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Use of structured electronic health record data to evaluate temporal trends and risk factors in the management of childhood diabetic ketoacidosis

Horvat, Christopher (2017) Use of structured electronic health record data to evaluate temporal trends and risk factors in the management of childhood diabetic ketoacidosis. Master Essay, University of Pittsburgh.

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Abstract

Importance Diabetic ketoacidosis (DKA) is the most serious acute complication of Type 1 diabetes. Detailed clinical data harbored by electronic health record (EHR) databases can be used to assess the impact of DKA performance improvement initiatives and generate novel disease insights. Objectives To examine trends in DKA outcomes surrounding performance improvement initiatives and identify clinical characteristics associated with treated cerebral edema. Design, Setting and Methods The EHR database at our tertiary children’s hospital was interrogated using a business intelligence platform to identify patients admitted with DKA between April 2009 and May 2016. Multivariable regression using robust standard errors to cluster patients with multiple encounters was used to examine temporal trends in the incidence of hypoglycemia, treated cerebral edema, central line placement, development of severe hyperchloremia, head computed tomography utilization, and hospital length of stay. Trends in outcomes surrounding several performance improvement initiatives were examined. Results Central line placement, head computed tomography utilization and the incidence of severe hyperchloremia decreased significantly throughout the study period. Performance improvement initiatives were significantly associated with decreasing hospital length of stay and reduced variability in length of stay among patients with severe DKA. Systolic blood pressure at presentation and during hospitalization was significantly associated with treatment for cerebral edema after adjusting for other biochemical indicators of disease severity. Discussion In this large, retrospective cohort of children with DKA derived from an EHR database, system-level changes in management were significantly associated with improved outcomes. This study demonstrates the potential of EHR data to meet simultaneous quality improvement and research goals of health systems seeking to improve population and public health. Further study is necessary to clarify the relationship between blood pressure and cerebral edema in this population.


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Details

Item Type: Other Thesis, Dissertation, or Long Paper (Master Essay)
Status: Unpublished
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Horvat, Christopherhorvatc@pitt.eduHORVATC
Contributors:
ContributionContributors NameEmailPitt UsernameORCID
Committee ChairCastle, Nicholascastlen@pitt.eduUNSPECIFIEDUNSPECIFIED
Committee MemberClark, Robertclarkrs@ccm.upmc.eduUNSPECIFIEDUNSPECIFIED
Date: 20 April 2017
Date Type: Submission
Publisher: University of Pittsburgh
Institution: University of Pittsburgh
Schools and Programs: Graduate School of Public Health > Health Policy & Management
Degree: MHA - Master of Health Administration
Thesis Type: Master Essay
Refereed: Yes
Date Deposited: 12 Jul 2017 19:00
Last Modified: 25 Sep 2017 04:55
URI: http://d-scholarship.pitt.edu/id/eprint/31410

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