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Journal of Clinical Outcomes Management最新文献

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Geriatric-Centered Interdisciplinary Care Pathway Reduces Delirium in Hospitalized Older Adults With Traumatic Injury 以老年病学为中心的跨学科护理途径可减少住院老年人创伤性损伤的谵妄
Q4 Medicine Pub Date : 2022-07-01 DOI: 10.12788/jcom.0105
Ko
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引用次数: 0
Author Q&A: Intravenous Immunoglobulin for Treatment of COVID-19 in Select Patients 作者问答:选择患者静脉注射免疫球蛋白治疗新冠肺炎
Q4 Medicine Pub Date : 2022-07-01 DOI: 10.12788/jcom.0103
Sakoulas
An interview with Dr George Sakoulas, an infectious diseases clinician at Sharp Memorial Hospital in San Diego CA, is presented. Sakoulas talks about work around COVID-19 management, the economics of inpatient care, and connection between the medical outcomes and pharmacoeconomics findings from his article and link it to the bedside and treatment of their patients.
本文介绍了对加州圣地亚哥夏普纪念医院传染病临床医生George Sakoulas博士的采访。Sakoulas谈到了围绕COVID-19管理的工作,住院治疗的经济学,以及他的文章中医疗结果与药物经济学发现之间的联系,并将其与患者的床边和治疗联系起来。
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引用次数: 0
Supporting Patients on Complex Care Journeys: How Technology Can Bridge the Gaps 支持患者进行复杂的护理之旅:技术如何弥合差距
Q4 Medicine Pub Date : 2022-07-01 DOI: 10.12788/jcom.0107
Flyckt
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引用次数: 0
Comorbidity Coding and Its Impact on Hospital Complexity: Reply 共病编码及其对医院复杂性的影响:回复
Q4 Medicine Pub Date : 2022-07-01 DOI: 10.12788/jcom.0102
Sosa
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引用次数: 0
Intravenous Immunoglobulin in Treating Nonventilated COVID-19 Patients With Moderate-to-Severe Hypoxia: A Pharmacoeconomic Analysis 静脉注射免疫球蛋白治疗COVID-19中至重度缺氧非通气患者:药物经济学分析
Q4 Medicine Pub Date : 2022-06-01 DOI: 10.12788/jcom.0094
M. Poremba
Objective: To compare the costs of hospitalization of patients with moderate-to-severe COVID-19 who received intravenous immunoglobulin (IVIG) with those of patients of similar comorbidity and illness severity who did not. Design: Analysis 1 was a case-control study of 10 nonventilated, moderately to severely hypoxic patients with COVID-19 who received IVIG (Privigen [CSL Behring]) matched 1:2 with 20 control patients of similar age, body mass index, degree of hypoxemia, and comorbidities. Analysis 2 consisted of patients enrolled in a previously published, randomized, open-label prospective study of 14 patients with COVID-19 receiving standard of care vs 13 patients who received standard of care plus IVIG (Octagam 10% [Octapharma]). Setting and participants: Patients with COVID-19 with moderate-to-severe hypoxemia hospitalized at a single site located in San Diego, California. Measurements: Direct cost of hospitalization. Results: In the first (case-control) population, mean total direct costs, including IVIG, for the treatment group were $21,982 per IVIG-treated case vs $42,431 per case for matched non-IVIG-receiving controls, representing a net cost reduction of $20,449 (48%) per case. For the second (randomized) group, mean total direct costs, including IVIG, for the treatment group were $28,268 per case vs $62,707 per case for untreated controls, representing a net cost reduction of $34,439 (55%) per case. Of the patients who did not receive IVIG, 24% had hospital costs exceeding $80,000;none of the IVIG-treated patients had costs exceeding this amount (P=.016, Fisher exact test). Conclusion: If allocated early to the appropriate patient type (moderate-to-severe illness without end-organ comorbidities and age <70 years), IVIG can significantly reduce hospital costs in COVID-19 care. More important, in our study it reduced the demand for scarce critical care resources during the COVID-19 pandemic.
目的:比较中重度COVID-19患者静脉注射免疫球蛋白(IVIG)与具有相似合并症和疾病严重程度但未静脉注射免疫球蛋白的住院费用。设计:分析1是一项病例对照研究,纳入10例接受IVIG (Privigen [CSL Behring])治疗的非通气、中度至重度缺氧的COVID-19患者,与20例年龄、体重指数、低氧血症程度和合并症相似的对照组患者进行1:2匹配。分析2包括纳入先前发表的一项随机、开放标签前瞻性研究的患者,其中14例接受标准治疗的COVID-19患者与13例接受标准治疗加IVIG (Octapharma 10%)的患者。环境和参与者:在加利福尼亚州圣地亚哥的一个医院住院的患有中重度低氧血症的COVID-19患者。测量方法:直接住院费用。结果:在第一组(病例对照)人群中,治疗组的平均总直接成本(包括IVIG)为每例接受IVIG治疗的病例21,982美元,而匹配的非接受IVIG治疗的对照组为每例42,431美元,每例净成本降低20,449美元(48%)。对于第二组(随机),治疗组的平均总直接成本(包括IVIG)为每例28,268美元,而未经治疗的对照组为62,707美元,每例净成本降低34,439美元(55%)。在未接受免疫球蛋白治疗的患者中,24%的患者住院费用超过80,000美元;接受免疫球蛋白治疗的患者的费用均未超过这一数额(P=。费雪精确检验)。结论:如果早期分配到适当的患者类型(无终末器官合并症的中重度疾病且年龄<70岁),IVIG可显着降低COVID-19护理的医院成本。更重要的是,在我们的研究中,它减少了对COVID-19大流行期间稀缺的重症监护资源的需求。
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引用次数: 2
Overall Survival Gain With Adding Darolutamide to ADT and Docetaxel in Metastatic, Hormone-Sensitive Prostate Cancer Darolutamide联合ADT和多西紫杉醇治疗转移性激素敏感前列腺癌的总生存期增加
Q4 Medicine Pub Date : 2022-06-01 DOI: 10.12788/jcom.0093
Kagathur
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引用次数: 0
The Intersection of Clinical Quality Improvement Research and Implementation Science 临床质量改进研究与实施科学的交叉
Q4 Medicine Pub Date : 2022-06-01 DOI: 10.12788/jcom.0099
Barkoudah
The Institute of Medicine brought much-needed attention to the need for process improvement in medicine with its seminal report To Err Is Human: Building a Safer Health System, which was issued in 1999, leading to the quality movement’s call to close health care performance gaps in Crossing the Quality Chasm: A New Health System for the 21st Century.1,2 Quality improvement science in medicine has evolved over the past 2 decades to include a broad spectrum of approaches, from agile improvement to continuous learning and improvement. Current efforts focus on Lean-based process improvement along with a reduction in variation in clinical practice to align practice with the principles of evidence-based medicine in a patient-centered approach.3 Further, the definition of quality improvement under the Affordable Care Act was framed as an equitable, timely, value-based, patient-centered approach to achieving population-level health goals.4 Thus, the science of quality improvement drives the core principles of care delivery improvement, and the rigorous evidence needed to expand innovation is embedded within the same framework.5,6 In clinical practice, quality improvement projects aim to define gaps and then specific steps are undertaken to improve the evidence-based practice of a specific process. The overarching goal is to enhance the efficacy of the practice by reducing waste within a particular domain. Thus, quality improvement and implementation research eventually unify how clinical practice is advanced concurrently to bridge identified gaps.7 System redesign through a patient-centered framework forms the core of an overarching strategy to support system-level processes. Both require a deep understanding of the fields of quality improvement science and implementation science.8 Furthermore, aligning clinical research needs, system aims, patients’ values, and clinical care give the new design a clear path forward. Patient-centered improvement includes the essential elements of system redesign around human factors, including communication, physical resources, and updated information during episodes of care. The patient-centered improvement design is juxtaposed with care planning and establishing continuum of care processes.9 It is essential to note that safety is rooted within the quality domain as a top priority in medicine.10 The best implementation methods and approaches are discussed and debated, and the improvement progress continues on multiple fronts.11 Patient safety systems are implemented simultaneously during the redesign phase. Moreover, identifying and testing the health care delivery methods in the era of competing strategic priorities to achieve the desirable clinical outcomes highlights the importance of implementation, while contemplating the methods of dissemination, scalability, and sustainability of the best evidence-based clinical practice. The cycle of quality improvement research completes the system implementation efforts. The c
医学研究所(Institute of Medicine)在1999年发布的开创性报告《犯错即是人:建立一个更安全的卫生系统》(to Err Is Human: Building a Safer Health System)中,对医学过程改进的需求给予了急需的关注,这导致了质量运动在《跨越质量鸿沟》(Crossing The quality Chasm)中呼吁缩小卫生保健绩效差距。21世纪的新卫生系统1,2在过去的20年里,医学质量改进科学已经发展到包括从敏捷改进到持续学习和改进的广泛方法。目前的工作重点是基于精益的流程改进,同时减少临床实践中的变化,以使实践与以患者为中心的循证医学原则保持一致此外,根据《负担得起的医疗法案》,质量改进的定义是一种公平、及时、以价值为基础、以病人为中心的实现全民健康目标的方法因此,质量改进科学推动了改善护理服务的核心原则,扩大创新所需的严格证据也嵌入在同一框架中。5,6在临床实践中,质量改进项目旨在确定差距,然后采取具体步骤来改进特定过程的循证实践。总体目标是通过减少特定领域内的浪费来增强实践的有效性。因此,质量改进和实施研究最终统一了如何同时推进临床实践,以弥合已确定的差距通过以患者为中心的框架进行系统重新设计,形成了支持系统级流程的总体战略的核心。两者都需要对质量改进科学和实施科学领域有深刻的理解此外,将临床研究需求、系统目标、患者价值和临床护理结合起来,为新设计提供了一条清晰的前进道路。以患者为中心的改进包括围绕人为因素重新设计系统的基本要素,包括沟通、物理资源和护理期间的更新信息。以病人为中心的改善设计与护理计划并列,并建立连续的护理过程必须注意的是,安全性植根于质量领域,是医学的重中之重对最佳的实施方法和途径进行了讨论和辩论,并且在多个方面继续进行改进患者安全系统在重新设计阶段同时实施。此外,在竞争战略优先事项的时代,确定和测试医疗保健提供方法,以实现理想的临床结果,突出了实施的重要性,同时考虑最佳循证临床实践的传播、可扩展性和可持续性方法。周期质量改进研究完成了系统实施工作。质量改进的概念框架包括护理和过渡的多个领域,以及在强调持续改进和学习的文化中应用最佳临床实践。同时,其运作原则应包括以一个简单而持续的学习系统为核心理念的持续改进。我们建议的实施方法包括采取简单而实际的步骤,同时将过程与结果度量分开,在整个过程中提取有效性。重要的是要记住,建立一个主动和系统的改进环境需要一个安全、可靠和有效的护理框架,以及物理系统、通信、专业环境和文化的一致性(图)。总之,质量改进研究的系统设计应包括体现有效实施战略的原则和概念框架,重点是操作和实际步骤。通过当前卫生保健系统指标的多维发展和实施科学方法的结合,将实现持续改进。
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引用次数: 0
A Quantification Method to Compare the Value of Surgery and Palliative Care in Patients With Complex Cardiac Disease: A Concept 比较复杂心脏病患者手术与姑息治疗价值的量化方法:一个概念
Q4 Medicine Pub Date : 2022-06-01 DOI: 10.12788/jcom.0095
Gerrah
Patients with complex cardiovascular disease are occasionally considered inoperable due to the high risk of surgical mortality. When the risk of perioperative mortality (POM) is predicted to be too high, surgical intervention is denied, and patients are often referred to palliative care. The risk of POM in cardiac surgery is often calculated using large-scale databases, such as the Society of Thoracic Surgeons (STS) records. The STS risk models, which are regularly updated, are based on large data sets and incorporate precise statistical methods for risk adjustment.1 In general, these calculators provide a percentage value that defines the magnitude of the risk of death, and then an arbitrary range is selected to categorize the procedure as low, medium, or high risk or inoperable status. The STS database does not set a cutoff point or range to define “operability.” Assigning inoperable status to a certain risk rate is problematic, with many ethical, legal, and moral implications, and for this reason, it has mostly remained undefined. In contrast, the lowand medium-risk ranges are easier to define. Another limitation encountered in the STS database is the lack of risk data for less common but very high-risk procedures, such as a triple valve replacement. A common example where risk classification has been defined is in patients who are candidates for surgical vs transcatheter aortic valve replacement. Some groups have described a risk of <4% as low risk,
由于手术死亡率高,复杂心血管疾病患者有时被认为不适合手术。当围手术期死亡率(POM)的风险被预测过高时,手术干预被拒绝,患者通常被转介到姑息治疗。心脏手术中POM的风险通常使用大型数据库计算,例如胸外科医生协会(STS)的记录。定期更新的STS风险模型是基于大量数据集,并采用精确的统计方法进行风险调整一般来说,这些计算器提供一个百分比值,定义死亡风险的大小,然后选择一个任意范围,将手术分类为低、中、高风险或不可手术状态。STS数据库没有设置一个截止点或范围来定义“可操作性”。将不可手术状态分配给一定的风险率是有问题的,涉及许多伦理、法律和道德方面的问题,因此,它在很大程度上仍未定义。相比之下,低风险和中等风险范围更容易定义。STS数据库遇到的另一个限制是缺乏不常见但高风险手术的风险数据,例如三瓣置换术。确定风险分类的一个常见例子是,选择手术或经导管主动脉瓣置换术的患者。一些团体将风险<4%描述为低风险,
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引用次数: 0
Where Does the Hospital Belong? Perspectives on Hospital at Home in the 21st Century 医院属于哪里?展望21世纪的居家医院
Q4 Medicine Pub Date : 2022-06-01 DOI: 10.12788/jcom.0098
Sharma
Brick-and-mortar hospitals in the United States have historically been considered the dominant setting for providing care to patients. The coordination and delivery of care has previously been bound to physical hospitals largely because multidisciplinary services were only accessible in an individual location. While the fundamental make-up of these services remains unchanged, these services are now available in alternate settings. Some of these services include access to a patient care team, supplies, diagnostics, pharmacy, and advanced therapeutic interventions. Presently, the physical environment is becoming increasingly irrelevant as the core of what makes the traditional hospital—the professional staff, collaborative work processes, and the dynamics of the space—have all been translated into a modern digitally integrated environment. The elements necessary to providing safe, effective care in a physical hospital setting are now available in a patient’s home.
美国的实体医院历来被认为是为病人提供护理的主要场所。以前,护理的协调和提供主要局限于实体医院,这主要是因为多学科服务只能在个别地点提供。虽然这些服务的基本组成保持不变,但这些服务现在可以在其他设置中使用。其中一些服务包括获得患者护理团队、供应、诊断、药房和先进的治疗干预措施。目前,物理环境正变得越来越无关紧要,因为传统医院的核心——专业人员、协作工作流程和空间的动态——都被转化为现代数字集成环境。在实体医院环境中提供安全、有效护理所需的要素现在在病人家中就可以获得。
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引用次数: 0
Fall Injury Among Community-Dwelling Older Adults: Effect of a Multifactorial Intervention and a Home Hazard Removal Program 社区居住的老年人跌倒伤害:多因素干预和家庭危险消除计划的效果
Q4 Medicine Pub Date : 2022-06-01 DOI: 10.12788/jcom.0096
W. Hung
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引用次数: 0
期刊
Journal of Clinical Outcomes Management
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