Publications

@article{nokey,

title = {Pediatric Mental Health Emergencies During 5 COVID-19 Waves in New York City},

author = {Deborah A. Levine and P. Stephen Oh and Katherine A. Nash and Will Simmons and Zachary M. Grinspan and Erika L. Abramson and Shari L. Platt and Cori Green

},

doi = {10.1542/peds.2022-060553},

year  = {2023},

date = {2023-11-01},

journal = {Pediatrics},

volume = {152},

number = {e2022060553},

issue = {5},

abstract = {Objectives: To describe the proportion of pediatric mental health emergency department (MH-ED) visits across 5 COVID-19 waves in New York City (NYC) and to examine the relationship between MH-ED visits, COVID-19 prevalence, and societal restrictions.



Methods: We conducted a time-series analysis of MH-ED visits among patients ages 5 to 17 years using the INSIGHT Clinical Research Network, a database from 5 medical centers in NYC from January 1, 2016, to June 12, 2022. We estimated seasonally adjusted changes in MH-ED visit rates during the COVID-19 pandemic, compared with predicted prepandemic levels, specific to each COVID-19 wave and stratified by mental health diagnoses and sociodemographic characteristics. We estimated associations between MH-ED visit rates, COVID-19 prevalence, and societal restrictions measured by the Stringency Index.



Results: Of 686 500 ED visits in the cohort, 27 168 (4.0%) were MH-ED visits. The proportion of MH-ED visits was higher during each COVID-19 wave compared with predicted prepandemic trends. Increased MH-ED visits were seen for eating disorders across all waves; anxiety disorders in all except wave 3; depressive disorders and suicidality/self-harm in wave 2; and substance use disorders in waves 2, 4, and 5. MH-ED visits were increased from expected among female, adolescent, Asian race, high Child Opportunity Index patients. There was no association between MH-ED visits and NYC COVID-19 prevalence or NY State Stringency Index.



Conclusions: The proportion of pediatric MH-ED visits during the COVID-19 pandemic was higher during each wave compared with the predicted prepandemic period, with varied increases among diagnostic and sociodemographic subgroups. Enhanced pediatric mental health resources are essential to address these findings.},

keywords = {COVID-19, emergency visits, mental health},

pubstate = {published},

tppubtype = {article}

}

@article{nokey,

title = {A qualitative study on precepting and teaching with telemedicine in the academic setting},

author = {Brittany J. Raffa and Kimberly A. Muellers and Katerina Andreadis and Jessica S. Ancker and Kori B. Flower and Carol R. Horowitz and Rainu Kaushal and Jenny J. Lin},

doi = {10.1097/ACM.0000000000005291},

year  = {2023},

date = {2023-06-05},

urldate = {2023-06-05},

journal = {Academic Medicine},

volume = {98},

issue = {10},

pages = {1204-1210},

abstract = {Purpose: To examine the impact of telemedicine use on precepting and teaching among preceptors and patients during the COVID-19 pandemic.



Method: The authors conducted a secondary analysis of a qualitative study focusing on providers' and patients' experiences with and attitudes toward telemedicine at 4 academic health centers. Teaching and precepting were emergent codes from the data and organized into themes. Themes were mapped to domains from the 2009 Consolidated Framework for Implementation Research (CFIR), a framework that assists with effective implementation and consists of 5 domains: intervention characteristics, outer settings, inner settings, characteristics of individuals, and process.



Results: In total, 86 interviews were conducted with 65 patients and 21 providers. Nine providers and 3 patients recounted descriptions related to teaching and precepting with telemedicine. Eight themes were identified, mapping across all 5 CFIR domains, with the majority of themes (n = 6) within the domains of characteristics of individuals, processes, and intervention characteristics. Providers and patients described how a lack of prepandemic telemedicine experience and inadequate processes in place to precept and teach with telemedicine affected the learning environment and perceived quality of care. They also discussed how telemedicine exacerbated existing difficulties in maintaining resident continuity. Providers described ways communication changed with telemedicine use during the pandemic, including having to wear masks while in the same room as the trainee and sitting closely to remain within range of the camera, as well as the benefit of observing trainees with the attending's camera off. Providers expressed a lack of protected structure and time for teaching and supervising with telemedicine, and a general view that telemedicine is here to stay.



Conclusions: Efforts should focus on increasing knowledge of telemedicine skills and improving processes to implement telemedicine in the teaching setting in order to best integrate it into undergraduate and graduate medical education.},

keywords = {COVID-19, telemedicine},

pubstate = {published},

tppubtype = {article}

}

@article{nokey,

title = {The impact of preexisting psychiatric disorders and antidepressant use on COVID-19 related outcomes: a multicenter study},

author = {Katharina Schultebraucks and Wivine Blekic and Cale Basaraba and Tom Corbeil and Zain Khan and Brandy F. Henry and Noa Krawczyk and Bianca D. Rivera and Bennett Allen and Caroline Arout and Harold Alan Pincus and Diana M. Martinez and Frances R. Levin},

doi = {10.1038/s41380-023-02049-4},

year  = {2023},

date = {2023-04-17},

journal = {Molecular Psychiatry},

volume = {28},

issue = {6},

pages = {2462-2468},

abstract = {Pre-existing mental disorders are linked to COVID-19-related outcomes. However, the findings are inconsistent and a thorough analysis of a broader spectrum of outcomes such as COVID-19 infection severity, morbidity, and mortality is required. We investigated whether the presence of psychiatric diagnoses and/or the use of antidepressants influenced the severity of the outcome of COVID-19. This retrospective cohort study evaluated electronic health records from the INSIGHT Clinical Research Network in 116,498 individuals who were diagnosed with COVID-19 between March 1, 2020, and February 23, 2021. We examined hospitalization, intubation/mechanical ventilation, acute kidney failure, severe sepsis, and death as COVID-19-related outcomes. After using propensity score matching to control for demographics and medical comorbidities, we used contingency tables to assess whether patients with (1) a history of psychiatric disorders were at higher risk of more severe COVID-19-related outcomes and (2) if use of antidepressants decreased the risk of more severe COVID-19 infection. Pre-existing psychiatric disorders were associated with an increased risk for hospitalization, and subsequent outcomes such as acute kidney failure and severe sepsis, including an increased risk of death in patients with schizophrenia spectrum disorders or bipolar disorders. The use of antidepressants was associated with significantly reduced risk of sepsis (p = 0.033), death (p = 0.026). Psychiatric disorder diagnosis prior to a COVID-19-related healthcare encounter increased the risk of more severe COVID-19-related outcomes as well as subsequent health complications. However, there are indications that the use of antidepressants might decrease this risk. This may have significant implications for the treatment and prognosis of patients with COVID-19.},

keywords = {COVID-19, psychiatric disorders},

pubstate = {published},

tppubtype = {article}

}

@article{nokey,

title = {Data-driven analysis to understand long COVID using electronic health records from the RECOVER initiative},

author = {Chengxi Zang and Yongkang Zhang and Jie Xu and Jiang Bian and Dmitry Morozyuk and Edward J. Schenck and Dhruv Khullar and Anna S. Nordvig and Elizabeth A. Shenkman and Russell L. Rothman and Jason P. Block and Kristin Lyman and Mark G Weiner and Thomas W. Carton and Fei Wang and Rainu Kaushal },

doi = {10.1038/s41467-023-37653-z},

year  = {2023},

date = {2023-04-07},

urldate = {2023-04-07},

journal = {Nature Communications},

volume = {14},

number = {1948},

issue = {1},

abstract = {Recent studies have investigated post-acute sequelae of SARS-CoV-2 infection (PASC, or long COVID) using real-world patient data such as electronic health records (EHR). Prior studies have typically been conducted on patient cohorts with specific patient populations which makes their generalizability unclear. This study aims to characterize PASC using the EHR data warehouses from two large Patient-Centered Clinical Research Networks (PCORnet), INSIGHT and OneFlorida+, which include 11 million patients in New York City (NYC) area and 16.8 million patients in Florida respectively. With a high-throughput screening pipeline based on propensity score and inverse probability of treatment weighting, we identified a broad list of diagnoses and medications which exhibited significantly higher incidence risk for patients 30-180 days after the laboratory-confirmed SARS-CoV-2 infection compared to non-infected patients. We identified more PASC diagnoses in NYC than in Florida regarding our screening criteria, and conditions including dementia, hair loss, pressure ulcers, pulmonary fibrosis, dyspnea, pulmonary embolism, chest pain, abnormal heartbeat, malaise, and fatigue, were replicated across both cohorts. Our analyses highlight potentially heterogeneous risks of PASC in different populations.},

keywords = {COVID-19, long COVID},

pubstate = {published},

tppubtype = {article}

}

@article{nokey,

title = {Patient and Provider Recommendations for Improved Telemedicine User Experience in Primary Care: A Multi-Center Qualitative Study},

author = {Saif Khairat and Prabal Chourasia and Kimberly A. Muellers and Katerina Andreadis and Jenny J. Lin and Jessica S. Ancker

},

doi = {https://doi.org/10.1089/tmr.2023.0002},

year  = {2023},

date = {2023-03-20},

journal = {Telemedicine Reports},

volume = {4},

issue = {1},

pages = {21-29},

abstract = {Objective: The purpose of this study was to explore telemedicine use and obtain actionable recommendations to improve telemedicine user experience from a diverse group of patients and providers.



Methods: We interviewed adult patients and primary care providers (PCPs) across three National Patient-Centered Clinical Research Network (PCORnet) sites in New York City, North Carolina, and Florida. Both patients and providers could participate via phone or videoconferencing; patients could complete the interview in English or Spanish. Spanish interviews were conducted by a member of the research team who spoke Spanish fluently. Interviews were audio-recorded, transcribed verbatim, and when necessary, professionally translated.



Results: We interviewed 21 PCPs and 65 patients between March and October 2021. We found that patients' and providers' perspectives on ways to improve the telemedicine experience focused on three recommendation themes: (1) expectations of care provided via telemedicine, (2) innovations to support usability, and (3) alleviation of physician burden. Key recommendations were related to expectations regarding (1) care provided, for example, adding educational content for the patients, and clarity about long-term payment models; (2) support innovation to improve telemedicine usability, for example, providing patients with remote monitoring devices, integrating in-home testing and nursing evaluation; (3) and reduce physician burden, for example, virtual rooming, reimbursement of time spent outside of the telemedicine encounter.



Discussion: Primary care patients and providers see merit in telemedicine. However, both groups recommended novel ways to improve the quality of care and user experience. Findings from this article suggest that policymakers would be best served by addressing current gaps in patient digital literacy by creating technical support strategies, and gaps in telemedicine reimbursement to present an equitable form of payment.},

keywords = {primary care, telemedicine, user experience},

pubstate = {published},

tppubtype = {article}

}

@article{nokey,

title = {Assessing the impact of privacy-preserving record linkage on record overlap and patient demographic and clinical characteristics in PCORnet®, the National Patient-Centered Clinical Research Network},

author = {Keith Marsolo and Daniel Kiernan and Sengwee Toh and Jasmin Phua and Darcy Louzao and Kevin Haynes and Mark Weiner and Francisco Angulo and Charles Bailey and Jiang Bian and Daniel Fort and Shaun Grannis and Ashok Kumar Krishnamurthy and Vinit Nair and Pedro Rivera and Jonathan Silverstein and Maryan Zirkle and Thomas Carton},

doi = {  https://doi.org/10.1093/jamia/ocac229},

year  = {2023},

date = {2023-02-16},

urldate = {2023-02-16},

journal = {Journal of the American Medical Informatics Association},

volume = {30},

issue = {3},

pages = {447-455},

abstract = {Objective: This article describes the implementation of a privacy-preserving record linkage (PPRL) solution across PCORnet®, the National Patient-Centered Clinical Research Network.



Material and methods: Using a PPRL solution from Datavant, we quantified the degree of patient overlap across the network and report a de-duplicated analysis of the demographic and clinical characteristics of the PCORnet population.



Results: There were ∼170M patient records across the responding Network Partners, with ∼138M (81%) of those corresponding to a unique patient. 82.1% of patients were found in a single partner and 14.7% were in 2. The percentage overlap between Partners ranged between 0% and 80% with a median of 0%. Linking patients' electronic health records with claims increased disease prevalence in every clinical characteristic, ranging between 63% and 173%.



Discussion: The overlap between Partners was variable and depended on timeframe. However, patient data linkage changed the prevalence profile of the PCORnet patient population.



Conclusions: This project was one of the largest linkage efforts of its kind and demonstrates the potential value of record linkage. Linkage between Partners may be most useful in cases where there is geographic proximity between Partners, an expectation that potential linkage Partners will be able to fill gaps in data, or a longer study timeframe.},

keywords = {distributed research networks, privacy-preserving record linkage, real-world data},

pubstate = {published},

tppubtype = {article}

}

@article{nokey,

title = {Racial/Ethnic Disparities in Post-acute Sequelae of SARS-CoV-2 Infection in New York: an EHR-Based Cohort Study from the RECOVER Program},

author = {Dhruv Khullar and Yongkang Zhang and Chengxi Zang and Zhenxing Xu and Fei Wang and Mark G. Weiner and Thomas W. Carton and Russell L. Rothman and Jason P. Block and Rainu Kaushal},

doi = {10.1007/s11606-022-07997-1},

year  = {2023},

date = {2023-02-16},

journal = {Journal of General Internal Medicine},

volume = {38},

issue = {5},

pages = {1127-1136},

abstract = {Background: Compared to white individuals, Black and Hispanic individuals have higher rates of COVID-19 hospitalization and death. Less is known about racial/ethnic differences in post-acute sequelae of SARS-CoV-2 infection (PASC).



Objective: Examine racial/ethnic differences in potential PASC symptoms and conditions among hospitalized and non-hospitalized COVID-19 patients.



Design: Retrospective cohort study using data from electronic health records.



Participants: 62,339 patients with COVID-19 and 247,881 patients without COVID-19 in New York City between March 2020 and October 2021.



Main measures: New symptoms and conditions 31-180 days after COVID-19 diagnosis.



Key results: The final study population included 29,331 white patients (47.1%), 12,638 Black patients (20.3%), and 20,370 Hispanic patients (32.7%) diagnosed with COVID-19. After adjusting for confounders, significant racial/ethnic differences in incident symptoms and conditions existed among both hospitalized and non-hospitalized patients. For example, 31-180 days after a positive SARS-CoV-2 test, hospitalized Black patients had higher odds of being diagnosed with diabetes (adjusted odds ratio [OR]: 1.96, 95% confidence interval [CI]: 1.50-2.56, q<0.001) and headaches (OR: 1.52, 95% CI: 1.11-2.08, q=0.02), compared to hospitalized white patients. Hospitalized Hispanic patients had higher odds of headaches (OR: 1.62, 95% CI: 1.21-2.17, q=0.003) and dyspnea (OR: 1.22, 95% CI: 1.05-1.42, q=0.02), compared to hospitalized white patients. Among non-hospitalized patients, Black patients had higher odds of being diagnosed with pulmonary embolism (OR: 1.68, 95% CI: 1.20-2.36, q=0.009) and diabetes (OR: 2.13, 95% CI: 1.75-2.58, q<0.001), but lower odds of encephalopathy (OR: 0.58, 95% CI: 0.45-0.75, q<0.001), compared to white patients. Hispanic patients had higher odds of being diagnosed with headaches (OR: 1.41, 95% CI: 1.24-1.60, q<0.001) and chest pain (OR: 1.50, 95% CI: 1.35-1.67, q < 0.001), but lower odds of encephalopathy (OR: 0.64, 95% CI: 0.51-0.80, q<0.001).



Conclusions: Compared to white patients, patients from racial/ethnic minority groups had significantly different odds of developing potential PASC symptoms and conditions. Future research should examine the reasons for these differences.},

keywords = {COVID-19, long COVID, racial/ethnic disparities},

pubstate = {published},

tppubtype = {article}

}

@article{nokey,

title = {Identifying environmental risk factors for post-acute sequelae of SARS-CoV-2 infection: An EHR-based cohort study from the recover program},

author = {Yongkang Zhang and Hui Hu and Vasilios Fokaidis and Colby Lewis V and Jie Xu and Chengxi Zang and Zhenxing Xu and Fei Wang and Michael Koropsak and Jiang Bian and Jaclyn Hall and Russell L. Rothman and Elizabeth A. Shenkman and Wei-Qi Wei and Mark G. Weiner and Thomas W. Carton and Rainu Kaushal},

doi = {10.1016/j.envadv.2023.100352},

year  = {2023},

date = {2023-02-08},

urldate = {2023-02-08},

journal = {Environmental Advances},

volume = {11},

number = {100352},

abstract = {Post-acute sequelae of SARS-CoV-2 infection (PASC) affects a wide range of organ systems among a large proportion of patients with SARS-CoV-2 infection. Although studies have identified a broad set of patient-level risk factors for PASC, little is known about the association between "exposome"-the totality of environmental exposures and the risk of PASC. Using electronic health data of patients with COVID-19 from two large clinical research networks in New York City and Florida, we identified environmental risk factors for 23 PASC symptoms and conditions from nearly 200 exposome factors. The three domains of exposome include natural environment, built environment, and social environment. We conducted a two-phase environment-wide association study. In Phase 1, we ran a mixed effects logistic regression with 5-digit ZIP Code tabulation area (ZCTA5) random intercepts for each PASC outcome and each exposome factor, adjusting for a comprehensive set of patient-level confounders. In Phase 2, we ran a mixed effects logistic regression for each PASC outcome including all significant (false positive discovery adjusted p-value < 0.05) exposome characteristics identified from Phase I and adjusting for confounders. We identified air toxicants (e.g., methyl methacrylate), particulate matter (PM2.5) compositions (e.g., ammonium), neighborhood deprivation, and built environment (e.g., food access) that were associated with increased risk of PASC conditions related to nervous, blood, circulatory, endocrine, and other organ systems. Specific environmental risk factors for each PASC condition and symptom were different across the New York City area and Florida. Future research is warranted to extend the analyses to other regions and examine more granular exposome characteristics to inform public health efforts to help patients recover from SARS-CoV-2 infection.},

keywords = {air pollution, built environment, COVID-19, exposome, long COVID, neighborhood deprivation},

pubstate = {published},

tppubtype = {article}

}

@article{nokey,

title = {COVID-19 complications among patients with opioid use disorder: a retrospective cohort study across five major NYC hospital systems},

author = {Noa Krawczyk and Bianca D. Rivera and Cale Basaraba and Thomas Corbeil and Bennett Allen and Katharina Schultebraucks and Brandy F. Henry and Harold A. Pincus and Frances R. Levin and Diana Martinez},

doi = {10.1111/add.16105},

year  = {2023},

date = {2023-01-08},

journal = {Addiction },

volume = {118},

issue = {5},

pages = {857-869},

abstract = {Background and aims: Individuals with opioid use disorder (OUD) suffer disproportionately from COVID-19. To inform clinical management of OUD patients, research is needed to identify characteristics associated with COVID-19 progression and death among this population. We aimed to investigate the role of OUD and specific comorbidities on COVID-19 progression among hospitalized OUD patients.



Design: Retrospective cohort study of merged electronic health records (EHR) from five large private health systems.



Setting: New York City, New York, USA, 2011-21.



Participants: Adults with a COVID-19 encounter and OUD or opioid overdose diagnosis between March 2020 and February 2021.



Measurements: Primary exposure included diagnosis of OUD/opioid overdose. Risk factors included age, sex, race/ethnicity and common medical, substance use and psychiatric comorbidities known to be associated with COVID-19 severity. Outcomes included COVID-19 hospitalization and subsequent intubation, acute kidney failure, severe sepsis and death.



Findings: Of 110 917 COVID-19+ adults, 1.17% were ever diagnosed with OUD/opioid overdose. OUD patients had higher risk of COVID-19 hospitalization [adjusted risk ratio (aRR) = 1.40, 95% confidence interval (CI) = 1.33, 1.47], intubation [adjusted odds ratio (aOR) = 2.05, 95% CI = 1.74, 2.42], kidney failure (aRR = 1.51, 95% CI = 1.34, 1.70), sepsis (aRR = 2.30, 95% CI = 1.88, 2.81) and death (aRR = 2.10, 95% CI = 1.84, 2.40). Among hospitalized OUD patients, risks for worse COVID-19 outcomes included being male; older; of a race/ethnicity other than white, black or Hispanic; and having comorbid chronic kidney disease, diabetes, obesity or cancer. Protective factors included having asthma, hepatitis-C and chronic pain.



Conclusions: Opioid use disorder patients appear to have a substantial risk for COVID-19-associated morbidity and mortality, with particular comorbidities and treatments moderating this risk.},

keywords = {COVID-19, data linkage, disparities, hospital care, opioid use disorder},

pubstate = {published},

tppubtype = {article}

}

@article{nokey,

title = {COVID-19 complications among patients with opioid use disorder: a retrospective cohort study across five major NYC hospital systems},

author = {Noa Krawczyk and Bianca D. Rivera and Cale Basaraba and Thomas Corbeil and Bennett Allen and Katharina Schultebraucks and Brandy F. Henry and Harold A. Pincus and Frances R. Levin and Diana Martinez},

doi = {10.1111/add.16105},

year  = {2023},

date = {2023-01-08},

urldate = {2023-01-08},

journal = {Addiction},

volume = {118},

issue = {5},

pages = {857-869},

abstract = {Background and aims: Individuals with opioid use disorder (OUD) suffer disproportionately from COVID-19. To inform clinical management of OUD patients, research is needed to identify characteristics associated with COVID-19 progression and death among this population. We aimed to investigate the role of OUD and specific comorbidities on COVID-19 progression among hospitalized OUD patients.



Design: Retrospective cohort study of merged electronic health records (EHR) from five large private health systems.



Setting: New York City, New York, USA, 2011-21.



Participants: Adults with a COVID-19 encounter and OUD or opioid overdose diagnosis between March 2020 and February 2021.



Measurements: Primary exposure included diagnosis of OUD/opioid overdose. Risk factors included age, sex, race/ethnicity and common medical, substance use and psychiatric comorbidities known to be associated with COVID-19 severity. Outcomes included COVID-19 hospitalization and subsequent intubation, acute kidney failure, severe sepsis and death.



Findings: Of 110 917 COVID-19+ adults, 1.17% were ever diagnosed with OUD/opioid overdose. OUD patients had higher risk of COVID-19 hospitalization [adjusted risk ratio (aRR) = 1.40, 95% confidence interval (CI) = 1.33, 1.47], intubation [adjusted odds ratio (aOR) = 2.05, 95% CI = 1.74, 2.42], kidney failure (aRR = 1.51, 95% CI = 1.34, 1.70), sepsis (aRR = 2.30, 95% CI = 1.88, 2.81) and death (aRR = 2.10, 95% CI = 1.84, 2.40). Among hospitalized OUD patients, risks for worse COVID-19 outcomes included being male; older; of a race/ethnicity other than white, black or Hispanic; and having comorbid chronic kidney disease, diabetes, obesity or cancer. Protective factors included having asthma, hepatitis-C and chronic pain.



Conclusions: Opioid use disorder patients appear to have a substantial risk for COVID-19-associated morbidity and mortality, with particular comorbidities and treatments moderating this risk.},

keywords = {COVID-19, data linkage, disparities, hospital care, opioid use disorder},

pubstate = {published},

tppubtype = {article}

}

@article{nokey,

title = {An Urgent Need for Guidelines for Telemedicine Use},

author = {Jenny J. Lin and Carol R. Horowitz and Jessica S. Ancker},

doi = {10.1007/s11606-022-07905-7},

year  = {2022},

date = {2022-11-04},

journal = {Journal of General Internal Medicine},

volume = {38},

issue = {4},

pages = {1061-1062},

keywords = {telemedicine},

pubstate = {published},

tppubtype = {article}

}

@article{nokey,

title = {Establishing a framework for privacy-preserving record linkage among electronic health record and administrative claims databases within PCORnet®, the National Patient-Centered Clinical Research Network},

author = {Daniel Kiernan and Thomas Carton and Sengwee Toh and Jasmin Phua and Maryan Zirkle and Darcy Louzao and Kevin Haynes and Mark Weiner and Francisco Angulo and Charles Bailey and Jiang Bian and Daniel Fort and Shaun Grannis and Ashok Kumar Krishnamurthy and Vinit Nair and Pedro Rivera and Jonathan Silverstein and Keith Marsolo },

doi = {https://doi.org/10.1186/s13104-022-06243-5},

year  = {2022},

date = {2022-10-31},

journal = {BMC Research Notes},

volume = {15},

issue = {1},

pages = {337},

abstract = {Objective: The aim of this study was to determine whether a secure, privacy-preserving record linkage (PPRL) methodology can be implemented in a scalable manner for use in a large national clinical research network.



Results: We established the governance and technical capacity to support the use of PPRL across the National Patient-Centered Clinical Research Network (PCORnet®). As a pilot, four sites used the Datavant software to transform patient personally identifiable information (PII) into de-identified tokens. We queried the sites for patients with a clinical encounter in 2018 or 2019 and matched their tokens to determine whether overlap existed. We described patient overlap among the sites and generated a "deduplicated" table of patient demographic characteristics. Overlapping patients were found in 3 of the 6 site-pairs. Following deduplication, the total patient count was 3,108,515 (0.11% reduction), with the largest reduction in count for patients with an "Other/Missing" value for Sex; from 198 to 163 (17.6% reduction). The PPRL solution successfully links patients across data sources using distributed queries without directly accessing patient PII. The overlap queries and analysis performed in this pilot is being replicated across the full network to provide additional insight into patient linkages among a distributed research network.},

keywords = {Medical record linkage, Patient data privacy},

pubstate = {published},

tppubtype = {article}

}

@article{nokey,

title = {Effect of Ivermectin vs Placebo on Time to Sustained Recovery in Outpatients with Mild to Moderate COVID-19: A Randomized Clinical Trial},

author = {Susanna Naggie and David R. Boulware and Christopher J. Lindsell and Thomas G. Stewart and Nina Gentile and Sean Collins and Matthew William McCarthy and Dushyantha Jayaweera and Mario Castro and Mark Sulkowski and Kathleen McTigue and Florence Thicklin and G. Michael Felker and Adit A. Ginde and Carolyn T. Bramante and Alex J. Slandzicki and Ahab Gabriel and Nirav S. Shah and Leslie A. Lenert and Sarah E. Dunsmore and Stacey J. Adam and Allison DeLong and George Hanna and April Remaly and Rhonda Wilder and Sybil Wilson and Elizabeth Shenkman and Adrian F. Hernandez and Accelerating COVID-19 Therapeutic Interventions and Vaccines (ACTIV-6) Study Group and Investigators},

doi = {10.1001/jama.2022.18590},

year  = {2022},

date = {2022-10-25},

journal = {JAMA},

volume = {328},

issue = {16},

pages = {1595-1603},

abstract = {Importance: The effectiveness of ivermectin to shorten symptom duration or prevent hospitalization among outpatients in the US with mild to moderate symptomatic COVID-19 is unknown.



Objective: To evaluate the efficacy of ivermectin, 400 μg/kg, daily for 3 days compared with placebo for the treatment of early mild to moderate COVID-19.



Design, setting, and participants: ACTIV-6, an ongoing, decentralized, double-blind, randomized, placebo-controlled platform trial, was designed to evaluate repurposed therapies in outpatients with mild to moderate COVID-19. A total of 1591 participants aged 30 years and older with confirmed COVID-19, experiencing 2 or more symptoms of acute infection for 7 days or less, were enrolled from June 23, 2021, through February 4, 2022, with follow-up data through May 31, 2022, at 93 sites in the US.



Interventions: Participants were randomized to receive ivermectin, 400 μg/kg (n = 817), daily for 3 days or placebo (n = 774).



Main outcomes and measures: Time to sustained recovery, defined as at least 3 consecutive days without symptoms. There were 7 secondary outcomes, including a composite of hospitalization or death by day 28.



Results: Among 1800 participants who were randomized (mean [SD] age, 48 [12] years; 932 women [58.6%]; 753 [47.3%] reported receiving at least 2 doses of a SARS-CoV-2 vaccine), 1591 completed the trial. The hazard ratio (HR) for improvement in time to recovery was 1.07 (95% credible interval [CrI], 0.96-1.17; posterior P value [HR >1] = .91). The median time to recovery was 12 days (IQR, 11-13) in the ivermectin group and 13 days (IQR, 12-14) in the placebo group. There were 10 hospitalizations or deaths in the ivermectin group and 9 in the placebo group (1.2% vs 1.2%; HR, 1.1 [95% CrI, 0.4-2.6]). The most common serious adverse events were COVID-19 pneumonia (ivermectin [n = 5]; placebo [n = 7]) and venous thromboembolism (ivermectin [n = 1]; placebo [n = 5]).



Conclusions and relevance: Among outpatients with mild to moderate COVID-19, treatment with ivermectin, compared with placebo, did not significantly improve time to recovery. These findings do not support the use of ivermectin in patients with mild to moderate COVID-19.},

keywords = {COVID-19},

pubstate = {published},

tppubtype = {article}

}

@article{nokey,

title = {Identifying Contextual and Spatial Risk Factors for Post-Acute Sequelae of SARS-CoV-2 Infection: An EHR-based Cohort Study from the RECOVER Program},

author = {Yongkang Zhang and Hui Hu and Vasilios Fokaidis and Colby Lewis and Jie Xu and Chengxi Zang and Zhenxing Xu and Fei Wang and Michael Koropsak and Jiang Bian and Jaclyn Hall and Russell L. Rothman and Elizabeth A. Shenkman and Wei-Qi Wei and Mark G. Weiner and Thomas W. Carton and Rainu Kaushal},

doi = {10.1101/2022.10.13.22281010},

year  = {2022},

date = {2022-10-13},

journal = {medRxiv},

abstract = {Post-acute sequelae of SARS-CoV-2 infection (PASC) affects a wide range of organ systems among a large proportion of patients with SARS-CoV-2 infection. Although studies have identified a broad set of patient-level risk factors for PASC, little is known about the contextual and spatial risk factors for PASC. Using electronic health data of patients with COVID-19 from two large clinical research networks in New York City and Florida, we identified contextual and spatial risk factors from nearly 200 environmental characteristics for 23 PASC symptoms and conditions of eight organ systems. We conducted a two-phase environment-wide association study. In Phase 1, we ran a mixed effects logistic regression with 5-digit ZIP Code tabulation area (ZCTA5) random intercepts for each PASC outcome and each contextual and spatial factor, adjusting for a comprehensive set of patient-level confounders. In Phase 2, we ran a mixed effects logistic regression for each PASC outcome including all significant (false positive discovery adjusted p-value < 0.05) contextual and spatial characteristics identified from Phase I and adjusting for confounders. We identified air toxicants (e.g., methyl methacrylate), criteria air pollutants (e.g., sulfur dioxide), particulate matter (PM 2.5 ) compositions (e.g., ammonium), neighborhood deprivation, and built environment (e.g., food access) that were associated with increased risk of PASC conditions related to nervous, respiratory, blood, circulatory, endocrine, and other organ systems. Specific contextual and spatial risk factors for each PASC condition and symptom were different across New York City area and Florida. Future research is warranted to extend the analyses to other regions and examine more granular contextual and spatial characteristics to inform public health efforts to help patients recover from SARS-CoV-2 infection.},

keywords = {COVID-19, long COVID},

pubstate = {published},

tppubtype = {article}

}

@article{nokey,

title = {Machine Learning for Identifying Data-Driven Subphenotypes of Incident Post-Acute SARS-CoV-2 Infection Conditions with Large Scale Electronic Health Records: Findings from the RECOVER Initiative},

author = {Hao Zhang and Chengxi Zang and Zhenxing Xu and Yongkang Zhang and Jie Xu and Jiang Bian and Dmitry Morozyuk and Dhruv Khullar and Yiye Zhang and Anna Starikovsky Nordvig and Edward J. Schenck and Elizabeth Ann Shenkman and Russel L. Rothman and Jason P. Block and Kristin Lyman and Mark G. Weiner and Thomas W. Carton and Fei Wang and Rainu Kaushal},

doi = {https://doi.org/10.1101/2022.05.21.22275412},

year  = {2022},

date = {2022-06-08},

journal = {medRxiv},

abstract = {The post-acute sequelae of SARS-CoV-2 infection (PASC) refers to a broad spectrum of symptoms and signs that are persistent, exacerbated, or newly incident in the post-acute SARS-CoV-2 infection period of COVID-19 patients. Most studies have examined these conditions individually without providing concluding evidence on co-occurring conditions. To answer this question, this study leveraged electronic health records (EHRs) from two large clinical research networks from the national Patient-Centered Clinical Research Network (PCORnet) and investigated patients' newly incident diagnoses that appeared within 30 to 180 days after a documented SARS-CoV-2 infection. Through machine learning, we identified four reproducible subphenotypes of PASC dominated by blood and circulatory system, respiratory, musculoskeletal and nervous system, and digestive system problems, respectively. We also demonstrated that these subphenotypes were associated with distinct patterns of patient demographics, underlying conditions present prior to SARS-CoV-2 infection, acute infection phase severity, and use of new medications in the post-acute period. Our study provides novel insights into the heterogeneity of PASC and can inform stratified decision-making in the treatment of COVID-19 patients with PASC conditions.},

keywords = {COVID-19, long COVID},

pubstate = {published},

tppubtype = {article}

}

@article{nokey,

title = {Association between antidiabetic drug use and the risk of COVID-19 hospitalization in the INSIGHT Clinical Research Network in New York City},

author = {JeaYoung Min and Will Simmons and Samprit Banerjee and Fei Wang and Nicholas Williams and Yongkang Zhang and April B. Reese and Alvin I. Mushlin and James H. Flory},

doi = {10.1111/dom.14704},

year  = {2022},

date = {2022-04-25},

journal = {Diabetes, Obesity & Metabolism},

volume = {24},

issue = {7},

pages = {1402-1405},

keywords = {antidiabetic drug, COVID-19, type 2 diabetes},

pubstate = {published},

tppubtype = {article}

}

@article{nokey,

title = {Cardiac Complications After SARS-CoV-2 Infection and mRNA COVID-19 Vaccination—PCORnet, United States, January 2021–January 2022},

author = {Jason P. Block and Tegan K. Boehmer and Christopher B. Forrest and Thomas W. Carton and Grace M. Lee and Umed A. Ajani and Dimitri A. Christakis and Lindsay G. Cowell and Christine Draper and Nidhi Ghildayal and Aaron M. Harris and Michael D. Kappelman and Jean Y. Ko and Kenneth H. Mayer and Kshema Nagavedu and Matthew E. Oster and Anuradha Paranjape and Jon Puro and Matthew D. Ritchey and David K. Shay and Deepika Thacker and Adi V. Gundlapalli},

doi = {10.15585/mmwr.mm7114e1},

year  = {2022},

date = {2022-04-08},

urldate = {2022-04-08},

journal = {Morbidity and Mortality Weekly Report},

volume = {71},

issue = {14},

pages = {517-523},

abstract = {Cardiac complications, particularly myocarditis and pericarditis, have been associated with SARS-CoV-2 (the virus that causes COVID-19) infection (1-3) and mRNA COVID-19 vaccination (2-5). Multisystem inflammatory syndrome (MIS) is a rare but serious complication of SARS-CoV-2 infection with frequent cardiac involvement (6). Using electronic health record (EHR) data from 40 U.S. health care systems during January 1, 2021-January 31, 2022, investigators calculated incidences of cardiac outcomes (myocarditis; myocarditis or pericarditis; and myocarditis, pericarditis, or MIS) among persons aged ≥5 years who had SARS-CoV-2 infection, stratified by sex (male or female) and age group (5-11, 12-17, 18-29, and ≥30 years). Incidences of myocarditis and myocarditis or pericarditis were calculated after first, second, unspecified, or any (first, second, or unspecified) dose of mRNA COVID-19 (BNT162b2 [Pfizer-BioNTech] or mRNA-1273 [Moderna]) vaccines, stratified by sex and age group. Risk ratios (RR) were calculated to compare risk for cardiac outcomes after SARS-CoV-2 infection to that after mRNA COVID-19 vaccination. The incidence of cardiac outcomes after mRNA COVID-19 vaccination was highest for males aged 12-17 years after the second vaccine dose; however, within this demographic group, the risk for cardiac outcomes was 1.8-5.6 times as high after SARS-CoV-2 infection than after the second vaccine dose. The risk for cardiac outcomes was likewise significantly higher after SARS-CoV-2 infection than after first, second, or unspecified dose of mRNA COVID-19 vaccination for all other groups by sex and age (RR 2.2-115.2). These findings support continued use of mRNA COVID-19 vaccines among all eligible persons aged ≥5 years.},

keywords = {COVID-19},

pubstate = {published},

tppubtype = {article}

}

@article{nokey,

title = {The use of electronic health records to inform cancer surveillance efforts: a scoping review and test of indicators for public health surveillance of cancer prevention and control},

author = {Sarah Conderino and Stefanie Bendik and Thomas B. Richards and Claudia Pulgarin and Pui Ying Chan and Julie Townsend and Sungwoo Lim and Timothy R. Roberts and Lorna E. Thorpe},

doi = {10.1186/s12911-022-01831-8},

year  = {2022},

date = {2022-04-06},

urldate = {2022-04-06},

journal = {BMC Medical Informatics and Decision Making},

volume = {22},

issue = {1},

pages = {91},

abstract = {Introduction: State cancer prevention and control programs rely on public health surveillance data to set objectives to improve cancer prevention and control, plan interventions, and evaluate state-level progress towards achieving those objectives. The goal of this project was to evaluate the validity of using electronic health records (EHRs) based on common data model variables to generate indicators for surveillance of cancer prevention and control for these public health programs.



Methods: Following the methodological guidance from the PRISMA Extension for Scoping Reviews, we conducted a literature scoping review to assess how EHRs are used to inform cancer surveillance. We then developed 26 indicators along the continuum of the cascade of care, including cancer risk factors, immunizations to prevent cancer, cancer screenings, quality of initial care after abnormal screening results, and cancer burden. Indicators were calculated within a sample of patients from the New York City (NYC) INSIGHT Clinical Research Network using common data model EHR data and were weighted to the NYC population using post-stratification. We used prevalence ratios to compare these estimates to estimates from the raw EHR of NYU Langone Health to assess quality of information within INSIGHT, and we compared estimates to results from existing surveillance sources to assess validity.



Results: Of the 401 identified articles, 15% had a study purpose related to surveillance. Our indicator comparisons found that INSIGHT EHR-based measures for risk factor indicators were similar to estimates from external sources. In contrast, cancer screening and vaccination indicators were substantially underestimated as compared to estimates from external sources. Cancer screenings and vaccinations were often recorded in sections of the EHR that were not captured by the common data model. INSIGHT estimates for many quality-of-care indicators were higher than those calculated using a raw EHR.



Conclusion: Common data model EHR data can provide rich information for certain indicators related to the cascade of care but may have substantial biases for others that limit their use in informing surveillance efforts for cancer prevention and control programs.},

keywords = {common data model, early detection of cancer, electronic health records, public health informatics, public health surveillance},

pubstate = {published},

tppubtype = {article}

}

@article{nokey,

title = {Effect of Normalizing eGFR to Standard Body Surface Area on Rates of Obesity-Related Hyperfiltration among Diverse Female Adolescents},

author = {Dana Bielopolski and Ohad S. Bentur and Neha Singh and Roger D. Vaughan and David M. Charytan and Rhonda G. Kost and Jonathan N. Tobin},

doi = {https://doi.org/10.1159/000522475},

year  = {2022},

date = {2022-04-04},

journal = {American Journal of Nephrology},

volume = {53},

issue = {4},

pages = {282-289},

abstract = {Introduction: Obesity is more prevalent among African American individuals, increasing the risk for cardiorenal morbidity. We explored interactions between race, BMI, and the risk of hyperfiltration associated with obesity-related glomerulopathy (ORG).



Methods: We created a cohort of female adolescents from electronic health records. Glomerular filtration rate (GFR) was estimated in two ways: (A) using standard age recommended formulae and (B) absolute eGFR - adjusted to individual body surface area (BSA). Multivariate logistic regression was used to analyze the contribution of risk factors for ORG-associated hyperfiltration defined as 135 mL/min/1.73 m2 or 135 mL/min, according to BMI group. Pearson's coefficient was used to assess correlation with creatinine clearance (CrCl).



Results: The final cohort included 7,315 African American and 15,102 non-African American adolescent females, with CrCl available for internal validation in 207 non-African American and 107 African American individuals. Compared with non-African American ethnicity, African American ethnicity was independently associated with a lower risk of hyperfiltration with standard eGFR calculations (odds ratio [OR] = 0.57, 95% confidence intervals [CIs] 0.45-0.71), associations were enhanced for absolute eGFR (OR = 0.81, 95% CI 0.69-0.95). Absolute eGFR values agreed better with CrCl (r = 0.63), compared to standard indexed eGFR formulae. Proportions classified as hyperfiltration changed with standard versus absolute eGFR; they were similar across BMI groups with the first and reflected obesity with the later.



Conclusion: Adjusting to individual BSA improves estimation of GFR and identification of obesity-related hyperfiltration. More accurate and earlier ascertainment of obesity-related hyperfiltration may have important consequences for preservation of kidney function.},

keywords = {eGFR, obesity},

pubstate = {published},

tppubtype = {article}

}

@article{nokey,

title = {Using Mobile Integrated Health and telehealth to support transitions of care among patients with heart failure (MIGHTy-Heart): protocol for a pragmatic randomised controlled trial},

author = {Ruth M. Masterson Creber and Brock Daniels and Kevin Munjal and Meghan Reading Turchioe and Leah Shafran Topaz and Crispin Goytia and Iván Díaz and Parag Goyal and Mark Weiner and Jiani Yu and Dhruv Khullar and David Slotwiner and Kumudha Ramasubbu and Rainu Kaushal },

doi = {10.1136/bmjopen-2021-054956},

year  = {2022},

date = {2022-03-10},

journal = {BMJ Open},

volume = {12},

issue = {3},

pages = {e054956},

abstract = {Introduction: Nearly one-quarter of patients discharged from the hospital with heart failure (HF) are readmitted within 30 days, placing a significant burden on patients, families and health systems. The objective of the 'Using Mobile Integrated Health and Telehealth to support transitions of care among patients with Heart failure' (MIGHTy-Heart) study is to compare the effectiveness of two postdischarge interventions on healthcare utilisation, patient-reported outcomes and healthcare quality among patients with HF.



Methods and analysis: The MIGHTy-Heart study is a pragmatic comparative effectiveness trial comparing two interventions demonstrated to improve the hospital to home transition for patients with HF: mobile integrated health (MIH) and transitions of care coordinators (TOCC). The MIH intervention bundles home visits from a community paramedic (CP) with telehealth video visits by emergency medicine physicians to support the management of acute symptoms and postdischarge care coordination. The TOCC intervention consists of follow-up phone calls from a registered nurse within 48-72 hours of discharge to assess a patient's clinical status, identify unmet clinical and social needs and reinforce patient education (eg, medication adherence and lifestyle changes). MIGHTy-Heart is enrolling and randomising (1:1) 2100 patients with HF who are discharged to home following a hospitalisation in two New York City (NY, USA) academic health systems. The coprimary study outcomes are all-cause 30-day hospital readmissions and quality of life measured with the Kansas City Cardiomyopathy Questionnaire 30 days after hospital discharge. The secondary endpoints are days at home, preventable emergency department visits, unplanned hospital admissions and patient-reported symptoms. Data sources for the study outcomes include patient surveys, electronic health records and claims submitted to Medicare and Medicaid.



Ethics and dissemination: All participants provide written or verbal informed consent prior to randomisation in English, Spanish, French, Mandarin or Russian. Study findings are being disseminated to scientific audiences through peer-reviewed publications and presentations at national and international conferences. This study has been approved by: Biomedical Research Alliance of New York (BRANY #20-08-329-380), Weill Cornell Medicine Institutional Review Board (20-08022605) and Mt. Sinai Institutional Review Board (20-01901).},

keywords = {adult cardiology, health policy, healthcare quality, heart failure, protocols and guidelines, telemedicine},

pubstate = {published},

tppubtype = {article}

}