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McFarlane Timothy

Description

Although recent data suggests childhood obesity prevalence has stabilized, an estimated 1 in 3 U.S. children are overweight or obese.1 Further, there is variation by racial and ethnic groups, location, age, and poverty2, resulting in a need for local data to support public health planning and evaluation efforts. Current methods for surveillance of childhood weight status rely on self-report from community-based surveys. However, surveys have long time intervals between data collection periods, are expensive, and are not often able to produce precise small-area estimates. EHRs have been increasingly proposed as an alternative or supplement to community surveys. Childhood weight and height is collected as a part of routine care, and leveraging these data from EHRs may provide rapid and locally precise estimates of childhood weight status. A concern for the use of EHRs is the potential for selection bias. EHRs represent only those seeking healthcare and may not generalize to the population. Additionally, the type of clinical visit (e.g., wellness vs. acute) may affect the prevalence estimates and the likelihood of collecting height and weight data in the EHR. Thus, in addition to EHRs being a convenience sample, there may be additional selection biases based on the type of visit and whether height and weight was measured and recorded. The current work sought to quantify the effect of visit type on childhood overweight and obesity prevalence and generate weights to adjust prevalence for potential EHR-related selection bias.

Objective: To discuss the use of electronic health records (EHRs) for estimation of overweight and obesity prevalence in children aged 2 to 19 years and to compare prevalence between the convenience sample obtained from EHRs to prevalence adjusted for potential selection bias.

Submitted by elamb on
Description

Drug overdoses are now the leading cause of accidental death in the United States, with an estimated 60,000 deaths in 2016. Nationally, EMS overdose responses with naloxone administration have nearly doubled from 2012 to 2016 from 573.6 to 1004.4 per 100,000 EMS events. Resuscitation using the opioid antagonist, naloxone is recommended in cases of suspected opioid ODs, and has been increasingly used by EMS agencies, law enforcement, healthcare providers, and Good Samaritans. While naloxone can save lives, it is not clear how often its use is appropriate; delivering the right care to the right patient at the right time. It has been suggested that community paramedic programs teamed with recovery services may help link OD patients to recovery and rehabilitation services and establish mechanisms for follow-up care. Prior to implementing community EMS programs, it is important to understand the EMS utilization patterns of the OD population. I-EMS interactions may present an opportunity for behavioral intervention and linkage to services to prevent future OD and death in the opioid-using population. Accurately documenting substances involved in drug overdose deaths has been of increasing interest to Marion County and Indiana with a recent law requiring toxicology testing 5,6. This project linked individual-level data across public health information systems to assess the appropriateness of naloxone administration, the frequency of I-EMS service utilization until final death outcome among the I-EMS OD deceased cohort, and underlying causes of death among the cohort.

Objective: To characterize the appropriateness of naloxone administration, causes of death, and history of Indianapolis Emergency Medical Services (I-EMS) service utilization among the drug overdose population in Marion County, Indiana between 2011 to 2017.

Submitted by elamb on
Description

Hypertension (HTN) is a highly prevalent chronic condition and strongly associated with morbidity and mortality. HTN is amenable to prevention and control through public and population health programs and policies. Therefore, public and population health programs require accurate, stable estimates of disease prevalence, and estimating HTN prevalence at the community-level is acutely important for timely detection, intervention, and effective evaluation. Current surveillance methods for HTN rely upon community-based surveys, such as the BRFSS. While BRFSS is the standard at the state- and national-level, they are expensive to collect, released once per year, and their confidence intervals are too wide for precise estimates at the local level. More timely, frequently updated, and locally precise prevalence estimates could greatly improve the timeliness and precision of public health interventions. The current study evaluated EHR data from a large, mature HIE as an alternative to community-based surveys for timely, accurate, and precise HTN prevalence estimation.

Objective:

To assess the equivalence of hypertension prevalence estimates between longitudinal electronic health record (EHR) data from a community-based health information exchange (HIE) and the Behavioral Risk Factor Surveillance System (BRFSS).

Submitted by elamb on