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PubMed1991

Special report. Integrating managed care. When managed care is a system.

In a comprehensive managed care system, all participants benefit from the improved quality and cost efficiency. When payers, beneficiaries, and providers communicate, share data, and participate in decision making, the result is more appropriate and more cost-efficient care. The following articles take a look at how each player in the health care system benefits from a comprehensive approach to health care. Payers (employers) benefit by being able to track the cost effectiveness of their health care through integrated data systems. Beneficiaries (employees and dependents) benefit by becoming more involved in the decisions being made by providers and third party payers about their care through patient education and advocacy programs. And health care providers benefit by gaining an increased leadership role in directing the management of their patients' care through practice guidelines. These guidelines will help doctors make decisions that lead to high quality care as well as build a foundation for standardized review criteria throughout the industry.

Clinical Protocols↗
PubMed1995

Drug utilization review in the managed care environment.

Traditional drug use evaluation (DUE) and Medicaid drug utilization review (DUR) prototypes do not meet the needs of managed care organizations. yet, creating entirely new systems for measuring quality drug use in managed care, such as HEDIS, needlessly discards the good clinical foundations already built in the other health care settings. A better solution would be for managed care to apply its hallmark traits, namely state-of-the-art electronic data management systems, integrated health care system interchange, and strong customer communication, to make the DUR process better. A strong union between clinical criteria and sophisticated health care management can revolutionize the DUR/DUE process.

Consumer Behavior↗
PubMed2026

CAUSAL artificial intelligence and data-driven decision intelligence in personalized medicine: a review of healthcare informatics systems.

This review examines the integration of causal artificial intelligence (AI) and data-driven decision intelligence within healthcare informatics systems to advance personalized medicine and clinical decision-making. A narrative review methodology was employed, synthesizing interdisciplinary literature from major databases, including PubMed, Scopus, Web of Science, IEEE Xplore, and ScienceDirect. Studies focusing on causal inference, decision intelligence, and healthcare informatics applications in personalized medicine were included. Data were extracted on methodological approaches, healthcare settings, analytical techniques, and clinical applications, followed by thematic synthesis. Findings indicate that causal AI enhances clinical decision support by enabling estimation of treatment effects and simulation of intervention outcomes at the individual patient level. Integration of multimodal health data such as electronic health records, genomic data, and real-time monitoring improves prediction accuracy and supports tailored treatment strategies. Additionally, causal models improve interpretability, fostering clinician trust and facilitating transparent decision-making. Robust healthcare informatics infrastructures, including interoperable systems and data warehouses, were identified as critical enablers of causal analytics. Overall, causal AI represents a transformative advancement in healthcare analytics, supporting more informed, individualized, and evidence-based clinical decisions. Its integration within healthcare informatics systems has significant potential to improve patient outcomes and guide the future of intelligent, personalized healthcare delivery.

Precision Medicine↗
PubMed2003

Work-related amputations in Michigan, 1997.

BACKGROUND: Work-related amputations are of concern in Michigan and nationally. This study reports on 1 year of data on work-related amputations, which were treated in Michigan hospital emergency departments (ED) or as in-patients in Michigan. METHODS: Michigan hospitals provided face sheets and discharge summaries of in-patient and ED visits for work-related amputations that occurred in 1997. Information was also obtained about worksite inspections associated with reported amputations from the Michigan Occupational Safety and Health Act (MIOSHA) program. Data from this study and from Michigan workers compensation were used to generate an estimate of the true numbers of work-related amputations in Michigan in 1997. RESULTS: Three hundred thirty-nine work-related amputations were identified by hospitals. Powered saws and power presses were the leading sources of injury. MIOSHA completed 30 enforcement inspections related to these amputations. Our best estimate of the total numbers of work-related amputations in 1997 for Michigan was 693, of which 562 resulted in hospitalization or ED treatment. CONCLUSIONS: In-patient and ED records provided information for identifying high risk groups and problem worksites in Michigan. Estimates generated from these data underscore that data on work-related amputations released by the Bureau of Labor Statistics (BLS), which reported 440 amputations in 1997, are a significant undercount--only 64%--of the true number of cases. Better integration of public health data into OSHA enforcement activity is needed.

Accidents, Occupational↗
PubMed2001

Correlates of depression in older Latinos.

OBJECTIVE: To report the rates of depressive disorders--i.e., major and subthreshold depression--as well as the correlates of depression in a sample of older Latino primary care consumers. The study addresses the gap in the literature concerning depression and older Latinos residing in the U.S. DATA SOURCES AND STUDY SETTING: Data were collected from 150 Latino primary care consumers (50+ years-old) in Los Angeles County. Depression was measured using the depression module of the PRIME-MD Patient Health Questionnaire. Demographic, stress-related, health, and social integration data were also collected. STUDY DESIGN: A cross sectional design was employed vis-à-vis face-to-face interviews of respondents at the clinic sites or in their homes. Descriptive analyses and logistic regression modeling were used to describe the sample and to examine the correlates of depression. PRINCIPLE FINDINGS: Rates of depression indicate that 24.1% of the sample reported symptoms sufficient to meet the criteria for a PHQ depression diagnosis. Only social functioning and income were associated with the presence of a depressive disorder. Interference with social activities with family and friends as a result of physical and emotional problems was associated with a 1.86-fold increase risk of being depressed. CONCLUSIONS: Although most of the cases were classified as subthreshold, prior work has shown that subthreshold depression can be clinically significant and debilitating. Using brief screening instruments such as the PHQ, practitioners can identify cases needing further assessment and treatment.

Acculturation↗
PubMed1982

A framework for designing an MIS for health delivery system in rural India.

A framework for designing an information system for planning and monitoring of rural health services is proposed in the Indian context. For effective monitoring the framework emphasises selection of a set of programmed and non-programme indicators on inputs, activities, efficiency and impact and their integration at the district level. For planning, a village level data base is proposed which will integrate environmental data with health programme data. Illustrative examples are provided for key features of the MIS and finally those elements of the information system which are either too complex or too voluminous to be handled manually are identified and the possibility of using computers for such analysis is explored.

India↗
PubMed1987

Use of manpower data in an integrated database for program efficiency analysis: an example from a statewide community mental health system.

This article describes a method for systematically utilizing manpower data to analyze program efficiency of community mental health services. Examples of how analyses of performance data can be substantially enhanced by integrating manpower staffing data with other key financial, client, and service volume variables are provided.

Community Mental Health Services↗
PubMed1994

Physicians in health care management: 6. Physician *bytes* computer.

Revolutionary advancements in information technology are improving access to medical information, operational efficiency and clinical effectiveness. Health care facilities and agencies are planning to acquire information systems that will affect clinical and administrative functions. Federal and provincial agencies are beginning to define and collect diverse health care data and integrate them in a national database. As the demand for and access to information grows physicians will be key providers and users. They will have increasing access to critical patient data through clinical information systems; however, their practice patterns, clinical outcomes and resource utilization will also be subject to increasing scrutiny. To ensure appropriate use of technology and information systems, careful planning, selection, implementation and management will be needed. Physicians will require training to use the information and systems effectively. They must also recognize the increasing importance of such systems in delivering and managing health care; they must play a pivotal role in resolving management, information and systems issues and in promoting sound information and management strategies; and they must encourage research and education in medical informatics.

Attitude to Computers↗
PubMed2003

From data to knowledge in e-health applications: an integrated system for medical information modelling and retrieval.

The system described in this paper uses the technological advances in information technology in order to influence and improve healthcare practice by enabling the flexible modelling, direct representation and adaptable use of medical knowledge. It aims at resolving a number of difficulties encountered by current information repositories, such as costly customization, reusability, high maintenance and poor information modelling, by employing the architecture of the functional data model (FDM), while maintaining full interoperability with existing systems by means of XML. On the information-modelling front the system supports a variety of modelling techniques that are especially relevant to medical applications, such as complex objects, incomplete or missing information, partially structured data and multimedia content. A prototype implementation of the system has been developed which consists of a multimedia-enhanced version of the functional database language FDL, and a web-based, two-way translator interface between the application's native language and XML. This interface provides full interoperability with other, heterogeneous systems over the web, thus, significantly reducing the complexity of developing distributed healthcare systems and e-health applications.

Computer Communication Networks↗
PubMed2002

A global livestock production and health atlas (GLiPHA) for interactive presentation, integration and analysis of livestock data.

An interactive electronic atlas has been developed with the purpose of providing a scaleable overview of spatial and temporal variation in animal production and health-related information for decision and policy makers in national and international institutions. The information contained in the atlas is currently managed and presented using the Key Indicators Mapping System (KIMS), and will also be integrated using the Key Indicators Database System (KIDS). Both systems were developed by the World Agricultural Information Centre of the FAO (FAO-WAICENT), the former as a stand-alone application and the latter for access via the Internet. Components of the atlas include vector maps, livestock disease and production databases, rules for country-level disease risk classification and 'disease cards' containing basic background information on diseases included in the atlas. The disease data is currently based primarily on Office International des Epizooties (OIE) disease reports, and the livestock production data on the FAO-WAICENT database. The atlas is highly interactive and allows visual presentation of information using maps, tables and charts. It also contains links to relevant resource information on the Internet. Diseases covered in the animal health layer include most OIE List A diseases and a subset of OIE List B diseases. Extensive analyses have been conducted to develop a set of qualitative and semi-quantitative criteria that allow improved disease status classifications based on 5-years cumulative OIE disease reports, and official disease control declarations. Classification rules were determined depending on the epidemiological features of each disease and considering spatial heterogeneity of disease presence in local regions.

Animal Diseases↗
PubMed1993

Fertility and infertility assessment by review of records.

The assessment of fertility and infertility in dairy herds requires accurate and complete data that are collected in a timely manner. The data must be entered in a record system that provides easy accessibility. An understanding of terminology and statistical calculations, along with knowledge of industry standards, reproductive physiology, and pathology is essential if problem solving is to occur. Problem solving begins by developing an understanding of the events influencing past reproductive performance. Progress is made by establishing a detailed reproductive management plan to monitor the current breeding herd and to identify potential problems before they occur. The introduction of microcomputers and on-farm record systems has greatly enhanced the veterinarian's ability to access and process data. For the first time in history, cowside health data collection systems integrated with production records are being used. This provides the opportunity to collect and summarize and analyze reproductive and production data as the events occur. Successful reproductive performance depends on effective and efficient management. For veterinarians to effectively and positively influence the reproductive performance of the herd, they must influence management. This requires working with dairy management to make changes in job assignments and description. Taking time to assess records with managers is an invaluable tool to convince dairy management of the necessity for change.

Animals↗
PubMedDate not supplied

First steps toward integration of divergent information systems.

Because of increased vertical and horizontal integration of health care businesses, integration of health care data is more crucial than ever. One hospital's first steps in this direction consisted of development of an online physician's office billing system through which users could access the hospital mainframe and data programs.

Computers↗
PubMed2003

Kaiser Permanente gets ready to roll out automated medical records system nationwide.

Use of automated medical records (AMRs) got a boost last month when Kaiser Permanente, the nation's largest integrated health management organization, announced that all its regions will begin moving to an AMR system this year. While the system has the obvious advantages of making healthcare records more up-to-date and complete when a patient visits, it also has numerous quality-of-care advantages--both for providers and Kaiser Permanente's 8.5 million members, officials say.

Delivery of Health Care, Integrated↗
PubMed2004

How the pediatric autopsy yields valuable information in a vertically integrated health care system.

CONTEXT: Although autopsy rates have declined significantly in recent decades, studies continue to validate the autopsy as an important source of clinically relevant information, a teaching tool, and a quality assurance measure. A recent review of autopsy series showed a decline in the number of serious errors likely to have affected clinical outcome detected at autopsy during the past 46 years, with a current major error rate of 8.4% to 24.4%. OBJECTIVE: Our hypothesis was that the pediatric autopsy would uncover a significant number of major unexpected findings at the high end of the spectrum predicted by a recent review. This study assesses the unexpected findings at a pediatric hospital whose autopsy service handles both in-house (tertiary care) and referral (mostly perinatal) cases for a vertically integrated health care system. DESIGN: Data were analyzed from an autopsy effectiveness report completed for all autopsies performed in 2000. The data from this series include concordance of premortem and postmortem diagnoses, with the autopsy considered the criterion standard. The autopsy effectiveness report also provided logistic information, such as problems with consents, medical records, specimen identification, and prosection. SETTING: Pediatric autopsies were performed by members of the Pediatric Pathology Division in a freestanding children's hospital in the Intermountain West of the United States with a large rural catchment area. This hospital is part of a large health maintenance organization serving the surrounding urban and rural areas. PATIENTS: A sample of all in-house and referral autopsies for the year 2000 was examined. MAIN OUTCOME MEASURE: The percentage of cases with a major or minor diagnostic discrepancy or unexpected pathologic finding using the autopsy as the criterion standard. RESULTS: The overall autopsy rate was 40% (39 hospital autopsies and 15 forensic autopsies per 135 total deaths) and was 32% excluding forensic cases. Twenty-two additional referral autopsies from outside institutions were performed. Of 61 autopsies, 12 (20%) revealed a major diagnostic discrepancy or unexpected pathologic finding, 17 (28%) had a minor unexpected finding or additional diagnosis, 41 (67%) clarified the differential diagnosis, 46 (75%) confirmed or verified a major diagnosis, and 21 (34%) provided information regarding treatment effects. Additionally, 3 (5%) had problems with identification, and 12 (20%) had problems with consent, all of which were resolved prior to initiation of the autopsy. CONCLUSIONS: These data confirm the value of the pediatric autopsy in a children's hospital and a vertically integrated health care system. It is an important medical and quality assurance procedure for assessing the accuracy of diagnoses, clarifying differential diagnoses, yielding unexpected findings, and providing feedback regarding therapeutic outcomes.

Autopsy↗
PubMed1997

The health care 100.

They are the giants of health care delivery: the top 100 integrated health systems. This exclusive ranking from St. Anthony Publishing includes revenue, physician and financial data on the nation;s largest integrated systems.

Catchment Area, Health↗
PubMed2025

Integrating explainable artificial intelligence with multiomics systems biology and electronic health record data mining for personalized drug repurposing in Alzheimer's disease.

Alzheimer's disease (AD) is characterized by region- and patient-specific molecular heterogeneity, which hinders therapeutic design. In this study, we introduce PRISM-ML (PRecision-medicine using Interpretable Systems and Multiomics with Machine Learning), an open-source integrated analysis pipeline that combines interpretable machine learning with systems biology and electronic health records data mining to elucidate the molecular diversity of AD and predict promising drug repurposing opportunities. First, we integrated and harmonized transcriptomic (bulk RNA-seq) and genomic (genome-wide association study) data from 2105 brain samples, each with matched data from the same individual (1363 AD patients, 742 controls; 9 tissues), sourced from three independent studies. Random forest classifiers with SHapley Additive exPlanations identified patient-specific biomarkers; unsupervised clustering resolved 36 molecularly distinct subtissues (defined as clusters of samples within a brain tissue that share a specific expression pattern); and gene-gene coexpression networks prioritized 262 high-centrality bottleneck genes as putative regulators of dysregulated pathways. Next, knowledge graph-based drug repurposing predicted six Food and Drug Administration (FDA)-approved drugs that simultaneously target multiple bottleneck genes and multiple AD-relevant pathways. Notably, in a large US de-identified insurance-claims database (n&#x2009;=&#x2009;364&#xa0;733), exposure to promethazine, one of the candidate drugs, was associated with a 57%-62% lower incidence of AD versus an active antihistamine comparator (adjusted hazard ratio 0.38; inverse-probability weighted 0.43; both P&#x2009;<&#x2009;.001), providing real-world support for its repurposing potential. In summary, PRISM-ML, as an explainable multiomics analysis pipeline, is readily transferable to other complex diseases, advancing precision medicine.

Alzheimer Disease↗