Evidence map›Paper›PMID 37257883›Full record

ArticleJournal of the American Medical Informatics Association : JAMIA2023

Developing electronic clinical quality measures to assess the cancer diagnostic process.

Daniel R Murphy, Andrew J Zimolzak, Divvy K Upadhyay, Li Wei, Preeti Jolly, Alexis Offner, Dean F Sittig, Saritha Korukonda, Riyaa Murugaesh Rekha, Hardeep Singh

Abstract read
In one paragraph

Article in Journal of the American Medical Informatics Association : JAMIA, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Daniel R MurphyCenter for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA.ORCID 0000-0002-2329-668X
Andrew J ZimolzakCenter for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA.ORCID 0000-0003-0973-5639
Divvy K UpadhyayDivision of Quality, Safety and Patient Experience, Geisinger, Danville, Pennsylvania, USA.
Li WeiCenter for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA.
Preeti JollyCenter for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA.
Alexis OffnerCenter for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA.
Dean F SittigDepartment of Clinical and Health Informatics, The University of Texas Health Science Center at Houston's School of Biomedical Informatics, Houston, Texas, USA.ORCID 0000-0001-5811-8915
Saritha KorukondaInvestigator-Initiated Research Operations, Geisinger, Danville, Pennsylvania, USA.
Riyaa Murugaesh RekhaDivision of Quality, Safety and Patient Experience, Geisinger, Danville, Pennsylvania, USA.
Hardeep SinghCenter for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA.ORCID 0000-0002-4419-8974

Funding

Diagnostic Safety Center for Advancing E-triggers and Rapid Feedback Implementation (DISCOVERI)R18HS029347 · AHRQ · BAYLOR COLLEGE OF MEDICINE · PI SINGH, HARDEEP · 2022 to 2025
$4.0M
Decision Making and Clinical Work of Test Result Follow-up in Health IT SettingsR01HS022087 · AHRQ · BAYLOR COLLEGE OF MEDICINE · PI SINGH, HARDEEP · 2013 to 2016
$2.0M
Developing e-Triggers to Detect Telemedicine Related Diagnostic Safety EventsR01HS028595 · AHRQ · BAYLOR COLLEGE OF MEDICINE · PI MURPHY, DANIEL R, SINGH, HARDEEP · 2022 to 2025
$1.6M
AHRQ HHS R01 HS022087AHRQ HHS R01 HS028595AHRQ HHS R18 HS029347
6 · The paper itself

Abstract

objectiveMeasures of diagnostic performance in cancer are underdeveloped. Electronic clinical quality measures (eCQMs) to assess quality of cancer diagnosis could help quantify and improve diagnostic performance. MATERIALS AND

methodsWe developed 2 eCQMs to assess diagnostic evaluation of red-flag clinical findings for colorectal (CRC; based on abnormal stool-based cancer screening tests or labs suggestive of iron deficiency anemia) and lung (abnormal chest imaging) cancer. The 2 eCQMs quantified rates of red-flag follow-up in CRC and lung cancer using electronic health record data repositories at 2 large healthcare systems. Each measure used clinical data to identify abnormal results, evidence of appropriate follow-up, and exclusions that signified follow-up was unnecessary. Clinicians reviewed 100 positive and 20 negative randomly selected records for each eCQM at each site to validate accuracy and categorized missed opportunities related to system, provider, or patient factors.

resultsWe implemented the CRC eCQM at both sites, while the lung cancer eCQM was only implemented at the VA due to lack of structured data indicating level of cancer suspicion on most chest imaging results at Geisinger. For the CRC eCQM, the rate of appropriate follow-up was 36.0% (26 746/74 314 patients) in the VA after removing clinical exclusions and 41.1% at Geisinger (1009/2461 patients; P < .001). Similarly, the rate of appropriate evaluation for lung cancer in the VA was 61.5% (25 166/40 924 patients). Reviewers most frequently attributed missed opportunities at both sites to provider factors (84 of 157).

conclusionsWe implemented 2 eCQMs to evaluate the diagnostic process in cancer at 2 large health systems. Health care organizations can use these eCQMs to monitor diagnostic performance related to cancer.

Indexed as

Lung NeoplasmsQuality Indicators, Health CareAffectDelivery of Health CareElectronic Health RecordsHumanscolon cancerdiagnostic delaysdiagnostic errorslung cancerquality measurestriggers

Identifiers

PMID37257883
PMCPMC10436145

What OpenQuestion holds

Textmetadata
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.