Scholars@Duke
Cara Louise O'Brien

Cara Louise O'Brien

Assistant Professor of Medicine
Medicine, General Internal Medicine
Box 31139 Med Ctr, Durham, NC 27710
Dept of Medicine, Durham, NC 27710

Selected Publications

Translating ethical and quality principles for the effective, safe and fair development, deployment and use of artificial intelligence technologies in healthcare.

Journal Article J Am Med Inform Assoc · February 16, 2024 OBJECTIVE: The complexity and rapid pace of development of algorithmic technologies pose challenges for their regulation and oversight in healthcare settings. We sought to improve our institution's approach to evaluation and governance of algorithmic techn ... Full text Link to item Cite

In-Hospital Virtual Peer-to-Peer Consultation to Increase Guideline-Directed Medical Therapy for Heart Failure: A Pilot Randomized Trial.

Journal Article Circ Heart Fail · February 2023 BACKGROUND: Guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF) improves clinical outcomes and quality of life. Optimizing GDMT in the hospital is associated with greater long-term use in HFrEF. This study aim ... Full text Link to item Cite

The Impact of Centers for Medicare & Medicaid Services SEP-1 Core Measure Implementation on Antibacterial Utilization: A Retrospective Multicenter Longitudinal Cohort Study With Interrupted Time-Series Analysis.

Journal Article Clin Infect Dis · August 31, 2022 BACKGROUND: The impact of the US Centers for Medicare & Medicaid Services (CMS) Severe Sepsis and Septic Shock: Management Bundle (SEP-1) core measure on overall antibacterial utilization is unknown. METHODS: We performed a retrospective multicenter longit ... Full text Link to item Cite

A framework for the oversight and local deployment of safe and high-quality prediction models.

Journal Article J Am Med Inform Assoc · August 16, 2022 Artificial intelligence/machine learning models are being rapidly developed and used in clinical practice. However, many models are deployed without a clear understanding of clinical or operational impact and frequently lack monitoring plans that can detec ... Full text Link to item Cite

Vitals are Vital: Simpler Clinical Data Model Predicts Decompensation in COVID-19 Patients

Journal Article ACI Open · January 2022 Abstract Objective Several risk scores have been developed and tested on coronavirus disease 2019 (COVID-19) patients to predict clinical decompensation. We aimed to compare an institutional, automated, custom-bui ... Full text Open Access Cite

In-Hospital Initiation of Sodium-Glucose Cotransporter-2 Inhibitors for Heart Failure With Reduced Ejection Fraction.

Journal Article J Am Coll Cardiol · November 16, 2021 Sodium-glucose cotransporter-2 inhibitor therapy is well suited for initiation during the heart failure hospitalization, owing to clinical benefits that accrue rapidly within days to weeks, a strong safety and tolerability profile, minimal to no effects on ... Full text Link to item Cite

Greater Compliance With Early Sepsis Management is Associated With Safer Care and Shorter Hospital Stay.

Journal Article J Healthc Qual · November 2021 This retrospective, cross-sectional study of U.S. hospitals in Medicare's Inpatient Quality Reporting Program aimed to determine whether variation in Sepsis/Septic Shock (Bundle SEP-1) compliance is linked to hospital size and measures of safety and operat ... Full text Link to item Cite

Integrating a Machine Learning System Into Clinical Workflows: Qualitative Study.

Journal Article J Med Internet Res · November 19, 2020 BACKGROUND: Machine learning models have the potential to improve diagnostic accuracy and management of acute conditions. Despite growing efforts to evaluate and validate such models, little is known about how to best translate and implement these products ... Full text Link to item Cite

Real-World Integration of a Sepsis Deep Learning Technology Into Routine Clinical Care: Implementation Study.

Journal Article JMIR Med Inform · July 15, 2020 BACKGROUND: Successful integrations of machine learning into routine clinical care are exceedingly rare, and barriers to its adoption are poorly characterized in the literature. OBJECTIVE: This study aims to report a quality improvement effort to integrate ... Full text Link to item Cite

Integrating a Machine Learning System Into Clinical Workflows: Qualitative Study (Preprint)

Journal Article · July 10, 2020 BACKGROUNDMachine learning models have the potential to improve diagnostic accuracy and management of acute conditions. Despite growing efforts to evaluate and validate such models, littl ... Full text Cite

Machine learning for early detection of sepsis: an internal and temporal validation study.

Journal Article JAMIA Open · July 2020 OBJECTIVE: Determine if deep learning detects sepsis earlier and more accurately than other models. To evaluate model performance using implementation-oriented metrics that simulate clinical practice. MATERIALS AND METHODS: We trained internally and tempor ... Full text Open Access Link to item Cite

“The human body is a black box”: Supporting clinical decision-making with deep learning

Conference FAT* 2020 - Proceedings of the 2020 Conference on Fairness, Accountability, and Transparency · January 27, 2020 Machine learning technologies are increasingly developed for use in healthcare. While research communities have focused on creating state-of-the-art models, there has been less focus on real world implementation and the associated challenges to fairness, t ... Full text Cite

Prevalence, Underlying Causes, and Preventability of Sepsis-Associated Mortality in US Acute Care Hospitals.

Journal Article JAMA Netw Open · February 1, 2019 IMPORTANCE: Sepsis is present in many hospitalizations that culminate in death. The contribution of sepsis to these deaths, and the extent to which they are preventable, is unknown. OBJECTIVE: To estimate the prevalence, underlying causes, and preventabili ... Full text Link to item Cite

Minimal Impact of Implemented Early Warning Score and Best Practice Alert for Patient Deterioration.

Journal Article Crit Care Med · January 2019 OBJECTIVES: Previous studies have looked at National Early Warning Score performance in predicting in-hospital deterioration and death, but data are lacking with respect to patient outcomes following implementation of National Early Warning Score. We sough ... Full text Link to item Cite

Compliance With the National SEP-1 Quality Measure and Association With Sepsis Outcomes: A Multicenter Retrospective Cohort Study.

Journal Article Crit Care Med · October 2018 OBJECTIVES: Many septic patients receive care that fails the Centers for Medicare and Medicaid Services' SEP-1 measure, but it is unclear whether this reflects meaningful lapses in care, differences in clinical characteristics, or excessive rigidity of the ... Full text Link to item Cite

Variability in determining sepsis time zero and bundle compliance rates for the centers for medicare and medicaid services SEP-1 measure.

Journal Article Infect Control Hosp Epidemiol · August 2018 We compared sepsis "time zero" and Centers for Medicare and Medicaid Services (CMS) SEP-1 pass rates among 3 abstractors in 3 hospitals. Abstractors agreed on time zero in 29 of 80 (36%) cases. Perceived pass rates ranged from 9 of 80 cases (11%) to 19 of ... Full text Link to item Cite

Costs and effectiveness of ximelagatran for stroke prophylaxis in chronic atrial fibrillation.

Journal Article JAMA · February 9, 2005 CONTEXT: Recent trials have found that ximelagatran and warfarin are equally effective in stroke prevention for patients with atrial fibrillation. Because ximelagatran can be taken in a fixed, oral dose without international normalized ratio monitoring and ... Full text Link to item Cite

PDAPP; YFP double transgenic mice: a tool to study amyloid-beta associated changes in axonal, dendritic, and synaptic structures.

Journal Article J Comp Neurol · February 17, 2003 Neuritic plaques are one of the stereotypical hallmarks of Alzheimer's disease (AD) pathology. These structures are composed of extracellular accumulations of fibrillar forms of the amyloid-beta peptide (Abeta), a variety of other plaque-associated protein ... Full text Link to item Cite