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32. Appendix_MDM-19-501-R1_8-4-2020_online_supp – Supplemental material for Opportunities, Pitfalls, and Alternatives in Adapting Electronic Health Records for Health Services Research

Author

Taksler, Glen B., Dalton, Jarrod E., Perzynski, Adam T., Rothberg, Michael B., Milinovich, Alex, Krieger, Nikolas I., Dawson, Neal V., Roach, Mary J., and Einstadter, Douglas

Subjects
111708 Health and Community Services, 111799 Public Health and Health Services not elsewhere classified, 160807 Sociological Methodology and Research Methods, FOS: Health sciences, FOS: Sociology
Abstract

Supplemental material, Appendix_MDM-19-501-R1_8-4-2020_online_supp for Opportunities, Pitfalls, and Alternatives in Adapting Electronic Health Records for Health Services Research by Glen B. Taksler, Jarrod E. Dalton, Adam T. Perzynski, Michael B. Rothberg, Alex Milinovich, Nikolas I. Krieger, Neal V. Dawson, Mary J. Roach and Douglas Einstadter in Medical Decision Making

Published
2020
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33. DS_10.1177_2381468318814769 – Supplemental material for An Alternative Mathematical Modeling Approach to Estimating a Reference Life Expectancy

Author

Stevens, Elizabeth R., Qinlian Zhou, Taksler, Glen B., Nucifora, Kimberly A., Gourevitch, Marc, and R. Scott Braithwaite

Subjects
111799 Public Health and Health Services not elsewhere classified, FOS: Health sciences
Abstract

Supplemental material, DS_10.1177_2381468318814769 for An Alternative Mathematical Modeling Approach to Estimating a Reference Life Expectancy by Elizabeth R. Stevens, Qinlian Zhou, Glen B. Taksler, Kimberly A. Nucifora, Marc Gourevitch and R. Scott Braithwaite in MDM Policy & Practice

Published
2019
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35. Opportunities, Pitfalls, and Alternatives in Adapting Electronic Health Records for Health Services Research.

Author

Taksler, Glen B., Dalton, Jarrod E., Perzynski, Adam T., Rothberg, Michael B., Milinovich, Alex, Krieger, Nikolas I., Dawson, Neal V., Roach, Mary J., Lewis, Michael D., and Einstadter, Douglas

Abstract

Electronic health records (EHRs) offer the potential to study large numbers of patients but are designed for clinical practice, not research. Despite the increasing availability of EHR data, their use in research comes with its own set of challenges. In this article, we describe some important considerations and potential solutions for commonly encountered problems when working with large-scale, EHR-derived data for health services and community-relevant health research. Specifically, using EHR data requires the researcher to define the relevant patient subpopulation, reliably identify the primary care provider, recognize the EHR as containing episodic (i.e., unstructured longitudinal) data, account for changes in health system composition and treatment options over time, understand that the EHR is not always well-organized and accurate, design methods to identify the same patient across multiple health systems, account for the enormous size of the EHR, and consider barriers to data access. Associations found in the EHR may be nonrepresentative of associations in the general population, but a clear understanding of the EHR-based associations can be enormously valuable to the process of improving outcomes for patients in learning health care systems. In the context of building 2 large-scale EHR-derived data sets for health services research, we describe the potential pitfalls of EHR data and propose some solutions for those planning to use EHR data in their research. As ever greater amounts of clinical data are amassed in the EHR, use of these data for research will become increasingly common and important. Attention to the intricacies of EHR data will allow for more informed analysis and interpretation of results from EHR-based data sets. [ABSTRACT FROM AUTHOR]

Published
2021
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41. Sociodemographic predictors of patients with brain metastases treated with stereotactic radiosurgery

Author

Alphonse-Sullivan, Natalie, primary, Taksler, Glen B., additional, Lycan, Thomas, additional, Weaver, Kathryn E., additional, McTyre, Emory R., additional, Shenker, Rachel F., additional, Page, Brandi R., additional, Isom, Scott, additional, Johnson, Adam, additional, Munley, Michael T., additional, Laxton, Adrian W., additional, Tatter, Stephen B., additional, Watabe, Kounosuke, additional, Chan, Michael D., additional, and Ruiz, Jimmy, additional

Published
2017
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44. Impact of video education on influenza vaccination in pregnancy

Author

Goodman, Kenneth, Mossad, Sherif B., Taksler, Glen B., Emery, Jonathan, Schramm, Sarah, and Rothberg, Michael B.

Subjects
Adult, Health Knowledge, Attitudes, Practice, Patient Education as Topic, Influenza Vaccines, Pregnancy, Influenza, Human, Vaccination, Humans, Videotape Recording, Female, Prenatal Care, Pregnancy Complications, Infectious, Article
Abstract

Despite influenza vaccination being an integral part of prenatal care, vaccination rates remain low. To evaluate the impact of pre-visit video education on patients' vaccination health beliefs and vaccination rate.From November 2013-January 2014 unvaccinated patients seen for routine prenatal carewere randomized into 2 study groups: pre-visit vaccination video education or control. Pre- and post-video health beliefs were assessed on a 5-point scale, and unvaccinated participants were subsequently interviewed by phone.In 105 randomized participants, intervention positively influenced health beliefs, as demonstrated by differences in mean pre- versus post-video scores for intervention versus control: vaccination may harm mother (difference = -0.05, p = 0.009) and baby (difference = -0.44, p = 0.015), and vaccination can protect mother (difference = 0.49, p = 0.003) and baby (difference = 0.59, p = 0.001). Vaccination rates were 28% intervention and 25% control (p = 0.70). Provider recommendation was associated with vaccination (47% if recommended vs. 12% if not, p0.001). Phone interviews revealed susceptibility, to influenza and vaccine safety as primary reasons for remaining unvaccinated.Video education positively influenced vaccination health beliefs without impacting vaccination rates. Physician's recommendation was strongly associated with participant's decision to become vaccinated and may be most effective when emphasizing influenza vaccination's protective impact on the newborn,.

Published
2015

46. Vitamin D deficiency in minority populations

Author

Taksler, Glen B, Cutler, David M., Giovannucci, Edward L., and Keating, Nancy Lynn

Abstract

Objective Black and Hispanic individuals synthesize less vitamin D per unit of sun exposure than white individuals. The relationship between UV radiation and vitamin D insufficiency in minorities has not been well explored. Design Prospective cohort study. Setting Using the National Health and Nutrition Examination Survey, we obtained serum vitamin D levels for non-Hispanic Whites, Hispanics and non-Hispanic Blacks aged ≥18 years from 2000–2006. We linked these data with the average monthly solar UV index by census tract and data on sun exposure, vitamin D supplementation, health and demographics. We used multivariable regression analyses to assess vitamin D deficiency (

Published
2014

47. Clinical and Economic Outcomes of Patients With Brain Metastases Based on Symptoms: An Argument for Routine Brain Screening of Those Treated With Upfront Radiosurgery

Author

Lester, Scott C., Taksler, Glen B., Kuremsky, J. Griff, Lucas, John T., Ayala-Peacock, Diandra N., Randolph, David M., Bourland, J. Daniel, Laxton, Adrian W., Tatter, Stephen B., and Chan, Michael D.

Subjects
Male, Salvage Therapy, Treatment Outcome, Brain Neoplasms, Cost-Benefit Analysis, Humans, Female, Middle Aged, Radiosurgery, Article, Aged, Proportional Hazards Models
Abstract

BACKGROUND: Insurers have started to deny reimbursement for routine brain surveillance with magnetic resonance imaging (MRI) after stereotactic radiosurgery (SRS) for brain metastases in favor of symptom-prompted imaging. The authors investigated the clinical and economic impact of symptomatic versus asymptomatic metastases and related these findings to the use of routine brain surveillance. METHODS: Between January 2000 and December 2010, 442 patients underwent upfront SRS for brain metastases. In total, 127 asymptomatic patients and 315 symptomatic patients were included. Medical records were used to determine the presenting symptoms, distant and local brain failure, retreatment, and need for hospital and rehabilitative care. Cost-of-care estimates were based on Medicare payment rates as of January 2013. RESULTS: Symptomatic patients had an increased hazard for all-cause mortality (hazard ratio, 1.448) and were more likely to experience neurologic death (42% vs 20%; P

Published
2013

48. Modeling Individual Patient Preferences for Colorectal Cancer Screening Based on Their Tolerance for Complications Risk.

Author

Taksler, Glen B., Perzynski, Adam T., and Kattan, Michael W.

Abstract

Introduction. Recommendations for colorectal cancer screening encourage patients to choose among various screening methods based on individual preferences for benefits, risks, screening frequency, and discomfort. We devised a model to illustrate how individuals with varying tolerance for screening complications risk might decide on their preferred screening strategy. Methods. We developed a discrete-time Markov mathematical model that allowed hypothetical individuals to maximize expected lifetime utility by selecting screening method, start age, stop age, and frequency. Individuals could choose from stool-based testing every 1 to 3 years, flexible sigmoidoscopy every 1 to 20 years with annual stool-based testing, colonoscopy every 1 to 20 years, or no screening. We compared the life expectancy gained from the chosen strategy with the life expectancy available from a benchmark strategy of decennial colonoscopy. Results. For an individual at average risk of colorectal cancer who was risk neutral with respect to screening complications (and therefore was willing to undergo screening if it would actuarially increase life expectancy), the model predicted that he or she would choose colonoscopy every 10 years, from age 53 to 73 years, consistent with national guidelines. For a similar individual who was moderately averse to screening complications risk (and therefore required a greater increase in life expectancy to accept potential risks of colonoscopy), the model predicted that he or she would prefer flexible sigmoidoscopy every 12 years with annual stool-based testing, with 93% of the life expectancy benefit of decennial colonoscopy. For an individual with higher risk aversion, the model predicted that he or she would prefer 2 lifetime flexible sigmoidoscopies, 20 years apart, with 70% of the life expectancy benefit of decennial colonoscopy. Conclusion. Mathematical models may formalize how individuals with different risk attitudes choose between various guideline-recommended colorectal cancer screening strategies. [ABSTRACT FROM AUTHOR]

Published
2017
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50. Quantifying the defensive medicine contribution to primary care costs

Author

Brateanu, Andrei, primary, Schramm, Sarah, additional, Hu, Bo, additional, Boyer, Kristen, additional, Nottingham, Kelly, additional, Taksler, Glen B., additional, Jolly, Stacey, additional, Goodman, Kenneth, additional, Misra-Hebert, Anita, additional, Vakharia, Nirav, additional, Hamilton, Aaron C., additional, Bales, Robert, additional, Manne, Mahesh, additional, Lathia, Amanda, additional, Deshpande, Abhishek, additional, and Rothberg, Michael B., additional

Published
2014
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