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A tale of three subspecialties: Diagnosis recording patterns are internally consistent but Specialty-Dependent.

ABSTRACT: Background:Structured diagnosis (DX) are crucial for secondary use of electronic health record (EHR) data. However, they are often suboptimally recorded. Our previous work showed initial evidence of variable DX recording patterns in oncology charts even after biopsy records are available. Objective:We verified this finding's internal and external validity. We hypothesized that this recording pattern would be preserved in a larger cohort of patients for the same disease. We also hypothesized that this effect would vary across subspecialties. Methods:We extracted DX data from EHRs of patients treated for brain, lung, and pancreatic neoplasms, identified through clinician-led chart reviews. We used statistical methods (i.e., binomial and mixed model regressions) to test our hypotheses. Results:We found variable recording patterns in brain neoplasm DX (i.e., larger number of distinct DX-OR = 2.2, P < 0.0001, higher descriptive specificity scores-OR = 1.4, P < 0.0001-and much higher entropy after the BX-OR = 3.8 P = 0.004 and OR = 8.0, P < 0.0001), confirming our initial findings. We also found strikingly different patterns for lung and pancreas DX. Although both seemed to have much lower DX sequence entropy after the BX-OR = 0.198, P = 0.015 and OR = 0.099, P = 0.015, respectively compared to OR = 3.8 P = 0.004). We also found statistically significant differences between the brain dataset and both the lung (P < 0.0001) and pancreas (0.009

SUBMITTER: Diaz-Garelli JF

PROVIDER: S-EPMC6951969 | biostudies-literature | 2019 Oct

REPOSITORIES: biostudies-literature

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A tale of three subspecialties: Diagnosis recording patterns are internally consistent but Specialty-Dependent.

Diaz-Garelli Jose-Franck JF Strowd Roy R Ahmed Tamjeed T Wells Brian J BJ Merrill Rebecca R Laurini Javier J Pasche Boris B Topaloglu Umit U

JAMIA open 20190805 3

<h4>Background</h4>Structured diagnosis (DX) are crucial for secondary use of electronic health record (EHR) data. However, they are often suboptimally recorded. Our previous work showed initial evidence of variable DX recording patterns in oncology charts even after biopsy records are available.<h4>Objective</h4>We verified this finding's internal and external validity. We hypothesized that this recording pattern would be preserved in a larger cohort of patients for the same disease. We also hy ...[more]

PMID: 31984369

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Project description:Bursting is one of the fundamental rhythms that excitable cells can generate either in response to incoming stimuli or intrinsically. It has been a topic of intense research in computational biology for several decades. The classification of bursting oscillations in excitable systems has been the subject of active research since the early 1980s and is still ongoing. As a by-product, it establishes analytical and numerical foundations for studying complex temporal behaviors in multiple timescale models of cellular activity. In this review, we first present the seminal works of Rinzel and Izhikevich in classifying bursting patterns of excitable systems. We recall a complementary mathematical classification approach by Bertram and colleagues, and then by Golubitsky and colleagues, which, together with the Rinzel-Izhikevich proposals, provide the state-of-the-art foundations to these classifications. Beyond classical approaches, we review a recent bursting example that falls outside the previous classification systems. Generalizing this example leads us to propose an extended classification, which requires the analysis of both fast and slow subsystems of an underlying slow-fast model and allows the dissection of a larger class of bursters. Namely, we provide a general framework for bursting systems with both subthreshold and superthreshold oscillations. A new class of bursters with at least 2 slow variables is then added, which we denote folded-node bursters, to convey the idea that the bursts are initiated or annihilated via a folded-node singularity. Key to this mechanism are so-called canard or duck orbits, organizing the underpinning excitability structure. We describe the 2 main families of folded-node bursters, depending upon the phase (active/spiking or silent/nonspiking) of the bursting cycle during which folded-node dynamics occurs. We classify both families and give examples of minimal systems displaying these novel bursting patterns. Finally, we provide a biophysical example by reinterpreting a generic conductance-based episodic burster as a folded-node burster, showing that the associated framework can explain its subthreshold oscillations over a larger parameter region than the fast subsystem approach.

Project description:BackgroundMultiple payment reform efforts are under way to improve the value of care delivered to Medicare beneficiaries, yet few directly address the interface between primary and specialty care.ObjectiveTo describe regional variation in outpatient visits for individual specialties and the association between specialty physician-specific payments and patient-reported satisfaction with care and health status.DesignRetrospective cross-sectional study.PatientsA 20 % random sample of Medicare fee-for-service beneficiaries in 2012.Main measuresRegions were grouped into quartiles of specialist index, defined as the observed/expected regional likelihood of having an outpatient visit to a specialist, for ten common specialties, adjusting for age, sex, and race. Outcomes were per capita specialty-specific physician payments and Medicare Current Beneficiary Survey responses.Key resultsThe proportion of beneficiaries seeing a specialist varied the most for endocrinology and gastroenterology (3.7- and 3.9-fold difference between the highest and lowest quartiles, respectively) and least for orthopedics and urology (1.5- and 1.7-fold difference, respectively). Multiple analyses suggested that this variation was not explained by prevalence of disease. Average specialty-specific payments were strongly associated with the likelihood of visiting a specialist. Differences in per capita payments from lowest (Q1) to highest quartiles (Q4) were greatest for cardiology ($89, $135, $172, $251) and dermatology ($46, $64, $82, $124). Satisfaction with overall care (median [interquartile range] across specialties: Q1, 93.3 % [92.6-93.7 %]; Q4, 93.1 % [92.9-93.2 %]) and self-reported health status (Q1, 37.1 % [36.9-37.7 %]; Q4, 38.2 % [37.2-38.4 %]) was similar across quartiles. Satisfaction with access to specialty care was consistently lower in the lowest quartile of specialty index (Q1, 89.7 % [89.2-91.1 %]; Q4, 94.5 % [94.4-94.8 %]).ConclusionsSubstantial regional variability in outpatient specialist visits is associated with greater payments with limited benefits in terms of patient-reported satisfaction with care or reported health status. Reducing outpatient physician visits may represent an important opportunity to improve the efficiency of care.

Dataset Information

A tale of three subspecialties: Diagnosis recording patterns are internally consistent but Specialty-Dependent.

Publications

A tale of three subspecialties: Diagnosis recording patterns are internally consistent but Specialty-Dependent.

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