Democratizing Information Creation From Health Care Data for Quality Improvement, Research, and Education—The Montefiore Medical Center Experience

Bellin, Eran; Fletcher, David; Geberer, Noah; Islam, Shahidul; Srivastava, Navneet

doi:10.1097/acm.0b013e3181df0f3b

Cited by 116 publications

(63 citation statements)

References 32 publications

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“…To identify patients to be included in the study, we employed “Clinical Looking Glass,” a proprietary software application developed at Montefiore Medical Center (MMC), that allows clinicians and researchers to identify populations of interest from the medical center database and to gather information about laboratory data, medications, demographics, and mortality [23]. MMC is a community-based urban tertiary care center that provides primary and specialty care to over 2 million people in the Bronx, New York [24].…”

Section: Methodsmentioning

confidence: 99%

Tubulointerstitial damage predicts end stage renal disease in lupus nephritis with preserved to moderately impaired renal function: A retrospective cohort study

Broder

Mowrey

Khan

et al. 2018

Seminars in Arthritis and Rheumatism

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Objectives The presence of tubulointerstitial damage (TID) on renal biopsy is considered to be a late sequela of lupus nephritis (LN). The objective of this study was to determine if TID predicts progression to end stage renal disease (ESRD) in LN patients without advanced kidney disease. Methods All SLE patients with an index biopsy consistent with LN between January 2005 and July 2015, and eGFR≥30 mL/min/1.73m2 were included. Moderate-to-severe TID was defined as the presence of moderate to severe tubular atrophy and/or interstitial fibrosis. Time to ESRD was defined as time from the index biopsy date to incident ESRD date; non-ESRD patients were censored at time of death or the last visit before December 2015. Time-dependent analyses were conducted to evaluate whether moderate to severe TID was predictive of ESRD progression. Results Of the 131 LN patients with eGFR≥30 mL/min/1.73m2, 17 (13%) patients progressed to ESRD. Moderate-to-severe TID was present in 13% of biopsies with eGFR≥60 mL/min/1.73m2 and in 33% of biopsies with eGFR between 30 and 60 mL/min/1.73m2. Moderate-to-severe TID was associated with a higher risk of ESRD progression: adjusted hazard ratio (HR) = 4.1, 95% CI (1.4, 12.1), p=0.01 for eGFR≥30 mL/min/1.73m2; HR 6.2, 95% CI (1.7, 23.2), p=0.008 for eGFR≥60 mL/min/1.73m2. There was no association between tubulointerstitial inflammation (TII) and ESRD progression. Conclusions Moderate-to-severe TID, but not TII, was a strong predictor of ESRD progression independent of eGFR or glomerular findings, therefore, providing an important window for potential early interventions.

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Section: Methodsmentioning

confidence: 99%

Tubulointerstitial damage predicts end stage renal disease in lupus nephritis with preserved to moderately impaired renal function: A retrospective cohort study

Broder

Mowrey

Khan

et al. 2018

Seminars in Arthritis and Rheumatism

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“…The study was approved by the Institutional Review Board and was HIPAA compliant. Study participants were identified using Clinical Looking Glass (CLG)®[14], a software application developed to evaluate health care quality, effectiveness, and efficiency using clinical and administrative datasets.…”

Section: Methodsmentioning

confidence: 99%

Preliminary development of a clinical decision rule for acute aortic syndromes

Lovy

Bellin

Levsky

et al. 2013

The American Journal of Emergency Medicine

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Objective Patients with suspected acute aortic syndromes (AAS) often undergo CT with negative results. We sought clinical and diagnostic criteria to identify low risk patients, an initial step in developing a clinical decision rule. Methods We retrospectively identified all adults presenting to our Emergency Department (ED) from 1/1/2006- 8/1/2010 who underwent CT angiography for suspected AAS without prior trauma or AAS. 1,465 patients met inclusion criteria; a retrospective case-controlled review (ratio 1:4) was conducted. Cases were diagnosed with aortic dissection, intramural hematoma, penetrating atherosclerotic ulcer or ruptured aneurysm. Results 2.7% (40/1,465) of patients who underwent CT had an AAS, 2 additional cases were diagnosed after admission [ED miss rate 5% (2/42)]. Patients with AAS were significantly older than controls (66 vs 59 yrs; p=.008). Risk factors included abnormal chest radiograph [sensitivity 79% (26/33), specificity 82% (113/137)] and acute chest pain [sensitivity 83% (29/35), specificity 71% (111/157)]. None of the 19 patients with resolved pain upon ED presentation had AAS. These data support a two-step rule: first screen for ongoing pain; if present, screen for acute chest pain or an abnormal chest radiograph. This approach achieves a 54% (84/155) reduction in CT usage with a sensitivity for AAS of 96% (95% CI: 89%-100%), negative predictive value of 99.8% (99.4%-100%) and a false negative rate of 1.7% (1/84). Conclusions Our results demonstrate a need to safely identify patients at low risk for AAS who can forgo CT. We developed a preliminary two-step clinical decision rule, which requires validation.

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“…The institutional database was surveyed by using a decision support tool (DST) (Clinical Looking Glass; Streamline Health, Atlanta, Ga) that integrates information from various hospital databases, including medical records, cancer registry, and radiology records (18). Cyst cohort.-The DST database was searched for abdominal CT or MR imaging performed between November 1, 2001, and November 1, 2011, in patients 18 years and older, for reports that contained the terms "pancr*" and "cyst*" in the same sentence.…”

Section: Cohort Selectionmentioning

confidence: 99%

Incidental Pancreatic Cystic Lesions: Is There a Relationship with the Development of Pancreatic Adenocarcinoma and All-Cause Mortality?

Chernyak¹,

Flusberg²,

Haramati³

et al. 2015

Radiology

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Purpose:To establish the effect of incidental pancreatic cysts found by using computed tomographic (CT) and magnetic resonance (MR) imaging on the incidence of pancreatic ductal adenocarcinoma and overall mortality in patients from an inner-city urban U.S. tertiary care medical center. Materials and Methods:Institutional review board granted approval for the study and waived the informed consent requirement. The study population comprised cyst and no-cyst cohorts drawn from all adults who underwent abdominal CT and/or MR November 1, 2001, to November 1, 2011. Cyst cohort included patients whose CT or MR imaging showed incidental pancreatic cysts; no-cyst cohort was three-to-one frequency matched by age decade, imaging modality, and year of initial study from the pool without reported incidental pancreatic cysts. Patients with pancreatic cancer diagnosed within 5 years before initial CT or MR were excluded. Demographics, study location (outpatient, inpatient, or emergency department), dates of pancreatic adenocarcinoma and death, and modified Charlson scores within 3 months before initial CT or MR examination were extracted from the hospital database. Cox hazard models were constructed; incident pancreatic adenocarcinoma and mortality were outcome events. Adenocarcinomas diagnosed 6 months or longer after initial CT or MR examination were considered incident. Results:There were 2034 patients in cyst cohort (1326 Conclusion:Incidental pancreatic cysts found by using CT or MR imaging are associated with increased mortality for patients younger than 65 years and an overall increased risk of pancreatic adenocarcinoma.q RSNA, 2014

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Democratizing Information Creation From Health Care Data for Quality Improvement, Research, and Education—The Montefiore Medical Center Experience

Cited by 116 publications

References 32 publications

Tubulointerstitial damage predicts end stage renal disease in lupus nephritis with preserved to moderately impaired renal function: A retrospective cohort study

Tubulointerstitial damage predicts end stage renal disease in lupus nephritis with preserved to moderately impaired renal function: A retrospective cohort study

Preliminary development of a clinical decision rule for acute aortic syndromes

Incidental Pancreatic Cystic Lesions: Is There a Relationship with the Development of Pancreatic Adenocarcinoma and All-Cause Mortality?

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