Roberta Ambuehl

Structure, Functions, and Activities of a Research Support Informatics Section

The authors describe a research group that supports the needs of investigators seeking data from an electronic medical record system. Since its creation in 1972, the Regenstrief Medical Records System has captured and stored more than 350 million discrete coded observations on two million patients. This repository has become a central data source for prospective and retrospective research. It is accessed by six data analysts--working closely with the institutional review board--who provide investigators with timely and accurate data while protecting patient and provider privacy and confidentiality. From January 1, 1999, to July 31, 2002, data analysts tracked their activities involving 47,559 hours of work predominantly for physicians (54%). While data retrieval (36%) and analysis (25%) were primary activities, data analysts also actively collaborated with researchers. Primary objectives of data provided to investigators were to address disease-specific (35.4%) and drug-related (12.2%) questions, support guideline implementation (13.1%), and probe various aspects of clinical epidemiology (5.7%). Outcomes of these endeavors included 117 grants (including 300,000 US dollars per year salary support for data analysts) and 139 papers in peer-reviewed journals by investigators who rated the support provided by data analysts as extremely valuable.

Prenatal syphilis screening rates measured using medicaid claims and electronic medical records

Background: To prevent congenital syphilis, the Centers for Disease Control and Prevention and professional organizations recommend universal prenatal syphilis screening. State-level or larger-scale evaluations of adherence to these guidelines have relied on administrative data. We measured prenatal syphilis screening rates in Indiana women with prenatal Medicaid coverage and also used electronic medical records to examine the completeness of syphilis screening claims in Medicaid administrative data. Methods: In statewide Indiana Medicaid claims data, diagnosis and procedure codes were used to identify women who delivered an infant between October 1, 1998, and September 30, 2002. Claims for prenatal (that is, during the 40 weeks before and including the delivery date) syphilis screens, including the “obstetric panel” of tests, and for prenatal visits were extracted. A subset of the study population received prenatal care in a large public hospital and its affiliated clinics served by an electronic medical records system. For these women, claims data were compared with laboratory reports. Results: Among 74,188 women with one delivery in Medicaid claims data, 60% had at least 1 prenatal syphilis screening claim, and 15% had 2 or more. Women with continuous Medicaid enrollment during pregnancy or with at least one prenatal visit claim had higher rates. Among the 3960 women for whom Medicaid claims and laboratory data were available, 49.8% had at least one prenatal syphilis screen in Medicaid claims, but 99.3% had at least one laboratory report of a syphilis screen. Conclusions: Measurements made using Medicaid administrative data appear to substantially underestimate true prenatal syphilis screening rates.

Risk of adverse gastrointestinal events from inhaled corticosteroids.

Study Objective. To determine whether patients prescribed inhaled corticosteroids are at risk for adverse gastrointestinal effects.

Age Differences in the Association Between Body Mass Index Class and Annualized Medicare Expenditures

Objective: The aim of the study is to assess the relationship between body mass index (BMI) class and Medicare claims among young-old (65-69), old (70-74), and old-old (75+) adults over a 10-year period. Method: We assessed costs by BMI class and age group among 9,300 respondents to the 1998 Health and Retirement Study (HRS) with linked 1998-2008 Medicare claims data. BMI was classified as normal (18.5-24.9), overweight (25-29.9), mild obesity (30-34.9), or severe obesity (35 or above). Results: Annualized total Medicare claims adjusted for age, gender, ethnicity, education, and smoking history were 109% greater for severely obese young-old adults in comparison with normal weight young-old adults (US

Changes of glucose levels precede dementia in African-Americans with diabetes but not in Caucasians

9,751 vs. US

Is the Safety Net Leaking?: Measuring Changes in Quality of Care and Healthcare Utilization for Patients with Diabetes Mellitus before and after Implementation of Cost-Sharing at a Public Hospital

4,663). Total annualized claim differences between the normal weight and severely obese in the old and old-old groups were not statistically significant. Discussion: Excess Medicare expenditures related to obesity may be concentrated among severely obese young-old adults. Preventing severe obesity among middle and older aged adults may have large cost implications for society.

A TIME-VARYING ASSOCIATION BETWEEN CHOLESTEROL LEVELS AND COGNITIVE FUNCTION

Changes in glucose levels may represent a powerful metabolic indicator of dementia in African‐Americans with diabetes. It is unclear whether these changes also occur in Caucasians.

DECLINE IN GLUCOSE LEVELS PRECEDES DEMENTIA IN ELDERLY AFRICAN AMERICANS WITH DIABETES

Background: In 2003, a county hospital system in the Midwest implemented policies that increased patient cost sharing via increased co-payments for services. The purpose of this study was to measure the impact of those changes for vulnerable patients with diabetes mellitus in subsequent years.. Methods: A state-of-the art electronic medical record system recorded quality and utilization measures for two years before and two years after the operational changes. Data from 2,394 patients with both diabetes mellitus and reliable utilization and quality of care data were included in the study. The associations between the quality of care, health care costs, healthcare utilization, patients’ third party pay or status, and the policy implementation were examined using Linear Mixed-Effects and Generalized Estimating Equations (GEE) models. Results: Compared to before the policy change, the quality of care measures significantly improved for patients with Medicare and indigent care pay or status. Healthcare costs, emergency department visits, and hospitalizations significantly increased after the policy change for patients with Medicare and indigent care insurance. Visits to primary care clinics decreased after the policy change for patients with Medicaid, Medicare, and self pay where as patients on the indigent care program had higher primary care visits. Conclusion: The policy implementation impacted patients in the Indigent Care program, as intended, but also impacted Medicare patients more negatively, in financial and utilization aspects, than expected by the policy. More costly utilization patterns, after increasing cost-sharing policy changes in public hospitals, may lead to higher medical costs for the system in the long-term.

Utilization of Occupational and Physical Therapy Services in Postacute Care: Findings from the 2006 Health and Retirement Study and Linked Medicare Claims Data

changes were observed in the same regions. Alzheimer disease pathology was also present in two members of the family. Conclusions: The E200K-129M haplotype is the most common form of fCJD while there are only five reported cases of E200K-129V haplotype in the literature. The presence of intraneuronal PrP immunopositive inclusions appears to be a consistent finding in subjects with the E200K mutation; however, their morphology needs to be further investigated with high resolution microscopy. Acknowledgements: P30AG010133; NIH P01 AG-14359, Charles S. Britton Fund and CDC UR8/CCU515004.

Health outcomes and cost of care among older adults with schizophrenia: a 10-year study using medical records across the continuum of care.

Background: Cognitive reserve (CR) hypothesis suggests that those with higher levels of reserve can tolerate risk factors of dementia better than those with lower levels of reserve. We tested if higher CR, as indexed by higher educational and occupational attainments, helps to withstand deteriorative effects of cardiovascular disease on cognition. Methods: We studied CR, history of cardiovascular disease (CVD) and old age cognition in a sample of 2284 individuals from a population-based Finnish Twin Cohort study. Summary score of middle age CR was based on five questions on educational and occupational status at a mean age of 47 years. Old age cognitive status at a mean age of 74 years was determined with two validated instruments: a self-report interview for cognitive status (TELE) and the Telephone Interview for Cognitive Status (TICS). We used Finnish dementia cutoff scores of <16 and <22.5 for TELE and TICS, respectively. CVD was obtained from hospital discharge registry data. Results:Both CR and CVD were significant predictors of dementia after a mean follow-up of 28 years. There was also a significant CR-CVD interaction indicating that CVDwas more strongly associated with dementia in thosewith low CR compared to those with high CR. In individuals with high CR, 2.6% (TELE) / 1.3% (TICS) of those without CVD and 0% (TELE) / 0% (TICS) of those with CVDwere demented. In individuals with low CR, 30.6% (TELE) / 25% (TICS) of those without CVD and 40.5% (TELE) / 37.1% (TICS) of those with CVD were demented. Moreover, the level of CR was more strongly (B 1⁄4 1.24 [95%CI 1.03; 1.44]) associated with total TELE/TICS score in those with a history of CVD compared to those without a history of CVD (B1⁄4 1.00 [95%CI 0.89; 1.11]). Conclusions: Our results support the CR hypothesis whereby those with higher levels of reserve tolerate risk factors of dementia better than those with low levels of reserve. Our results also demonstrate that there may be subgroups who are at elevated risk for dementia due to cardiovascular disease. Detecting high risk subgroups is important for early detection of cognitive impairment and dementia.