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Implementation of a novel linkage of primary care electronic medical record data with hospital data in South Eastern Ontario [Big data]

Annals of Family Medicine

Context: Currently, primary care data, community data, and hospital data are not linked in Ontario, resulting in a disconnect in continuity of care. Overall, this project highlights a robust linkage process which can be scaled and spread across primary care clinics and health conditions.

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Electronic Health Record Use and Patient-Centredness [Education and training]

Annals of Family Medicine

Context: Large-scale electronic health record (EHR) programs have reported a number of issues to their implementation in primary care including physician patient-centredness and clinical performance. Setting: An academic primary care clinic based in a hospital. Population: Ten resident physicians and six staff physicians.

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Transitional Care Management care team impact on no-show rates to hospital discharge appointments [Patient education/adherence]

Annals of Family Medicine

Context: The Transitional Care Management (TCM) clinic visit is a uniquely billed visit type to review a recently discharged patient’s hospital course, reconcile medications, and continue ongoing workup. Objective: Our objective was to improve the TCM clinic no-show rate and thereby improve patient outcomes.

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Clinical outcomes of administering an ePROM of barriers to adherence to ART to people with HIV through a patient portal [Clinical research (other)]

Annals of Family Medicine

We used the patient portal (Opal) to administer the I-Score, a 7-item electronic patient-reported outcome measure (ePROM) of barriers to ART adherence. Setting: A hospital-based clinic in Montreal, Canada. Study Design Analysis: 6-month one-arm implementation pilot study.

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Exploring Trends in Postpartum Hemorrhage with SHRINE Network Aggregated Electronic Health Records (EHR) Data. [Health care disparities]

Annals of Family Medicine

The Shared Health Research Information Network (SHRINE) offers rapid, secure access to aggregate counts of patient data from participating hospitals. We have used repeated annual cross-sectional analyses to extract aggregated EHR counts data that included demographics, PPH risk factors and comorbidities in live births during hospital stays.

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SGLT-2 inhibitor, cardiovascular risk and outcome in patients with comorbidity of hypertension and diabetes [Cardiovascular disease]

Annals of Family Medicine

Objective This study aims to investigate the effects of SGLT-2 inhibitors on level of cardiovascular risk (evaluate by China-PAR) and hospitalization events in patient with comorbidity of hypertension and diabetes. Setting or Dataset Five electronic systems of community clinic.

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Maryland's Primary Care Program: incremental progress or breakthrough?

The Health Policy Exchange

Our residency, formerly a collaboration with Providence Hospital, is now known as the Medstar Health/Georgetown-Washington Hospital Center Family Medicine Residency Program. I stepped down as director of the Robert L. Phillips, Jr.