Outcomes & Safety
17 Mar Risk Factors For Adverse Events After Total Shoulder Replacement
MedicalResearch.com Interview with: [caption id="attachment_33051" align="alignleft" width="130"]
Dr. Parsons[/caption]
Brad Parsons, MD
Associate Professor, Orthopaedics
Icahn School of Medicine at Mount Sinai
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: As bundled payment initiatives increase in order to contain health care costs, total shoulder arthroplasty (TSA) is a likely future target.
Understanding modifiable drivers of complications and unplanned readmission as well as identifying when such events occur will be critical for orthopedic surgeons and hospitals to improve outcomes and to make fixed-price payment models feasible for TSA.
Utilizing the American College of Surgeons National Surgical Quality Improvement Program we identified 5801 patients that underwent TSA with a 2.7% readmission rate and 2.5% severe adverse event rate. Patients with 3 or more risk factors were found to have a significantly increased risk of readmission and severe adverse events within the first two weeks postoperatively.
11 Mar Physicians, PAs and Nurse Practitioners Provide Similar Amount of Low Value Care
MedicalResearch.com Interview with: [caption id="attachment_32850" align="alignleft" width="200"]
Dr. John N. Mafi[/caption]
John N. Mafi, MD, MPH
Division of General Internal Medicine and Health Services Research
Department of Medicine, Ronald Reagan UCLA Medical Center
Los Angeles, CA
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Our country has a primary care physician shortage. Some have advocated that we expand the scope of practice for nurse practitioners and physician assistants to help alleviate this problem and improve access to primary care. But a 2013 study in the New England Journal of Medicine found that a large number of physicians believed that nurse practitioners provided lower value care when compared with physicians. We decided to put that belief to the test. We studied 29,000 U.S. patients who saw either a nurse practitioner, physician assistant, or physician in the primary care setting for common conditions, and we compared the rate of low-value or unnecessary services—for example, unnecessary antibiotics for the common cold, or MRI for low back pain, or a CT scan for headache. Things that don’t help patients and may harm.
We found no difference in the rates of low value services between nurse practitioners, physician assistants, and physicians. In other words, they did equivalent amounts of inappropriate or bad care.
08 Mar Drop in Adverse Drug Events Linked to Meaningful Use of Electronic Records
MedicalResearch.com Interview with: Michael Furukawa, Ph.D. Senior Economist Agency for Healthcare Research and Quality MedicalResearch.com: What is the background for this study? What are the main findings? Response: Despite some progress, patient safety remains a serious concern in U.S. health care delivery, particularly in acute care hospitals. In part to support safety improvement, the Health Information Technology for Economic and Clinical Health (HITECH) Act promoted widespread adoption and use of certified electronic health record technology. To meet Meaningful Use (MU) requirements in the law, hospitals are required to adopt specific capabilities, such as computerized physician order entry, which are expected to reduce errors and promote safer care. We found that, after the HITECH Act was made law, the occurrence of in-hospital adverse drug events (ADEs) declined significantly from 2010 to 2013, a decline of 19%. Hospital adoption of medication-related MU capabilities was associated with 11% lower odds of ADEs occurring, but the effects did not vary by the number of years of experience with these capabilities. Interoperability capability was associated with 19% lower odds of adverse drug events occurring. Greater exposure to MU capabilities explained about one-fifth of the observed reduction in ADEs.03 Mar Regional Variation in Chemotherapy Prescriptions For Metastatic Prostate Cancer
Posted at 14:43h
in ASCO, Author Interviews, Outcomes & Safety, Pharmacology, Prostate Cancer, University of Michigan
MedicalResearch.com Interview with:
[caption id="attachment_32608" align="alignleft" width="128"]
Dr. Caram[/caption]
Megan Elizabeth Veresh Caram MD
Clinical Lecturer
Internal Medicine, Hematology & Oncology
University of Michigan
MedicalResearch.com: What is the background for this study?
Response: Abiraterone and enzalutamide are oral medications that were approved by the Food & Drug Administration in 2011 and 2012 to treat men with metastatic castration-resistant prostate cancer. Most men with advanced prostate cancer are over age 65 and thus eligible for Medicare Part D. We conducted a study to better understand the early dissemination of these drugs across the United States using national Medicare Part D and Dartmouth Atlas data.
02 Mar Hospital Floors May Be Underappreciated Source Of Hospital Infections
MedicalResearch.com Interview with: [caption id="attachment_32590" align="alignleft" width="200"]
Dr. Curtis J. Donskey[/caption]
Curtis J. Donskey, MD
Geriatric Research, Education, and Clinical Center
Cleveland Veterans Affairs Medical Center
Cleveland, OH 44106
MedicalResearch.com: What is the background for this study?
Response: Many hospitals are making efforts to improve cleaning to reduce the risk for transmission of infection from contaminated environmental surfaces. Most of these efforts focus on surfaces like bed rails that are frequently touched by staff and patients. Despite the fact that floors have consistently been the most heavily contaminated surfaces in hospitals, they have not been a focus of cleaning interventions because they are rarely touched. However, it is plausible that bacteria on floors could picked up by shoes and socks and then transferred onto hands. In a recent study, we found that when a nonpathogenic virus was inoculated onto floors in hospital rooms, it did spread to the hands of patients and to surfaces inside and outside the room. Based on those results, we assessed the frequency of floor contamination in 5 hospitals and examined the potential for transfer of bacteria from the floor to hands.
01 Mar Family Input Improves Hospital Safety Surveillance
MedicalResearch.com Interview with: [caption id="attachment_32411" align="alignleft" width="95"]
Dr. Khan[/caption]
Alisa Khan, MD, MPH
Staff Physician
Instructor in Pediatrics
Boston Children's Hospital
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Medical errors are known to be a leading cause of death in the United States. However, the true rate at which errors and adverse events occur in medicine is believed to be even higher than what has been found through the most rigorous patient safety studies.
Families are typically excluded from safety surveillance efforts, both in research and operationally in hospitals. We found that including families in safety reporting at four pediatric hospitals led to significantly higher error/adverse event detection rates, compared to the safety surveillance methodology typically considered most rigorous and highest yield in safety research. In addition, families reported errors/adverse events at similar rates as providers and at several-fold higher rates than the hospital incident reports which typically form the basis of operational hospital safety surveillance.
25 Feb Enrollment in Heart Failure Registry Associated With Improved Survival
MedicalResearch.com Interview with: Lars H. Lund, MD Phd, Assoc. Prof., FESC Department of Medicine, Karolinska Institutet, and Department of Cardiology, Karolinska University Hospital Sweden MedicalResearch.com: What is the background for this study? What are the main findings? Response: Registries are accepted for quality reporting but it is actually unknown whether in heart failure they directly improve outcomes. Here, enrollment in SwedeHF was strongly associated with reduced mortality.17 Feb Estimating Hospital-Related Deaths Due to Medical Error
MedicalResearch.com Interview wth: [caption id="attachment_32106" align="alignleft" width="200"]
Dr. Kevin Kavanagh[/caption]
Kevin Kavanagh, MD, MS
Board Chairman of Health Watch USA
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The genesis of our study was a desire to respond to a keynote speech at a major national patient safety conference which seemed to mitigate the problem of preventable hospital mortality in the United States.
Our main finding is that there is credible evidence indicating that the preventable hospital mortality rate is more than 160,000 per year. When one considers the events which were not captured, and that we did not count diagnostic errors or post-discharge presentation of events, this number can be projected to approximate or exceed 200,000.
06 Feb Study Validates Good Quality Care Provided By Foreign-Trained Doctors
Posted at 16:10h
in Author Interviews, BMJ, Brigham & Women's - Harvard, Education, Outcomes & Safety
MedicalResearch.com Interview with:
[caption id="attachment_31685" align="alignleft" width="180"]
Dr. Yusuke Tsugawa[/caption]
Yusuke Tsugawa, MD, MPH, PhD
Research Associate at Department of Health Policy and Management
Harvard T.H. Chan School of Public Health
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Prior evidence has been mixed as to whether or not patient outcomes
differ between U.S. and foreign medical graduates.
However, previous studies used small sample sizes or data from a small number of states.
Therefore, it was largely unknown how international medical graduates
perform compared with US medical graduates.
To answer this question, we analyzed a nationally representative
sample of Medicare beneficiaries admitted to hospitals with a medical
condition in 2011-2014. Our sample included approximately 1.2 million
hospitalizations treated by 40,000 physicians. After adjusting for
severity of illness of patients and hospitals (we compared physicians
within the same hospital), we found that patient treated by
international medical graduates had lower mortality than patients
cared for by US medical graduates (adjusted 30-day mortality rate
11.2% vs 11.6%, p<0.001). We observed no difference in readmissions,
whereas costs of care was slightly higher for international medical
graduates.
01 Feb Best Case/Worst Case Framework Helps Surgeons Communicate With Frail Seriously Ill Patients
MedicalResearch.com Interview with: [caption id="attachment_31637" align="alignleft" width="189"]
Dr. Margaret Schwarze[/caption]
Margaret L Schwarze, MD, MPP
Associate Professor
Division of Vascular Surgery
University of Wisconsin
MedicalResearch.com: What is the background for this study?
Response: Surgery can have life-altering consequences for frail older adults, yet many undergo an operation during the last year of life. Surgeons commonly rely on informed consent to disclose risks of discrete complications; however, this information is challenging for patients to interpret with respect to their goals and values.
Our research group developed a communication framework, called Best Case/Worst Case, to change how surgeons communicate with patients facing serious illness. Surgeons use the framework to describe the best, worst, and most likely scenarios to present a choice between valid treatment alternatives and help patients imagine how they might experience a range of possible treatment outcomes.
25 Jan Maternal Mortality and Morbidity Increased on Weekends
Posted at 21:31h
in Author Interviews, Baylor College of Medicine Houston, OBGYNE, Outcomes & Safety
MedicalResearch.com Interview with;
Dr. Amirhossein Moaddab
Postdoctoral Research Fellow at Baylor College of Medicine
Houston, Texas
MedicalResearch.com: What is the background for this study?
Response: Based on data from the Centers for Disease Control and Prevention, the United States maternal mortality ratio is three to four times higher than that of most other developed nations. Previous studies from the demonstrated a possible association between weekend hospital admissions and higher rates of mortality and poor health outcomes.
We investigated differences in maternal and fetal death ratios on weekends compared to weekdays and during different months of the year. In addition we investigated the presence of any medical and obstetrics complications in women who gave birth to a live child and in their offspring by day of delivery.
27 Dec Hospital Readmissions Fell After Penalties Instituted But Then Plateaued
MedicalResearch.com Interview with: Nihar R. Desai, MD, MPH Assistant Professor of Medicine Section of Cardiovascular Medicine, Yale School of Medicine Center for Outcomes Research and Evaluation Yale New Haven Health System MedicalResearch.com: What is the background for this study? Response: Reducing rates of readmissions after hospitalization has been a major focus for patients, providers, payers, and policymakers because they reflect, at least partially, the quality of care and care transitions, and account for substantial costs. The Hospital Readmission Reduction Program (HRRP) was enacted under Section 3025 of the Patient Protection and Affordable Care Act (ACA) in March 2010 and imposed financial penalties beginning in October 2012 for hospitals with higher than expected readmissions for acute myocardial infarction (AMI), congestive heart failure (HF), and pneumonia among their fee-for-service Medicare beneficiaries. In recent years, readmission rates have fallen nationally, and for both target (AMI, HF, pneumonia) and non-target conditions. We were interested in determining whether the Hospital Readmission Reduction Program (HRRP) associated with different changes in readmission rates for targeted and non-targeted conditions for penalized vs non-penalized hospitals?20 Dec Patients Treated By Female Doctors Have Better Outcomes and Fewer Readmissions
Posted at 12:42h
in Author Interviews, Brigham & Women's - Harvard, Gender Differences, Hospital Readmissions, JAMA
MedicalResearch.com Interview with:
[caption id="attachment_30658" align="alignleft" width="180"]
Dr. Yusuke Tsugawa[/caption]
Yusuke Tsugawa, MD, MPH, PhD
Department of Health Policy and Management
Harvard T. H. Chan School of Public Health,
Department of Medicine
Brigham and Women’s Hospital and Harvard Medical School
Boston, Massachusetts
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: We analyzed a 20% sample of Medicare beneficiaries hospitalized with a medical condition in 2011-2014, and found that patients treated by female doctors have lower mortality and readmission rates than those cared for by male doctors.
17 Dec Relationship Between Physician Burnout and Quality of Care
MedicalResearch.com Interview with: [caption id="attachment_30593" align="alignleft" width="128"]
Dr. Salyers[/caption]
Michelle P. Salyers Ph.D.
Professor, Psychology
Director, Clinical Psychology Program
Director, ACT Center of Indiana
Affiliated Scientist, Regenstrief Institute, Inc.
Indiana University-Purdue University
Indianapolis, IN
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Professional burnout among healthcare providers is receiving more attention in research and in public press. There have long been speculations that the level of burnout may be related to quality of care provided, and many studies have been done linking provider burnout with different aspects of quality of care.
This study brings together that literature, to summarize and quantify the link between professional burnout in healthcare provider and the quality of care they provide. We were able to combine data from 82 independent samples, across health care disciplines, settings, and types of quality indicators. We found small to medium relationships between provider burnout and indicators of quality of care.
12 Dec Recommended Medical Handoff Strategies Remain Underutilized
MedicalResearch.com Interview with: [caption id="attachment_30135" align="alignleft" width="225"]
Dr. Charlie Wray[/caption]
Charlie M. Wray, DO, MS
Assistant Clinical Professor of Medicine
University of California, San Francisco Department of Medicine
San Francisco VA Medical Center
MedicalResearch.com: What is the background for this study?
Response: Since the establishment of residency duty hour regulations in 2010, which subsequently lead to increased discontinuity of inpatient care and more resident shift work, educators and researchers have attempted to establish which shift handoff technique(s) or strategies work best.
National organizations, such as the ACGME, AHRQ, and the Joint Commission have made specific recommendations that are considered "best practice". In our study, using an annual national survey given to Internal Medicine Program Directors, we examined the degree of implementation of these recommended handoff strategies and the proportion of Program Director satisfaction with each of the respective strategies.
09 Dec End of Resident Rotation May Be Risky Time For Hospitalized Patients
MedicalResearch.com Interview with: [caption id="attachment_30402" align="alignleft" width="133"]
Dr. Joshua Denson[/caption]
Joshua L Denson MD
Pulmonary and Critical Care Medicine
University of Colorado School of Medicine
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Miscommunication during physician transition in care has been associated with adverse patient events and medical errors; however, an understudied topic is the transition in care that occurs each month when resident physicians switch clinical rotations, also called an end-of-rotation transition. During this handoff, hospitalized patients (up to 10-20) are handed over to an oncoming physician who has never met the patients. We sought to investigate if this type of transition was associated with worse patient outcomes, specifically mortality.
On July 1, 2011, the Accreditation Council for Graduate Medical Education (ACGME) duty-hour regulations limited first-year resident physicians (interns) to 16 continuous hours of work. Although these rules do not appear to have affected overall patient safety outcomes, they have been associated with an increase in shift-to-shift handoffs among training physicians. Given this, we wanted to study how they might impact patient outcomes surrounding end-of-rotation transitions in care.
08 Dec Patients Prefer Online Portal To Receive Skin Biopsy Results
Posted at 16:33h
in Author Interviews, Dermatology, Electronic Records, JAMA, Outcomes & Safety, Surgical Research
MedicalResearch.com Interview with:
Sophia Akhiyat
M.D. Candidate, Class of 2017
The George Washington University School of Medicine and Health Sciences
METEOR Fellowship
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Our study was inspired by one of Choudhry et al,1 in which patients' preferences for skin biopsy result disclosure was surveyed at melanoma clinics affiliated with several academic institutions. We sought to broaden participant inclusion criteria by evaluating patients' preferences at a general dermatology clinic at an academic center.
Our findings support that the highest ranked patient-preferred method for receiving skin biopsy results was through an online portal. Patients also reported that the most important factors when selecting a modality for communication were the amount of information given and time available to discuss results. We also observed a relationship between a younger patient age range and online portal experience as well as a preference for biopsy notification via online portal.
1Choudhry A, Hong J, Chong K, et al. Patients' Preferences for Biopsy Result Notification in an Era of Electronic Messaging Methods. JAMA Dermatol. 2015;151(5):513-521.
04 Dec Delayed Epinephrine Linked To Worse Survival From In-Patient Cardiac Arrest
Posted at 23:04h
in AHA Journals, Author Interviews, Heart Disease, Outcomes & Safety, UT Southwestern
MedicalResearch.com Interview with:
Rohan Khera, MD
Cardiology Fellow, T32 Clinical-Investigator Pathway
UT Southwestern Medical Center
Dallas, TX
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Nearly 200 thousand people have an in-hospital cardiac arrest in the US each year. Of these, the vast majority have a non-shockable initial rhythm – either pulseless electric activity (PEA) or asystole. The survival of this type of arrest remains poor at around 12-14%. Moreover, even after accounting for differences in case mix, there is a wide variation in survival across hospitals – and this serves as a potential avenue for targeting quality improvement strategies at poor performing hospitals.
Recent data suggest that a shorter time from the onset of cardiac arrest to the first dose of epinephrine is independently associated with higher survival. Against this background of wide hospital variation in cardiac arrest survival, and patient-level data suggesting an association between time to epinephrine and patient survival, we wanted to assess (A) if there were differences in time to epinephrine administration across hospitals, and (B) if a hospital’s rate of timely epinephrine use was associated with its cardiac arrest survival rate. Within Get With The Guidelines-Resuscitation, we identified nearly 104-thousand adult patients at 548 hospitals with an in-hospital cardiac arrest attributable to a non-shockable rhythms. delays to epinephrine,
We found that (a) proportion of cardiac arrests with delayed epinephrine markedly across hospitals, ranging from no arrests with delay (or 0%) to more than half of arrests at a hospital (54%).
There was an inverse correlation between a hospital’s rate of delayed epinephrine administration and its risk-standardized rate of survival to discharge and survival with functional recovery - compared to a low-performing hospitals, survival and recovery was 20% higher at hospitals that performed best on timely epinephrine use.
30 Nov Poor Ratings Linked to Hospitals in Distressed Neighborhoods
MedicalResearch.com Interview with: Jianhui Hu, PhD Center for Health Policy & Health Services Research Henry Ford Health System Detroit, Michigan MedicalResearch.com: What is the background for this study? What are the main findings? Response: In July of 2016, the Center for Medicare and Medicaid services (CMS) released its first-ever hospital Star Rating for consumers to use to compare hospital quality. Since earlier studies have shown that hospitals serving lower-socioeconomic-status (SES) communities have lower scores on measures like readmission rate that are a part of the Star Rating system, we wanted to find out whether a similar relationship might be found between community-level SES and the Star Ratings. Our study used a recently released “stress” ranking of 150 most populated U.S cities and explored possible associations with the hospital Star Ratings. This “stress” ranking was a composite score of 27 individual metrics measuring a number of characteristics of the cities, such as job security, unemployment rate, housing affordability, poverty, mental health, physical activity, health condition, crime rate, etc. Our study found that less-stressed cities had average higher hospital Star Ratings (and more-stressed cities had lower average hospital Star Ratings). Cities such as Detroit and Newark are good examples of those with high “stress” and relatively low hospital Star Ratings, and cities like Madison and Sioux Falls of those with relatively low stress and relatively high hospital Star Ratings. Our correlational analysis indicated that around 20% of the difference in the Star Ratings can be explained by characteristics of the cities in which hospitals were located.28 Nov Peripheral IV Lines Linked To Lower Risk of Blood Clots After Transfusion
MedicalResearch.com Interview with: Mary A.M. Rogers, PhD, MS Research Associate Professor Research Director, Patient Safety Enhancement Program Department of Internal Medicine University of Michigan Ann Arbor, MI MedicalResearch.com: What is the background for this study? Response: Peripherally inserted central catheters (PICCs) are commonly used for vascular access in hospitalized patients. Previous studies have shown that PICCs of larger gauge (diameter) increase the risk of developing venous thromboembolism (blood clots in the deep veins that sometimes travel to the lung). Red blood cell transfusion is also known to increase the risk of venous thromboembolism. Because PICCs are often used to transfuse blood, we designed a study to investigate whether the method of transfusion delivery influences the risk of developing venous thromboembolism.28 Nov Patient Room Lighting Improves Sleep in Hospital Patients
Posted at 14:08h
in Author Interviews, Critical Care - Intensive Care - ICUs, Outcomes & Safety, Sleep Disorders
MedicalResearch.com Interview with:
Luc Schlangen PhD
Principal Scientist at Philips Lighting Research Eindhoven
the Netherlands
MedicalResearch.com: What is the background for this study? What are the main finding
Response: Everyone knows that sleep is critical to one’s overall health and well-being. Yet one-third of the general adult population report difficulties sleeping. Ongoing social commitments and work routines make it difficult to make sleep a priority, also in hospitals.
People increasingly recognize that the usage of light emitting electronic devices before bedtime is compromising sleep. Consequently, many people started to use these devices in a more sleep-permissive mode during the evening, using algorithms that automatically dim down the intensity and blue content of their tablet and smart phone screens as the evening progresses. Moreover, there is increasing evidence that brighter daytime light conditions help to improve mood and nighttime sleep quality.
These observations inspired us to undertake a joint study with the Maastricht University Medical Center. In the study we explored whether a tunable lighting system with extra daytime brightness and lower light intensities and warmer tones of light in the evening and night, can improve sleep and wellbeing in hospital patients. We found that the system was well appreciated and helped hospital patients to fall asleep more rapidly. Moreover, after 5 days in a room with such a dynamic lighting system patients slept longer by almost 30 minutes as compared to a standardly lit room.
22 Nov More Surgeries, Fewer Deaths From Abdominal Aortic Aneurysms in US than UK
MedicalResearch.com Interview with: [caption id="attachment_29912" align="alignleft" width="200"]
Dr. Alan Karthikesalingam[/caption]
Alan Karthikesalingam MD PhD, NIHR
Academic Clinical Lecturer in Vascular Surgery
St George's Vascular Institute
London, UK
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The background for this study was that the typical diameter at abdominal aortic aneurysm (AAA) repair, and the population incidence of AAA repair, have been known to vary considerably between different countries. This study aimed to observe whether a discrepancy in the population incidence rate of AAA repair between England and the USA was seen alongside a discrepancy in population rates of AAA-related mortality or AAA rupture in those countries.
19 Nov Hypoglycemia Linked To Increased Mortality in Hospitalized Patients
Posted at 20:30h
in Author Interviews, Critical Care - Intensive Care - ICUs, Diabetes, JCEM, Outcomes & Safety
MedicalResearch.com Interview with:
Amit Akirov, MD
Institute of Endocrinology
Rabin Medical Center- Beilinson Hospital
Petach Tikva, Israel
MedicalResearch.com: What is the background for this study?
Response: As hypoglycemia is common among hospitalized patients with and without diabetes mellitus, we aimed to investigate the association between spontaneous and insulin-related hypoglycemia including severe hypoglycemia and all-cause mortality among a large cohort of hospitalized patients.
16 Nov Substituting Less Well Trained Assistants For Nurses Increased Hospital Mortality
Posted at 20:41h
in Author Interviews, BMJ, Cost of Health Care, Nursing, Outcomes & Safety, University of Pennsylvania
MedicalResearch.com Interview with:
[caption id="attachment_29710" align="alignleft" width="200"]
Dr Linda H Aiken[/caption]
Dr Linda H Aiken PhD, FAAN, FRCN, RN
Claire M. Fagin Leadership Professor in Nursing
Professor of Sociology, School of Arts & Sciences
Director, Center for Health Outcomes and Policy Research
University of Pennsylvania School of Nursing
Center for Health Outcomes and Policy Research
Philadelphia, PA 19104
MedicalResearch.com: What is the background for this study?
Response: The idea that adding lower skilled and lower wage caregivers to hospitals instead of increasing the number of professional nurses could save money without adversely affecting care outcomes is intuitively appealing to mangers and policymakers but evidence is lacking on whether this strategy is safe or saves money.
15 Nov Heart Disease Patients Admitted To Critical Care Units in Teaching Hospitals May Fare Better
Posted at 12:36h
in Author Interviews, Critical Care - Intensive Care - ICUs, Education, Heart Disease, Outcomes & Safety
MedicalResearch.com Interview with:
[caption id="attachment_29515" align="alignleft" width="143"]
Dr. Sean van Diepen[/caption]
Dr. Sean van Diepen, MD, FRCPC
Assistant Professor of Critical Care Medicine and Cardiology
Coronary Intensive Care Unit Co-Director
University of Alberta Hospital
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Studies have documented a wide variation in CCU admission rates for patients hospitalized with acute coronary syndromes (ACS) or heart failure (HF). The reasons underpinning these differences are incompletely understood and little is known about the associations between hospital type, resource utilization, and clinical outcomes among patients admitted to the CCU with an ACS or HF.
In a national cohort of 220,759 patients, we observed that CCU admission rates varied by hospital type: 41% in teaching hospitals, 29.9% in large teaching hospitals, 42.6% in medium community hospitals and13.7% in small community hospitals. The percentage of patients that did not receive critical care therapies within the first 2 days of admission were: 35.5%, 58.0%, 83.3% and 95.6%, respectively. Compared large community hospitals, community hospitals all had higher adjusted in hospital mortality rates.
07 Nov Death Rate Higher In C.diff Patients Who Do Not Receive Guideline-Adherent Therapy
MedicalResearch.com Interview with: [caption id="attachment_29447" align="alignleft" width="200"]
Dr. Shannon Novosad[/caption]
Dr. Shannon Novosad, MD
Epidemic Intelligence Service, CDC
Division of Healthcare Quality Promotion
National Center for Emerging and Zoonotic Infectious Diseases
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Clostridium difficile can cause an infection in the colon called colitis. Symptoms include diarrhea, fever, nausea, and abdominal pain. It is an important cause of healthcare associated infections with approximately half a million C. difficile infections and 29,000 associated deaths in 2011. The Infectious Diseases Society of America and Society for Healthcare Epidemiology of America published guidelines in 2010 advising clinicians on appropriate antibiotic regimens to treat C. difficile infection. Prior studies have found that provider adherence to these guidelines, particularly in those with severe disease, is poor. However, these studies primarily involved patients treated at a single healthcare facility. We were interested in examining CDI treatment practices in a larger group of patients with C. difficile infection located across geographically diverse areas. Further we wanted to learn more about what patient characteristics might be associated with receiving guideline-adherent therapy for C. difficile infection.
We used data from the Center for Disease Control and Prevention’s Emerging Infections Program (EIP) which performs active population and laboratory-based surveillance for C. difficile infections in 10 U.S. sites and examined how 11,717 patients including 2006 with severe disease were treated. We found that provider adherence to national treatment guidelines was low with only around 40% of those with severe disease being prescribed the appropriate antibiotic treatment. Our analysis suggests that those who were tested for C. difficile in the hospital or who were admitted to the hospital around the time of diagnosis were more likely to receive recommended antibiotic therapy.
In addition, patients greater than 65 years old or with more underlying comorbidities were more likely to receive the right antibiotic treatment. We also found that after adjusting for age and underlying comorbidities, the odds of death within 30 days of diagnosis was almost 400% higher in patients who did not receive guideline-adherent therapy compared to those who did.
18 Oct LEAN Principles Improved Surgical Safety, Outcomes and Efficiency
MedicalResearch.com Interview with: Vishal Sarwahi, MD, senior author Associate Surgeon-in-Chief Chief, Spinal Deformity and Pediatric Orthopaedics Billie and George Ross center for Advanced Pediatric Orthopaedics and Minimally Invasive Spinal Surgery Cohen's Children Medical Center Northwell Hofstra School of Medicine and [caption id="attachment_28960" align="alignleft" width="125"]
Stephen F. Wendolowski[/caption]
Stephen F. Wendolowski
Research Assistant
Pediatric Orthopaedics
Cohen Children’s Medical Center
New Hyde Park, NY, 11040
MedicalResearch.com: What is LEAN?
Response: LEAN is a management principle that supports the concept of continuous improvement through small incremental changes to not only improve efficiency, but also quality. Particularly, we took interest in the 5S’s – Sort, Simplify, Sweep, Standardize, and Self-Discipline. We felt that Sort, Simplify, and Standardize were the most relevant to surgery.
17 Oct Quality of Outpatient Care Has Not Consistently Improved Over Last Decade
MedicalResearch.com Interview with: [caption id="attachment_28930" align="alignleft" width="180"]
Dr. David Levine[/caption]
David Michael Levine M.D.,M.A.
Division of General Internal Medicine and Primary Care
Brigham and Women’s Hospital
Boston, Massachusetts
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: About a decade ago, researchers showed that Americans only received half of recommended health care. Since then, national, regional, and local initiatives have attempted to improve quality and patient experience, but there is incomplete information about whether such efforts have been successful.
We found that over the past decade the quality of outpatient care has not consistently improved, while patient experience has improved.
12 Oct Big Data Using Predictive Analytics Aims To Improve Medication Adherence
[caption id="attachment_28837" align="alignleft" width="200"]
Neil Smiley[/caption]
MedicalResearch.com Interview with:
Neil Smiley
Founder and CEO of Loopback Analytics
Editor's note: Loopback Analytics mission is to "integrate data across a myriad of healthcare information systems to bridge the expanding gaps within the care continuum". CEO Neil Smiley discusses the problem of medication adherence and possible means to address the issue.
MedicalResearch.com: What is meant by medication "adherence"? How big a problem does this represent in term of health care outcomes and costs?
Response: Medication adherence is the degree to which a patient is taking medications as prescribed. Poor medication adherence takes the lives of 125,000 Americans annually, and costs the health care system nearly $300 billion a year in additional doctor visits, emergency department visits and hospitalizations.
MedicalResearch.com: What can be done by health care providers, systems and pharmacists to improve medication adherence?
Response: There are many potential failure points after a prescription is written, that range from affordability, transportation, literacy, confusion over brand vs. generics, duplication of therapy. Many patients simply stop taking medications when they start feeling better or fail to refill chronic maintenance medications. Healthcare providers can improve adherence by anticipating and eliminating potential points of failure before they become problems. For example, high risk patients leaving the hospital are less likely to be readmitted if they get their prescriptions before they are discharged. Follow-up consultations by pharmacists can assist patients with side effects that may otherwise cause patients to abandon their treatment plan and provide patients with education on how to take medications correctly.