Enhancing and Disaggregating Native Hawaiian and Pacific Islander (NHPI) Data Using Natural Language Processing and an Expanded Race/Ethnicity Lexicon.

Native Hawaiian and Pacific Islander (NHPI) populations are often aggregated into broad racial categories, obscuring potential disparities. This study leverages an expanded race/ethnicity lexicon and natural language processing (NLP) to identify documentation of NHPI subgroups to address gaps in electronic health records' (EHRs) recorded race. Results demonstrate the potential of NLP to classify NHPI documentation, disaggregate legacy categories, and improve health equity by incorporating more detailed subgroup data into standardized healthcare data sets.

Unlocking efficiency in real-world collaborative studies: a multi-site international study with one-shot lossless GLMM algorithm.

The widespread adoption of real-world data has given rise to numerous healthcare-distributed research networks, but multi-site analyses still face administrative burdens and data privacy challenges. In response, we developed a Collaborative One-shot Lossless Algorithm for Generalized Linear Mixed Models (COLA-GLMM), the first-ever algorithm that achieves both lossless and one-shot properties. COLA-GLMM ensures accuracy against the gold standard of pooled data while requiring only summary statistics and completes within a single communication round, eliminating the usual back-and-forth overhead.

Risk of Thyroid Tumors With GLP-1 Receptor Agonists: A Retrospective Cohort Study.

Objective: To assess the association between glucagon-like peptide 1 receptor agonist (GLP-1RA) use and risk of incident thyroid tumors.

Research Design And Methods: The retrospective, active-comparator new-user cohort study used international administrative claims and electronic health record databases. Participants included patients with type 2 diabetes mellitus (T2DM) with prior metformin therapy initiating a GLP-1RA versus new users of sodium-glucose cotransporter 2 inhibitors (SGLT2is), dipeptidyl peptidase 4 inhibitors (DPP-4is), and sulfonylureas (SUs).

Comparative Safety of Second-Line Antihyperglycemic Agents in Older Adults with Type 2 Diabetes: A Multinational Real-World Evidence From LEGEND-T2DM.

Background: As prescribing of newer antihyperglycemic agents expands, there remains limited comparative safety data for older adults-a population particularly vulnerable to adverse drug events and underrepresented in clinical trials. We aimed to evaluate the real-world safety of second-line antihyperglycemic agents among older adults with type 2 diabetes.

Methods: We conducted a multinational cohort study using nine harmonized electronic health record and claims databases from the U.

Semaglutide and Nonarteritic Anterior Ischemic Optic Neuropathy.

Importance: Semaglutide, a glucagonlike peptide-1 receptor agonist (GLP-1RA), has recently been implicated in cases of nonarteritic anterior ischemic optic neuropathy (NAION), raising safety concerns in the treatment of type 2 diabetes (T2D).

Objective: To investigate the potential association between semaglutide and NAION in the Observational Health Data Sciences and Informatics (OHDSI) network.

Design, Setting, And Participants: This was a retrospective study across 14 databases (6 administrative claims and 8 electronic health records).

Sexual orientation-related disparities in health conditions that elevate COVID-19 severity.

Purpose: The Veterans Health Administration (VA) is the largest single integrated healthcare system in the US and is likely the largest healthcare provider for people with minoritized sexual orientations (e.g., gay, lesbian, bisexual).

Positive Predictive Value of COVID-19 ICD-10 Diagnosis Codes Across Calendar Time and Clinical Setting.

Purpose: To estimate the positive predictive value (PPV) of International Classification of Diseases, Tenth Revision (ICD-10) code U07.1, COVID-19 virus identified, in the Department of Veterans of Affairs (VA).

Patients And Methods: Records of ICD-10 code U07.

Military Sexual Trauma and Adverse Mental and Physical Health and Clinical Comorbidity in Women Veterans.

Introduction: Military sexual trauma (MST)-exposure to sexual harassment or assault during military service-is a major health priority for the Veterans Health Administration (VHA). We examined the health correlates of MST in the largest sample of U.S.

Healthcare service utilization for formerly homeless veterans in permanent supportive housing: Do neighborhoods matter?

Neighborhood characteristics are associated with residents' healthcare use. However, we understand less about these relationships among formerly homeless persons, who often have complex healthcare needs, including mental health and substance use disorders. Among formerly homeless Veterans, we examined: (a) how neighborhood characteristics are associated with Veteran Health Administration (VHA) healthcare use and, (b) if these relationships varied by Veterans' level of healthcare need.

Association of Posttraumatic Stress Disorder and Incident Ischemic Heart Disease in Women Veterans.

Importance: Posttraumatic stress disorder (PTSD) is associated with greater risk of ischemic heart disease (IHD) in predominantly male populations or limited community samples. Women veterans represent a growing, yet understudied, population with high levels of trauma exposure and unique cardiovascular risks, but research on PTSD and IHD in this group is lacking.

Objective: To determine whether PTSD is associated with incident IHD in women veterans.

Variation in Sexual Orientation Documentation in a National Electronic Health Record System.

The purpose of this study was to determine variation in sexual minority (SM) sexual orientation documentation within the electronic medical records of the Veterans Health Administration (VHA). Documentation of SM sexual orientation was retrospectively extracted from clinical notes and administrative data in the VHA from October 1, 1999 to July 1, 2019. The rate of documentation overall and by calendar year was calculated, and differences across patient, provider, and clinic characteristics were evaluated.

Why patients stop using their home telehealth technologies over time: Predictors of discontinuation in Veterans with heart failure.

Background: Daily use of home telehealth (HT) technologies decreases over time. Barriers to continued use are unclear.

Purpose: To examine predictors of drop-out from HT in Veterans with heart failure.

Adherence to the Use of Home Telehealth Technologies and Emergency Room Visits in Veterans with Heart Failure.

Prior studies have posited poor patient adherence to remote patient monitoring as the reason for observed lack of benefits. The purpose of this study was to examine the relationship between average adherence to the daily use of home telehealth (HT) and emergency room (ER) visits in Veterans with heart failure. This was a retrospective study using administrative data of Veterans with heart failure enrolled in Veterans Affairs (VA) HT Program in the first half of 2014.

The Utility of Clinical Notes for Sexual Minority Health Research.

Introduction: Despite improvements in electronic medical record capability to collect data on sexual orientation, not all healthcare systems have adopted this practice. This can limit the usability of systemwide electronic medical record data for sexual minority research. One viable resource might be the documentation of sexual orientation within clinical notes.

Home Telehealth Technologies for Heart Failure: An Examination of Adherence Among Veterans.

The current retrospective cohort study uses Department of Veterans Affairs (VA) clinical and facility data of Veterans with heart failure enrolled in the VA Home Tele-health (HT) Program. General estimating equations with facility as a covariate were used to model percent average adherence at 1, 3, 6, and 12 months post-enrollment. Most HT patients were White, male, and of older age (mean = 71 years).

Translating Social Determinants of Health into Standardized Clinical Entities.

Social determinants of health (SDH) are a valuable source of health information which still are not fully utilized in the clinical space. Knowing that a certain patient has trouble finding transportation, has a potentially hazardous relationship with a family member or close relative, is currently unemployed, or various other social factors would allow providers to tailor treatment plans in a way to best help that patient. However, these SDH must be gathered, represented, and stored in a standardized way before they can be leveraged by informatics tools designed for health providers.

Sex and the Diagnostic Pathway to Bladder Cancer among Veterans: No Evidence of Disparity.

Background: Longer time intervals from presentation with hematuria to bladder cancer diagnosis have been reported among women compared with men. Despite women being the fastest growing cohort within the Department of Veterans Affairs, little is known about women veterans with bladder cancer. Our objectives were to quantify the time from hematuria to bladder cancer diagnosis in Department of Veterans Affairs and assess differences between sexes.

Incrementally Transforming Electronic Medical Records into the Observational Medical Outcomes Partnership Common Data Model: A Multidimensional Quality Assurance Approach.

Background: The development and adoption of health care common data models (CDMs) has addressed some of the logistical challenges of performing research on data generated from disparate health care systems by standardizing data representations and leveraging standardized terminology to express clinical information consistently. However, transforming a data system into a CDM is not a trivial task, and maintaining an operational, enterprise capable CDM that is incrementally updated within a data warehouse is challenging.

Objectives: To develop a quality assurance (QA) process and code base to accompany our incremental transformation of the Department of Veterans Affairs Corporate Data Warehouse health care database into the Observational Medical Outcomes Partnership (OMOP) CDM to prevent incremental load errors.

Characterizing VA Users with the OMOP Common Data Model.

In 2015, the VA Informatics and Computing Infrastructure, a resource center of the Department of Veterans Affairs, began to transform parts of its Corporate Data Warehouse (CDW) into the Observational Medical Outcomes Partnership) Common Data Model for use by its research and operations communities. Using the hierarchical relationships within the clinical vocabularies in OMOP we found differences in visits, disease prevalence, and medications prescribed between male and female veterans seen between VA fiscal years 2000-17.

Using Enriched Samples for Semi-Automated Vocabulary Expansion to Identify Rare Events in Clinical Text: Sexual Orientation as a Use Case.

We demonstrate the utility of concept lexicon expansion and evaluation using enriched samples of patients and documents with sexual orientation as a use case for rare event detection in electronic medical records. Using this approach, we found 7 additional words and 21 misspellings beyond our initial set of five seed words. We can use the expanded vocabulary to further develop a full natural language processing system to identify instances where sexual orientation is documented.

Risperdal CONSTA Needle Detachment. Incidence Rates Before and After Kit Redesign: A Retrospective Study using Electronic Health Records and Natural Language Processing in the Department of Veterans Affairs.

Introduction: Janssen received reports of needle detachments for Risperdal CONSTA and, in response, redesigned the kit.

Objective: The study objective was to estimate the rate of Risperdal CONSTA needle detachments prior to and after the introduction of a redesigned kit.

Methods: This retrospective study used record abstraction in the US Department of Veterans Affairs (VA).

Epidermal Growth Factor Receptor Mutational Testing and Erlotinib Treatment Among Veterans Diagnosed With Lung Cancer in the United States Department of Veterans Affairs.

Introduction: We examined mutational testing of the epidermal growth factor gene (EGFR) and erlotinib treatment among veterans diagnosed with non-small-cell lung cancer in the United States Department of Veterans Affairs (VA). Our objectives were to identify the prevalence of clinically actionable EGFR mutations, to determine whether testing and treatment were guideline concordant, to evaluate the impact of testing and treatment on survival, and to estimate the rate of testing.

Patients And Methods: Test results were linked to electronic health records from VA Corporate Data Warehouse and the VA Central Cancer Registry.