Stephanie Kennebeck | University of Cincinnati College of Medicine (original) (raw)

Papers by Stephanie Kennebeck

Clinical Pediatric Emergency Medicine, Sep 1, 2005

ABSTRACT

Yearbook of medical informatics, Jan 10, 2016

The objectives of this paper are to review and discuss the methods that are being used internatio... more The objectives of this paper are to review and discuss the methods that are being used internationally to report on, mitigate, and eliminate technology-induced errors. The IMIA Working Group for Health Informatics for Patient Safety worked together to review and synthesize some of the main methods and approaches associated with technology- induced error reporting, reduction, and mitigation. The work involved a review of the evidence-based literature as well as guideline publications specific to health informatics. The paper presents a rich overview of current approaches, issues, and methods associated with: (1) safe HIT design, (2) safe HIT implementation, (3) reporting on technology-induced errors, (4) technology-induced error analysis, and (5) health information technology (HIT) risk management. The work is based on research from around the world. Internationally, researchers have been developing methods that can be used to identify, report on, mitigate, and eliminate technology-i...

Pediatric Research 53(4 Part, Dec 31, 2003

Objectives (1) To develop an automated eligibility screening (ES) approach for clinical trials in... more Objectives (1) To develop an automated eligibility screening (ES) approach for clinical trials in an urban tertiary care pediatric emergency department (ED); (2) to assess the effectiveness of natural language processing (NLP), information extraction (IE), and machine learning (ML) techniques on real-world clinical data and trials. Data and methods We collected eligibility criteria for 13 randomly selected, disease-specific clinical trials actively enrolling patients between January 1, 2010 and August 31, 2012. In parallel, we retrospectively selected data fields including demographics, laboratory data, and clinical notes from the electronic health record (EHR) to represent profiles of all 202 795 patients visiting the ED during the same period. Leveraging NLP, IE, and ML technologies, the automated ES algorithms identified patients whose profiles matched the trial criteria to reduce the pool of candidates for staff screening. The performance was validated on both a physiciangenerated gold standard of trial-patient matches and a reference standard of historical trial-patient enrollment decisions, where workload, mean average precision (MAP), and recall were assessed. Results Compared with the case without automation, the workload with automated ES was reduced by 92% on the gold standard set, with a MAP of 62.9%. The automated ES achieved a 450% increase in trial screening efficiency. The findings on the gold standard set were confirmed by large-scale evaluation on the reference set of trial-patient matches. Discussion and conclusion By exploiting the text of trial criteria and the content of EHRs, we demonstrated that NLP-, IE-, and ML-based automated ES could successfully identify patients for clinical trials.

Background: One critical hurdle for clinical trial recruitment is the lack of an efficient method... more Background: One critical hurdle for clinical trial recruitment is the lack of an efficient method for identifying subjects who meet the eligibility criteria. Given the large volume of data documented in electronic health records (EHRs), it is labor-intensive for the staff to screen relevant information, particularly within the time frame needed. To facilitate subject identification, we developed a natural language processing (NLP) and machine learning–based system, Automated Clinical Trial Eligibility Screener (ACTES), which analyzes structured data and unstructured narratives automatically to determine patients’ suitability for clinical trial enrollment. In this study, we integrated the ACTES into clinical practice to support real-time patient screening. Objective: This study aimed to evaluate ACTES’s impact on the institutional workflow, prospectively and comprehensively. We hypothesized that compared with the manual screening process, using EHR-based automated screening would imp...

Academic Pediatrics

OBJECTIVE To modify and test an existing measure of trust validated in a primary care setting for... more OBJECTIVE To modify and test an existing measure of trust validated in a primary care setting for use in a pediatric emergency department (PED). METHODS The study population was parents/guardians who brought their child to an urban PED with a chief complaint of abdominal pain or head injury. We used a 2-phase design with modifications resulting from cognitive interviews with 15 participants followed by a field test with 150 participants. We measured usefulness by percent missing responses and ceiling effects. Cronbach's Alpha and Greatest Lower Bound measured reliability. As evidence of validity, we calculated a total trust score by summing the item scale values and correlating the score with measures of constructs shown to be positively associated with trust in other settings. We conducted a similar analysis to test a published shortened version of the same scale. RESULTS Four items were modified prior to field testing. Ceiling effects for each item ranged from 53 to 67%. Missing data was minimal affecting only 2 items. The modified measure exhibited high reliability (Cronbach's Alpha = 0.88, Greatest Lower Bound = 0.93). Total trust scores ranged from 27 to 50 with mean (SD) = 45.1 (4.9). The trust score exhibited a high positive correlation with communication and overall satisfaction, and moderate correlation with intent to adhere to physician recommendations. The short version of the scale performed similarly. CONCLUSIONS This study provides evidence that the modified Wake Forest measure of trust is applicable and useful in the PED setting for this patient population.

Advanced Emergency Nursing Journal

Even with extensive evidence documenting the incidence, risk factors, and negative outcomes of wo... more Even with extensive evidence documenting the incidence, risk factors, and negative outcomes of workplace violence (WPV) against emergency department (ED) employees, there is a lack of intervention strategies reported that could be subjected to a clinical trial in the ED setting. The purpose of this article is to report the outcomes of a novel process adapted from the Framework for Program Evaluation in Public Health for soliciting intervention strategies from a WPV Community Advisory Board (CAB) organized by the U.S. Occupational Safety and Health Administration's WPV prevention guidelines. Ten professionals comprising both practitioners and researchers from a variety of disciplines ultimately constituted the WPV CAB. In total, 127 strategies to address WPV in ED settings organized by the Occupational Safety and Health Administration's WPV guideline elements were recommended. The use of a CAB and the Framework was shown to be effective for generating WPV intervention strategies.

BACKGROUND One critical hurdle for clinical trial recruitment is the lack of an efficient method ... more BACKGROUND One critical hurdle for clinical trial recruitment is the lack of an efficient method for identifying subjects who meet eligibility criteria. Given the large volume of data documented in electronic health records (EHRs), it is labor-intensive for the staff to screen relevant information, particularly within the time frame needed. To facilitate subject identification, we developed a natural language processing (NLP) and machine learning-based system, Automated Clinical Trial Eligibility Screener© (ACTES), which analyzed structured data and unstructured narratives automatically to determine patients' suitability for clinical trial enrollment. In this study, we integrated the ACTES into clinical practice to support real-time patient screening. OBJECTIVE Our objective was to evaluate the ACTES's impact on the institutional workflow prospectively and comprehensively. We hypothesized that compared with the manual screening process, using EHR-based automated screening wo...

The American Journal of Emergency Medicine

Objectives Care decisions for young children presenting to the emergency department (ED) with hea... more Objectives Care decisions for young children presenting to the emergency department (ED) with head injury are often challenging (e.g. whether to obtain neuroimaging). We sought to identify factors associated with acute management of children at‐risk for clinically important traumatic brain injury (ciTBI) and describe symptom management. Methods Observational evaluation of children, ages 0–4 years, presenting to a pediatric ED following minor head injury. Children with ≥1 risk element per the Pediatric Emergency Care Academic Research Network's decision rule were deemed “at‐risk” for ciTBI. Clinician surveys regarding their initial clinical management were used to identify three care groups. Nonparametric tests analyzed group differences and logistic regression investigated associations of putative high‐risk factors with neuroimaging. Results Of 104 children enrolled: (i) 30 underwent neuroimaging, (ii) 59 were observed, and (iii) 15 were discharged following the clinician's initial patient exam. Children with a non‐frontal scalp hematoma were more likely to receive immediate neuroimaging and children not acting like themselves per caregiver report were more likely to be initially observed, relative to the other care groups (p ≤ 0.01). Among high‐risk factors, altered mental status (OR 5.12, 95% CI 1.8–21.1), presence of ≥3 risk elements of the decision rule (OR 3.5, 95% CI 1.2–10.6), unclear skull fracture on exam (OR 31.3, 95% CI 5.4–593.8), and age < 3 months (OR 5.3, 95% CI 1.5–21.9) were associated with neuroimaging. No child had ciTBI. TBI symptoms (e.g. vomiting) were infrequently treated. Conclusions ED management varied for young children with similar risk stratification. Investigation of how age in concert with specific risk factors influences medical decision making would advance evidenced‐based care.

Patient Experience Journal

To develop and validate a measure of the quality of the pediatric emergency department care exper... more To develop and validate a measure of the quality of the pediatric emergency department care experience from the parent perspective. This was a multiphase study conducted at a tertiary-care pediatric health system using qualitative and quantitative methods. A list of candidate questions was developed to measure each of eight dimensions of familycentered pediatric emergency care described in a published framework. This list was evaluated and refined using the Question Appraisal System (QAS-99) followed by cognitive interviewing methods. Remaining questions were field tested using survey methods via telephone interviews with randomly selected parents. Composite scores to measure each of the eight dimensions of family-centered pediatric emergency care were calculated. Reliability was evaluated using measures of internal consistency. Construct validity was evaluated by measuring the association of each question and composite scores with overall satisfaction. A pool of 77 questions was reduced to 51 using QAS-99 criteria. Cognitive interviews with 19 parents resulted in a final list of 24 questions for field testing. With a response rate of 46%, 404 parents participated in the field test. Each individual question exhibited a significant positive association with overall satisfaction. Measures of internal consistency did not support the composite scores based on the initial eight dimensions. An exploratory factor analysis resulted in alternative composite measures that exhibited acceptable reliability and construct validity. This study has resulted in a measure that can be used to inform quality improvement work aimed at improving the pediatric emergency department care experience.

Pediatric Emergency Care

Objective Challenges with efficient patient recruitment including sociotechnical barriers for cli... more Objective Challenges with efficient patient recruitment including sociotechnical barriers for clinical trials are major barriers to the timely and efficacious conduct of translational studies. We conducted a time-and-motion study to investigate the workflow of clinical trial enrollment in a pediatric emergency department. Methods We observed clinical research coordinators during 3 clinically staffed shifts. One clinical research coordinator was shadowed at a time. Tasks were marked in 30-second intervals and annotated to include patient screening, patient contact, performing procedures, and physician contact. Statistical analysis was conducted on the patient enrollment activities. Results We conducted fifteen 120-minute observations from December 12, 2013, to January 3, 2014 and shadowed 8 clinical research coordinators. Patient screening took 31.62% of their time, patient contact took 18.67%, performing procedures took 17.6%, physician contact was 1%, and other activities took 31.0%. Conclusions Screening patients for eligibility constituted the most time. Automated screening methods could help reduce this time. The findings suggest improvement areas in recruitment planning to increase the efficiency of clinical trial enrollment.

Applied clinical informatics, Jul 20, 2016

The objective of this study is to develop an algorithm to accurately identify children with sever... more The objective of this study is to develop an algorithm to accurately identify children with severe early onset childhood obesity (ages 1-5.99 years) using structured and unstructured data from the electronic health record (EHR). Childhood obesity increases risk factors for cardiovascular morbidity and vascular disease. Accurate definition of a high precision phenotype through a standardize tool is critical to the success of large-scale genomic studies and validating rare monogenic variants causing severe early onset obesity. Rule based and machine learning based algorithms were developed using structured and unstructured data from two EHR databases from Boston Children's Hospital (BCH) and Cincinnati Children's Hospital and Medical Center (CCHMC). Exclusion criteria including medications or comorbid diagnoses were defined. Machine learning algorithms were developed using cross-site training and testing in addition to experimenting with natural language processing features. P...

International Journal of Pediatrics, 2016

Background and Objectives.The prevalence of severe obesity in children has doubled in the past de... more Background and Objectives.The prevalence of severe obesity in children has doubled in the past decade. The objective of this study is to identify the clinical documentation of obesity in young children with a BMI ≥ 99th percentile at two large tertiary care pediatric hospitals.Methods.We used a standardized algorithm utilizing data from electronic health records to identify children with severe early onset obesity (BMI ≥ 99th percentile at age <6 years). We extracted descriptive terms and ICD-9 codes to evaluate documentation of obesity at Boston Children’s Hospital and Cincinnati Children’s Hospital and Medical Center between 2007 and 2014.Results.A total of 9887 visit records of 2588 children with severe early onset obesity were identified. Based on predefined criteria for documentation of obesity, 21.5% of children (13.5% of visits) had positive documentation, which varied by institution. Documentation in children first seen under 2 years of age was lower than in older childre...

Common variations at the loci harboring the fat mass and obesity gene (FTO), MC4R, and TMEM18 are... more Common variations at the loci harboring the fat mass and obesity gene (FTO), MC4R, and TMEM18 are consistently reported as being associated with obesity and body mass index (BMI) especially in adult population. In order to confirm this effect in pediatric population five European ancestry cohorts from pediatric eMERGE-II network (CCHMC-BCH) were evaluated. Method: Data on 5049 samples of European ancestry were obtained from the Electronic Medical Records (EMRs) of two large academic centers in five different genotyped cohorts. For all available samples, gender, age, height, and weight were collected and BMI was calculated. To account for age and sex differences in BMI, BMI z-scores were generated using 2000 Centers of Disease Control and Prevention (CDC) growth charts. A Genome-wide association study (GWAS) was performed with BMI z-score. After removing missing data and outliers based on principal components (PC) analyses, 2860 samples were used for the GWAS study. The association between each single nucleotide polymorphism (SNP) and BMI was tested using linear regression adjusting for age, gender, and PC by cohort. The effects of SNPs were modeled assuming additive, recessive, and dominant effects of the minor allele. Meta-analysis was conducted using a weighted z-score approach. Results: The mean age of subjects was 9.8 years (range 2-19). The proportion of male subjects was 56%. In these cohorts, 14% of samples had a BMI ≥95 and 28 ≥ 85%. Meta analyses produced a signal at 16q12 genomic region with the best result of p = 1.43 × 10 −7 [p 8 (rec) = 7.34 × 10 −) for the SNP rs8050136 at the first intron of FTO gene (z = 5.26) and with no heterogeneity between cohorts (p = 0.77). Under a recessive model, another published SNP at this locus, rs1421085, generates the best result [z 5.782, p (rec) 8.21 × 10 −9 = = ]. Imputation in this region using dense 1000-Genome and Hapmap CEU samples revealed 71 SNPs with p < 10 −6 , all at the first intron of FTO locus. When heterogeneity was permitted between cohorts, signals were also obtained in other previously identified loci, including MC4R (rs12964056, p = 6.87 × 10 −7 , z = −4.98), cholecystokinin CCK (rs8192472, p = 1.33 × 10 −6 , z = −4.85), Interleukin 15 (rs2099884, p = 1.27 × 10 −5 , z = 4.34), low density lipoprotein receptor-related protein 1B [LRP1B (rs7583748, p = 0.00013, z = −3.81)] and near transmembrane protein 18 (TMEM18) (rs7561317, p = 0.001, z = −3.17). We also detected a novel locus at chromosome 3 at COL6A5 [best SNP = rs1542829, minor allele frequency (MAF) of 5% p = 4.35 × 10 −9 , z = 5.89]. Conclusion: An EMR linked cohort study demonstrates that the BMI-Z measurements can be successfully extracted and linked to genomic data with meaningful confirmatory results. We verified the high prevalence of childhood rate of overweight and obesity in our cohort (28%). In addition, our data indicate that genetic variants in the first intron of FTO, a known adult genetic risk factor for BMI, are also robustly associated with BMI in pediatric population.

Journal of the American Medical Informatics Association : JAMIA, 2015

Annals of Emergency Medicine, 2013

Chest, 2005

Tumors of the mediastinum are rare in pediatrics but may present in dramatic fashion. Respiratory... more Tumors of the mediastinum are rare in pediatrics but may present in dramatic fashion. Respiratory symptoms such as cough, stridor, and wheezing are present in more than 60% of patients on presentation. A small but significant subset of patients will present with respiratory failure, superior vena cava syndrome, or other immediately life-threatening complaints. Greater than 50% of these masses are malignant, but even nonmalignant tumors can obstruct vital structures and present in a critical fashion. This review seeks to explain the most common mediastinal tumors in childhood and presents a reasonable algorithm for initial workup and treatment by the primary care or emergency department physician. To optimize outcome, these children are best served by a tertiary hospital where the availability of pediatric medical and surgical subspecialists and potential life-saving interventions are possible.