To explore the use of health plan quality measures specified for electronic clinical data to monitor immunizations.

We analyzed 2018 data submitted by health plans reporting 2 new Healthcare Effectiveness Data and Information Set measures assessing receipt of clinically recommended vaccines among pregnant women and adults. We analyzed the number of plans reporting a valid performance rate and electronic data source used. We consulted expert panels and reviewed coverage rates from other sources to understand the results.

We received 136 data submissions across commercial, Medicaid and Medicare plans and 87 submissions across commercial and Medicaid plans for the adult and prenatal immunization measures, respectively. These submissions represent approximately 15% of possible submissions. Plans used claims, registries and electronic health records. see more Mean performance rates for adult immunizations were 21.2 (commercial), 14.0 (Medicaid) and 19.5% (Medicare). Mean rates for prenatal immunizations were 33.1 (commercial) and 16.7% (Medicaid).

Results from the first year of reporting 2 electronic clinical data measures suggest health plans can feasibly report these measures and are seeking electronic data to supplement claims. Comparison of rates to other national results showed lower than expected rates for the adult immunization measure. However, prenatal immunization rates were on par with those from a national survey, suggesting this measure is closer to use for quality improvement.

Quality measure reporting that encourages connection to electronic data sources is a step forward in performance monitoring and improvement. The use of electronic sources may advance health information exchange for patient care.

Quality measure reporting that encourages connection to electronic data sources is a step forward in performance monitoring and improvement. The use of electronic sources may advance health information exchange for patient care.Inactive Carrier phases in chronic hepatitis B virus (HBV) infection present minimal liver disease and HBV replication activity suggesting a partial immune-reconstitution although the mechanisms responsible remain elusive. Moreover, HBsAg production -hypothesized to modulate the immune response- is unaltered. Here, we assessed the intrahepatic transcriptome in Inactive Carrier patients vs healthy liver donors, also in the context of diverse HBsAg levels (serum and liver), to better understand the phenomenon of immune control. We found a de-regulated liver transcriptome in Inactive Carrier patients vs healthy controls despite normal liver function. Moreover, diverse HBsAg levels impacted minimally at the liver transcriptome in Inactive Carrier patients although gene correlation analysis revealed leukocyte activation, recruitment and innate responses genes to correlate with liver HBsAg levels. These findings provide more insight into the mechanisms underlying anti-HBV strategies that are currently under development aimed at interfering with HBsAg production or at inducing a state of immune control.

There is widespread concern that clinical notes have grown longer and less informative over the past decade. Addressing these concerns requires a better understanding of the magnitude, scope, and potential causes of increased note length and redundancy.

To measure changes between 2009 and 2018 in the length and redundancy of outpatient progress notes across multiple medical specialties and investigate how these measures associate with author experience and method of note entry.

This cross-sectional study was conducted at Oregon Health & Science University, a large academic medical center. Participants included clinicians and staff who wrote outpatient progress notes between 2009 and 2018 for a random sample of 200 000 patients. Statistical analysis was performed from March to August 2020.

Use of a comprehensive electronic health record to document patient care.

Note length, note redundancy (ie, the proportion of text identical to the patient’s last note), and percentage of templated, copied, or 7%]) longer notes than more senior authors, as did more recent hires (1.8% for each year later [95% CI, 1.3%-2.4%]).

In this study, outpatient progress notes grew longer and more redundant over time, potentially limiting their use in patient care. Interventions aimed at reducing outpatient progress note length and redundancy may need to simultaneously address multiple factors such as note template design and training for both new and established clinicians.

In this study, outpatient progress notes grew longer and more redundant over time, potentially limiting their use in patient care. Interventions aimed at reducing outpatient progress note length and redundancy may need to simultaneously address multiple factors such as note template design and training for both new and established clinicians.

Intracerebral hemorrhage (ICH) contributes significantly to the global burden of disease.

To examine the association of ICH and secondary injury with disability-adjusted life-years (DALYs) for the individual patient.

This cohort study was conducted using data from the Universitätsklinikum Erlangen Cohort of Patients With Spontaneous Intracerebral Hemorrhage study. Consecutive patients admitted to a single tertiary care center from January 1, 2006, to December 31, 2015, were included. The sample comprised patients with oral anticoagulation-associated ICH (OAC-ICH) or primary spontaneous ICH (non-OAC-ICH). Statistical analysis was conducted from October 1 to December 31, 2020.

ICH occurrence and secondary injury.

DALYs, years of life lost (YLL), and years lived with disability (YLD) were analyzed by hematoma location, ICH volume, and secondary injury (ie, hematoma expansion [HE], intraventricular hemorrhage [IVH], and perihemorrhagic edema [PHE]).

Among 1322 patients with ICH, 615 (46.5%) were womeny secondary injuries.

These findings suggest that there is a high burden of disability associated with ICH and secondary injuries, and the findings may guide public health strategies. The study findings further suggest that IVH and PHE may be relevant for the overall outcome of patients with ICH, that DALYs may represent a viable outcome parameter for studies to evaluate treatment outcomes in ICH research, and that IVH and PHE may represent potential treatment targets.

These findings suggest that there is a high burden of disability associated with ICH and secondary injuries, and the findings may guide public health strategies. The study findings further suggest that IVH and PHE may be relevant for the overall outcome of patients with ICH, that DALYs may represent a viable outcome parameter for studies to evaluate treatment outcomes in ICH research, and that IVH and PHE may represent potential treatment targets.