scholarly journals Point-of-Care Cluster Randomized Trial in Stroke Secondary Prevention Using Electronic Health Records

Stroke ◽  
2014 ◽  
Vol 45 (7) ◽  
pp. 2066-2071 ◽  
Author(s):  
Alex Dregan ◽  
Tjeerd P. van Staa ◽  
Lisa McDermott ◽  
Gerard McCann ◽  
Mark Ashworth ◽  
...  
Keyword(s):  
Electronic Health Records ◽  
Secondary Prevention ◽  
Randomized Trial ◽  
Point Of Care ◽  
Cluster Randomized Trial ◽  
Health Records ◽  
Electronic Health ◽  
Cluster Randomized

Five analytic challenges in working with electronic health records data to support clinical trials with some solutions

2020 ◽  
Vol 17 (4) ◽  
pp. 370-376
Author(s):  
Benjamin A Goldstein
Keyword(s):  
Clinical Trials ◽  
Electronic Health Records ◽  
Large Scale ◽  
Point Of Care ◽  
Cross Sectional ◽  
Health Records ◽  
Data Resource ◽  
Electronic Health ◽  
Data Elements ◽  
Data Efficiency

Electronic health records data are becoming a key data resource in clinical research. Owing to issues of data efficiency, electronic health records data are being used for clinical trials. This includes both large-scale pragmatic trails and smaller—more focused—point-of-care trials. While electronic health records data open up a number of scientific opportunities, they also present a number of analytic challenges. This article discusses five particular challenges related to organizing electronic health records data for analytic purposes. These are as follows: (1) data are not organized for research purposes, (2) data are both densely and irregularly observed, (3) we don’t have all data elements we may want or need, (4) data are both cross-sectional and longitudinal, and (5) data may be informatively observed. While laying out these challenges, the article notes how many of these challenges can be addressed by careful and thoughtful study design as well as by integration of clinicians and informaticians into the analytic team.

scholarly journals Impact of Point-of-Care Xpert MTB/RIF on Tuberculosis Treatment Initiation. A Cluster-randomized Trial

2017 ◽  
Vol 196 (7) ◽  
pp. 901-910 ◽  
Author(s):  
Richard J. Lessells ◽  
Graham S. Cooke ◽  
Nuala McGrath ◽  
Mark P. Nicol ◽  
Marie-Louise Newell ◽  
...  
Keyword(s):  
Randomized Trial ◽  
Treatment Initiation ◽  
Point Of Care ◽  
Cluster Randomized Trial ◽  
Tuberculosis Treatment ◽  
Cluster Randomized

scholarly journals Collaborative care in secondary prevention of cardiovascular disease in India: Findings from a multi-stakeholder, qualitative analysis

2021 ◽  
Author(s):  
Kavita Singh ◽  
Mark D. Huffman ◽  
Nikhil Tandon ◽  
Raji Devarajan ◽  
Dorairaj Prabhakaran ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Electronic Health Records ◽  
Secondary Prevention ◽  
Collaborative Care ◽  
Health Workers ◽  
Text Messages ◽  
Health Records ◽  
Physician Health ◽  
Electronic Health ◽  
Health Administrators

Abstract Background. Cardiovascular disease (CVD) is pervasive in India, and little is known about the perception of patients and providers about collaborative care in secondary prevention of CVD. To fill this gap, we performed a needs assessment and investigated the barriers and facilitators of the collaborative quality improvement (C-QIP) strategy for secondary prevention of CVD in India.Methods. Between September 2019 – February 2020, we conducted semi-structured in-depth interviews with providers, health administrators, patients and caregivers to understand the challenges and facilitators of the C-QIP strategy consisting of electronic health records-decision support system (EHR-DSS), non-physician health worker and text messages for healthy lifestyle. Also, data were analyzed from the lens of consolidated framework for implementation research (CFIR) to guide effective implementation of the C-QIP strategy. We used an iterative approach for qualitative data analysis based on the framework method. Results. We interviewed 38 physicians, 14 non-physician health workers (nurses, community health workers, pharmacists), 4 health administrators, 16 patients and their caregivers. Challenges perceived from providers’ and health administrators’ perspectives to implement quality in CVD care were related to CFIR actors and inner and outer settings: high patient volume, too few specialists, time-constraints, physician burnout, lack of robust communication system or referral linkage, paucity of electronic health records, lack of patient counsellors, polypharmacy and lack of sustainable financing schemes for outpatient services. In addition, low health literacy, high cost of treatment, misinformation bias, and difficulty in maintaining lifestyle changes were key barriers from patients’ and caregivers’ perspectives. Potential benefits of the C-QIP strategy emerged, such as standardized treatment protocol to minimize variation in care, reduced medication errors, improved physician-patient relationships, and enhanced self-care management. However, concerns were raised about feasibility, adoption, and implementation of EHR-DSS across heterogenous healthcare settings, including related to interoperability, patient confidentiality and data security, appropriateness across diverse patient groups, and care delivery costs.Conclusions. Our findings reveal context-specific, patient-, provider- and health system factors that will influence C-QIP strategy implementation in India. Strategies to optimize chronic care of CVD need to be low-cost, culturally acceptable, targeted, and integrated into existing systems and care pathways to be successful.

scholarly journals Collaborative Care in Secondary Prevention of Cardiovascular Disease in India: Findings From A Multi-Stakeholder, Qualitative Analysis

2021 ◽  
Author(s):  
Kavita Singh ◽  
Mark D. Huffman ◽  
Nikhil Tandon ◽  
Raji Devarajan ◽  
Dorairaj Prabhakaran ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Electronic Health Records ◽  
Secondary Prevention ◽  
Collaborative Care ◽  
Health Workers ◽  
Text Messages ◽  
Health Records ◽  
Physician Health ◽  
Electronic Health ◽  
Health Administrators

Abstract Background. Cardiovascular disease (CVD) is pervasive in India, and little is known about the perception of patients and providers about collaborative care in secondary prevention of CVD. To fill this gap, we performed a needs assessment and investigated the barriers and facilitators of the collaborative quality improvement (C-QIP) strategy for secondary prevention of CVD in India.Methods. Between September 2019 – February 2020, we conducted semi-structured in-depth interviews with providers, health administrators, patients and caregivers to understand the challenges and facilitators of the C-QIP strategy consisting of electronic health records-decision support system (EHR-DSS), non-physician health worker and text messages for healthy lifestyle. Also, data were analyzed from the lens of consolidated framework for implementation research (CFIR) to guide effective implementation of the C-QIP strategy. We used an iterative approach for qualitative data analysis based on the framework method. Results. We interviewed 38 physicians, 14 non-physician health workers (nurses, community health workers, pharmacists), 4 health administrators, 16 patients and their caregivers. Challenges perceived from providers’ and health administrators’ perspectives to implement quality in CVD care were related to CFIR actors and inner and outer settings: high patient volume, too few specialists, time-constraints, physician burnout, lack of robust communication system or referral linkage, paucity of electronic health records, lack of patient counsellors, polypharmacy and lack of sustainable financing schemes for outpatient services. In addition, low health literacy, high cost of treatment, misinformation bias, and difficulty in maintaining lifestyle changes were key barriers from patients’ and caregivers’ perspectives. Potential benefits of the C-QIP strategy emerged, such as standardized treatment protocol to minimize variation in care, reduced medication errors, improved physician-patient relationships, and enhanced self-care management. However, concerns were raised about feasibility, adoption, and implementation of EHR-DSS across heterogenous healthcare settings, including related to interoperability, patient confidentiality and data security, appropriateness across diverse patient groups, and care delivery costs.Conclusions. Our findings reveal context-specific, patient-, provider- and health system factors that will influence C-QIP strategy implementation in India. Strategies to optimize chronic care of CVD need to be low-cost, culturally acceptable, targeted, and integrated into existing systems and care pathways to be successful.

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