Edward Ewen

Data warehousing in an integrated health system: building the business case

1. ABSTRACT Healthcare presents unique challenges for the architect of a data warehouse. Integrated health systems are shifting its focus away from the acute care setting and moving towards cross-continuum care management. Improving healthcare quality while reducing costs requires the elimination of unnecessary variation in the care process. This paper describes the lessons learned during the business case development for the project. Topics include establishing the need for a data warehouse, understanding data warehousing in healthcare, justifying the cost of a data warehouse, building the team, and setting achievable goals.

Electronic Health Record Use to Classify Patients with Newly Diagnosed versus Preexisting Type 2 Diabetes: Infrastructure for Comparative Effectiveness Research and Population Health Management

Use of electronic health record (EHR) content for comparative effectiveness research (CER) and population health management requires significant data configuration. A retrospective cohort study was conducted using patients with diabetes followed longitudinally (N=36,353) in the EHR deployed at outpatient practice networks of 2 health care systems. A data extraction and classification algorithm targeting identification of patients with a new diagnosis of type 2 diabetes mellitus (T2DM) was applied, with the main criterion being a minimum 30-day window between the first visit documented in the EHR and the entry of T2DM on the EHR problem list. Chart reviews (N=144) validated the performance of refining this EHR classification algorithm with external administrative data. Extraction using EHR data alone designated 3205 patients as newly diagnosed with T2DM with classification accuracy of 70.1%. Use of external administrative data on that preselected population improved classification accuracy of cases identified as new T2DM diagnosis (positive predictive value was 91.9% with that step). Laboratory and medication data did not help case classification. The final cohort using this 2-stage classification process comprised 1972 patients with a new diagnosis of T2DM. Data use from current EHR systems for CER and disease management mandates substantial tailoring. Quality between EHR clinical data generated in daily care and that required for population health research varies. As evidenced by this process for classification of newly diagnosed T2DM cases, validation of EHR data with external sources can be a valuable step.

Initial and subsequent therapy for newly diagnosed type 2 diabetes patients treated in primary care using data from a vendor-based electronic health record†

Diabetes is a leading cause of death and disability, and its prevalence is increasing. When diet fails, patients with type 2 diabetes mellitus (T2DM) are prescribed oral hypoglycemics for glycemic control. Few studies have explored initial use or change from initial oral hypoglycemic therapy in the primary care setting. We aimed to describe the utilization of initial oral hypoglycemics among newly diagnosed patients with diabetes from 1998–2009 and changes from initial to subsequent therapy among patients prescribed older oral hypoglycemic agents using electronic health records.

Early data from project engage: a program to identify and transition medically hospitalized patients into addictions treatment

BackgroundPatients with untreated substance use disorders (SUDs) are at risk for frequent emergency department visits and repeated hospitalizations. Project Engage, a US pilot program at Wilmington Hospital in Delaware, was conducted to facilitate entry of these patients to SUD treatment after discharge. Patients identified as having hazardous or harmful alcohol consumption based on results of the Alcohol Use Disorders Identification Test-Primary Care (AUDIT-PC), administered to all patients at admission, received bedside assessment with motivational interviewing and facilitated referral to treatment by a patient engagement specialist (PES). This program evaluation provides descriptive information on self-reported rates of SUD treatment initiation of all patients and health-care utilization and costs for a subset of patients.MethodsProgram-level data on treatment entry after discharge were examined retrospectively. Insurance claims data for two small cohorts who entered treatment after discharge (2009, n = 18, and 2010, n = 25) were reviewed over a six-month period in 2009 (three months pre- and post-Project Engage), or over a 12-month period in 2010 (six months pre- and post-Project Engage). These data provided descriptive information on health-care utilization and costs. (Data on those who participated in Project Engage but did not enter treatment were unavailable).ResultsBetween September 1, 2008, and December 30, 2010, 415 patients participated in Project Engage, and 180 (43%) were admitted for SUD treatment. For a small cohort who participated between June 1, 2009, and November 30, 2009 (n = 18), insurance claims demonstrated a 33% (

Patterns of warfarin use and subsequent outcomes in atrial fibrillation in primary care practices

35,938) decrease in inpatient medical admissions, a 38% (

Comparative effectiveness research using electronic health records: impacts of oral antidiabetic drugs on the development of chronic kidney disease

4,248) decrease in emergency department visits, a 42% (

Efficiency and economic benefits of a payer-based electronic health record in an emergency department

1,579) increase in behavioral health/substance abuse (BH/SA) inpatient admissions, and a 33% (

Determining the In‐Hospital Cost of Bleeding in Patients Undergoing Percutaneous Coronary Intervention

847) increase in outpatient BH/SA admissions, for an overall decrease of

Appropriate Admissions to the Appropriate Unit: A Decision Tree Approach

37,760. For a small cohort who participated between June 1, 2010, and November 30, 2010 (n = 25), claims demonstrated a 58% (

Cost Effectiveness of Enoxaparin in Acute ST-Segment Elevation Myocardial Infarction: The ExTRACT-TIMI 25 (Enoxaparin and Thrombolysis Reperfusion for Acute Myocardial Infarction Treatment-Thrombolysis In Myocardial Infarction 25) Study

68,422) decrease in inpatient medical admissions; a 13% (