Adam B. Wilcox

The Effect of Technology-Supported, Multidisease Care Management on the Mortality and Hospitalization of Seniors

OBJECTIVES: To explore changes in mortality and hospital usage for chronically ill seniors enrolled in a multidisease care management program, Care Management Plus (CMP).

Use of health-related, quality-of-life metrics to predict mortality and hospitalizations in community-dwelling seniors

OBJECTIVES: To investigate whether health‐related quality‐of‐life (HRQoL) scores in a primary care population can be used as a predictor of future hospital utilization and mortality.

Reference Standards, Judges, and Comparison Subjects

Medical informatics systems are often designed to perform at the level of human experts. Evaluation of the performance of these systems is often constrained by lack of reference standards, either because the appropriate response is not known or because no simple appropriate response exists. Even when performance can be assessed, it is not always clear whether the performance is sufficient or reasonable. These challenges can be addressed if an evaluator enlists the help of clinical domain experts. 1) The experts can carry out the same tasks as the system, and then their responses can be combined to generate a reference standard. 2)The experts can judge the appropriateness of system output directly. 3) The experts can serve as comparison subjects with which the system can be compared. These are separate roles that have different implications for study design, metrics, and issues of reliability and validity. Diagrams help delineate the roles of experts in complex study designs.

The Role of Domain Knowledge in Automating Medical Text Report Classification

OBJECTIVE To analyze the effect of expert knowledge on the inductive learning process in creating classifiers for medical text reports. DESIGN The authors converted medical text reports to a structured form through natural language processing. They then inductively created classifiers for medical text reports using varying degrees and types of expert knowledge and different inductive learning algorithms. The authors measured performance of the different classifiers as well as the costs to induce classifiers and acquire expert knowledge. MEASUREMENTS The measurements used were classifier performance, training-set size efficiency, and classifier creation cost. RESULTS Expert knowledge was shown to be the most significant factor affecting inductive learning performance, outweighing differences in learning algorithms. The use of expert knowledge can affect comparisons between learning algorithms. This expert knowledge may be obtained and represented separately as knowledge about the clinical task or about the data representation used. The benefit of the expert knowledge is more than that of inductive learning itself, with less cost to obtain. CONCLUSION For medical text report classification, expert knowledge acquisition is more significant to performance and more cost-effective to obtain than knowledge discovery. Building classifiers should therefore focus more on acquiring knowledge from experts than trying to learn this knowledge inductively.

Association of Integrated Team-Based Care With Health Care Quality, Utilization, and Cost

IMPORTANCE The value of integrated team delivery models is not firmly established. OBJECTIVE To evaluate the association of receiving primary care in integrated team-based care (TBC) practices vs traditional practice management (TPM) practices (usual care) with patient outcomes, health care utilization, and costs. DESIGN A retrospective, longitudinal, cohort study to assess the association of integrating physical and mental health over time in TBC practices with patient outcomes and costs. SETTING AND PARTICIPANTS Adult patients (aged ≥18 years) who received primary care at 113 unique Intermountain Healthcare Medical Group primary care practices from 2003 through 2005 and had yearly encounters with Intermountain Healthcare through 2013, including some patients who received care in both TBC and TPM practices. EXPOSURES Receipt of primary care in TBC practices compared with TPM practices for patients treated in internal medicine, family practice, and geriatrics practices. MAIN OUTCOMES AND MEASURES Outcomes included 7 quality measures, 6 health care utilization measures, payments to the delivery system, and program investment costs. RESULTS During the study period (January 2010-December 2013), 113,452 unique patients (mean age, 56.1 years; women, 58.9%) accounted for 163,226 person-years of exposure in 27 TBC practices and 171,915 person-years in 75 TPM practices. Patients treated in TBC practices compared with those treated in TPM practices had higher rates of active depression screening (46.1% for TBC vs 24.1% for TPM; odds ratio [OR], 1.91 [95% CI, 1.75 to 2.08), adherence to a diabetes care bundle (24.6% for TBC vs 19.5% for TPM; OR, 1.26 [95% CI, 1.11 to 1.42]), and documentation of self-care plans (48.4% for TBC vs 8.7% for TPM; OR, 5.59 [95% CI, 4.27 to 7.33]), lower proportion of patients with controlled hypertension (<140/90 mm Hg) (85.0% for TBC vs 97.7% for TPM; OR, 0.87 [95% CI, 0.80 to 0.95]), and no significant differences in documentation of advanced directives (9.6% for TBC vs 9.9% for TPM; OR, 0.97 [95% CI, 0.91 to 1.03]). Per 100 person-years, rates of health care utilization were lower for TBC patients compared with TPM patients for emergency department visits (18.1 for TBC vs 23.5 for TPM; incidence rate ratio [IRR], 0.77 [95% CI, 0.74 to 0.80]), hospital admissions (9.5 for TBC vs 10.6 for TPM; IRR, 0.89 [95% CI, 0.85 to 0.94]), ambulatory care sensitive visits and admissions (3.3 for TBC vs 4.3 for TPM; IRR, 0.77 [95% CI, 0.70 to 0.85]), and primary care physician encounters (232.8 for TBC vs 250.4 for TPM; IRR, 0.93 [95% CI, 0.92 to 0.94]), with no significant difference in visits to urgent care facilities (55.7 for TBC vs 56.2 for TPM; IRR, 0.99 [95% CI, 0.97 to 1.02]) and visits to specialty care physicians (213.5 for TBC vs 217.9 for TPM; IRR, 0.98 [95% CI, 0.97 to 0.99], P > .008). Payments to the delivery system were lower in the TBC group vs the TPM group (

Emergency Department Access to a Longitudinal Medical Record

3400.62 for TBC vs

Online Health Information Seeking Behaviors of Hispanics in New York City: A Community-Based Cross-Sectional Study

3515.71 for TPM; β, -

Bias Associated with Mining Electronic Health Records

115.09 [95% CI, -

Measuring the Effects of Health Information Technology on Quality of Care: A Novel Set of Proposed Metrics for Electronic Quality Reporting

199.64 to -

Health data use, stewardship, and governance: ongoing gaps and challenges: a report from AMIA's 2012 Health Policy Meeting

30.54]) and were less than investment costs of the TBC program. CONCLUSIONS AND RELEVANCE Among adults enrolled in an integrated health care system, receipt of primary care at TBC practices compared with TPM practices was associated with higher rates of some measures of quality of care, lower rates for some measures of acute care utilization, and lower actual payments received by the delivery system.