Featured Publications
Predicting 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 demandMachineValidatingPatientsInterrupted Time Series of User‐centered Clinical Decision Support Implementation for Emergency Department–initiated Buprenorphine for Opioid Use Disorder
Holland WC, Nath B, Li F, Maciejewski K, Paek H, Dziura J, Rajeevan H, Lu CC, Katsovich L, D'Onofrio G, Melnick ER. Interrupted Time Series of User‐centered Clinical Decision Support Implementation for Emergency Department–initiated Buprenorphine for Opioid Use Disorder. Academic Emergency Medicine 2020, 27: 753-763. PMID: 32352206, PMCID: PMC7496559, DOI: 10.1111/acem.14002.Peer-Reviewed Original ResearchConceptsOpioid use disorderComputerized clinical decision support systemsRates of EDBUP initiationUse disordersClinical decision support implementationEmergency department initiationRoutine emergency careInterrupted time series studyAdult ED patientsInterrupted time seriesClinical decision support systemElectronic health recordsClinicians' unfamiliarityED initiationDecision support implementationED dischargeOpioid withdrawalSecondary outcomesOngoing trialsPrimary outcomeAcademic EDED patientsSingle EDUnique patientsUser centered clinical decision support to implement initiation of buprenorphine for opioid use disorder in the emergency department: EMBED pragmatic cluster randomized controlled trial
Melnick ER, Nath B, Dziura JD, Casey MF, Jeffery MM, Paek H, Soares WE, Hoppe JA, Rajeevan H, Li F, Skains RM, Walter LA, Patel MD, Chari SV, Platts-Mills TF, Hess EP, D'Onofrio G. User centered clinical decision support to implement initiation of buprenorphine for opioid use disorder in the emergency department: EMBED pragmatic cluster randomized controlled trial. The BMJ 2022, 377: e069271. PMID: 35760423, PMCID: PMC9231533, DOI: 10.1136/bmj-2021-069271.Peer-Reviewed Original ResearchConceptsOpioid use disorderUsual care armEmergency departmentUse disordersCare armPragmatic clusterClinical decision supportIntervention armRoutine emergency careSecondary implementation outcomesSeverity of withdrawalTertiary care centerClinical decision support toolInitiation of buprenorphineElectronic health record tasksElectronic health record workflowsRE-AIM frameworkElectronic health record platformsHealth record platformsClinical decision support systemElectronic health recordsVisit documentationTreatment of addictionUsual careAdult patientsTrends and Disparities in Access to Buprenorphine Treatment Following an Opioid-Related Emergency Department Visit Among an Insured Cohort, 2014-2020
Stevens MA, Tsai J, Savitz ST, Nath B, Melnick ER, D’Onofrio G, Jeffery MM. Trends and Disparities in Access to Buprenorphine Treatment Following an Opioid-Related Emergency Department Visit Among an Insured Cohort, 2014-2020. JAMA Network Open 2022, 5: e2215287. PMID: 35657629, PMCID: PMC9166266, DOI: 10.1001/jamanetworkopen.2022.15287.Peer-Reviewed Original ResearchPragmatic clinical trial design in emergency medicine: Study considerations and design types
Gettel CJ, Yiadom MYAB, Bernstein SL, Grudzen CR, Nath B, Li F, Hwang U, Hess EP, Melnick ER. Pragmatic clinical trial design in emergency medicine: Study considerations and design types. Academic Emergency Medicine 2022, 29: 1247-1257. PMID: 35475533, PMCID: PMC9790188, DOI: 10.1111/acem.14513.Peer-Reviewed Original ResearchConceptsPragmatic clinical trialsClinical trial designTrial designReal-world clinical practicePragmatic clinical trial designElectronic health recordsEmergency departmentClinical trialsStudy design typeClinical practiceStudy typeTrial componentsHealth recordsEmergency medicineEmergency medicine investigatorsHuman subjects concernsInvestigatorsStudy findingsStudy considerationsTrialistsTrialsAnalysis of Electronic Health Record Use and Clinical Productivity and Their Association With Physician Turnover
Melnick ER, Fong A, Nath B, Williams B, Ratwani RM, Goldstein R, O’Connell R, Sinsky CA, Marchalik D, Mete M. Analysis of Electronic Health Record Use and Clinical Productivity and Their Association With Physician Turnover. JAMA Network Open 2021, 4: e2128790. PMID: 34636911, PMCID: PMC8511970, DOI: 10.1001/jamanetworkopen.2021.28790.Peer-Reviewed Original ResearchConceptsElectronic health recordsPhysician turnoverRetrospective cohort studyElectronic health record usePractice networkPhysician productivityWarrants further investigationCohort studyEHR timeAge 45Care teamPhysician departurePhysician ordersMAIN OUTCOMEHigh riskPatient timeAmbulatory physiciansPatient volumeUnique physiciansRecord useEHR useHealth care organizationsPhysiciansHealth recordsClinical timeTrends in Electronic Health Record Inbox Messaging During the COVID-19 Pandemic in an Ambulatory Practice Network in New England
Nath B, Williams B, Jeffery MM, O’Connell R, Goldstein R, Sinsky CA, Melnick ER. Trends in Electronic Health Record Inbox Messaging During the COVID-19 Pandemic in an Ambulatory Practice Network in New England. JAMA Network Open 2021, 4: e2131490. PMID: 34636917, PMCID: PMC8511977, DOI: 10.1001/jamanetworkopen.2021.31490.Peer-Reviewed Original ResearchCharacterizing physician EHR use with vendor derived data: a feasibility study and cross-sectional analysis
Melnick ER, Ong SY, Fong A, Socrates V, Ratwani RM, Nath B, Simonov M, Salgia A, Williams B, Marchalik D, Goldstein R, Sinsky CA. Characterizing physician EHR use with vendor derived data: a feasibility study and cross-sectional analysis. Journal Of The American Medical Informatics Association 2021, 28: 1383-1392. PMID: 33822970, PMCID: PMC8279798, DOI: 10.1093/jamia/ocab011.Peer-Reviewed Original ResearchConceptsElectronic health recordsEHR timeCross-sectional analysisAmbulatory physiciansPatient timeHealth systemClinical hoursHours of patientsMedStar Health systemYale-New HavenObstetrics/gynecologyNeurology/psychiatryMultivariable analysisPhysician genderCertain medical specialtiesPhysical medicineFemale physiciansEHR usePhysiciansHealth recordsHealthcare systemMedical specialtiesHoursSpecialtiesGenderThe association between perceived electronic health record usability and professional burnout among US nurses
Melnick ER, West CP, Nath B, Cipriano PF, Peterson C, Satele DV, Shanafelt T, Dyrbye LN. The association between perceived electronic health record usability and professional burnout among US nurses. Journal Of The American Medical Informatics Association 2021, 28: 1632-1641. PMID: 33871018, PMCID: PMC8324227, DOI: 10.1093/jamia/ocab059.Peer-Reviewed Original ResearchConceptsElectronic health record usabilityUS nursesDose-response relationshipEHR usabilityCross-sectional surveyMultivariable analysisOdds of burnoutLower oddsNursing experiencePractice settingsCurrent EHRsNursesMaslach Burnout InventoryMean hoursProfessional burnoutScoresSUS scoreRandom sampleTechnology usabilityBurnout InventoryOddsStandardized metricsRelationship statusAssociationSystem Usability ScaleEmergency Department Visits for Nonfatal Opioid Overdose During the COVID-19 Pandemic Across Six US Health Care Systems
Soares WE, Melnick ER, Nath B, D'Onofrio G, Paek H, Skains RM, Walter LA, Casey MF, Napoli A, Hoppe JA, Jeffery MM. Emergency Department Visits for Nonfatal Opioid Overdose During the COVID-19 Pandemic Across Six US Health Care Systems. Annals Of Emergency Medicine 2021, 79: 158-167. PMID: 34119326, PMCID: PMC8449788, DOI: 10.1016/j.annemergmed.2021.03.013.Peer-Reviewed Original ResearchConceptsHealth care systemCause ED visitsNonfatal opioid overdoseED visitsOpioid use disorderCare systemOpioid overdoseUse disordersCOVID-19 pandemicOpioid-related complicationsEmergency department visitsHospital-based interventionsED visit ratesEmergency department utilizationVisit countsUS health care systemOpioid overdose ratesDepartment visitsHistorical controlsAdult visitsOpioid overdosesOverdose ratesMedical emergencyVisit ratesMore weeksTrends in Emergency Department Visits and Hospital Admissions in Health Care Systems in 5 States in the First Months of the COVID-19 Pandemic in the US
Jeffery MM, D’Onofrio G, Paek H, Platts-Mills TF, Soares WE, Hoppe JA, Genes N, Nath B, Melnick ER. Trends in Emergency Department Visits and Hospital Admissions in Health Care Systems in 5 States in the First Months of the COVID-19 Pandemic in the US. JAMA Internal Medicine 2020, 180: 1328-1333. PMID: 32744612, PMCID: PMC7400214, DOI: 10.1001/jamainternmed.2020.3288.Peer-Reviewed Original ResearchConceptsHospital admission ratesEmergency department visitsED visitsHealth care systemAdmission ratesDepartment visitsHospital admissionCare systemCOVID-19 pandemicLarge health care systemAcute care deliveryCross-sectional studyAnnual ED volumeCoronavirus disease 2019Daily ED visitsInflux of patientsPublic health officialsCOVID-19 case ratesCOVID-19 casesNational public healthDisease 2019MAIN OUTCOMEED volumeSerious symptomsContagious infectionRacial 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 analysisAdoption 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 ResearchIdentifying 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 Research
2024
Formative 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 physicians