clinical looking glass introductory session in-class...
TRANSCRIPT
Clinical Looking Glass Introductory Session
Study Designer and Event Canvas Exercise
1 Clinical Looking Glass Training, Montefiore Medical Center rev: MM-02/07/2013
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).
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.
Login
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. http://clgpoc.afms.mil/CLGNET
3. 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 2012. First you must identify the patients, then you can analyze various
outcomes for them.
Exercise Overview
1 Create a New Study ............................................................................................................................... 2
2 Define Your Group in Event Canvas ...................................................................................................... 3
3 Define Your List Method ..................................................................................................................... 17
4 Get Results! ......................................................................................................................................... 20
5 Extra Credit ......................................................................................................................................... 30
Clinical Looking Glass Introductory Session
Study Designer and Event Canvas Exercise
2 Clinical Looking Glass Training, Montefiore Medical Center rev: MM-02/07/2013
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.
Clinical Looking Glass Introductory Session
Study Designer and Event Canvas Exercise
3 Clinical Looking Glass Training, Montefiore Medical Center rev: MM-02/07/2013
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.
Clinical Looking Glass Introductory Session
Study Designer and Event Canvas Exercise
4 Clinical Looking Glass Training, Montefiore Medical Center rev: MM-02/07/2013
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.
Clinical Looking Glass Introductory Session
Study Designer and Event Canvas Exercise
5 Clinical Looking Glass Training, Montefiore Medical Center rev: MM-02/07/2013
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.
Clinical Looking Glass Introductory Session
Study Designer and Event Canvas Exercise
6 Clinical Looking Glass Training, Montefiore Medical Center rev: MM-02/07/2013
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.
Clinical Looking Glass Introductory Session
Study Designer and Event Canvas Exercise
7 Clinical Looking Glass Training, Montefiore Medical Center rev: MM-02/07/2013
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 .
Clinical Looking Glass Introductory Session
Study Designer and Event Canvas Exercise
8 Clinical Looking Glass Training, Montefiore Medical Center rev: MM-02/07/2013
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 .
Clinical Looking Glass Introductory Session
Study Designer and Event Canvas Exercise
9 Clinical Looking Glass Training, Montefiore Medical Center rev: MM-02/07/2013
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.
Clinical Looking Glass Introductory Session
Study Designer and Event Canvas Exercise
10 Clinical Looking Glass Training, Montefiore Medical Center rev: MM-02/07/2013
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.
Clinical Looking Glass Introductory Session
Study Designer and Event Canvas Exercise
11 Clinical Looking Glass Training, Montefiore Medical Center rev: MM-02/07/2013
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.
Clinical Looking Glass Introductory Session
Study Designer and Event Canvas Exercise
12 Clinical Looking Glass Training, Montefiore Medical Center rev: MM-02/07/2013
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.
Clinical Looking Glass Introductory Session
Study Designer and Event Canvas Exercise
13 Clinical Looking Glass Training, Montefiore Medical Center rev: MM-02/07/2013
2. The Demographics editor opens. Name your new demographic definition.
3. Right click on and select Add Contiion.
4. The Demographic Condition Editor opens.
Clinical Looking Glass Introductory Session
Study Designer and Event Canvas Exercise
14 Clinical Looking Glass Training, Montefiore Medical Center rev: MM-02/07/2013
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
Clinical Looking Glass Introductory Session
Study Designer and Event Canvas Exercise
15 Clinical Looking Glass Training, Montefiore Medical Center rev: MM-02/07/2013
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
Clinical Looking Glass Introductory Session
Study Designer and Event Canvas Exercise
16 Clinical Looking Glass Training, Montefiore Medical Center rev: MM-02/07/2013
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.
Clinical Looking Glass Introductory Session
Study Designer and Event Canvas Exercise
17 Clinical Looking Glass Training, Montefiore Medical Center rev: MM-02/07/2013
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 .
Clinical Looking Glass Introductory Session
Study Designer and Event Canvas Exercise
18 Clinical Looking Glass Training, Montefiore Medical Center rev: MM-02/07/2013
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.
Clinical Looking Glass Introductory Session
Study Designer and Event Canvas Exercise
19 Clinical Looking Glass Training, Montefiore Medical Center rev: MM-02/07/2013
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.
Clinical Looking Glass Introductory Session
Study Designer and Event Canvas Exercise
20 Clinical Looking Glass Training, Montefiore Medical Center rev: MM-02/07/2013
4 Get Results!
1. Run your List by clicking either or .
Clinical Looking Glass Introductory Session
Study Designer and Event Canvas Exercise
21 Clinical Looking Glass Training, Montefiore Medical Center rev: MM-02/07/2013
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.
Clinical Looking Glass Introductory Session
Study Designer and Event Canvas Exercise
22 Clinical Looking Glass Training, Montefiore Medical Center rev: MM-02/07/2013
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
Clinical Looking Glass Introductory Session
Study Designer and Event Canvas Exercise
23 Clinical Looking Glass Training, Montefiore Medical Center rev: MM-02/07/2013
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 .
Clinical Looking Glass Introductory Session
Study Designer and Event Canvas Exercise
24 Clinical Looking Glass Training, Montefiore Medical Center rev: MM-02/07/2013
2. Excel 2007 supports larger cohorts with more columns than Excel 2003. 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.
Clinical Looking Glass Introductory Session
Study Designer and Event Canvas Exercise
25 Clinical Looking Glass Training, Montefiore Medical Center rev: MM-02/07/2013
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.
Clinical Looking Glass Introductory Session
Study Designer and Event Canvas Exercise
26 Clinical Looking Glass Training, Montefiore Medical Center rev: MM-02/07/2013
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.
Clinical Looking Glass Introductory Session
Study Designer and Event Canvas Exercise
27 Clinical Looking Glass Training, Montefiore Medical Center rev: MM-02/07/2013
8. Close the Outcome control by clicking the twisty in the upper right corner.
9. Click on the End Point control to expand it.
Clinical Looking Glass Introductory Session
Study Designer and Event Canvas Exercise
28 Clinical Looking Glass Training, Montefiore Medical Center rev: MM-02/07/2013
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:
Clinical Looking Glass Introductory Session
Study Designer and Event Canvas Exercise
29 Clinical Looking Glass Training, Montefiore Medical Center rev: MM-02/07/2013
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
Clinical Looking Glass Introductory Session
Study Designer and Event Canvas Exercise
30 Clinical Looking Glass Training, Montefiore Medical Center rev: MM-02/07/2013
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.