Data Quality of Automated Comorbidity Lists in Patients With Mental Health and Substance Use Disorders.

EHRs provide an opportunity to conduct research on underrepresented oncology populations with mental health and substance use disorders. However, a lack of data quality may introduce unintended bias into EHR data. The objective of this article is describe our analysis of data quality within automated comorbidity lists commonly found in EHRs. Investigators conducted a retrospective chart review of 395 oncology patients from a safety-net integrated healthcare system. Statistical analysis included κ coefficients and a condition logistic regression. Subjects were racially and ethnically diverse and predominantly used Medicaid insurance. Weak κ coefficients ( κ = 0.2-0.39, P < .01) were noted for drug and alcohol use disorders indicating deficiencies in comorbidity documentation within the automated comorbidity list. Further, conditional logistic regression analyses revealed deficiencies in comorbidity documentation in patients with drug use disorders (odds ratio, 11.03; 95% confidence interval, 2.71-44.9; P = .01) and psychoses (odds ratio, 0.04; confidence interval, 0.02-0.10; P < .01). Findings suggest deficiencies in automatic comorbidity lists as compared with a review of provider narrative notes when identifying comorbidities. As healthcare systems increasingly use EHR data in clinical studies and decision making, the quality of healthcare delivery and clinical research may be affected by discrepancies in the documentation of comorbidities.

Mental Health and Substance Use Disorders in Patients Diagnosed With Cancer: An Integrative Review of Healthcare Utilization.

PROBLEM IDENTIFICATION: The impact of mental health disorders (MHDs) and substance use disorders (SUDs) on healthcare utilization (HCU) in patients with cancer is an understudied phenomenon. LITERATURE SEARCH: A literature search of studies published prior to January 2018 that examined HCU in patients with preexisting MHDs or SUDs diagnosed with cancer was conducted. DATA EVALUATION: The research team evaluated 22 studies for scientific rigor and examined significant trends in HCU, as well as types of the MHD, SUD, and cancer studied. SYNTHESIS: The heterogeneity of HCU outcome measures, MHD, SUD, sample sizes, and study settings contributed to inconsistent study findings. However, study trends indicated higher rates of HCU by patients with depression and lower rates of HCU by patients with schizophrenia. In addition, the concept of HCU measures is evolving, addressing not only volume of health services, but also quality and efficacy. IMPLICATIONS FOR RESEARCH: Oncology nurses are essential to improving HCU in patients with MHDs and SUDs because of their close connections with patients throughout the stages of cancer care. Additional prospective studies are needed to examine specific MHDs and different types of SUDs beyond alcohol use, improving cancer care and the effectiveness of HCU in this vulnerable population.

Postoperative Cognitive Dysfunction after Noncardiac and Nonneurologic Surgery: An Integrative Review.

Postoperative cognitive dysfunction (POCD), a subtle change in patients' cognition that occurs after anesthesia and surgery, is a major concern for the growing, elderly population. The purpose of this integrative review was to examine the state of the science of POCD after noncardiac surgery. English-language research articles published from 2004 until May 2015 in adults were reviewed. A literature search revealed 587 studies with 16 articles meeting inclusion criteria. Six research domains were identified; 2 areas-anesthetic technique and biomarkers-were the focus of this review because there were more than 3 studies in each area. Bispectral index monitoring, as an anesthetic technique to decrease the incidence rate of POCD, was a major focus of research studies (n = 4). Based on the quality appraisal and study findings, the reviewer recommends that higher bispectral index levels of 40 to 60 be maintained to decrease short-term POCD. Further research is needed for the use of biomarkers as risk factors in POCD prevention research. Overall, the review was limited by methodologic weaknesses and a lack of standardized neuropsychological testing in studies. Further research is needed for the use of other anesthetic techniques and biomarkers in the study of POCD.

Earthquakes in El Salvador: a descriptive study of health concerns in a rural community and the clinical implications: Part III--Mental health and psychosocial effects.

BACKGROUND: In 2001, the mountain town of San Sebastian, El Salvador experienced a series of earthquakes that affected the livelihood of its people. METHODS: A convenience sample of 100 households of 594 inhabitants of San Sebastian and the surrounding rural farming areas was completed. One study participant for each household was evaluated for mental health and psychosocial changes after the earthquakes. The participant's questionnaire was used to investigate the relationship between physical health, access to health care, housing, food and water, and the occurrence of negative mental health markers six months after the disasters. RESULTS: Findings indicate that the majority (67%) of respondents experienced 6 or more mental health complaints. Risk factors associated with multiple negative mental health symptoms included change in household income and loss of job, a new illness or a new injury in the household, reliance on healthcare services since the earthquake, and managing a chronic illness. CONCLUSION: Findings indicate a need for rapid, acute mental health screening with at-risk groups and the need to educate the entire community regarding what medical and mental health treatments are available to reduce barriers to treatment and increase public awareness.

Earthquakes in El Salvador: a descriptive study of health concerns in a rural community and the clinical implications--part II.

Results reported in Part I of the Earthquakes in El Salvador series (see Disaster Management & Response 2003;1:105-9) indicated clinically relevant findings. The findings indicated a need for greater public health action within all five categories reviewed: healthcare, access to healthcare, housing, food, water and sanitation. Significant results between urban and rural communities indicated a need for broader community aid, public health and sanitation services to rural areas. Faster and more efficient disaster management and care services throughout the San Sebastian community were also necessary modifications.

Earthquakes in El Salvador: a descriptive study of health concerns in a rural community and the clinical implications, part I.

INTRODUCTION: This is the first article in a series that evaluates the health concerns of people living in a Salvadoran rural community after major earthquakes. Part I reviews the background, methods, and results of post-earthquake conditions with regards to healthcare, access to healthcare, housing, food, water and sanitation. Part II reviews the implications of these results and recommendations for improvements within the community. Part III investigates the psychosocial and mental health consequences of the earthquakes and provides suggestions for improved mental health awareness, assessment, and intervention. BACKGROUND: El Salvador experienced 2 major earthquakes in January and February 2001. This study evaluates the effects of the earthquakes on the health practices in the rural town of San Sebastian. METHODS: The research was conducted with use of a convenience sample survey of subjects affected by the earthquakes. The sample included 594 people within 100 households. The 32-question survey assessed post-earthquake conditions in the areas of health care and access to care, housing, food and water, and sanitation. RESULTS: Communicable diseases affected a number of family members. After the earthquakes, 38% of households reported new injuries, and 79% reported acute exacerbations of chronic illness. Rural inhabitants were 30% more likely to have an uninhabitable home than were urban inhabitants. Concerns included safe housing, water purification, and waste elimination. CONCLUSION: The findings indicate a need for greater public health awareness and community action to adapt living conditions after a disaster and prevent the spread of communicable disease.