Vishnu Prakas Nair

All Publications

• Comparing IM Residency Application Personal Statements Generated by GPT-4 and Authentic Applicants. Journal of general internal medicine Nair, V., Nayak, A., Ahuja, N., Weng, Y., Keet, K., Hosamani, P., Hom, J. 2024

  View details for DOI 10.1007/s11606-024-08784-w

  View details for PubMedID 38689120

  View details for PubMedCentralID 10589311

• Health Professional vs Layperson Values and Preferences on Scarce Resource Allocation. JAMA network open Buhr, R. G., Huynh, A., Lee, C., Nair, V. P., Romero, R., Wisk, L. E. 2024; 7 (3): e241958

  Abstract

  COVID-19 prompted rapid development of scarce resource allocation (SRA) policies to be implemented if demand eclipsed health systems' ability to provide critical care. While SRA policies follow general ethical frameworks, understanding priorities of those affected by policies and/or tasked with implementing them is critical.To evaluate whether community members and health care profesionals (HCP) agree with SRA protocols at the University of California (UC).This survey study used social media and community-partnered engagement to recruit participants to a web-based survey open to all participants aged older than 18 years who wished to enroll. This study was fielded between May and September 2020 and queried participants' values and preferences on draft SRA policy tenets. Participants were also encouraged to forward the survey to their networks for snowball sampling. Data were analyzed from July 2020 to January 2024.Survey items assessed values and preferences, graded on Likert scales. Agreement was tabulated as difference in Likert points between expressed opinion and policy tenets. Descriptive statistics were tested for significance by HCP status. Free text responses were analyzed using applied rapid qualitative analysis.A total of 1545 participants aged older than 18 years (mean [SD] age 49 [16] years; 1149 female participants [74%], 478 health care practitioners [30%]) provided data on SRA values and preferences. Agreement with UC SRA policy as drafted was moderately high among respondents, ranging from 67% to 83% across domains. Higher agreement with the interim policy was observed for laypersons across all domains except health-related factors. HCPs agreed more strongly on average that resources should not be allocated to those less likely to survive (HCP mean, 3.70; 95% CI, 3.16-3.59; vs layperson mean, 3.38; 95% CI, 3.17-3.59; P = .002), and were more in favor of reallocating life support from patients less likely to those more likely to survive (HCP mean, 6.41; 95% CI, 6.15-6.67; vs layperson mean, 5.40; 95% CI, 5.23-5.58; P < .001). Transparency and trust building themes were common in free text responses and highly rated on scaled items.This survey of SRA policy values found moderate agreement with fundamental principles of such policies. Engagement with communities affected by SRA policy should continue in iterative refinement in preparation for future crises.

  View details for DOI 10.1001/jamanetworkopen.2024.1958

  View details for PubMedID 38470416

• Developing an electronic health record measure of low-value esophagogastroduodenoscopy for GERD at a large academic health system. BMJ open quality Reynolds, C. A., Nair, V., Villaflores, C., Dominguez, K., Arbanas, J. C., Treasure, M., Skootsky, S., Tseng, C. H., Sarkisian, C., Patel, A., Ghassemi, K., Fendrick, A. M., May, F. P., Mafi, J. N. 2023; 12 (4)

  Abstract

  Low-value esophagogastroduodenoscopies (EGDs) for uncomplicated gastro-oesophageal reflux disease (GERD) can harm patients and raise patient and payer costs. We developed an electronic health record (EHR) 'eMeasure' to detect low-value EGDs.Retrospective cohort of 518 adult patients diagnosed with GERD who underwent initial EGD between 1 January 2019 and 31 December 2019.Outpatient primary care and gastroenterology clinics at a large, urban, academic health centre.Adult primary care patients at the University of California Los Angeles who underwent initial EGD for GERD in 2019.EGD appropriateness criteria were based on the American College of Gastroenterology 2012 guidelines. An initial EGD was considered low-value if it lacked a documented guideline-based indication, including alarm symptoms (eg, iron-deficiency anaemia); failure of an 8-week proton pump inhibitor trial or elevated Barrett's oesophagus risk. We performed manual chart review on a random sample of 204 patients as a gold standard of the eMeasure's validity. We estimated EGD costs using Medicare physician and facility fee rates.Among 518 initial EGDs performed (mean age 53 years; 54% female), the eMeasure identified 81 (16%) as low-value. The eMeasure's sensitivity was 42% (95% CI 22 to 61) and specificity was 93% (95% CI 89 to 96). Stratifying across clinics, 62 (74.6%) low-value EGDs originated from 2 (12.5%) out of 16 clinics. Total cost for 81 low-value EGDs was approximately US$75 573, including US$14 985 in patients' out-of-pocket costs.We developed a highly specific eMeasure that showed that low-value EGDs occurred frequently in our healthcare system and were concentrated in a minority of clinics. These results can inform future QI efforts at our institution, such as best practice alerts for the ordering physician. Moreover, this open-source eMeasure has a much broader potential impact, as it can be integrated into any EHR and improve medical decision-making at the point of care.

  View details for DOI 10.1136/bmjoq-2023-002363

  View details for PubMedID 38135304

  View details for PubMedCentralID PMC10749030

• Leveraging Electronic Health Records to Measure Low-Value Screening Colonoscopy AMERICAN JOURNAL OF MEDICINE Soroudi, C., Mafi, J., Myint, A., Gardner, J., Kahlon, S., Mongare, M., Yang, L., Tseng, C., Reynolds, C., Nair, V., Villaflores, C., Cates, R., Gupta, R., Sarkisian, C., May, F. P. 2022; 135 (6): 715-+

  View details for DOI 10.1016/j.amjmed.2021.12.008

  View details for Web of Science ID 000832988000027

  View details for PubMedID 35219690

  View details for PubMedCentralID PMC10176807