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Article ; Online: Patient Perspectives on a Targeted Text Messaging Campaign to Encourage Screening for Diabetes: Qualitative Study.

Lenoir, Kristin M / Sandberg, Joanne C / Miller, David P / Wells, Brian J

JMIR formative research

2023 Volume 7, Page(s) e41011

Abstract: Background: A sizeable proportion of prediabetes and diabetes cases among adults in the United States remain undiagnosed. Patient-facing clinical decision support (CDS) tools that leverage electronic health records (EHRs) have the potential to increase ... ...

Abstract	Background: A sizeable proportion of prediabetes and diabetes cases among adults in the United States remain undiagnosed. Patient-facing clinical decision support (CDS) tools that leverage electronic health records (EHRs) have the potential to increase diabetes screening. Given the widespread mobile phone ownership across diverse groups, text messages present a viable mode for delivering alerts directly to patients. The use of unsolicited text messages to offer hemoglobin A Objective: This study aims to gauge the perceptions of and receptiveness to text messages to inform content that would facilitate engagement with text messages intended to initiate a mobile health (mHealth) intervention for targeted screening. Messages were designed to invite those not already diagnosed with diabetes to make a decision to take part in HbA Methods: In total, 6 focus groups were conducted at Wake Forest Baptist Health (WFBH) between September 2019 and February 2020. The participants were adult patients without diabetes who had completed an in-person visit at the Family and Community Medicine Clinic within the previous year. We displayed a series of text messages and asked the participants to react to the message content and suggest improvements. Content was deductively coded with respect to the Health Belief Model (HBM) and inductively coded to identify other emergent themes that could potentially impact engagement with text messages. Results: Participants (N=36) were generally receptive to the idea of receiving a text-based alert for HbA Conclusions: Our findings suggest that patients may be receptive to text messages that alert them to a risk of having an elevated HbA
Language	English
Publishing date	2023-01-17
Publishing country	Canada
Document type	Journal Article
ISSN	2561-326X
ISSN (online)	2561-326X
DOI	10.2196/41011
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Article: Using Electronic Health Records for the Learning Health System: Creation of a Diabetes Research Registry.

Wells, Brian J / Downs, Stephen M / Ostasiewski, Brian

JMIR medical informatics

2022 Volume 10, Issue 9, Page(s) e39746

Abstract: Electronic health records (EHRs) were originally developed for clinical care and billing. As such, the data are not collected, organized, and curated in a fashion that is optimized for secondary use to support the Learning Health System. Population ... ...

Abstract	Electronic health records (EHRs) were originally developed for clinical care and billing. As such, the data are not collected, organized, and curated in a fashion that is optimized for secondary use to support the Learning Health System. Population health registries provide tools to support quality improvement. These tools are generally integrated with the live EHR, are intended to use a minimum of computing resources, and may not be appropriate for some research projects. Researchers may require different electronic phenotypes and variable definitions from those typically used for population health, and these definitions may vary from study to study. Establishing a formal registry that is mapped to the Observation Medical Outcomes Partnership common data model provides an opportunity to add custom mappings and more easily share these with other institutions. Performing preprocessing tasks such as data cleaning, calculation of risk scores, time-to-event analysis, imputation, and transforming data into a format for statistical analyses will improve efficiency and make the data easier to use for investigators. Research registries that are maintained outside the EHR also have the luxury of using significant computational resources without jeopardizing clinical care data. This paper describes a virtual Diabetes Registry at Atrium Health Wake Forest Baptist and the plan for its continued development.
Language	English
Publishing date	2022-09-23
Publishing country	Canada
Document type	Journal Article
ZDB-ID	2798261-0
ISSN	2291-9694
ISSN	2291-9694
DOI	10.2196/39746
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Article ; Online: Catch Me if You Can: Acute Events Hidden in Structured Chronic Disease Diagnosis Descriptions Show Detectable Recording Patterns in EHR.

Diaz-Garelli, Franck / Lenoir, Kristin M / Wells, Brian J

AMIA ... Annual Symposium proceedings. AMIA Symposium

2021 Volume 2020, Page(s) 373–382

Abstract: Our previous research shows that structured cancer DX description data accuracy varied across electronic health record (EHR) segments (e.g. encounter DX, problem list, etc.). We provide initial evidence corroborating these findings in EHRs from patients ... ...

Abstract	Our previous research shows that structured cancer DX description data accuracy varied across electronic health record (EHR) segments (e.g. encounter DX, problem list, etc.). We provide initial evidence corroborating these findings in EHRs from patients with diabetes. We hypothesized that the odds of recording an "uncontrolled diabetes" DX increased after a hemoglobin A1c result above 9% and that this rate would vary across EHR segments. Our statistical models revealed that each DX indicating uncontrolled diabetes was 2.6% more likely to occur post-A1c>9% overall (adj-p=.0005) and 3.9% after controlling for EHR segment (adj-p<.0001). However, odds ratios varied across segments (1.021<OR<1.224, .0001<adj-p<.087). The number of providers (adj-p<.0001) and departments (adjp<.0001) also impacted the number of DX reporting uncontrolled diabetes. Segment heterogeneity must be accounted for when analyzing clinical data. Understanding this phenomenon will support accuracy-driven EHR data extraction to foster reliable secondary analyses of EHR data.<br />
MeSH term(s)	Chronic Disease ; Datasets as Topic ; Diabetes Mellitus/diagnosis ; Electronic Health Records ; Glycated Hemoglobin/analysis ; Humans ; Machine Learning ; Medical Informatics/methods ; Models, Statistical ; Odds Ratio
Chemical Substances	Glycated Hemoglobin A
Language	English
Publishing date	2021-01-25
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ISSN	1942-597X
ISSN (online)	1942-597X
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Article ; Online: Mental Health and Benzodiazepine Use Among Patients on Chronic Opioid Therapy.

Smith, Abigail Y / Kirk, Julienne K / Smith, Paul F / Wells, Brian J

Journal of the American Board of Family Medicine : JABFM

2021 Volume 34, Issue 1, Page(s) 99–104

Abstract: Introduction: Higher daily doses of opioids as well as co-prescription of benzodiazepines have been associated with risk of overdose. The current study characterizes prescribing patterns in a family medicine practice with regard to patient mental health ...

Abstract	Introduction: Higher daily doses of opioids as well as co-prescription of benzodiazepines have been associated with risk of overdose. The current study characterizes prescribing patterns in a family medicine practice with regard to patient mental health diagnoses, benzodiazepine prescriptions, morphine milligram equivalent opioid dose, and patient demographics. Methods: Patients on chronic opioid therapy were studied in 2018 and 2019. Mental health diagnoses, opioid dose, benzodiazepine prescriptions and demographic characteristics were extracted from the electronic health record. Data were compared between years and logistic regression was used to determine which patient characteristics were associated with likelihood of decreased opioid dose. Results: A total of 387 patients were prescribed chronic opioid therapy in 2018, and 231 in 2019. In 2018, 49.9% of patients prescribed chronic opioids had mental health diagnoses. In 2019, this proportion rose to 92.2%. In 2019, 205 of the original 387 patients were still with the practice but were not prescribed chronic opioids. Among the factors studied, psychiatric diagnosis and higher opioid dose were associated with a significantly lower likelihood of tapering doses. Discussion: As practices taper or de-prescribe opioids, or implement harm reduction methods such as de-prescribing benzodiazepines, it is important to understand patient characteristics and their relationship to success with tapering. This study adds to the evidence that odds of successfully tapering opioids may be significantly impacted by patients' mental health diagnosis and opioid dose.
MeSH term(s)	Analgesics, Opioid/adverse effects ; Benzodiazepines/adverse effects ; Drug Overdose ; Electronic Health Records ; Humans ; Mental Health ; Practice Patterns, Physicians'
Chemical Substances	Analgesics, Opioid ; Benzodiazepines (12794-10-4)
Language	English
Publishing date	2021-01-12
Publishing country	United States
Document type	Journal Article
ZDB-ID	2239939-2
ISSN	1558-7118 ; 1557-2625
ISSN (online)	1558-7118
ISSN	1557-2625
DOI	10.3122/jabfm.2021.01.200320
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Zs.A 2626: Show issues

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Article ; Online: Cardiovascular health assessment in routine cancer follow-up in community settings: survivor risk awareness and perspectives.

Weaver, Kathryn E / Dressler, Emily V / Smith, Sydney / Nightingale, Chandylen L / Klepin, Heidi D / Lee, Simon Craddock / Wells, Brian J / Hundley, W Gregory / DeMari, Joseph A / Price, Sarah N / Foraker, Randi E

BMC cancer

2024 Volume 24, Issue 1, Page(s) 158

Abstract: Background: Guidelines recommend cardiovascular risk assessment and counseling for cancer survivors. For effective implementation, it is critical to understand survivor cardiovascular health (CVH) profiles and perspectives in community settings. We ... ...

Abstract	Background: Guidelines recommend cardiovascular risk assessment and counseling for cancer survivors. For effective implementation, it is critical to understand survivor cardiovascular health (CVH) profiles and perspectives in community settings. We aimed to (1) Assess survivor CVH profiles, (2) compare self-reported and EHR-based categorization of CVH factors, and (3) describe perceptions regarding addressing CVH during oncology encounters. Methods: This cross-sectional analysis utilized data from an ongoing NCI Community Oncology Research Program trial of an EHR heart health tool for cancer survivors (WF-1804CD). Survivors presenting for routine care after potentially curative treatment recruited from 8 oncology practices completed a pre-visit survey, including American Heart Association Simple 7 CVH factors (classified as ideal, intermediate, or poor). Medical record abstraction ascertained CVD risk factors and cancer characteristics. Likert-type questions assessed desired discussion during oncology care. Results: Of 502 enrolled survivors (95.6% female; mean time since diagnosis = 4.2 years), most had breast cancer (79.7%). Many survivors had common cardiovascular comorbidities, including high cholesterol (48.3%), hypertension or high BP (47.8%) obesity (33.1%), and diabetes (20.5%); 30.5% of survivors received high cardiotoxicity potential cancer treatment. Less than half had ideal/non-missing levels for physical activity (48.0%), BMI (18.9%), cholesterol (17.9%), blood pressure (14.1%), healthy diet (11.0%), and glucose/ HbA1c (6.0%). While > 50% of survivors had concordant EHR-self-report categorization for smoking, BMI, and blood pressure; cholesterol, glucose, and A1C were unknown by survivors and/or missing in the EHR for most. Most survivors agreed oncology providers should talk about heart health (78.9%). Conclusions: Tools to promote CVH discussion can fill gaps in CVH knowledge and are likely to be well-received by survivors in community settings. Trial registration: NCT03935282, Registered 10/01/2020.
MeSH term(s)	Female ; Humans ; Male ; Blood Pressure ; Breast Neoplasms ; Cardiovascular Diseases/epidemiology ; Cardiovascular Diseases/etiology ; Cholesterol ; Cross-Sectional Studies ; Follow-Up Studies ; Glucose ; Health Status ; Risk Assessment ; Risk Factors ; Survivors ; United States ; Clinical Trials as Topic
Chemical Substances	Cholesterol (97C5T2UQ7J) ; Glucose (IY9XDZ35W2)
Language	English
Publishing date	2024-01-31
Publishing country	England
Document type	Journal Article
ZDB-ID	2041352-X
ISSN	1471-2407 ; 1471-2407
ISSN (online)	1471-2407
ISSN	1471-2407
DOI	10.1186/s12885-024-11912-8
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Article ; Online: Creating learning health systems and the emerging role of biomedical informatics.

Kohn, Martin S / Topaloglu, Umit / Kirkendall, Eric S / Dharod, Ajay / Wells, Brian J / Gurcan, Metin

Learning health systems

2021 Volume 6, Issue 1, Page(s) e10259

Abstract: Introduction: The nature of information used in medicine has changed. In the past, we were limited to routine clinical data and published clinical trials. Today, we deal with massive, multiple data streams and easy access to new tests, ideas, and ... ...

Abstract	Introduction: The nature of information used in medicine has changed. In the past, we were limited to routine clinical data and published clinical trials. Today, we deal with massive, multiple data streams and easy access to new tests, ideas, and capabilities to process them. Whereas in the past getting information for decision-making was a challenge, now, it is how to analyze, evaluate and prioritize all that is readily available through the multitude of data-collecting devices. Clinicians must become adept with the tools needed to deal with the era of big data, requiring a major change in how we learn to make decisions. Major change is often met with resistance and questions about value. A Learning Health System is an enabler to encourage the development of such tools and demonstrate value in improved decision-making. Methods: We describe how we are developing a Biomedical Informatics program to help our medical institution's evolution as an academic Learning Health System, including strategy, training for house staff and examples of the role of informatics from operations to research. Results: We described an array of learning health system implementations and educational programs to improve healthcare and prepare a cadre of physicians with basic information technology skills. The programs have been well accepted with, for example, increasing interest and enrollment in the educational programs. Conclusions: We are now in an era when large volumes of a wide variety of data are readily available. The challenge is not so much in the acquisition of data, but in assessing the quality, relevance and value of the data. The data we can get may not be the data we need. In the past, sources of data were limited, and trial results published in journals were the major source of evidence for decision making. The advent of powerful analytics systems has changed the concept of evidence. Clinicians will have to develop the skills necessary to work in the era of big data. It is not reasonable to expect that all clinicians will also be data scientists. However, understanding the role of AI and predictive analytics, and how to apply them, will become progressively more important. Programs such as the one being implemented at Wake Forest fill that need.
Language	English
Publishing date	2021-03-11
Publishing country	United States
Document type	Journal Article
ISSN	2379-6146
ISSN (online)	2379-6146
DOI	10.1002/lrh2.10259
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Article: Impact of the COVID-19 Pandemic on Diabetes Care Among a North Carolina Patient Population.

Bancks, Michael P / Lin, Meng-Yun / Bertoni, Alain / Futrell, Wendell M / Liu, Zhixiu / Ostasiewski, Brian / Wells, Brian J / Hanchate, Amresh

Clinical diabetes : a publication of the American Diabetes Association

2022 Volume 40, Issue 4, Page(s) 467–476

Abstract: In this study, researchers reviewed electronic health record data to assess whether the coronavirus disease 2019 pandemic was associated with disruptions in diabetes care processes of A1C testing, retinal screening, and nephropathy evaluation among ... ...

Abstract	In this study, researchers reviewed electronic health record data to assess whether the coronavirus disease 2019 pandemic was associated with disruptions in diabetes care processes of A1C testing, retinal screening, and nephropathy evaluation among patients receiving care with Wake Forest Baptist Health in North Carolina. Compared with the pre-pandemic period, they found an increase of 13-21 percentage points in the proportion of patients delaying diabetes care for each measure during the pandemic. Alarmingly, delays in A1C testing were greatest for individuals with the most severe disease and may portend an increase in diabetes complications.
Language	English
Publishing date	2022-06-15
Publishing country	United States
Document type	Journal Article
ZDB-ID	1025953-3
ISSN	0891-8929
ISSN	0891-8929
DOI	10.2337/cd21-0136
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Article ; Online: Low Peak Inspiratory Flow Rates are Common Among COPD Inpatients and are Associated with Increased Healthcare Resource Utilization: A Retrospective Cohort Study.

Clark, Brendan / Wells, Brian J / Saha, Amit K / Franchino-Elder, Jessica / Shaikh, Asif / Donato, Bonnie M K / Ohar, Jill A

International journal of chronic obstructive pulmonary disease

2022 Volume 17, Page(s) 1483–1494

Abstract: Background: Patients with chronic obstructive pulmonary disease (COPD) can have low peak inspiratory flow (PIF), especially after hospitalization for acute exacerbation of COPD (AECOPD).: Purpose: To characterize patients hospitalized for AECOPD, and ...

Abstract	Background: Patients with chronic obstructive pulmonary disease (COPD) can have low peak inspiratory flow (PIF), especially after hospitalization for acute exacerbation of COPD (AECOPD). Purpose: To characterize patients hospitalized for AECOPD, and to assess the prevalence of low PIF, changes in PIF after hospitalization, and the association of low PIF with healthcare resource utilization (HRU) outcomes. Patients and methods: A retrospective cohort study was conducted using electronic health record data of hospitalized COPD patients in the Wake Forest Baptist Health system (01/01/2017 through 06/30/2020). Patients with a first eligible AECOPD hospitalization (index hospitalization) who were discharged before 05/31/2020 were included. PIF was measured using the In-Check DIAL™ at both medium-low resistance (R-2) and high resistance (R-5) during the index hospitalization. For R-2 and R-5, PIF was divided into low PIF (< 60 L/min; < 30 L/min) and high PIF (≥ 60 L/min; ≥ 30 L/min) groups. The primary outcome was the prevalence of low PIF. The stability of PIF after hospitalization was described. Adjusted regression models evaluated associations between low PIF and subsequent 30-day readmissions, 90-day readmissions, and HRU outcomes, including hospitalizations, emergency department visits, inpatient days, and intensive care unit (ICU) days. Results: In total, 743 patients with PIF measured at R-2 and R-5 during a AECOPD hospitalization were included. The prevalence of low PIF was 56.9% at R-2 and 14.7% at R-5. PIF values were relatively stable after hospitalization. Adjusted analyses showed significant increases in HRU (all-cause hospitalizations [31%], COPD hospitalizations [33%], COPD inpatient days [46%], and COPD ICU days [24%]) during the follow-up period among patients with low PIF (< 60 L/min) at R-2. The 30- and 90-day readmission risks were similar between patients with low PIF and high PIF. Conclusion: Low PIF is common among patients hospitalized for AECOPD, relatively stable after hospital discharge, and associated with increased HRU.
MeSH term(s)	Humans ; Inpatients ; Patient Acceptance of Health Care ; Patient Readmission ; Pulmonary Disease, Chronic Obstructive/diagnosis ; Pulmonary Disease, Chronic Obstructive/epidemiology ; Pulmonary Disease, Chronic Obstructive/therapy ; Retrospective Studies
Language	English
Publishing date	2022-06-29
Publishing country	New Zealand
Document type	Journal Article
ZDB-ID	2212419-6
ISSN	1178-2005 ; 1176-9106
ISSN (online)	1178-2005
ISSN	1176-9106
DOI	10.2147/COPD.S355772
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Article ; Online: Characteristics of Adult Primary Care Patients Who Use the Patient Portal: A Cross-Sectional Analysis.

Casacchia, Nicholas J / Rosenthal, Gary E / O'Connell, Nathaniel S / Bundy, Richa / Witek, Lauren / Wells, Brian J / Palakshappa, Deepak

Applied clinical informatics

2022 Volume 13, Issue 5, Page(s) 1053–1062

Abstract: Background: The patient portal allows patients to engage with their health care team beyond the clinical encounter. While portals can improve patient outcomes, there may be disparities in which patients access the portal by sociodemographic factors. ... ...

Abstract	Background: The patient portal allows patients to engage with their health care team beyond the clinical encounter. While portals can improve patient outcomes, there may be disparities in which patients access the portal by sociodemographic factors. Understanding the characteristics of patients who use the portal could help design future interventions to expand portal adoption. Objectives: This study aimed to (1) examine the socioeconomic factors, comorbid conditions, and health care utilization among patients of a large academic primary care network who are users and non-users of the patient portal; and (2) describe the portal functions most frequently utilized. Methods: We included all adult patients at Atrium Health Wake Forest Baptist who had at least two primary care visits between 2018 and 2019. Patients' demographics, comorbidities, health care utilization, and portal function usage were extracted from the electronic health record and merged with census data (income, education, and unemployment) from the American Community Survey. A myWakeHealth portal user was defined as a patient who used a bidirectional portal function at least once during the study period. We used multivariable logistic regression to determine which patient characteristics were independently associated with being a portal user. Results: Of the 178,720 patients who met inclusion criteria, 32% ( Conclusion: We found that patient demographics and area socioeconomic factors were associated with patient portal adoption. These findings suggest that efforts to improve portal adoption should be targeted at vulnerable patients.
MeSH term(s)	Adult ; Humans ; Female ; Patient Portals ; Cross-Sectional Studies ; Electronic Health Records ; Delivery of Health Care ; Primary Health Care
Language	English
Publishing date	2022-09-27
Publishing country	Germany
Document type	Journal Article ; Research Support, N.I.H., Extramural
ISSN	1869-0327
ISSN (online)	1869-0327
DOI	10.1055/a-1951-3153
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Article ; Online: Developing a Data Quality Standard Primer for Cardiovascular Risk Assessment from Electronic Health Record Data Using the DataGauge Process.

Diaz-Garelli, Franck / Long, Andrew / Bancks, Michael P / Bertoni, Alain G / Narayanan, Adhithya / Wells, Brian J

AMIA ... Annual Symposium proceedings. AMIA Symposium

2022 Volume 2021, Page(s) 388–397

Abstract: The learning health systems aim to support the needs of patients with chronic diseases, which require methods that account for electronic health recorded (EHR) data limitations. EHR data is often used to calculate cardiovascular risk scores. However, it ... ...

Abstract	The learning health systems aim to support the needs of patients with chronic diseases, which require methods that account for electronic health recorded (EHR) data limitations. EHR data is often used to calculate cardiovascular risk scores. However, it is unclear whether EHR data presents high enough quality to provide accurate estimates. Still, there is currently no open standard available to assess data quality for such applications. We applied the DataGauge process to develop a data quality standard based on expert clinical, analytical and informatics knowledge by conducting four interviews and one focus group that produced 61 individual data quality requirements. These requirements covered all standard data quality dimensions and uncovered 705 quality issues in EHR data for 456 patients. These requirements will be expanded and further validated in future work. Our work initiates the development of open and explicit data quality standards for specific secondary uses of clinical data.
MeSH term(s)	Cardiovascular Diseases/diagnosis ; Data Accuracy ; Electronic Health Records ; Humans ; Knowledge ; Risk Factors
Language	English
Publishing date	2022-02-21
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ISSN	1942-597X
ISSN (online)	1942-597X
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