Using electronic health records to streamline provider recruitment for implementation science studies.
Using electronic health records to streamline provider recruitment for implementation science studies.
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DOI：
10.1371/journal.pone.0267915
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发表时间：
2022
期刊：
影响因子：
3.7
通讯作者：
中科院分区：
文献类型：
--
作者：
医疗保健提供者通常被定位为研究参与者，特别是对于评估提供者或系统级问题的实施科学研究。通常，提供者的资格取决于提供者和患者的因素。手动图表审查和自我报告是常见的提供商筛选策略，但需要大量时间、精力和资源。电子健康记录 (EHR) 数据的自动使用可以简化实施科学研究的提供者身份识别。在这里，我们描述了一种为退伍军人健康管理局 (VHA) 资助的研究提供者筛查的方法，该研究的重点是对膀胱癌患者实施风险调整监测。我们的目标是确定在 2020 年 1 月 16 日开始招募之前的 12 个月内，在 6 个预先指定的机构中对膀胱癌患者进行了 ≥10 次膀胱镜监测手术的提供者，并且目前正在 6 个预先指定的机构中的 1 个机构中执业。使用 VHA EHR 数据（使用 CPT、ICD10 程序和 ICD10 诊断代码），我们确定了初次膀胱癌诊断后进行的膀胱镜检查程序（即监测程序）。程序与 VHA 工作人员数据相关联，以确定记录提供者、他们进行的膀胱镜检查次数以及他们当前的执业地点。为了验证这种方法，我们对随机抽样的已确定提供商执行的 105 个程序进行了图表审查。计算正确识别程序的比例（阳性预测值 (PPV)）以及二项式 95% 置信区间 (CI)。我们确定了 1999 年 10 月 1 日至 2020 年 1 月 16 日期间，全国 VHA 对 703,324 名患者进行了 1,917,856 次膀胱镜检查。在这些手术中，40% 的患者是有膀胱癌病史的患者，由 15,065 名不同的提供者完成。其中，61 人进行了 ≥ 10 次手术，并且目前在研究招募前 1 年内在 6 家感兴趣的机构中的 1 家执业。对 7 家提供商的随机图表审查发现，105 项程序中的 101 项（PPV：96%；95% CI：91% 至 99%）是监测程序，并由选定的提供商在记录日期执行。这些结果表明，当纳入标准包含患者（诊断和手术之间的时间关系）和提供者层面（手术频率和当前实践位置）因素时，EHR 数据可用于准确识别作为研究参与者的医疗保健提供者。由于管理代码和提供者标识符在大多数（如果不是全部）EHR 中收集用于计费目的，因此这种方法可以从 VHA 中的提供者招募转化为其他医疗保健系统。实施研究应考虑这种筛选提供者的方法。
Healthcare providers are often targeted as research participants, especially for implementation science studies evaluating provider- or system-level issues. Frequently, provider eligibility is based on both provider and patient factors. Manual chart review and self-report are common provider screening strategies but require substantial time, effort, and resources. The automated use of electronic health record (EHR) data may streamline provider identification for implementation science research. Here, we describe an approach to provider screening for a Veterans Health Administration (VHA)-funded study focused on implementing risk-aligned surveillance for bladder cancer patients. Our goal was to identify providers at 6 pre-specified facilities who performed ≥10 surveillance cystoscopy procedures among bladder cancer patients in the 12 months prior to recruitment start on January 16, 2020, and who were currently practicing at 1 of 6 pre-specified facilities. Using VHA EHR data (using CPT, ICD10 procedure, and ICD10 diagnosis codes), we identified cystoscopy procedures performed after an initial bladder cancer diagnosis (i.e., surveillance procedures). Procedures were linked to VHA staff data to determine the provider of record, the number of cystoscopies they performed, and their current location of practice. To validate this approach, we performed a chart review of 105 procedures performed by a random sample of identified providers. The proportion of correctly identified procedures was calculated (Positive Predictive Value (PPV)), along with binomial 95% confidence intervals (CI). We identified 1,917,856 cystoscopies performed on 703,324 patients from October 1, 1999—January 16, 2020, across the nationwide VHA. Of those procedures, 40% were done on patients who had a prior record of bladder cancer and were completed by 15,065 distinct providers. Of those, 61 performed ≥ 10 procedures and were currently practicing at 1 of the 6 facilities of interest in the 1 year prior to study recruitment. The random chart review of 7 providers found 101 of 105 procedures (PPV: 96%; 95% CI: 91% to 99%) were surveillance procedures and were performed by the selected provider on the recorded date. These results show that EHR data can be used for accurate identification of healthcare providers as research participants when inclusion criteria consist of both patient- (temporal relationship between diagnosis and procedure) and provider-level (frequency of procedure and location of current practice) factors. As administrative codes and provider identifiers are collected in most, if not all, EHRs for billing purposes this approach can be translated from provider recruitment in VHA to other healthcare systems. Implementation studies should consider this method of screening providers.
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影响因子：
3
作者：
Gordon MK;Baum RA;Gardner W;Kelleher KJ;Langberg JM;Brinkman WB;Epstein JN
通讯作者：
Epstein JN
影响因子：
9.7
作者：
Fihn, Stephan D.;Francis, Joseph;Graham, Gail L.
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Graham, Gail L.
影响因子：
13.8
作者：
Schroeck, Florian R.;Lynch, Kristine E.;Sirovich, Brenda
通讯作者：
Sirovich, Brenda
影响因子：
3.5
作者：
van Velthoven MH;Mastellos N;Majeed A;O'Donoghue J;Car J
通讯作者：
Car J
影响因子：
4.5
作者：
Ballaro, A;Oliver, S;Emberton, M
通讯作者：
Emberton, M