Browsing by Author "Thyvalikakath, Thankam"
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Item A pragmatic, stepped-wedge, hybrid type II trial of interoperable clinical decision support to improve venous thromboembolism prophylaxis for patients with traumatic brain injury(Springer Nature, 2024-08-05) Tignanelli, Christopher J.; Shah, Surbhi; Vock, David; Siegel, Lianne; Serrano, Carlos; Haut, Elliott; Switzer, Sean; Martin, Christie L.; Rizvi, Rubina; Peta, Vincent; Jenkins, Peter C.; Lemke, Nicholas; Thyvalikakath, Thankam; Osheroff, Jerome A.; Torres, Denise; Vawdrey, David; Callcut, Rachael A.; Butler, Mary; Melton, Genevieve B.; Surgery, School of MedicineBackground: Venous thromboembolism (VTE) is a preventable medical condition which has substantial impact on patient morbidity, mortality, and disability. Unfortunately, adherence to the published best practices for VTE prevention, based on patient centered outcomes research (PCOR), is highly variable across U.S. hospitals, which represents a gap between current evidence and clinical practice leading to adverse patient outcomes. This gap is especially large in the case of traumatic brain injury (TBI), where reluctance to initiate VTE prevention due to concerns for potentially increasing the rates of intracranial bleeding drives poor rates of VTE prophylaxis. This is despite research which has shown early initiation of VTE prophylaxis to be safe in TBI without increased risk of delayed neurosurgical intervention or death. Clinical decision support (CDS) is an indispensable solution to close this practice gap; however, design and implementation barriers hinder CDS adoption and successful scaling across health systems. Clinical practice guidelines (CPGs) informed by PCOR evidence can be deployed using CDS systems to improve the evidence to practice gap. In the Scaling AcceptabLE cDs (SCALED) study, we will implement a VTE prevention CPG within an interoperable CDS system and evaluate both CPG effectiveness (improved clinical outcomes) and CDS implementation. Methods: The SCALED trial is a hybrid type 2 randomized stepped wedge effectiveness-implementation trial to scale the CDS across 4 heterogeneous healthcare systems. Trial outcomes will be assessed using the RE2-AIM planning and evaluation framework. Efforts will be made to ensure implementation consistency. Nonetheless, it is expected that CDS adoption will vary across each site. To assess these differences, we will evaluate implementation processes across trial sites using the Exploration, Preparation, Implementation, and Sustainment (EPIS) implementation framework (a determinant framework) using mixed-methods. Finally, it is critical that PCOR CPGs are maintained as evidence evolves. To date, an accepted process for evidence maintenance does not exist. We will pilot a "Living Guideline" process model for the VTE prevention CDS system. Discussion: The stepped wedge hybrid type 2 trial will provide evidence regarding the effectiveness of CDS based on the Berne-Norwood criteria for VTE prevention in patients with TBI. Additionally, it will provide evidence regarding a successful strategy to scale interoperable CDS systems across U.S. healthcare systems, advancing both the fields of implementation science and health informatics.Item Assessing Information Congruence of Documented Cardiovascular Disease between Electronic Dental and Medical Records(2018) Patel, Jay; Mowery, Danielle; Krishnan, Anand; Thyvalikakath, ThankamDentists are more often treating patients with Cardiovascular Diseases (CVD) in their clinics; therefore, dentists may need to alter treatment plans in the presence of CVD. However, it’s unclear to what extent patient-reported CVD information is accurately captured in Electronic Dental Records (EDRs). In this pilot study, we aimed to measure the reliability of patient-reported CVD conditions in EDRs. We assessed information congruence by comparing patients’ self-reported dental histories to their original diagnosis assigned by their medical providers in the Electronic Medical Record (EMR). To enable this comparison, we encoded patients CVD information from the free-text data of EDRs into a structured format using natural language processing (NLP). Overall, our NLP approach achieved promising performance extracting patients’ CVD-related information. We observed disagreement between self-reported EDR data and physician-diagnosed EMR data.Item Association between intracranial carotid artery calcifications and periodontitis: A cone-beam computed tomography study(AAP, 2021-10) AlSakr, Abdulaziz; Blanchard, Steven; Wong, Phillip; Thyvalikakath, Thankam; Hamada, Yusuke; Periodontology, School of DentistryBackground Intracranial carotid artery calcifications (ICACs) are one type of calcification that may be detected as incidental findings in cone-beam computed tomography (CBCT). This retrospective study aimed to examine the prevalence of ICACs on CBCT images and their associations among age, gender, chronic periodontitis, and patient-reported cardiovascular diseases (CVDs). Methods A total of 303 CBCT scans were reviewed and a total of 208 patients met the inclusion criteria. The presence or absence of ICACs was evaluated in the ophthalmic and cavernous segments of each scan. Patient demographic data, including age, gender, and medical history, specifically focused on CVDs were recorded. The presence or absence of periodontitis was recorded from each subject with full mouth radiographs and clinical measurements. Odds ratios (ORs) were calculated as part of the logistic regression analysis. Results Overall, ICACs were found in 93 subjects (45%). The bilateral ICACs were found in 43 subjects (21% of the total subjects, 46% of the subjects with ICACs). There were statistically significant associations between presence of ICACs and periodontitis (OR = 4.55), hypertension (OR = 3.02), hyperlipidemia (OR = 2.87), increasing age (OR = 2.24), and the male gender (OR = 1.85). Smoking status was not significantly correlated with ICACs. Conclusion This study revealed that nearly half (45%) of the subjects displayed ICACs on the CBCT images. ICACs are significantly related to the status of chronic periodontitis, age, gender, and CVDs. A more careful review of CBCT scans is highly recommended to detect these calcifications and refer patients for further medical evaluation.Item Characterizing Restorative Dental Treatments of Sjögren's Syndrome Patients Using Electronic Dental Records Data(IOS Press, 2017) Siddiqui, Zasim; Wang, Yue; Makkad, Payal; Thyvalikakath, Thankam; Cariology, Operative Dentistry and Dental Public Health, School of DentistryScant knowledge exists on the type of restorative treatments Sjögren's syndrome patients (SSP) receive in spite of their high dental disease burden due to hyposalivation. Increased adoption of electronic dental records (EDR) could help in leveraging information from these records to assess dental treatment outcomes in SSP. In this study, we evaluated the feasibility of using EDR to characterize the dental treatments SSP received and assess the longevity of implants in these patients. We identified 180 SSP in ten years of patients' data at the Indiana University School of Dentistry clinics. A total of 104 (57.77%) patients received restorative or endodontic treatments. Eleven patients received 23 implants with a survival rate of 87% at 40 months follow-up. We conclude that EDR data could be used for characterizing the treatments received by SSP and for assessing treatment outcomes.Item Dentists’ Information Needs and Opinions on Accessing Patient Information via Health Information Exchange: Survey Study(JMIR, 2024-01-11) Li, Shuning; Gomez, Grace Felix; Xu, Huiping; Rajapuri, Anushri Singh; Dixon, Brian E.; Thyvalikakath, Thankam; Biostatistics and Health Data Science, Richard M. Fairbanks School of Public HealthBackground: The integration of medical and dental records is gaining significance over the past 2 decades. However, few studies have evaluated the opinions of practicing dentists on patient medical histories. Questions remain on dentists' information needs; their perception of the reliability of patient-reported medical history; satisfaction with the available information and the methods to gather this information; and their attitudes to other options, such as a health information exchange (HIE) network, to collect patient medical history. Objective: This study aims to determine Indiana dentists' information needs regarding patients' medical information and their opinions about accessing it via an HIE. Methods: We administered a web-based survey to Indiana Dental Association members to assess their current medical information-retrieval approaches, the information critical for dental care, and their willingness to access or share information via an HIE. We used descriptive statistics to summarize survey results and multivariable regression to examine the associations between survey respondents' characteristics and responses. Results: Of the 161 respondents (161/2148, 7.5% response rate), 99.5% (n=160) respondents considered patients' medical histories essential to confirm no contraindications, including allergies or the need for antibiotic prophylaxis during dental care and other adverse drug events. The critical information required were medical conditions or diagnosis, current medications, and allergies, which were gathered from patient reports. Furthermore, 88.2% (n=142) of respondents considered patient-reported histories reliable; however, they experienced challenges obtaining information from patients and physicians. Additionally, 70.2% (n=113) of respondents, especially those who currently access an HIE or electronic health record, were willing to use an HIE to access or share their patient's information, and 91.3% (n=147) shared varying interests in such a service. However, usability, data accuracy, data safety, and cost are the driving factors in adopting an HIE. Conclusions: Patients' medical histories are essential for dentists to optimize dental care, especially for those with chronic conditions. In addition, most dentists are interested in using an HIE to access patient medical histories. The findings from this study can provide an alternative option for improving communications between dental and medical professionals and help the health information technology system or tool developers identify critical requirements for more user-friendly designs.Item Differences in medication usage of dental patients by age, gender, race/ethnicity and insurance status(IOS, 2021) Siddiqui, Zasim; Wang, Yue; Patel, Jay; Thyvalikakath, Thankam; Cariology, Operative Dentistry and Dental Public Health, School of DentistryBACKGROUND: Limited studies have investigated the medication profile of young adult dental patients despite the high prevalence of prescription opioid abuse in this population. OBJECTIVE: This study investigated the extent and differences in medication usage of dental patients older than 18 years by age, race/ethnicity, gender, insurance status and mechanism of action in an academic dental clinic setting. METHODS: Using an automated approach, medication names in the electronic dental record were retrieved and classified according to the National Drug Code directory. Descriptive statistics, multivariable ANOVA and Post hoc tests were performed to detect differences in the number of medications by patient demographics. RESULTS: Of the 11,220 adult patients, 53 percent reported taking at least one medication with significant differences in medication usage by demographics. Hydroxymethylglutaryl-coenzyme A reductase inhibitors (21–36%), and angiotensin-converting enzyme inhibitors (19–23%) ranked the top two medication classes among patients 55 years and older. Opioid agonists (7–14%), and Selective Serotonin Reuptake Inhibitors (SSRIs) (5–12%) ranked the top two medication classes among patients aged 18–54 years. CONCLUSIONS: The results underscore the importance of dental providers to review medical and medication histories of patients regardless of their age to avoid adverse events and to determine patient’s risk for opioid abuse.Item Evaluation of a Dental Diagnostic Terminology Subset(IOS, 2019) Taylor, Heather L.; Siddiqui, Zasim; Frazier, Kendall; Thyvalikakath, Thankam; Cariology, Operative Dentistry and Dental Public Health, School of DentistryThe objective of this study was to determine how well a subset of SNODENT, specifically designed for general dentistry, meets the needs of dental practitioners. Participants were asked to locate their written diagnosis for tooth conditions among the SNODENT terminology uploaded into an electronic dental record. Investigators found that 65% of providers’ original written diagnoses were in “agreement” with their selected SNODENT dental diagnostic subset concept(s).Item Extraction and Evaluation of Medication Data from Electronic Dental Records(IOS Press, 2017) Wang, Yue; Siddiqui, Zasim; Krishnan, Anand; Patel, Jay; Thyvalikakath, Thankam; Cariology, Operative Dentistry and Dental Public Health, School of DentistryWith an increase in the geriatric population, dental care professionals are presented with older patients who are managing their comorbidities using multiple medications. In this study, we developed a system to extract medication information from electronic dental records (EDRs) and provided patient distribution by the number of medications.Item Extraction and Evaluation of Medication Data from Electronic Dental Records(IOS Press, 2017) Wang, Yue; Siddiqui, Zasim; Krishnan, Anand; Patel, Jay; Thyvalikakath, Thankam; Cariology, Operative Dentistry and Dental Public Health, School of DentistryWith an increase in the geriatric population, dental care professionals are presented with older patients who are managing their comorbidities using multiple medications. In this study, we developed a system to extract medication information from electronic dental records (EDRs) and provided patient distribution by the number of medications.Item Identifying Patients' Smoking Status from Electronic Dental Records Data(IOS Press, 2017) Patel, Jay; Siddiqui, Zasim; Krishnan, Anand; Thyvalikakath, Thankam; Cariology, Operative Dentistry and Dental Public Health, School of DentistrySmoking is a significant risk factor for initiation and progression of oral diseases. A patient's current smoking status and tobacco dependency can aid clinical decision making and treatment planning. The free-text nature of this data limits accessibility causing obstacles during the time of care and research utility. No studies exist on extracting patient's smoking status automatically from the Electronic Dental Record. This study reports the development and evaluation of an NLP system for this purpose.