Introduction Monitoring and understanding population health requires conducting health-related su... more Introduction Monitoring and understanding population health requires conducting health-related surveys and surveillance. The objective of our study was to assess whether data from self-administered surveys could be collected electronically from patients in urban, primarycare, safety-net clinics and subsequently linked and compared with the same patients' electronic health records (EHRs). Methods Data from self-administered surveys were collected electronically from a convenience sample of 527 patients at 2 Chicago health centers from September through November, 2014. Survey data were linked to EHRs. Results A total of 251 (47.6%) patients who completed the survey consented to having their responses linked to their EHRs. Consenting participants were older, more likely to report fair or poor health, and took longer to complete the survey than those who did not consent. For 8 of 18 categorical variables, overall percentage of agreement between survey data and EHR data exceeded 80% (sex, race/ethnicity, pneumococcal vaccination, self-reported body mass index [BMI], diabetes, high blood pressure, medication for high blood pressure, and hyperlipidemia), and of these, the level of agreement was good or excellent (κ ≥0.64) except for pneumococcal vaccination (κ = 0.40) and hyperlipidemia (κ = 0.47). Of 7 continuous variables, agreement was substantial for age and weight (concordance coefficients ≥0.95); however, with the exception of calculated survey BMI and EHR-BMI (concordance coefficient = 0.88), all other continuous variables had poor agreement. Conclusions Self-administered and web-based surveys can be completed in urban, primary-care, safety-net clinics and linked to EHRs. Linking survey and EHR data can enhance public health surveillance by validating self-reported data, completing gaps in patient data, and extending sample sizes obtained through current methods. This approach will require promoting and sustaining patient involvement.
Journal of the American Board of Family Medicine, May 1, 2016
Recent research demonstrates an increased need to understand the contribution of social determina... more Recent research demonstrates an increased need to understand the contribution of social determinants of health (SDHs) in shaping an individual's health status and outcomes. We studied patients with diabetes in safety-net centers and evaluated associations of their disease complexity, demographic characteristics, comorbidities, insurance status, and primary language with their HbA1c level over time. Methods: Adult patients with diabetes with at least 3 distinct primary care visits between January 1, 2006, and December 31, 2013, were identified in the CHARN data warehouse. These patients were categorized into 4 groups: those without a diagnosis of cardiovascular disease (CVD) or depression; those with CVD but not depression; those with depression but not CVD; and those with CVD and depression. Charlson score; demographic characteristics such as age, sex, and race/ethnicity; and SDHs such as primary language and insurance status were used as predictors. The outcome measure was HbA1c. Hypothesis testing was conducted using 3-level hierarchical linear models. Results: Baseline HbA1c differed significantly across the 4 diabetes groups and by race/ethnicity. The amount of HbA1c change over time differed by insurance status. Patients who were continuously insured tended to have lower baseline HbA1c and a smaller increase. Chinese-speaking patients tended to have lower baseline HbA1c but a larger increase over time compared with English speakers. There were various unexpected associations: compared with the diabetes-only group, mean HbA1c tended to be lower among the other more complex groups at baseline; women tended to have lower measures at baseline; older age and higher Charlson scores were associated with lower HbA1c. Conclusions: There is still unexplained variability relating to both baseline HbA1c values and change over time in the model. SDHs, such as insurance status and primary language, are associated with HbA1c, and results suggest that these relationships vary with disease status among patients with diabetes in safety-net centers. It is important to recognize that there are complex relationships among demographic and SDH measures in complex patients, and there is work to be done in correctly modeling and understanding these relationships. We also recommend prioritizing the collection of SDH and enabling services data for safety-net patients that would be instrumental in conducting a more comprehensive study.
Journal of the American Board of Family Medicine : JABFM
Recent research demonstrates an increased need to understand the contribution of social determina... more Recent research demonstrates an increased need to understand the contribution of social determinants of health (SDHs) in shaping an individual's health status and outcomes. We studied patients with diabetes in safety-net centers and evaluated associations of their disease complexity, demographic characteristics, comorbidities, insurance status, and primary language with their HbA1c level over time. Adult patients with diabetes with at least 3 distinct primary care visits between January 1, 2006, and December 31, 2013, were identified in the CHARN data warehouse. These patients were categorized into 4 groups: those without a diagnosis of cardiovascular disease (CVD) or depression; those with CVD but not depression; those with depression but not CVD; and those with CVD and depression. Charlson score; demographic characteristics such as age, sex, and race/ethnicity; and SDHs such as primary language and insurance status were used as predictors. The outcome measure was HbA1c. Hypoth...
Electronic health records represent a rich and growing source of clinical data for research. Priv... more Electronic health records represent a rich and growing source of clinical data for research. Privacy, regulatory, and institutional concerns limit the speed and ease of sharing this data. VaultDB is a framework for securely computing SQL queries over private data from two or more sources. It evaluates queries using secure multiparty computation: cryptographic protocols that evaluate a function such that the only information revealed from running it is the query answer. We describe the development of a HIPAA-compliant version of VaultDB on the Chicago Area Patient Centered Outcomes Research Network (CAPriCORN). This multi-institutional clinical research network spans the electronic health records of nearly 13M patients over hundreds of clinics and hospitals in the Chicago metropolitan area. Our results from deploying at three health systems within this network show its efficiency and scalability for distributed clinical research analyses without moving patient records from their site of origin.
Background Homelessness is associated with substantial morbidity. Data linkages between homeless ... more Background Homelessness is associated with substantial morbidity. Data linkages between homeless and health systems are important to understand unique needs across homeless populations, identify homeless individuals not registered in homeless databases, quantify the impact of housing services on health-system use, and motivate health systems and payers to contribute to housing solutions. Methods We performed a cross-sectional survey including six health systems and two Homeless Management Information Systems (HMIS) in Cook County, Illinois. We performed privacy-preserving record linkage to identify homelessness through HMIS or ICD-10 codes captured in electronic medical records. We measured the prevalence of health conditions and health-services use across the following typologies: housing-service utilizers stratified by service provided (stable, stable plus unstable, unstable) and non-utilizers (i.e., homelessness identified through diagnosis codes—without receipt of housing servic...
Team Members: Andrew Hamilton, MS, RN, Chief Operating Officer and Director of Clinical Informati... more Team Members: Andrew Hamilton, MS, RN, Chief Operating Officer and Director of Clinical Informatics, Alliance of Chicago Erin Kaleba, MPH, Director of Research Initiatives, Alliance of Chicago Fred Rachman, MD, Chief Executive Officer, Alliance Clare Tanner, PhD, Program Director, MPHI Nathan Taylor, MS, Quality Informatics Analyst, Alliance of Chicago Joanne White, Project Coordinator, MPHI Shaohui Zhai, PhD, Statistician, MPHI Kai Zheng, PhD, Assistant Professor, School of Public Health Department of Health Management and Policy, School of Information, School of Nursing, The University of Michigan
Journal of the American Association of Nurse Practitioners, 2013
To present a tool that can be used to evaluate patient safety in both nurse-led and physician-led... more To present a tool that can be used to evaluate patient safety in both nurse-led and physician-led practices. This article describes our experience with the Physician Practice Patient Safety Assessment (PPPSA) tool in six safety net practices-three of which were primary care nurse-managed health centers and three were physician-led federally qualified health centers. The information provided is from the tool itself and how it might be used in clinical settings, especially primary care. The PPPSA is a tool to measure the extent to which patient safety practices are rigorously and systematically implemented throughout a health center. The tool's methodology requires discussion and consensus, incorporating a team approach with multiple perspectives within a center. It is designed to promote changes in practices that would improve patient safety. The tool has enormous relevance for primary care settings, especially those preparing themselves for patient-centered medical home status a...
Journal of the American Association of Nurse Practitioners, 2014
This study, conducted in five safety-net practices, including two nurse-managed health centers (N... more This study, conducted in five safety-net practices, including two nurse-managed health centers (NMHCs) and three federally qualified health centers (FQHCs), examined the impact of implementing a commercial electronic health records (EHRs) system on medication safety. A mixed methods approach with two sources of data were used: (a) a query of prescription records captured by the EHR retrieving co-prescribed medications with identified drug-drug interaction (DDI) risks, and (b) semistructured interviews with clinicians and leadership about the usability and benefits of EHR-embedded clinical decision support in the form of DDI alerts. We found an exceptionally low rate of DDI pairs in all five practices. Only 130 "true" DDI pairs were confirmed representing 149,087 visits and 62 providers. Among the 130, the largest categories were related to antihypertensive medications, which are in fact often prescribed together. There were no significant differences between physicians and...
Journal of the American Medical Informatics Association, 2014
The Chicago Area Patient-Centered Outcomes Research Network (CAPriCORN) represents an unprecedent... more The Chicago Area Patient-Centered Outcomes Research Network (CAPriCORN) represents an unprecedented collaboration across diverse healthcare institutions including private, county, and state hospitals and health systems, a consortium of Federally Qualified Health Centers, and two Department of Veterans Affairs hospitals. CAPriCORN builds on the strengths of our institutions to develop a cross-cutting infrastructure for sustainable and patient-centered comparative effectiveness research in Chicago. Unique aspects include collaboration with the University HealthSystem Consortium to aggregate data across sites, a centralized communication center to integrate patient recruitment with the data infrastructure, and a centralized institutional review board to ensure a strong and efficient human subject protection program. With coordination by the Chicago Community Trust and the Illinois Medical District Commission, CAPriCORN will model how healthcare institutions can overcome barriers of data integration, marketplace competition, and care fragmentation to develop, test, and implement strategies to improve care for diverse populations and reduce health disparities.
Monitoring and understanding population health requires conducting health-related surveys and sur... more Monitoring and understanding population health requires conducting health-related surveys and surveillance. The objective of our study was to assess whether data from self-administered surveys could be collected electronically from patients in urban, primary-care, safety-net clinics and subsequently linked and compared with the same patients' electronic health records (EHRs). Data from self-administered surveys were collected electronically from a convenience sample of 527 patients at 2 Chicago health centers from September through November, 2014. Survey data were linked to EHRs. A total of 251 (47.6%) patients who completed the survey consented to having their responses linked to their EHRs. Consenting participants were older, more likely to report fair or poor health, and took longer to complete the survey than those who did not consent. For 8 of 18 categorical variables, overall percentage of agreement between survey data and EHR data exceeded 80% (sex, race/ethnicity, pneumo...
Journal of the American Medical Informatics Association : JAMIA
The Chicago Area Patient-Centered Outcomes Research Network (CAPriCORN) represents an unprecedent... more The Chicago Area Patient-Centered Outcomes Research Network (CAPriCORN) represents an unprecedented collaboration across diverse healthcare institutions including private, county, and state hospitals and health systems, a consortium of Federally Qualified Health Centers, and two Department of Veterans Affairs hospitals. CAPriCORN builds on the strengths of our institutions to develop a cross-cutting infrastructure for sustainable and patient-centered comparative effectiveness research in Chicago. Unique aspects include collaboration with the University HealthSystem Consortium to aggregate data across sites, a centralized communication center to integrate patient recruitment with the data infrastructure, and a centralized institutional review board to ensure a strong and efficient human subject protection program. With coordination by the Chicago Community Trust and the Illinois Medical District Commission, CAPriCORN will model how healthcare institutions can overcome barriers of dat...
Introduction Monitoring and understanding population health requires conducting health-related su... more Introduction Monitoring and understanding population health requires conducting health-related surveys and surveillance. The objective of our study was to assess whether data from self-administered surveys could be collected electronically from patients in urban, primarycare, safety-net clinics and subsequently linked and compared with the same patients' electronic health records (EHRs). Methods Data from self-administered surveys were collected electronically from a convenience sample of 527 patients at 2 Chicago health centers from September through November, 2014. Survey data were linked to EHRs. Results A total of 251 (47.6%) patients who completed the survey consented to having their responses linked to their EHRs. Consenting participants were older, more likely to report fair or poor health, and took longer to complete the survey than those who did not consent. For 8 of 18 categorical variables, overall percentage of agreement between survey data and EHR data exceeded 80% (sex, race/ethnicity, pneumococcal vaccination, self-reported body mass index [BMI], diabetes, high blood pressure, medication for high blood pressure, and hyperlipidemia), and of these, the level of agreement was good or excellent (κ ≥0.64) except for pneumococcal vaccination (κ = 0.40) and hyperlipidemia (κ = 0.47). Of 7 continuous variables, agreement was substantial for age and weight (concordance coefficients ≥0.95); however, with the exception of calculated survey BMI and EHR-BMI (concordance coefficient = 0.88), all other continuous variables had poor agreement. Conclusions Self-administered and web-based surveys can be completed in urban, primary-care, safety-net clinics and linked to EHRs. Linking survey and EHR data can enhance public health surveillance by validating self-reported data, completing gaps in patient data, and extending sample sizes obtained through current methods. This approach will require promoting and sustaining patient involvement.
Journal of the American Board of Family Medicine, May 1, 2016
Recent research demonstrates an increased need to understand the contribution of social determina... more Recent research demonstrates an increased need to understand the contribution of social determinants of health (SDHs) in shaping an individual's health status and outcomes. We studied patients with diabetes in safety-net centers and evaluated associations of their disease complexity, demographic characteristics, comorbidities, insurance status, and primary language with their HbA1c level over time. Methods: Adult patients with diabetes with at least 3 distinct primary care visits between January 1, 2006, and December 31, 2013, were identified in the CHARN data warehouse. These patients were categorized into 4 groups: those without a diagnosis of cardiovascular disease (CVD) or depression; those with CVD but not depression; those with depression but not CVD; and those with CVD and depression. Charlson score; demographic characteristics such as age, sex, and race/ethnicity; and SDHs such as primary language and insurance status were used as predictors. The outcome measure was HbA1c. Hypothesis testing was conducted using 3-level hierarchical linear models. Results: Baseline HbA1c differed significantly across the 4 diabetes groups and by race/ethnicity. The amount of HbA1c change over time differed by insurance status. Patients who were continuously insured tended to have lower baseline HbA1c and a smaller increase. Chinese-speaking patients tended to have lower baseline HbA1c but a larger increase over time compared with English speakers. There were various unexpected associations: compared with the diabetes-only group, mean HbA1c tended to be lower among the other more complex groups at baseline; women tended to have lower measures at baseline; older age and higher Charlson scores were associated with lower HbA1c. Conclusions: There is still unexplained variability relating to both baseline HbA1c values and change over time in the model. SDHs, such as insurance status and primary language, are associated with HbA1c, and results suggest that these relationships vary with disease status among patients with diabetes in safety-net centers. It is important to recognize that there are complex relationships among demographic and SDH measures in complex patients, and there is work to be done in correctly modeling and understanding these relationships. We also recommend prioritizing the collection of SDH and enabling services data for safety-net patients that would be instrumental in conducting a more comprehensive study.
Journal of the American Board of Family Medicine : JABFM
Recent research demonstrates an increased need to understand the contribution of social determina... more Recent research demonstrates an increased need to understand the contribution of social determinants of health (SDHs) in shaping an individual's health status and outcomes. We studied patients with diabetes in safety-net centers and evaluated associations of their disease complexity, demographic characteristics, comorbidities, insurance status, and primary language with their HbA1c level over time. Adult patients with diabetes with at least 3 distinct primary care visits between January 1, 2006, and December 31, 2013, were identified in the CHARN data warehouse. These patients were categorized into 4 groups: those without a diagnosis of cardiovascular disease (CVD) or depression; those with CVD but not depression; those with depression but not CVD; and those with CVD and depression. Charlson score; demographic characteristics such as age, sex, and race/ethnicity; and SDHs such as primary language and insurance status were used as predictors. The outcome measure was HbA1c. Hypoth...
Electronic health records represent a rich and growing source of clinical data for research. Priv... more Electronic health records represent a rich and growing source of clinical data for research. Privacy, regulatory, and institutional concerns limit the speed and ease of sharing this data. VaultDB is a framework for securely computing SQL queries over private data from two or more sources. It evaluates queries using secure multiparty computation: cryptographic protocols that evaluate a function such that the only information revealed from running it is the query answer. We describe the development of a HIPAA-compliant version of VaultDB on the Chicago Area Patient Centered Outcomes Research Network (CAPriCORN). This multi-institutional clinical research network spans the electronic health records of nearly 13M patients over hundreds of clinics and hospitals in the Chicago metropolitan area. Our results from deploying at three health systems within this network show its efficiency and scalability for distributed clinical research analyses without moving patient records from their site of origin.
Background Homelessness is associated with substantial morbidity. Data linkages between homeless ... more Background Homelessness is associated with substantial morbidity. Data linkages between homeless and health systems are important to understand unique needs across homeless populations, identify homeless individuals not registered in homeless databases, quantify the impact of housing services on health-system use, and motivate health systems and payers to contribute to housing solutions. Methods We performed a cross-sectional survey including six health systems and two Homeless Management Information Systems (HMIS) in Cook County, Illinois. We performed privacy-preserving record linkage to identify homelessness through HMIS or ICD-10 codes captured in electronic medical records. We measured the prevalence of health conditions and health-services use across the following typologies: housing-service utilizers stratified by service provided (stable, stable plus unstable, unstable) and non-utilizers (i.e., homelessness identified through diagnosis codes—without receipt of housing servic...
Team Members: Andrew Hamilton, MS, RN, Chief Operating Officer and Director of Clinical Informati... more Team Members: Andrew Hamilton, MS, RN, Chief Operating Officer and Director of Clinical Informatics, Alliance of Chicago Erin Kaleba, MPH, Director of Research Initiatives, Alliance of Chicago Fred Rachman, MD, Chief Executive Officer, Alliance Clare Tanner, PhD, Program Director, MPHI Nathan Taylor, MS, Quality Informatics Analyst, Alliance of Chicago Joanne White, Project Coordinator, MPHI Shaohui Zhai, PhD, Statistician, MPHI Kai Zheng, PhD, Assistant Professor, School of Public Health Department of Health Management and Policy, School of Information, School of Nursing, The University of Michigan
Journal of the American Association of Nurse Practitioners, 2013
To present a tool that can be used to evaluate patient safety in both nurse-led and physician-led... more To present a tool that can be used to evaluate patient safety in both nurse-led and physician-led practices. This article describes our experience with the Physician Practice Patient Safety Assessment (PPPSA) tool in six safety net practices-three of which were primary care nurse-managed health centers and three were physician-led federally qualified health centers. The information provided is from the tool itself and how it might be used in clinical settings, especially primary care. The PPPSA is a tool to measure the extent to which patient safety practices are rigorously and systematically implemented throughout a health center. The tool's methodology requires discussion and consensus, incorporating a team approach with multiple perspectives within a center. It is designed to promote changes in practices that would improve patient safety. The tool has enormous relevance for primary care settings, especially those preparing themselves for patient-centered medical home status a...
Journal of the American Association of Nurse Practitioners, 2014
This study, conducted in five safety-net practices, including two nurse-managed health centers (N... more This study, conducted in five safety-net practices, including two nurse-managed health centers (NMHCs) and three federally qualified health centers (FQHCs), examined the impact of implementing a commercial electronic health records (EHRs) system on medication safety. A mixed methods approach with two sources of data were used: (a) a query of prescription records captured by the EHR retrieving co-prescribed medications with identified drug-drug interaction (DDI) risks, and (b) semistructured interviews with clinicians and leadership about the usability and benefits of EHR-embedded clinical decision support in the form of DDI alerts. We found an exceptionally low rate of DDI pairs in all five practices. Only 130 "true" DDI pairs were confirmed representing 149,087 visits and 62 providers. Among the 130, the largest categories were related to antihypertensive medications, which are in fact often prescribed together. There were no significant differences between physicians and...
Journal of the American Medical Informatics Association, 2014
The Chicago Area Patient-Centered Outcomes Research Network (CAPriCORN) represents an unprecedent... more The Chicago Area Patient-Centered Outcomes Research Network (CAPriCORN) represents an unprecedented collaboration across diverse healthcare institutions including private, county, and state hospitals and health systems, a consortium of Federally Qualified Health Centers, and two Department of Veterans Affairs hospitals. CAPriCORN builds on the strengths of our institutions to develop a cross-cutting infrastructure for sustainable and patient-centered comparative effectiveness research in Chicago. Unique aspects include collaboration with the University HealthSystem Consortium to aggregate data across sites, a centralized communication center to integrate patient recruitment with the data infrastructure, and a centralized institutional review board to ensure a strong and efficient human subject protection program. With coordination by the Chicago Community Trust and the Illinois Medical District Commission, CAPriCORN will model how healthcare institutions can overcome barriers of data integration, marketplace competition, and care fragmentation to develop, test, and implement strategies to improve care for diverse populations and reduce health disparities.
Monitoring and understanding population health requires conducting health-related surveys and sur... more Monitoring and understanding population health requires conducting health-related surveys and surveillance. The objective of our study was to assess whether data from self-administered surveys could be collected electronically from patients in urban, primary-care, safety-net clinics and subsequently linked and compared with the same patients' electronic health records (EHRs). Data from self-administered surveys were collected electronically from a convenience sample of 527 patients at 2 Chicago health centers from September through November, 2014. Survey data were linked to EHRs. A total of 251 (47.6%) patients who completed the survey consented to having their responses linked to their EHRs. Consenting participants were older, more likely to report fair or poor health, and took longer to complete the survey than those who did not consent. For 8 of 18 categorical variables, overall percentage of agreement between survey data and EHR data exceeded 80% (sex, race/ethnicity, pneumo...
Journal of the American Medical Informatics Association : JAMIA
The Chicago Area Patient-Centered Outcomes Research Network (CAPriCORN) represents an unprecedent... more The Chicago Area Patient-Centered Outcomes Research Network (CAPriCORN) represents an unprecedented collaboration across diverse healthcare institutions including private, county, and state hospitals and health systems, a consortium of Federally Qualified Health Centers, and two Department of Veterans Affairs hospitals. CAPriCORN builds on the strengths of our institutions to develop a cross-cutting infrastructure for sustainable and patient-centered comparative effectiveness research in Chicago. Unique aspects include collaboration with the University HealthSystem Consortium to aggregate data across sites, a centralized communication center to integrate patient recruitment with the data infrastructure, and a centralized institutional review board to ensure a strong and efficient human subject protection program. With coordination by the Chicago Community Trust and the Illinois Medical District Commission, CAPriCORN will model how healthcare institutions can overcome barriers of dat...
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Papers by Fred Rachman