A5011618952- Palliative Care and End-of-Life Issues
- Healthcare Policy and Management
- Ethics in medical practice
- Patient Dignity and Privacy
- Primary Care and Health Outcomes
- Family and Patient Care in Intensive Care Units
- Psychosomatic Disorders and Their Treatments
- Health Literacy and Information Accessibility
- Health Systems, Economic Evaluations, Quality of Life
- Sepsis Diagnosis and Treatment
- Electronic Health Records Systems
- Mobile Health and mHealth Applications
- Healthcare Technology and Patient Monitoring
- Grief, Bereavement, and Mental Health
- Maternal and Perinatal Health Interventions
- Childhood Cancer Survivors' Quality of Life
- Patient-Provider Communication in Healthcare
- Cardiac, Anesthesia and Surgical Outcomes
- Data-Driven Disease Surveillance
- Advanced X-ray and CT Imaging
- Radiation Dose and Imaging
- Advanced Neural Network Applications
- Reproductive Health and Contraception
- Global Maternal and Child Health
- Radiomics and Machine Learning in Medical Imaging
Philadelphia VA Medical Center
2018-2022
University of Pennsylvania
2017-2021
United States Department of Veterans Affairs
2021
General Department of Preventive Medicine
2020
Mental Illness Research, Education and Clinical Centers
2020
Stanford University
2010-2018
Santa Clara Valley Medical Center
2016
Brigham and Women's Hospital
2003-2004
Harvard University
2003
Background Sepsis remains the top cause of morbidity and mortality hospitalised patients despite concerted efforts. Clinical decision support for sepsis has shown mixed results reflecting heterogeneous populations, methodologies interventions. Objectives To determine whether addition a real-time electronic health record (EHR)-based clinical alert improves adherence to treatment guidelines outcomes in with suspected severe sepsis. Design Patient-level randomisation, single blinded. Setting...
Abstract Objective To evaluate whether longer term participation in the bundled payments for care initiative (BPCI) medical conditions United States, which held hospitals financially accountable all spending during an episode of from hospital admission to 90 days after discharge, was associated with changes spending, mortality, or health service use. Design Quasi-experimental difference-in-differences analysis. Setting US participating acute myocardial infarction, congestive heart failure,...
Rationale: Admissions to ICUs are common during terminal hospitalizations, but little is known about how ICU care affects the end-of-life experience for patients dying in hospitals and their families.Objectives: We measured association between hospitalization family ratings of who died 106 Veterans Affairs from 2010 2016.Methods: Patients were divided into four categories: no-ICU care, ICU-only mixed (died outside ICU), ICU). Multivariable linear probability models adjusted patient hospital...
Legal formalities impose barriers to creating advance directives. Eliminating legal requirements would allow such documents be more easily integrated into health care systems and increase the likelihood of their being used achieve intended goals.
Increasing use of EHRs has generated interest in the potential computerized clinical decision support to improve treatment sepsis. Electronic sepsis alerts have had mixed results due poor test characteristics, inability detect a timely fashion and outside software limiting widespread adoption. We describe development, evaluation validation an accurate severe alert with impact management.To develop, evaluate, validate embedded commercial EHR.The was developed by identifying most common...
The rise of electronic medical records promotes the collection and aggregation data. These data have tremendous potential utility for health policy public health; yet there are gaps in scholarly literature. No articles or legal literature mapped “information flows” from patient to database, commentary has focused more on privacy than data’s social value incentives production. Utilizing short case studies flows, I show that ample exist, much them available online through government websites...
Mobile applications offer a new approach to personal health records, which are internet-based tools for patients consolidate and manage their information. The University of Pennsylvania Health System (UPHS) was one the first systems participate in Apple Records (AHR), prominent example this generation records.This study aimed characterize early adoption AHR among UPHS understand user perspectives.An email-based survey with fixed answer, Likert scale, open-ended questions administered all...
Little is understood about the different ways patients complete advance directives (ADs), which most commonly through lawyers and increasingly using websites.To understand patients' perspectives on approaches to facilitating AD completion, value of legal regulation ADs, use a web-based platform create an AD.Semi-structured interviews with patients.We purposively sampled 25 at least 70 years age or chronic disease from 2 internal medicine clinics.Interviews focused experiences creating...
Background: Digital tools to document care preferences in serious illnesses are increasingly common, but their impact is unknown. We developed a web-based advance directive (AD) featuring (1) modular content eliciting detailed preferences, (2) the ability electronically transmit ADs electronic health record (EHR), and (3) use of nudges promote transmission sharing. Objective: To compare web-based, EHR-transmissible AD paper AD. Methods: Patients with gastrointestinal lung malignancies were...
Quality improvement (QI) is an important function of learning health systems, and public policy should promote QI activities. Use systematic methodologies in has prompted substantial confusion regarding when human subjects research under the Common Rule, this persists with revised Rule. Difficulty distinguishing from imposes costs on quality process. I offer guidance to IRBs mitigate these suggest a new regulatory exclusion for minimal risk
Medicare reimbursement for hospitals is increasingly tied to performance. The use of individual provider performance reports offers the potential improve clinical outcomes through social comparison, and isolated cases dashboard uses at specific institutions have been previously reported. However, little known about overall trends in how electronic health record track provide feedback on We used data from 2013 2015 American Hospital Association (AHA) Annual Survey Information Technology...
In the United States, patients who lose ability to make their own medical decisions are subject laws of respective states. Laws governing advance directives and physician orders for life-sustaining therapies (POLST), establishing a surrogate in absence an directive, vary substantially by jurisdiction. This article traces those from origins, describes current practices challenges with application patient care, considers future avenues ethics research legislative reform.