David W Bates

David W Bates
Brigham and Women's Hospital | BWH · Division of General Internal Medicine and Primary Care

MD, MSc

About

1,306
Publications
335,990
Reads
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109,997
Citations
Introduction
David W Bates currently works at the Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital. David does research in medical informatics, patient safety, quality of care, health services research, epidemiology and primary care.
Additional affiliations
July 2000 - present
Partners HealthCare
Position
  • Medical Director of Clinical and Quality Analysis
January 2000 - present
Harvard University
Position
  • Professor (Full)
July 1986 - present
Brigham and Women's Hospital
Position
  • Chief

Publications

Publications (1,306)
Article
Full-text available
Delivery of serious illness communication (SIC) is necessary to ensure that all seriously ill patients receive goal-concordant care. However, the current SIC delivery process contains barriers that prevent the delivery of timely and effective SIC. In this paper, we describe the current bottlenecks of the traditional SIC workflow and explore how a h...
Article
As technology continues to improve, health care systems have the opportunity to use a variety of innovative tools for decision-making, including artificial intelligence (AI) applications. However, there has been little research on the feasibility and efficacy of integrating AI systems into real-world clinical practice, especially from the perspecti...
Article
Objective: Clinicians spend significant time working in the electronic health record (EHR). The US is an outlier in EHR time, suggesting that EHR-related work may be driven in part by the legal environment and threat of malpractice. To assess this, we evaluate the association between state-level malpractice climate and clinician time spent in the...
Article
Full-text available
An abundant and growing supply of digital health applications (apps) exists in the commercial tech-sector, which can be bewildering for clinicians, patients, and payers. A growing challenge for the health care system is therefore to facilitate the identification of safe and effective apps for health care practitioners and patients to generate the m...
Article
Importance: COVID-19 has highlighted widespread chronic underinvestment in digital health that hampered public health responses to the pandemic. Recognizing this, the Riyadh Declaration on Digital Health, formulated by an international interdisciplinary team of medical, academic, and industry experts at the Riyadh Global Digital Health Summit in A...
Article
Supported by the Centers for Medicare & Medicaid Services (CMS), Brigham and Women's Hospital (BWH) has retooled the existing claims-based measures NQF1550 and NQF3493 into an electronic clinical quality measure (eCQM) to assess the risk-standardized complication rate (RSCR) following elective primary total hip (THA) and knee arthroplasty (TKA) at...
Article
The Centers for Medicare & Medicaid Services (CMS) supported Brigham and Women's Hospital (BWH) Center for Patient Safety, Research, and Practice to retool one existing National Quality Forum (NQF) endorsed clinical quality measure (CQM) measure into an electronic clinical quality measure (eCQM) and develop three new eCQMs related to orthopedic car...
Article
Brigham and Women's Hospital has received funding from the Centers for Medicare and Medicaid Services to develop a novel electronic clinical quality measure to assess the risk-standardized major bleeding and venous thromboembolism (VTE) rate following elective total hip and/or knee arthroplasty. There are currently no existing measures that evaluat...
Article
Objectives: Delayed emergency department (ED) and hospital patient throughput is recognized as a critical threat to patient safety. Increasingly, hospitals are investing significantly in deploying command centers, long used in airlines and the military, to proactively manage hospital-wide patient flow. This scoping review characterizes the evidenc...
Article
Background: Surgical patients with limited digital literacy may experience reduced telemedicine access. We investigated racial/ethnic and socioeconomic disparities in telemedicine compared with in-person surgical consultation during the coronavirus disease 2019 (COVID-19) pandemic. Study design: Retrospective analysis of new visits within the Di...
Article
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Introduction Currently, several countries are facing severe public health and policy challenges when designing their COVID-19 screening strategy. A quantitative analysis of the potential impact that combing the Rapid Antigen Test (RAT; Wet screening) and digital checker (Dry screening) can have on the healthcare system is lacking. Method We create...
Preprint
Background: People with type 2 diabetes would progress slowly and have few symptoms before diagnosed, if any, and don’t discover their condition until complications develop. Furthermore, with the development of the diabetes, patients often develop comorbidities. However, heterogeneity of progression coupled with deficiencies in electronic health re...
Article
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Objective Physician burnout is at epidemic proportions, impacts clinical outcomes, and is very costly. Although there is emerging data about effective interventions, most physicians at risk of burnout do not seek help. Survey-based measures exist which can quantify burnout within populations, but these are usually only administered episodically. We...
Article
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Objectives Those who work in health care organisations are a potentially valuable source of information about safety concerns, yet failures of voice are persistent. We propose the concept of ‘voiceable concern’ and offer an empirical exploration. Methods We conducted a qualitative study involving 165 semi-structured interviews with a range of staf...
Article
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Artificial intelligence (AI) represents a valuable tool that could be widely used to inform clinical and public health decision-making to effectively manage the impacts of a pandemic. The objective of this scoping review was to identify the key use cases for involving AI for pandemic preparedness and response from the peer-reviewed, preprint, and g...
Article
Background Language barriers can limit access to care for patients with a non-English primary language (NEPL). The objective of this study was to define the association between primary language and emergency versus elective surgery among diverticulitis patients. Materials and Methods Retrospective cohort study of adult patients from the 2009-2014...
Article
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Introduction The purpose of this study is to incorporate behavioural economic principles and user-centred design principles into a multicomponent intervention for the management of uncontrolled hypertension (HTN) in chronic kidney disease (CKD) in primary care. Methods and analysis This is a multicentre, pragmatic, controlled trial cluster-randomi...
Chapter
This chapter presents selected special applications of pharamcoepidemiology, which include studies of drug utilization; evaluating and improving prescribing; special methodological issues in pharmacoepidemiologic studies of vaccine safety; epidemiologic studies of implantable medical devices; research on the effects of medications in pregnancy and...
Article
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Background The opioid epidemic in North America has been driven by an increase in the use and potency of prescription opioids, with ensuing excessive opioid-related deaths. Internationally, there are lower rates of opioid-related mortality, possibly because of differences in prescribing and health system policies. Our aim was to compare opioid pres...
Article
Objective To develop a comprehensive post-acute sequelae of COVID-19 (PASC) symptom lexicon (PASCLex) from clinical notes to support PASC symptom identification and research. Methods We identified 26,117 COVID-19 positive patients from the Mass General Brigham’s electronic health records (EHR) and extracted 328,879 clinical notes from their post-a...
Article
Full-text available
Adverse drug events (ADEs) represent one of the most prevalent types of health-care-related harm, and there is substantial room for improvement in the way that they are currently predicted and detected. We conducted a scoping review to identify key use cases in which artificial intelligence (AI) could be leveraged to reduce the frequency of ADEs. W...
Article
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The objective of this study is to review and compare patient safety dashboards used by hospitals and identify similarities and differences in their design, format, and scope. We reviewed design features of electronic copies of patient safety dashboards from a representative sample of 10 hospitals. The results show great heterogeneity in the format,...
Article
Background Medical interns are at risk for sleep deprivation from long and often rotating work schedules. However, the effects of specific rotations on sleep are less clear. Objective To examine differences in sleep duration and alertness among internal medicine interns during inpatient intensive care unit (ICU) compared to general medicine (GM) r...
Article
Background Continuous monitoring system technology (CMST) aids in earlier detection of deterioration of hospitalized patients, but whether improved outcomes are sustainable is unknown. Methods This interrupted time series evaluation explored whether optimized clinical use of CMST was associated with sustained improvement in ICU utilization, hospit...
Article
Objectives Medication use in the perioperative setting presents many patient safety challenges that may be improved with electronic clinical decision support (CDS). The objective of this paper is to describe the development and analysis of user feedback for a robust, real-time medication-related CDS application designed to provide patient-specific...
Article
Objective We examined clinical decision support (CDS) alerts designed specifically for medication shortages to characterize and assess provider behavior in response to these short-term clinical situations. Materials and Methods We conducted a retrospective analysis of the usage of medication shortage alerts (MSAs) that included at least one alterna...
Article
Objectives: Intraoperative hypertension and hypotension are common and often related to adverse medication events (AMEs). The study objective is to estimate the annual additional fully allocated costs to the U.S. healthcare system related to AMEs associated with clinically significant intraoperative hypertension and hypotension. Methods: Using a...
Article
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Importance Despite billions spent in public investment, electronic health records (EHRs) have not delivered on the promise of large quality and safety improvement. Simultaneously, there is debate on whether public quality reporting is a useful tool to incentivize quality improvement. Objective To evaluate whether publicly reported feedback was ass...
Article
Full-text available
Big data epidemiology facilitates pandemic response by providing data-driven insights by utilizing big data tools that differ from traditional methods. Aspects regarding ‘garbage in, garbage out’, such as insufficient data, inaccessibility of data, missing data, uncertainty in handling data and bias in analysis or common findings are addressable by...
Article
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This paper proposes a novel unsupervised document embedding based clustering algorithm to generate clinical note templates. We adapted Charikar’s SimHash to embed each clinical document into a vector representation. We modified the traditional K-means algorithm to merge any two clusters with centroids when they are very close. Under the K-means par...
Article
Background This study investigated the effect of limited English proficiency on access to neuro-oncologic surgery. We compared rates of emergent/urgent admission and admission to high-volume hospitals for English and non-English primary language patients with brain neoplasms. Methods Using the AHRQ-HCUP New Jersey State Inpatient Database, we incl...
Article
Background/objectives: To assess nurses' opinions of the efficacy of using the FallTIPS (Tailoring Interventions for Patient Safety) fall prevention program. Design: Survey research. Setting: Seven adult acute-care hospitals in 2 hospital centers located in Boston and NYC. Participants: A total of 298 medical-surgical nurses on 14 randomly s...
Article
Objectives We describe an approach for analyzing failures in diagnostic processes in a small, enriched cohort of general medicine patients who expired during hospitalization and experienced medical error. Our objective was to delineate a systematic strategy for identifying frequent and significant failures in the diagnostic process to inform strate...
Article
Objective To determine user and electronic health records (EHR) integration requirements for a scalable remote symptom monitoring intervention for asthma patients and their providers. Methods Guided by the Non-Adoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework, we conducted a user-centered design process involving Englis...
Preprint
UNSTRUCTURED Electronic patient data are critical to clinical and translational science, and research patient data repositories (RPDRs) are a central resource for any work in biomedical data science. However, the data science ecosystem, due to its inherently transdisciplinary nature, poses challenges to existing RPDRs and demands expansions and new...
Article
Organizational, administrative, and educational challenges in establishing and sustaining biomedical data science infrastructures lead to the inefficient use of Research Patient Data Repositories (RPDRs). The challenges, including but not limited to deployment, sustainability, cost optimization, collaboration, governance, security, rapid response,...
Article
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Background: Failure of safe care transitions after hospital discharge results in unnecessary worsening of symptoms, extended period of illness or readmission to the hospital. Objective: The objective of this study was to add to the understanding of the working of care transition interventions between hospital and home through unraveling the cont...
Article
Objective Little is known regarding variation among electronic health record (EHR) vendors in quality performance. This issue is compounded by selection effects in which high-quality hospitals coalesce to a subset of market leading vendors. We measured hospital performance, stratified by EHR vendor, across 4 quality metrics. Materials and Methods...
Article
Background Despite research indicating that patients with Non-English Primary Language (NEPL) have increased hospital length of stay (LOS) for craniotomies, there is a paucity of neurosurgical research examining the impact of language on short-term outcomes. This study sought to evaluate short-term outcomes for English Primary Language (EPL) and NE...
Preprint
Full-text available
Objective: To develop a comprehensive post-acute sequelae of COVID-19 (PASC) symptom lexicon from clinical notes to support PASC symptom identification and research. Methods: We identified 26,117 COVID-19 positive patients from the Mass General Brigham's electronic health records (EHR) and extracted 328,879 clinical notes from their post-acute infe...
Article
Objectives Prior to COVID-19, levels of adoption of telehealth were low in the U.S., though they exploded during the pandemic. Following the pandemic, it will be critical to identify the characteristics that were associated with adoption of telehealth prior to the pandemic as key drivers of adoption and outside of a public health emergency. Materi...
Article
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Open discussions of social justice and health inequities may be an uncommon focus within information technology science, business, and health care delivery partnerships. However, the COVID-19 pandemic—which disproportionately affected Black, indigenous, and people of color—has reinforced the need to examine and define roles that technology partners...
Preprint
UNSTRUCTURED As technology continues to improve, healthcare systems have the opportunity to utilize a variety of innovative tools for decision making that extend beyond traditional clinical decision support systems (CDSSs). The feasibility and efficacy integrating artificial intelligence (AI) systems into medical practice has shown variable success...
Chapter
Public policy shapes all aspects of a healthcare system, including how health IT is used. This chapter reviews key policy goals relevant to informatics and how health IT policy has changed substantially in recent years, from a focus on accelerating adoption to a greater emphasis on interoperability and fostering innovation. It also discusses the ro...
Article
Objectives Nursing documentation behavior within electronic health records may reflect a nurse’s concern about a patient and can be used to predict patient deterioration. Our study objectives were to quantify variations in nursing documentation patterns, confirm those patterns and variations with clinicians, and identify which patterns indicate pat...
Article
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The integration of advanced analytics and artificial intelligence (AI) technologies into the practice of medicine holds much promise. Yet, the opportunity to leverage these tools carries with it an equal responsibility to ensure that principles of equity are incorporated into their implementation and use. Without such efforts, tools will potentiall...
Article
Objective: The purpose of this study was to qualitatively examine safety experiences of hospitalized patients and families. Methods: We conducted 5 focus groups at 2 sites with patients and family members of patients who had been hospitalized at least once within the preceding 2 years. Using a semistructured focus group script, participants were...
Article
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Objective: Considerable international investment in hospital electronic prescribing (ePrescribing) systems has been made, but despite this, it is proving difficult for most organizations to realize safety, quality, and efficiency gains in prescribing. The objective of this work was to develop policy-relevant insights into the optimization of hospi...
Article
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In recent years, the field of artificial intelligence (AI) in oncology has grown exponentially. AI solutions have been developed to tackle a variety of cancer-related challenges. Medical institutions, hospital systems, and technology companies are developing AI tools aimed at supporting clinical decision making, increasing access to cancer care, an...
Preprint
Full-text available
Background Chronic kidney disease is common, leads to end stage renal disease, and is a major risk factor for cardiovascular disease. Although both chronic kidney disease and hypertension, the main risk factor for disease progression, are not difficult to diagnose, both often go unrecognized by primary care providers. It has yet to be determined wh...
Preprint
BACKGROUND People with type 2 diabetes have few symptoms, if any, and don’t discover their condition until complications develop. However, little is known about the progression of complications in type 2 diabetes due to data defects in electronic health records (e.g., incomplete records, discrete observation, irregular visits, and progression heter...
Article
The importance of employee voice—speaking up and out about concerns—is widely recognised as fundamental to patient safety and quality of care. However, failures of voice continue to occur, often with disastrous consequences. In this article, we argue that the enduring sociological concepts of the informal organisation and formal organisation offer...
Article
Full-text available
Objective Our goal was to research and develop exploratory analysis tools for clinical notes, which now are underrepresented to limit the diversity of data insights on medically relevant applications. Results We characterize how exploratory analysis can affect representation learning on clinical narratives and present several self-developed tools...
Article
Objectives: There is considerable evidence that providing patients with access to their health information is beneficial, but there is limited evidence regarding the effect of providing real-time patient safety-related information on health outcomes. The aim of this study was to evaluate the association between use of an electronic patient safety...
Article
While electronic health records (EHRs) have been associated with positive effects, such as improved health care outcomes¹ and reduced errors,² they have also increasingly filled clinicians’ days and have been associated with negative downstream effects on satisfaction with work³ and well-being.⁴ Previous work has described EHR use patterns within s...
Article
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Objective To develop an in-depth understanding of how hospitals with a long history of health information technology (HIT) use have responded to the COVID-19 pandemic from a HIT perspective. Materials and methods We undertook interviews with 44 healthcare professionals with a background in informatics from six hospitals internationally. Interviews...
Article
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Although models have been developed for predicting severity of COVID-19 from the medical history of patients, simplified models with good accuracy could be more practical. In this study, we examined utility of simpler models for estimating risk of hospitalization of patients with COVID-19 and mortality of these patients based on demographic charact...
Article
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Telehealth services that allow remote communication between the patient and the clinical team are an emerging part of care delivery. Given language barriers, patients with limited English proficiency present a unique set of challenges in integrating telehealth and ensuring equity. Using data from 84,419 respondents in the 2015-18 California Health...
Article
Full-text available
Artificial intelligence (AI) represents a valuable tool that could be used to improve the safety of care. Major adverse events in healthcare include: healthcare-associated infections, adverse drug events, venous thromboembolism, surgical complications, pressure ulcers, falls, decompensation, and diagnostic errors. The objective of this scoping revi...