Regenstrief Institute

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https://hdl.handle.net/1805/16545

The Regenstrief Institute works with a body of faculty investigators from the Indiana University School of Medicine and includes three research centers, the Center for Health Services Research, the Center for Biomedical Informatics, and the IU Center for Aging Research. Within and across these centers the institute seeks to find ways to integrate research discovery, technological advances, and systems improvement into the practice of medicine.

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Communicating with Clinicians: The Experiences of Surrogate Decision‐Makers for Hospitalized Older Adults
(2012-08) Torke, Alexia M.; Petronio, Sandra; Purnell, Christianna E.; Sachs, Greg A.; Helft, Paul R.; Callahan, Christopher M.
OBJECTIVES: To describe communication experiences of surrogates who had recently made a major medical decision for a hospitalized older adult. DESIGN: Semistructured interviews about a recent hospitalization. SETTING: Two hospitals affiliated with one large medical school: an urban public hospital and a university-affiliated tertiary referral hospital. PARTICIPANTS: Surrogates were eligible if they had recently made a major medical decision for a hospitalized individual aged 65 and older and were available for an interview within 1 month (2-5 months if the patient died). MEASUREMENTS: Interviews were audio-recorded, transcribed, and analyzed using methods of grounded theory. RESULTS: Thirty-five surrogates were interviewed (80% female, 44% white, 56% African American). Three primary themes emerged. First, it was found that the nature of surrogate-clinician relationships was best characterized as a relationship with a "team" of clinicians rather than individual clinicians because of frequent staff changes and multiple clinicians. Second, surrogates reported their communication needs, including frequent communication, information, and emotional support. Surrogates valued communication from any member of the clinical team, including nurses, social workers, and physicians. Third, surrogates described trust and mistrust, which were formed largely through surrogates' communication experiences. CONCLUSION: In the hospital, surrogates form relationships with a "team" of clinicians rather than with individuals, yet effective communication and expressions of emotional support frequently occur, which surrogates value highly. Future interventions should focus on meeting surrogates' needs for frequent communication and high levels of information and emotional support.
Correlation Between Caregiver Reports of Physical Function and Performance-based Measures in a Cohort of Older Adults With Alzheimer Disease
(Ovid Technologies (Wolters Kluwer) - Lippincott Williams & Wilkins, 2016-04) Bernard, Brittany L.; Bracey, Lauren E.; Lane, Kathleen A.; Ferguson, Denisha Y.; LaMantia, Michael A.; Gao, Sujuan; Miller, Douglas K.; Callahan, Christopher M.; Medicine, School of Medicine
The objectives of this report are to determine the association between performance-based measures of physical function with caregiver reports of physical function in older adults with Alzheimer disease (AD) and to examine whether those associations vary by the level of patients' cognitive functioning. Subjects included 180 patient-caregiver dyads who are enrolled in a clinical trial testing the impact of an occupational therapy intervention plus guideline-level care to delay functional decline among older adults with AD. The primary caregiver-reported measure is the Alzheimer's Disease Cooperative Study Group Activities of Daily Living Inventory (ADCS-ADL). Performance-based measures include the Short Physical Performance Battery and the Short Portable Sarcopenia Measure. Analysis of covariance (ANCOVA) models were used to determine the associations of each physical performance measure with ADCS-ADL, adjusting for cognition function and other covariates. We found significant correlations between caregiver reports and observed performance-based measures across all levels of cognitive function, with patients in the lowest cognitive group showing the highest correlation. These findings support the use of proxy reports to assess physical function among older adults with AD.
Defining the Domain of Geriatric Medicine in an Urban Public Health System Affiliated with an Academic Medical Center
(Wiley, 2008-10) Callahan, Christopher M.; Weiner, Michael; Counsell, Steven R.; Department of Medicine, IU School of Medicine
The American Geriatrics Society has recommended a reexamination of the roles and deployment of providers with expertise in geriatric medicine. Healthcare systems use a variety of strategies to maximize their geriatric expertise. In general, these health systems tend to focus geriatric medicine resources on a group of older adults that are locally defined as the most in need. This article describes a model of care within an academic urban public health system and describes how local characteristics interact to define the domain of geriatric medicine. This domain is defined using 4 years of data from an electronic medical record combined with data collected from clinical trials. From January 2002 to December 2005, 31,443 adults aged 65 and older were seen at any clinical site within this healthcare system. The mean age was 75 (range 65–105); 61% were women; 35% African American, and 2% Hispanic. The payer mix was 80% Medicare and 17% Medicaid. The local geriatric medicine program includes sites of care in inpatient, ambulatory, nursing home, and home-based settings. By design, this geriatric medicine clinical practice complements the care provided to older adults by the primary care practice. Primary care physicians tend to cede care to geriatric medicine for older adults with advanced disability or geriatric syndromes. This is most apparent for older adults in nursing facilities or those requiring home-based care. There is a dynamic interplay between design features, reputation, and capacity that modulates volume, location, and type of patients seen by geriatrics.
Emergency Department Use Among Older Adults With Dementia
(Wolters Kluwer, 2016-01) LaMantia, Michael A.; Stump, Timothy E.; Messina, Frank C.; Miller, Douglas K.; Callahan, Christopher M.; Department of Medicine, IU School of Medicine
Although persons with dementia are frequently hospitalized, relatively little is known about the health profile, patterns of health care use, and mortality rates for patients with dementia who access care in the emergency department (ED). We linked data from our hospital system with Medicare and Medicaid claims, Minimum Data Set, and Outcome and Assessment Information Set data to evaluate 175,652 ED visits made by 10,354 individuals with dementia and 15,020 individuals without dementia over 11 years. Survival rates after ED visits and associated charges were examined. Patients with dementia visited the ED more frequently, were hospitalized more often than patients without dementia, and had an increased odds of returning to the ED within 30 days of an index ED visit compared with persons who never had a dementia diagnosis (odds ratio, 2.29; P<0.001). Survival rates differed significantly between patients by dementia status (P<0.001). Mean Medicare payments for ED services were significantly higher among patients with dementia. These results show that older adults with dementia are frequent ED visitors who have greater comorbidity, incur higher charges, are admitted to hospitals at higher rates, return to EDs at higher rates, and have higher mortality after an ED visit than patients without dementia.
Generative Adversarial Networks for Creating Synthetic Free-Text Medical Data: A Proposal for Collaborative Research and Re-use of Machine Learning Models
(AMIA Informatics summit 2021 Conference Proceedings., 2021-03) Kasthurirathne, Suranga N.; Dexter, Gregory; Grannis, Shaun J.
Restrictions in sharing Patient Health Identifiers (PHI) limit cross-organizational re-use of free-text medical data. We leverage Generative Adversarial Networks (GAN) to produce synthetic unstructured free-text medical data with low re-identification risk, and assess the suitability of these datasets to replicate machine learning models. We trained GAN models using unstructured free-text laboratory messages pertaining to salmonella, and identified the most accurate models for creating synthetic datasets that reflect the informational characteristics of the original dataset. Natural Language Generation metrics comparing the real and synthetic datasets demonstrated high similarity. Decision models generated using these datasets reported high performance metrics. There was no statistically significant difference in performance measures reported by models trained using real and synthetic datasets. Our results inform the use of GAN models to generate synthetic unstructured free-text data with limited re-identification risk, and use of this data to enable collaborative research and re-use of machine learning models.
Identifying Biases in Clinical Decision Models Designed to Predict Need of Wraparound Services
(AMIA Informatics summit 2021 Conference Proceedings, 2021-03) Kasthurirathne, Suranga N.; Vest, Joshua R.; Grannis, Shaun J.
Investigation of systemic biases in AI models for the clinical domain have been limited. We re-created a series of models predicting need of wraparound services, and inspected them for biases across age, gender and race using the AI Fairness 360 framework. AI models reported performance metrics which were comparable to original efforts. Investigation of biases using the AI Fairness framework found low likelihood that patient age, gender and sex are introducing bias into our algorithms.
Informatics Interventions for Maternal Morbidity: A Scoping Review
(National Library of Medicine, 2023-06-23) Inderstrodt, Jill; Stumpff, Julia C.; Smollen, Rebecca; Sridhar, Shreya; El-Azab, Sarah A.; Ojo, Opeyemi; Haggstrom, David A.
Individuals of childbearing age in the U.S. currently enter pregnancy less healthy than previous generations, putting them at risk for maternal morbidities such as preeclampsia, gestational diabetes mellitus (GDM), and postpartum mental health conditions. These conditions leave mothers at risk for long-term health complications that, when left unscreened and unmonitored, can be deadly. One approach to ensuring long-term health for mothers is designing informatics interventions that: (a) prevent maternal morbidities, (b) treat perinatal conditions, and (c) allow for continuity of treatment. This scoping review examines the extent, range, and nature of informatics interventions that have been tested on maternal morbidities that can have long-term health effects on mothers. It uses MEDLINE, EMBASE, and Cochrane Library to chart demographic, population, and intervention data regarding informatics and maternal morbidity. Studies (n=79) were extracted for analysis that satisfied the following conditions: (a) tested a medical or clinical informatics intervention; (b) tested on adults with a uterus or doctors who treat people with a uterus; and (c) tested on the following conditions: preeclampsia, GDM, preterm birth, severe maternal morbidity as defined by the CDC, and perinatal mental health conditions. Of the 79 studies extracted, 38% (n=30) tested technologies for GDM, 38% (n=30) tested technologies for postpartum depression, and 15.2% (n=12) tested technologies for preeclampsia. In terms of technologies, 35.4% (n = 28) tested a smartphone or tablet app, 29.1% (n=23) tested a telehealth intervention, and 15.2% (n=12) tested remote monitoring technologies (blood pressure, blood glucose). Most (86.1%; n=68) of the technologies were tested for patient physical or mental health outcomes. This scoping review reveals that most tested informatics interventions are those aimed at three conditions (GDM, preeclampsia, mental health) and that there may be opportunities to treat other common causes of maternal mortality (i.e. postpartum hemorrhage) using proven technologies such as mobile applications.
Informatics Interventions for Maternal Morbidity: Scoping Review
(JMIR Publications, 2025-03-25) Inderstrodt, Jill; Stumpff, Julia C.; Smollen, Rebecca; Sridhar, Shreya; El-Azab, Sarah; Ojo, Opeyemi; Bowns, Brendan; Haggstrom, David A.
Background: Women have been entering pregnancy less healthy than previous generations, placing them at increased risk for pregnancy complications. One approach to ensuring effective monitoring and treatment of at-risk women is designing technology-based interventions that prevent maternal morbidities and treat perinatal conditions. Objective: This scoping review evaluates what informatics interventions have been designed and tested to prevent and treat maternal morbidity. Methods: MEDLINE, Embase, and Cochrane Library were searched to identify relevant studies. The inclusion criteria were studies that tested a medical or clinical informatics intervention; enrolled adult women; and addressed preeclampsia, gestational diabetes mellitus (GDM), preterm birth, Centers for Disease Control and Prevention-defined severe maternal morbidity, or perinatal mental health conditions. Demographic, population, and intervention data were extracted to characterize the technologies, conditions, and populations addressed. Results: A total of 80 studies were identified that met the inclusion criteria. Many of the studies tested for multiple conditions. Of these, 73% (60/82) of the technologies were tested for either GDM or perinatal mental health conditions, and 15% (12/82) were tested for preeclampsia. For technologies, 32% (28/87) of the technologies tested were smartphone or tablet applications, 26% (23/87) were telehealth interventions, and 14% (12/87) were remote monitoring technologies. Of the many outcomes measured by the studies, almost half (69/140, 49%) were patient physical or mental health outcomes. Conclusions: Per this scoping review, most informatics interventions address three conditions: GDM, preeclampsia, and mental health. There may be opportunities to treat other potentially lethal conditions like postpartum hemorrhage using proven technologies such as mobile apps. Ample gaps in the literature exist concerning the use of informatics technologies aimed at maternal morbidity. There may be opportunities to use informatics for lesser-targeted conditions and populations.
Non-Traditional Surrogate Decision Makers for Hospitalized Older Adults
(Lippincott, Williams & Wilkins, 2018-04) Comer, Amber R.; Slaven, James E.; Montz, Annie; Burke, Emily; Inger, Lev; Torke, Alexia; Robert H. Mckinney School of Law
Background Without advanced preparation of legal documents, state law determines who may serve as a surrogate decision maker for patients in hospitals. Objectives To examine the relationship characteristics associated with traditional versus non-traditional healthcare surrogates who are making medical decisions for patients in hospitals. Research Design Secondary analysis of a baseline cross-sectional survey of a larger prospective observational study. Subjects 364 patient/ surrogate dyads consisting of patients age 65 years and older admitted to the medical or medical ICU services who lacked decision making capacity based on a physician assessment and also had a surrogate available. Results This study of surrogate decision makers for hospitalized older adults found that the relationships of non-traditional surrogates such as, nieces, nephews, and friends serving in the surrogate role is nearly identical to those of traditional, first degree relatives serving as a surrogate. Over two-thirds (71.2%) of non-traditional surrogates saw the patient in person at least weekly compared to 80.8% of legal surrogates (p-value .9023). Almost all traditional and non-traditional surrogates discussed the patient’s medical preferences with the patient (96.9% of legal surrogates and 89.2% of non-traditional surrogates; p=0.0510). Conclusion This study shows that both traditional and non-traditional surrogates, who are a patient’s primary care giver have similar relationships with patients. The findings of this study suggest that requiring family members such as grandchildren to take the extra step of formal appointment through a legal channel may not be necessary to protect patients. Therefore, broader state laws expanding the list of surrogates authorized by state statute to include more non-traditional surrogates may be necessary.
Older primary care patients' attitudes and willingness to screen for dementia
(Hindawi, 2015-04-20) Fowler, Nicole R.; Perkins, Anthony J.; Turchan, Hilary A.; Frame, Amie; Monahan, Patrick; Gao, Sujuan; Boustani, Malaz A.; Biostatistics, School of Public Health
OBJECTIVE: To understand older primary care patients' perceptions of the risks and benefits of dementia screening and to measure the association between attitudes and screening behaviors. METHODS: Eligible patients completed the Perceptions Regarding Investigational Screening for Memory in Primary Care (PRISM-PC) questionnaire and then were asked to undergo dementia screening by a telephone screening instrument. RESULTS: Higher scores on the PRISM-PC questionnaire items that measure attitudes about benefits of screening were associated with decreased odds of refusing screening. Participants who refused screening had significantly lower PRISM-PC questionnaire scores on the items that measure perceived benefits compared to those who agreed to screening. Participants who refused screening were less likely to agree on screening for other conditions, such as depression and cancer. Participants who know someone with Alzheimer's disease (AD) were less likely to refuse screening. DISCUSSION: Patients' attitudes about the benefits of dementia screening are associated with their acceptance of dementia screening.

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