pSCANNER: Patient-centered scalable national network for effectiveness research

pre-printThis article describes the patient-centered Scalable National Network for Effectiveness Research (pSCANNER), which is part of the recently formed PCORnet, a national network composed of learning healthcare systems and patient-powered research networks funded by the Patient Centered Outcomes Research Institute (PCORI). It is designed to be a stakeholder-governed federated network that uses a distributed architecture to integrate data from three existing networks covering over 21 million patients in all 50 states: (1) VA Informatics and Computing Infrastructure (VINCI), with data from Veteran Health Administration's 151 inpatient and 909 ambulatory care and community-based outpatient clinics; (2) the University of California Research exchange (UC-ReX) network, with data from UC Davis, Irvine, Los Angeles, San Francisco, and San Diego; and (3) SCANNER, a consortium of UCSD, Tennessee VA, and three federally qualified health systems in the Los Angeles area supplemented with claims and health information exchange data, led by the University of Southern California. Initial use cases will focus on three conditions: (1) congestive heart failure; (2) Kawasaki disease; (3) obesity. Stakeholders, such as patients, clinicians, and health service researchers, will be engaged to prioritize research questions to be answered through the network. We will use a privacy-preserving distributed computation model with synchronous and asynchronous modes. The distributed system will be based on a common data model that allows the construction and evaluation of distributed multivariate models for a variety of statistical analyses

An enhanced concept based approach medical information retrieval to address readability, vocabulary and presentation issues

Querying of health information retrieval for health advice has now become a general and notable task performed by individuals on the Internet. However, the failure of the existing approaches to integrate program modules that would address the information needs of all categories of end-users remains. This study focused on proposing an improved framework and designing an enhanced concept based approach (ECBA) for medical information retrieval that would better address readability, vocabulary mismatched and presentation issues by generating medical discharge documents and medical search queries results in both medical expert and layman’s forms. Three special program modules were designed and integrated in the enhanced concept based approach namely: medical terms control module, vocabulary controlled module and readability module to specifically address the information needs of both medical experts and laymen end-users. Eight benched marked datasets namely: Medline, UMLS, MeSH, Metamap, Metathesaurus, Diagnosia 7, Khresmoi Project 6 and Genetic Home Reference were used in validating the systems performance. Additionally, the ECBA was compared using three existing approaches such as concept based approach (CBA), query likelihood model (QLM) and latent semantic indexing (LSI). The evaluation was conducted using the performance and statistical metrics: P@40, NDCG@40, MAP, Analysis of Variance (ANOVA) and Turkey HSD Tests. The outcome of the final experimental results obtained shows that, the ECBA consistently obtained above 93% accuracy rate results on Medline, UMLS and MeSH Datasets, 92% on Metamap, Metathesaurus and Diagnosia 7 datasets and 91% on Khresmoi Project 6 and Genetic Home Reference datasets. Also, the statistical analysis performance results obtained by each of the four approaches: ECBA, CBA, QLM and LSI shows that, there is a significant difference among their Mean Scores, hence, the null hypothesis of no significant difference was rejected

Front-Line Physicians' Satisfaction with Information Systems in Hospitals

Day-to-day operations management in hospital units is difficult due to continuously varying situations, several actors involved and a vast number of information systems in use. The aim of this study was to describe front-line physicians' satisfaction with existing information systems needed to support the day-to-day operations management in hospitals. A cross-sectional survey was used and data chosen with stratified random sampling were collected in nine hospitals. Data were analyzed with descriptive and inferential statistical methods. The response rate was 65 % (n = 111). The physicians reported that information systems support their decision making to some extent, but they do not improve access to information nor are they tailored for physicians. The respondents also reported that they need to use several information systems to support decision making and that they would prefer one information system to access important information. Improved information access would better support physicians' decision making and has the potential to improve the quality of decisions and speed up the decision making process.Peer reviewe

Policy and Place: A Spatial Data Science Framework for Research and Decision-Making

abstract: A major challenge in health-related policy and program evaluation research is attributing underlying causal relationships where complicated processes may exist in natural or quasi-experimental settings. Spatial interaction and heterogeneity between units at individual or group levels can violate both components of the Stable-Unit-Treatment-Value-Assumption (SUTVA) that are core to the counterfactual framework, making treatment effects difficult to assess. New approaches are needed in health studies to develop spatially dynamic causal modeling methods to both derive insights from data that are sensitive to spatial differences and dependencies, and also be able to rely on a more robust, dynamic technical infrastructure needed for decision-making. To address this gap with a focus on causal applications theoretically, methodologically and technologically, I (1) develop a theoretical spatial framework (within single-level panel econometric methodology) that extends existing theories and methods of causal inference, which tend to ignore spatial dynamics; (2) demonstrate how this spatial framework can be applied in empirical research; and (3) implement a new spatial infrastructure framework that integrates and manages the required data for health systems evaluation. The new spatially explicit counterfactual framework considers how spatial effects impact treatment choice, treatment variation, and treatment effects. To illustrate this new methodological framework, I first replicate a classic quasi-experimental study that evaluates the effect of drinking age policy on mortality in the United States from 1970 to 1984, and further extend it with a spatial perspective. In another example, I evaluate food access dynamics in Chicago from 2007 to 2014 by implementing advanced spatial analytics that better account for the complex patterns of food access, and quasi-experimental research design to distill the impact of the Great Recession on the foodscape. Inference interpretation is sensitive to both research design framing and underlying processes that drive geographically distributed relationships. Finally, I advance a new Spatial Data Science Infrastructure to integrate and manage data in dynamic, open environments for public health systems research and decision- making. I demonstrate an infrastructure prototype in a final case study, developed in collaboration with health department officials and community organizations.Dissertation/ThesisDoctoral Dissertation Geography 201

Doctor of Philosophy

DissertationHealth information technology (HIT) in conjunction with quality improvement (QI) methodologies can promote higher quality care at lower costs. Unfortunately, most inpatient hospital settings have been slow to adopt HIT and QI methodologies. Successful adoption requires close attention to workflow. Workflow is the sequence of tasks, processes, and the set of people or resources needed for those tasks that are necessary to accomplish a given goal. Assessing the impact on workflow is an important component of determining whether a HIT implementation will be successful, but little research has been conducted on the impact of eMeasure (electronic performance measure) implementation on workflow. One solution to addressing implementation challenges such as the lack of attention to workflow is an implementation toolkit. An implementation toolkit is an assembly of instruments such as checklists, forms, and planning documents. We developed an initial eMeasure Implementation Toolkit for the heart failure (HF) eMeasure to allow QI and information technology (IT) professionals and their team to assess the impact of implementation on workflow. During the development phase of the toolkit, we undertook a literature review to determine the components of the toolkit. We conducted stakeholder interviews with HIT and QI key informants and subject matter experts (SMEs) at the US Department of Veteran Affairs (VA). Key informants provided a broad understanding about the context of workflow during eMeasure implementation. Based on snowball sampling, we also interviewed other SMEs based on the recommendations of the key informants who suggested tools and provided information essential to the toolkit development. The second phase involved evaluation of the toolkit for relevance and clarity, by experts in non-VA settings. The experts evaluated the sections of the toolkit that contained the tools, via a survey. The final toolkit provides a distinct set of resources and tools, which were iteratively developed during the research and available to users in a single source document. The research methodology provided a strong unified overarching implementation framework in the form of the Promoting Action on Research Implementation in Health Services (PARIHS) model in combination with a sociotechnical model of HIT that strengthened the overall design of the study