Robert Thombley
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View article: From 4Ms to 5 domains: ensuring new CMS Age-Friendly hospital measure improves care for older adults
From 4Ms to 5 domains: ensuring new CMS Age-Friendly hospital measure improves care for older adults Open
In 2024, the Centers for Medicare and Medicaid Services (CMS) added a novel Age-Friendly Hospital Inpatient Quality Reporting (IQR) Measure, composed of 10 attestation statements in 5 domains. The measure is designed to improve care for ol…
View article: Outcomes Associated With an Age-Friendly Emergency Department Intervention
Outcomes Associated With an Age-Friendly Emergency Department Intervention Open
View article: Differences in physician electronic health record use by telemedicine intensity: evidence from 2 academic medical centers
Differences in physician electronic health record use by telemedicine intensity: evidence from 2 academic medical centers Open
Objective Evaluate the association between telemedicine intensity and ambulatory physician electronic health record (EHR) use following the COVID-19 pandemic. Materials and Methods This retrospective study included ambulatory physicians in…
View article: Education Research: Exploring the Impact of Standardized, Condition-Specific Note Templates on Quality Metrics and Efficiency in Multiple Resident Clinics
Education Research: Exploring the Impact of Standardized, Condition-Specific Note Templates on Quality Metrics and Efficiency in Multiple Resident Clinics Open
Standardized, condition-specific templates improved documentation of quality metrics without increasing time spent. Despite initial low uptake of template use, an increase was observed over time, indicating potential for wider acceptance w…
View article: Primary Care Physician Perceptions of the Impact of CMS E/M Coding Changes and Associations with Changes in EHR Time
Primary Care Physician Perceptions of the Impact of CMS E/M Coding Changes and Associations with Changes in EHR Time Open
Background In 2021, CMS changed ambulatory evaluation and management (E/M) documentation requirements to reduce physician documentation burden. No prior work has assessed primary care physician (PCP) perceptions of the impact of these chan…
View article: 4 Steps to 4Ms: A Navigation Guide for a Hospital-Based Composite Measure of 4Ms Care and the Implications for Outcomes Assessment
4 Steps to 4Ms: A Navigation Guide for a Hospital-Based Composite Measure of 4Ms Care and the Implications for Outcomes Assessment Open
The 4Ms Framework is the foundation of the Age-Friendly Health System (AFHS) movement. While the framework is based on standalone evidence for each M, there is limited evidence about the impact on outcomes when practiced as a set. A compos…
View article: Assessing Equitable Adherence to the Age-Friendly Health System’s 4Ms Framework in an Academic Inpatient Setting
Assessing Equitable Adherence to the Age-Friendly Health System’s 4Ms Framework in an Academic Inpatient Setting Open
While thousands of health systems have begun to implement the Age-Friendly Health System’s 4Ms Framework to improve care for older patients, an important phase of work is achieving consistent adherence to 4Ms care processes. Identifying me…
View article: Developing electronic health record‐based measures of the <scp>4Ms</scp> to support implementation and evidence generation for <scp>Age‐Friendly</scp> Health Systems
Developing electronic health record‐based measures of the <span>4Ms</span> to support implementation and evidence generation for <span>Age‐Friendly</span> Health Systems Open
Background To support implementation of the 4Ms framework and more rigorous evidence of 4Ms impact, we translated Institute for Healthcare Improvement's (IHI's) recommended 4Ms routine care practices into electronic health record‐based, en…
View article: Guidance for reporting analyses of metadata on electronic health record use
Guidance for reporting analyses of metadata on electronic health record use Open
Introduction Research on how people interact with electronic health records (EHRs) increasingly involves the analysis of metadata on EHR use. These metadata can be recorded unobtrusively and capture EHR use at a scale unattainable through …
View article: Changes in Physician Electronic Health Record Use With the Expansion of Telemedicine
Changes in Physician Electronic Health Record Use With the Expansion of Telemedicine Open
Importance Understanding the drivers of electronic health record (EHR) burden, including EHR time and patient messaging, may directly inform strategies to address physician burnout. Given the COVID-19−induced expansion of telemedicine—now …
View article: Physician Electronic Health Record Use After Changes in US Centers for Medicare & Medicaid Services Documentation Requirements
Physician Electronic Health Record Use After Changes in US Centers for Medicare & Medicaid Services Documentation Requirements Open
This cohort study examines changes in physician electronic health record (EHR) documentation time before and after changes in Centers for Medicare & Medicaid evaluation and management requirements.
View article: Team is brain: leveraging EHR audit log data for new insights into acute care processes
Team is brain: leveraging EHR audit log data for new insights into acute care processes Open
Objective To determine whether novel measures of contextual factors from multi-site electronic health record (EHR) audit log data can explain variation in clinical process outcomes. Materials and Methods We selected one widely-used process…
View article: Development and Testing of an Emergency Department Quality Measure for Pediatric Suicidal Ideation and Self-Harm
Development and Testing of an Emergency Department Quality Measure for Pediatric Suicidal Ideation and Self-Harm Open
View article: Follow-Up After Asthma Emergency Department Visits and Its Relationship With Subsequent Asthma-Related Utilization
Follow-Up After Asthma Emergency Department Visits and Its Relationship With Subsequent Asthma-Related Utilization Open
View article: Changes in Drug List Prices and Amounts Paid by Patients and Insurers
Changes in Drug List Prices and Amounts Paid by Patients and Insurers Open
This study's findings suggest that drug list prices more than doubled over a 7-year study period. Despite rising manufacturer discounts and rebates, these price increases were associated with large increases in patient out-of-pocket costs …
View article: Using diagnosis codes in claims data to identify cohorts of breast cancer patients following initial treatment
Using diagnosis codes in claims data to identify cohorts of breast cancer patients following initial treatment Open
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View article: Context is Key: Using the Audit Log to Capture Contextual Factors Affecting Stroke Care Processes.
Context is Key: Using the Audit Log to Capture Contextual Factors Affecting Stroke Care Processes. Open
High quality patient care through timely, precise and efficacious management depends not only on the clinical presentation of a patient, but the context of the care environment to which they present. Understanding and improving factors tha…
View article: Long-Term Trends in Postoperative Opioid Prescribing, 1994 to 2014
Long-Term Trends in Postoperative Opioid Prescribing, 1994 to 2014 Open
After the US introduction of long-acting opioids such as OxyContin, postoperative opioid prescribing in commercially insured patients increased in parallel with broader US opioid-prescribing trends, most notably among patients undergoing o…
View article: Identifying tests related to breast cancer care in claims data
Identifying tests related to breast cancer care in claims data Open
To develop a method for calculating rates of testing for breast cancer recurrence in patients who have already undergone initial treatment for breast cancer, we calculated rates in a cohort of Medicare breast cancer patients and an age-mat…
View article: Age‐ and Lesion‐Related Comorbidity Burden Among US Adults With Congenital Heart Disease: A Population‐Based Study
Age‐ and Lesion‐Related Comorbidity Burden Among US Adults With Congenital Heart Disease: A Population‐Based Study Open
Background As patients with congenital heart disease ( CHD ) are living longer, understanding the comorbidities they develop as they age is increasingly important. However, there are no published population‐based estimates of the comorbidi…
View article: Validation of Prediction Models for Critical Care Outcomes Using Natural Language Processing of Electronic Health Record Data
Validation of Prediction Models for Critical Care Outcomes Using Natural Language Processing of Electronic Health Record Data Open
Intensive care unit mortality prediction models incorporating measures of clinical trajectory and NLP-derived terms yielded excellent predictive performance and generalized well in this sample of hospitals. The role of these automated algo…
View article: Geographic Variation in Postoperative Imaging for Low-Risk Breast Cancer
Geographic Variation in Postoperative Imaging for Low-Risk Breast Cancer Open
Background: The objective of this study was to examine the presence and magnitude of US geographic variation in use rates of both recommended and high-cost imaging in young patients with early-stage breast cancer during the 18 month…