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.