Biomedical and Health Informatics Electronic Theses (UMKC)
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The items in this collection are the theses written by students of the Department of Biomedical and Health Informatics. Some items may be viewed only by members of the University of Missouri System and/or University of Missouri-Kansas City. Click on one of the browse buttons above for a complete listing of the works.
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Item The impact of 340B disruption on patients with autoimmune rheumatic diseases(2025) Puthawala, Emily Elizabeth; Nichols, Mark (Professor of bioinformatics)Patients with autoimmune inflammatory rheumatic diseases (AIRDs) rely on disease-modifying antirheumatic drugs (DMARDs) to manage disease progression. AIRD patients are often prescribed biologic DMARDs (bDMARDs), which increases the financial burden of treatment. Since 1992, qualifying covered entities, such as University Health and Lakewood Medical Center, have been eligible to purchase discounted drugs through the Federal 340B Drug Pricing Program. Originally, 340B pricing was restricted to in-house hospital pharmacies. In 1996, covered entities were permitted to contract with one outside pharmacy. This was expanded to any pharmacy starting in 2010, improving medication access. In 2023, major drug manufacturers reinstated pre-2010 requirements resulting in disruption to bDMARD access. The aim of this study is to characterize the AIRD patient population affected, determine impacts on patient outcomes, and quantify changes in healthcare utilization and spending. This is a retrospective within-subject study utilizing pharmacy and EHR data from University Health and Lakewood Medical Center. This study is IRB exempt. Included patients were >18 years old, who utilized the 340B program. These patients were seen in the rheumatology clinic in the 6 months prior to and post 340B policy reversal. Patients who established care less than 3 months prior to the disruption were excluded. EHR data was deidentified, stored in REDCap, and analyzed using IMB SPSS. Of 222 patients screened, 43 were included. Patients were mostly female (67%), white (67%), and enrolled in Medicare (47%). We uncovered a significant impact on patients’ 340B usage. On average, patients filled 75 fewer days’ supply of bDMARDs through the 340B program in the 6 months post disruption [95% CI (46, 109), p <0.001]. No increased use of rescue medications such as glucocorticoids (p = 0.25), NSAIDs (p = 1.0) and opiates (p = 0.39) or ER visits (p = 0.26) was observed. We found evidence to suggest that the sudden reinstatement of pre-2010 pharmacy requirements for 340B discounts had a negative effect on medication accessibility for patients with AIRD. Future directions include quantifying prescription costs for patients as a result of decreased 340B participation and the impact of medication disruption in primary care and other subspecialty clinics.Item Nontraumatic dental conditions in U.S. emergency departments: evaluating the 2021 AHRQ HCUP Nationwide Emergency Department Sample(2025) Kaz Frick, Emma Elyse; Simon, Stephen D.This study examined visit characteristics of encounters for nontraumatic dental conditions within U.S. emergency departments using the 2021 Nationwide Emergency Department Sample from the AHRQ. The aim was to test associations between visit characteristics and nontraumatic dental conditions (NTDC) to uncover key predictors of ED safety-net use among vulnerable populations. Logistic regression using domain analysis was performed comparing encounters for nontraumatic dental conditions to low back pain encounters and to headache encounters in two models. Trends persisting between the two models were evaluated, and adjusted odds ratios (OR) and 95% confidence intervals were reported. Males (OR 1.2), working age adults 18-44 years (OR 2.6), patients residing in lower income communities (OR 1.14), and Medicaid patients (OR 1.8) or the uninsured (OR 1.6) were found to be at increased risk of using the ED to treat NTDC. Hispanic patients had decreased risk in comparison to White patients (OR 0.68). Key predictors of preventable emergency dental visits are covered under public insurance or no insurance, living in low-income communities or in rural areas. The results of this study support targeted interventions for working age adults who are ineligible for public dental benefits, particularly for male patients, and for improving access to dental care in rural areas.Item Examining the relationship among adults with ADHD and SUD: a retrospective analysis of demographic factors using the Health Facts Database(2025) Todd, Reagan Elizabeth; Simon, Stephen D.Background: Attention-deficit/hyperactivity disorder (ADHD) is traditionally considered as a childhood disorder; however, a significant proportion of adults experience persistent symptoms, often undiagnosed or untreated. There continues to be significant gaps in understanding the relationship between ADHD and substance use disorder (SUD), particularly in adult populations. Given similar symptom overlap between ADHD and SUD, diagnosis and treatment can be challenging. Objective: This study aims to examine the relationship between ADHD and SUD in adults, focusing on demographic factors that contribute to SUD risk. Methods: A retrospective cohort study was conducted using secondary data from the Cerner Health Facts® database. This study consisted of adults ages 18-65 with an ADHD diagnosis who had visited a facility that provided data to Health Facts®. Patients were then categorized based upon their SUD status (active use and in remission, or no history of use). ADHD and SUD diagnoses were obtained using ICD-9 and ICD-10 codes. Frequencies were obtained for age, race/ethnicity, gender, marital status, and geographic locations. Logistic regression analyses were employed to evaluate the relationships between demographic variables and overall SUD and substance specific use and SUD outcomes. Results: Overall females had 20% lower odds of developing a SUD compared to males. African Americans had 35% lower odds compared to Caucasian patients, while Native Americans had increased odds in the unadjusted model only. Married individuals and older adults had a significantly lower odds of SUD development. Regional variation was observed with lower odds in the Southern region, but higher and nonsignificant odds in the West. Substant-specific models for cannabis, stimulants, and nicotine were also analyzed due to their higher prevalence. Conclusion: This study provides critical insights to the demographic factors associated with SUD risk in adults with ADHD. The findings suggest a need for targeted interventions and improved diagnostic measures for both ADHD and SUD. Future research should explore causal relationships and the various treatments to improve outcomes for this population.Item How marital status plays a role in diagnosing bipolar disorder in patients originally diagnosed with depression(2024) McCamy, Lisa Marion; Cheng, An-LinBipolar disorder (BD), or manic depression, is a chronic illness marked by intense mood swings, from severe depression to euphoria, affecting mood, energy, and activity. BD patients often present with depression and are thus initially diagnosed with major depressive disorder (MDD). Misdiagnosis of MDD in BD patients leads to more depressive episodes, psychotic symptoms, and hospitalizations. The delay from MDD to BD diagnosis can average nearly nine years, with a range of one to 45 years. Approximately 70% of BD patients continue to be misdiagnosed with MDD. This study aims to determine if marital status influences this delay. Method: the study evaluated a total of 3,257 individuals greater than 18 years of age who were initially diagnosed with MDD, and then later correctly diagnosed with BD. Results: Married individuals initially diagnosed with MDD had a significantly longer delay in months to correct BD diagnosis compared to single individuals. Further analysis revealed that married females had a significant increase in the time to receive a correct BD diagnosis compared to married males. Conclusion: The present study's findings indicated that single patients misdiagnosed with MDD experience a shorter delay than married patients before receiving a correct BD diagnosis. While single patients have an advantage overall, married males experience a shorter delay than married females before receiving a correct BD diagnosis. To our knowledge, these are new findings and should be researched further to see if they could be of assistance in reducing or eliminating the delay to a correct diagnosis of BD.Item Pregnancy outcomes in females with hidradenitis suppurativa(2024) Walsh, David Paige, Jr.; Wyckoff, Gerald J.; Wang, Shizhen, (Jeff); Lee, Yugyung, 1960-; Monaghan-Nichols, PaulaA pregnancy datamart was constructed from Cerner Health Facts EMR data using pypreg, a python package developed by the author based on a validated pregnancy identification algorithm by Keran Moll. The demographics of the pregnancy datamart were consistent with the demographics of Health Facts overall. Various measures were compared against national data for the United States including rates of cesarean section, 42-day maternal mortality, severe maternal morbidity, preeclampsia, fetal growth restriction, gestational diabetes, and gestational hypertension. These measures were compared using Chi-square and Breslow-Day. No evidence suggested the rates observed in the datamart were substantially different from national figures. Thus, providing a degree of validity to the data. During construction of the datamart, several data quality problems were identified in Health Facts and were addressed. The quality issues included patient identifiers that are defined to be unique being linked to other unique patient identifiers, patient encounters with more than one date of admission, patient encounters being listed at more than one facility, and patient age not changing appropriately over time. A small percentage of the total encounters and patients were recommended to be removed from the general database to avoid unforeseen problems due to their inclusion in research. With the pregnancy datamart established, pregnancy outcomes were studied between the populations with and without hidradenitis suppurativa. Several covariates were selected based on association with inflammatory imbalance or association with condition for use in a multinomial logistic regression. This model type was selected to model all outcomes simultaneously to avoid the problem of multiple testing. Additionally, two models were considered. The first model treated each pregnancy as an independent event, while the second model only looked at the first record pregnancy for each patient. The odds ratios for negative pregnancy outcomes were elevated in both model types. When considering model predictions on counterfactual data and the estimated marginal means, several negative outcomes showed significant increases in risk.