Electronic health record-based assessment of cardiovascular health: The stroke prevention in healthcare delivery environments (SPHERE) study

Foraker, Randi E.; Shoben, Abigail B.; Kelley, Marjorie M.; Lai, Albert M.; Lopetegui, Marcelo A.; Jackson, Rebecca D.; Langan, Michael; Payne, Philip R. O.

doi:10.1016/j.pmedr.2016.07.006

Cited by 24 publications

(23 citation statements)

References 33 publications

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“…First, in the database, it was not possible to definitively identify who provides care; thus, it was assumed that older adults cohabiting with the AD patient are the primary caregiver; however, if adult children or paid help are the primary caregivers, the true burden may have been underestimated. Second, while the EHR data are a valuable source for evaluating clinical outcomes, these datasets rarely—and the Southwestern Ontario dataset did not—include data on costs, requiring the use of literature‐based estimates. Although previous studies have evaluated caregiver costs by AD severity, MMSE score cutoffs to classify AD severity vary, which hampers the comparability of costs between published studies.…”

Section: Discussionmentioning

confidence: 99%

The clinical and economic burden among caregivers of patients with Alzheimer's disease in Canada

Szabo¹,

Lakzadeh²,

Cline

et al. 2019

Int J Geriat Psychiatry

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Objective To estimate the clinical and direct medical economic burden among Alzheimer disease (AD) caregivers using real‐world, longitudinal patient‐level data in Canada. Methods/Design This retrospective observational study assessed the clinical and direct medical economic burden among individuals who cohabitate with AD patients (“AD caregiver cohort”) compared with older adults who were cohabiting with another adult without dementia (“comparison cohort”) using real‐world data from the Southwestern Ontario database, a representative Canadian electronic health record (EHR) longitudinal EHR. Results The AD caregiver cohort (n = 2749; mild AD: n = 2254, moderate AD: n = 302, and severe AD, n = 193) had a similar or higher level of clinical and economic burden than the comparison cohort (n = 12 152). The overall AD cohort and caregivers of patients with mild AD had a similar clinical burden to the comparison cohort. Those caregiving for more severely affected AD patients had an increased risk of comorbidities and required more medication, physician attention, and hospital encounters compared with caregivers of less severe AD patients and the comparison cohort. Mean annual costs were higher among the AD caregiver cohort than the comparison cohort, and those caregiving for moderate and severe AD patients incurred the highest costs. Overall mortality was higher in the AD caregiver cohort compared with the comparison cohort. Conclusions Caregivers of patients with mild AD had a similar clinical and direct economic burden to older adults who were not dementia caregivers, whereas the burden among caregivers of moderate and severe AD patients was much greater.

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Section: Discussionmentioning

confidence: 99%

The clinical and economic burden among caregivers of patients with Alzheimer's disease in Canada

Szabo¹,

Lakzadeh²,

Cline

et al. 2019

Int J Geriat Psychiatry

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“…Detailed description and evaluation of the tool in the primary care setting have been previously published. 26,27,42 Briefly, a link to the tool was available to primary care providers within the EHR. The tool can be used on any given EHR platform.…”

Section: Methods Designmentioning

confidence: 99%

Oncologists' Perceptions of a Digital Tool to Improve Cancer Survivors' Cardiovascular Health

et al. 2019

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Background Cardiovascular (CV) disease continues to be a leading cause of morbidity and mortality with higher rates among cancer survivors than in the general population. Objective This study was aimed to understand oncology providers' attitudes toward a digital CV health tool, delivered via a tablet, to promote CV health in cancer survivors. Methods Using qualitative methods, 14 oncologists, from community and academic practice sites, were interviewed while they used the tool. Interviews were videotaped then analyzed using NVivo 11 software. Themes were inductively developed from the interviews. Results Three major themes emerged from the interviews as follows: (1) system functionality, (2) facilitators and barriers to integration, and (3) appropriate end-users. Oncologists recognized the critical role of CV health promotion among cancer survivors and identified features about the tool that would be helpful for CV health promotion. Workflow (subtheme) was a barrier to tool use. This feedback enabled tool redesign for further testing in the context of survivorship care. Conclusion Our findings emphasized the importance of identifying appropriate End-users which may include other survivorship care providers, patients, and primary care providers. Implications Our research addresses the knowledge gap in the use of digital tools in cancer survivorship care, specifically digital tools to promote CV health. Future research is needed to evaluate digital tools in cancer survivorship care. Research investigating patients as users of digital tools may provide additional insight.

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“…PREVENT integrates information from multiple input modalities and locations across the EHR. A previously described and validated scoring system (63)(64)(65)(66) calculates an overall cardiovascular health score based on the AHA's Life Simple 7 definitions of ideal (green), intermediate (yellow) and poor (red) health. Child and adolescent cut points (67,68) were applied to categorize and score each risk factor as follows: 2 points for each factor at ideal levels, 1 point for each factor classified as intermediate, and 0 points for each factor indicating poor health.…”

Section: Metrics Of Successmentioning

confidence: 99%

Development of a Health Information Technology Tool for Behavior Change to Address Obesity and Prevent Chronic Disease Among Adolescents: Designing for Dissemination and Sustainment Using the ORBIT Model

Kepper

Walsh‐Bailey

Brownson

et al. 2021

Front. Digit. Health

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Health information technology (HIT) has not been broadly adopted for use in outpatient healthcare settings to effectively address obesity in youth, especially among disadvantaged populations that face greater barriers to good health. A well-designed HIT tool can deliver behavior change recommendations and provide community resources to address this gap, and the Obesity-Related Behavioral Intervention Trials (ORBIT) model can guide its development and refinement. This article reports the application of the ORBIT model to (1) describe the characteristics and design of a novel HIT tool (the PREVENT tool) using behavioral theory, (2) illustrate the use of stakeholder-centered “designing for dissemination and sustainability” principles, and (3) discuss the practical implications and directions for future research. Two types of stakeholder engagement (customer discovery and user testing) were conducted with end users (outpatient healthcare teams). Customer discovery interviews (n = 20) informed PREVENT tool components and intervention targets by identifying (1) what healthcare teams (e.g., physicians, dietitians) identified as their most important “jobs to be done” in helping adolescents who are overweight/obese adopt healthy behaviors, (2) their most critical “pains” and “gains” related to overweight/obesity treatment, and (3) how they define success compared to competing alternatives. Interviews revealed the need for a tool to help healthcare teams efficiently deliver tailored, evidence-based behavior change recommendations, motivate patients, and follow-up with patients within the constraints of clinic schedules and workflows. The PREVENT tool was developed to meet these needs. It facilitates prevention discussions, delivers tailored, evidence-based recommendations for physical activity and food intake, includes an interactive map of community resources to support behavior change, and automates patient follow-up. Based on Self-Determination Theory, the PREVENT tool engages the patient to encourage competence and autonomy to motivate behavior change. The use of this intentional, user-centered design process should increase the likelihood of the intended outcomes (e.g., behavior change, weight stabilization/loss) and ultimately increase uptake, implementation success, and long-term results. After initial tool development, user-testing interviews (n = 13) were conducted using a think-aloud protocol that provided insight into users' (i.e., healthcare teams) cognitive processes, attitudes, and challenges when using the tool. Overall, the PREVENT tool was perceived to be useful, well-organized, and visually appealing.

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Electronic health record-based assessment of cardiovascular health: The stroke prevention in healthcare delivery environments (SPHERE) study

Cited by 24 publications

References 33 publications

The clinical and economic burden among caregivers of patients with Alzheimer's disease in Canada

The clinical and economic burden among caregivers of patients with Alzheimer's disease in Canada

Oncologists' Perceptions of a Digital Tool to Improve Cancer Survivors' Cardiovascular Health

Development of a Health Information Technology Tool for Behavior Change to Address Obesity and Prevent Chronic Disease Among Adolescents: Designing for Dissemination and Sustainment Using the ORBIT Model

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