Paper on Severity of Illness
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Saturday, May 26, 2018.
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The objective of this assignment is to show you how data from electronic
health records can be analyzed using standard query language. You are
asked to analyze claims data and report the accuracy of a proposed severity
index compared to established indices in the field. By end of semester you
are expected to submit the paper for publication.
The instructor will provide you with claims data from
a national sample of hospitals. You are asked to analyze
these data and report the accuracy of several methods of measuring
severity of illness. You would need to use Standard Query
Language to accomplish this task. Before the analysis is done,
you need to prepare a paper reporting
your plans and methods. Once the analysis is done you will
write the results and discussion section of your paper. You are asked to submit your paper
for peer feedback by midterm and for
publication by end of semester.
The idea of students contributing to the literature is nothing
new. For sometime, it has been clear that when students are
asked to teach others they learn a great deal more than when they
study the material for themselves. This is why medical
residents are asked to "lean one, do one, and teach one."
Managers too can learn more from doing and teaching others.
The objective of asking you to write a paper is to help you learn in
more detail the use of standard query language.
- Select a topic: All students are encouraged to write
on the accuracy of co-morbidity indices but they can choose
different diseases. Some can focus on myocardial
infarctions and cardiac events. Others might want to focus
on diabetes. Still others may want to focus on different
diseases. Once you choose a disease you need to select
from the data only cases in which the disease was present.
In claims data this is done through selecting cases in which
particular diagnoses codes are present. You need to search
the web or PubMed to identify which codes you should select to
obtain a comprehensive list of patients.
PubMed►
MI patients►
Cancer patients►
- Select the procedures you wish to test. Use PubMed and
Google Scholar to find relevant articles on measurement of
co-morbidities, severity measures and prognostic indicators in
the disease you are interested in. Select at least 2
approaches that use claims data to predict prognosis of the
patients.
One suggestion
could be to go with Charleston Co-morbidity index and our
proposed approach to measurement of severity.
- Get the data from your instructor. The data we
use is available from Agency for Healthcare Quality and
Research. In order to make sure that you have access to
the data, we have requested the data and it is available through
your instructor.
- Select a journal where you like to submit the paper:
Select the journal where the paper will be submitted and follow
the format of the journal. Some example journals are provided
here:
- Health Services Research Journal
More►
- Quality Management in Healthcare
More►
- Health Care Financing review
More►
- Journal of American Medical Informatics Association
More►
- Check published literature: Look at PubMed and also
check Google Scholar to find out scientific progress in the
field.
Do not make claims that are not supported by data. Do not
digress from your topic area. Do not reference web sites. The literature review
should be comprehensive, i.e. refer to all relevant papers, but write less than 3-paragraphs long.
- Draft paper: The draft of the paper must be finished
by one week before the mid-term. Write the introduction and
section on methods and data sources ahead of completing the
analysis of the data. Analyze data available through the
instructor. Make sure that your method section refers to
both how you selected patients with different diagnoses and how
you measured their severity. Write well. Make sure your points are clear
and are demonstrated with appropriate charts and figures.
Describe the source of the data and the results of your
analysis. Give a case example that supports your main finding.
Explain all terms when they are first mentioned and list them
also at end of the paper. Make sure that the draft paper has
the following sections (See the journal you are submitting to
for more detailed instructions):
- Title page: Choose a title that appropriately
describes the paper. Include author's names but no contact
information or other personal information.
- Abstract: The summary should be able to stand
for itself and the reader should understand the scope of the
paper from it. It should refer to each of the major
sections of the paper. A well organized paper will allow
you to take a sentence from each section in the paper to
organize the summary.
- Introduction: Discuss why this topic is
important. Provide a short review of the literature.
- Methods: Provide a step by step guide on how you
analyzed the data, where the data comes from and other
details of the study. Describe what statistic you used
to compare the accuracy of various indices. The test of validity
should be conducted
on cases not used in estimating parameters of the revised
index. Different methods can be used in comparing two
indices:
- Results: Provide the
findings in standalone tables and figures.
- Discussion: Discuss the
limitation of the work and the importance of the findings.
Do not claim more than the data show.
- References and links: Give references to
literature cited following the format of the journal you are
submitting to.
- Reviewers comments: Show peer review comments
and extent of revisions done based on reviewer comments
- Get feedback: The instructor will assign your work
to two other students to review; likewise you need to review the
work of two other students. Use the following rubric to
organize your response (make comments for each of the sections
indicated. Do not leave any of the sections blank) as well as
expect your peer reviewer to follow the same rubric:
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- Dates
- Report of the paper was later than expected and
whether your review was done in 24 hours.
- Begin with what worked well. Point to specific sections
of the paper and use adjectives liberally to praise the
author. This is the only place you are allowed to use
adjectives, in all other sections avoid use of any
adjectives.
- Presentation:
- Discuss whether each major point has been made with
an appropriate visual aid.
- Discuss the use of font size to mark paper sections
and the hierarchy of ideas
- Discuss if color has been used appropriately to
highlight significant points
- Discuss writing style and errors. Discuss if the
methods and sources of data were accurately and
succinctly depicted.
- Discuss the organization of the paper.
- Discuss if references are linked to PubMed and other
literature.
- Content:
- Make sure that relevant literature is reviewed.
Check that a search on PubMed does not identify articles
that should have been reviewed but have not been
reviewed. Indicate what you searched for, list the top
10 relevant articles and discuss how many were included
in the paper.
- Discuss if the authors have followed the recommended
outline and whether their departures from the outline
makes sense.
- Check that the title is appropriate for the paper.
Make sure that the paper does not digress into unrelated
materials.
- List what questions you had that were not answered
by the paper. Discuss if the paper's limitations were
addressed
- What did you learn:
- Discuss what you learned from the paper that you
would try to do better in your own draft paper. Note
that your comments in this section should refer to how
you would change your own paper. The focus of
improvement is on you and not the author of the paper
you have reviewed. Give a timetable by which you would
complete the changes.
- Grade
- Rank order the two papers you have reviewed,
indicating which in your opinion was best.
- Compare your work to the works you have reviewed and
indicate which was best.
Revise the manuscript: Using the feedback you have
received and what you have learned from your review of work of
others, revise the manuscript. A significant revision must be
done, even if you have no critical comments and even if the
original draft was the best paper in the world. Make sure that
you include a section at the end of the paper referring to what
was revised.
Present your work: Present your
findings to the entire class.
Post to the web or publish: The instructor may ask
you to combine your work with others in class and submit your
work for publication.
Timetable
The first draft of the paper is due one week
before the mid-term. Your peer review of other student's work
should be completed within 24 hours of receiving the paper.
Your final draft is due at midterm. The final version of the
paper is due after Spring break. You must report where you
have submitted the paper by end of semester.
- Students who wish to prepare a video instead of the paper
can do so. All videos should also be submitted to peer review
before final submission to the instructor and posting to the
web.
- If you have a different project that fits your career
better, please let the instructor know. The project must
involve data from electronic health records and use of Standard
Query Language to analyze the data.
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