Michael D. Murray}},
  year = {2015},
  month = dec,
  journal = {Health Information and Libraries Journal},
  volume = {33},
  number = {1},
  pages = {7--32},
  publisher = {Wiley-Blackwell},
  issn = {1471-1834},
  doi = {10.1111/hir.12127},
  abstract = {To explore the ability of an integrated health information infrastructure to support outcomes research.A systematic review of articles published from 1983 to 2012 by Regenstrief Institute investigators using data from an integrated electronic health record infrastructure involving multiple provider organisations was performed. Articles were independently assessed and classified by study design, disease and other metadata including bibliometrics.A total of 190 articles were identified. Diseases included cognitive, (16) cardiovascular, (16) infectious, (15) chronic illness (14) and cancer (12). Publications grew steadily (26 in the first decade vs. 100 in the last) as did the number of investigators (from 15 in 1983 to 62 in 2012). The proportion of articles involving non-Regenstrief authors also expanded from 54\% in the first decade to 72\% in the last decade. During this period, the infrastructure grew from a single health system into a health information exchange network covering more than 6 million patients. Analysis of journal and article metrics reveals high impact for clinical trials and comparative effectiveness research studies that utilised data available in the integrated infrastructure.Integrated information infrastructures support growth in high quality observational studies and diverse collaboration consistent with the goals for the learning health system. More recent publications demonstrate growing external collaborations facilitated by greater access to the infrastructure and improved opportunities to study broader disease and health outcomes.Integrated information infrastructures can stimulate learning from electronic data captured during routine clinical care but require time and collaboration to reach full potential.}
}

@article{briane.dixonWhichVeteransEnroll2016,
  title = {Which Veterans Enroll in a {{VA}} Health Information Exchange Program?},
  author = {{Brian E. Dixon} and {Susan Ofner} and {Susan M. Perkins} and {Laura Myers} and {Marc B. Rosenman} and {Alan J. Zillich} and {Dustin D. French} and {Michael Weiner} and {David A. Haggstrom}},
  year = {2016},
  month = jun,
  journal = {Journal of the American Medical Informatics Association},
  volume = {24},
  number = {1},
  pages = {96--105},
  publisher = {Oxford University Press},
  issn = {1067-5027},
  doi = {10.1093/jamia/ocw058},
  abstract = {Objective: To characterize patients who voluntarily enrolled in an electronic health information exchange (HIE) program designed to share data between Veterans Health Administration (VHA) and non-VHA institutions. Materials and Methods: Patients who agreed to participate in the HIE program were compared to those who did not. Patient characteristics associated with HIE enrollment were examined using a multivariable logistic regression model. Variables selected for inclusion were guided by a health care utilization model adapted to explain HIE enrollment. Data about patients' sociodemographics (age, gender), comorbidity (Charlson index score), utilization (primary and specialty care visits), and access (distance to VHA medical center, insurance, VHA benefits) were obtained from VHA and HIE electronic health records. Results: Among 57 072 patients, 6627 (12\%) enrolled in the HIE program during its first year. The likelihood of HIE enrollment increased among patients ages 50--64, of female gender, with higher comorbidity, and with increasing utilization. Living in a rural area and being unmarried were associated with decreased likelihood of enrollment. Discussion and Conclusion: Enrollment in HIE is complex, with several factors involved in a patient's decision to enroll. To broaden HIE participation, populations less likely to enroll should be targeted with tailored recruitment and educational strategies. Moreover, inclusion of special populations, such as patients with higher comorbidity or high utilizers, may help refine the definition of success with respect to HIE implementation.}
}

@article{brianhazlehurstCERHubInformatics2015,
  title = {{{CER Hub}}: {{An}} Informatics Platform for Conducting Comparative Effectiveness Research Using Multi-Institutional, Heterogeneous, Electronic Clinical Data},
  author = {{Brian Hazlehurst} and {Stephen E. Kurtz} and {Andrew L. Masica} and {Victor J. Stevens} and {Mary Ann McBurnie} and {Jon Puro} and {Vinutha Vijayadeva} and {David H. Au} and {Elissa D. Brannon} and {Dean F. Sittig}},
  year = {2015},
  month = oct,
  journal = {International Journal of Medical Informatics},
  volume = {84},
  number = {10},
  pages = {763--773},
  publisher = {Elsevier BV},
  issn = {1386-5056},
  doi = {10.1016/j.ijmedinf.2015.06.002},
  abstract = {Comparative effectiveness research (CER) requires the capture and analysis of data from disparate sources, often from a variety of institutions with diverse electronic health record (EHR) implementations. In this paper we describe the CER Hub, a web-based informatics platform for developing and conducting research studies that combine comprehensive electronic clinical data from multiple health care organizations. The CER Hub platform implements a data processing pipeline that employs informatics standards for data representation and web-based tools for developing study-specific data processing applications, providing standardized access to the patient-centric electronic health record (EHR) across organizations. The CER Hub is being used to conduct two CER studies utilizing data from six geographically distributed and demographically diverse health systems. These foundational studies address the effectiveness of medications for controlling asthma and the effectiveness of smoking cessation services delivered in primary care. The CER Hub includes four key capabilities: the ability to process and analyze both free-text and coded clinical data in the EHR; a data processing environment supported by distributed data and study governance processes; a clinical data-interchange format for facilitating standardized extraction of clinical data from EHRs; and a library of shareable clinical data processing applications. CER requires coordinated and scalable methods for extracting, aggregating, and analyzing complex, multi-institutional clinical data. By offering a range of informatics tools integrated into a framework for conducting studies using EHR data, the CER Hub provides a solution to the challenges of multi-institutional research using electronic medical record data.}
}

@article{cadyploesslPrevalenceDepressionAntidepressant2013,
  title = {Prevalence of {{Depression}} and {{Antidepressant Therapy Use}} in a {{Pediatric Cystic Fibrosis Population}}},
  author = {{Cady Ploessl} and {Rebecca S. Pettit} and {Jennifer Donaldson}},
  year = {2013},
  month = dec,
  journal = {Annals of Pharmacotherapy},
  volume = {48},
  number = {4},
  pages = {488--493},
  publisher = {SAGE Publishing},
  issn = {1060-0280},
  doi = {10.1177/1060028013514846},
  abstract = {Background: Depression is associated with significant morbidity and mortality. In recent years reports of depression in cystic fibrosis (CF) patients of all ages have increased. As awareness of depression in CF increases, there remains limited data regarding the prevalence and management of depression in the pediatric CF population. Objectives: To assess the prevalence of depression, describe depression treatment regimens, and identify risk factors for depression in the pediatric CF population at a single care center. Methods: A retrospective chart review was conducted on 190 patients at 1 accredited CF center. Patient demographics and clinical characteristics were collected and compared between patients with depression and patients without depression. In addition, the treatment strategies of patients with depression were recorded. Results: The number of patients with a documented diagnosis of depression was found to be 9\%, and 50\% of these patients were prescribed antidepressant therapy. The most common class of medication prescribed for depression in these patients was the selective serotonin reuptake inhibitors, where fluoxetine was the most common medication. Patients with depression had a lower mean absolute forced expiratory volume in 1 s (1.88 vs 2.48 L; P = .042), more than 5 total hospitalizations per year (4 vs 1; P = .012), and more outpatient CF exacerbations requiring treatment (1.5 vs 0; P = .023) per year than patients without depression. Conclusion: Identified risk factors may be used to increase depression screening of CF pediatric patients, allowing for early detection and screening in this potentially high-risk patient population. More studies are needed to determine efficacious treatment for depression in pediatric CF patients.}
}

@article{catrionaparkerHealthInformationExchanges2016,
  title = {Health Information Exchanges---{{Unfulfilled}} Promise as a Data Source for Clinical Research},
  author = {{Catriona Parker} and {Michael Weiner} and {Mathew J. Reeves}},
  year = {2016},
  month = mar,
  journal = {International Journal of Medical Informatics},
  volume = {87},
  number = {NA},
  pages = {1--9},
  publisher = {Elsevier BV},
  issn = {1386-5056},
  doi = {10.1016/j.ijmedinf.2015.12.005},
  abstract = {To determine the use of health information exchange organizations (HIEs) to support and conduct clinical research.This scoping review included US-based studies published between January 2003 and March 2014 that used data from an HIE to address at least one of three categories of research: clinical or epidemiological research, financial evaluation, or utilization of health services. Eligibility was not restricted to research on HIEs. Studies with research questions outside of the evaluation of HIEs themselves were sought.Eighteen articles met final study inclusion criteria from an initial list of 847 hits. Fifteen studies addressed a clinical or epidemiological research question, 6 addressed a financial consideration, and 8 addressed a utilization issue. Considerable overlap was found among the research categories: 13 articles addressed more than one category. Of the eighteen included studies, only two used HIE data to answer a research objective that was NOT specific to HIE use. Research designs were varied and ranged from observational studies, such as cohort and cross-sectional studies, to randomized trials. The 18 articles represent the involvement of a small number of HIEs; 7 of the studies were from a single HIE.This review demonstrates that HIE-provided information is available and used to answer clinical or epidemiological, financial, or utilization-based research questions; however, the majority of the studies using HIE data are done with the primary goal of evaluating the use and impact of HIEs on health care delivery and outcomes. As HIEs mature and become integrated parts of the health care industry, the authors anticipate that fewer studies will be published that describe or validate the role of HIEs, and more will use HIEs as multi-institutional data sources for conducting clinical research and improving health services and clinical outcomes.Articles identified in this review indicate the limited extent that HIE data are being used for clinical research outside of the evaluation of HIEs themselves, as well as the limited number of specific HIEs that are involved in generating published research. Significant barriers exist that prevent HIEs from developing into an invaluable resource for clinical research including technological infrastructure limitations, business processes limiting secondary use of data, and lack of participating provider support. Research to better understand challenges to developing the necessary infrastructure and policies to foster HIE engagement in research would be valuable as HIEs represent an opportunity to engage non-traditional health care provider research partners.}
}

@article{chienweichiangTranslationalHighDimensionalDrug2017,
  title = {Translational {{High-Dimensional Drug Interaction Discovery}} and {{Validation Using Health Record Databases}} and {{Pharmacokinetics Models}}},
  author = {{Chien Wei Chiang} and {Pengyue Zhang} and {Xueying Wang} and {Lei Wang} and {Shijun Zhang} and {Xia Ning} and {Li Shen} and {Sara K. Quinney} and {Lang Li}},
  year = {2017},
  month = dec,
  journal = {Clinical Pharmacology \& Therapeutics},
  volume = {103},
  number = {2},
  pages = {287--295},
  publisher = {Nature Portfolio},
  issn = {0009-9236},
  doi = {10.1002/cpt.914},
  abstract = {Polypharmacy increases the risk of drug--drug interactions (DDIs). Combining epidemiological studies with pharmacokinetic modeling, we detected and evaluated high-dimensional DDIs among 30 frequent drugs. Multidrug combinations that increased the risk of myopathy were identified in the US Food and Drug Administration Adverse Event Reporting System (FAERS) and electronic medical record (EMR) databases by a mixture drug-count response model. CYP450 inhibition was estimated among the 30 drugs in the presence of 1 to 4 inhibitors using in vitro / in vivo extrapolation. Twenty-eight three-way and 43 four-way DDIs had significant myopathy risk in both databases and predicted increases in the area under the concentration--time curve ratio (AUCR) {$>$}2-fold. The high-dimensional DDI of omeprazole, fluconazole, and clonidine was associated with a 6.41-fold (FAERS) and 18.46-fold (EMR) increased risk of myopathy local false discovery rate ({$<$}0.005); the AUCR of omeprazole in this combination was 9.35. The combination of health record informatics and pharmacokinetic modeling is a powerful translational approach to detect high-dimensional DDIs.}
}

@article{claudiaguerrazziInternationalPerspectiveHealth2019,
  title = {An {{International Perspective}} on {{Health Information Exchange}}: {{Adoption}} in {{OECD Countries With Different Health Care System Configurations}}},
  author = {{Claudia Guerrazzi}},
  year = {2019},
  month = jun,
  journal = {Medical Care Research and Review},
  volume = {77},
  number = {4},
  pages = {299--311},
  publisher = {SAGE Publishing},
  issn = {1077-5587},
  doi = {10.1177/1077558719858245},
  abstract = {The sharing of information among various care providers is becoming an essential feature of health care systems, and many countries are now adopting policies to foster health information exchange, defined as the electronic transfer of data or information among health care organizations involved in the delivery of care. Given the increasing adoption of this type of policy in several Organization for Economic Cooperation and Development countries, it is important to compare experiences from different countries, because policy adoption in one country can be explained more comprehensively and coherently through comparison with similar policies adopted in other nations. To make a more meaningful cross-country comparison, this article identifies a taxonomy of health systems, and it analyzes institutional and resource-based factors related to health information exchange adoption and how they differ in three main types of health systems: the National Health Service, social health insurance, and private health insurance.}
}

@article{colinrogersonFrequencyCorrelatesPediatric2022,
  title = {Frequency and {{Correlates}} of {{Pediatric High-Flow Nasal Cannula Use}} for {{Bronchiolitis}}, {{Asthma}}, and {{Pneumonia}}},
  author = {{Colin Rogerson} and {Aaron E. Carroll} and {Wanzhu Tu} and {He Tian} and {Titus Schleyer} and {Courtney M. Rowan} and {Arthur H. Owora} and {Eneida A. Mendon{\c c}a}},
  year = {2022},
  month = may,
  journal = {Respiratory Care},
  volume = {67},
  number = {8},
  pages = {976--984},
  publisher = {American Association for Respiratory Care},
  issn = {0020-1324},
  doi = {10.4187/respcare.09777},
  abstract = {Heated humidified high-flow nasal cannula (HFNC) is a respiratory support device historically used in pediatrics for infants with bronchiolitis. No large-scale analysis has determined the current frequency or demographic distribution of HFNC use in children. The objective of this study was to determine the frequency and correlates of HFNC use in children presenting to the hospital for asthma, bronchiolitis, or pneumonia.This longitudinal observational study was based on electronic health record data from a large regional health information exchange, the Indiana Network for Patient Care (INPC). Subjects were age 0-18 y with recorded hospital encounters at an INPC hospital between 2010-2019 with International Classification of Diseases codes for bronchiolitis, asthma, or pneumonia. Annual proportions of HFNC use among all hospital encounters were assessed using generalized additive models. Log-binomial regression models were used to identify correlates of incident HFNC use and determine risk ratios of specific subjects receiving HFNC.The study sample included 242,381 unique subjects with 412,712 hospital encounters between 2010-2019. The 10-y period prevalence of HFNC use was 2.54\% (6,155/242,381) involving 7,974 encounters. Hospital encounters utilizing HFNC increased by 400\%, from 326 in 2010 to 1,310 in 2019. This increase was evenly distributed across all 3 diagnostic categories (bronchiolitis, asthma, and pneumonia). Sex, race, age, and ethnicity all significantly influenced the risk of HFNC use. Over the 10-y period, the percentage of all hospital encounters using HFNC increased from 1.11\% in 2010 to 3.15\% in 2018. Subjects with multiple diagnoses had significantly higher risk of receiving HFNC.The use of HFNC in children presenting to the hospital with common respiratory diseases has increased substantially over the past decade and is no longer confined to treating infants with bronchiolitis. Demographic and diagnostic factors significantly influenced the frequency of HFNC use.}
}

@article{darenm.beamImmediateDischargeHome2015,
  title = {Immediate {{Discharge}} and {{Home Treatment With Rivaroxaban}} of {{Low}}-risk {{Venous Thromboembolism Diagnosed}} in {{Two U}}.{{S}}. {{Emergency Departments}}: {{A One}}-year {{Preplanned Analysis}}},
  author = {{Daren M. Beam} and {Zachary P. Kahler} and {Jeffrey A. Kline}},
  year = {2015},
  month = jun,
  journal = {Academic Emergency Medicine},
  volume = {22},
  number = {7},
  pages = {788--795},
  publisher = {Wiley-Blackwell},
  issn = {1069-6563},
  doi = {10.1111/acem.12711},
  abstract = {The study hypothesis was that a target-specific anticoagulant would allow successful home treatment of selected patients with deep vein thrombosis (DVT) and pulmonary embolism (PE) diagnosed in two urban emergency departments (EDs).A protocol was established for treating low-risk DVT or PE patients with rivaroxaban and clinic, follow-up at both 2 to 5 weeks, and 3 to 6 months. Patients were determined to be low-risk by using a modified version of the Hestia criteria, supplemented by additional criteria for patients with active cancer. Acceptable outcome rates were defined as venous thromboembolism (VTE) recurrence {$\leq$} 2.1\% or bleeding {$\leq$} 9.4\% during treatment. VTE recurrence required positive imaging of any VTE. The International Society of Thrombosis and Hemostasis definition of major or clinically relevant nonmajor bleeding was used.From March 2013 through April 2014, a total of 106 patients were treated. Seventy-one (68\%) had DVT, 30 (28\%) had PE, and five (3\%) had both, representing 51\% of all DVTs and 27\% of all PEs diagnosed in both EDs during the period of study. The 106 patients have been followed for a mean ({\textpm}SD) of 389 ({\textpm}111) days (range = 213 to 594 days). No patient had VTE recurrence, and no patient had a major or clinically relevant bleeding event while on therapy (none of the 106, 0\%, 95\% confidence interval [CI] = 0\% to 3.4\%). However, three patients 2.8\% (95\% CI = 1\% to 8\%) had recurrent DVT after cessation of therapy.Patients diagnosed with VTE and immediately discharged from the ED while treated with rivaroxaban had a low rate of VTE recurrence and bleeding.}
}

@article{debrarevereNotifiableConditionReporting2017,
  title = {Notifiable Condition Reporting Practices: Implications for Public Health Agency Participation in a Health Information Exchange},
  author = {{Debra Revere} and {Rebecca Hills} and {Brian E. Dixon} and {P. Joseph Gibson} and {Shaun J. Grannis}},
  year = {2017},
  month = mar,
  journal = {BMC Public Health},
  volume = {17},
  number = {1},
  pages = {NA-NA},
  publisher = {BioMed Central},
  issn = {1471-2458},
  doi = {10.1186/s12889-017-4156-4},
  abstract = {The future of notifiable condition reporting in the United States is undergoing a transformation with the increasing development of Health Information Exchanges which support electronic data-sharing and -transfer networks and the wider adoption of electronic laboratory reporting. Communicable disease report forms originating in clinics are an important source of surveillance data for public health agencies. However, problems of poor data quality and delayed submission of reports to public health agencies are common. In addition, studies of barriers and facilitators to reporting have assumed that the primary reporter is the treating physician, although the extent to which a provider is involved in the reporting workflow is unclear. We sought to better understand the barriers to and burden of notifiable condition reporting from the perspectives of the three primary groups involved in reporting workflow: providers, clinic staff who bear the principal responsibility for reporting, and the public health workers who receive and process reports from clinics. In addition, we sought to situate these findings within the context of the future of notifiable disease reporting and the potential impacts of electronic lab and medical records on the surveillance system. Seven ambulatory care clinics and 3 public health agencies that are part of a Health Information Exchange in the state of Indiana, USA, participated in the study. Data were obtained from a survey of clinic physicians (N = 29), interviews with clinic reporters (N = 11), and interviews with public health workers (N = 9). Survey data were summarized descriptively and interview transcripts underwent qualitative analysis. In both clinics and public health agencies, the laboratory report initiates reporting workflow. Provider involvement with reporting primarily revolves around ordering medications to treat a condition confirmed by the lab result. In clinics, reporting is typically the responsibility of clinic reporters who vary in frequency of reporting. We found an association between frequency of reporting, reporting knowledge and perceptions of reporting burden. In both clinics and public health agencies, interruptions and delays in reporting workflow are encountered due to inaccurate or missing information and impact reporting timeliness, data quality and report completeness. Both providers and clinic reporters lack clarity regarding how data submitted by their reports are used by public health agencies. It is possible that the value of reporting may be diminished when those responsible do not perceive receiving benefit in return. This may account for the low awareness of or recollection of public health communications with clinics that we observed. Despite the high likelihood that public health advisories and guidance are based, in part, on data submitted by clinics, a direct concordance may not be recognized. Unlike most studies of notifiable condition reporting, this study included the clinic reporters who bear primary responsibility for completing and submitting reports to public health agencies. A primary barrier to this reporting is timely and easy access to data. It is possible that expanded adoption of electronic health record and laboratory reporting systems will improve access to this data and reduce reporting the burden. However, a complete reliance on automatic electronic extraction of data requires caution and necessitates continued interfacing with clinic reporters for the foreseeable future---particularly for notifiable conditions that are high-impact, uncommon, prone to false positive readings by labs, or are hard to verify. An important finding of this study is the association between frequency of reporting, reporting knowledge and perceptions of reporting burden. Increased automation could result in even lower reporting knowledge and familiarity with reporting requirements which could actually increase reporters' perception of notifiable condition reporting as burdensome. Another finding was of uncertainty regarding how data sent to public health agencies is used or provides clinical benefit. A strong recommendation generated by these findings is that, given their central role in reporting, clinic reporters are a significant target audience for public health outreach and education that aims to alleviate perceived reporting burden and improve reporting knowledge. In particular, communicating the benefits of public health's use of the data may reduce a perceived lack of information reciprocity between clinical and public health organizations.}
}

@article{dinademner-fushmanPreparingCollectionRadiology2015,
  title = {Preparing a Collection of Radiology Examinations for Distribution and Retrieval},
  author = {{Dina Demner-Fushman} and {Marc D. Kohli} and {Marc B. Rosenman} and {Sonya E. Shooshan} and {Laritza Rodriguez} and {Sameer Antani} and {George R. Thoma} and {Clement J. McDonald}},
  year = {2015},
  month = jul,
  journal = {Journal of the American Medical Informatics Association},
  volume = {23},
  number = {2},
  pages = {304--310},
  publisher = {Oxford University Press},
  issn = {1067-5027},
  doi = {10.1093/jamia/ocv080},
  abstract = {Clinical documents made available for secondary use play an increasingly important role in discovery of clinical knowledge, development of research methods, and education. An important step in facilitating secondary use of clinical document collections is easy access to descriptions and samples that represent the content of the collections. This paper presents an approach to developing a collection of radiology examinations, including both the images and radiologist narrative reports, and making them publicly available in a searchable database.The authors collected 3996 radiology reports from the Indiana Network for Patient Care and 8121 associated images from the hospitals' picture archiving systems. The images and reports were de-identified automatically and then the automatic de-identification was manually verified. The authors coded the key findings of the reports and empirically assessed the benefits of manual coding on retrieval.The automatic de-identification of the narrative was aggressive and achieved 100\% precision at the cost of rendering a few findings uninterpretable. Automatic de-identification of images was not quite as perfect. Images for two of 3996 patients (0.05\%) showed protected health information. Manual encoding of findings improved retrieval precision.Stringent de-identification methods can remove all identifiers from text radiology reports. DICOM de-identification of images does not remove all identifying information and needs special attention to images scanned from film. Adding manual coding to the radiologist narrative reports significantly improved relevancy of the retrieved clinical documents. The de-identified Indiana chest X-ray collection is available for searching and downloading from the National Library of Medicine (http://openi.nlm.nih.gov/).}
}

@article{drewphillipsComparisonAutomatedPosttonsillectomy2017,
  title = {Comparison of {{Automated Posttonsillectomy Bleed Capture With Self-report}}},
  author = {{Drew Phillips} and {Susan E. Ellsperman} and {Bruce H. Matt} and {Ben L. Zarzaur}},
  year = {2017},
  month = aug,
  journal = {JAMA otolaryngology-- head \& neck surgery},
  volume = {143},
  number = {8},
  pages = {764--764},
  publisher = {American Medical Association},
  issn = {2168-6181},
  doi = {10.1001/jamaoto.2017.0148},
  abstract = {Tonsillectomy is one of the most common procedures performed by otolaryngologists and is associated with postoperative bleeding. Bleed rates are usually monitored by self-report.To evaluate whether using automated capture and reporting of pediatric posttonsillectomy bleeding is feasible and accurate compared with traditional self-reporting by the surgical team.An automated complication-reporting algorithm was designed to query the local health information exchange and then tested against self-reported tonsillectomy complication data collected from January 1, 2014, through December 31, 2015, at a tertiary pediatric hospital. The algorithm identified patients undergoing tonsillectomy and searched their postoperative encounters for a hand-selected set of diagnosis codes from the International Classification of Diseases, Ninth Revision and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision and free-text words to identify complication events. Five months of the 2014-2015 data set were used to help design the algorithm. Data from the remaining 19 months were compared with self-reported complications.Automated system findings compared with self-reported bleeding events.During the 19-month period, 1017 tonsillectomies were performed. We compared the algorithm's effectiveness in finding tonsillectomy and adenotonsillectomy procedures for the evaluated surgeons with the hand-reviewed master tonsillectomy list. The algorithm reported 51 false-positive (5.01\% missed) and 74 false-negative (7.28\% misidentified) procedures. The algorithm agreed with self-report for 986 tonsillectomies and disagreed on 31 cases (3.05\%) ({$\kappa$} = 0.69; 95\% CI, 0.66-0.73). The algorithm was found to be sensitive to correctly identifying 60.53\% (95\% CI, 48.63\%-71.34\%) of tonsillectomies as having bleeding complications, with a specificity of 98.30\% (95\% CI, 97.19\%-98.99\%).Capture of posttonsillectomy bleeding is possible through an automatic search of the medical record, although the algorithm will require continued refinement. Leveraging health information exchange data increases the possibilities of capturing complications at hospitals outside the local health system. Use of these algorithms will allow repeatable automated feedback to be provided to surgeons on a cyclical basis.}
}

@article{dustind.frenchHealthyAgingBrain2014,
  title = {Healthy {{Aging Brain Center Improved Care Coordination And Produced Net Savings}}},
  author = {{Dustin D. French} and {Michael A. LaMantia} and {Lee Livin} and {Dorian Herceg} and {Catherine A. Alder} and {Malaz Boustani}},
  year = {2014},
  month = apr,
  journal = {Health Affairs},
  volume = {33},
  number = {4},
  pages = {613--618},
  publisher = {Project HOPE},
  issn = {0278-2715},
  doi = {10.1377/hlthaff.2013.1221},
  abstract = {Over the past two decades the collaborative care model within primary care has proved to be effective in improving care quality, efficiency, and outcomes for older adults suffering from dementia and depression. In collaboration with community partners, scientists from Indiana University have implemented this model at the Healthy Aging Brain Center (HABC), a memory care clinic that is part of Eskenazi Health, an integrated safety-net health care system in Indianapolis, Indiana. The HABC generates an annual net cost savings of up to \$2,856 per patient, which adds up to millions of dollars for Eskenazi Health's patients. This article demonstrates the financial sustainability of the care processes implemented in the HABC, as well as the possibility that payers and providers could share savings from the use of the HABC model. If it were implemented nationwide, annual cost savings could be in the billions of dollars.}
}

@article{dustind.frenchShortTermMedicalCosts2016,
  title = {Short-{{Term Medical Costs}} of a {{VHA Health Information Exchange}}},
  author = {{Dustin D. French} and {Brian E. Dixon} and {Susan M. Perkins} and {Laura Myers} and {Michael Weiner} and {Allan J. Zillich} and {David A. Haggstrom}},
  year = {2016},
  month = jan,
  journal = {Medicine},
  volume = {95},
  number = {2},
  pages = {e2481-e2481},
  publisher = {Wolters Kluwer},
  issn = {0025-7974},
  doi = {10.1097/md.0000000000002481},
  abstract = {The Virtual Lifetime Electronic Record (VLER) Health program provides the Veterans Health Administration (VHA) a framework whereby VHA providers can access the veterans' electronic health record information to coordinate healthcare across multiple sites of care. As an early adopter of VLER, the Indianapolis VHA and Regenstrief Institute implemented a regional demonstration program involving bi-directional health information exchange (HIE) between VHA and non-VHA providers. The aim of the study is to determine whether implementation of VLER HIE reduces 1 year VHA medical costs. A cohort evaluation with a concurrent control group compared VHA healthcare costs using propensity score adjustment. A CHEERs compliant checklist was used to conduct the cost evaluation. Patients were enrolled in the VLER program onsite at the Indianapolis VHA in outpatient clinics or through the release-of-information office. VHA cost data (in 2014 dollars) were obtained for both enrolled and nonenrolled (control) patients for 1 year prior to, and 1 year after, the index date of patient enrollment. There were 6104 patients enrolled in VLER and 45,700 patients in the control group. The annual adjusted total cost difference per patient was associated with a higher cost for VLER enrollees \$1152 (95\% CI: \$807--1433) (P {$<$} 0.01) (in 2014 dollars) than VLER nonenrollees. Short-term evaluation of this demonstration project did not show immediate reductions in healthcare cost as might be expected if HIE decreased redundant medical tests and treatments. Cost reductions from shared health information may be realized with longer time horizons.}
}

@article{emilyc.webberPopulationHealthPediatric2016,
  title = {Population {{Health}} and {{Pediatric Informatics}}},
  author = {{Emily C. Webber}},
  year = {2016},
  month = apr,
  journal = {Pediatric Clinics of North America},
  volume = {NA},
  number = {NA},
  pages = {NA-NA},
  publisher = {Elsevier BV},
  issn = {0031-3955},
  doi = {10.1016/j.pcl.2015.12.001},
  abstract = {Applications of health information technology (health IT) are now widespread in the form of electronic medical records (EMRs), greatly reshaping the practice of clinical pediatrics. Population health stands to benefit greatly from the data produced by the alignment of pediatrics with other social determinants of health: medical care, genetics, individual behavior, social and physical environment. Before this potential can be realized, population health information models must be integrated into the design and evolution of EMRs and other data sources.}
}

@article{emilyfreemanExploringRacialAge2020,
  title = {Exploring {{Racial}} and {{Age Disproportionalities}} in {{COVID-19 Positive Pediatric Cohort}}},
  author = {{Emily Freeman} and {Younghwan Song} and {Katie Allen} and {Siu L. Hui} and {Eneida A. Mendon{\c c}a}},
  year = {2020},
  month = dec,
  journal = {Proceedings of IMPRS},
  volume = {3},
  number = {NA},
  pages = {NA-NA},
  publisher = {Indiana University School of Medicine},
  issn = {2641-2470},
  doi = {10.18060/24605},
  abstract = {Background: Social and health inequities place marginalized populations at increased risk of contracting the novel coronavirus 2019 (COVID-19). While COVID-19 literature continues to accumulate, there remains a lack of comprehensive epidemiological data on COVID-19 in children. The study aims to identify demographic trends in disease severity amongst COVID-19 positive pediatric patients. \&\#x0D; \&\#x0D; Methods: We analyzed the medical records of 2217 laboratory-confirmed COVID-19 pediatric patients, ages 0-18, across Indiana. Working with Regenstrief Institute Center of Biomedical Informatics, data was extracted from the databases of Indiana Network for Patient Care, Indiana University Health, and Eskenazi Health from February 28th, 2020 to July 13th, 2020. Factors of interest were age, race, and ethnicity. The study assessed the clinical outcome of disease severity which was defined by one of the following clinical designations: outpatient management exclusively, emergency care without hospital admission, non-pediatric intensive care unit (PICU) hospitalization, PICU hospitalization, and death. \&\#x0D; \&\#x0D; Results: The laboratory confirmed COVID-19 pediatric cohort was composed of 12.2\% (N= 270) Black or African American, 49.3\% (N=1094) white, and 3.2\% (N= 71) American Indian/Alaska Native, Asian/Pacific Islander, and Multiracial combined group. 34.4\% of Black or African American patients required emergency (12.2\%) or inpatient care (22.2\%) while 24.4\% white patients required emergency (7.0\%) or inpatient care (17.3\%). 17.6\% of the cohort was 0-5 years old, 24.8\% was 6-12 years old, and 57.6\% was 13-18 years old. 30.9\% of the 0-5 age group required emergency or inpatient care while the percentages of the 6-12 age group and 13-18 age group requiring emergency or inpatient care were 20.6\% and 18.9\%, respectively. \&\#x0D; \&\#x0D; Conclusion: \&\#x0D; While our data is preliminary and requires additional validation, our exploration of racial and age disproportionalities in pediatric coronavirus severity serves to expand on the current COVID-19 literature and understanding of this virus.}
}

@article{ericm.meslinGivingPatientsGranular2013,
  title = {Giving Patients Granular Control of Personal Health Information: {{Using}} an Ethics `{{Points}} to {{Consider}}' to Inform Informatics System Designers},
  author = {{Eric M. Meslin} and {Sheri Alpert} and {Aaron E. Carroll} and {Jere D. Odell} and {William M. Tierney} and {Peter H. Schwartz}},
  year = {2013},
  month = dec,
  journal = {International Journal of Medical Informatics},
  volume = {82},
  number = {12},
  pages = {1136--1143},
  publisher = {Elsevier BV},
  issn = {1386-5056},
  doi = {10.1016/j.ijmedinf.2013.08.010},
  abstract = {There are benefits and risks of giving patients more granular control of their personal health information in electronic health record (EHR) systems. When designing EHR systems and policies, informaticists and system developers must balance these benefits and risks. Ethical considerations should be an explicit part of this balancing. Our objective was to develop a structured ethics framework to accomplish this.We reviewed existing literature on the ethical and policy issues, developed an ethics framework called a "Points to Consider" (P2C) document, and convened a national expert panel to review and critique the P2C.We developed the P2C to aid informaticists designing an advanced query tool for an electronic health record (EHR) system in Indianapolis. The P2C consists of six questions ("Points") that frame important ethical issues, apply accepted principles of bioethics and Fair Information Practices, comment on how questions might be answered, and address implications for patient care.The P2C is intended to clarify what is at stake when designers try to accommodate potentially competing ethical commitments and logistical realities. The P2C was developed to guide informaticists who were designing a query tool in an existing EHR that would permit patient granular control. While consideration of ethical issues is coming to the forefront of medical informatics design and development practices, more reflection is needed to facilitate optimal collaboration between designers and ethicists. This report contributes to that discussion.}
}

@article{ericormanTrendsCharacteristicsMortality2019,
  title = {Trends in {{Characteristics}}, {{Mortality}}, and {{Other Outcomes}} of {{Patients With Newly Diagnosed Cirrhosis}}},
  author = {{Eric Orman} and {Anna Roberts} and {Marwan Ghabril} and {Lauren Nephew} and {Archita P. Desai} and {Kavish R. Patidar} and {Naga Chalasani}},
  year = {2019},
  month = jun,
  journal = {JAMA network open},
  volume = {2},
  number = {6},
  pages = {e196412-e196412},
  publisher = {American Medical Association},
  issn = {2574-3805},
  doi = {10.1001/jamanetworkopen.2019.6412},
  abstract = {Changes in the characteristics of patients with cirrhosis are likely to affect future outcomes and are important to understand in planning for the care of this population.To identify changes in demographic and clinical characteristics and outcomes in patients with newly diagnosed cirrhosis.A retrospective cohort study of patients with a new diagnosis of cirrhosis was conducted using the Indiana Network for Patient Care, a large statewide regional health information exchange, between 2004 and 2014. Patients with at least 1 year of continuous follow-up before the cirrhosis diagnosis were followed up through August 1, 2015. The analysis was conducted from December 2018 to January 2019.Age, cause of cirrhosis, and year of diagnosis.Overall rates for mortality, liver transplant, hepatocellular carcinoma, and hepatic decompensation (composite of ascites, hepatic encephalopathy, or variceal bleeding).A total of 9261 patients with newly diagnosed cirrhosis were identified (mean [SD] age, 57.9 [12.6] years; 5109 [55.2\%] male). A 69\% increase in new diagnoses occurred over the course of the study period (620 in 2004 vs 1045 in 2014). The proportion of those younger than 40 years increased by 0.20\% per year (95\% CI, 0.04\% to 0.36\%; P for trend = .02), and the proportion of those aged 65 years and older increased by 0.81\% per year (95\% CI, 0.51\% to 1.11\%; P for trend {$<$} .001). The proportion of patients with alcoholic cirrhosis increased by 0.80\% per year (95\% CI, 0.49\% to 1.12\%), and the proportion with nonalcoholic steatohepatitis increased by 0.59\% per year (95\% CI, 0.30\% to 0.87\%), whereas the proportion with viral hepatitis decreased by 1.36\% per year (95\% CI, -1.68\% to -1.03\%) (P {$<$} .001 for all). In patients younger than 40 years, 40 to 64 years, and 65 years and older, mortality rates were 6.4 (95\% CI, 5.4 to 7.6), 9.9 (95\% CI, 9.5 to 10.4), and 16.2 (95\% CI, 15.2 to 17.2) per 100 person-years, respectively (P {$<$} .001). Mortality rates decreased during the study period (11.9 [95\% CI, 10.7-13.1] per 100 person-years in 2004 vs 10.0 [95\% CI, 8.1-12.2] per 100 person-years in 2014; annual adjusted hazard ratio, 0.87 [95\% CI, 0.86 to 0.88]) and were lower in those with alcoholic cirrhosis compared with patients with viral hepatitis (adjusted hazard ratio, 0.89 [95\% CI, 0.80 to 0.98]). Rates of hepatocellular carcinoma were low in patients younger than 40 years (0.5 [95\% CI, 0.2 to 0.9] per 100 person-years). Liver transplant rates were low throughout the study period (0.3 [95\% CI, 0.3-0.4] per 100 person-years). In patients with compensated cirrhosis, rates of hepatic decompensation were lower in patients younger than 40 years (adjusted subhazard ratio 0.78; 95\% CI, 0.62 to 0.99) and in patients with nonalcoholic steatohepatitis (adjusted subhazard ratio, 0.51; 95\% CI, 0.43 to 0.60).The population of patients with newly diagnosed cirrhosis in Indiana has experienced changes in the age distribution and cause of cirrhosis, with decreasing mortality rates. These findings support investment in the prevention and treatment of alcoholic liver disease and nonalcoholic steatohepatitis, particularly in younger and older patients. Additional study is needed to identify the reasons for decreasing mortality rates.}
}

@article{erika.imelProportionOsteoporoticWomen2016,
  title = {Proportion of Osteoporotic Women Remaining at Risk for Fracture despite Adherence to Oral Bisphosphonates},
  author = {{Erik A. Imel} and {George J. Eckert} and {Ankita Modi} and {Zhuokai Li} and {J. C. Martin} and {Anne E. de Papp} and {Katie Allen} and {C. Conrad Johnston} and {Siu L. Hui} and {Ziyue Liu}},
  year = {2016},
  month = feb,
  journal = {Bone},
  volume = {83},
  number = {NA},
  pages = {267--275},
  publisher = {Elsevier BV},
  issn = {1873-2763},
  doi = {10.1016/j.bone.2015.11.021},
  abstract = {Adherence to oral bisphosphonates is often low, but even adherent patients may remain at elevated fracture risk. The goal of this study was to estimate the proportion of bisphosphonate-adherent women remaining at high risk of fracture.A retrospective cohort of women aged 50years and older, adherent to oral bisphosphonates for at least two years was identified, and data were extracted from a multi-system health information exchange. Adherence was defined as having a dispensed medication possession ratio{$\geq$}0.8. The primary outcome was clinical occurrence of: low trauma fracture (months 7-36), persistent T-score{$\leq$}-2.5 (months 13-36), decrease in bone mineral density (BMD) at any skeletal site{$\geq$}5\%, or the composite of any one of these outcomes.Of 7435 adherent women, 3110 had either pre- or post-adherent DXA data. In the full cohort, 7\% had an incident osteoporotic fracture. In 601 women having both pre- and post-adherent DXA to evaluate BMD change, 6\% had fractures, 22\% had a post-treatment T-score{$\leq$}-2.5, and 16\% had BMD decrease by {$\geq$}5\%. The composite outcomes occurred in 35\%. Incident fracture was predicted by age, previous fracture, and a variety of co-morbidities, but not by race, glucocorticoid treatment or type of bisphosphonate.Despite bisphosphonate adherence, 7\% had incident osteoporotic fractures and 35\% had either fracture, decreases in BMD, or persistent osteoporotic BMD, representing a substantial proportion of treated patients in clinical practices remaining at risk for future fractures. Further studies are required to determine the best achievable goals for osteoporosis therapy, and which patients would benefit from alternate therapies.}
}

@article{gailm.keenanResponseLetterEditor2017,
  title = {Response {{To}}: {{Letter}} to {{The Editor}} - {{Comments}} on {{The Use}} of {{LOINC}} and {{SNOMED CT}} for {{Representing Nursing Data}}},
  author = {{Gail M. Keenan} and {Yingwei Yao} and {Karen Dunn Lopez} and {Vanessa Emille Carvalho de Sousa} and {Janet Stifter} and {Tamara Gon{\c c}alves Rezende Macieira} and {Andrew D. Boyd} and {T. Heather Herdman} and {Sue Moorhead} and {Anna M. McDaniel} and {Diana J. Wilkie}},
  year = {2017},
  month = aug,
  journal = {International journal of nursing knowledge},
  volume = {29},
  number = {2},
  pages = {86--88},
  publisher = {Wiley},
  issn = {2047-3087},
  doi = {10.1111/2047-3095.12182}
}

@article{gregorya.coteLowerProviderVolume2013,
  title = {Lower {{Provider Volume}} Is {{Associated With Higher Failure Rates}} for {{Endoscopic Retrograde Cholangiopancreatography}}},
  author = {{Gregory A. Cote} and {Timothy D. Imler} and {Huiping Xu} and {Evgenia Teal} and {Dustin D. French} and {Thomas F. Imperiale} and {Marc B. Rosenman} and {J.F. Wilson} and {Siu L. Hui} and {Stuart Sherman}},
  year = {2013},
  month = dec,
  journal = {Medical Care},
  volume = {51},
  number = {12},
  pages = {1040--1047},
  publisher = {Lippincott Williams \& Wilkins},
  issn = {0025-7079},
  doi = {10.1097/mlr.0b013e3182a502dc},
  abstract = {Among physicians who perform endoscopic retrograde cholangiopancreatography (ERCP), the relationship between procedure volume and outcome is unknown.Quantify the ERCP volume-outcome relationship by measuring provider-specific failure rates, hospitalization rates, and other quality measures.Retrospective cohort.A total of 16,968 ERCPs performed by 130 physicians between 2001 and 2011, identified in the Indiana Network for Patient Care.Physicians were classified by their average annual Indiana Network for Patient Care volume and stratified into low ({$<$}25/y) and high ({$\geq$}25/y). Outcomes included failed procedures, defined as repeat ERCP, percutaneous transhepatic cholangiography or surgical exploration of the bile duct{$\leq$}7 days after the index procedure, hospitalization rates, and 30-day mortality.Among 15,514 index ERCPs, there were 1163 (7.5\%) failures; the failure rate was higher among low (9.5\%) compared with high volume (5.7\%) providers (P{$<$}0.001). A second ERCP within 7 days (a subgroup of failure rate) occurred more frequently when the original ERCP was performed by a low-volume (4.1\%) versus a high-volume physician (2.3\%, P=0.013). Patients were more frequently hospitalized within 24 hours when the ERCP was performed by a low-volume (28.3\%) versus high-volume physician (14.8\%, P=0.002). Mortality within 30 days was similar (low=1.9\%, high=1.9\%). Among low-volume physicians and after adjusting, the odds of having a failed procedure decreased 3.3\% (95\% confidence interval, 1.6\%-5.0\%, P{$<$}0.001) with each additional ERCP performed per year.Lower provider volume is associated with higher failure rate for ERCP, and greater need for postprocedure hospitalization.}
}

@article{hannahbozellAssessingFollowupCare2020,
  title = {Assessing Follow-up Care Compliance in Children Hospitalized for Traumatic Brain Injuries},
  author = {{Hannah Bozell} and {Ashley Vetor} and {Jodi Raymond} and {Alexandra Hochstetler} and {Teresa M. Bell}},
  year = {2020},
  month = dec,
  journal = {Proceedings of IMPRS},
  volume = {NA},
  number = {NA},
  pages = {NA-NA},
  publisher = {Indiana University School of Medicine},
  issn = {2641-2470},
  doi = {10.18060/24540},
  abstract = {Background and Hypothesis: There is limited information regarding healthcare utilization and outcomes in children hospitalized for traumatic brain injury (TBI). Nearly 50\% of adults hospitalized for trauma do not attend follow-up appointments, although completion of post-discharge care is associated with improved outcomes and decreased likelihood of subsequent emergency department (ED) visits. The Regestrief Institute Indiana Network for Patient Care (INPC) is a regional health information exchange (HIE) with health record data. This includes inpatient, outpatient, and ED visits, as well as imaging and lab data. The objective of this study is to use HIE data to assess long-term healthcare utilization, complications, and sequelae of pediatric patients hospitalized for TBI to see if follow-up compliance can identify patients at risk for post-TBI complications, including unplanned care, as well as long-term secondary health conditions. \&\#x0D; \&\#x0D; Methods: 387 patients treated at a pediatric level 1 trauma center in Indiana admitted for TBI were identified using trauma registry data. EHR data in the INPC on patients for two years post-discharged were analyzed. Associations between compliance with follow-up care instructions given at discharge/subsequent medical visits and longitudinal utilization/outcomes were examined using Fisher's exact test. \&\#x0D; \&\#x0D; Results: After reviewing patient records, we found that 60.7\% of patients received all follow-up care and 8.5\% of patients received partial follow-up care, leaving 25.1\% of patients receiving no follow up care and 5.7\% of patients lost to follow-up after discharge. 12\% of patients went to the ER for an injury-related issue and 6.2\% of patients were readmitted. 19.4\% of individuals experienced complications from injury while 12.4\% of individuals had suspected sequela. Factors influencing recovery included race, age, insurance, injury severity, ICU admission, and ventilator usage. \&\#x0D; \&\#x0D; Implications and Importance: Using HIE data can identify factors of hospitalized children vulnerable to not achieving optimal recovery and determine what care is critical to improving long-term health and quality of life outcomes.}
}

@article{heidilindrothDynamicDeliriumSeverity2021,
  title = {Dynamic {{Delirium Severity Trajectories}} and {{Their Association With}} 2-{{Year Healthcare Utilization}} and {{Mortality Outcomes}}},
  author = {{Heidi Lindroth} and {Sanjay Mohanty} and {Damaris Ortiz} and {Sujuan Gao} and {Anthony J. Perkins} and {Sikandar Khan} and {Malaz Boustani} and {Babar Khan}},
  year = {2021},
  month = sep,
  journal = {Critical care explorations},
  volume = {3},
  number = {9},
  pages = {e0524-e0524},
  publisher = {Wolters Kluwer},
  issn = {2639-8028},
  doi = {10.1097/cce.0000000000000524},
  abstract = {Delirium severity has been associated with a higher risk of mortality and an increasing morbidity burden. Recently defined delirium severity trajectories were predictive of 30-day mortality in a critically ill patient population. No studies to date have examined associations between delirium severity trajectories and 2-year mortality and healthcare utilization outcomes.To examine the associations between recently defined delirium severity trajectories and 2-year healthcare utilization outcomes of emergency department visits, rehospitalizations, and mortality.This is a secondary analysis using data from the randomized controlled clinical trial Pharmacological Management of Delirium in the Intensive Care Unit and Deprescribing in the Pharmacologic Management of Delirium trial conducted from 2009 to 2015. Patients who were greater than or equal to 18 years old, were in the ICU for greater than or equal to 24 hours, and had a positive delirium assessment (Confusion Assessment Method for the ICU) were included in the original trial. Participants were included in the secondary analysis if 2-year healthcare utilization and mortality data were available (n = 431).Healthcare utilization data within 2 years of the initial discharge date were pulled from the Indiana Network for Patient Care. Data over a 2-year period on emergency department visits (days to first emergency department visit, number of emergency department visits), inpatient hospitalizations (days to first hospitalizations, number of hospitalizations), and mortality (time to death) were extracted. Univariate relationships, Cox proportional hazard models, and competing risk modeling were used to examine statistical relationships in SAS v9.4.The overall sample (n = 431) had a mean age of 60 (sd, 16), 56\% were females, and 49\% African-Americans. No significant associations were identified between delirium severity trajectories and time to event for emergency department visit, mortality, or rehospitalization within 2 years of the index hospital discharge.This secondary analysis did not identify a significant relationship between delirium severity trajectories and healthcare utilization or mortality within 2 years of hospital discharge.}
}

@article{hughc.hendrieGlucoseLevelDecline2016,
  title = {Glucose Level Decline Precedes Dementia in Elderly {{African Americans}} with Diabetes},
  author = {{Hugh C. Hendrie} and {Mengjie Zheng} and {Wei Li} and {Kathleen A. Lane} and {Roberta Ambuehl} and {Christianna Purnell} and {Frederick W. Unverzagt} and {Alexia M. Torke} and {Ashok Balasubramanyam} and {Chris Callahan} and {Sujuan Gao}},
  year = {2016},
  month = oct,
  journal = {Alzheimers \& Dementia},
  volume = {13},
  number = {2},
  pages = {111--118},
  publisher = {Elsevier BV},
  issn = {1552-5260},
  doi = {10.1016/j.jalz.2016.08.017},
  abstract = {High blood glucose levels may be responsible for the increased risk for dementia in diabetic patients.A secondary data analysis merging electronic medical records (EMRs) with data collected from the Indianapolis-Ibadan Dementia project (IIDP). Of the enrolled 4105 African Americans, 3778 were identified in the EMR. Study endpoints were dementia, mild cognitive impairment (MCI), or normal cognition. Repeated serum glucose measurements were used as the outcome variables.Diabetic participants who developed incident dementia had a significant decrease in serum glucose levels in the years preceding the diagnosis compared to the participants with normal cognition (P = .0002). They also had significantly higher glucose levels up to 9 years before the dementia diagnosis (P = .0367).High glucose levels followed by a decline occurring years before diagnosis in African American participants with diabetes may represent a powerful presymptomatic metabolic indicator of dementia.}
}

@article{hugor.martinezNoncompactionCardiomyopathyHeterotaxy2017,
  title = {Noncompaction Cardiomyopathy and Heterotaxy Syndrome},
  author = {{Hugo R. Martinez} and {Stephanie M. Ware} and {Marcus S. Schamberger} and {John J. Parent}},
  year = {2017},
  month = sep,
  journal = {Progress in Pediatric Cardiology},
  volume = {46},
  number = {NA},
  pages = {23--27},
  publisher = {Elsevier BV},
  issn = {1058-9813},
  doi = {10.1016/j.ppedcard.2017.06.007},
  abstract = {Left ventricular noncompaction cardiomyopathy (LVNC) is characterized by compact and trabecular layers of the left ventricular myocardium. This cardiomyopathy may occur with congenital heart disease (CHD). Single cases document co-occurrence of LVNC and heterotaxy, but no data exist regarding the prevalence of this association. This study sought to determine whether a non-random association of LVNC and heterotaxy exists by evaluating the prevalence of LVNC in patients with heterotaxy. In a retrospective review of the Indiana Network for Patient Care, we identified 172 patients with heterotaxy (69 male, 103 female). Echocardiography and cardiac magnetic resonance imaging results were independently reviewed by two cardiologists to ensure reproducibility of LVNC. A total of 13/172 (7.5\%) patients met imaging criteria for LVNC. The CHD identified in this subgroup included atrioventricular septal defects [11], dextrocardia [10], systemic and pulmonary venous return abnormalities [7], and transposition of the great arteries [5]. From this subgroup, 61\% (n = 8) of the patients developed arrhythmias; and 61\% (n = 8) required medical management for chronic heart failure. This study indicates that LVNC has increased prevalence among patients with heterotaxy when compared to the general population (0.014-1.3\%) suggesting possible common genetic mechanisms. Interestingly, mice with a loss of function of Scrib or Vangl2 genes showed abnormal compaction of the ventricles, anomalies in cardiac looping, and septation defects in previous studies. Recognition of the association between LVNC and heterotaxy is important for various reasons. First, the increased risk of arrhythmias demonstrated in our population. Secondly, theoretical risk of thromboembolic events remains in any LVNC population. Finally, many patients with heterotaxy undergo cardiac surgery (corrective and palliative) and when this is associated with LVNC, patients should be presumed to incur a higher peri-operative morbidity based on previous studies. Further research will continue to determine long-term and to corroborate genetic pathways.}
}

@article{jaibirkheraInvestigatingQualityCompleteness2020,
  title = {Investigating the Quality and Completeness of Medication Data Available within the {{Indiana Network}} for {{Patient Care}}},
  author = {{Jaibir Khera} and {Shaun J. Grannis} and {Suranga Nath Kasthurirathne}},
  year = {2020},
  month = dec,
  journal = {Proceedings of IMPRS},
  volume = {3},
  number = {NA},
  pages = {NA-NA},
  publisher = {Indiana University School of Medicine},
  issn = {2641-2470},
  doi = {10.18060/24658},
  abstract = {Background and Hypothesis: Healthcare data is increasingly fragmented across multiple points of care due to increased specialization of healthcare services and mobility of patient populations [1]. The Indiana Network for Patient Care (INPC) plays a pivotal role in capturing, standardizing, and integrating comprehensive datasets[2]. Currently, the INPC receives medication data from a variety of sources. However, some of these sources are costly and may be incomplete and/or inaccurate. We aim to characterize the degree to which additional claims data can augment or replace existing INPC medication data. Our hypothesis is that the new claims datasets will provide additional medication information for patients in the INPC. \&\#x0D; Methods: Data analysts extracted and formatted a claims data sample for analysis. Individuals from the sample dataset were then mapped to INPC data using global person identifiers. The resulting analysis was split into two phases. \&\#x0D; Phase 1: To provide an initial high-level assessment of overlap and complementarity between INPC and new claims data, we computed the number of patients captured in each data source. Patients were classified into five groups as illustrated in Figure 1. To investigate Medicare usage, we also stratified datasets by patient age: less than 65 and 65 and older. \&\#x0D; \&\#x0D; Figure 1: Venn diagram illustrating medication claims data analysis approach. Several subgroups among the INPC will be compared to existing pharmacy claims and new claims data sources. \&\#x0D; Phase 2: Investigation of data quality on a clinical use case. These datasets will be used to investigate the current state of the opioid epidemic in Indiana. \&\#x0D; Results: With the completion of phase 1, we expect to characterize the current state of claims data across each of the patient groups, and how they influence data quality within the INPC. \&\#x0D; Discussion. The quality and completeness of medication data currently available via the INPC in unclear. Our efforts add clarity to the current status of these datasets, and how they can be augmented for increased research and clinical productivity. \&\#x0D; \&\#x0D; Citations \&\#x0D; [1] Stange, K.C., The problem of fragmentation and the need for integrative solutions. The Annals of Family Medicine. 7(2):100-103, 2009. \&\#x0D; [2] McDonald, C. J., Overhage, J. M., Barnes, M., Schadow, G., Blevins, L., Dexter, P. R., ... \&amp; INPC Management Committee. (2005). The Indiana network for patient care: a working local health information infrastructure. Health affairs, 24(5), 1214-1220.}
}

@article{jasonmackeyProphylacticAnticonvulsantsIntracerebral2017,
  title = {Prophylactic {{Anticonvulsants}} in {{Intracerebral Hemorrhage}}},
  author = {{Jason Mackey} and {Ashley D Blatsioris} and {Elizabeth A. S. Moser} and {Ravan J. L. Carter} and {Chandan Saha} and {Alec Stevenson} and {A Hulin} and {Darren O'Neill} and {Aaron Cohen-Gadol} and {Thomas J. Leipzig} and {Linda S. Williams}},
  year = {2017},
  month = mar,
  journal = {Neurocritical Care},
  volume = {27},
  number = {2},
  pages = {220--228},
  publisher = {Springer Science+Business Media},
  issn = {1541-6933},
  doi = {10.1007/s12028-017-0385-8},
  abstract = {Prophylactic anticonvulsants are routinely prescribed in the acute setting for intracerebral hemorrhage (ICH) patients, but some studies have reported an association with worse outcomes. We sought to characterize the prevalence and predictors of prophylactic anticonvulsant administration after ICH as well as guideline adherence. We also sought to determine whether prophylactic anticonvulsants were independently associated with poor outcome. We performed a retrospective study of primary ICH in our two academic centers. We used a propensity matching approach to make treated and non-treated groups comparable. We conducted multiple logistic regression analysis to identify independent predictors of prophylactic anticonvulsant initiation and its association with poor outcome as measured by modified Rankin score. We identified 610 patients with primary ICH, of whom 98 were started on prophylactic anticonvulsants. Levetiracetam (97\%) was most commonly prescribed. Age (OR 0.97, 95\% CI 0.95--0.99, p {$<$} .001), lobar location (OR 2.94, 95\% CI 1.76--4.91, p {$<$} .001), higher initial National Institutes of Health Stroke Scale (NIHSS) score (OR 2.31, 95\% CI 1.40--3.79, p = .001), craniotomy (OR 3.06, 95\% CI 1.51--6.20, p = .002), and prior ICH (OR 2.36, 95\% CI 1.10--5.07, p = .028) were independently associated with prophylactic anticonvulsant initiation. Prophylactic anticonvulsant use was not associated with worse functional outcome [modified Rankin score (mRS) 4--6] at hospital discharge or with increased case-fatality. There was no difference in prescribing patterns after 2010 guideline publication. Levetiracetam was routinely prescribed following ICH and was not associated with worse outcomes. Future investigations should examine the effect of prophylactic levetiracetam on cost and neuropsychological outcomes as well as the role of continuous EEG in identifying subclinical seizures.}
}

@article{jeffreya.klineEvaluationPulmonaryEmbolism2018,
  title = {Evaluation of the Pulmonary Embolism Rule out Criteria ({{PERC}} Rule) in Children Evaluated for Suspected Pulmonary Embolism},
  author = {{Jeffrey A. Kline} and {Angela M. Ellison} and {Jessica Kanis} and {Jonathan Pike} and {Cassandra L. Hall}},
  year = {2018},
  month = aug,
  journal = {Thrombosis Research},
  volume = {168},
  number = {NA},
  pages = {1--4},
  publisher = {Elsevier BV},
  issn = {0049-3848},
  doi = {10.1016/j.thromres.2018.05.026},
  abstract = {Background The pulmonary embolism rule out criteria (PERC) reliably predicts a low probability of PE in adults. We examine the diagnostic accuracy of the objective components of the PERC rule in children previously tested for PE. Methods Children aged 5--17 who had a D-dimer or pulmonary vascular imaging ordered from 2004 to 2014 in a large multicenter hospital network were identified by query of administrative databases. Using explicit, predefined methods, trained abstracters selected charts of children clearly tested for PE, collected the 8 objective variables for PERC, and determined PE criterion standard status (image or autopsy confirmed PE or deep vein thrombosis within 30 days by query of the Indiana Network for Patient Care (INPC)). Results We identified 543 patients, including 56 (10.3\%, 95\% CI: 7.8--13.1\%) who were PE+, with a mean and median age of 15 years. All 8 objective criteria from PERC were negative in 170 patients (31\%), including one with PE (false negative rate 0.6\%, 0--3.2\%). Diagnostic sensitivity and specificity were 98.2\% (90.5--100\%), and 34.7 (30.5--39.1\%), respectively, leading to a likelihood ratio negative = 0.05 (0.1--0.27). When treated as a diagnostic test based upon sum of criteria positive, PERC had good discrimination between PE+ vs PE- with an area under receiver operating characteristic curve 0.81 (0.75--0.86). Conclusions In this sample of children and teenagers with suspected PE, the PERC rule was negative in 31\%, and demonstrated good overall diagnostic accuracy, including a low false negative rate. These data support the need for a large, prospective diagnostic validation study of PERC in children.}
}

@article{jennifercouzin-frankelMedicineContendsHow2019,
  title = {Medicine Contends with How to Use Artificial Intelligence},
  author = {{Jennifer Couzin-Frankel}},
  year = {2019},
  month = jun,
  journal = {Science},
  volume = {364},
  number = {6446},
  pages = {1119--1120},
  publisher = {American Association for the Advancement of Science},
  issn = {0036-8075},
  doi = {10.1126/science.364.6446.1119},
  abstract = {Barriers include lack of reproducibility across hospitals and populations.}
}

@article{jessicakanisClinicalCharacteristicsChildren2017,
  title = {Clinical Characteristics of Children Evaluated for Suspected Pulmonary Embolism with {{D-dimer}} Testing},
  author = {{Jessica Kanis} and {Jonathan Pike} and {Cassandra L. Hall} and {Jeffrey A. Kline}},
  year = {2017},
  month = nov,
  journal = {Archives of Disease in Childhood},
  volume = {103},
  number = {9},
  pages = {835--840},
  publisher = {BMJ},
  issn = {0003-9888},
  doi = {10.1136/archdischild-2017-313317},
  abstract = {Background We sought to determine clinical variables in children tested for suspected pulmonary embolism (PE) that predict PE+ outcome for the development of paediatric PE prediction rule. Methods Data were collected by query of a laboratory database for D-dimer from January 2004 to December 2014 for a large multicentre hospital system and the radiology database for pulmonary vascular imaging in children aged 5--17. Using explicit, predefined methods, trained abstractors, determined if D-dimer was sent in the evaluation of PE and then recorded predictor data which was tested for association with PE+ outcome using univariate techniques. Results D-dimer was ordered in 526 children for clinical suspicion of PE. Thirty-four of 526 were PE+ (6.4\%, 95\% CI 4.3\% to 8.7\%). The radiology database identified 17 additional patients with PE (n=51 PE+ total). Children evaluated for PE were primarily in the ED setting (80\%), teenagers (88\%) and 2:1 female:male. Children with PE had higher mean heart and higher respiratory rate and a lower pulse oximetry and haemoglobin concentration. On univariate analysis, five conditions were more frequent in PE+ compared with no PE: surgery, central line, limb immobility, prior PE or deep vein thrombosis and cancer. Conclusions The rate of PE diagnosis in children with D-dimer was 6.4\%, similar to that seen in adults; most children with PE are over 13 years and had clinical predictors known to increase probability of PE in symptomatic adults. Future studies should use these criteria to develop a clinical decision rule for PE in children.}
}

@article{jianzouBayesianSpatioTemporal2014,
  title = {A {{Bayesian}} Spatio--Temporal Approach for Real--Time Detection of Disease Outbreaks: A Case Study},
  author = {{Jian Zou} and {Alan F. Karr} and {Gauri Sankar Datta} and {James Lynch} and {Shaun J. Grannis}},
  year = {2014},
  month = dec,
  journal = {BMC Medical Informatics and Decision Making},
  volume = {14},
  number = {1},
  pages = {NA-NA},
  publisher = {BioMed Central},
  issn = {1472-6947},
  doi = {10.1186/s12911-014-0108-4},
  abstract = {For researchers and public health agencies, the complexity of high-dimensional spatio-temporal data in surveillance for large reporting networks presents numerous challenges, which include low signal-to-noise ratios, spatial and temporal dependencies, and the need to characterize uncertainties. Central to the problem in the context of disease outbreaks is a decision structure that requires trading off false positives for delayed detections.In this paper we apply a previously developed Bayesian hierarchical model to a data set from the Indiana Public Health Emergency Surveillance System (PHESS) containing three years of emergency department visits for influenza-like illness and respiratory illness. Among issues requiring attention were selection of the underlying network (Too few nodes attenuate important structure, while too many nodes impose barriers to both modeling and computation.); ensuring that confidentiality protections in the data do not impede important modeling day of week effects; and evaluating the performance of the model.Our results show that the model captures salient spatio-temporal dynamics that are present in public health surveillance data sets, and that it appears to detect both "annual" and "atypical" outbreaks in a timely, accurate manner. We present maps that help make model output accessible and comprehensible to public health authorities. We use an illustrative family of decision rules to show how output from the model can be used to inform false positive-delayed detection tradeoffs.The advantages of our methodology for addressing the complicated issues of real world surveillance data applications are three-fold. We can easily incorporate additional covariate information and spatio-temporal dynamics in the data. Second, we furnish a unified framework to provide uncertainties associated with each parameter. Third, we are able to handle multiplicity issues by using a Bayesian approach. The urgent need to quickly and effectively monitor the health of the public makes our methodology a potentially plausible and useful surveillance approach for health professionals.}
}

@article{joannedaggyEvaluatingLatentClass2014,
  title = {Evaluating Latent Class Models with Conditional Dependence in Record Linkage},
  author = {{Joanne Daggy} and {Huiping Xu} and {Siu L. Hui} and {Shaun J. Grannis}},
  year = {2014},
  month = jun,
  journal = {Statistics in Medicine},
  volume = {33},
  number = {24},
  pages = {4250--4265},
  publisher = {Wiley},
  issn = {0277-6715},
  doi = {10.1002/sim.6230},
  abstract = {Record linkage methods commonly use a traditional latent class model to classify record pairs from different sources as true matches or non-matches. This approach was first formally described by Fellegi and Sunter and assumes that the agreement in fields is independent conditional on the latent class. Consequences of violating the conditional independence assumption include bias in parameter estimates from the model. We sought to further characterize the impact of conditional dependence on the overall misclassification rate, sensitivity, and positive predictive value in the record linkage problem when the conditional independence assumption is violated. Additionally, we evaluate various methods to account for the conditional dependence. These methods include loglinear models with appropriate interaction terms identified through the correlation residual plot as well as Gaussian random effects models. The proposed models are used to link newborn screening data obtained from a health information exchange. On the basis of simulations, loglinear models with interaction terms demonstrated the best misclassification rate, although this type of model cannot accommodate other data features such as continuous measures for agreement. Results indicate that Gaussian random effects models, which can handle additional data features, perform better than assuming conditional independence and in some situations perform as well as the loglinear model with interaction terms. Copyright {\copyright} 2014 John Wiley \& Sons, Ltd.}
}

@article{joannedaggyPracticalApproachIncorporating2013,
  title = {A Practical Approach for Incorporating Dependence among Fields in Probabilistic Record Linkage},
  author = {{Joanne Daggy} and {Huiping Xu} and {Siu L. Hui} and {Roland E. Gamache} and {Shaun J. Grannis}},
  year = {2013},
  month = aug,
  journal = {BMC Medical Informatics and Decision Making},
  volume = {13},
  number = {1},
  pages = {NA-NA},
  publisher = {BioMed Central},
  issn = {1472-6947},
  doi = {10.1186/1472-6947-13-97},
  abstract = {Methods for linking real-world healthcare data often use a latent class model, where the latent, or unknown, class is the true match status of candidate record-pairs. This commonly used model assumes that agreement patterns among multiple fields within a latent class are independent. When this assumption is violated, various approaches, including the most commonly proposed loglinear models, have been suggested to account for conditional dependence. We present a step-by-step guide to identify important dependencies between fields through a correlation residual plot and demonstrate how they can be incorporated into loglinear models for record linkage. This method is applied to healthcare data from the patient registry for a large county health department. Our method could be readily implemented using standard software (with code supplied) to produce an overall better model fit as measured by BIC and deviance. Finding the most parsimonious model is known to reduce bias in parameter estimates. This novel approach identifies and accommodates conditional dependence in the context of record linkage. The conditional dependence model is recommended for routine use due to its flexibility for incorporating conditional dependence and easy implementation using existing software.}
}

@article{joshuar.vestAssociationsQueryBased2019,
  title = {The Associations between Query-based and Directed Health Information Exchange with Potentially Avoidable Use of Health Care Services},
  author = {{Joshua R. Vest} and {Mark Aaron Unruh} and {Jason S. Shapiro} and {Lawrence P. Casalino}},
  year = {2019},
  month = may,
  journal = {Health Services Research},
  volume = {54},
  number = {5},
  pages = {981--993},
  publisher = {Wiley-Blackwell},
  issn = {0017-9124},
  doi = {10.1111/1475-6773.13169},
  abstract = {Objective To quantify the impact of two approaches (directed and query-based) to health information exchange (HIE) on potentially avoidable use of health care services. Data Sources/Study Setting Data on ambulatory care providers' adoption of HIE were merged with Medicare fee-for-service claims from 2008 to 2014. Providers were from 13 counties in New York served by the Rochester Regional Health Information Organization (RHIO). Study Design Linear regression models with provider and year fixed effects were used to estimate changes in the probability of utilization outcomes for Medicare beneficiaries attributed to providers adopting directed and/or query-based HIE compared with beneficiaries attributed to providers who had not adopted HIE. Data Collection Providers' HIE adoption status was determined through Rochester RHIO registration records. RHIO and claims data were linked via National Provider Identifiers. Principal Findings Query-based HIE adoption was associated with a 0.2 percentage point reduction in the probability of an ambulatory care sensitive hospitalization and a 1.1 percentage point decrease in the likelihood of an unplanned readmission. Directed HIE adoption was not associated with any outcome. Conclusions The Centers for Medicare \& Medicaid Services' (CMS) EHR certification criteria includes requirements for directed HIE, but not query-based HIE. Pending further research, certification criteria should place equal weight on facilitating query-based and directed exchange.}
}

@article{joshuar.vestIndianapolisProviderUse2018,
  title = {Indianapolis {{Provider}}'s {{Use Of Wraparound Services Associated With Reduced Hospitalizations And Emergency Department Visits}}},
  author = {{Joshua R. Vest} and {Lisa E. Harris} and {Dawn P. Haut} and {Paul K. Halverson} and {Nir Menachemi}},
  year = {2018},
  month = oct,
  journal = {Health Affairs},
  volume = {37},
  number = {10},
  pages = {1555--1561},
  publisher = {Project HOPE},
  issn = {0278-2715},
  doi = {10.1377/hlthaff.2018.0075},
  abstract = {Recent changes to US reimbursement policies are increasingly holding providers financially accountable for patients' health. Providing nonmedical services in conjunction with primary care---known as wraparound services---is one strategy to improve patient outcomes and reduce overall health care spending. These services leverage additional providers to address patients' social determinants of health. Eskenazi Health---an Indianapolis, Indiana, safety-net provider---introduced wraparound services at its federally qualified health center sites. Behavioral health, social work, dietetics, patient navigation, and other services that address patients' social and behavioral needs are co-located with primary care services. In an eleven-year panel of primary care patients, receipt of any wraparound service was negatively associated with subsequent hospitalizations and emergency department visits. The estimated cost savings from potentially avoided hospitalizations alone was \$1.4 million annually. Under value-based payment, wraparound services may be one part of a portfolio of strategies to address the social, behavioral, and environmental factors that drive poor patient health and increase costs.}
}

@article{jumsukkoOndansetronBlocksWildtype2018,
  title = {Ondansetron Blocks Wild-Type and p.{{F503L}} Variant Small-Conductance {{Ca2}}+-Activated {{K}}+ Channels},
  author = {{Jum Suk Ko} and {Shuai Guo} and {Jonathan Hassel} and {Patr{\'i}cia B. S. Celestino-Soper} and {Ty C. Lynnes} and {James E. Tisdale} and {James Zheng} and {Stanley Taylor} and {Tatiana Foroud} and {Michael D. Murray} and {Richard J. Kovacs} and {Xiaochun Li} and {Shien Fong Lin} and {Zhenhui Chen} and {Matteo Vatta} and {Peng Sheng Chen} and {Michael Rubart}},
  year = {2018},
  month = aug,
  journal = {American Journal of Physiology-heart and Circulatory Physiology},
  volume = {315},
  number = {2},
  pages = {H375-H388},
  publisher = {American Physical Society},
  issn = {0363-6135},
  doi = {10.1152/ajpheart.00479.2017},
  abstract = {Apamin-sensitive small-conductance Ca 2+ -activated K + (SK) current ( I KAS ) is encoded by Ca 2+ -activated K + channel subfamily N ( KCNN) genes. I KAS importantly contributes to cardiac repolarization in conditions associated with reduced repolarization reserve. To test the hypothesis that I KAS inhibition contributes to drug-induced long QT syndrome (diLQTS), we screened for KCNN variants among patients with diLQTS, determined the properties of heterologously expressed wild-type (WT) and variant KCNN channels, and determined if the 5-HT 3 receptor antagonist ondansetron blocks I KAS . We searched 2,306,335 records in the Indiana Network for Patient Care and found 11 patients with diLQTS who had DNA available in the Indiana Biobank. DNA sequencing discovered a heterozygous KCNN2 variant (p.F503L) in a 52-yr-old woman presenting with corrected QT interval prolongation at baseline (473 ms) and further corrected QT interval lengthening (601 ms) after oral administration of ondansetron. That patient was also heterozygous for the p.S38G and p.P2835S variants of the QT-controlling genes KCNE1 and ankyrin 2, respectively. Patch-clamp experiments revealed that the p.F503L KCNN2 variant heterologously expressed in human embryonic kidney (HEK)-293 cells augmented Ca 2+ sensitivity, increasing I KAS density. The fraction of total F503L-KCNN2 protein retained in the membrane was higher than that of WT KCNN2 protein. Ondansetron at nanomolar concentrations inhibited WT and p.F503L SK2 channels expressed in HEK-293 cells as well as native SK channels in ventricular cardiomyocytes. Ondansetron-induced I KAS inhibition was also demonstrated in Langendorff-perfused murine hearts. In conclusion, the heterozygous p.F503L KCNN2 variant increases Ca 2+ sensitivity and I KAS density in transfected HEK-293 cells. Ondansetron at therapeutic (i.e., nanomolar) concentrations is a potent I KAS blocker. NEW \&amp; NOTEWORTHY We showed that ondansetron, a 5-HT 3 receptor antagonist, blocks small-conductance Ca 2+ -activated K + (SK) current. Ondansetron may be useful in controlling arrhythmias in which increased SK current is a likely contributor. However, its SK-blocking effects may also facilitate the development of drug-induced long QT syndrome.}
}

@article{karishmakhullarImpactElectronicDocumentation2014,
  title = {Impact of {{Electronic Documentation}} on {{Pap Screening Rates}} in an {{Urban Health Center}}},
  author = {{Karishma Khullar} and {Sarah Peitzmeier} and {Rachel Koffman} and {Jennifer Potter}},
  year = {2014},
  month = jan,
  journal = {Journal of Community Health},
  volume = {39},
  number = {3},
  pages = {416--422},
  publisher = {Springer Science+Business Media},
  issn = {0094-5145},
  doi = {10.1007/s10900-014-9822-1}
}

@article{katherines.l.lauRaceEthnicityBehavioral2017,
  title = {Race/{{Ethnicity}}, and {{Behavioral Health Status}}: {{First Arrest}} and {{Outcomes}} in a {{Large Sample}} of {{Juvenile Offenders}}},
  author = {{Katherine S. L. Lau} and {Marc B. Rosenman} and {Sarah E. Wiehe} and {Wanzhu Tu} and {Matthew C. Aalsma}},
  year = {2017},
  month = dec,
  journal = {Journal of Behavioral Health Services \& Research},
  volume = {NA},
  number = {NA},
  pages = {NA-NA},
  publisher = {Springer Science+Business Media},
  issn = {1094-3412},
  doi = {10.1007/s11414-017-9578-3},
  abstract = {The objective of this study was to assess the simultaneous effects of gender, race/ethnicity, and pre-arrest behavioral health (BH) service-use on age at first arrest, and first arrest outcomes. Between January 2004 and December 2011, arrest and medical records were collected on a retrospective longitudinal cohort of 12,476 first-time offenders, ages 8-18 years. Black youth were arrested at younger ages than white or Hispanic youth. Youth with psychiatric problems were arrested at younger ages than youth with substance-use, dual-diagnoses, or no BH problems. Compared to white males, black males had lower odds of detention and BH referrals. Compared to white females, black females had higher odds of release and lower odds of probation, detention, and BH referrals. A significant gender-by-BH problem interaction revealed males and females with previous psychiatric problems were arrested at younger ages than youth with substance, dual-diagnosis, or no prior problems. Implications are discussed.}
}

@article{kathleent.unroeOptimizingPatientTransfers2014,
  title = {The {{Optimizing Patient Transfers}}, {{Impacting Medical Quality}}, and {{Improving Symptoms}}: {{Transforming Institutional Care Approach}}: {{Preliminary Data}} from the {{Implementation}} of a {{Centers}} for {{Medicare}} and {{Medicaid Services Nursing Facility Demonstration Project}}},
  author = {{Kathleen T. Unroe} and {Arif Nazir} and {Laura R. Holtz} and {Helen Maurer} and {Ellen Winchell Miller} and {Susan E. Hickman} and {Michael A. La Mantia} and {Merih Bennett} and {Greg Arling} and {Greg A. Sachs}},
  year = {2014},
  month = dec,
  journal = {Journal of the American Geriatrics Society},
  volume = {63},
  number = {1},
  pages = {165--169},
  publisher = {Wiley-Blackwell},
  issn = {0002-8614},
  doi = {10.1111/jgs.13141},
  abstract = {The Optimizing Patient Transfers, Impacting Medical Quality, and Improving Symptoms: Transforming Institutional Care (OPTIMISTIC) project aims to reduce avoidable hospitalizations of long-stay residents enrolled in 19 central Indiana nursing facilities. This clinical demonstration project, funded by the Centers for Medicare and Medicaid Services Innovations Center, places a registered nurse in each nursing facility to implement an evidence-based quality improvement program with clinical support from nurse practitioners. A description of the model is presented, and early implementation experiences during the first year of the project are reported. Important elements include better medical care through implementation of Interventions to Reduce Acute Care Transfers tools and chronic care management, enhanced transitional care, and better palliative care with a focus on systematic advance care planning. There were 4,035 long-stay residents in 19 facilities enrolled in OPTIMISTIC between February 2013 and January 2014. Root-cause analyses were performed for all 910 acute transfers of these long stay residents. Of these transfers, the project RN evaluated 29\% as avoidable (57\% were not avoidable and 15\% were missing), and opportunities for quality improvement were identified in 54\% of transfers. Lessons learned in early implementation included defining new clinical roles, integrating into nursing facility culture, managing competing facility priorities, communicating with multiple stakeholders, and developing a system for collecting and managing data. The success of the overall initiative will be measured primarily according to reduction in avoidable hospitalizations of long-stay nursing facility residents.}
}

@article{kellycaineDesigningPatientCenteredUser2014,
  title = {Designing a {{Patient-Centered User Interface}} for {{Access Decisions}} about {{EHR Data}}: {{Implications}} from {{Patient Interviews}}},
  author = {{Kelly Caine} and {B A Spencer Kohn} and {Carrie Lawrence} and {Rima Hanania} and {Eric M. Meslin} and {William M. Tierney}},
  year = {2014},
  month = dec,
  journal = {Journal of General Internal Medicine},
  volume = {30},
  number = {S1},
  pages = {7--16},
  publisher = {Springer Science+Business Media},
  issn = {0884-8734},
  doi = {10.1007/s11606-014-3049-9},
  abstract = {Electronic health records change the landscape of patient data sharing and privacy by increasing the amount of information collected and stored and the number of potential recipients. Patients desire granular control over who receives what information in their electronic health record (EHR), but there are no current patient interfaces that allow them to record their preferences for EHR access.Our aim was to derive the user needs of patients regarding the design of a user interface that records patients' individual choices about who can access data in their EHRs.We used semi-structured interviews.The study was conducted in Central Indiana.Thirty patients with data stored in an EHR, the majority of whom (70 \%) had highly sensitive health EHR data, were included in the study.We conducted a thematic and quantitative analysis of transcribed interview data.Patients rarely knew what data were in their EHRs, but would have liked to know. They also wanted to be able to control who could access what information in their EHR and wanted to be notified when their data we re accessed.We derived six implications for the design of a patient-centered tool to allow individual choice in the disclosure of EHR: easy patient access to their EHRs; an overview of current EHR sharing permissions; granular, hierarchical control over EHR access; EHR access controls based on dates; contextual privacy controls; and notification when their EHRs are accessed.}
}

@article{khoaa.nguyenMedicationUseVeterans2017,
  title = {Medication {{Use}} among {{Veterans}} across {{Health Care Systems}}},
  author = {{Khoa A. Nguyen} and {David A. Haggstrom} and {Susan Ofner} and {Susan M. Perkins} and {Dustin D. French} and {Laura Myers} and {Marc B. Rosenman} and {Michael Weiner} and {Brian E. Dixon} and {Alan J. Zillich}},
  year = {2017},
  month = jan,
  journal = {Applied Clinical Informatics},
  volume = {26},
  number = {01},
  pages = {235--249},
  publisher = {Schattauer Verlag},
  issn = {1869-0327},
  doi = {10.4338/aci-2016-10-ra-0184},
  abstract = {Summary Introduction: Dual healthcare system use can create gaps and fragments of information for patient care. The Department of Veteran Affairs is implementing a health information exchange (HIE) program called the Virtual Lifetime Electronic Record (VLER), which allows providers to access and share information across healthcare systems. HIE has the potential to improve the safety of medication use. However, data regarding the pattern of outpatient medication use across systems of care is largely unknown. Therefore, the objective of this study is to describe the prevalence of medication dispensing across VA and non-VA health care systems among a cohort Veteran population Methods: This study included all Veterans who had two outpatient visits or one inpatient visit at the Indianapolis VA during a 1-year period prior to VLER enrollment. Source of medication data was assessed at the subject level, and categorized as VA, INPC (non-VA), or both. The primary target was identification of sources for medication data. Then, we compared the mean number of prescriptions, as well as overall and pairwise differences in medication dispensing. Results: Out of 52,444 Veterans, 17.4\% of subjects had medication data available in a regional HIE. On average, 40 prescriptions per year were prescribed for Veterans who used both sources compared to 29 prescriptions per year from VA only and 25 prescriptions per year from INPC only sources. The annualized prescription rate of Veterans in the dual use group was 36\% higher than those who had only VA data available and 61\% higher than those who had only INPC data available. Conclusions: Our data demonstrated that 17.4\% of subjects had medication use identified from non-VA sources, including prescriptions for antibiotics, antineoplastics, and anticoagulants. These data support the need for HIE programs to improve coordination of information, with the potential to reduce adverse medication interactions and improve medication safety.}
}

@article{konradm.szymanskiMortalityBladderAugmentation2015,
  title = {Mortality after {{Bladder Augmentation}} in {{Children}} with {{Spina Bifida}}},
  author = {{Konrad M. Szymanski} and {Rosalia Misseri} and {Benjamin Whittam} and {Cyrus M. Adams} and {Jordan Kirkegaard} and {Shelly King} and {Martin Kaefer} and {Richard C. Rink} and {Mark P. Cain}},
  year = {2015},
  month = feb,
  journal = {The Journal of Urology},
  volume = {193},
  number = {2},
  pages = {643--649},
  publisher = {Elsevier BV},
  issn = {0022-5347},
  doi = {10.1016/j.juro.2014.07.101},
  abstract = {Renal failure has been a leading cause of death for children with spina bifida. Although improvements in management have increased survival, current data on mortality are sparse. Bladder augmentation, a modern intervention to preserve renal function, carries risks of morbidity and mortality. We determined long-term mortality and causes of death in patients with spina bifida treated with bladder augmentation.We retrospectively reviewed the records of patients with spina bifida who underwent bladder augmentation between 1979 and 2013. Those born before 1972 or older than 21 years at augmentation were excluded. Demographic and surgical data were collected. Outcomes were obtained from medical records, death records and the Social Security Death Index. Fisher exact and Wilcoxon rank-sum tests and Kaplan-Meier plots were used for analysis.Of 888 patients in our bladder reconstruction database 369 with spina bifida met inclusion criteria. Median followup was 10.8 years. A total of 28 deaths (7.6\%) occurred. The leading causes of mortality were nonurological infections (ventriculoperitoneal shunt related, decubitus ulcer fasciitis, etc) and pulmonary disease. Two patients (0.5\%) died of renal failure. No patient died of malignancy or bladder perforation. Patients with a ventriculoperitoneal shunt had a higher mortality rate than those without a shunt (8.9\% vs 1.5\%, p = 0.04).Previously reported mortality rates of 50\% to 60\% in patients with spina bifida do not appear to apply in children who have undergone bladder augmentation. On long-term followup leading causes of death in patients with spina bifida after bladder augmentation were nonurological infections rather than complications associated with augmentation or renal failure.}
}

@article{kristabruckerAssessingRiskFuture2018,
  title = {Assessing {{Risk}} of {{Future Suicidality}} in {{Emergency Department Patients}}},
  author = {{Krista Brucker} and {Duggan C} and {J O Niezer} and {K. Roseberry} and {Helen Le-Niculescu} and {Alexander B. Niculescu} and {Jeffrey A. Kline}},
  year = {2018},
  month = oct,
  journal = {Academic Emergency Medicine},
  volume = {26},
  number = {4},
  pages = {376--383},
  publisher = {Wiley-Blackwell},
  issn = {1069-6563},
  doi = {10.1111/acem.13562},
  abstract = {Background Emergency departments (ED) are the first line of evaluation for patients at risk and in crisis, with or without overt suicidality (ideation, attempts). Currently employed triage and assessments methods miss some of the individuals who subsequently become suicidal. The Convergent Functional Information for Suicidality (CFI-S) 22-item checklist of risk factors, which does not ask directly about suicidal ideation, has demonstrated good predictive ability for suicidality in previous studies in psychiatrict patients but has not been tested in the real-world setting of EDs. Methods We administered CFI-S prospectively to a convenience sample of consecutive ED patients. Patients were also asked at triage about suicidal thoughts or intentions per standard ED suicide clinical screening (SCS), and the treating ED physician was asked to fill a physician gestalt visual analog scale (VAS) for likelihood of future suicidality spectrum events (SSE; ideation, preparatory acts, attempts, completed suicide). We performed structured chart review and telephone follow-up at 6 months post--index visit. Results The median time to complete the CFI-S was 3 minutes (first to third quartile = 3--6 minutes). Of the 338 patients enrolled, 45 (13.3\%) were positive on the initial SCS, and 32 (9.5\%) experienced a SSE in the 6 months of follow-up. Overall, SCS had modest diagnostic accuracy sensitivity 14/32 = 44\%, (95\% CI: 26--62\%) and specificity 275/306 = 90\%, (86--93\%). The physician VAS also had moderate overall diagnostic accuracy (AUC 0.75, confidence interval [CI] = 0.66--0.85), and the CFI-S was best (AUC = 0.81, CI = 0.76--0.87). The top CFI-S differentiating items were psychiatric illness, perceived uselessness, and social isolation. Conclusions Using CFI-S, or some of its items, in busy EDs may help improve the detection of patients at high risk for future suicidality.}
}

@article{kristins.hendrixAttitudesUseNewborn2013,
  title = {Attitudes {{About}} the {{Use}} of {{Newborn Dried Blood Spots}} for {{Research}}: {{A Survey}} of {{Underrepresented Parents}}},
  author = {{Kristin S. Hendrix} and {Eric M. Meslin} and {Aaron E. Carroll} and {Stephen M. Downs}},
  year = {2013},
  month = sep,
  journal = {Academic Pediatrics},
  volume = {13},
  number = {5},
  pages = {451--457},
  publisher = {Elsevier BV},
  issn = {1876-2859},
  doi = {10.1016/j.acap.2013.04.010},
  abstract = {Objective To identify the relative importance of factors that impact parents' attitudes toward use of their child's dried newborn blood spots for research purposes. Methods Respondents were parents aged 18 and older with at least one child aged 17 or younger born in Indiana visiting an urban pediatrics clinic. They were asked to rate the acceptability of hypothetical scenarios involving the research use of blood spots. Three pieces of information varied between the scenarios: 1) who would be conducting the research; 2) whether the child's identity would be linked to the spots; and 3) whether and how often the parents' consent would be sought before the research began. Results A total of 506 predominantly black and low-income parents completed the survey. The conjoint analysis model showed good fit (Pearson's R = 0.998, P {$<$} .001). The rank order of factors affecting parents' attitudes was: 1) consent (importance score = 64.9), 2) whether the child's identity was linked to the spot (importance score = 19.4), and 3) affiliation of the researcher using the spots (importance score = 14.6). Respondents preferred being asked for their consent each time their children's spots would be used. They preferred that the children's identity not be linked to the spots and that the research be conducted by university researchers, though these issues had less impact on attitudes than consent. Conclusions Parents strongly prefer that consent be sought for each use of their children's blood spots. These findings have implications for future research and policy-making decisions.}
}

@article{laradakhoulRacialDisparitiesLiver2018,
  title = {Racial {{Disparities}} in {{Liver Transplantation}} for {{Hepatocellular Carcinoma Are Not Explained}} by {{Differences}} in {{Comorbidities}}, {{Liver Disease Severity}}, or {{Tumor Burden}}},
  author = {{Lara Dakhoul} and {Samer Gawrieh} and {Keaton R. Jones} and {Marwan Ghabril} and {Chelsey McShane} and {Eric Orman} and {Eduardo Vilar-Gomez} and {Naga Chalasani} and {Lauren Nephew}},
  year = {2018},
  month = dec,
  journal = {Hepatology communications},
  volume = {3},
  number = {1},
  pages = {52--62},
  publisher = {Wiley},
  issn = {2471-254X},
  doi = {10.1002/hep4.1277},
  abstract = {Black patients have higher mortality and are less likely to receive liver transplantation for hepatocellular carcinoma (HCC) than white patients. Reasons for these disparities have not been fully elucidated. Comorbid disease, liver disease severity, cirrhosis etiologies, and tumor characteristics were compared between black and white patients with HCC seen at the Indiana University Academic Medical Center from January 2000 to June 2014. Logistic regression was used to investigate the primary outcome, which was liver transplantation. Log-rank testing was used to compare survival between the two groups. Subgroup analysis explored reasons for failure to undergo liver transplantation in patients within Milan criteria. The cohort included 1,032 (86\%) white and 164 (14\%) black patients. Black and white patients had similar Model for End-Stage Liver Disease (MELD) and Child-Pugh scores (CPSs). There was a trend toward larger tumor size (5.3 cm versus 4.7 cm; P = 0.05) in black patients; however, Barcelona Clinic Liver Cancer (BCLC) staging and Milan criteria were similar. Black patients were less likely to undergo liver transplantation than white patients; this was a disparity that was not attenuated (odds ratio [OR], 0.43; 95\% confidence interval [CI], 0.21-0.90) on multivariable analysis. Substance abuse was more frequently cited as the reason black patients within Milan criteria failed to undergo transplantation compared to white patients. Survival was similar between the two groups. Conclusion: Racial differences in patient and tumor characteristics were small and did not explain the disparity in liver transplantation. Higher rates of substance abuse in black patients within Milan criteria who failed to undergo transplantation suggest social factors contribute to this disparity in this cohort.}
}

@article{lauram.tormoehlenDisparitiesGuidelineAdherence2016,
  title = {Disparities and Guideline Adherence in Drugs of Abuse Screening in Intracerebral Hemorrhage},
  author = {{Laura M. Tormoehlen} and {Ashley D Blatsioris} and {Elizabeth A. S. Moser} and {Ravan J. L. Carter} and {Alec Stevenson} and {Susan Ofner} and {A Hulin} and {Darren O'Neill} and {Aaron Cohen-Gadol} and {Thomas J. Leipzig} and {Linda S. Williams} and {Jason Mackey}},
  year = {2016},
  month = dec,
  journal = {Neurology},
  volume = {88},
  number = {3},
  pages = {252--258},
  publisher = {Lippincott Williams \& Wilkins},
  issn = {0028-3878},
  doi = {10.1212/wnl.0000000000003505},
  abstract = {Objective: To characterize the pattern of urine drug screening in a cohort of intracerebral hemorrhage (ICH) patients at our academic centers. Methods: We identified cases of primary ICH occurring from 2009 to 2011 in our academic centers. Demographic data, imaging characteristics, processes of care, and short-term outcomes were ascertained. We performed logistic regression to identify predictors for screening and evaluated preguideline and postguideline reiteration screening patterns. Results: We identified 610 patients with primary ICH in 2009--2011; 379 (62.1\%) were initially evaluated at an outside hospital. Overall, 142/610 (23.3\%) patients were screened, with 21 positive for cocaine and 3 for amphetamine. Of patients \&lt;55 years of age, only 65/140 (46.4\%) were screened. Black patients \&lt;55 years of age were screened more than nonblack patients \&lt;55 years of age (38/61 [62.3\%] vs 27/79 [34.2\%]; p = 0.0009). In the best multivariable model, age group ( p = 0.0001), black race ( p = 0.4529), first Glasgow Coma Scale score ( p = 0.0492), current smoking ( p \&lt; 0.0001), and age group {\texttimes} black race ( p = 0.0097) were associated with screening. Guideline reiteration in 2010 did not improve the proportion \&lt;55 years of age who were screened: 42/74 (56.8\%) were screened before and 23/66 (34.9\%) after ( p = 0.01). Conclusions: We found disparities in drugs of abuse (DOA) screening and suboptimal guideline adherence. Systematic efforts to improve screening for DOA are warranted. Improved identification of sympathomimetic exposure may improve etiologic classification and influence decision-making and prognosis counseling.}
}

@article{lauraruppertLinkageIndianaState2016,
  title = {Linkage of {{Indiana State Cancer Registry}} and {{Indiana Network}} for {{Patient Care Data}}.},
  author = {{Laura Ruppert} and {Jiang He} and {Joel Martin} and {G. Eckert} and {Fangqian Ouyang} and {Abby Church} and {Paul Dexter} and {Siu-kuen Azor Hui} and {David A. Haggstrom}},
  year = {2016},
  month = jan,
  journal = {PubMed},
  volume = {43},
  number = {4},
  pages = {174--8},
  publisher = {National Institutes of Health},
  issn = {NA},
  abstract = {BACKGROUND: Large automated electronic health records (EHRs), if brought together in a federated data model, have the potential to serve as valuable population-based tools in studying the patterns and effectiveness of treatment. The Indiana Network for Patient Care (INPC) is a unique federated EHR data repository that contains data collected from a large population across various health care settings throughout the state of Indiana. The INPC clinical data environment allows quick access and extraction of information from medical charts. The purpose of this project was to evaluate 2 different methods of record linkage between the Indiana State Cancer Registry (ISCR) and INPC, determine the match rate for linkage between the ISCR and INPC data for patients diagnosed with cancer, and to assess the completeness of the ISCR based on additional validated cancer cases identified in the INPC EHRs. METHODS: Deterministic and probabilistic algorithms were applied to link ISCR cases to the INPC. The linkage results were validated by manual review and the accuracy assessed with positive predictive value (PPV). Medical charts of melanoma and lung cancer cases identified in INPC but not linked to ISCR were manually reviewed to identify true incidence cancers missed by the ISCR, from which the completeness of the ISCR was estimated for each cancer. RESULTS: Both deterministic and probabilistic approaches to linking ISCR and INPC had extremely high PPV ({$>$}99\%) for identifying true matches for the overall cohort and each subcohort. The combined match rate for melanoma and lung cancer cases identified in the ISCR that matched to any patient occurrence in INPC (not by disease) was 85.5\% for the complete cohort, 94.4\% for melanoma, and 84.4\% for lung cancer. The estimated completeness of capture by the ISCR was 84\% for melanoma and 98\% for lung cancer. Conclusion: Cancer registries can be successfully linked to patients' EHR data from institutions participating in a regional health information organization (RHIO) with a high match rate. A pragmatic approach to data linkage may apply both deterministic and probabilistic approaches together for the diverse purposes of cancer control research. The RHIO has the potential to add value to the state cancer registry through the identification of additional true incident cases, but more advanced approaches, such as natural language processing, are needed.}
}

@article{laurenk.stewartMetabolicSyndromeIncreases2020,
  title = {Metabolic {{Syndrome Increases Risk}} of {{Venous Thromboembolism Recurrence}} after {{Acute Pulmonary Embolism}}},
  author = {{Lauren K. Stewart} and {Jeffrey A. Kline}},
  year = {2020},
  month = jul,
  journal = {Annals of the American Thoracic Society},
  volume = {17},
  number = {7},
  pages = {821--828},
  publisher = {American Thoracic Society},
  issn = {2325-6621},
  doi = {10.1513/annalsats.201907-518oc},
  abstract = {Rationale: Metabolic syndrome (MetS), the clinical clustering of hypertension, dyslipidemia, insulin resistance, and abdominal obesity, has been associated with a prothrombotic and hypofibrinolytic state, although data linking MetS with venous thromboembolism (VTE) remain limited.Objectives: The aim of this study was to measure the prevalence of MetS in patients with pulmonary embolism (PE) across a large population and to examine its impact on VTE recurrence.Methods: This was a retrospective, population-based analysis using deidentified information from a large statewide database, the Indiana Network for Patient Care. All patients with an International Classification of Diseases--defined diagnosis of PE from 2004 to 2017 were included. We measured the frequency with which patients with PE carried a comorbid diagnosis of each MetS component. Multiple logistic regression analysis was performed with VTE recurrence as the dependent variable to test the independent effect of MetS diagnosis, with a statistical model using a directed acyclic graph to account for potential confounders and mediators. Kaplan-Meier curves were constructed to compare rates of VTE recurrence over time based on the presence or absence of MetS and its individual components.Results: A total of 72,936 patients were included in this analysis. The most common MetS component was hypertension with a prevalence of 59\%, followed by hyperlipidemia (41\%), diabetes mellitus (24\%), and obesity (22\%). Of these patients, 69\% had at least one comorbid component of MetS. The overall incidence of VTE recurrence was 17\%, increasing stepwise with each additional MetS component and ranging from 6\% in patients with zero components to 37\% in those with all four. Logistic regression analysis yielded an adjusted odds ratio of 3.03 (95\% CI, 2.90--3.16) for the effect of composite diagnosis requiring at least three of the four components of MetS diagnosis on VTE recurrence.Conclusions: The presence of comorbid MetS in patients with PE is associated with significantly higher rates of VTE recurrence, supporting the importance of recognizing these risk factors and initiating appropriate therapies to reduce recurrence risk.}
}

@article{laurenk.stewartStatinUseAssociated2020,
  title = {Statin {{Use}} Is {{Associated}} with {{Reduced Risk}} of {{Recurrence}} in {{Patients}} with {{Venous Thromboembolism}}},
  author = {{Lauren K. Stewart} and {Elisa Sarmiento} and {Jeffrey A. Kline}},
  year = {2020},
  month = aug,
  journal = {The American Journal of Medicine},
  volume = {133},
  number = {8},
  pages = {930-935.e8},
  publisher = {Elsevier BV},
  issn = {0002-9343},
  doi = {10.1016/j.amjmed.2019.12.032},
  abstract = {Statin therapy appears to reduce incidence of venous thromboembolism in secondary analyses of non-venous thromboembolism trials, but no evidence has shown effect of statins in large population samples. The objective of this study was to examine the magnitude of the effect of statin therapy on venous thromboembolism recurrence across a large statewide population.This was a retrospective analysis of the Indiana Network for Patient Care database. All patients with an International Classification of Diseases-defined diagnosis of either deep vein thrombosis or pulmonary embolism from 2004-2017 were included. We collected Generic Product Identifier codes to determine whether patients had been prescribed a statin medication and divided patients into 2 groups: + or - statin. We then performed a propensity-matching analysis to balance covariates and created a final logistic regression model with statin use as the predictor variable and venous thromboembolism recurrence as the dependent variable.This study included a total of 192,908 patients with documented statin use in 13.5\%. Venous thromboembolism recurrence occurred in 16\% of all patients over the study period. After propensity matching, patients not on a statin were found to have significantly higher rates of venous thromboembolism recurrence (20\% vs 16\%, P {$<$} .0001). Logistic regression yielded an odds ratio of 0.75 (95\% confidence interval, 0.72-0.79) for venous thromboembolism recurrence for those on statin therapy.We found that a statin prescription reduced risk of venous thromboembolism recurrence by approximately 25\% after adjusting for risk factors, supporting the adjunctive role of statins in the prevention of venous thromboembolism recurrence.}
}

@article{laurenm.westaferHotPressOutpatient2015,
  title = {Hot {{Off}} the {{Press}}: {{Outpatient Anticoagulation}} for {{Venous Thromboembolism Diagnosed}} in the {{Emergency Department}}},
  author = {{Lauren M. Westafer} and {Christopher R. Carpenter} and {William K. Milne}},
  year = {2015},
  month = oct,
  journal = {Academic Emergency Medicine},
  volume = {22},
  number = {11},
  pages = {1355--1357},
  publisher = {Wiley-Blackwell},
  issn = {1069-6563},
  doi = {10.1111/acem.12809},
  abstract = {The diagnosis of venous thromboembolism (VTE), including deep venous thrombosis (DVT) and pulmonary embolism (PE), is common in emergency departments (EDs), with one out of every 400 to 1,500 adult ED patients in the United States diagnosed with PE.1 Emergency physicians (EPs) in the United States discharge a minority of these patients, yet there is increasing interest in managing newly diagnosed VTE patients in the outpatient setting.2 However, prior studies investigating the safety and efficacy of outpatient management of VTE have limited generalizability, as they were conducted in various health care settings outside the United States and have not yet addressed the safety and efficacy of novel oral anticoagulants (NOACs) as the initial outpatient therapeutic choice. Furthermore, existing studies are largely observational studies rather than randomized controlled trials.3-5 This prospective observational study evaluated outpatient rivaroxaban VTE treatment for patients discharged home from the ED and who were at low risk of adverse outcomes. The primary outcomes were VTE recurrence or hemorrhage. Over the course of 1 year, 106 patients received outpatient treatment with rivaroxaban for VTE at two academic EDs in Indiana, including one urban teaching hospital with approximately 80\% of patients below the federal poverty line. Of these, 57\% had DVT, 28\% had PE, and 5\% had both DVT and PE. Rivaroxaban duration was individually tailored for each patient by the ED-led anticoagulation clinic in which patients followed up within 3 weeks of discharge from the ED. Several limitations of this study were noted. First, the ability of others to replicate the study's resources is questionable. Although 80\% of the patient population of one of the study hospitals is below the federal poverty line, these patients had follow-up with the study authors at an ED anticoagulation clinic that does not exist in most settings and that would require time and expertise to establish. Furthermore, indigent patients had access to rivaroxaban for free or at substantially discounted cost through the support of Janssen Pharmaceuticals and the Johnson \& Johnson Patient Assistance Foundation, Inc. Many ED providers are probably unaware of these resources for providing access to rivaroxaban for economically disadvantaged patients, and the pharmaceutical support required to ensure that sustained access to this medication may not be available long term. The duration of rivaroxaban anticoagulation was not predetermined and was left to clinical judgment, which might vary significantly between providers. Additionally, this study used the modified Hestia criteria and the Prediction of Mortality from Pulmonary Embolism in Cancer (POMPE-C) to identify appropriately low-risk VTE patients who are suitable for outpatient therapy. The Pulmonary Embolism Severity Index (PESI) score is a more widely validated risk stratification tool, and the authors do not explain why they used an alternative score.6 Among 106 patients with discharge diagnoses of DVT or PE treated at home with rivaroxaban, none developed recurrent or new VTE while on anticoagulation (0 of 106, 0\%, 95\% confidence interval [CI] = 0 to 3.4\%). Six months after completing rivaroxaban treatment, three of 106 (3\%, 95\% CI = 0.6\% to 8\%) developed VTE recurrence, and none had a major bleeding event. Two patients died from causes deemed to be unrelated to VTE or rivaroxaban therapy. Seventeen patients had solely medical record or telephone follow-up. Three of these patients had no follow-up and were not present in the Social Security Death Index or Indiana Network for Patient Care. This interim analysis of a preliminary study sought to provide information on the safety and efficacy of outpatient treatment with one NOAC for VTE. The study implies safety and efficacy of outpatient rivaroxaban therapy in carefully selected populations at two sociodemographically diverse academic EDs. The three patients lost to follow-up in the paper were known by study authors to be alive and without diagnosed recurrent VTE afterward. Further, Janssen Pharmaceuticals has a program in place to guarantee that patients with insurance receive rivaroxaban for \$10 per month. The Johnson \& Johnson Patient Assistance Foundation, Inc., provides free rivaroxaban patients who have no coverage and low income (defined via a sliding scale based on family size).7 Additionally, the ED anticoagulation clinic staffed by the study authors served primarily as a means of answering patients questions and ensuring patients were able to obtain their medications, but did not provide other non--VTE-associated medical care, which may alleviate some readers' concerns about the expense and complexity of developing a similar clinic in their local settings. An observational study from two U.S. academic EDs suggests that outpatient treatment with rivaroxaban may result in low recurrence rate of VTE and a low risk of bleeding. Given the nonrandomized, observational nature of this protocol, this study offers preliminary data that should be incorporated in the shared decision-making for outpatient VTE management. This article reports interim results from an ongoing study and highlights areas for future investigation. Unanswered questions remain about which risk-stratification instrument to use to identify low-risk VTE patients and the experiences of other institutions obtaining rivaroxaban for indigent patients, as well as the potential harms and benefits of outpatient VTE management in settings lacking long-term follow-up for patients without an ED-based anticoagulation clinic. Providers awaiting randomized studies, including trials of outpatient treatment compared with inpatient management, should know that the MERCURY-PE trial has begun and should provide more definitive safety and efficacy evidence for the outpatient treatment of new VTE.}
}

@article{laurennephew3550UnderstandingRacial2019,
  title = {3550 {{Understanding Racial Disparities}} in {{Hepatocellular Carcinoma Treatments}} and {{Outcomes}}},
  author = {{Lauren Nephew} and {Susan M. Rawl} and {Naga Chalasani}},
  year = {2019},
  month = mar,
  journal = {Journal of clinical and translational science},
  volume = {3},
  number = {s1},
  pages = {99--99},
  publisher = {Cambridge University Press},
  issn = {2059-8661},
  doi = {10.1017/cts.2019.225},
  abstract = {OBJECTIVES/SPECIFIC AIMS: Black patients with hepatocellular carcinoma (HCC) receive fewer curative therapies and have higher mortality than other groups. Reducing this disparity will require an in-depth understanding of patient comorbidities, tumor characteristics, and social determinants of health. Our objectives are to a) perform a multi-center retrospective cohort study of black and white patients diagnosed with HCC in the Indianapolis area. b) prospectively enroll black and white patients with HCC to collect clinical characteristics as well as data on the social determinants of health. METHODS/STUDY POPULATION: A retrospective chart review of patients with a diagnosis of HCC from 2010-2017 from five area Indianapolis hospitals will be performed. Demographics, comorbidities, liver disease severity, and tumor characteristics will be collected using the Indiana Network for Patient Care database and compared between black and white patients. Concomitantly, a prospective cohort of black and white patients will be enrolled and surveyed to collect data on socioeconomic status and income adequacy, literacy, functional status, substance abuse history, social support, activation, and adherence. The primary outcomes are the receipt of curative therapies for HCC including liver transplantation, resection or ablation. The secondary outcome is mortality. Multivariable logistic regression models will be used to explore disparities seen in the primary and secondary outcomes. RESULTS/ANTICIPATED RESULTS: These preliminary results include Indiana University Hospital (IUH) findings; a multicenter analysis is underway. The IUH cohort included 1,032 (86\%) white and 164 (14\%) black patients. Black and white patients had similar Model for End-Stage Liver Disease and Child-Pugh scores. There was a trend toward larger tumor size (5.3 cm vs. 4.7 cm; P = 0.05) in black patients; however, Barcelona Clinic Liver Cancer staging and Milan criteria were similar. Black patients were less likely to undergo liver transplantation than white patients---a disparity that was not attenuated (odds ratio [OR], 0.43; 95\% confidence interval [CI]: 0.21-0.90) on multivariable analysis. Substance abuse was more frequently cited as the reason black patients within Milan criteria failed to undergo transplantation than white patients. Survival was similar between the two groups. DISCUSSION/SIGNIFICANCE OF IMPACT: Racial differences in patient and tumor characteristics were small in our single center analysis and did not explain the disparity in liver transplantation. This analysis however only reflects 25\% of patients diagnosed with HCC in the Indianapolis metropolitan, highlighting the need for a multicenter study. Higher rates of substance abuse in black patients within Milan criteria who failed to undergo transplantation suggest social factors contribute to this disparity and highlight the need for a prospective study that can explore these and other social factors.}
}

@article{laurens.hughesCommunityVitalSigns2016,
  title = {Community {{Vital Signs}}: {{Taking}} the {{Pulse}} of the {{Community While Caring}} for {{Patients}}},
  author = {{Lauren S. Hughes} and {Robert L. Phillips} and {Jennifer E. DeVoe} and {Andrew Bazemore}},
  year = {2016},
  month = may,
  journal = {Journal of the American Board of Family Medicine},
  volume = {29},
  number = {3},
  pages = {419--422},
  publisher = {American Board of Family Medicine},
  issn = {1557-2625},
  doi = {10.3122/jabfm.2016.03.150172},
  abstract = {In 2014 both the Institute of Medicine and the National Quality Forum recommended the inclusion of social determinants of health data in electronic health records (EHRs). Both entities primarily focus on collecting socioeconomic and health behavior data directly from individual patients. The burden of reliably, accurately, and consistently collecting such information is substantial, and it may take several years before a primary care team has actionable data available in its EHR. A more reliable and less burdensome approach to integrating clinical and social determinant data exists and is technologically feasible now. Community vital signs-aggregated community-level information about the neighborhoods in which our patients live, learn, work, and play-convey contextual social deprivation and associated chronic disease risks based on where patients live. Given widespread access to "big data" and geospatial technologies, community vital signs can be created by linking aggregated population health data with patient addresses in EHRs. These linked data, once imported into EHRs, are a readily available resource to help primary care practices understand the context in which their patients reside and achieve important health goals at the patient, population, and policy levels.}
}

@article{malazboustaniPassiveDigitalSignature2019,
  title = {Passive {{Digital Signature}} for {{Early Identification}} of {{Alzheimer}}'s {{Disease}} and {{Related Dementia}}},
  author = {{Malaz Boustani} and {Anthony J. Perkins} and {Rezaul Karim Khandker} and {Stephen Duong} and {Paul Dexter} and {Richard B. Lipton} and {Christopher M. Black} and {Vasu Chandrasekaran} and {Craig A. Solid} and {Patrick O. Monahan}},
  year = {2019},
  month = nov,
  journal = {Journal of the American Geriatrics Society},
  volume = {68},
  number = {3},
  pages = {511--518},
  publisher = {Wiley-Blackwell},
  issn = {0002-8614},
  doi = {10.1111/jgs.16218},
  abstract = {OBJECTIVES Developing scalable strategies for the early identification of Alzheimer's disease and related dementia (ADRD) is important. We aimed to develop a passive digital signature for early identification of ADRD using electronic medical record (EMR) data. DESIGN A case-control study. SETTING The Indiana Network for Patient Care (INPC), a regional health information exchange in Indiana. PARTICIPANTS Patients identified with ADRD and matched controls. MEASUREMENTS We used data from the INPC that includes structured and unstructured (visit notes, progress notes, medication notes) EMR data. Cases and controls were matched on age, race, and sex. The derivation sample consisted of 10 504 cases and 39 510 controls; the validation sample included 4500 cases and 16 952 controls. We constructed models to identify early 1- to 10-year, 3- to 10-year, and 5- to 10-year ADRD signatures. The analyses included 14 diagnostic risk variables and 10 drug classes in addition to new variables produced from unstructured data (eg, disorientation, confusion, wandering, apraxia, etc). The area under the receiver operating characteristics (AUROC) curve was used to determine the best models. RESULTS The AUROC curves for the validation samples for the 1- to 10-year, 3- to 10-year, and 5- to 10-year models that used only structured data were .689, .649, and .633, respectively. For the same samples and years, models that used both structured and unstructured data produced AUROC curves of .798, .748, and .704, respectively. Using a cutoff to maximize sensitivity and specificity, the 1- to 10-year, 3- to 10-year, and 5- to 10-year models had sensitivity that ranged from 51\% to 62\% and specificity that ranged from 80\% to 89\%. CONCLUSION EMR-based data provide a targeted and scalable process for early identification of risk of ADRD as an alternative to traditional population screening. J Am Geriatr Soc 68:511--518, 2020}
}

@article{marcb.rosenmanDatabaseQueriesHospitalizations2014,
  title = {Database Queries for Hospitalizations for Acute Congestive Heart Failure: Flexible Methods and Validation Based on Set Theory},
  author = {{Marc B. Rosenman} and {He Jian} and {J. C. Martin} and {Kavitha Nutakki} and {George J. Eckert} and {Kathleen A. Lane} and {Irmina Gradus-Pizlo} and {Siu L. Hui}},
  year = {2014},
  month = mar,
  journal = {Journal of the American Medical Informatics Association},
  volume = {21},
  number = {2},
  pages = {345--352},
  publisher = {Oxford University Press},
  issn = {1067-5027},
  doi = {10.1136/amiajnl-2013-001942},
  abstract = {Background and objective Electronic health records databases are increasingly used for identifying cohort populations, covariates, or outcomes, but discerning such clinical `phenotypes' accurately is an ongoing challenge. We developed a flexible method using overlapping (Venn diagram) queries. Here we describe this approach to find patients hospitalized with acute congestive heart failure (CHF), a sampling strategy for one-by-one `gold standard' chart review, and calculation of positive predictive value (PPV) and sensitivities, with SEs, across different definitions.}
}

@article{marcb.rosenmanNascentRegionalSystem2014,
  title = {Nascent {{Regional System}} for {{Alerting Infection Preventionists}} about {{Patients}} with {{Multidrug-Resistant Gram-Negative Bacteria}}: {{Implementation}} and {{Initial Results}}},
  author = {{Marc B. Rosenman} and {Kinga A. Szucs} and {S. Maria E. Finnell} and {Shahid Khokhar} and {James Egg} and {Larry Lemmon} and {David Shepherd} and {Jeff Friedlin} and {Xiaochun Li} and {Abel N. Kho}},
  year = {2014},
  month = oct,
  journal = {Infection Control and Hospital Epidemiology},
  volume = {35},
  number = {S3},
  pages = {S40-S47},
  publisher = {University of Chicago Press},
  issn = {0899-823X},
  doi = {10.1086/677833},
  abstract = {To build and to begin evaluating a regional automated system to notify infection preventionists (IPs) when a patient with a history of gram-negative rod multidrug-resistant organism (GNRMDRO) is admitted to an emergency department (ED) or inpatient setting.Observational, retrospective study.Twenty-seven hospitals, mostly in the Indianapolis metropolitan area, in a health information exchange (HIE).During testing of the new system: 80,180 patients with microbiology cultures between October 1, 2013, and December 31, 2013; 573 had a GNRMDRO. METHODS/INTERVENTION: A Health Level Seven (HL7) data feed from the HIE was obtained, corrected, enhanced, and used for decision support (secure e-mail notification to the IPs). Retrospective analysis of patients with microbiology data (October 1, 2013, through December 31, 2013) and subsequent healthcare encounters (through February 6, 2014).The 573 patients (median age, 66 years; 68\% women) had extended-spectrum {$\beta$}-lactamase-producing Enterobacteriaceae (78\%), carbapenem-resistant Enterobacteriaceae (7\%), Pseudomonas aeruginosa (9\%), Acinetobacter baumannii (3\%), or other GNR (3\%). Body sources were urine (68\%), sputum/trachea/bronchoalveolar lavage (13\%), wound/skin (6\%), blood (6\%), or other/unidentified (7\%). Between October 1, 2013, and February 6, 2014, 252 (44\%) of 573 had an ED or inpatient encounter after the GNRMDRO culture, 47 (19\% of 252) at an institution different from where the culture was drawn. During the first 7 weeks of actual alerts (January 29, 2014, through March 19, 2014), alerts were generated regarding 67 patients (19 of 67 admitted elsewhere from where the culture was drawn).It proved challenging but ultimately feasible to create a regional microbiology-based alert system. Even in a few months, we observed substantial crossover between institutions. This system, if it contributes to timely isolation, may help reduce the spread of GNRMDROs.}
}

@article{marjoriem.conantMandatoryInfectiousDiseases2014,
  title = {Mandatory Infectious Diseases Approval of Outpatient Parenteral Antimicrobial Therapy ({{OPAT}}): Clinical and Economic Outcomes of Averted Cases},
  author = {{Marjorie M. Conant} and {Sharon M. Erdman} and {Danielle Osterholzer}},
  year = {2014},
  month = feb,
  journal = {Journal of Antimicrobial Chemotherapy},
  volume = {69},
  number = {6},
  pages = {1695--1700},
  publisher = {Oxford University Press},
  issn = {0305-7453},
  doi = {10.1093/jac/dku015},
  abstract = {The use of outpatient parenteral antimicrobial therapy (OPAT) has been increasing worldwide due to its evident clinical utility; however, there is also concern about overuse and increased risk to patients in terms of antibiotic toxicity and intravenous line-associated complications. At our university-affiliated county teaching hospital with mandatory Infectious Diseases (ID) approval for all OPAT courses, we looked at clinical outcomes and cost savings of patients denied OPAT.Electronic medical records of patients denied OPAT were retrospectively reviewed. Demographic, medical, infection-specific and drug-specific data were collected for each patient, including the regimen ultimately recommended by ID in lieu of OPAT. Patients were determined to have clinical cure, probable cure or treatment failure based on resolution or recurrence of infection for up to 1 year after OPAT denial. The amount of money saved in direct OPAT costs in these patients was calculated.Fifty-six patients were denied OPAT during the study period and were discharged with either oral or no additional antibiotics. Clinical cure was documented in 42 patients (75\%), probable cure in 7 patients (12.5\%) and treatment failure in 7 patients (12.5\%). Of the seven treatment failures, only one patient (1.8\%) was deemed to be a true failure after thorough chart review. Overall, the estimated OPAT-specific cost saving was \$215 424 or \$3847 per patient.Mandatory ID approval of all OPAT courses can decrease healthcare costs while maintaining good clinical outcomes.}
}

@article{masoudhosseiniImpactDocumentConsolidation2018,
  title = {Impact of Document Consolidation on Healthcare Providers' Perceived Workload and Information Reconciliation Tasks: A Mixed Methods Study},
  author = {{Masoud Hosseini} and {Anthony Faiola} and {Josette Jones} and {Daniel J. Vreeman} and {Huanmei Wu} and {Brian E. Dixon}},
  year = {2018},
  month = dec,
  journal = {Journal of the American Medical Informatics Association},
  volume = {26},
  number = {2},
  pages = {134--142},
  publisher = {Oxford University Press},
  issn = {1067-5027},
  doi = {10.1093/jamia/ocy158},
  abstract = {Abstract Background Information reconciliation is a common yet complex and often time-consuming task performed by healthcare providers. While electronic health record systems can receive ``outside information'' about a patient in electronic documents, rarely does the computer automate reconciling information about a patient across all documents. Materials and Methods Using a mixed methods design, we evaluated an information system designed to reconcile information across multiple electronic documents containing health records for a patient received from a health information exchange (HIE) network. Nine healthcare providers participated in scenario-based sessions in which they manually consolidated information across multiple documents. Accuracy of consolidation was measured along with the time spent completing 3 different reconciliation scenarios with and without support from the information system. Participants also attended an interview about their experience. Perceived workload was evaluated quantitatively using the NASA-TLX tool. Qualitative analysis focused on providers' impression of the system and the challenges faced when reconciling information in practice. Results While 5 providers made mistakes when trying to manually reconcile information across multiple documents, no participants made a mistake when the system supported their work. Overall perceived workload decreased significantly for scenarios supported by the system (37.2\% in referrals, 18.4\% in medications, and 31.5\% in problems scenarios, P \&amp;lt; 0.001). Information reconciliation time was reduced significantly when the system supported provider tasks (58.8\% in referrals, 38.1\% in medications, and 65.1\% in problem scenarios). Conclusion Automating retrieval and reconciliation of information across multiple electronic documents shows promise for reducing healthcare providers' task complexity and workload.}
}

@article{masoudhosseiniReconcilingDisparateInformation2017,
  title = {Reconciling Disparate Information in Continuity of Care Documents: {{Piloting}} a System to Consolidate Structured Clinical Documents},
  author = {{Masoud Hosseini} and {Josette Jones} and {Anthony Faiola} and {Daniel J. Vreeman} and {Huanmei Wu} and {Brian E. Dixon}},
  year = {2017},
  month = oct,
  journal = {Journal of Biomedical Informatics},
  volume = {74},
  number = {NA},
  pages = {123--129},
  publisher = {Elsevier BV},
  issn = {1532-0464},
  doi = {10.1016/j.jbi.2017.09.001},
  abstract = {Due to the nature of information generation in health care, clinical documents contain duplicate and sometimes conflicting information. Recent implementation of Health Information Exchange (HIE) mechanisms in which clinical summary documents are exchanged among disparate health care organizations can proliferate duplicate and conflicting information. To reduce information overload, a system to automatically consolidate information across multiple clinical summary documents was developed for an HIE network. The system receives any number of Continuity of Care Documents (CCDs) and outputs a single, consolidated record. To test the system, a randomly sampled corpus of 522 CCDs representing 50 unique patients was extracted from a large HIE network. The automated methods were compared to manual consolidation of information for three key sections of the CCD: problems, allergies, and medications. Manual consolidation of 11,631 entries was completed in approximately 150 h. The same data were automatically consolidated in 3.3 min. The system successfully consolidated 99.1\% of problems, 87.0\% of allergies, and 91.7\% of medications. Almost all of the inaccuracies were caused by issues involving the use of standardized terminologies within the documents to represent individual information entries. This study represents a novel, tested tool for de-duplication and consolidation of CDA documents, which is a major step toward improving information access and the interoperability among information systems. While more work is necessary, automated systems like the one evaluated in this study will be necessary to meet the informatics needs of providers and health systems in the future.}
}

@article{michaeld.murrayAntihypertensiveMedicationDementia2018,
  title = {Antihypertensive {{Medication}} and {{Dementia Risk}} in {{Older Adult African Americans}} with {{Hypertension}}: {{A Prospective Cohort Study}}},
  author = {{Michael D. Murray} and {Hugh C. Hendrie} and {Kathleen A. Lane} and {Mengjie Zheng} and {Roberta Ambuehl} and {Shanshan Li} and {Frederick W. Unverzagt} and {Christopher M. Callahan} and {Sujuan Gao}},
  year = {2018},
  month = jan,
  journal = {Journal of General Internal Medicine},
  volume = {33},
  number = {4},
  pages = {455--462},
  publisher = {Springer Science+Business Media},
  issn = {0884-8734},
  doi = {10.1007/s11606-017-4281-x},
  abstract = {African Americans are especially at risk of hypertension and dementia. Antihypertensive medications reduce the risk of cardiovascular events, but may also reduce the risk of dementia.To assess the longitudinal effects of antihypertensive medications and blood pressure on the onset of incident dementia in a cohort of African Americans.Prospective cohort.1236 community-dwelling patients from an inner-city public health care system, aged 65 years and older, with a history of hypertension but no history of dementia, and who had at least three primary care visits and a prescription filled for any medication.Blood pressure was the average of three seated measurements. Dementia was diagnosed using a two-stage design, with a screening evaluation every 2 to 3 years followed by a comprehensive in-home clinical evaluation for those with a positive screen. Laboratory, inpatient and outpatient encounter data, coded diagnoses and procedures, and medication records were derived from a health information exchange.Of the 1236 hypertensive participants without dementia at baseline, 114 (9\%) developed incident dementia during follow-up. Individuals prescribed any antihypertensive medication (n = 816) were found to have a significantly reduced risk of dementia (HR = 0.57, 95\% CI 0.37-0.88, p = 0.0114) compared to untreated hypertensive participants (n = 420). When this analysis was repeated including a variable indicating suboptimally treated blood pressure ({$>$} 140 mmHg systolic or {$>$}90 mmHg diastolic), the effect of antihypertensive medication was no longer statistically significant (HR = 0.65, 95\% CI 0.32-1.30, p = 0.2217).Control of blood pressure in older adult African American patients with hypertension is a key intervention for preventing dementia, with similar benefits from most of the commonly available antihypertensive medications.}
}

@article{michellenstramLogicalObservationIdentifiers2019,
  title = {Logical {{Observation Identifiers Names}} and {{Codes}} for {{Laboratorians}}},
  author = {{Michelle N Stram} and {Tony Gigliotti} and {Douglas J. Hartman} and {Andrea Pitkus} and {Stanley M. Huff} and {Michael Riben} and {Walter H. Henricks} and {Navid Farahani} and {Liron Pantanowitz}},
  year = {2019},
  month = jun,
  journal = {Archives of Pathology \& Laboratory Medicine},
  volume = {144},
  number = {2},
  pages = {229--239},
  publisher = {American Medical Association},
  issn = {0003-9985},
  doi = {10.5858/arpa.2018-0477-ra},
  abstract = {Context.--- The Logical Observation Identifiers Names and Codes (LOINC) system is supposed to facilitate interoperability, and it is the federally required code for exchanging laboratory data. Objective.--- To provide an overview of LOINC, emerging issues related to its use, and areas relevant to the pathology laboratory, including the subtleties of test code selection and importance of mapping the correct codes to local test menus. Data Sources.--- This review is based on peer-reviewed literature, federal regulations, working group reports, the LOINC database (version 2.65), experience using LOINC in the laboratory at several large health care systems, and insight from laboratory information system vendors. Conclusions.--- The current LOINC database contains more than 55 000 numeric codes specific for laboratory tests. Each record in the LOINC database includes 6 major axes/parts for the unique specification of each individual observation or measurement. Assigning LOINC codes to a laboratory's test menu should be a defined process. In some cases, LOINC can aid in distinguishing laboratory data among different information systems, whereby such benefits are not achievable by relying on the laboratory test name alone. Criticisms of LOINC include the complexity and resource-intensive process of selecting the most correct code for each laboratory test, the real-world experience that these codes are not uniformly assigned across laboratories, and that 2 tests that may have the same appropriately assigned LOINC code may not necessarily have equivalency to permit interoperability of their result data. The coding system's limitations, which subsequently reduce the potential utility of LOINC, are poorly understood outside of the laboratory.}
}

@article{mustafafidahusseinCorpusbasedApproachAutomated2014,
  title = {A Corpus-Based Approach for Automated {{LOINC}} Mapping},
  author = {{Mustafa Fidahussein} and {Daniel J. Vreeman}},
  year = {2014},
  month = jan,
  journal = {Journal of the American Medical Informatics Association},
  volume = {21},
  number = {1},
  pages = {64--72},
  publisher = {Oxford University Press},
  issn = {1067-5027},
  doi = {10.1136/amiajnl-2012-001159},
  abstract = {Objective To determine whether the knowledge contained in a rich corpus of local terms mapped to LOINC (Logical Observation Identifiers Names and Codes) could be leveraged to help map local terms from other institutions. Methods We developed two models to test our hypothesis. The first based on supervised machine learning was created using Apache's OpenNLP Maxent and the second based on information retrieval was created using Apache's Lucene. The models were validated by a random subsampling method that was repeated 20 times and that used 80/20 splits for training and testing, respectively. We also evaluated the performance of these models on all laboratory terms from three test institutions. Results For the 20 iterations used for validation of our 80/20 splits Maxent and Lucene ranked the correct LOINC code first for between 70.5\% and 71.4\% and between 63.7\% and 65.0\% of local terms, respectively. For all laboratory terms from the three test institutions Maxent ranked the correct LOINC code first for between 73.5\% and 84.6\% (mean 78.9\%) of local terms, whereas Lucene's performance was between 66.5\% and 76.6\% (mean 71.9\%). Using a cut-off score of 0.46 Maxent always ranked the correct LOINC code first for over 57\% of local terms. Conclusions This study showed that a rich corpus of local terms mapped to LOINC contains collective knowledge that can help map terms from other institutions. Using freely available software tools, we developed a data-driven automated approach that operates on term descriptions from existing mappings in the corpus. Accurate and efficient automated mapping methods can help to accelerate adoption of vocabulary standards and promote widespread health information exchange.}
}

@article{natalieslopenExposureIntimatePartner2013,
  title = {Exposure to Intimate Partner Violence and Parental Depression Increases Risk of {{ADHD}} in Preschool Children},
  author = {{Natalie Slopen} and {Katie A. McLaughlin}},
  year = {2013},
  month = jul,
  journal = {Evidence-based Mental Health},
  volume = {16},
  number = {4},
  pages = {102--102},
  publisher = {BMJ},
  issn = {1362-0347},
  doi = {10.1136/eb-2013-101411},
  abstract = {A substantial body of research has documented that exposure to childhood adversity, including witnessing intimate partner violence (IPV) and parental depression, influences millions of children annually, and is associated with elevated psycho-pathology in youth.1 However, much of the existing research is limited in ways that impede causal inference and clear clinical implications. Bauer and colleagues should be commended for their study, which found that children whose parents reported IPV and depressive symptoms before age three had increased risk of developing attention deficit hyper-activity disorder (ADHD) between 3 and 6 years of age, and children whose parents reported depressive symptoms (in the absence of IPV) were more likely to be prescribed psychotropic medications. This study overcomes many common limitations by incorporating valuable design characteristics, including: (1) a prospective design to establish temporal ordering; (2) recruitment from primary-care clinics, resulting in findings that are broadly generalisable; (3) a preschool-age sample, representing a developmental period for which prospective research is limited; (4) use of billing codes and pharmacy claims to ascertain outcomes, which avoids biases associated with parental report and (5) simultaneous consideration of IPV and parental depression, as these adversities often cluster together. This study has important implications for clinical practice because it demonstrates that simple surveillance strategies in clinics are able to identify families experiencing risk factors for mental health problems or psychotropic drug treatment in preschool-age children. Clinicians can use this information to identify families in need of intervention and children who would benefit from prevention-oriented interventions to mitigate risk for psychopathology. Future research is needed to understand whether early identification can be improved by using more robust brief screening measures. It will be important for future studies to evaluate the specificity of these findings for ADHD; it is currently unknown whether this is a developmentally specific outcome that broadens to other forms of psychopathology as children develop. Identifying the psychosocial and neurobiological mechanisms underlying these associations may facilitate the development of novel interventions.}
}

@article{navdeeptangriArtificialIntelligenceIdentification2022,
  title = {Artificial {{Intelligence}} in the {{Identification}}, {{Management}}, and {{Follow-Up}} of {{CKD}}},
  author = {{Navdeep Tangri} and {Thomas Ferguson}},
  year = {2022},
  month = mar,
  journal = {Kidney360},
  volume = {3},
  number = {3},
  pages = {554--556},
  publisher = {American Society of Nephrology},
  issn = {2641-7650},
  doi = {10.34067/kid.0007572021},
  abstract = {Challenges in Screening and Identification Most CKD remains underrecognized as a problem until eGFR is {$<$}30--45 ml/min per 1.73 m2, and the utility of broad population screening continues to be debated. In the absence of large, randomized trials for CKD screening, the best available evidence comes from observational studies and Markov models, and this literature suggests that screening is cost-effective for patients with diabetes or hypertension or for those with a family history of CKD. The most important factor in determining the cost-effectiveness of screening a cohort of patients is the expected prevalence of CKD in the sample (1). As such, a machine learning approach to classify a patient's risk of developing CKD may be helpful. In patients with diabetes, a model using seven routinely available features was developed by Roche in collaboration with IBM to determine incident CKD. The model used a medically supported feature selection strategy, and included the variables age, body mass index, eGFR, creatinine, albumin, glucose, and hemoglobin A1C (2). The final logistic regression model had decent discrimination, with an area under the receiver operating characteristic curve (AUC) of 0.79 in the combined data from the IBM Explorys database and the Indiana Network for Patient Care (INPC) database. Further, a random forest machine learning approach was applied in the INPC dataset, with an AUC of 0.83 for the seven-feature model and a modest improvement to 0.85 for a 35-feature model (2). External validation of the INPC random forest model would be recommended to establish broader utility. Using a population health approach to identify undiagnosed CKD using data from electronic health records (EHRs) or laboratory information systems can facilitate rapid and cost-effective classification of many patients. However, when laboratory data are not available, insurers and health systems often have access to data from claims and medications. To date, multiple private companies in the CKD space (e.g., Strive Health, Cricket Health, and Monogram Health) all report that they apply machine learning methods to claims data to identify patients with or at risk for CKD. Unfortunately, none of their findings are published, and therefore they are impossible to evaluate for measures of diagnostic accuracy. Although it may be important for these organizations not to present their proprietary models, it would be valuable to present at least summary findings in distinct populations with appropriate peer review. Changes in CKD Management Although current guidelines recommend referral of patients with CKD stage 4 (eGFR {$<$}30 ml/min per 1.73 m2) to nephrology, there is still a high rate of low-risk referrals in patients with earlier stages of CKD, and similarly a significant number of high-risk patients are still referred late, when the window to prevent kidney failure no longer exists (3). Since 2015, at least four drugs across two drug classes (sodium-glucose cotransporter 2 inhibitors and mineralocorticoid receptor antagonists) have been approved to slow CKD progression and to reduce cardiovascular events in patients at nearly all stages of CKD (4--7). Although these drugs, when added to renin-angiotensin-aldosterone inhibitors, have clinically meaningful benefits on major adverse kidney and cardiovascular events, the clinical benefit and cost-effectiveness is likely highest in patients at high or intermediate risk of kidney disease progression. In these patients, the number needed to treat to prevent adverse outcomes is likely to be low. When used early in the course of disease, these therapies can potentially help patients avoid dialysis for a lifetime rather than simply delay it by 1--2 years (Figure 1).Figure 1.: Delay of progression afforded by novel therapies in patients with CKD.Artificial Intelligence as a Solution New organizations focused on artificial intelligence (AI)-augmented CKD care have begun to enter the market. One example, pulseData, has received a patent in 2021 for machine learning systems with respect to the management of kidney disease, which apply AI techniques to determine risk scores incorporating data related to demographics, vitals, diagnoses, procedures, diagnostic tests, biomarkers, genetic tests, and patient behaviors or symptoms. The algorithms require at least one of TNF receptor-1 or TNF receptor-2, and at least one laboratory result associated with kidney injury molecule-1. Additional biomarkers evaluated include eGFR, urine albumin-to-creatinine ratio, serum creatinine, tests from the comprehensive metabolic panel, lipid profile, coagulation panel, magnesium, phosphorous, brain natriuretic peptide, hemoglobin A1C, uric acid, and endostatin. Models for the prediction of kidney failure demonstrated excellent discrimination (C statistics {$>$}0.90 for 1-year prediction), whereas those for incident CKD had C statistics of 0.84 for 1-year prediction, 0.81 at 2 years, and 0.79 at 5 years (8). An additional machine learning model has been developed by Renalytix AI, an in vitro diagnostics company. The model, referred to as KidneyIntelX, was developed for use as a clinical decision aid in the management of diabetic kidney disease using information from EHRs and biomarkers. This algorithm also uses TNF receptor-1, TNF receptor-2, and kidney injury molecule-1, and has demonstrated modest predictive accuracy, with a C statistic of 0.77 for the prediction of progression in diabetic kidney disease patients, outperforming the comparator clinical model (AUC of 0.61) (9). The model requires a total of more than 100 features, including the three plasma biomarkers, 27 other laboratory values, 20 ICD diagnostic codes, 30 medications, three measures of vital signs (systolic and diastolic blood pressure and body mass index), and it was developed on a population will fewer than 200 events (9). Additional data presented from Renalytix AI show that individual biomarkers from the test are associated with CKD progression; however, their use in an algorithm to predict CKD progression has several limitations. First, the models are not externally validated, and given the tendency of machine models to overfit the development dataset, external validation is necessary before implementation. Second, for prediction models, calibration is equally as if not more important than discrimination when applying a model to a clinical risk threshold. The KidneyIntelX model consistently underpredicts across all quantiles of risk in internal validation. Third, an economic analysis of these models may be overly optimistic because it suggests delay or prevention of 5000 dialysis starts in a hypothetical cohort of 100,000 patients. Given the internal validation cohort has a kidney failure rate of 5\% over 5 years, this would suggest that simply providing a risk score from a modestly accurate model would affect every dialysis start (9,10). Next Steps and Future Directions We believe the ideal solution would be an externally validated model that is broadly applicable in all stages of CKD, using routinely collected laboratory values that can be rapidly accessed from any conventional laboratory system. Involvement of only routinely collected laboratory tests can be helpful to avoid issues with specific assays, many of which can be relatively expensive, especially if they need to be applied to scale on a population with the magnitude of individuals with CKD. Integration of the risk-based information to EHR systems to communicate knowledge efficiently to care providers is also an integral quality of translating AI algorithms into practice, applying knowledge translation techniques to explain findings effectively to both providers and patients. In addition, it is crucial that as models become clinically used to establish a framework: (1) they allow updating of calibration or risk relationships as available treatments change; (2) they allow evaluated models to ensure that they do not disadvantage individuals on the basis of race or socioeconomic factors; and (3) they continue to be externally validated in diverse populations. In conclusion, in an era of an aging population, rising medical costs, and novel therapies, a focus on personalizing medicine through highly accurate risk stratification can provide substantial benefits to the health care system. AI algorithms can be a useful tool to help guide these clinical decisions and to help align strained resources more efficiently. Disclosures T.W. Ferguson reports personal fees from Baxter, Inc., ClinPredict, Quanta Dialysis Technologies Ltd., and Strategic Health Resources, and personal fees/other from Klinrisk. N. Tangri reports grants, personal fees, and other from Tricida, Inc.; grants and personal fees from Astra Zeneca, Inc., Bayer, Boehringer Ingelheim/Eli Lilly, and Janssen; personal fees from Otsuka, Inc., and Roche; other from Mesentech and PulseData; and personal fees and other from ClinPredict and Klinrisk. ClinPredict and Klinrisk are engaged in efforts to develop and implement models for CKD progression in health systems. Funding None.}
}

@article{naveenashishGlobalDataSharing2016,
  title = {Global {{Data Sharing}} in {{Alzheimer Disease Research}}},
  author = {{Naveen Ashish} and {Priya Bhatt} and {Arthur W. Toga}},
  year = {2016},
  month = apr,
  journal = {Alzheimer Disease \& Associated Disorders},
  volume = {30},
  number = {2},
  pages = {160--168},
  publisher = {Lippincott Williams \& Wilkins},
  issn = {0893-0341},
  doi = {10.1097/wad.0000000000000121},
  abstract = {Many investigators recognize the importance of data sharing; however, they lack the capability to share data. Research efforts could be vastly expanded if Alzheimer disease data from around the world was linked by a global infrastructure that would enable scientists to access and utilize a secure network of data with thousands of study participants at risk for or already suffering from the disease. We discuss the benefits of data sharing, impediments today, and solutions to achieving this on a global scale. We introduce the Global Alzheimer's Association Interactive Network (GAAIN), a novel approach to create a global network of Alzheimer disease data, researchers, analytical tools, and computational resources to better our understanding of this debilitating condition. GAAIN has addressed the key impediments to Alzheimer disease data sharing with its model and approach. It presents practical, promising, yet, data owner-sensitive data-sharing solutions.}
}

@article{nerissas.bauerSecondhandSmokeExposure2015,
  title = {Secondhand {{Smoke Exposure}}, {{Parental Depressive Symptoms}} and {{Preschool Behavioral Outcomes}}},
  author = {{Nerissa S. Bauer} and {Vibha Anand} and {Aaron E. Carroll} and {Stephen M. Downs}},
  year = {2015},
  month = jan,
  journal = {Journal of Pediatric Nursing},
  volume = {30},
  number = {1},
  pages = {227--235},
  publisher = {Elsevier BV},
  issn = {0882-5963},
  doi = {10.1016/j.pedn.2014.06.004},
  abstract = {Little is known about the association of secondhand smoke (SHS) exposure and behavioral conditions among preschoolers. A cross-sectional analysis was used to examine billing and pharmacy claims from November 2004 to June 2012 linked to medical encounter-level data for 2,441 children from four pediatric community health clinics. Exposure to SHS was associated with attention deficit-hyperactivity disorder/ADHD and disruptive behavior disorder/DBD after adjusting for potential confounding factors. Assessment of exposure to SHS and parental depressive symptoms in early childhood may increase providers' ability to identify children at higher risk of behavioral issues and provide intervention at the earliest stages. Little is known about the association of secondhand smoke (SHS) exposure and behavioral conditions among preschoolers. A cross-sectional analysis was used to examine billing and pharmacy claims from November 2004 to June 2012 linked to medical encounter-level data for 2,441 children from four pediatric community health clinics. Exposure to SHS was associated with attention deficit-hyperactivity disorder/ADHD and disruptive behavior disorder/DBD after adjusting for potential confounding factors. Assessment of exposure to SHS and parental depressive symptoms in early childhood may increase providers' ability to identify children at higher risk of behavioral issues and provide intervention at the earliest stages.}
}

@article{nicholaspettitDisparitiesOutcomesPatients2022,
  title = {Disparities in Outcomes among Patients Diagnosed with Cancer in Proximity to an Emergency Department Visit},
  author = {{Nicholas Pettit} and {Elisa Sarmiento} and {Jeffrey A. Kline}},
  year = {2022},
  month = jun,
  journal = {Scientific Reports},
  volume = {12},
  number = {1},
  pages = {NA-NA},
  publisher = {Nature Portfolio},
  issn = {2045-2322},
  doi = {10.1038/s41598-022-13422-8},
  abstract = {A suspected diagnosis of cancer in the emergency department (ED) may be associated with poor outcomes, related to health disparities, however data are limited. This is a retrospective observational cohort of the Indiana State Department of Health Cancer Registry, and the Indiana Network for Patient Care. First time cancer diagnoses appearing in the registry between January 2013 and December 2017 were included. Cases identified as patients who had an ED visit in the 6 months before their cancer diagnosis; controls had no preceding ED visits. The primary outcome was mortality, comparing ED-associated mortality to non-ED-associated. 134,761 first-time cancer patients were identified, including 15,432 (11.5\%) cases. The mean age was same at 65, more of the cases were Black than the controls (12.4\% vs 7.4\%, P {$<$} .0001) and more were low income (36.4\%. vs 29.3\%). The top 3 ED-associated cancer diagnoses were lung (18.4\%), breast (8.9\%), and colorectal cancers (8.9\%), whereas the controls were breast (17\%), lung (14.9\%), and prostate cancers (10.1\%). Cases observed an over three-fold higher mortality, with cumulative death rate of 32.9\% for cases vs 9.0\% for controls (P {$<$} .0001). Regression analysis predicting mortality, controlling for many confounders produced an odds ratio of 4.12 (95\% CI 3.72-4.56 for cases). This study found that an ED visit within 6 months prior to the first time of ICD-coded cancer is associated with Black race, low income and an overall three-fold increased adjusted risk of death. The mortality rates for ED-associated cancers are uniformly worse for all cancer types. These data suggest that additional work is needed to reduce disparities among ED-associated cancer diagnoses.}
}

@article{nicoler.fowlerExaminingBenefitsHarms2020,
  title = {Examining the Benefits and Harms of {{Alzheimer}}'s Disease Screening for Family Members of Older Adults: Study Protocol for a Randomized Controlled Trial},
  author = {{Nicole R. Fowler} and {Katharine J. Head} and {Anthony J. Perkins} and {Sujuan Gao} and {Christopher M. Callahan} and {Tamilyn Bakas} and {Shelley Suarez} and {Malaz Boustani}},
  year = {2020},
  month = feb,
  journal = {Trials},
  volume = {21},
  number = {1},
  pages = {NA-NA},
  publisher = {Springer Science+Business Media},
  issn = {1745-6215},
  doi = {10.1186/s13063-019-4029-5},
  abstract = {Abstract Background Multiple national expert panels have identified early detection of Alzheimer's disease and related dementias (ADRD) as a national priority. However, the United States Preventive Services Task Force (USPSTF) does not currently support screening for ADRD in primary care given that the risks and benefits are unknown. The USPSTF stresses the need for research examining the impact of ADRD screening on family caregiver outcomes. Methods The Caregiver Outcomes of Alzheimer's Disease Screening (COADS) is a randomized controlled trial that will examine the potential benefits or harms of ADRD screening on family caregivers. It will also compare the effectiveness of two strategies for diagnostic evaluation and management after ADRD screening. COADS will enroll 1800 dyads who will be randomized into three groups ( n = 600/group): the `Screening Only' group will receive ADRD screening at baseline and disclosure of the screening results, with positive-screen participants receiving a list of local resources for diagnostic follow-up; the `Screening Plus' group will receive ADRD screening at baseline coupled with disclosure of the screening results, with positive-screen participants referred to a dementia collaborative care program for diagnostic evaluation and potential care; and the control group will receive no screening. The COADS trial will measure the quality of life of the family member (the primary outcome) and family member mood, anxiety, preparedness and self-efficacy (the secondary outcomes) at baseline and at 6, 12, 18 and 24 months. Additionally, the trial will examine the congruence of depressive and anxiety symptoms between older adults and family members at 6, 12, 18 and 24 months and compare the effectiveness of two strategies for diagnostic evaluation and management after ADRD screening between the two groups randomized to screening (Screening Only versus Screening Plus). Discussion We hypothesize that caregivers in the screening arms will express higher levels of health-related quality of life, lower depressive and anxiety symptoms, and better preparation for caregiving with higher self-efficacy at 24 months. Results from this study will directly inform the National Plan to Address Alzheimer's Disease, the USPSTF and other organizations regarding ADRD screening and early detection policies. Trial registration ClinicalTrials.gov , NCT03300180 . Registered on 3 October.}
}

@article{nicoler.fowlerIndianaUniversityCognitive2014,
  title = {The {{Indiana University Cognitive Health Outcomes Investigation}} of the {{Comparative Effectiveness}} of Dementia Screening ({{CHOICE}}) Study: Study Protocol for a Randomized Controlled Trial},
  author = {{Nicole R. Fowler} and {Amanda Harrawood} and {Amie Frame} and {Anthony J. Perkins} and {Sujuan Gao} and {Christopher M. Callahan} and {Greg A. Sachs} and {Dustin D. French} and {Malaz Boustani}},
  year = {2014},
  month = jun,
  journal = {Trials},
  volume = {15},
  number = {1},
  pages = {NA-NA},
  publisher = {Springer Science+Business Media},
  issn = {1745-6215},
  doi = {10.1186/1745-6215-15-209},
  abstract = {Dementia affects over 4 million people in the US and is frequently unrecognized and underdiagnosed in primary care. Routine dementia screening in primary care is not recommended by the US Preventive Services Task Force due to lack of empirical data on the benefits and harms of screening. This trial seeks to fill this gap and contribute information about the benefits, harms, and costs of routine screening for dementia in primary care. Single-blinded, parallel, randomized controlled clinical trial with 1:1 allocation. A total of 4,000 individuals aged {$\geq$}65 years without a diagnosis of dementia, cognitive impairment, or serious mental illness receiving care at primary care practices within two cities in Indiana. Subjects will be randomized to either i) screening for dementia using the Memory Impairment Screen Telephone version or ii) no screening for dementia. Subjects who screen positive for dementia will be referred to the local Aging Brain Care program that delivers an evidence-based collaborative care model for dementia and depression. Research assistants will administer the 15-item Health Utility Index, Patient Health Questionnaire, Generalized Anxiety Disorder Scale, and Medical Outcomes Study at baseline, 1, 6, and 12 months. Information about advanced care planning will be collected at baseline and 12 months. All enrollees' medical records will be reviewed to collect data on health care utilization and costs. We have two primary hypotheses; first, in comparison to non-screened subjects, those who are screened and referred to a dementia collaborative care program will have a higher health-related quality of life as measured by the Health Utility Index at 12 months post-screening. Second, in comparison to non-screened subjects, those who are screened and referred to a dementia collaborative care program will not have higher depression or anxiety at one month post-screening as measured by the Patient Health Questionnaire and Generalized Anxiety Disorder Scale scales. Our secondary hypothesis is that screened subjects will have an Incremental Cost-Effectiveness Ratio below the maximum acceptable threshold of \$60,000 per quality adjusted life year saved at 12 months. Ongoing; registered on September 19, 2012. ClinicalTrials.gov Identifier: 2012 NCT01699503 .}
}

@article{nicoler.fowlerPatientCharacteristicsAssociated2018,
  title = {Patient Characteristics Associated with Screening Positive for {{Alzheimer}}\&rsquo;s Disease and Related Dementia},
  author = {{Nicole R. Fowler} and {Anthony J. Perkins} and {Sujuan Gao} and {Greg A. Sachs} and {Uebelhor A} and {Malaz Boustani}},
  year = {2018},
  month = sep,
  journal = {Clinical Interventions in Aging},
  volume = {Volume 13},
  number = {NA},
  pages = {1779--1785},
  publisher = {Dove Medical Press},
  issn = {1176-9092},
  doi = {10.2147/cia.s164957},
  abstract = {Patient characteristics associated with screening positive for Alzheimers disease and related dementia Nicole R Fowler,1--4 Anthony J Perkins,4 Sujuan Gao,5 Greg A Sachs,1--3 Austin K Uebelhor,2,3 Malaz A Boustani1--4 1Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA; 2Indiana University Center for Aging Research, Indianapolis, IN, USA; 3Regenstrief Institute, Inc., Indianapolis, IN, USA; 4Center for Health Innovation and Implementation Science, Indiana Clinical and Translational Science Institute, Indianapolis, IN, USA; 5Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA Introduction: Screening all older adults for Alzheimer's disease and related dementias (ADRD) in primary care may not be acceptable or feasible. The goal of this study was to identify factors that could optimize screening in primary care and enhance its feasibility.Methods: This is a cross-sectional study in rural, suburban, and urban primary care practices in Indiana. A total of 1,723 patients {$\geq$}65 years of age were screened for ADRD using the Memory Impairment Screen. Logistic regression was used to identify patient-specific factors associated with screening positive for ADRD.Results: The positive screening rate was 4.9\%. Rates varied significantly across the three study sites. The rural site had the lowest rate (2.8\%), which was significantly lower than the rates at the suburban (5.6\%) and urban (6.6\%) sites (P}
}

@article{nicoler.fowlerSupportingBreastCancer2018,
  title = {Supporting Breast Cancer Screening Decisions for Caregivers of Older Women with Dementia: Study Protocol for a Randomized Controlled Trial},
  author = {{Nicole R. Fowler} and {Mara A. Schonberg} and {Greg A. Sachs} and {Peter H. Schwartz} and {Sujuan Gao} and {Kathleen A. Lane} and {Lev Inger} and {Alexia M. Torke}},
  year = {2018},
  month = dec,
  journal = {Trials},
  volume = {19},
  number = {1},
  pages = {NA-NA},
  publisher = {Springer Science+Business Media},
  issn = {1745-6215},
  doi = {10.1186/s13063-018-3039-z},
  abstract = {Alzheimer's disease and related dementias (ADRD) impact a woman's life expectancy and her ability to participate in medical decision-making about breast cancer screening, necessitating the involvement of family caregivers. Making decisions about mammography screening for women with ADRD is stressful. There are no data that suggest that breast cancer screening helps women with ADRD live longer or better. Decision aids may improve the quality of decision-making about mammography for ADRD patients and may inform family caregivers about the risks, benefits, and need for decision-making around mammography screening. The Decisions about Cancer Screening in Alzheimer's Disease (DECAD) trial, a randomized controlled clinical trial, will enroll 426 dyads of older women with ADRD ({$\geq$}75 years) and a family caregiver from clinics and primary-care practices in Indiana to test a novel, evidence-based decision aid. This decision aid includes information about the impact of ADRD on life expectancy, the benefit of mammograms, and the impact on the quality of life for older women with ADRD. Dyads will be randomized to receive the decision aid or active control information about home safety. This trial will examine the effect on the caregiver's decisional conflict (primary outcome) and the caregiver's decision-making self-efficacy (secondary outcome). A second follow-up at 15 months will include a brief, semi-structured interview with the caregiver regarding the patient's experience with mammograms and decision-making about mammograms. At the same time, a review of the patient's electronic medical record (EMR) will look at discussions about mammography with their primary-care physician and mammogram orders, receipt, results, and burden (e.g., additional diagnostic procedures due to false-positive results, identification of an abnormality on the screening exam but further work-up declined, and identification of a clinically unimportant cancer). A third follow-up at 24 months will extract EMR data on mammogram orders, occurrences, results, and the burden of mammograms. We hypothesize that caregivers who receive the decision aid will have lower levels of decisional conflict and higher levels of decision-making self-efficacy compared to the control group. We also hypothesize that the DECAD decision aid will reduce mammography use among older women with ADRD. Clinical Trials Register, NCT03282097 . Registered on 13 September 2017.}
}

@article{nolll.campbellAdherenceTolerabilityAlzheimer2017,
  title = {Adherence and {{Tolerability}} of {{Alzheimer}}'s {{Disease Medications}}: {{A Pragmatic Randomized Trial}}},
  author = {{Noll L. Campbell} and {Anthony J. Perkins} and {Sujuan Gao} and {Todd C. Skaar} and {Lang Li} and {Hugh C. Hendrie} and {Nicole R. Fowler} and {Christopher M. Callahan} and {Malaz Boustani}},
  year = {2017},
  month = mar,
  journal = {Journal of the American Geriatrics Society},
  volume = {65},
  number = {7},
  pages = {1497--1504},
  publisher = {Wiley-Blackwell},
  issn = {0002-8614},
  doi = {10.1111/jgs.14827},
  abstract = {Post-marketing comparative trials describe medication use patterns in diverse, real-world populations. Our objective was to determine if differences in rates of adherence and tolerability exist among new users to acetylcholinesterase inhibitors (AChEI's).Pragmatic randomized, open label comparative trial of AChEI's currently available in the United States.Four memory care practices within four healthcare systems in the greater Indianapolis area.Eligibility criteria included older adults with a diagnosis of possible or probable Alzheimer's disease (AD) who were initiating treatment with an AChEI. Participants were required to have a caregiver to complete assessments, access to a telephone, and be able to understand English. Exclusion criteria consisted of a prior severe adverse event from AChEIs.Participants were randomized to one of three AChEIs in a 1:1:1 ratio and followed for 18 weeks.Caregiver-reported adherence, defined as taking or not taking study medication, and caregiver-reported adverse events, defined as the presence of an adverse event.196 participants were included with 74.0\% female, 30.6\% African Americans, and 72.9\% who completed at least twelfth grade. Discontinuation rates after 18 weeks were 38.8\% for donepezil, 53.0\% for galantamine, and 58.7\% for rivastigmine (P = .063) in the intent to treat analysis. Adverse events and cost explained 73.1\% and 25.4\% of discontinuation. No participants discontinued donepezil due to cost. Adverse events were reported by 81.2\% of all participants; no between-group differences in total adverse events were statistically significant.This pragmatic comparative trial showed high rates of adverse events and cost-related non-adherence with AChEIs. Interventions improving adherence and persistence to AChEIs may improve AD management.Clinicaltrials.gov: NCT01362686 (https://clinicaltrials.gov/ct2/show/NCT01362686).}
}

@article{nolll.campbellAnticholinergicsInfluenceTransition2018,
  title = {Anticholinergics {{Influence Transition}} from {{Normal Cognition}} to {{Mild Cognitive Impairment}} in {{Older Adults}} in {{Primary Care}}},
  author = {{Noll L. Campbell} and {Kathleen A. Lane} and {Sujuan Gao} and {Malaz Boustani} and {Fred Unverzagt}},
  year = {2018},
  month = apr,
  journal = {Pharmacotherapy},
  volume = {38},
  number = {5},
  pages = {511--519},
  publisher = {Wiley-Blackwell},
  issn = {0277-0008},
  doi = {10.1002/phar.2106},
  abstract = {To determine the influence of anticholinergic medications on transitions in cognitive diagnosis of older adults in primary care.This observational cohort study was conducted over a mean follow-up of 3.2 years. Anticholinergic exposure was defined by pharmacy dispensing and claims records. Cognitive diagnosis was performed by an expert panel at baseline and annually up to 4 years.Medication exposure and other clinical data were extracted from the Indiana Network for Patient Care (INPC). The cognitive diagnosis was derived from a cognitive screening and diagnosis study.A total of 350 adults 65 years and older without dementia and receiving primary care in a safety net health care system.Cognitive diagnosis followed a two-phase screening and consensus-based neuropsychiatric examination to determine a baseline diagnosis as normal cognition, mild cognitive impairment (MCI), or dementia, with a follow-up neuropsychiatric examination and consensus-based diagnosis repeated annually. The Anticholinergic Cognitive Burden scale was used to identify anticholinergics dispensed up to 10 years before enrollment and annually throughout the study. A total standard daily dose of anticholinergics was calculated by using pharmacy dispensing data from the INPC. Among 350 participants, a total of 978 diagnostic assessments were completed over a mean follow-up of 3.2 years. Compared with stable cognition, increasing use of strong anticholinergics calculated by total standard daily dose increased the odds of transition from normal cognition to MCI (odds ratio [OR] 1.15, 95\% confidence interval [CI] 1.01-1.31, p = 0.0342). Compared with stable MCI, strong anticholinergics did not influence the reversion of MCI to normal cognition (OR 0.95, 95\% CI 0.86-1.05, p = 0.3266).De-prescribing interventions in older adults with normal cognition should test anticholinergics as potentially modifiable risk factors for cognitive impairment.}
}

@article{nolll.campbellSelfReportedMedicationAdherence2016,
  title = {Self-{{Reported Medication Adherence Barriers Among Ambulatory Older Adults}} with {{Mild Cognitive Impairment}}},
  author = {{Noll L. Campbell} and {Jia Zhan} and {Wanzhu Tu} and {Zach A. Weber} and {Roberta Ambeuhl} and {Caroline McKay} and {Newell E. McElwee}},
  year = {2016},
  month = feb,
  journal = {Pharmacotherapy},
  volume = {36},
  number = {2},
  pages = {196--202},
  publisher = {Wiley-Blackwell},
  issn = {0277-0008},
  doi = {10.1002/phar.1702},
  abstract = {To compare the frequencies of barriers to medication adherence reported by ambulatory older adults with a diagnosis of mild cognitive impairment (MCI) and ambulatory older adults with normal cognition.Cross-sectional study.Outpatient clinics within a safety-net health care system.Ambulatory older adults ({$\geq$} 65 yrs) with a diagnosis of MCI (96 participants) or normal cognition (104 participants).Self-reported beliefs and barriers to medication nonadherence were assessed by items from the Morisky Medication Adherence Survey, the Adherence Estimator, and barriers derived from a systematic review of studies in older adults with cognitive impairment. Participants with a diagnosis of MCI had a mean age of 72 years, 77\% were female, and 37\% were African-American. Participants with normal cognition had a mean age of 76 years, 79\% were female, and 47\% were African-American. Among all participants, 83\% reported the presence of at least one barrier to medication adherence, and 62.5\% reported two or more barriers to medication adherence. The most commonly reported barriers were difficulty remembering the amount or time of each medication to take (49\%), difficulty opening or reading prescription bottles (42\%), feeling worse when taking medications (29\%), and trouble affording medications (26\%). Considering the multiple comparisons made in this analysis, few significant differences in barrier frequencies were identified between the groups with MCI and normal cognition.Multiple medication adherence barriers were identified among all participants, including cognitive, physical, and financial barriers, although few significant differences were identified between those with and without MCI. Interventions capable of addressing multiple barriers are required to improve medication adherence in older adults with and without MCI.}
}

@article{p.zhangMixtureDoseResponse2015,
  title = {A {{Mixture Dose}}--{{Response Model}} for {{Identifying High}}-{{Dimensional Drug Interaction Effects}} on {{Myopathy Using Electronic Medical Record Databases}}},
  author = {{P. Zhang} and {Lei Du} and {L. Wang} and {M. Liu} and {Lijun Cheng} and {Chien Wei Chiang} and {Hao Wu} and {Sara K. Quinney} and {Li Shen} and {L. Li}},
  year = {2015},
  month = jul,
  journal = {CPT: pharmacometrics \& systems pharmacology},
  volume = {4},
  number = {8},
  pages = {474--480},
  publisher = {Nature Portfolio},
  issn = {2163-8306},
  doi = {10.1002/psp4.53},
  abstract = {Interactions between multiple drugs may yield excessive risk of adverse effects. This increased risk is not uniform for all combinations, although some combinations may have constant adverse effect risks. We developed a statistical model using medical record data to identify drug combinations that induce myopathy risk. Such combinations are revealed using a novel mixture model, comprised of a constant risk model and a dose-response risk model. The dose represents the number of drug combinations. Using an empirical Bayes estimation method, we successfully identified high-dimensional (two to six) drug combinations that are associated with excessive myopathy risk at significantly low local false-discovery rates. From the curve of a dose-response model and high-dimensional drug interaction data, we observed that myopathy risk increases as the drug interaction dimension increases. This is the first time that such a dose-response relationship for high-dimensional drug interactions was observed and extracted from the medical record database.}
}

@article{pamelabilothomasPredictingOnsetComplications2018,
  title = {Predicting Onset of Complications from Diabetes: A Graph Based Approach},
  author = {{Pamela Bilo Thomas} and {Daniel H. Robertson} and {Nitesh V. Chawla}},
  year = {2018},
  month = nov,
  journal = {Applied Network Science},
  volume = {3},
  number = {1},
  pages = {NA-NA},
  publisher = {Springer Nature},
  issn = {2364-8228},
  doi = {10.1007/s41109-018-0106-z},
  abstract = {Diabetes is a significant health concern with more than 30 million Americans living with diabetes. Onset of diabetes increases the risk for various complications, including kidney disease, myocardial infractions, heart failure, stroke, retinopathy, and liver disease. In this paper, we study and predict the onset of these complications using a network-based approach by identifying fast and slow progressors. That is, given a patient's diagnosis of diabetes, we predict the likelihood of developing one or more of the possible complications, and which patients will develop complications quickly. This combination of "if a complication will be developed" with "how fast it will be developed" can aid the physician in developing better diabetes management program for a given patient.}
}

@article{patrickjonesGallbladderEjectionFraction2016,
  title = {Gallbladder {{Ejection Fraction Is Unrelated}} to {{Gallbladder Pathology}} in {{Children}} and {{Adolescents}}},
  author = {{Patrick Jones} and {Marc B. Rosenman} and {Marian D. Pfefferkorn} and {Frederick J. Rescorla} and {William E. Bennett}},
  year = {2016},
  month = jul,
  journal = {Journal of Pediatric Gastroenterology and Nutrition},
  volume = {NA},
  number = {NA},
  pages = {NA-NA},
  publisher = {Lippincott Williams \& Wilkins},
  issn = {0277-2116},
  doi = {10.1097/mpg.0000000000001065},
  abstract = {Biliary dyskinesia is a common diagnosis that frequently results in cholecystectomy. In adults, most clinicians use a cut off value for the gallbladder ejection fraction (GBEF) of {$<$}35\% to define the disease. This disorder is not well characterized in children. Our aim was to determine the relation between GBEF and gallbladder pathology using a large statewide medical record repository.We obtained records from all patients of 21 years and younger who underwent hepatic iminodiacetic acid (HIDA) testing within the Indiana Network for Patient Care from 2004 to 2013. GBEF results were obtained from radiology reports using data mining techniques. Age, sex, race, and insurance status were obtained for each patient. Any gallbladder pathology obtained subsequent to an HIDA scan was also obtained and parsed for mention of cholecystitis, cholelithiasis, or cholesterolosis. We performed mixed effects logistic regression analysis to determine the influence of age, sex, race, insurance status, pathologist, and GBEF on the presence of these histologic findings.Two thousand eight hundred forty-one HIDA scans on 2558 patients were found. Of these, 310 patients had a full-text gallbladder pathology report paired with the HIDA scan. GBEF did not correlate with the presence of gallbladder pathology (cholecystitis, cholelithiasis, or cholesterolosis) when controlling for age, sex, race, insurance status, and pathologist using a mixed effects model.Hypokinetic gallbladders are no more likely to have gallbladder pathology than normal or hyperkinetic gallbladders in the setting of a patient with both a HIDA scan and a cholecystectomy. Care should be used when interpreting the results of HIDA scans in children and adolescents.}
}

@article{patrickt.s.laiMeasuringVisualizingChlamydia2019,
  title = {Measuring and {{Visualizing Chlamydia}} and {{Gonorrhea Inequality}}: {{An Informatics Approach Using Geographical Information Systems}}},
  author = {{Patrick T. S. Lai} and {Jeffrey S. Wilson} and {Huanmei Wu} and {Josette Jones} and {Brian E. Dixon}},
  year = {2019},
  month = sep,
  journal = {Online Journal of Public Health Informatics},
  volume = {11},
  number = {2},
  pages = {NA-NA},
  publisher = {University of Illinois at Chicago},
  issn = {1947-2579},
  doi = {10.5210/ojphi.v11i2.10155},
  abstract = {IntroductionHealth inequality measurements are vital in understanding disease patterns to identify high-risk patients and implementing effective intervention programs in treating and managing sexually transmitted diseases. Our study seeks to measure and identify inequalities among chlamydia and gonorrhea rates using Gini coefficient measurements and spatial visualization mapping from geographical information systems. Additionally, we seek to examine trends of disease rate distribution longitudinally over a ten-year period for an urbanized county.MethodsChlamydia and gonorrhea data from January 2005 to December 2014 were collected from the Indiana Network for Patient Care, a health information exchange system that gathers patient data from electronic health records. The Gini coefficient was used to calculate the magnitude of inequality in disease rates. Spatial visualization mapping and decile categorization of disease rates were conducted to identify locations where high and low rates of disease persisted and to visualize differences in inequality. A multiple comparisons ANOVA test was conducted to determine if Gini coefficient values were statistically different between townships and time periods during the study.ResultsOur analyses show that chlamydia and gonorrhea rates are not evenly distributed. Inequalities in disease rates existed for different areas of the county with higher disease rates occurring near the center of the county. Inequality in gonorrhea rates were higher than chlamydia rates. Disease rates were statistically different when geographical locations or townships were compared to each other (p \&lt; 0.0001) but not for different years or time periods (p = 0.5152).ConclusionThe ability to use Gini coefficients combined with spatial visualization techniques presented a valuable opportunity to analyze information from health information systems in investigating health inequalities. Knowledge from this study can benefit and improve health quality, delivery of services, and intervention programs while managing healthcare costs.}
}

@article{phoebussuncaoAssociationInsuranceStatus2021,
  title = {The {{Association}} of {{Insurance Status}} and {{Complications After Carpal Tunnel Release}}},
  author = {{Phoebus Sun Cao} and {Scott N. Loewenstein} and {Lava Timsina} and {Joshua M. Adkinson}},
  year = {2021},
  month = feb,
  journal = {Hand},
  volume = {18},
  number = {2},
  pages = {192--197},
  publisher = {SAGE Publishing},
  issn = {1558-9447},
  doi = {10.1177/1558944721990818},
  abstract = {Background: Carpal tunnel release (CTR) is one of the most commonly performed procedures in hand surgery. Complications from surgery are a rare but significant patient dissatisfier. The purpose of this study was to determine whether insurance status is independently associated with complications after CTR. Methods: We retrospectively identified all patients undergoing CTR between 2008 and 2018 using the Indiana Network for Patient Care, a state-wide health information exchange, and built a database that included patient demographics and comorbidities. Patients were followed for 90 days to determine whether a postoperative complication occurred. To minimize dropout, only patients with 1 year of encounters after surgery were included. Results: Of the 26 151 patients who met inclusion criteria, 2662 (10.2\%) had Medicare, 7027 (26.9\%) had Medicaid, and 16 462 (62.9\%) had commercial insurance. Compared with Medicare, Medicaid status ( P \&lt; .001) and commercial insurance status ( P \&lt; .001) were independently associated with postoperative CTR complications. The overall complication rate was 2.23\%, with infection, wound breakdown, and complex regional pain syndrome being the most common complications. Younger age, alcohol use, diabetes mellitus, hypertension, and depression were also independently associated with complications. Conclusions: The incidence of complications after CTR is low. Insurance status, patient demographics, and medical comorbidities, however, should be evaluated preoperatively to appropriately risk stratify patients. Furthermore, surgeons can use these data to initiate preventive measures such as working to manage current comorbidities and lifestyle choices, and to optimize insurance coverage.}
}

@article{randallw.groutDevelopmentValidationProofofconcept2021,
  title = {Development, Validation, and Proof-of-Concept Implementation of a Two-Year Risk Prediction Model for Undiagnosed Atrial Fibrillation Using Common Electronic Health Data ({{UNAFIED}})},
  author = {{Randall W. Grout} and {Siu L. Hui} and {Timothy D. Imler} and {Sarah A. El-Azab} and {Jarod Baker} and {George H. Sands} and {Mohammad Ateya} and {Francis Pike}},
  year = {2021},
  month = apr,
  journal = {BMC Medical Informatics and Decision Making},
  volume = {21},
  number = {1},
  pages = {NA-NA},
  publisher = {BioMed Central},
  issn = {1472-6947},
  doi = {10.1186/s12911-021-01482-1},
  abstract = {Abstract Background Many patients with atrial fibrillation (AF) remain undiagnosed despite availability of interventions to reduce stroke risk. Predictive models to date are limited by data requirements and theoretical usage. We aimed to develop a model for predicting the 2-year probability of AF diagnosis and implement it as proof-of-concept (POC) in a production electronic health record (EHR). Methods We used a nested case--control design using data from the Indiana Network for Patient Care. The development cohort came from 2016 to 2017 (outcome period) and 2014 to 2015 (baseline). A separate validation cohort used outcome and baseline periods shifted 2 years before respective development cohort times. Machine learning approaches were used to build predictive model. Patients {$\geq$} 18 years, later restricted to age {$\geq$} 40 years, with at least two encounters and no AF during baseline, were included. In the 6-week EHR prospective pilot, the model was silently implemented in the production system at a large safety-net urban hospital. Three new and two previous logistic regression models were evaluated using receiver-operating characteristics. Number, characteristics, and CHA 2 DS 2 -VASc scores of patients identified by the model in the pilot are presented. Results After restricting age to {$\geq$} 40 years, 31,474 AF cases (mean age, 71.5 years; female 49\%) and 22,078 controls (mean age, 59.5 years; female 61\%) comprised the development cohort. A 10-variable model using age, acute heart disease, albumin, body mass index, chronic obstructive pulmonary disease, gender, heart failure, insurance, kidney disease, and shock yielded the best performance (C-statistic, 0.80 [95\% CI 0.79--0.80]). The model performed well in the validation cohort (C-statistic, 0.81 [95\% CI 0.8--0.81]). In the EHR pilot, 7916/22,272 (35.5\%; mean age, 66 years; female 50\%) were identified as higher risk for AF; 5582 (70\%) had CHA 2 DS 2 -VASc score {$\geq$} 2. Conclusions Using variables commonly available in the EHR, we created a predictive model to identify 2-year risk of developing AF in those previously without diagnosed AF. Successful POC implementation of the model in an EHR provided a practical strategy to identify patients who may benefit from interventions to reduce their stroke risk.}
}

@article{ranjanin.moorthiSarcopeniaFrailtyCachexia2020,
  title = {Sarcopenia, Frailty and Cachexia Patients Detected in a Multisystem Electronic Health Record Database},
  author = {{Ranjani N. Moorthi} and {Ziyue Liu} and {Sarah A. El-Azab} and {Lauren R. Lembcke} and {Matthew Miller} and {Andrea A. Broyles} and {Erik A. Imel}},
  year = {2020},
  month = jul,
  journal = {BMC Musculoskeletal Disorders},
  volume = {21},
  number = {1},
  pages = {NA-NA},
  publisher = {BioMed Central},
  issn = {1471-2474},
  doi = {10.1186/s12891-020-03522-9},
  abstract = {Sarcopenia, cachexia and frailty have overlapping features and clinical consequences, but often go unrecognized. The objective was to detect patients described by clinicians as having sarcopenia, cachexia or frailty within electronic health records (EHR) and compare clinical variables between cases and matched controls.We conducted a case-control study using retrospective data from the Indiana Network for Patient Care multi-health system database from 2016 to 2017. The computable phenotype combined ICD codes for sarcopenia, cachexia and frailty, with clinical note text terms for sarcopenia, cachexia and frailty detected using natural language processing. Cases with these codes or text terms were matched to controls without these codes or text terms matched on birth year, sex and race. Two physicians reviewed EHR for all cases and a subset of controls. Comorbidity codes, laboratory values, and other coded clinical variables were compared between groups using Wilcoxon matched-pair sign-rank test for continuous variables and conditional logistic regression for binary variables.Cohorts of 9594 cases and 9594 matched controls were generated. Cases were 59\% female, 69\% white, and a median (1st, 3rd quartiles) age 74.9 (62.2, 84.8) years. Most cases were detected by text terms without ICD codes n = 8285 (86.4\%). All cases detected by ICD codes (total n = 1309) also had supportive text terms. Overall 1496 (15.6\%) had concurrent terms or codes for two or more of the three conditions (sarcopenia, cachexia or frailty). Of text term occurrence, 97\% were used positively for sarcopenia, 90\% for cachexia, and 95\% for frailty. The remaining occurrences were negative uses of the terms or applied to someone other than the patient. Cases had lower body mass index, albumin and prealbumin, and significantly higher odds ratios for diabetes, hypertension, cardiovascular and peripheral vascular diseases, chronic kidney disease, liver disease, malignancy, osteoporosis and fractures (all p {$<$} 0.05). Cases were more likely to be prescribed appetite stimulants and caloric supplements.Patients detected with a computable phenotype for sarcopenia, cachexia and frailty differed from controls in several important clinical variables. Potential uses include detection among clinical cohorts for targeting recruitment for research and interventions.}
}

@article{reneea.mischlerComparisonOralIron2017,
  title = {Comparison of {{Oral Iron Supplement Formulations}} for {{Normalization}} of {{Iron Status Following Roux-EN-y Gastric Bypass Surgery}}: A {{Randomized Trial}}},
  author = {{Renee A. Mischler} and {Seth M. Armah} and {Bruce A. Craig} and {Arthur D. Rosen} and {Ambar Banerjee} and {Don J. Selzer} and {Jennifer Choi} and {Nana Gletsu-Miller}},
  year = {2017},
  month = aug,
  journal = {Obesity Surgery},
  volume = {28},
  number = {2},
  pages = {369--377},
  publisher = {Springer Science+Business Media},
  issn = {0960-8923},
  doi = {10.1007/s11695-017-2858-4},
  abstract = {The evidence behind recommendations for treatment of iron deficiency (ID) following roux-en-y gastric bypass surgery (RYGB) lacks high quality studies.Academic, United States OBJECTIVE: The objective of the study is to compare the effectiveness of oral iron supplementation using non-heme versus heme iron for treatment of iron deficiency in RYGB patients.In a randomized, single-blind study, women post-RYGB and iron deficient received non-heme iron (FeSO4, 195 mg/day) or heme iron (heme-iron-polypeptide, HIP, 31.5 to 94.5 mg/day) for 8 weeks. Measures of iron status, including blood concentrations of ferritin, soluble transferrin receptor (sTfR), and hemoglobin, were assessed.At baseline, the mean {\textpm} standard deviation for age, BMI, and years since surgery of the sample was 41.5 {\textpm} 6.8 years, 34.4 {\textpm} 5.9 kg/m2, and 6.9 {\textpm} 3.1 years, respectively; and there were no differences between FeSO4 (N = 6) or HIP (N = 8) groups. Compliance was greater than 94\%. The study was stopped early due to statistical and clinical differences between groups. Values before and after FeSO4 supplementation, expressed as least square means (95\% CI) were hemoglobin, 10.8 (9.8, 11.9) to 13.0 (11.9, 14.0) g/dL; sTfR, 2111 (1556, 2864) to 1270 (934, 1737) {$\mu$}g/L; ferritin, 4.9 (3.4, 7.2) to 15.5 (10.6, 22.6) {$\mu$}g/L; and sTfR:ferritin ratio, 542 (273, 1086) to 103 (51, 204); all p {$<$} 0.0001. With HIP supplementation, no change was observed in any of the iron status biomarkers (all p {$>$} 0.05).In accordance with recommendations, oral supplementation using FeSO4, but not HIP, was efficacious for treatment of iron deficiency after RYGB.}
}

@article{s.mariae.finnellDecolonizationChildrenIncision2014,
  title = {Decolonization of {{Children After Incision}} and {{Drainage}} for {{MRSA Abscess}}},
  author = {{S. Maria E. Finnell} and {Marc B. Rosenman} and {John C. Christenson} and {Stephen M. Downs}},
  year = {2014},
  month = nov,
  journal = {Clinical Pediatrics},
  volume = {54},
  number = {5},
  pages = {445--450},
  publisher = {SAGE Publishing},
  issn = {0009-9228},
  doi = {10.1177/0009922814556059},
  abstract = {Whether decolonization following incision and drainage (I\&D) for methicillin-resistant Staphylococcus aureus (MRSA) abscess decreases repeat I\&D and MRSA-positive cultures in children is unknown.Referral to the Pediatric Infectious Disease Service (PIDS) for decolonization was determined for eligible children (2003-2010), with outcomes studied over 12 months.We identified 653 children; 54 had been seen by PIDS. In the PIDS group, no patients (0/54, 0\%) had a repeat I\&D. In the no PIDS group 36/599 (6\%) had a repeat I\&D, P = .06. Logistic regression modeling for repeat I\&D showed no significant effect, odds ratio = 0.29; 95\% confidence interval = 0.04-2.15; P = .23. In the PIDS group, 3 patients (3/54, 5.6\%) had a repeat MRSA-positive culture. In the no PIDS group, 58/599 (9.7\%) had a positive repeat culture, P = .46. Logistic regression modeling for positive culture showed no significant effect (odds ratio = 0.55; 95\% confidence interval = 0.17-1.81; P = .32).We detected no statistically significant association between decolonization and repeat I\&D or MRSA-positive culture.}
}

@article{sachinh.jainBigDataNew2014,
  title = {Is {{Big Data}} the {{New Frontier}} for {{Academic-Industry Collaboration}}?},
  author = {{Sachin H. Jain} and {Michael Rosenblatt} and {Jon Duke}},
  year = {2014},
  month = jun,
  journal = {JAMA},
  volume = {311},
  number = {21},
  pages = {2171--2171},
  publisher = {American Medical Association},
  issn = {0098-7484},
  doi = {10.1001/jama.2014.1845},
  abstract = {Academic-industry research collaborations have long been a source of controversy in medicine. Advocates suggest that collaborations can focus academic researchers on important clinical and translational research problems and provide them with financial and capability-enhancing technical resources.1 Critics maintain that industry engagement distracts from, or distorts, the teaching and research missions of academia.2 Although regulatory and compliance frameworks have been established to govern these relationships, controversy continues to surround efforts to enhance industry and academia collaborations.}
}

@article{sarahr.hoodAssociationMedicationAdherence2018,
  title = {Association {{Between Medication Adherence}} and the {{Outcomes}} of {{Heart Failure}}},
  author = {{Sarah R. Hood} and {Anthony J. Giazzon} and {Gwen Seamon} and {Kathleen A. Lane} and {Jane Wang} and {George J. Eckert} and {Wanzhu Tu} and {Michael D. Murray}},
  year = {2018},
  month = apr,
  journal = {Pharmacotherapy},
  volume = {38},
  number = {5},
  pages = {539--545},
  publisher = {Wiley-Blackwell},
  issn = {0277-0008},
  doi = {10.1002/phar.2107},
  abstract = {Previous studies of heart failure patients demonstrated an association between cardiovascular medication adherence and hospitalizations or a composite end point of hospitalization and death. Few studies have assessed the impact of treatment adherence within large general medical populations that distinguish the health outcomes of emergency department visits, hospitalization, and death.To determine the association of incremental cardiovascular medication adherence on emergency department visits, hospitalization, and death in adult heart failure patients in Indiana.Retrospective cohort study conducted using electronic health record data from the statewide Indiana Network for Patient Care between 2004 and 2009.Patients were at least 18 years of age with a diagnosis of heart failure and prescribed at least one cardiovascular medication for heart failure. Adherence was measured as the proportion of days covered (PDC) using pharmacy transaction data. Clinical end points included emergency department visits, hospital admissions, length of hospital stay, and mortality. Generalized linear models were used to determine the effect of a 10\% increase in PDC on clinical end points adjusting for age, sex, race, Charlson Comorbidity Index, and medications.Electronic health records were available for 55,312 patients (mean age {\textpm} standard deviation 68 {\textpm} 16 yrs; 54\% women; 65\% white). Mean PDC for all heart failure medications was 63\% {\textpm} 23\%. For every 10\% increase in PDC, emergency department visits decreased 11\% (rate ratio [RR] 0.89, 95\% confidence interval [CI] 0.89-0.89), hospital admissions decreased 6\% (RR 0.94, 95\% CI 0.94-0.94), total length of hospital stay decreased 1\% (RR 0.99, 95\% CI 0.99-1.00), and all-cause mortality decreased 9\% (odds ratio 0.91; 95\% CI 0.90-0.92).Incremental medication adherence was associated with reductions in emergency department visits, hospital admissions, length of hospital stay, and all-cause mortality.}
}

@article{sariyaudayachalermOpioidPrescribingHealth2021,
  title = {Opioid Prescribing and Health Outcomes in Opioid-Naive Patients: {{Analysis}} of a Statewide Health Information Exchange},
  author = {{Sariya Udayachalerm} and {Matthew J. Bair} and {Kimberly S. Plake} and {Chien-Yu Huang} and {Michael D. Murray} and {David R. Foster}},
  year = {2021},
  month = sep,
  journal = {Journal of the American Pharmacists Association},
  volume = {61},
  number = {5},
  pages = {623-631.e3},
  publisher = {Elsevier BV},
  issn = {1544-3191},
  doi = {10.1016/j.japh.2021.04.020},
  abstract = {Background Widespread use of prescription opioids is associated with adverse outcomes. Objective To identify factors associated with adverse health outcomes and health care use using a statewide health information exchange. Methods This is a retrospective cohort study using the Indiana Network for Patient Care. Adult opioid-naive patients who received an opioid prescription between January 2012 and December 2017 were included. The outcomes included (1) a composite outcome of any combination of opioid abuse, dependence, or overdose, (2) all-cause mortality, and (3) health care use. Independent variables included opioid dosage, dispensed amount, days supply, concurrent use of short-acting (SA) and long-acting (LA) opioids, and concurrent use with benzodiazepine or gabapentinoids. Additional variables included patients' age, sex, race, modified Charlson Comorbidity Index score, mental health conditions, and medications for opioid use disorders. Factors associated with composite outcome and mortality were identified using Cox proportional hazards and reported as adjusted hazard ratio (aHR) and 95\% CI. Factors associated with health care use were identified using Poisson regression and reported as adjusted incidence rate ratio (aIRR) and 95\% CI. Results 1,328,287 opioid prescriptions were identified for 341,722 patients. Opioid-related factors associated with the composite outcome, mortality, and hospitalizations, respectively, included opioid dosage (aHR 1.003 [95\% CI 1.001--1.006]; aHR not applicable; aIRR 1.07 [1.06--1.08]), opioid days supply (aHR 1.03 [1.02--1.03]; aHR 1.009 [1.005--1.014]; aIRR 0.94 [0.92--0.96]), concurrent SA/LA opioids (aHR 2.12 [1.78--2.54]; aHR 1.40 [1.14--1.70]; aIRR 1.40 [1.37--1.42]), and use of benzodiazepines/gabapentinoids (aHR 1.68 [1.38--2.04]; aHR 1.23 [1.01--1.51]; aIRR 1.25 [1.23--1.27]). Conclusion Many factors are associated with poor health outcomes, especially concurrent use of SA and LA opioids and overlapping prescriptions of opioids with benzodiazepines or gabapentinoids. Identification of factors associated with adverse outcomes may help identify patients at risk for poor outcomes and could inform possible interventions.}
}

@article{scottn.loewensteinCombinedCarpalTunnel2018,
  title = {Combined {{Carpal Tunnel Release}} and {{Palmar Fasciectomy}} for {{Dupuytren}}'s {{Contracture Does Not Increase}} the {{Risk}} for {{Complex Regional Pain Syndrome}}},
  author = {{Scott N. Loewenstein} and {Stephen Duquette} and {Joshua M. Adkinson}},
  year = {2018},
  month = nov,
  journal = {Plastic and Reconstructive Surgery},
  volume = {142},
  number = {5},
  pages = {1251--1257},
  publisher = {Lippincott Williams \& Wilkins},
  issn = {0032-1052},
  doi = {10.1097/prs.0000000000004838},
  abstract = {Background: Hand surgery dogma suggests that simultaneous surgical treatment of carpal tunnel syndrome and Dupuytren's contracture results in an increased incidence of complex regional pain syndrome. As a result, many surgeons do not perform surgery for the two conditions concurrently. The authors' goal was to determine the extent of this association. Methods: The authors identified all patients undergoing surgical treatment for carpal tunnel syndrome, Dupuytren's contracture, or both between April of 1982 and March of 2017 using the Indiana Network for Patient Care, a large, multi-institutional, statewide information exchange. Demographics, comorbidities, and 1-year postoperative incidence of complex regional pain syndrome were recorded. Results: A total of 51,739 patients (95.6 percent) underwent carpal tunnel release only, 2103 (3.9 percent) underwent palmar fasciectomy only, and 305 (0.6 percent) underwent concurrent carpal tunnel release and palmar fasciectomy. There was no difference in the likelihood of developing complex regional pain syndrome ( p = 0.163) between groups. Independent risk factors for developing complex regional pain syndrome were younger age; anxiety; depression; epilepsy; gout; and history of fracture of the radius, ulna, or carpus. Conclusions: Concurrent carpal tunnel release and palmar fasciectomy is not associated with an increased risk for developing complex regional pain syndrome. Patient demographics, medical comorbidities, and a history of upper extremity trauma are associated with the development of complex regional pain syndrome after surgery and should be discussed preoperatively as potential risk factors. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.}
}

@article{scottn.loewensteinEffectPeripheralNerve2020,
  title = {The {{Effect}} of {{Peripheral Nerve Blocks}} on {{Emergency Department Utilization After Upper Extremity Surgery}}},
  author = {{Scott N. Loewenstein} and {Ravi Bamba} and {Joshua M. Adkinson}},
  year = {2020},
  month = sep,
  journal = {Plastic and reconstructive surgery. Global open},
  volume = {8},
  number = {9S},
  pages = {108--108},
  publisher = {Wolters Kluwer},
  issn = {2169-7574},
  doi = {10.1097/01.gox.0000720876.17850.d5},
  abstract = {INTRODUCTION: Peripheral nerve blocks demonstrate great utility in producing regional anesthesia and reducing pain after upper extremity surgery. The purpose of this study was to characterize emergency department (ED) utilization after outpatient upper extremity surgery with and without peripheral nerve blocks. METHODS: We studied a single state population through the Indiana Network for Patient Care, a statewide health information exchange capturing 95\% of inpatient and outpatient encounters. Patients who received upper extremity surgery from January 2009 through June 2019 were included. From free text and codified data retrieved through the continuum of healthcare, we built a database incorporating patient demographics (including census-based median household income), preoperative comorbidities, concurrent procedures performed, and postoperative ED visit encounter information. We performed univariate analysis to characterize the population, bivariate analysis with Student's t tests and chi-square tests to determine relationships between variables, and multivariable logistic regression to assess for independent risk factors for postoperative ED visits. RESULTS: Among 152,085 unique upper extremity surgical patients, there were 108,451 (71.3\%) who had outpatient surgery. Nine thousand seventy-nine outpatients (8.4\%) had peripheral nerve blocks. Within 2 days of surgery, 69 patients (0.8\%) who received blocks and 396 patients (0.4\%) who did not went to the ED for evaluation (P {$<$} 0.001). Postoperative pain was the principal cause of this ED visit more frequently in patients receiving blocks compared to those that did not (53.6\% versus 35.1\%; P {$<$} 0.001). By 1 postoperative week, the increased risk for postoperative ED visit among patients receiving peripheral nerve blocks returned to baseline. When controlling for comorbidities and demographics, only peripheral nerve blocks (adjusted OR, 1.71; P = 0.007), and preprocedural opioid use (adjusted OR, 1.43; P = 0.020) conferred independently increased odds for ED utilization within the first 2 postoperative days. CONCLUSIONS: Peripheral nerve blocks used for upper extremity surgery are associated with unplanned ED utilization, most likely related to rebound pain. Through proper patient education and pain management, we can minimize this unnecessary resource utilization.}
}

@article{scottn.loewensteinEmergencyDepartmentUtilization2020,
  title = {Emergency {{Department Utilization After Administration}} of {{Peripheral Nerve Blocks}} for {{Upper Extremity Surgery}}},
  author = {{Scott N. Loewenstein} and {Ravinder Bamba} and {Joshua M. Adkinson}},
  year = {2020},
  month = oct,
  journal = {Hand},
  volume = {17},
  number = {4},
  pages = {624--629},
  publisher = {SAGE Publishing},
  issn = {1558-9447},
  doi = {10.1177/1558944720963867},
  abstract = {Background The purpose of this study was to determine the impact of upper extremity peripheral nerve blocks on emergency department (ED) utilization after hand and upper extremity surgery. Methods We reviewed all outpatient upper extremity surgeries performed in a single Midwestern state between January 2009 and June 2019 using the Indiana Network for Patient Care. These encounters were used to develop a database of patient demographics, comorbidities, concurrent procedures, and postoperative ED visit utilization data. We performed univariate, bivariate, and multivariate logistic regression analyses. Results Among 108 451 outpatient surgical patients, 9079 (8.4\%) received blocks. Within 1 week of surgery, a greater proportion of patients who received peripheral nerve blocks (1.4\%) presented to the ED than patients who did not (0.9\%) ( P \&lt; .001). The greatest risk was in the first 2 postoperative days (relative risk, 1.78; P \&lt; .001). Pain was the principal reason for ED utilization in the block cohort (53.6\%) compared with those who did not undergo a block (35.1\%) ( P \&lt; .001). When controlling for comorbidities and demographics, only peripheral nerve blocks (adjusted odds ratio [OR], 1.71; P = 0.007) and preprocedural opioid use (adjusted OR, 1.43; P = .020) conferred an independently increased risk of ED utilization within the first 2 postoperative days. Conclusions Peripheral nerve blocks used for upper extremity surgery are associated with a higher risk of unplanned ED utilization, most likely related to rebound pain. Through proper patient education and pain management, we can minimize this unnecessary resource utilization.}
}

@article{seandelaceyHyperparathyroidismParathyroidectomyXlinked2019,
  title = {Hyperparathyroidism and Parathyroidectomy in {{X-linked}} Hypophosphatemia Patients},
  author = {{Sean DeLacey} and {Ziyue Liu} and {Andrea A. Broyles} and {Sarah A. El-Azab} and {Cristian F. Guandique} and {Benjamin C. James} and {Erik A. Imel}},
  year = {2019},
  month = oct,
  journal = {Bone},
  volume = {127},
  number = {NA},
  pages = {386--392},
  publisher = {Elsevier BV},
  issn = {1873-2763},
  doi = {10.1016/j.bone.2019.06.025},
  abstract = {X-linked hypophosphatemia (XLH) causes rickets, osteomalacia, skeletal deformities and growth impairment, due to elevated fibroblast growth factor 23 and hypophosphatemia. Conventional therapy requires high doses of phosphate salts combined with active vitamin D analogues. Risks of this regimen include nephrocalcinosis and secondary hyperparathyroidism or progression to tertiary (hypercalcemic) hyperparathyroidism. The primary goals were to estimate the prevalence of hyperparathyroidism and to characterize parathyroidectomy outcomes regarding hypercalcemia among XLH patients. XLH patients attending our center from 1/2000 to 12/2017 were included in a retrospective chart review. Prevalence of nephrocalcinosis and eGFR {$<$} 60 ml/min/1.73m2 was also assessed. Of 104 patients with XLH, 84 had concurrent measurements of calcium and PTH (40 adults and 44 children). Of these, 70/84 (83.3\%), had secondary or tertiary hyperparathyroidism at any time point. Secondary hyperparathyroidism was persistent in 62.2\% of those with data at multiple timepoints. Tertiary hyperparathyroidism had an overall prevalence of 14/84 (16.7\%) patients. Parathyroidectomy was performed in 8/84 (9.5\%) of the total population. After parathyroidectomy, persistent or recurrent tertiary hyperparathyroidism was detected in 6/8 (75\%) patients at a median of 6 years (from 0 to 29 years). One patient had chronic post-surgical hypoparathyroidism and one patient remained normocalcemic 4 years after surgery. Nephrocalcinosis was more prevalent in patients with tertiary hyperparathyroidism than those without (60.0\% vs 18.6\%). Chronic kidney disease (eGFR {$<$} 60 ml/min/1.73m2) was also more prevalent in patients with tertiary hyperparathyroidism than those without (35.7\% vs 1.5\%). The majority of patients with XLH develop secondary hyperparathyroidism during treatment with phosphate and active vitamin D. A significant proportion develops tertiary hyperparathyroidism and most have recurrence or persistence of hypercalcemia after surgery.}
}

@article{senxiongDesigningStandardProtocol2019,
  title = {Designing a Standard Protocol for Manually Reviewing Patient Data Demographics for Record Linkage},
  author = {{Sen Xiong} and {Faap Shuan Grannis}},
  year = {2019},
  month = oct,
  journal = {Proceedings of IMPRS},
  volume = {2},
  number = {1},
  pages = {NA-NA},
  publisher = {Indiana University School of Medicine},
  issn = {2641-2470},
  doi = {10.18060/23638},
  abstract = {Background and Hypothesis: Accurate record linkage is essential to address fragmentation of patient data across independent healthcare organizations. To accurately evaluate record linkage methods, so-called ``gold standard'' data sets with labeled true matches and non-matches are needed. Human review, the process of manually assessing potentially linked patient demographic records and determining whether the record pair belongs to an idiosyncratic individual, is needed to create these datasets. However, the human review process is susceptible to bias and human error. Consequently, record linkage accuracy evaluations are prone to be biased by inaccurate gold standards. Consistent and scientifically rigorous methods for creating gold standard record linkage data sets must be developed, as none have yet been described. In this study, we describe a repeatable process for developing consistent manually reviewed datasets and analyze the results obtained from 15 human reviews of 200 record pairs following our protocol.\&\#x0D; Experimental Design/Methods: We obtained patient records from the Indiana Network for Patient Care and Marion County Health Department. We created record pairs for manual reviews by probabilistically linking datasets using multiple blocking schemes. Two-hundred record pairs were then manually reviewed by 15 different individuals and the results were analyzed.\&\#x0D; Results: Across the 200 record pairs reviewed by 15 reviewers, 155 were nondiscordant pairs whereas 45 were discordant, 40 among which were the result of outliers.\&\#x0D; Conclusion and Potential Impact: From the record pair evaluation results, some empirical rules can be established for the process of manual review, though the nuances of evaluation reasoning require more discussion and a larger sample size. Nonetheless, establishing a standard for manual reviewing is a step towards better health care and complete patient records.}
}

@article{setarahmohammadnaderPrevalenceImpairingBehavioral2019,
  title = {Prevalence of Impairing Behavioral Health Problems in {{ED}} Patients and Association with {{ED}} Utilization.},
  author = {{Setarah Mohammad Nader} and {Facep Paul Musey}},
  year = {2019},
  month = oct,
  journal = {Proceedings of IMPRS},
  volume = {NA},
  number = {NA},
  pages = {NA-NA},
  publisher = {Indiana University School of Medicine},
  issn = {2641-2470},
  doi = {10.18060/23544},
  abstract = {Background and Hypothesis: It has been observed that patients with poor mental health are relatively frequent users of the Emergency Departments (ED). The objective of this study is to evaluate the prevalence of numerous behavioral health domains (depression, anxiety, PTSD, substance abuse, and suicidality) in patients presenting to the Emergency Department and the association of each of these domains with ED utilization.\&\#x0D; Experimental Design or Project Methods: This prospective study seeks to enroll a convenience sample of 1000 Englishspeaking adults presenting to IU Health Methodist and Eskenazi Emergency Departments without psychiatric chief-complaints. Patients were assessed for behavioral health problems using the CAT-MHTM, PHQ-8 and GAD-7 screening tools, which were administered via tablet device. Additionally, data on disposition medical history, discharge diagnoses, and ED utilization in the 12 months before and after enrollment from electronic medical records and data from the Indiana Network for Patient Care (INPC) will be reviewed.\&\#x0D; Results: Over the course of five weeks, 375 patients have been enrolled. Of those 59.4\% were female with an overall mean age of 46.1 (SD {\textpm} 16.4); 52.9\% were white and 39.8\% black/African American. Among enrollees 42.2\% screened positive for depression, 29.7\% for anxiety, and 1.3\% for suicidal ideation. Patients who screened positive for depression were predominately females (76.1\% vs 23.9\%), those who screened positive for anxiety were also predominately females (71.6\% vs. 28.4\%). However, 3 out of the 5 (60\%) patients that screened positive for suicidal ideation were males. The preliminary analysis of GAD-7 showed of those enrolled 215 (57.5\%) had no anxiety, 157 (42\%) had mild-severe anxiety. PHQ-8 scores showed 194 (51.9\%) had no depression, 178 (47.5\%) had mild-severe depression. Similarly, CAT-MH results showed 216 (57.8\%) had no depression, 158 (42.2\%) had mild-severe depression, while 263 (70.3\%) had no anxiety and 111 (29.7\%) had mild-severe anxiety. Full data analysis including comparative analysis of the CAT-MH with PHQ-8 and GAD-7 scores will take place after 1000 patients have been enrolled and data has been received from the INPC.\&\#x0D; Conclusion and Potential Impact: In our sample, almost half of patients that visit the ED have screened positive for mental health problems. We believe that early identification and appropriate referral may reduce inappropriate ED utilization.}
}

@article{sikandarkhanMobileCriticalCare2018,
  title = {Mobile Critical Care Recovery Program (m-{{CCRP}}) for Acute Respiratory Failure Survivors: Study Protocol for a Randomized Controlled Trial},
  author = {{Sikandar Khan} and {Ashok Biju} and {Sophia Wang} and {Sujuan Gao} and {Omar Irfan} and {Amanda Harrawood} and {Stephanie Martinez} and {E. Cobham Brewer} and {Anthony J. Perkins} and {Frederick W. Unverzagt} and {Sue Lasiter} and {Ben L. Zarzaur} and {Omar Rahman} and {Malaz Boustani} and {Babar Khan}},
  year = {2018},
  month = feb,
  journal = {Trials},
  volume = {19},
  number = {1},
  pages = {NA-NA},
  publisher = {Springer Science+Business Media},
  issn = {1745-6215},
  doi = {10.1186/s13063-018-2449-2},
  abstract = {Patients admitted to intensive care units (ICU) with acute respiratory failure (ARF) face chronic complications that can impede return to normal daily function. A mobile, collaborative critical care model may enhance the recovery of ARF survivors. The Mobile Critical Care Recovery Program (m-CCRP) study is a two arm, randomized clinical trial. We will randomize 620 patients admitted to the ICU with acute respiratory failure requiring mechanical ventilation in a 1:1 ratio to one of two arms (310 patients per arm) -- m-CCRP intervention versus attention control. Those in the intervention group will meet with a care coordinator after hospital discharge in predetermined intervals to aid in the recovery process. Baseline assessments and personalized goal setting will be used to develop an individualized care plan for each patient after discussion with an interdisciplinary team. The attention control arm will receive printed material and telephone reminders emphasizing mobility and management of chronic conditions. Duration of the intervention and follow-up is 12 months post-randomization. Our primary aim is to assess the efficacy of m-CCRP in improving the quality of life of ARF survivors at 12 months. Secondary aims of the study are to evaluate the efficacy of m-CCRP in improving function (cognitive, physical, and psychological) of ARF survivors and to determine the efficacy of m-CCRP in reducing acute healthcare utilization. The proposed randomized controlled trial will evaluate the efficacy of a collaborative critical care recovery program in accomplishing the Institute of Healthcare Improvement's triple aims of better health, better care, at lower cost. We have developed a collaborative critical care model to promote ARF survivors' recovery from the physical, psychological, and cognitive impacts of critical illness. In contrast to a single disease focus and clinic-based access, m-CCRP represents a comprehensive, accessible, mobile, ahead of the curve intervention, focused on the multiple aspects of the unique recovery needs of ARF survivors. NCT03053245 , clinicaltrials.gov, registered February 1, 2017.}
}

@article{stefanravizzaPredictingEarlyRisk2019,
  title = {Predicting the Early Risk of Chronic Kidney Disease in Patients with Diabetes Using Real-World Data},
  author = {{Stefan Ravizza} and {Tony Huschto} and {A. K. Adamov} and {Lars B{\"o}hm} and {Alexander B{\"u}sser} and {Frederik F. Fl{\"o}ther} and {Rolf Hinzmann} and {Helena K{\"o}nig} and {Scott M. McAhren} and {Daniel H. Robertson} and {Titus Schleyer} and {Bernd Schneidinger} and {Wolfgang Petrich}},
  year = {2019},
  month = jan,
  journal = {Nature Medicine},
  volume = {25},
  number = {1},
  pages = {57--59},
  publisher = {Nature Portfolio},
  issn = {1078-8956},
  doi = {10.1038/s41591-018-0239-8}
}

@article{surangakasturiPredictingCOVID19Related2021,
  title = {Predicting {{COVID-19}}--{{Related Health Care Resource Utilization Across}} a {{Statewide Patient Population}}: {{Model Development Study}}},
  author = {{Suranga Kasturi} and {Jeremy Park} and {David Wild} and {Bashir M. Khan} and {David A. Haggstrom} and {Shaun J. Grannis}},
  year = {2021},
  month = nov,
  journal = {Journal of Medical Internet Research},
  volume = {23},
  number = {11},
  pages = {e31337-e31337},
  publisher = {JMIR Publications},
  issn = {1438-8871},
  doi = {10.2196/31337},
  abstract = {The COVID-19 pandemic has highlighted the inability of health systems to leverage existing system infrastructure in order to rapidly develop and apply broad analytical tools that could inform state- and national-level policymaking, as well as patient care delivery in hospital settings. The COVID-19 pandemic has also led to highlighted systemic disparities in health outcomes and access to care based on race or ethnicity, gender, income-level, and urban-rural divide. Although the United States seems to be recovering from the COVID-19 pandemic owing to widespread vaccination efforts and increased public awareness, there is an urgent need to address the aforementioned challenges.This study aims to inform the feasibility of leveraging broad, statewide datasets for population health-driven decision-making by developing robust analytical models that predict COVID-19-related health care resource utilization across patients served by Indiana's statewide Health Information Exchange.We leveraged comprehensive datasets obtained from the Indiana Network for Patient Care to train decision forest-based models that can predict patient-level need of health care resource utilization. To assess these models for potential biases, we tested model performance against subpopulations stratified by age, race or ethnicity, gender, and residence (urban vs rural).For model development, we identified a cohort of 96,026 patients from across 957 zip codes in Indiana, United States. We trained the decision models that predicted health care resource utilization by using approximately 100 of the most impactful features from a total of 1172 features created. Each model and stratified subpopulation under test reported precision scores {$>$}70\%, accuracy and area under the receiver operating curve scores {$>$}80\%, and sensitivity scores approximately {$>$}90\%. We noted statistically significant variations in model performance across stratified subpopulations identified by age, race or ethnicity, gender, and residence (urban vs rural).This study presents the possibility of developing decision models capable of predicting patient-level health care resource utilization across a broad, statewide region with considerable predictive performance. However, our models present statistically significant variations in performance across stratified subpopulations of interest. Further efforts are necessary to identify root causes of these biases and to rectify them.}
}

@article{suranganathkasthurirathneAssessingCapacitySocial2017,
  title = {Assessing the Capacity of Social Determinants of Health Data to Augment Predictive Models Identifying Patients in Need of Wraparound Social Services},
  author = {{Suranga Nath Kasthurirathne} and {Joshua R. Vest} and {Nir Menachemi} and {Paul K. Halverson} and {Shaun J. Grannis}},
  year = {2017},
  month = nov,
  journal = {Journal of the American Medical Informatics Association},
  volume = {25},
  number = {1},
  pages = {47--53},
  publisher = {Oxford University Press},
  issn = {1067-5027},
  doi = {10.1093/jamia/ocx130},
  abstract = {Abstract Introduction A growing variety of diverse data sources is emerging to better inform health care delivery and health outcomes. We sought to evaluate the capacity for clinical, socioeconomic, and public health data sources to predict the need for various social service referrals among patients at a safety-net hospital. Materials and Methods We integrated patient clinical data and community-level data representing patients' social determinants of health (SDH) obtained from multiple sources to build random forest decision models to predict the need for any, mental health, dietitian, social work, or other SDH service referrals. To assess the impact of SDH on improving performance, we built separate decision models using clinical and SDH determinants and clinical data only. Results Decision models predicting the need for any, mental health, and dietitian referrals yielded sensitivity, specificity, and accuracy measures ranging between 60\% and 75\%. Specificity and accuracy scores for social work and other SDH services ranged between 67\% and 77\%, while sensitivity scores were between 50\% and 63\%. Area under the receiver operating characteristic curve values for the decision models ranged between 70\% and 78\%. Models for predicting the need for any services reported positive predictive values between 65\% and 73\%. Positive predictive values for predicting individual outcomes were below 40\%. Discussion The need for various social service referrals can be predicted with considerable accuracy using a wide range of readily available clinical and community data that measure socioeconomic and public health conditions. While the use of SDH did not result in significant performance improvements, our approach represents a novel and important application of risk predictive modeling.}
}

@article{suranganathkasthurirathneBetterPublicHealth2017,
  title = {Toward Better Public Health Reporting Using Existing off the Shelf Approaches: {{The}} Value of Medical Dictionaries in Automated Cancer Detection Using Plaintext Medical Data},
  author = {{Suranga Nath Kasthurirathne} and {Brian E. Dixon} and {Judy Wawira Gichoya} and {Huiping Xu} and {Yuni Xia} and {Burke W. Mamlin} and {Shaun J. Grannis}},
  year = {2017},
  month = may,
  journal = {Journal of Biomedical Informatics},
  volume = {69},
  number = {NA},
  pages = {160--176},
  publisher = {Elsevier BV},
  issn = {1532-0464},
  doi = {10.1016/j.jbi.2017.04.008},
  abstract = {Existing approaches to derive decision models from plaintext clinical data frequently depend on medical dictionaries as the sources of potential features. Prior research suggests that decision models developed using non-dictionary based feature sourcing approaches and ``off the shelf'' tools could predict cancer with performance metrics between 80\% and 90\%. We sought to compare non-dictionary based models to models built using features derived from medical dictionaries. We evaluated the detection of cancer cases from free text pathology reports using decision models built with combinations of dictionary or non-dictionary based feature sourcing approaches, 4 feature subset sizes, and 5 classification algorithms. Each decision model was evaluated using the following performance metrics: sensitivity, specificity, accuracy, positive predictive value, and area under the receiver operating characteristics (ROC) curve. Decision models parameterized using dictionary and non-dictionary feature sourcing approaches produced performance metrics between 70 and 90\%. The source of features and feature subset size had no impact on the performance of a decision model. Our study suggests there is little value in leveraging medical dictionaries for extracting features for decision model building. Decision models built using features extracted from the plaintext reports themselves achieve comparable results to those built using medical dictionaries. Overall, this suggests that existing ``off the shelf'' approaches can be leveraged to perform accurate cancer detection using less complex Named Entity Recognition (NER) based feature extraction, automated feature selection and modeling approaches.}
}

@article{suranganathkasthurirathneMachineLearningApproaches2019,
  title = {Machine {{Learning Approaches}} to {{Identify Nicknames}} from {{A Statewide Health Information Exchange}}.},
  author = {{Suranga Nath Kasthurirathne} and {Shaun J. Grannis}},
  year = {2019},
  month = jan,
  journal = {PubMed},
  volume = {2019},
  number = {NA},
  pages = {639--647},
  publisher = {National Institutes of Health},
  issn = {NA},
  abstract = {Patient matching is essential to minimize fragmentation of patient data. Existing patient matching efforts often do not account for nickname use. We sought to develop decision models that could identify true nicknames using features representing the phonetical and structural similarity of nickname pairs. We identified potential male and female name pairs from the Indiana Network for Patient Care (INPC), and developed a series of features that represented their phonetical and structural similarities. Next, we used the XGBoost classifier and hyperparameter tuning to build decision models to identify nicknames using these feature sets and a manually reviewed gold standard. Decision models reported high precision/positive predictive value and accuracy scores for both male and female name pairs despite the low number of true nickname matches in the datasets under study. Ours is one of the first efforts to identify patient nicknames using machine learning approaches.}
}

@article{swapnaabhyankarLetterEditorCommentsUse2017,
  title = {Letter to the {{Editor-Comments}} on the {{Use}} of {{LOINC}} and {{SNOMED CT}} for {{Representing Nursing Data}}},
  author = {{Swapna Abhyankar} and {Daniel J. Vreeman} and {Bonnie L. Westra} and {Connie W Delaney}},
  year = {2017},
  month = aug,
  journal = {International journal of nursing knowledge},
  volume = {29},
  number = {2},
  pages = {82--85},
  publisher = {Wiley},
  issn = {2047-3087},
  doi = {10.1111/2047-3095.12183}
}

@article{thomasmwogiEvaluationTwoMethods2014,
  title = {An {{Evaluation}} of {{Two Methods}} for {{Generating Synthetic HL7 Segments Reflecting Real-World Health Information Exchange Transactions}}.},
  author = {{Thomas Mwogi} and {Paul G. Biondich} and {Shaun J. Grannis}},
  year = {2014},
  month = jan,
  journal = {PubMed},
  volume = {2014},
  number = {NA},
  pages = {1855--63},
  publisher = {National Institutes of Health},
  issn = {NA},
  abstract = {Motivated by the need for readily available data for testing an open-source health information exchange platform, we developed and evaluated two methods for generating synthetic messages. The methods used HL7 version 2 messages obtained from the Indiana Network for Patient Care. Data from both methods were analyzed to assess how effectively the output reflected original 'real-world' data. The Markov Chain method (MCM) used an algorithm based on transitional probability matrix while the Music Box model (MBM) randomly selected messages of particular trigger type from the original data to generate new messages. The MBM was faster, generated shorter messages and exhibited less variation in message length. The MCM required more computational power, generated longer messages with more message length variability. Both methods exhibited adequate coverage, producing a high proportion of messages consistent with original messages. Both methods yielded similar rates of valid messages.}
}

@article{timothyd.mcfarlaneEstimatingChildhoodObesity2019,
  title = {Towards {{Estimating Childhood Obesity Prevalence Using Electronic Health Records}}},
  author = {{Timothy D. McFarlane}},
  year = {2019},
  month = may,
  journal = {Online Journal of Public Health Informatics},
  volume = {11},
  number = {1},
  pages = {NA-NA},
  publisher = {University of Illinois at Chicago},
  issn = {1947-2579},
  doi = {10.5210/ojphi.v11i1.9805},
  abstract = {ObjectiveTo discuss the use of electronic health records (EHRs) for estimation of overweight and obesity prevalence in children aged 2 to 19 years and to compare prevalence between the convenience sample obtained from EHRs to prevalence adjusted for potential selection bias.IntroductionAlthough recent data suggests childhood obesity prevalence has stabilized, an estimated 1 in 3 U.S. children are overweight or obese.1 Further, there is variation by racial and ethnic groups, location, age, and poverty2, resulting in a need for local data to support public health planning and evaluation efforts. Current methods for surveillance of childhood weight status rely on self-report from community-based surveys. However, surveys have long time intervals between data collection periods, are expensive, and are not often able to produce precise small-area estimates. EHRs have been increasingly proposed as an alternative or supplement to community surveys. Childhood weight and height is collected as a part of routine care, and leveraging these data from EHRs may provide rapid and locally precise estimates of childhood weight status. A concern for the use of EHRs is the potential for selection bias. EHRs represent only those seeking healthcare and may not generalize to the population. Additionally, the type of clinical visit (e.g., wellness vs. acute) may affect the prevalence estimates and the likelihood of collecting height and weight data in the EHR. Thus, in addition to EHRs being a convenience sample, there may be additional selection biases based on the type of visit and whether height and weight was measured and recorded. The current work sought to quantify the effect of visit type on childhood overweight and obesity prevalence and generate weights to adjust prevalence for potential EHR-related selection bias.MethodsTwo years (2014-2015) of EHR data were obtained from the Indiana Network for Patient Care, a community health information exchange. Data included clinical encounters of patients living in the eight-county metropolitan area of Indianapolis, Indiana. BMI was calculated using recorded height and weight from the most recent encounter. Encounters were screened for valid BMI entries by examining records in the 0-5th and 95-100th percentiles. BMI results were validated using the following procedure: censoring records with one encounter; removing encounters with implausible values (5 \&lt; BMI \&lt; 100); calculating the mean BMI across remaining encounters; calculating the percent difference from the mean BMI for each encounter; and removing encounters with BMI results greater or less than 10\% from the mean BMI. Records which could not be validated were censored and treated as missing height and weight. Using the age- and sex- specific Centers for Disease Control and Prevention growth charts, patients were classified as underweight (0-5th percentiles), normal weight (5-85th percentiles), overweight (85-95th percentiles), and obese (\&gt;95th percentile).Wellness visits were identified using the following ICD-9-CM or ICD-10-CM diagnosis codes: V20.2, V70.0, V70.9; and Z00.121, Z00.129, Z00.00, Z00.01. To adjust for potential selection bias, two stabilized inverse probability weights (SIPW) were constructed. First, to account for potential selection bias induced by visit type and, second, to account for potential selection bias due to censoring (i.e., missing height and weight data). The SIPW were generated using logistic regression models to calculate the predicted probabilities for visit type and uncensored observations as a function of the covariates race, ethnicity, age, gender, and insurance. The SIPW weights were specified as depicted below, where W=1 is a wellness visit, L=observed covariates, and C=0 is uncensored for each child, i.[Insert formulas here]The final weight (SWFinal) was applied to the sample to create a pseudo-population in which there is no association between covariates, L and visit type and which has the same distribution of covariates, L, as the censored individuals not included in the pseudo-population, thus making censoring occur at random, given the observed covariates. Under the assumption of exchangeability and no unmeasured or residual confounding, the pseudo-population will no longer have selection bias due to differences in visit type and missing data.ResultsThe sample consisted of 130,626 unique individuals between the ages of 2 and 19 years, of which 92,755 (71\%) had at least one recorded height and weight result. Of the 10,184 records screened for BMI results, 5,242 (51\%) were validated using measurements from previous encounters. The final sample consisted of 87,804 records with a valid BMI result (67\%) and 42,822 records censored due to missing data (33\%). Compared to the U.S. Census, the EHR sample over-represented older girls (e.g., 31.2\% vs. 41.2\% 15-19 year-old girls) and under-represented younger girls (e.g., 34.3\% vs. 29.5\% for 5-9 year-old girls). Wellness visits were associated with censoring due to missing data; only 3\% of censored encounters were wellness visits compared to 33\% of uncensored encounters [P({$\chi$}21\&gt;14437 =\&lt; 0.0001)].In the unweighted sample, the overall prevalence of overweight or obesity was 36.5\%. The overweight or obesity prevalence was lower among wellness visits (33.9\%) than other visits (37.8\%; P({$\chi$}21\&gt;124.2=\&lt; 0.0001). Similarly, wellness visits had lower prevalence estimates when stratified by sex, race, age, ethnicity, and insurance (Table 1). After weighting the sample by SWFinal, the overall prevalence of overweight or obesity was 36.2\% and the difference between wellness (35.1\%) and other visits (36.7\%) was attenuated, though statistically significant [P({$\chi$}21\&gt;22.2 =\&lt;0.001). Likewise, the differences between wellness and other visits in the weighted pseudo-population were attenuated when stratified by covariates, compared to unweighted analyses (Table 1). While the SIPW method demonstrated some adjustment for selection bias due to visit type and censoring due to missing data, the adjustment was incomplete, likely as a result of unmeasured and imperfectly measured covariates.ConclusionsWellness visits were associated with lower childhood overweight and obesity prevalence and were more likely to have weight and height measurements recorded in the EHR than other visit types. Adjusting prevalence for EHR-related selection bias using stabilized inverse probability weights may produce more valid estimates but the lack of social determinant data in EHRs results in imperfect adjustment. Future work should integrate individual- or community-level social determinants of health data into the weighting models.References1. Skinner, AC, \&amp; Skelton, JA. Prevalence and trends in obesity and severe obesity among children in the United States, 1999-2012. JAMA Pediatr. 2014; 168(6).2. Ogden CL. et al. Differences in Obesity Prevalence by Demographics and Urbanization in US Children and Adolescents, 2013-2016. JAMA. 2018;319(23).}
}

@article{timothyd.mcfarlaneIncreasedRiskStroke2020,
  title = {Increased {{Risk}} of {{Stroke Among Young Adults With Serious Traumatic Brain Injury}}},
  author = {{Timothy D. McFarlane} and {Josh Love} and {Shane Hanley} and {Brian E. Dixon} and {Flora M. Hammond}},
  year = {2020},
  month = may,
  journal = {Journal of Head Trauma Rehabilitation},
  volume = {35},
  number = {3},
  pages = {E310-E319},
  publisher = {Lippincott Williams \& Wilkins},
  issn = {0885-9701},
  doi = {10.1097/htr.0000000000000539},
  abstract = {Objective: To quantify the risk of acute ischemic stroke (AIS) following traumatic brain injury (TBI) according to severity. Setting: Indiana Network for Patient Care, including medical records from more than 100 Indiana hospitals and affiliated practices. Participants: Individuals 18 years and older with TBI from 2005 to 2014. Design: Retrospective cohort. Main Measures: AIS incidence in the first 30, 31 to 180, and 181 days after TBI. Time to AIS using a stratified Cox proportional hazards model. Results: Among 58 294 patients with TBI, AIS risk was greatest in the first 30 days (incidence rate = 23.3 per 1000 person-months), declining to 3.1 and 1.3 per 1000 person-months after 31 to 180 and 181 days or more, respectively. Cervical artery dissection increased the risk of AIS in the first 30 days (incidence rate = 170.9 per 1000 person-months). In the first 30 days, serious TBI increased risk for all age groups, with the largest effect observed among those aged 18 to 24 years. Over time, serious TBI modified the effect of age on AIS only for those aged 18 to 24 years. Conclusions: These findings add to a growing body of work demonstrating that the acute and postacute stages of TBI play an accelerative role in AIS risk, particularly among younger patients, cervical artery dissection, and serious TBI.}
}

@article{timothyd.mcfarlaneUsingElectronicHealth2018,
  title = {Using {{Electronic Health Records}} for {{Public Health Hypertension Surveillance}}},
  author = {{Timothy D. McFarlane} and {Brian E. Dixon} and {P. Joseph Gibson}},
  year = {2018},
  month = may,
  journal = {Online Journal of Public Health Informatics},
  volume = {10},
  number = {1},
  pages = {NA-NA},
  publisher = {University of Illinois at Chicago},
  issn = {1947-2579},
  doi = {10.5210/ojphi.v10i1.8992},
  abstract = {ObjectiveTo assess the equivalence of hypertension prevalence estimates between longitudinal electronic health record (EHR) data from a community-based health information exchange (HIE) and the Behavioral Risk Factor Surveillance System (BRFSS).IntroductionHypertension (HTN) is a highly prevalent chronic condition and strongly associated with morbidity and mortality. HTN is amenable to prevention and control through public and population health programs and policies. Therefore, public and population health programs require accurate, stable estimates of disease prevalence, and estimating HTN prevalence at the community-level is acutely important for timely detection, intervention, and effective evaluation. Current surveillance methods for HTN rely upon community-based surveys, such as the BRFSS. While BRFSS is the standard at the state- and national-level, they are expensive to collect, released once per year, and their confidence intervals are too wide for precise estimates at the local level. More timely, frequently updated, and locally precise prevalence estimates could greatly improve the timeliness and precision of public health interventions. The current study evaluated EHR data from a large, mature HIE as an alternative to community-based surveys for timely, accurate, and precise HTN prevalence estimation.MethodsTwo years (2014-2015) of EHR data were obtained from the Indiana Network for Patient Care for two major health systems in Marion County, Indiana, representing approximately 75\% of the total county population (n=530,244). These data were linked and evaluated for prevalent HTN. Six HTN phenotypes were defined using structured data variables including clinical diagnoses (ICD9/10 codes), blood pressure (BP) measurements (HTN = {$\geq$}140mmhg systolic or {$\geq$}90mmHg diastolic), and dispensed HTN medications (Table 1). Phenotypes were validated using a random sample of 600 records, comparing EHR phenotype HTN to HTN as determined through manual chart review by a Registered Nurse. Each phenotype was further evaluated against BRFSS estimates for Marion County, and stratified by sex, race, and age to compare EHR-generated HTN prevalence measures to those known and in current use for chronic disease surveillance. Comparisons were made using the two one-sided statistical test (TOST) of equivalence, wherein the null hypothesis is the BRFSS and EHR prevalence estimates are different by +/-5\% and the alternative is estimates differ by less than +/-5\%. Rejection of the null resulted in the conclusion of equivalence of the estimates for use in population/public health.ResultsIn general, the performance of the EHR phenotypes was characterized by high specificity (\&gt;87\%) and low to moderate sensitivity (range 25.4\%-95.3\%). The false positive rate was lowest among the phenotype defining HTN by both clinical diagnosis and BP measurements (0.3\%), and sensitivity was greatest for the phenotype combining all three structured data elements (95.2\%). The prevalence of HTN in Marion County, Indiana (2014-2015) for the EHR sample (n=530,244) ranged between 13.7\% and 36.2\%, compared to 28.4\% in the BRFSS sample (Table 1). Only one EHR phenotype ({$\geq$}1 HTN BP measurement) demonstrated equivalence with BRFSS prevalence at the county level (difference 0.9\%, 90\% CI for difference -2.3\%-4.0\%). HTN prevalence by sex, race, age, sex and age, and sex and race (n=120 comparisons) failed to demonstrate equivalence between EHR and BRFSS measures in all but two comparisons, both among females aged 18-39 years. Differences between EHR and BRFSS HTN prevalence at the subgroup level varied but were particularly pronounced among older adults. As suspected, HTN prevalence precision was improved in the EHR sample with the largest subgroup 95\% CI width of 0.7\% for male African Americans compared to the BRFSS sample 95\% CI width of 29.6\%.ConclusionsThe applicability of the tested HTN phenotypes will vary based upon which EHR structured data elements are available to public health (i.e., ICD10, vitals, medications). We found that HTN surveillance using a community-based HIE was not a valid replacement for the BRFSS, although the HIE-based estimates could be readily generated and had much narrower confidence intervals.ReferencesMozaffarian D, et al. Heart Disease and Stroke Statistics --- 2016 Update. Circulation. 2016; 133: e38-e360.Yoon S, Fryar C, Carroll M. HTN Prevalence and Control Among Adults: United States, 2011--2014. NCHS Data Brief No. 220. 2015; Hyattsville, MD: National Center for Health Statistics, Centers for Disease Control and Prevention, US Dept of Health and Human Services.}
}

@article{titusschleyerQuantifyingUnmetNeed2019,
  title = {Quantifying {{Unmet Need}} in {{Statin-Treated Hyperlipidemia Patients}} and the {{Potential Benefit}} of {{Further LDL-C Reduction Through}} an {{EHR-Based Retrospective Cohort Study}}},
  author = {{Titus Schleyer} and {Siu L. Hui} and {Jane Wang} and {Zuoyi Zhang} and {Kristina M. Knapp} and {Jarod Baker} and {Monica Chase} and {Robert Boggs} and {Ross J. Simpson}},
  year = {2019},
  month = may,
  journal = {Journal of managed care \& specialty pharmacy},
  volume = {25},
  number = {5},
  pages = {544--554},
  publisher = {AMCP},
  issn = {2376-0540},
  doi = {10.18553/jmcp.2019.25.5.544},
  abstract = {Statins are effective in helping prevent cardiovascular disease (CVD). However, studies suggest that only 20\%-64\% of patients taking statins achieve reasonable low-density lipoprotein cholesterol (LDL-C) thresholds. On-treatment levels of LDL-C remain a key predictor of residual CVD event risk.To (a) determine how many patients on statins achieved the therapeutic threshold of LDL-C {$<$} 100 mg per dL (general cohort) and {$<$} 70 mg per dL (secondary prevention cohort, or subcohort, with preexisting CVD); (b) estimate the number of potentially avoidable CVD events if the threshold were reached; and (c) forecast potential cost savings.A retrospective, longitudinal cohort study using electronic health record data from the Indiana Network for Patient Care (INPC) was conducted. The INPC provides comprehensive information about patients in Indiana across health care organizations and care settings. Patients were aged {$>$} 45 years and seen between January 1, 2012, and October 31, 2016 (ensuring study of contemporary practice), were statin-naive for 12 months before the index date of initiating statin therapy, and had an LDL-C value recorded 6-18 months after the index date. Subsequent to descriptive cohort analysis, the theoretical CVD risk reduction achievable by reaching the threshold was calculated using Framingham Risk Score and Cholesterol Treatment Trialists' Collaboration formulas. Estimated potential cost savings used published first-year costs of CVD events, adjusted for inflation and discounted to the present day.Of the 89,267 patients initiating statins, 30,083 (33.7\%) did not achieve the LDL-C threshold (subcohort: 58.1\%). In both groups, not achieving the threshold was associated with patients who were female, black, and those who had reduced medication adherence. Higher levels of preventive aspirin use and antihypertensive treatment were associated with threshold achievement. In both cohorts, approximately 64\% of patients above the threshold were within 30 mg per dL of the respective threshold. Adherence to statin therapy regimen, judged by a medication possession ratio of {$\geq$} 80\%, was 57.4\% in the general cohort and 56.7\% in the subcohort. Of the patients who adhered to therapy, 23.7\% of the general cohort and 50.5\% of the subcohort had LDL-C levels that did not meet the threshold. 10-year CVD event risk in the at-or-above threshold group was 22.78\% (SD = 17.24\%) in the general cohort and 29.56\% (SD = 18.19\%) in the subcohort. By reducing LDL-C to the threshold, a potential relative risk reduction of 14.8\% in the general cohort could avoid 1,173 CVD events over 10 years (subcohort: 15.7\% and 454 events). Given first-year inpatient and follow-up costs of \$37,300 per CVD event, this risk reduction could save about \$1,455 per patient treated to reach the threshold (subcohort: \$1,902; 2017 U.S. dollars) over a 10-year period.Across multiple health care systems in Indiana, between 34\% (general cohort) and 58\% (secondary prevention cohort) of patients treated with statins did not achieve therapeutic LDL-C thresholds. Based on current CVD event risk and cost projections, such patients seem to be at increased risk and may represent an important and potentially preventable burden on health care costs.Funding support for this study was provided by Merck (Kenilworth, NJ). Chase and Boggs are employed by Merck. Simpson is a consultant to Merck and Pfizer. The other authors have nothing to disclose.}
}

@article{viviennej.zhuComparisonDataDrivenbased2014,
  title = {A {{Comparison}} of {{Data Driven-based Measures}} of {{Adherence}} to {{Oral Hypoglycemic Agents}} in {{Medicaid Patients}}.},
  author = {{Vivienne J. Zhu} and {Wanzhu Tu} and {Marc B. Rosenman} and {J. Marc Overhage}},
  year = {2014},
  month = jan,
  journal = {PubMed},
  volume = {2014},
  number = {NA},
  pages = {1294--301},
  publisher = {National Institutes of Health},
  issn = {NA},
  abstract = {We evaluated and compared different methods for measuring adherence to Oral Antihyperglycemic Agents (OHA), based on the correlation between these measures and glycated hemoglobin A1C (HbA1c) levels in Medicaid patients with Type 2 diabetes. An observational sample of 831 Medicaid patients with Type 2 diabetes who had HbA1c test results recorded between January 1, 2001 and December 31, 2005 was identified in the Indiana Network of Patient Care (INPC). OHA adherence was measured by medication possession ratio (MPR), proportion of days covered (PDC), and the number of gaps (GAP) for 3, 6, and 12-month intervals prior to the HbA1c test date. All three OHA adherence measurements showed consistent and significant correlation with HbA1c level. The 6-month PDC showed the strongest association with HbA1c levels in both unadjusted (-1.07, P{$<$}0.0001) and adjusted (-1.12, P{$<$}0.0001) models.}
}

@article{viviennej.zhuNonadherenceOralAntihyperglycemic2015,
  title = {Nonadherence to {{Oral Antihyperglycemic Agents}}: {{Subsequent Hospitalization}} and {{Mortality}} among {{Patients}} with {{Type}} 2 {{Diabetes}} in {{Clinical Practice}}.},
  author = {{Vivienne J. Zhu} and {Wanzhu Tu} and {Marc B. Rosenman} and {J. Marc Overhage}},
  year = {2015},
  month = jan,
  journal = {PubMed},
  volume = {216},
  number = {NA},
  pages = {60--3},
  publisher = {National Institutes of Health},
  issn = {NA},
  abstract = {Using real-world clinical data from the Indiana Network for Patient Care, we analyzed the associations between non-adherence to oral antihyperglycemic agents (OHA) and subsequent diabetes-related hospitalization and all-cause mortality for patients with type 2 diabetes. OHA adherence was measured by the annual proportion of days covered (PDC) for 2008 and 2009. Among 24,067 eligible patients, 35,507 annual PDCs were formed. Over 90\% (n=21,798) of the patients had a PDC less than 80\%. In generalized linear mixed model analyses, OHA non-adherence is significantly associated with diabetes related hospitalizations (OR: 1.2; 95\% CI [1.1,1.3]; p\&lt;0.0001). Older patients, white patients, or patients who had ischemic heart disease, stroke, or renal disease had higher odds of hospitalization. Similarly, OHA non-adherence increased subsequent mortality (OR: 1.3; 95\% CI [1.02, 1.61]; p\&lt;0.0001). Patient age, male gender, income and presence of ischemic heart diseases, stroke, and renal disease were also significantly associated with subsequent all-cause death.}
}

@article{w.grahamcarlosSmokingRelatedHomeOxygen2016,
  title = {Smoking-{{Related Home Oxygen Burn Injuries}}: {{Continued Cause}} for {{Alarm}}},
  author = {{W. Graham Carlos} and {Mary S. Baker} and {Katie McPherson} and {Gabriel T. Bosslet} and {Rajiv Sood} and {Alexia M. Torke}},
  year = {2016},
  month = jan,
  journal = {Respiration},
  volume = {91},
  number = {2},
  pages = {151--155},
  publisher = {Karger Publishers},
  issn = {0025-7931},
  doi = {10.1159/000443798},
  abstract = {\&lt;b\&gt;\&lt;i\&gt;Background:\&lt;/i\&gt;\&lt;/b\&gt; Home oxygen therapy is a mainstay of treatment for patients with various cardiopulmonary diseases. In spite of warnings against smoking while using home oxygen, many patients sustain burn injuries. \&lt;b\&gt;\&lt;i\&gt;Objectives:\&lt;/i\&gt;\&lt;/b\&gt; We aimed to quantify the morbidity and mortality of such patients admitted to our regional burn unit over a 6-year period. \&lt;b\&gt;\&lt;i\&gt;Methods:\&lt;/i\&gt;\&lt;/b\&gt; A retrospective chart review of all patients admitted to a regional burn center from 2008 through 2013 was completed. Admitted patients sustaining burns secondary to smoking while using home oxygen therapy were selected as the study population to determine morbidity. \&lt;b\&gt;\&lt;i\&gt;Results:\&lt;/i\&gt;\&lt;/b\&gt; Fifty-five subjects were admitted to the burn unit for smoking-related home oxygen injuries. The age range was 40-84 years. Almost all subjects were on home oxygen for chronic obstructive pulmonary disease (96\%). Seventy-two percent of burns involved \&lt;5\% of the total body surface area, 51\% of patients were intubated, and of those 33\% had evidence of inhalation injury. The hospital mortality rate was 14.5\%. The mean length of hospital stay was 8.6 days, and 54.5\% were discharged to a nursing home or another advanced facility. Finally, concomitant substance abuse was found in 27\%, and a previous history of injury from smoking while on home oxygen was discovered in 14.5\%. \&lt;b\&gt;\&lt;i\&gt;Conclusions:\&lt;/i\&gt;\&lt;/b\&gt; This single-center analysis is one of the largest describing burn injuries stemming from smoking while using home oxygen therapy. We identified the morbidity and mortality associated with these injuries. Ongoing education and careful consideration of prescribing home oxygen therapy for known smokers is highly encouraged.}
}

@article{wanzhutuTriamtereneEnhancesBlood2015,
  title = {Triamterene {{Enhances}} the {{Blood Pressure Lowering Effect}} of {{Hydrochlorothiazide}} in {{Patients}} with {{Hypertension}}},
  author = {{Wanzhu Tu} and {Brian S. Decker} and {Z.C. He} and {Blake L. Erdel} and {George J. Eckert} and {Richard Hellman} and {Michael D. Murray} and {John A. Oates} and {J. Howard Pratt}},
  year = {2015},
  month = jul,
  journal = {Journal of General Internal Medicine},
  volume = {31},
  number = {1},
  pages = {30--36},
  publisher = {Springer Science+Business Media},
  issn = {0884-8734},
  doi = {10.1007/s11606-015-3469-1},
  abstract = {Triamterene, because of its potassium-sparing properties, is frequently used in combination with hydrochlorothiazide (HCTZ) to treat patients with hypertension. By inhibiting the epithelial sodium channel (ENaC) in the cortical collecting duct, triamterene reduces potassium secretion, thus reducing the risk of hypokalemia. Whether triamterene has an independent effect on blood pressure (BP) has not been well studied. To determine if triamterene provides an effect to further lower BP in patients treated with HCTZ. We conducted an observational study using electronic medical record data from the Indiana Network for Patient Care. Participants were 17,291 patients with the diagnosis of hypertension between 2004 and 2012. BP was the primary outcome. We compared the BP between patients who were taking HCTZ, with and without triamterene, either alone or in combination with other antihypertensive medications, by using a propensity score analysis. For each medication combination, we estimated the propensity score (i.e., probability) of a patient receiving triamterene using a logistic regression model. Patients with similar propensity scores were stratified into subclasses and BP was compared between those taking triamterene or not within each subclass; the effect of triamterene was then assessed by combining BP differences estimated from all subclasses. The mean systolic BP in the triamterene + HCTZ group was 3.8 mmHg lower than in the HCTZ only group (p {$<$} 0.0001); systolic BP was similarly lower for patients taking triamterene with other medication combinations. Systolic BP reduction was consistently observed for different medication combinations. The range of systolic BP reduction was between 1 and 4 mm Hg, depending on the concurrently used medications. In the present study, triamterene was found to enhance the effect of HCTZ to lower BP. In addition to its potassium-sparing action, triamterene's ability to lower BP should also be considered.}
}

@article{wen-haochiangPatternDiscoveryHighOrder2018,
  title = {Pattern {{Discovery}} from {{High-Order Drug-Drug Interaction Relations}}},
  author = {{Wen-Hao Chiang} and {Titus Schleyer} and {Li Shen} and {Lang Li} and {Xia Ning}},
  year = {2018},
  month = jun,
  journal = {Journal of healthcare informatics research},
  volume = {2},
  number = {3},
  pages = {272--304},
  publisher = {Springer Science+Business Media},
  issn = {2509-498X},
  doi = {10.1007/s41666-018-0020-2},
  abstract = {Drug-drug interactions (DDIs) and associated adverse drug reactions (ADRs) represent a significant public health problem in the USA. The research presented in this manuscript tackles the problems of representing, quantifying, discovering, and visualizing patterns from high-order DDIs in a purely data-driven fashion within a unified graph-based framework and via unified convolution-based algorithms. We formulate the problem based on the notions of nondirectional DDI relations (DDI-nd's) and directional DDI relations (DDI-d's), and correspondingly developed weighted complete graphs and hyper-graphlets for their representation, respectively. We also develop a convolutional scheme and its stochastic algorithm SD2ID2S to discover DDI-based drug-drug similarities. Our experimental results demonstrate that such approaches can well capture the patterns of high-order DDIs.}
}

@article{williamm.tierneyBreakdownsInformationHighway2018,
  title = {Breakdowns on the Information Highway during Inter-Hospital Patient Transfers},
  author = {{William M. Tierney}},
  year = {2018},
  month = jun,
  journal = {Journal of General Internal Medicine},
  volume = {NA},
  number = {NA},
  pages = {NA-NA},
  publisher = {Springer Science+Business Media},
  issn = {0884-8734},
  doi = {10.1007/s11606-018-4538-z}
}

@article{williamm.tierneyProviderResponsesPatients2014,
  title = {Provider {{Responses}} to {{Patients Controlling Access}} to Their {{Electronic Health Records}}: {{A Prospective Cohort Study}} in {{Primary Care}}},
  author = {{William M. Tierney} and {Sheri Alpert} and {Amy Byrket} and {Kelly Caine} and {Jeremy C. Leventhal} and {Eric M. Meslin} and {Peter H. Schwartz}},
  year = {2014},
  month = dec,
  journal = {Journal of General Internal Medicine},
  volume = {30},
  number = {S1},
  pages = {31--37},
  publisher = {Springer Science+Business Media},
  issn = {0884-8734},
  doi = {10.1007/s11606-014-3053-0},
  abstract = {Applying Fair Information Practice principles to electronic health records (EHRs) requires allowing patient control over who views their data.We designed a program that captures patients' preferences for provider access to an urban health system's EHR. Patients could allow or restrict providers' access to all data (diagnoses, medications, test results, reports, etc.) or only highly sensitive data (sexually transmitted infections, HIV/AIDS, drugs/alcohol, mental or reproductive health). Except for information in free-text reports, we redacted EHR data shown to providers according to patients' preferences. Providers could "break the glass" to display redacted information. We prospectively studied this system in one primary care clinic, noting redactions and when users "broke the glass," and surveyed providers about their experiences and opinions.Eight of nine eligible clinic physicians and all 23 clinic staff participated. All 105 patients who enrolled completed the preference program. Providers did not know which of their patients were enrolled, nor their preferences for accessing their EHRs. During the 6-month prospective study, 92 study patients (88 \%) returned 261 times, during which providers viewed their EHRs 126 times (48 \%). Providers "broke the glass" 102 times, 92 times for patients not in the study and ten times for six returning study patients, all of whom had restricted EHR access. Providers "broke the glass" for six (14 \%) of 43 returning study patients with redacted data vs. zero among 49 study patients without redactions (p = 0.01). Although 54 \% of providers agreed that patients should have control over who sees their EHR information, 58 \% believed restricting EHR access could harm provider-patient relationships and 71 \% felt quality of care would suffer.Patients frequently preferred restricting provider access to their EHRs. Providers infrequently overrode patients' preferences to view hidden data. Providers believed that restricting EHR access would adversely impact patient care. Applying Fair Information Practice principles to EHRs will require balancing patient preferences, providers' needs, and health care quality.}
}

@article{xianingImprovingInformationRetrieval2021,
  title = {Improving Information Retrieval from Electronic Health Records Using Dynamic and Multi-Collaborative Filtering},
  author = {{Xia Ning} and {Ziwei Fan} and {Evan Burgun} and {Zhiyun Ren} and {Titus Schleyer}},
  year = {2021},
  month = aug,
  journal = {PLOS ONE},
  volume = {16},
  number = {8},
  pages = {e0255467-e0255467},
  publisher = {Public Library of Science},
  issn = {1932-6203},
  doi = {10.1371/journal.pone.0255467},
  abstract = {Due to the rapid growth of information available about individual patients, most physicians suffer from information overload and inefficiencies when they review patient information in health information technology systems. In this paper, we present a novel hybrid dynamic and multi-collaborative filtering method to improve information retrieval from electronic health records. This method recommends relevant information from electronic health records to physicians during patient visits. It models information search dynamics using a Markov model. It also leverages the key idea of collaborative filtering, originating from Recommender Systems, for prioritizing information based on various similarities among physicians, patients and information items. We tested this new method using electronic health record data from the Indiana Network for Patient Care, a large, inter-organizational clinical data repository maintained by the Indiana Health Information Exchange. Our experimental results demonstrated that, for top-5 recommendations, our method was able to correctly predict the information in which physicians were interested in 46.7\% of all test cases. For top-1 recommendations, the corresponding figure was 24.7\%. In addition, the new method was 22.3\% better than the conventional Markov model for top-1 recommendations.}
}

@article{xiaochunliGlucagonlikePeptide1based2013,
  title = {Glucagon-like Peptide 1-Based Therapies and Risk of Pancreatitis: A Self-Controlled Case Series Analysis},
  author = {{Xiaochun Li} and {Zuoyi Zhang} and {Jon Duke}},
  year = {2013},
  month = dec,
  journal = {Pharmacoepidemiology and Drug Safety},
  volume = {23},
  number = {3},
  pages = {234--239},
  publisher = {Wiley-Blackwell},
  issn = {1053-8569},
  doi = {10.1002/pds.3542},
  abstract = {Purpose Previous studies have suggested a link between glucagon-like peptide 1 (GLP-1)-based therapies and acute pancreatitis, while other studies have found no association. Because differences in diabetes severity may confound this relationship, a self-controlled case series (SCCS) analysis has been suggested as a means to control for individual-level confounding. Methods We evaluated the relationship between GLP-1-based therapies and pancreatitis by SCCS method using a large observational database. We calculated the incidence density ratio of pancreatitis for exposure versus non-exposure to each drug. To examine the robustness of our findings, we performed sensitivity analyses by varying risk windows, using two pancreatitis definitions and including incident pancreatitis or all occurrences. Results From dispensing data on 1.2 million patients, we found 7992 sitagliptin-exposed patients and 3552 exenatide-exposed patients between 2004 and 2009. Using an ICD9/CPT-based case definition of pancreatitis, we identified 207 sitagliptin and 82 exenatide cases. Augmenting this definition with laboratory criteria increased our cohort to 245 sitagliptin and 96 exenatide cases. For sitagliptin and exenatide cases, respectively, the mean duration of observation was 5.2 and 5.5 years, and the mean duration of drug exposure was 0.7 and 0.5 years. For all analyses (including different pancreatitis definitions, risk periods, and incident or recurrent events), the incidence density ratios for development of pancreatitis during exposure versus non-exposure ranged from 0.68 to 1.46, with all having 95\% confidence intervals containing 1. Conclusions We found no association between the use of GLP-1-based therapies and pancreatitis using SCCS analysis in a large observational database. Copyright {\copyright} 2013 John Wiley \& Sons, Ltd.}
}

@article{xiaodongpengExploringStructuralProtein2014,
  title = {Exploring a Structural Protein--Drug Interactome for New Therapeutics in Lung Cancer},
  author = {{Xiaodong Peng} and {Fang Wang} and {Liwei Li} and {Khuchtumur Bum-Erdene} and {David Xu} and {Bo Wang} and {Anthony Sinn} and {Karen E. Pollok} and {George E. Sandusky} and {Lang Li} and {John J. Turchi} and {Shadia I. Jalal} and {Samy O. Meroueh}},
  year = {2014},
  month = jan,
  journal = {Molecular BioSystems},
  volume = {10},
  number = {3},
  pages = {581--591},
  publisher = {Royal Society of Chemistry},
  issn = {1742-2051},
  doi = {10.1039/c3mb70503j},
  abstract = {The pharmacology of drugs is often defined by more than one protein target.}
}

@article{xueyingwangMixtureDrugCount2017,
  title = {Mixture Drug-count Response Model for the High-dimensional Drug Combinatory Effect on Myopathy},
  author = {{Xueying Wang} and {Pengyue Zhang} and {Chien Wei Chiang} and {Hao Wu} and {Li Shen} and {Xia Ning} and {Donglin Zeng} and {Lei Wang} and {Sara K. Quinney} and {Weixing Feng} and {Lang Li}},
  year = {2017},
  month = nov,
  journal = {Statistics in Medicine},
  volume = {37},
  number = {4},
  pages = {673--686},
  publisher = {Wiley},
  issn = {0277-6715},
  doi = {10.1002/sim.7545},
  abstract = {Drug-drug interactions (DDIs) are a common cause of adverse drug events (ADEs). The electronic medical record (EMR) database and the FDA's adverse event reporting system (FAERS) database are the major data sources for mining and testing the ADE associated DDI signals. Most DDI data mining methods focus on pair-wise drug interactions, and methods to detect high-dimensional DDIs in medical databases are lacking. In this paper, we propose 2 novel mixture drug-count response models for detecting high-dimensional drug combinations that induce myopathy. The ``count'' indicates the number of drugs in a combination. One model is called fixed probability mixture drug-count response model with a maximum risk threshold (FMDRM-MRT). The other model is called count-dependent probability mixture drug-count response model with a maximum risk threshold (CMDRM-MRT), in which the mixture probability is count dependent. Compared with the previous mixture drug-count response model (MDRM) developed by our group, these 2 new models show a better likelihood in detecting high-dimensional drug combinatory effects on myopathy. CMDRM-MRT identified and validated (54; 374; 637; 442; 131) 2-way to 6-way drug interactions, respectively, which induce myopathy in both EMR and FAERS databases. We further demonstrate FAERS data capture much higher maximum myopathy risk than EMR data do. The consistency of 2 mixture models' parameters and local false discovery rate estimates are evaluated through statistical simulation studies.}
}

@article{xuhanIdentificationMechanisticInvestigation2015,
  title = {Identification and {{Mechanistic Investigation}} of {{Drug}}--{{Drug Interactions Associated With Myopathy}}: {{A Translational Approach}}},
  author = {{Xu Han} and {Sara K. Quinney} and {Z Wang} and {P Zhang} and {Jon Duke} and {Zeruesenay Desta} and {JS Elmendorf} and {D. A. Flockhart} and {L Li}},
  year = {2015},
  month = aug,
  journal = {Clinical Pharmacology \& Therapeutics},
  volume = {98},
  number = {3},
  pages = {321--327},
  publisher = {Nature Portfolio},
  issn = {0009-9236},
  doi = {10.1002/cpt.150},
  abstract = {Myopathy is a group of muscle diseases that can be induced or exacerbated by drug-drug interactions (DDIs). We sought to identify clinically important myopathic DDIs and elucidate their underlying mechanisms. Five DDIs were found to increase the risk of myopathy based on analysis of observational data from the Indiana Network of Patient Care. Loratadine interacted with simvastatin (relative risk 95\% confidence interval [CI] = [1.39, 2.06]), alprazolam (1.50, 2.31), ropinirole (2.06, 5.00), and omeprazole (1.15, 1.38). Promethazine interacted with tegaserod (1.94, 4.64). In vitro investigation showed that these DDIs were unlikely to result from inhibition of drug metabolism by CYP450 enzymes or from inhibition of hepatic uptake via the membrane transporter OATP1B1/1B3. However, we did observe in vitro synergistic myotoxicity of simvastatin and desloratadine, suggesting a role in loratadine-simvastatin interaction. This interaction was epidemiologically confirmed (odds ratio 95\% CI = [2.02, 3.65]) using the data from the US Food and Drug Administration Adverse Event Reporting System.}
}

@article{yu-binyangMicroSharePrivacyPreservedMedical2018,
  title = {{{MicroShare}}: {{Privacy-Preserved Medical Resource Sharing}} through {{MicroService Architecture}}},
  author = {{Yu-Bin Yang} and {Quan Zu} and {Peng Liu} and {Defang Ouyang} and {Xiaoshan Li}},
  year = {2018},
  month = jan,
  journal = {International Journal of Biological Sciences},
  volume = {14},
  number = {8},
  pages = {907--919},
  publisher = {Ivyspring International Publisher},
  issn = {1449-2288},
  doi = {10.7150/ijbs.24617},
  abstract = {This paper takes up the problem of medical resource sharing through MicroService architecture without compromising patient privacy. To achieve this goal, we suggest refactoring the legacy EHR systems into autonomous MicroServices communicating by the unified techniques such as RESTFul web service. This lets us handle clinical data queries directly and far more efficiently for both internal and external queries. The novelty of the proposed approach lies in avoiding the data de-identification process often used as a means of preserving patient privacy. The implemented toolkit combines software engineering technologies such as Java EE, RESTful web services, JSON Web Tokens to allow exchanging medical data in an unidentifiable XML and JSON format as well as restricting users to the need-to-know principle. Our technique also inhibits retrospective processing of data such as attacks by an adversary on a medical dataset using advanced computational methods to reveal Protected Health Information (PHI). The approach is validated on an endoscopic reporting application based on openEHR and MST standards. From the usability perspective, the approach can be used to query datasets by clinical researchers, governmental or non-governmental organizations in monitoring health care and medical record services to improve quality of care and treatment.}
}

@article{yuxizhuMultistateTransitionModel2021,
  title = {A Multistate Transition Model for Statin-induced Myopathy and Statin Discontinuation},
  author = {{Yuxi Zhu} and {Chun-Pin Chiang} and {Lei Wang} and {Guy Brock} and {M. Wesley Milks} and {Weidan Cao} and {Pengyue Zhang} and {Donglin Zeng} and {Macarius Donneyong} and {Lang Li}},
  year = {2021},
  month = sep,
  journal = {CPT: pharmacometrics \& systems pharmacology},
  volume = {10},
  number = {10},
  pages = {1236--1244},
  publisher = {Nature Portfolio},
  issn = {2163-8306},
  doi = {10.1002/psp4.12691},
  abstract = {The overarching goal of this study was to simultaneously model the dynamic relationships among statin exposure, statin discontinuation, and potentially statin-related myopathic outcomes. We extracted data from the Indiana Network of Patient Care for 134,815 patients who received statin therapy between January 4, 2004, and December 31, 2008. All individuals began statin treatment, some discontinued statin use, and some experienced myopathy and/or rhabdomyolysis while taking the drug or after discontinuation. We developed a militate model to characterize 12 transition probabilities among six different states defined by use or discontinuation of statin and its associated myopathy or rhabdomyolysis. We found that discontinuation of statin therapy was common and frequently early, with 44.4\% of patients discontinuing therapy after 1 month, and discontinuation is a strong indicator for statin-induced myopathy (risk ratio, 10.8; p {$<$} 0.05). Women more likely than men (p {$<$} 0.05) and patients aged 65 years and older had a higher risk than those aged younger than 65 years to discontinue statin use or experience myopathy. In conclusion, we introduce an innovative multistate model that allows clear depiction of the relationship between statin discontinuation and statin-induced myopathy. For the first time, we have successfully demonstrated and quantified the relative risk of myopathy between patients who continued and discontinued statin therapy. Age and sex were two strong risk factors for both statin discontinuation and incident myopathy.}
}

@article{z.liuDisparitiesOsteoporosisTreatments2015,
  title = {Disparities in Osteoporosis Treatments},
  author = {{Z. Liu} and {Jerusha Weaver} and {Anne E. de Papp} and {Z. Li} and {J. C. Martin} and {Katie Allen} and {Siu L. Hui} and {Erik A. Imel}},
  year = {2015},
  month = jul,
  journal = {Osteoporosis International},
  volume = {27},
  number = {2},
  pages = {509--519},
  publisher = {Springer Science+Business Media},
  issn = {0937-941X},
  doi = {10.1007/s00198-015-3249-0}
}