Clinical Looking Glass Introductory Session In-Class Exercise Two: Congestive Heart Failure

Transcription

1 Clinical Looking Glass Introductory Session In-Class Exercise Two: Congestive Heart Failure Document Conventions Keyboard keys are identified by italics (Enter, Return) Most on-screen buttons are presented as images ( ). Some on-screen buttons are identified by bold (Save). Login On-screen menus are identified by bold (Analysis, Select Saved Set) On-screen menu items are identified by italics (Edit, Modify Event Def.) On-screen tabs are identified by bold (All Events tab) Modules of CLG are identified by italics (Event Canvas, Time to Event) The names of cohorts, event collections, sets, event types, and other objects used within CLG are identified with quote marks ( Glucose Combo: FSG+Blood, Macrolides-2006 ). When instructed to enter an object name, you type what is in between the quote marks excluding any closing punctuation. Do not type the quote marks. 1. Launch Internet Explorer 2. Paste the CLG URL in the browser URL field and press Enter. This will take you to the Clinical Looking Glass home page Log in using the user name and password provided by the instructor. Clinical Scenario You need to evaluate patients of age 65 or older who were admitted with congestive heart failure from January through March of First you must identify the patients, then you can analyze various outcomes for them. Exercise Overview 1 Create a New Study Define Your Group in Event Canvas Define Your List Method Get Results! Extra Credit

2 1 Create a New Study 1. Navigate to Study Designer under the Analysis menu. 2. When Study Designer has loaded, click the in the upper left: 3. Name your new study. 2

3 4. Select the Groups tab. Enter a name for group 1. 2 Define Your Group in Event Canvas 1. Click on the (the Builder Button) to access Event Canvas where you will define and build your new cohort. 3

4 2. Event Canvas launches in a new window and a new blank Cohort is loaded with the Event Condition Editor open. 3. Name your new cohort. 4

5 2.1 Define an Event Condition 1. Name the event condition. 2.2 Define an Event Defintion 1. Click on New Event Def. to expand the menu and select New Event Def. 2. The Event Definition Palette opens in a new window. 5

6 3. Name the new event and select the Event type Inpatient Care Admit. 2.3 Define an attribute condition 1. Define the CHF condition: right click on and select Add Condition. 2. The Event Definition Editor opens. 6

7 3. Select Inpatient ICD9 Group from the drop down menu. 2.4 Define a Set 1. You need to define a diagnosis set using Set Builder. To access it, click. 7

8 2. Set Builder opens with the currently selected set loaded. Clear this set by clicking the Clear button. 3. Search for Heart Failure diagnoses: Type Heart Failure in the Search field and click. 8

9 4. You may select only the diagnoses codes that you wish to include in your set by holding down the Control key as you click on each one. For this set, you want all of the codes displayed in the search results, so simply click. 5. Review the Assigned list. If it is correct, click Save. 6. Name your new set CHF All and click Save. 7. Note the confirmation message. Click Close. 9

10 2.5 Use Your New Set in Your Condition Definition 1. Click the set menu and find your new set at the top of the list. Select it by clicking on it. 2. Do not change the settings for Primary or Secondary and Present on Admission? 3. Click to save your condition definition. 10

11 4. Your Definition Canvas should look like this. Click to save your Event Definition. 5. Note that your newly defined Event Definition is selected in the Event Condition Editor with a prefix of the event type ( CHF Admissions ). 2.6 Define Time Period 1. Click New Duration Def. and select New Duration Def. 11

12 2. Enter a name for your duration. 3. Enter the date range in the from and to fields. Click the inclusion check boxes to include both the start and end date that you entered. When you are done click. 4. Note that your duration definition is now selected in your Event Condition. 2.7 Define Demographic Condition 1. Click No Demographics and select New Demographics Def. 12

13 2. The Demographics editor opens. Name your new demographic definition. 3. Right click on and select Add Contiion. 4. The Demographic Condition Editor opens. 13

14 5. Click Please Select and select Age. 6. Click the operator drop down and select the greater than or equal to symbol (>=). 7. Type 65 in the value field. 8. Click 14

15 9. Verify that your demographic condition now includes Greater than 65. Click. 10. Your Event Condition is complete. Click. 2.8 Build the Cohort 1. To find out how many patients meet the conditions you have defined, click 15

16 2. Congratulations! You have identified your patient group. Click. 3. Click the button to exit the Edit mode. 4. Click the refresh and close button on the Event Canvas management Pane to return to Study Designer. 2.9 Add Your Group 1. Click the Cohort/Collection drop down and, if necessary, scroll to the bottom of the list to find your new cohort. 16

17 3 Define Your List Method 1. Click the Methods tab and click the to add a new method. 2. Select the <List> method type. 3. Enter a name for your method and click. 17

18 3.1 Configure Your List Method 1. Your new method is displayed. In the lower half of the screen, columns that will be included in your output by default are listed in the Selected Attributes box. 2. Click on Patient Address and then click to remove this column from your output. 18

19 3. Drag EventType from the left Available Attributes box and drop it anywhere in the right Selected Attributes Box. 4. Delete a few more columns and drag in a few more from the left. 5. Click the Demographics tab to see the complete list of available demographics attributes. Some will be grey because they are already included in the Selected Attributes list. 19

20 4 Get Results! 1. Run your List by clicking either or. 20

21 2. While your method runs, let s review the rest of the List Method screen. In List Method you have the option of selecting an outcome and end point. This allows you to search each patient s record for a particular event starting at their index date and stopping at the end point that you define. The end point can be a set unit of time (e.g., 30 days), or another event (e.g., hospital admission). One other important control is the Column Control Expander. Click this to enlarge the column selection panel to cover over the Roadway controls. 21

22 3. Your List is probably complete by now and your screen looks like this: 4. The data grid is a quick way to view your results. Scroll the grid vertically and horizontally to see all of your columns and rows. Use the page controls to page through your entire cohort. 5. If you have access to patient identifiers, the Show Identifiers control will be available to you. If you do not have access, it will be disabled. If you have access, click the Show Identifiers check box. 6. The HIPAA Challenge box is displayed. You must provide your reason for viewing patient identifiers. When you need to see identifiers, you can click the appropriate radio button and 22

23 enter the required information in the text box. Your entry is logged along with a record of what data you viewed. Click the Cancel button now. 4.1 Export Your Results 1. Export your cohort to MS Excel or a Comma Separated Value (CSV) file by selecting the format from the Export type menu and clicking. 23

24 2. Excel 2007 supports larger cohorts with more columns than Excel CSV is useful for importing your data into external applications, and if you do not have MS Excel. When the export completes, click the View the exported results menu and click on Data File. NOTE: you must disable all pop-up blockers in your web browser. 3. In the File Download pop-up, click to view your file. 4. If you have MS Excel, it launches and your results are opened in a spreadsheet. If you selected CSV format, the file will be opened in MS Excel if you have it, otherwise you ll be prompted to save the file. In the MS Excel formats, the summary of the cohort is included on tab one and the data is on tab two. In CSV, the summary files are separate from the data. 24

25 4.2 Add an Outcome 1. Return to Study Designer and click. Click the question mark in the Outcome control. 2. Let s examine admissions for a year after each patient s index date. Click to launch the Event Definition Builder. 25

26 3. The Event Definition Builder opens with a new, blank definition ready to be defined. 4. Name your new definition Admission. 5. Click the Event Type menu and select Inpatient Care Admit from the list. 6. Click to save and close your new definition. Click at the top of the Management Pane to close the Event Definition Builder and update your event definitions list in Study Designer. 7. Click the Event Definition menu and if necessary scroll your list of event definitions to the bottom to select your new Admission event defintion. 26

27 8. Close the Outcome control by clicking the twisty in the upper right corner. 9. Click on the End Point control to expand it. 27

28 10. Enter 180 in the Time from Start field. 11. Click the twisty in the upper right corner to close the End Point control. 12. Because your cohort index event and your outcome are of the same event type (Admission), you need to tell the List method not to include the Index event as an outcome. Click the Start control to expand it. 13. Type 1 in the Blackout field. This tells List Method to start looking for the outcome one day after each patient s Index date. 14. Click the twisty in the upper right corner to collapse the Start control. 15. Your Roadway should now look like this: 28

29 16. Notice that the Outcomes tab has been brought into focus in the Column control. One column from your outcome has been added to the Selected Attributes list. Take a moment to note the green, blue, and magenta icons next to each column name. These color and letter combinations tell you what type of attribute each column will contain from your group, a demographic, or an outcome. 17. You may delete or drag in additional Outcome columns at this time. 4.3 Get More Results 1. When you are ready, click. 2. While your method is processing, take a look at the View control. Prior to running, you may choose to create a Long view of your results. The default is Wide view. We ll get into the difference later in class. 3. Your results should be back by now. Scroll the data grid horizontally until you see your outcome columns. You can see that some patients were re-admitted while others were not. Also note 29

30 that the columns related to the cohort Index event are prefixed with the word INDEX while the outcome columns are not. 4. Go ahead and export your results. 5. Save your study and results by clicking or (save and close). When you reopen this study, your List results will be there. 5 Extra Credit 1. Finished early? Test how much you ve learned by doing the following: Go back to the study criteria. Open the end point control. Launch Event Definition Builder. Add the CHF diagnosis to your outcome event. Rerun your List method to see only readmissions for CHF. 30