Christopher V Almario1, William D Chey2, Sentia Iriana3, Francis Dailey3, Karen Robbins3, Anish V Patel3, Mark Reid4, Cynthia Whitman5, Garth Fuller5, Roger Bolus6, Buddy Dennis7, Rey Encarnacion7, Bibiana Martinez8, Jennifer Soares8, Rushaba Modi9, Nikhil Agarwal9, Aaron Lee3, Scott Kubomoto3, Gobind Sharma3, Sally Bolus6, Lin Chang10, Brennan M R Spiegel11. 1. Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Division of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA; Division of Digestive Diseases, UCLA, Los Angeles, CA, USA; Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA, USA. 2. Division of Gastroenterology, University of Michigan, Ann Arbor, MI, USA. 3. Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA, USA. 4. Division of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA; Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA, USA. 5. Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA, USA. 6. Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA, USA. 7. UCLA Computing Technology Research Laboratory (CTRL), Los Angeles, CA, USA. 8. Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Division of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA; Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA, USA. 9. Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Division of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA; Division of Digestive Diseases, UCLA, Los Angeles, CA, USA. 10. Division of Digestive Diseases, UCLA, Los Angeles, CA, USA. 11. Division of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Division of Gastroenterology, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA; Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA, USA. Electronic address: Brennan.Spiegel@cshs.org.
Abstract
OBJECTIVE: It is important for clinicians to inquire about "alarm features" as it may identify those at risk for organic disease and who require additional diagnostic workup. We developed a computer algorithm called Automated Evaluation of Gastrointestinal Symptoms (AEGIS) that systematically collects patient gastrointestinal (GI) symptoms and alarm features, and then "translates" the information into a history of present illness (HPI). Our study's objective was to compare the number of alarms documented by physicians during usual care vs. that collected by AEGIS. METHODS: We performed a cross-sectional study with a paired sample design among patients visiting adult GI clinics. Participants first received usual care by their physicians and then completed AEGIS. Each individual thus contributed both a physician-documented and computer-generated HPI. Blinded physician reviewers enumerated the positive alarm features (hematochezia, melena, hematemesis, unintentional weight loss, decreased appetite, and fevers) mentioned in each HPI. We compared the number of documented alarms within patient using the Wilcoxon signed-rank test. RESULTS: Seventy-five patients had both physician and AEGIS HPIs. AEGIS identified more patients with positive alarm features compared to physicians (53% vs. 27%; p<.001). AEGIS also documented more positive alarms (median 1, interquartile range [IQR] 0-2) vs. physicians (median 0, IQR 0-1; p<.001). Moreover, clinicians documented only 30% of the positive alarms self-reported by patients through AEGIS. CONCLUSIONS: Physicians documented less than one-third of red flags reported by patients through a computer algorithm. These data indicate that physicians may under report alarm features and that computerized "checklists" could complement standard HPIs to bolster clinical care.
OBJECTIVE: It is important for clinicians to inquire about "alarm features" as it may identify those at risk for organic disease and who require additional diagnostic workup. We developed a computer algorithm called Automated Evaluation of Gastrointestinal Symptoms (AEGIS) that systematically collects patientgastrointestinal (GI) symptoms and alarm features, and then "translates" the information into a history of present illness (HPI). Our study's objective was to compare the number of alarms documented by physicians during usual care vs. that collected by AEGIS. METHODS: We performed a cross-sectional study with a paired sample design among patients visiting adult GI clinics. Participants first received usual care by their physicians and then completed AEGIS. Each individual thus contributed both a physician-documented and computer-generated HPI. Blinded physician reviewers enumerated the positive alarm features (hematochezia, melena, hematemesis, unintentional weight loss, decreased appetite, and fevers) mentioned in each HPI. We compared the number of documented alarms within patient using the Wilcoxon signed-rank test. RESULTS: Seventy-five patients had both physician and AEGIS HPIs. AEGIS identified more patients with positive alarm features compared to physicians (53% vs. 27%; p<.001). AEGIS also documented more positive alarms (median 1, interquartile range [IQR] 0-2) vs. physicians (median 0, IQR 0-1; p<.001). Moreover, clinicians documented only 30% of the positive alarms self-reported by patients through AEGIS. CONCLUSIONS: Physicians documented less than one-third of red flags reported by patients through a computer algorithm. These data indicate that physicians may under report alarm features and that computerized "checklists" could complement standard HPIs to bolster clinical care.
Authors: Catherine M DesRoches; Dustin Charles; Michael F Furukawa; Maulik S Joshi; Peter Kralovec; Farzad Mostashari; Chantal Worzala; Ashish K Jha Journal: Health Aff (Millwood) Date: 2013-07-09 Impact factor: 6.301
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Authors: Brennan M R Spiegel; Ron D Hays; Roger Bolus; Gil Y Melmed; Lin Chang; Cynthia Whitman; Puja P Khanna; Sylvia H Paz; Tonya Hays; Steve Reise; Dinesh Khanna Journal: Am J Gastroenterol Date: 2014-09-09 Impact factor: 10.864
Authors: Christopher V Almario; William D Chey; Dinesh Khanna; Sasan Mosadeghi; Shahzad Ahmed; Elham Afghani; Cynthia Whitman; Garth Fuller; Mark Reid; Roger Bolus; Buddy Dennis; Rey Encarnacion; Bibiana Martinez; Jennifer Soares; Rushaba Modi; Nikhil Agarwal; Aaron Lee; Scott Kubomoto; Gobind Sharma; Sally Bolus; Brennan M R Spiegel Journal: Am J Gastroenterol Date: 2016-08-02 Impact factor: 10.864
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Authors: Klara Albrink; Carla Joos; Dominik Schröder; Frank Müller; Eva Hummers; Eva Maria Noack Journal: BMC Med Inform Decis Mak Date: 2022-07-19 Impact factor: 3.298
Authors: Brennan M R Spiegel; Christopher V Almario; Natalie J Hall; Sameer K Berry; Jack Aguilar; Elizabeth Brier; Parth Shah; Derek Cheng; Jeremy Herman; Theodore Stein Journal: JMIR Form Res Date: 2021-05-04