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Biomedical subjects

W E Hammond

Publications and source records attributed to W E Hammond.

At least 19 recordsLinked to original sources
PubMed2001

Characteristics of adult primary care patients as predictors of future health services charges.

BACKGROUND: Utilization risk assessment is potentially useful for allocation of health care resources, but precise measurement is difficult. OBJECTIVE: Test the hypotheses that health-related quality of life (HRQOL), severity of illness, and diagnoses at a single primary care visit are comparable case-mix predictors of future 1-year charges in all clinical settings within a large health system, and that these predictors are more accurate in combination than alone. RESEARCH DESIGN: Longitudinal observational study in which subjects' characteristics were measured at baseline, and their outpatient clinic visits and charges and their inpatient hospital days and charges were tracked for 1 year. SUBJECTS: Adult primary care patients. MEASURES: Duke Health Profile for HRQOL, Duke Severity of Illness Checklist for severity of illness, and Johns Hopkins Ambulatory Care Groups for diagnostic groups classification. RESULTS: Of 1,202 patients, 84.4% had follow up in the primary care clinic, 63.2% in subspecialty clinics, 14.8% in the emergency room, and 9.6% in the hospital. Of $6,290,775 total charges, $779,037 (12.2%) was for follow-up primary care. The highest accuracy was found for predicting primary care charges, where R2 for predictors ranged from 0.083 for medical record auditor-reported severity of illness to 0.107 for HRQOL. When predictors were combined, the highest R2 of 0.125 was found for the combination of HRQOL and diagnostic groups. CONCLUSIONS: Baseline HRQOL, severity of illness, and diagnoses were comparable predictors of 1-year health services charges in all clinical sites but most predictive for primary care charges, and were more accurate in combination than alone.

Adult↗
PubMed2001

A national agenda for public health informatics.

The American Medical Informatics Association 2001 Spring Congress brought together the public health and informatics communities to develop a national agenda for public health informatics. Discussions on funding and governance; architecture and infrastructure; standards and vocabulary; research, evaluation, and best practices; privacy, confidentiality, and security; and training and workforce resulted in 74 recommendations with two key themes: (1) all stakeholders need to be engaged in coordinated activities related to public health information architecture, standards, confidentiality, best practices, and research and (2) informatics training is needed throughout the public health workforce. Implementation of this consensus agenda will help promote progress in the application of information technology to improve public health.

Congresses as Topic↗
PubMed2001

Standards for the electronic health record, emerging from health care's Tower of Babel.

This paper considers the standardization of an Electronic Health Record (EHR). Relations between several distinct medical datasets and information systems are mapped in order to derive a more precise definition of the EHR. Two international efforts to establish standards for the EHR are presented and critiqued. Strategies for standardizing the EHR are analyzed and recommendations are provided for approaching the standardization process.

Computer Communication Networks↗
PubMed1998

Managing healthcare: a view of tomorrow.

This paper presents a vision of the future in which standards exist at all levels necessary to accomplish true interoperability. The infrastructure has been established to support connectivity among all healthcare-related institutions as well as the population at large. Provider and patient care integrated in the process of an individual's care.

Forecasting↗
PubMed1998

Object technology: raising the standards for healthcare information systems.

Netscape and the public Internet have accelerated the acceptance of many different open "Internet standards". Through wide acceptance of its browser, Netscape gave a boost to the Java programming language helping it become truly platform independent. Objects written in Java are ideal building blocks for application components. CORBA gives such objects the ability to communicate and operate over networks. Applications built with these distributed objects become the services in an Internet-wide healthcare framework. The convergence of object technologies has raised the standards for modern healthcare information systems. To illustrate the relationship among such technologies, this paper presents an architecture for a Universal Healthcare Information System (UHIS) in terms of its web, Java and CORBA components.

Computer Systems↗
PubMed1998

A comparison of neural network models for the prediction of the cost of care for acute coronary syndrome patients.

Acute coronary syndromes have remained the focus of many clinical economic studies due to the increasing prevalence of the disease and the tightening of cost controls. An accurate descriptive cost model for this population would be a valuable tool for clinical researchers. With such a model, the relative importance of different factors upon the total cost of care could be determined through computer simulation. This study explored the use of different neural network architectures in creating a descriptive cost model. This was a difficult problem in that the costs span 3 orders of magnitude but the output variable of the neural network must be restricted to the range 0-1. Models that used logarithmic transformations and multiple modular networks were created and analyzed. It was found that the model with a single network and logarithmic transformation performed significantly better than other more complicated networks.

Coronary Disease↗
PubMed1998

A proposal for incorporating health level seven (HL7) vocabulary in the UMLS Metathesaurus.

The HL7 Vocabulary Technical Committee (TC) was organized to select and maintain the vocabulary used in HL7 messages. The goal is to make implementations of the Version 3 HL7 Standard more plug-and-play compatible. In order to make the vocabulary readily accessible to the public, HL7 is collaborating with the U.S. National Library of Medicine (NLM) to include HL7 vocabulary in the Unified Medical Language System (UMLS) Metathesaurus. This article describes a proposal for how HL7 data elements and coded values can be represented accurately in the relational tables of the UMLS Metathesaurus.

Computer Communication Networks↗
PubMed1997

Computerized decision support based on a clinical practice guideline improves compliance with care standards.

PURPOSE: Clinical guidelines are designed to assist in the management of specific diseases; however, these guidelines are often neglected in the delivery of care. The purpose of this study was to determine whether clinician use of an clinical practice guideline would increase in response to having, at the patient visit, a decision support system based on a practice guideline that generates a customized management protocol for the individual patient using data from the patient's electronic medical record. SUBJECTS AND METHODS: In a 6-month controlled trial at a primary care clinic, 58 primary care clinicians were randomized to receive either a special encounter form with the computer-generated guideline recommendations or a standard encounter form. The effect of computer-generated advice on clinician behavior was measured as rate of compliance with guideline recommendations. Data from 30 clinicians were analyzed; data from 28 clinicians were excluded because these clinicians did not meet predefined criteria for minimum exposure to diabetic patient care. RESULTS: Availability of patient management recommendations generated by the decision support system resulted in a two-fold increase in clinician compliance with care guidelines for diabetes mellitus (P = 0.01). Median compliance for the group receiving the recommendations was 32.0% versus 15.6% for the control group. CONCLUSION: Decision support based on a clinical practice guideline is an effective tool for assisting clinicians in the management of diabetic patients. This decision support system provides a model for how a clinical practice guideline can be integrated into the care process by computer to assist clinicians in managing a specific disease through helping them comply with care standards. Use of decision support systems based on clinical practice guidelines could ultimately improve the quality of medical care.

Decision Making, Computer-Assisted↗
PubMed1997

Duke Case-Mix System (DUMIX) for ambulatory health care.

The Duke Case-Mix System (DUMIX), which combines age, gender, patient-reported perceived and physical health status, and provider-reported or auditor-reported severity of illness to classify patients by their risk of high future utilization, explained 17.1% of the variance in future clinic charges and 16.6% of the variance in return visits. When a random half of 413 ambulatory adults were classified into four risk classes by predictive regression coefficients from the other half, there was a stepwise increase in actual future utilization by risk class. The most accurate classification was for Class 4 (highest risk) patients, with a sensitivity of 40.8%, specificity of 82.1%, and likelihood ratio of 2.3. These 23.7% of patients accounted for 44.2% of charges for all patients. When predictive coefficients from this population were used to classify a different group of 206 ambulatory adults, past utilization also increased in stepwise order by case-mix class.

Adolescent↗
PubMed1997

Medical data mining: knowledge discovery in a clinical data warehouse.

Clinical databases have accumulated large quantities of information about patients and their medical conditions. Relationships and patterns within this data could provide new medical knowledge. Unfortunately, few methodologies have been developed and applied to discover this hidden knowledge. In this study, the techniques of data mining (also known as Knowledge Discovery in Databases) were used to search for relationships in a large clinical database. Specifically, data accumulated on 3,902 obstetrical patients were evaluated for factors potentially contributing to preterm birth using exploratory factor analysis. Three factors were identified by the investigators for further exploration. This paper describes the processes involved in mining a clinical database including data warehousing, data query and cleaning, and data analysis.

Data Interpretation, Statistical↗
PubMed1997

Data mining issues for improved birth outcomes.

Issues obstructing progress in data mining for improved health outcomes include data quality problems, data redundancy, data inconsistency, repeated measures, temporal (time-contextual) measures, and data volume. Related issues involve theoretical and technical problems involving uncertainty management, missing data and missing values, and matching appropriate data mining techniques to patient data sets. Results of data mining research in progress are reported for Duke University's perinatal database that contains nearly a decade of clinical patient data, 71,753 database (patient) records and 4-5000 variables per patient.

Artificial Intelligence↗
PubMed1996

Politics and standards.

Explore the source record for details and available documents.

Delivery of Health Care, Integrated↗
PubMed1996

Implications of the Java language on computer-based patient records.

The growth of the utilization of the World Wide Web (WWW) as a medium for the delivery of computer-based patient records (CBPR) has created a new paradigm in which clinical information may be delivered. Until recently the authoring tools and environment for application development on the WWW have been limited to Hyper Text Markup Language (HTML) utilizing common gateway interface scripts. While, at times, this provides an effective medium for the delivery of CBPR, it is a less than optimal solution. The server-centric dynamics and low levels of interactivity do not provide for a robust application which is required in a clinical environment. The emergence of Sun Microsystems' Java language is a solution to the problem. In this paper we examine the Java language and its implications to the CBPR. A quantitative and qualitative assessment was performed. The Java environment is compared to HTML and Telnet CBPR environments. Qualitative comparisons include level of interactivity, server load, client load, ease of use, and application capabilities. Quantitative comparisons include data transfer time delays. The Java language has demonstrated promise for delivering CBPRs.

Computer Communication Networks↗
PubMed1996

Documenting data delivery: design, deployment, and decision.

Developing and deploying informatics solutions which are useful and acceptable to busy physicians are challenging tasks. We describe the design, deployment, and evaluation process by which the delivery of routine clinical laboratory reports is automated using electronic mail. Data from TMR, an operational computer-based patient record (CPR), are presented to providers using an individualized, modern interface. This system is compared to the existing, paper-based system for delivery of data from the same CPR. Differences between the two systems of data delivery are analyzed, with emphases on 1) electronic documentation of data delivery and receipt, 2) electronic and/or paper documentation of clinical action taken as a result of laboratory reports, 3) timeliness of report availability, 4) costs, 5) workflow compatibility, and 6) physician satisfaction. The new delivery system employs inexpensive, commercially available software applications and entails only trivial changes to the proprietary CPR. Built into the new system are features which allow quantitative measurements of its performance for analysis along with survey-based user satisfaction data. The open systems design is deliberately non-proprietary, inexpensive, and generalizable. Accordingly, it offers practical possibilities for settings in which clinical information systems are just being planned, as well as for those in which such systems are already established.

Clinical Laboratory Information Systems↗
PubMed1995

The status of healthcare standards in the United States.

Healthcare standards in the US are produced by six standard developers organizations: ACR/NEMA, ASC X12N, ASTM, HL7, IEEE, and NCPDP. The activities of these groups are coordinated through the ANSI HISPP. While considerable progress has been made in the area of data interchange standards, little progress has been made in the area of vocabulary standards.

Computer Communication Networks↗