abstract: Background: Process mining (PM) using event log files is gaining popularity in healthcare to investigate clinical pathways. But it has many unique challenges. Clinical Pathways (CPs) are often complex and unstructured which results in spaghetti-like models. Moreover, the log files collected from the electronic health record (EHR) often contain noisy and incomplete data. Objective: Based on the traditional process mining technique of using event logs generated by an EHR, observational video data from rapid ethnography (RE) were combined to model, interpret, simplify and validate the perioperative (PeriOp) CPs. Method: The data collection and analysis pipeline consisted of the following steps: (1) Obtain RE data, (2) Obtain EHR event logs, (3) Generate CP from RE data, (4) Identify EHR interfaces and functionalities, (5) Analyze EHR functionalities to identify missing events, (6) Clean and preprocess event logs to remove noise, (7) Use PM to compute CP time metrics, (8) Further remove noise by removing outliers, (9) Mine CP from event logs and (10) Compare CPs resulting from RE and PM. Results: Four provider interviews and 1,917,059 event logs and 877 minutes of video ethnography recording EHRs interaction were collected. When mapping event logs to EHR functionalities, the intraoperative (IntraOp) event logs were more complete (45%) when compared with preoperative (35%) and postoperative (21.5%) event logs. After removing the noise (496 outliers) and calculating the duration of the PeriOp CP, the median was 189 minutes and the standard deviation was 291 minutes. Finally, RE data were analyzed to help identify most clinically relevant event logs and simplify spaghetti-like CPs resulting from PM. Conclusion: The study demonstrated the use of RE to help overcome challenges of automatic discovery of CPs. It also demonstrated that RE data could be used to identify relevant clinical tasks and incomplete data, remove noise (outliers), simplify CPs and validate mined CPs. / Dissertation/Thesis / Masters Thesis Computer Science 2020

abstract: ABSTRACT Academic literature and industry benchmarking reports were reviewed to determine the way facilities benchmarking reports were perceived in the healthcare industry. Interviews were conducted through a Delphi panel of industry professionals who met experience and other credential requirements. Two separate rounds of interviewing were conducted where each candidate was asked the same questions to determine the current views of benchmarking reports and associated data in the healthcare industry. The questions asked in the second round were developed from the answers to the first-round questions. The research showed the panel preferred changes in the data collection methods as well as changes in the way the data is presented. The need for these changes was unanimous among the members of the panel. The main recommendations among the group were: 1. An interactive method such as a member portal with the ability to customize, run scenarios, and save data is the preferred method. 2. Facilities Management (FM) teams are often not included in the data collection of the benchmark reports. Including FM groups would allow more accuracy and more detailed data resulting in more accurate and in-depth reports. 3. More consistency and “apples to apples” comparisons need to be provided in the reports. More categories and variables need to be added to the reports to offer more in depth comparisons and assessments between buildings. Identifiers to help the users compare the physical condition of their facility to others needs to be included. Suggestions are as follows: a. Facility Condition Index (FCI)- easily available to all participants and allows an idea of the comparison of upkeep and maintenance of their facility to that of others. b. An indicator on whether the comparison buildings are Centers for Medicare and Medicaid Services (CMS) accredited. 4. Gross Square Footage (GSF) is not an accurate assessment on its own. Too many variables are left unidentified to offer an accurate assessment with this method alone. / Dissertation/Thesis / Masters Thesis Construction Management 2020

Studies indicate that voluntary reporting detects relatively few adverse events (AEs) (Ehland et al., 1999, Cooper et al., 1984). At Boston Children’s Hospital (BCH), several systems exist to document AEs. First, anesthesiologists document clinical care and AEs in the patient medical record (the Anesthesia Information Management System (AIMS)). Second, in an effort to capture AEs, the Department of Anesthesiology, Critical Care and Pain Medicine developed an internal tool, the Anesthesia System for Clinical Event Tracking (ASCENT), which is integrated into clinicians’ electronic documentation. Finally, a BCH hospital-wide reporting system, the Safety Event Reporting System (SERS), allows all employees and patients to report an AE.  The goals of this study are 1) to compare the effectiveness of documentation in AIMS, ASCENT, and SERS, 2) to determine the incidence of AEs in January 2018 and June 2019, independently, and 3) compare the effectiveness of documentation AEs in ASCENT after implementation of an improved, integrated reporting system. After IRB approval, a manual chart review of 3,3204 cases requiring anesthesia in January 2018 and 3,387 cases requiring anesthesia in June 2019 was conducted. Anesthesia notes, vital signs, and administered medications documented in AIMS were reviewed to determine if an AE had occurred. Descriptions of each case were recorded, and cases with indications for AEs were verified by clinicians. Next, each AE was categorized by event type. Both ASCENT and SERS were then queried for the reported adverse events during the same time period. The total number of AEs was described using counts with the distribution of types of AEs presented using percentages.     Among the 3,204 cases reviewed in January 2018, there were 569 events documented in AIMS, out of which, 39 (6.9%) were documented in ASCENT, and 2 (0.4%) in SERS. The overall rate of AEs was determined to be 1.8 events/10 cases. For June 2019, a total of 3,387 cases were reviewed for the occurrence of AEs. Among the reviewed cases, there were 396 events documented in AIMS, out of which, 106 (26.8%) were documented in the ASCENT database, and 3 (0.8%) in SERS. The overall rate of AEs was determined to be 1.2 events/10 cases. This study demonstrates that voluntary reporting of AEs may be improved if the reporting systems are better-integrated with patient medical records. In agreement with existing literature, this study also illustrates that hospital-wide reporting systems, such as SERS, fail to collect most adverse events (Levinson, 2012). To achieve comprehensive reporting of AEs, systems must be integrated into clinicians’ workflow. Education regarding the reporting systems along with technology improvements may further enhance the capture of AEs. Further investigation will be conducted to determine severity, preventability and association with anesthesia.

No description available.

No description available.

Introduction: Adverse childhood experiences (ACEs) have been considered a significant risk factor for poorer adult outcomes. Considering the studies linking ACEs to chronic diseases in adulthood as well as the increasing prevalence for these chronic conditions, exposure to childhood traumas represents a significant economic burden in the United States which has not been explored. This study provides the first examination of the attributable burden and costs of conditions associated with exposure to ACEs in Tennessee (TN) and Virginia (VA) during 2017. Methods: This is a cross-sectional study of individuals aged 18+ having exposure to ACEs using Behavioral Risk Factor Surveillance System (BRFSS) data for TN and VA in 2017. Eight chronic diseases (asthma, obesity, hypertension, diabetes, chronic obstructive pulmonary disease (COPD), depression, cardiovascular disease, and arthritis ) and two risk factors (smoking and drinking ) associated with ACEs were analyzed. Pearson's chi-square tests analyzed the association between individuals exposed to ACEs and the risk factors with the chronic diseases. The population attributable risk (PAR) were estimated for the ACEs related diseases and risk factors. These estimates were combined with published estimates of health care expenses and Disability Adjusted-Life-Years (DALYs). Results: Among those who had experienced at least 1 ACE in TN, 10% had COPD, 17% had diabetes, 36% had obesity, and 30% had depression. Individuals who had experienced at least 1 ACE in VA had higher percentages for COPD, obesity and depression diseases compared to those who had no ACE (p< .0001). ACEs exposure resulted in a burden of about 115,00 years and 125,000 years in terms of DALYs in TN and VA respectively. The total health spending associated with ACEs based on PARs was about $650 million ($158.15 per adult) and $942 million ($305.02 per adult) in TN and VA respectively. Depression accounted for the largest combined sum of health care spending (TN - $448,105,983, VA – $633,225,398). With DALYs valued at $235,855 in 2017 dollars, the monetized cost of DALYs attributable to ACEs was over $27 billion, $6615 per exposed adult Tennessean. The monetized loss due to DALYs represents over $30 billion (in 2017 dollars) , $9,737 per exposed adult in Virginia. Conclusions: This study emphasizes the need to reduce ACEs which can be utilized to inform interventions to reduce the impact of ACEs in Tennessee and Virginia. Medical conditions attributable to childhood traumas can result in increased utilization of hospital services, psychiatric care, as well as care related to chronic conditions, which includes increased primary and specialty care utilization as well as the cost of medications. While medical expenses represent a significant burden, reduced quality of life resulting from ACE attributable conditions also represents a burden in disability adjusted life years (DALYs) and premature morbidity. As resources are limited and the burden of ACEs shown here is very high, there is the need for a wide range of prevention and treatment strategies to mitigate these effects.

Background: Many patients discharged from the hospital do not appropriately fill their discharge medications. At Boston Medical Center, an urban safety net facility, a bedside discharge medication delivery service was pilot tested in 2012 to ensure pediatric patients with asthma left in possession of their new medications. The service was expanded to all pediatric discharges in 2013. It is unknown whether beside delivery increases the proportion of written prescriptions captured by the hospital-owned pharmacy or if the service achieves a positive return on investment. Whether such a service improves patients’ satisfaction, medication adherence, or clinical outcomes is also unknown. Methods: Two primary methodologies were used to evaluate the impact of this novel service. The first evaluated the relative risk of filling a prescription in the hospital- owned pharmacy after the expansion of delivery eligibility criteria using two years of discharge prescription information, corresponding pharmacy fill data, and a hierarchical model with generalized estimating equations (GEE) to account for non-independent events. Initial patient-level impacts of the delivery service were evaluated through a pilot randomized controlled trial to test logistics and obtain empiric estimates of study parameters. Results: Patients were 1.44 times more likely to fill a medication at the hospital- owned pharmacy providing the delivery service after the intervention (95%CI 1.3-1.59). The increased profit generated by prescriptions captured as a result of offering the delivery service is estimated to be equivalent to 8-15% of a pharmacist full-time- equivalent (FTE), whereas only 3% of an FTE was required to provide the service, indicating a positive return on investment. Pilot study data suggest families did not differ significantly with regards to perceived satisfaction or reported outcomes whether randomized to usual care or delivery. Conclusion: A service to deliver discharge medications can yield a positive return on investment, allowing an institution to offset uncompensated care. To further study the intervention, a trial with randomization at the level of the ward or institution is needed. / 2017-10-02T00:00:00Z

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No description available.

Title: Helping or Hovering: Examining Social Loafing and the Free-Rider Effect in Youth’s Transition Readiness Author: Mekyala Williams, East Tennessee State University Co-author(s): Kiana Johnson, MS, PhD Department of Pediatrics Quillen College of Medicine East Tennessee State University Lindsay Ellis Lee, PhD Department of Pediatrics Quillen College of Medicine East Tennessee State University Introduction Transition readiness in youth has been hard to study because parents and providers have served as managers rather than coaches hindering the process. Social loafing is a phenomenon that explains why people are more prone to exert less effort in group settings. We decided to observe the prevalence of social loafing in youth we examined if students knew how to perform specific transition readiness skills but allowed their support systems to do the task for them. This would be measured in opposition to them performing the tasks themselves since they do have the necessary skillset. The present study aims to validate the 4 domain subscales (i.e., managing medications, keeping appointments, tracking health issues, and talking with providers) found in the revised 20-item Transition Readiness Assessment Questionnaire (TRAQ). Additionally, the study will evaluate youth reliance on familial support systems for healthcare through the lens of the social loafing phenomenon. Methods To obtain demographic information, participants were asked on the survey to report their sex, age, ethnicity, and race (i.e., White, Black or African American, Asian, Native Hawaiian/Pacific Islander, Hispanic/Latino, American Indian, or Alaska Native, or other). Once all the surveys were completed, participants were categorized into white and non-white. We surveyed 161 youth from two different schools in South Central Appalachia about their transition readiness using anchors from the TRAQ with revised response categories. The response categories were whether they know how to do the specific task or not and whether youth perform the task themselves or if someone else does the task for them. Using confirmatory factor analysis, the revised 20-item version of the TRAQ will validate with the present sample. All statistical analyses will be conducted in R. Anticipatory Results and Conclusions Preliminary results based on the 161 participants found that youth can perform these tasks but very frequently allow someone else to do them. Out of the 20 items listed on the TRAQ, the endorsement rate of social loafing response varied between 10% and 52%. Fifteen out of the 20 items had a 30% response rate for social loafing. For the transition to adulthood to be successful for youth, they have to learn to accept different roles and responsibilities without the help of anyone else. This emphasizes the importance of shifting parents and providers to a coaching role rather than a managing role. Doing so will help enhance the youths’ ability and independence as they get older. This can also be applied to healthcare settings as using a coaching approach will minimize social loafing and allow more competence in managing their health.