2024
Trends in the Prescribing of Buprenorphine for Opioid Use Disorder, 2019-2023
Savitz S, Stevens M, Nath B, D’Onofrio G, Melnick E, Jeffery M. Trends in the Prescribing of Buprenorphine for Opioid Use Disorder, 2019-2023. Mayo Clinic Proceedings Innovations Quality & Outcomes 2024, 8: 308-320. PMID: 38841599, PMCID: PMC11152959, DOI: 10.1016/j.mayocpiqo.2024.04.004.Peer-Reviewed Original ResearchOpioid use disorderTreat alcohol use disorderAlcohol use disorderUse disorderX-waiverMedicare Advantage enrolleesTreat opioid use disorderRate ratiosEvaluate trendsPrescribing of buprenorphineOptumLabs Data WarehouseDaily doseCommercial enrolleesCoronavirus diseasePrescription fillsBuprenorphineDays supplyBuprenorphine prescribingFilling patternBuprenorphine accessImprove buprenorphine accessStudy periodResponse to coronavirus diseasePrescriber typePrescribingVirtual Scribes and Physician Time Spent on Electronic Health Records
Rotenstein L, Melnick E, Iannaccone C, Zhang J, Mugal A, Lipsitz S, Healey M, Holland C, Snyder R, Sinsky C, Ting D, Bates D. Virtual Scribes and Physician Time Spent on Electronic Health Records. JAMA Network Open 2024, 7: e2413140. PMID: 38787556, PMCID: PMC11127114, DOI: 10.1001/jamanetworkopen.2024.13140.Peer-Reviewed Original ResearchConceptsEHR timeElectronic health recordsHealth recordsPhysician timePre-post quality improvement studyPrimary care specialtiesQuality improvement studyFactors associated with changesAssociated with significant decreasesAssociated with burnoutMultivariate linear regression modelAcademic medical centerCare specialtiesImprovement studyLinear regression modelsMedical specialistsMedical specialtiesOutpatient settingStudy sampleSignificant decreasePhysiciansMedical CenterParticipation episodesAppointmentWomen's HospitalReply to "Considering Health Systems Worldwide: Point of View From a Middle-Income Country".
Tu L, Melnick E, Venkatesh A, Sheth K, Navaratnam D, Yaesoubi R, Forman H, Mahajan A. Reply to "Considering Health Systems Worldwide: Point of View From a Middle-Income Country". American Journal Of Roentgenology 2024, 222: e2430900. PMID: 38294162, DOI: 10.2214/ajr.24.30900.Peer-Reviewed Original ResearchFormative evaluation of an emergency department clinical decision support system for agitation symptoms: a study protocol
Wong A, Nath B, Shah D, Kumar A, Brinker M, Faustino I, Boyce M, Dziura J, Heckmann R, Yonkers K, Bernstein S, Adapa K, Taylor R, Ovchinnikova P, McCall T, Melnick E. Formative evaluation of an emergency department clinical decision support system for agitation symptoms: a study protocol. BMJ Open 2024, 14: e082834. PMID: 38373857, PMCID: PMC10882402, DOI: 10.1136/bmjopen-2023-082834.Peer-Reviewed Original ResearchConceptsComputerised clinical decision supportED treatRestraint useExperiences of restraint useMental health-related visitsEmergency departmentPrevent agitationSystems-related factorsImprove patient experienceClinical decision support systemsRegional health systemClinical decision supportDe-escalation techniquesRandomised controlled trialsFormative evaluationPeer-reviewed journalsBest-practice guidanceAt-risk populationsCDS toolsThematic saturationED cliniciansPatient experienceED sitesHealth systemED physiciansStructure and Funding of Clinical Informatics Fellowships: A National Survey of Program Directors
Patel T, Chaise A, Hanna J, Patel K, Kochendorfer K, Medford R, Mize D, Melnick E, Hron J, Youens K, Pandita D, Leu M, Ator G, Yu F, Genes N, Baker C, Bell D, Pevnick J, Conrad S, Chandawarkar A, Rogers K, Kaelber D, Singh I, Levy B, Finnell J, Kannry J, Pageler N, Mohan V, Lehmann C. Structure and Funding of Clinical Informatics Fellowships: A National Survey of Program Directors. Applied Clinical Informatics 2024, 15: 155-163. PMID: 38171383, PMCID: PMC10881258, DOI: 10.1055/a-2237-8309.Peer-Reviewed Original ResearchConceptsProgram directorsAmerican BoardCommunity health care systemAccreditation Council for Graduate Medical EducationAmerican Board of Medical SpecialtiesAdministrative supportFunding sourcesOnline REDCap surveyHealth care systemFunding modelsGraduate Medical EducationAmerican Board of Preventive MedicineHospital information technologyMedical education officeGraduate medical education officeSurvey of program directorsFellowship training programsFamily medicineFellowship program directorsEmergency medicineHealth systemSurveyed program directorsCare systemNational survey of program directorsInformatics practice
2023
Cost-Effectiveness of CT, CTA, MRI, and Specialized MRI for Evaluation of Patients Presenting to the Emergency Department With Dizziness.
Tu L, Melnick E, Venkatesh A, Sheth K, Navaratnam D, Yaesoubi R, Forman H, Mahajan A. Cost-Effectiveness of CT, CTA, MRI, and Specialized MRI for Evaluation of Patients Presenting to the Emergency Department With Dizziness. American Journal Of Roentgenology 2023, 222: e2330060. PMID: 37937837, DOI: 10.2214/ajr.23.30060.Peer-Reviewed Original ResearchQuality-adjusted life yearsEvaluation of patientsSecondary prevention measuresEmergency departmentProbabilistic sensitivity analysesConventional MRICumulative quality-adjusted life yearsCost-effective strategyIncremental costNoncontrast CT headAcute stroke treatmentSpecialized MRISelection of patientsHigher quality-adjusted life yearsConventional brain MRIMarkov decision-analytic modelNon-contrast CTNoncontrast head CTHealthcare system perspectiveUse of MRIBase-case analysisPrevention measuresDecision analytic modelGreater quality-adjusted life yearsDeterministic sensitivity analysesAdoption of Emergency Department–Initiated Buprenorphine for Patients With Opioid Use Disorder
Gao E, Melnick E, Paek H, Nath B, Taylor R, Loza A. Adoption of Emergency Department–Initiated Buprenorphine for Patients With Opioid Use Disorder. JAMA Network Open 2023, 6: e2342786. PMID: 37948075, PMCID: PMC10638655, DOI: 10.1001/jamanetworkopen.2023.42786.Peer-Reviewed Original ResearchConceptsHealth care systemED initiationOpioid use disorderBuprenorphine initiationCare systemUse disordersEmergency Department-Initiated BuprenorphineSecondary analysisClinician's roleEmergency department initiationClinical decision support interventionClinical decision support toolProportional hazard modelingCare of patientsNetwork of cliniciansDecision support interventionsAdvanced practice practitionersDose-dependent mannerUnique cliniciansTime-dependent covariatesTrial interventionNonintervention groupED clustersMore effective interventionsNumber of exposuresWhy Do Physicians Depart Their Practice? A Qualitative Study of Attrition in a Multispecialty Ambulatory Practice Network
O'Connell R, Hosain F, Colucci L, Nath B, Melnick E. Why Do Physicians Depart Their Practice? A Qualitative Study of Attrition in a Multispecialty Ambulatory Practice Network. The Journal Of The American Board Of Family Medicine 2023, 36: 1050-1057. PMID: 37857441, DOI: 10.3122/jabfm.2023.230052r2.Peer-Reviewed Original ResearchQuantifying EHR and Policy Factors Associated with the Gender Productivity Gap in Ambulatory, General Internal Medicine
Li H, Rotenstein L, Jeffery M, Paek H, Nath B, Williams B, McLean R, Goldstein R, Nuckols T, Hoq L, Melnick E. Quantifying EHR and Policy Factors Associated with the Gender Productivity Gap in Ambulatory, General Internal Medicine. Journal Of General Internal Medicine 2023, 39: 557-565. PMID: 37843702, PMCID: PMC10973284, DOI: 10.1007/s11606-023-08428-5.Peer-Reviewed Original ResearchElectronic health recordsWork relative value unitsPhysician genderPractice characteristicsWomen physiciansMen physiciansGeneral internal medicine physiciansEHR useInternal medicine physiciansPhysician productivityGeneral internal medicineMultivariable adjustmentPatient counselingCare discussionsPhysician ageClinical activityMedicine physiciansIdentifying and Addressing Barriers to Implementing Core Electronic Health Record Use Metrics for Ambulatory Care: Virtual Consensus Conference Proceedings
Levy D, Moy A, Apathy N, Adler-Milstein J, Rotenstein L, Nath B, Rosenbloom S, Kannampallil T, Mishuris R, Alexanian A, Sieja A, Hribar M, Patel J, Sinsky C, Melnick E. Identifying and Addressing Barriers to Implementing Core Electronic Health Record Use Metrics for Ambulatory Care: Virtual Consensus Conference Proceedings. Applied Clinical Informatics 2023, 14: 944-950. PMID: 37802122, PMCID: PMC10686750, DOI: 10.1055/a-2187-3243.Peer-Reviewed Original ResearchAssociation of Primary Care Physicians’ Electronic Inbox Activity Patterns with Patients’ Likelihood to Recommend the Physician
Rotenstein L, Melnick E, Jeffery M, Zhang J, Sinsky C, Gitomer R, Bates D. Association of Primary Care Physicians’ Electronic Inbox Activity Patterns with Patients’ Likelihood to Recommend the Physician. Journal Of General Internal Medicine 2023, 39: 150-152. PMID: 37731135, PMCID: PMC10817856, DOI: 10.1007/s11606-023-08417-8.Peer-Reviewed Original ResearchClinical Decision Support: Moving Beyond Interruptive “Pop-up” Alerts
Sangal R, Sharifi M, Rhodes D, Melnick E. Clinical Decision Support: Moving Beyond Interruptive “Pop-up” Alerts. Mayo Clinic Proceedings 2023, 98: 1275-1279. PMID: 37661138, PMCID: PMC10491420, DOI: 10.1016/j.mayocp.2023.05.025.Peer-Reviewed Original ResearchNational trends in emergency conditions through the Omicron COVID‐19 wave in commercial and Medicare Advantage enrollees
Stevens M, Melnick E, Savitz S, Jeffery M, Nath B, Janke A. National trends in emergency conditions through the Omicron COVID‐19 wave in commercial and Medicare Advantage enrollees. Journal Of The American College Of Emergency Physicians Open 2023, 4: e13023. PMID: 37576118, PMCID: PMC10423035, DOI: 10.1002/emp2.13023.Peer-Reviewed Original ResearchEmergency care-sensitive conditionsMedicare Advantage enrolleesED visitsVisit ratesPulmonary embolismPandemic waveWave 2Acute cardiovascular conditionsCause ED visitsMyocardial infarction rateED visit ratesEmergency department visitsPre-pandemic ratesCross-sectional analysisPre-pandemic periodInfarction rateCOVID-19 waveDepartment visitsSevere arrhythmiasFemale enrolleesMyocardial infarctionCardiovascular conditionsPercent changeSensitive conditionsEnrolleesCT With CTA Versus MRI in Patients Presenting to the Emergency Department With Dizziness: Analysis Using Propensity Score Matching.
Tu L, Navaratnam D, Melnick E, Forman H, Venkatesh A, Malhotra A, Yaesoubi R, Sureshanand S, Sheth K, Mahajan A. CT With CTA Versus MRI in Patients Presenting to the Emergency Department With Dizziness: Analysis Using Propensity Score Matching. American Journal Of Roentgenology 2023, 221: 836-845. PMID: 37404082, DOI: 10.2214/ajr.23.29617.Peer-Reviewed Original ResearchConceptsSecondary stroke prevention medicationsStroke prevention medicationsEmergency departmentPrevention medicationsEchocardiography evaluationPosterior circulation strokeProportion of patientsGroup of patientsPhysical examination findingsNeuroimaging resultsUse of MRIReview of systemsGreater frequencyPropensity-score matchingExamination findingsRetrospective studyED readmissionMedical historyHead CTClinical impactMRI examinationsBrain MRINeck CTADizzinessPatientsFentanyl-Associated Overdose Deaths Outside the Hospital
Jeffery M, Stevens M, D'Onofrio G, Melnick E. Fentanyl-Associated Overdose Deaths Outside the Hospital. New England Journal Of Medicine 2023, 389: 87-88. PMID: 37342960, PMCID: PMC10388669, DOI: 10.1056/nejmc2304991.Peer-Reviewed Original ResearchHumans as an Essential Source of Safety: A Frameshift for System Resilience
Farley H, Harry E, Sinsky C, Boehm E, Privitera M, Melnick E. Humans as an Essential Source of Safety: A Frameshift for System Resilience. Mayo Clinic Proceedings Innovations Quality & Outcomes 2023, 7: 241-243. PMID: 37304062, PMCID: PMC10250566, DOI: 10.1016/j.mayocpiqo.2023.05.001.Peer-Reviewed Original ResearchImplementation strategies to address the determinants of adoption, implementation, and maintenance of a clinical decision support tool for emergency department buprenorphine initiation: a qualitative study
Simpson M, Ritger C, Hoppe J, Holland W, Morris M, Nath B, Melnick E, Tietbohl C. Implementation strategies to address the determinants of adoption, implementation, and maintenance of a clinical decision support tool for emergency department buprenorphine initiation: a qualitative study. Implementation Science Communications 2023, 4: 41. PMID: 37081581, PMCID: PMC10117277, DOI: 10.1186/s43058-023-00421-7.Peer-Reviewed Original ResearchOpioid use disorderBuprenorphine initiationClinical decision support toolEmergency departmentED cliniciansSignificant public health problemCDS interventionsIntervention EDsUsual care armPragmatic clinical trialsPublic health problemEvidence-based treatmentsCare armED initiationBuprenorphine treatmentED settingIntervention armOngoing treatmentClinical trialsClinician experienceClinician trainingUse disordersBuprenorphineHealth problemsSecondary aimFunding Research on Health Workforce Well-being to Optimize the Work Environment
Melnick E, Sinsky C, Shanafelt T. Funding Research on Health Workforce Well-being to Optimize the Work Environment. JAMA 2023, 329: 1145-1146. PMID: 36821127, DOI: 10.1001/jama.2023.2073.Peer-Reviewed Original ResearchRacial and ethnic disparities in emergency department–initiated buprenorphine across five health care systems
Holland W, Li F, Nath B, Jeffery M, Stevens M, Melnick E, Dziura J, Khidir H, Skains R, D'Onofrio G, Soares W. Racial and ethnic disparities in emergency department–initiated buprenorphine across five health care systems. Academic Emergency Medicine 2023, 30: 709-720. PMID: 36660800, PMCID: PMC10467357, DOI: 10.1111/acem.14668.Peer-Reviewed Original ResearchConceptsOpioid use disorderCommunity emergency departmentsEmergency departmentDischarge diagnosisHealth care systemHispanic patientsBlack patientsHospital typeCare systemNon-Hispanic patientsOpioid overdose deathsClinical decision support systemOpioid withdrawalPrimary outcomeMedication treatmentBuprenorphine accessED treatmentTreatment accessOverdose deathsX-waiverBuprenorphinePatientsUse disordersEthnic disparitiesSecondary analysisPredicting physician departure with machine learning on EHR use patterns: A longitudinal cohort from a large multi-specialty ambulatory practice
Lopez K, Li H, Paek H, Williams B, Nath B, Melnick E, Loza A. Predicting physician departure with machine learning on EHR use patterns: A longitudinal cohort from a large multi-specialty ambulatory practice. PLOS ONE 2023, 18: e0280251. PMID: 36724149, PMCID: PMC9891518, DOI: 10.1371/journal.pone.0280251.Peer-Reviewed Original ResearchConceptsElectronic health recordsEHR use patternsHealthcare industryPhysician departureSHAP valuesHealth recordsPhysician characteristicsLongitudinal cohortPhysician ageRisk physiciansAmbulatory practiceTargeted interventionsAppropriate interventionsPhysiciansTop variablesDocumentation timePhysician turnoverPredictive modelHeavy burdenInterventionInboxPhysician demandMachineValidatingPatients