Sabrina Casucci

Assessment of Innovative Emergency Department Information Displays in a Clinical Simulation Center

The objective of this work was to assess the functional utility of new display concepts for an emergency department information system created using cognitive systems engineering methods, by comparing them to similar displays currently in use. The display concepts were compared to standard displays in a clinical simulation study during which nurse-physician teams performed simulated emergency department tasks. Questionnaires were used to assess the cognitive support provided by the displays, participants’ level of situation awareness, and participants’ workload during the simulated tasks. Participants rated the new displays significantly higher than the control displays in terms of cognitive support. There was no significant difference in workload scores between the display conditions. There was no main effect of display type on situation awareness, but there was a significant interaction; participants using the new displays showed improved situation awareness from the middle to the end of the session. This study demonstrates that cognitive systems engineering methods can be used to create innovative displays that better support emergency medicine tasks, without increasing workload, compared to more standard displays. These methods provide a means to develop emergency department information systems—and more broadly, health information technology—that better support the cognitive needs of healthcare providers.

The Roles of Chronic Disease Complexity, Health System Integration, and Care Management in Post-Discharge Healthcare Utilization in a Low-Income Population

Economically disadvantaged individuals with chronic disease have high rates of in-patient (IP) readmission and emergency department (ED) utilization following initial hospitalization. The purpose of this study was to explore the relationships between chronic disease complexity, health system integration (admission to accountable care organization [ACO] hospital), availability of care management interventions (membership in managed care organization [MCO]), and 90-day post-discharge healthcare utilization. We used de-identified Medicaid claims data from two counties in western New York. The study population was 114,295 individuals who met inclusion criteria, of whom 7,179 had index hospital admissions in the first 9 months of 2013. Individuals were assigned to three disease complexity segments based on presence of 12 prevalent conditions. The 30-day inpatient (IP) readmission rates ranged from 6% in the non-chronic segment to 12% in the chronic disease complexity segment and 21% in the organ system failure complexity segment. Rehospitalization rates (both inpatient and emergency department [ED]) were lower for patients in MCOs and ACOs than for those in fee-for-service care. Complexity of chronic disease, initial hospitalization in a facility that was part of an ACO, MCO membership, female gender, and longer length of stay were associated with a significantly longer time to readmission in the first 90 days, that is, fewer readmissions. Our results add to evidence that high-value post-discharge utilization (fewer IP or ED rehospitalizations and early outpatient follow-up) require population-based transitional care strategies that improve continuity between settings and take into account the illness complexity of the Medicaid population.

Integrating social context into comprehensive shared care plans: A scoping review

Background Failure to address social determinants of health (SDH) may contribute to the problem of readmissions in high-risk individuals. Comprehensive shared care plans (CSCP) may improve care continuity and health outcomes by communicating SDH risk factors across settings. Purpose The purpose of this study to evaluate the state of knowledge for integrating SDH into a CSCP. Our scoping review of the literature considered 13,886 articles, of which seven met inclusion criteria. Results Identified themes were: integrate health and social sectors; interoperability; standardizing ontologies and interventions; process implementation; professional tribalism; and patient centeredness. Discussion There is an emerging interest in bridging the gap between health and social service sectors. Standardized ontologies and theoretical definitions need to be developed to facilitate communication, indexing, and data retrieval. Conclusions We identified a gap in the literature that indicates that foundational work will be required to guide the development of a CSCP that includes SDH that can be shared across settings. The lack of studies published in the United States suggests that this is a critical area for future research and funding.

Integrating Social Determinants of Health into Primary Care Clinical and Informational Workflow during Care Transitions

Context: Care continuity during transitions between the hospital and home requires reliable communication between providers and settings and an understanding of social determinants that influence recovery. Case Description: The coordinating transitions intervention uses real time alerts, delivered directly to the primary care practice for complex chronically ill patients discharged from an acute care setting, to facilitate nurse care coordinator led telephone outreach. The intervention incorporates claims-based risk stratification to prioritize patients for follow-up and an assessment of social determinants of health using the Patient-centered Assessment Method (PCAM). Results from transitional care are stored and transmitted to qualified healthcare providers across the continuum. Findings: Reliance on tools that incorporated interoperability standards facilitated exchange of health information between the hospital and primary care. The PCAM was incorporated into both the clinical and informational workflow through the collaboration of clinical, industry, and academic partners. Health outcomes improved at the study practice over their baseline and in comparison with control practices and the regional Medicaid population. Major Themes: Current research supports the potential impact of systems approaches to care coordination in improving utilization value after discharge. The project demonstrated that flexibility in developing the informational and clinical workflow was critical in developing a solution that improved continuity during transitions. There is additional work needed in developing managerial continuity across settings such as shared comprehensive care plans. Conclusions: New clinical and informational workflows which incorporate social determinant of health data into standard practice transformed clinical practice and improved outcomes for patients.

Exploring Medicaid claims data to understand predictors of healthcare utilization and mortality for Medicaid individuals with or without a diagnosis of lung cancer: a feasibility study

Health disparities in low-income populations complicate care for at-risk individuals or those diagnosed with lung cancer and may influence their patterns of healthcare utilization. The purpose of this study is to examine whether age, sex, providers affiliation, Medicare dual eligibility, and number of comorbidities can predict healthcare utilization, as well as to examine factors influencing mortality in lung biopsy patients. A retrospective review of de-identified Medicaid claims of adults having a lung biopsy in 2013 resulted in classification into lung cancer and non-lung cancer cases based on a lung cancer diagnostic code within 30 days after biopsy. Biopsy cases were further divided by whether or not the providers institution was accredited by the Commission on Cancer (CoC). Inpatient (IP), outpatient (OP), and emergency department (ED) utilization was followed from initial date of biopsy through 2015, or to the earliest date of death, disenrollment, or study end for both groups. The result of Cox proportional hazards regression model indicated that age and the number of comorbidities significantly predicted OP use and the number of comorbidities significantly predicted ED use in patients with lung cancer. However, for non-lung cancer patients, only the number of comorbidities significantly predicted IP and ED uses. Furthermore, for patients with lung cancer, the significant factors of mortality included IP use per month and the number of comorbidities. Patients with lung cancer who received a lung biopsy by a CoC-accredited organization had a longer time of survival from the biopsy event. Our findings suggest that understanding predictors of healthcare utilization and mortality may create opportunities to improve health and quality of life through better healthcare coordination.

Development and Description of a Synthetic, High-Fidelity, Emergency Department Patient Dataset for the Evaluation of Healthcare IT Products

Developing novel interfaces for high-risk situations, such as the Emergency Department, requires a sufficient quantity of detailed patient data to support usability and evaluation activities, yet patient privacy restrictions often prevent the use of actual patient data for these activities. We developed a synthetic dataset to provide a suitable alternative to the use of actual patient data that can be integrated into a variety of research activities. The Emergency Department Information Systems (EDIS) Dataset was developed through close collaboration of experts in Emergency Medicine, Human Factors, and Systems Engineering and provides an ecologically valid set of data for 54 patients, treated in an Emergency Department operating at steady-state, with realistic patient loads and flow. The dataset includes both static and dynamic data for each patient case over a 500-minute time period. A sample application of the dataset is provided to demonstrate how the dataset was used to support the design and evaluation of novel EDIS interface displays and its potential adaptation for future HIT research. This dataset provides a readily adaptable alternative to researchers in need of synthetic patient data to support HIT research and development activities. The EDIS dataset and supporting material are freely available through the University at Buffalo Institutional Repository and can be directly accessed with the URL: hdl.handle.net/10477/75188.