首页 > 最新文献

Journal of Clinical Outcomes Management最新文献

英文 中文
Coronary CT Angiography Compared to Coronary Angiography or Standard of Care in Patients With Intermediate-Risk Stable Chest Pain 中危稳定型胸痛患者冠状动脉CT血管造影与冠状动脉造影或护理标准的比较
Q4 Medicine Pub Date : 2022-06-01 DOI: 10.12788/jcom.0097
Nguyen
{"title":"Coronary CT Angiography Compared to Coronary Angiography or Standard of Care in Patients With Intermediate-Risk Stable Chest Pain","authors":"Nguyen","doi":"10.12788/jcom.0097","DOIUrl":"https://doi.org/10.12788/jcom.0097","url":null,"abstract":"","PeriodicalId":15393,"journal":{"name":"Journal of Clinical Outcomes Management","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44245269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Oxygen Therapies and Clinical Outcomes for Patients Hospitalized With COVID-19: First Surge vs Second Surge COVID-19住院患者的氧气治疗和临床结果:第一次激增vs第二次激增
Q4 Medicine Pub Date : 2022-03-28 DOI: 10.12788/jcom.0086
T. Liesching, Yuxiu PhD Lei
Objective: To compare the utilization of oxygen therapies and clinical outcomes of patients admitted for COVID-19 during the second surge of the pandemic to that of patients admitted during the first surge. Design: Observational study using a registry database. Setting: Three hospitals (791 inpatient beds and 76 intensive care unit [ICU] beds) within the Beth Israel Lahey Health system in Massachusetts. Participants: We included 3183 patients with COVID-19 admitted to hospitals. Measurements: Baseline data included demographics and comorbidities. Treatments included low-flow supplemental oxygen (2-6 L/min), high-flow oxygen via nasal cannula, and invasive mechanical ventilation. Outcomes included ICU admission, length of stay, ventilator days, and mortality. Results: A total of 3183 patients were included: 1586 during the first surge and 1597 during the second surge. Compared to the first surge, patients admitted during the second surge had a similar rate of receiving low-flow supplemental oxygen (65.8% vs 64.1%, P=.3), a higher rate of receiving high-flow nasal cannula (15.4% vs 10.8%, P=.0001), and a lower ventilation rate (5.6% vs 9.7%, P<.0001). The outcomes during the second surge were better than those during the first surge: lower ICU admission rate (8.1% vs 12.7%, P<.0001), shorter length of hospital stay (5 vs 6 days, P<.0001), fewer ventilator days (10 vs 16, P=.01), and lower mortality (8.3% vs 19.2%, P<.0001). Among ventilated patients, those who received high-flow nasal cannula had lower mortality. Conclusion: Compared to the first surge of the COVID-19 pandemic, patients admitted during the second surge had similar likelihood of receiving low-flow supplemental oxygen, were more likely to receive high-flow nasal cannula, were less likely to be ventilated, and had better outcomes.
目的:比较新冠肺炎疫情第二次暴发期间住院患者与第一次暴发期间入院患者的氧气疗法使用情况和临床结果。设计:使用注册数据库进行观察研究。设置:马萨诸塞州Beth Israel Lahey卫生系统内的三家医院(791张住院病床和76张重症监护室病床)。参与者:我们包括3183名入住医院的新冠肺炎患者。测量:基线数据包括人口统计学和合并症。治疗包括低流量补充氧气(2-6 L/min)、通过鼻插管的高流量氧气和有创机械通气。结果包括ICU入院、住院时间、呼吸机天数和死亡率。结果:共有3183名患者被纳入:1586名在第一次激增期间,1597名在第二次激增期间。与第一次激增相比,第二次激增期间入院的患者接受低流量补充氧气的比率相似(65.8%对64.1%,P=.03),接受高流量鼻插管的比率较高(15.4%对10.8%,P=.0001),以及较低的通气率(5.6%vs 9.7%,P<.0001)。第二次激增期间的结果优于第一次激增期间:较低的ICU入院率(8.1%vs 12.7%,P<.0001)、较短的住院时间(5天vs 6天,P<0.0001)、较少的呼吸机天数(10天vs 16天,P=.01)和较低的死亡率(8.3%vs 19.2%,P=.0001)在通气患者中,接受高流量鼻插管的患者死亡率较低。结论:与新冠肺炎大流行的第一次激增相比,在第二次激增期间入院的患者接受低流量补充氧气的可能性相似,更有可能接受高流量鼻插管,不太可能通风,结果更好。
{"title":"Oxygen Therapies and Clinical Outcomes for Patients Hospitalized With COVID-19: First Surge vs Second Surge","authors":"T. Liesching, Yuxiu PhD Lei","doi":"10.12788/jcom.0086","DOIUrl":"https://doi.org/10.12788/jcom.0086","url":null,"abstract":"Objective: To compare the utilization of oxygen therapies and clinical outcomes of patients admitted for COVID-19 during the second surge of the pandemic to that of patients admitted during the first surge. Design: Observational study using a registry database. Setting: Three hospitals (791 inpatient beds and 76 intensive care unit [ICU] beds) within the Beth Israel Lahey Health system in Massachusetts. Participants: We included 3183 patients with COVID-19 admitted to hospitals. Measurements: Baseline data included demographics and comorbidities. Treatments included low-flow supplemental oxygen (2-6 L/min), high-flow oxygen via nasal cannula, and invasive mechanical ventilation. Outcomes included ICU admission, length of stay, ventilator days, and mortality. Results: A total of 3183 patients were included: 1586 during the first surge and 1597 during the second surge. Compared to the first surge, patients admitted during the second surge had a similar rate of receiving low-flow supplemental oxygen (65.8% vs 64.1%, P=.3), a higher rate of receiving high-flow nasal cannula (15.4% vs 10.8%, P=.0001), and a lower ventilation rate (5.6% vs 9.7%, P<.0001). The outcomes during the second surge were better than those during the first surge: lower ICU admission rate (8.1% vs 12.7%, P<.0001), shorter length of hospital stay (5 vs 6 days, P<.0001), fewer ventilator days (10 vs 16, P=.01), and lower mortality (8.3% vs 19.2%, P<.0001). Among ventilated patients, those who received high-flow nasal cannula had lower mortality. Conclusion: Compared to the first surge of the COVID-19 pandemic, patients admitted during the second surge had similar likelihood of receiving low-flow supplemental oxygen, were more likely to receive high-flow nasal cannula, were less likely to be ventilated, and had better outcomes.","PeriodicalId":15393,"journal":{"name":"Journal of Clinical Outcomes Management","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44801707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Using a Real-Time Prediction Algorithm to Improve Sleep in the Hospital 利用实时预测算法改善医院睡眠
Q4 Medicine Pub Date : 2022-03-28 DOI: 10.12788/jcom.0090
Ko
{"title":"Using a Real-Time Prediction Algorithm to Improve Sleep in the Hospital","authors":"Ko","doi":"10.12788/jcom.0090","DOIUrl":"https://doi.org/10.12788/jcom.0090","url":null,"abstract":"","PeriodicalId":15393,"journal":{"name":"Journal of Clinical Outcomes Management","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46367497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Evaluation of the Empower Veterans Program for Military Veterans With Chronic Pain 对患有慢性疼痛的退伍军人的授权退伍军人计划的评估
Q4 Medicine Pub Date : 2022-03-28 DOI: 10.12788/jcom.0089
Uche
Objective: The purpose of this quality improvement project was to abstract and analyze previously collected data from veterans with high-impact chronic pain who attended the Empower Veterans Program (EVP) offered by a Veterans Administration facility in the northeastern United States. Methods: This quality improvement project used data collected from veterans with chronic pain who completed the veterans health care facility’s EVP between August 2017 and August 2019. Preand postintervention data on pain intensity, pain interference, quality of life, and pain catastrophizing were compared using paired t-tests. Results: Although data were abstracted from 115 patients, the final sample included 67 patients who completed both pre-and postintervention questionnaires. Baseline measures of completers and noncompleters were similar. Comparison of pre and post mean scores on completers showed statistically significant findings (P = .004) based on the Bonferroni correction. The medium and large effect sizes (Cohen’s d) indicated clinically significant improvements for veterans who completed the program. Veterans reported high levels of satisfaction with the program. Conclusion: Veterans with chronic high-impact noncancer pain who completed the EVP had reduced pain intensity, pain interference, pain catastrophizing as well as improved quality of life and satisfaction with their health.
目的:本质量改进项目的目的是提取和分析先前收集的数据,这些数据来自参加由美国东北部退伍军人管理局提供的授权退伍军人计划(EVP)的患有严重慢性疼痛的退伍军人。方法:本质量改进项目使用了2017年8月至2019年8月期间完成退伍军人医疗机构EVP的慢性疼痛退伍军人的数据。采用配对t检验比较干预前后疼痛强度、疼痛干扰、生活质量和疼痛灾变的数据。结果:虽然数据来自115名患者,但最终样本包括67名完成干预前和干预后问卷的患者。完成者和未完成者的基线测量相似。在Bonferroni校正的基础上,完成者前后平均得分的比较显示有统计学意义(P = 0.004)。中等和较大的效应量(Cohen’s d)表明,完成该计划的退伍军人在临床上有显著的改善。退伍军人对这个项目的满意度很高。结论:患有慢性高影响性非癌性疼痛的退伍军人在完成EVP后,疼痛强度、疼痛干扰、疼痛灾难化降低,生活质量和健康满意度提高。
{"title":"Evaluation of the Empower Veterans Program for Military Veterans With Chronic Pain","authors":"Uche","doi":"10.12788/jcom.0089","DOIUrl":"https://doi.org/10.12788/jcom.0089","url":null,"abstract":"Objective: The purpose of this quality improvement project was to abstract and analyze previously collected data from veterans with high-impact chronic pain who attended the Empower Veterans Program (EVP) offered by a Veterans Administration facility in the northeastern United States. Methods: This quality improvement project used data collected from veterans with chronic pain who completed the veterans health care facility’s EVP between August 2017 and August 2019. Preand postintervention data on pain intensity, pain interference, quality of life, and pain catastrophizing were compared using paired t-tests. Results: Although data were abstracted from 115 patients, the final sample included 67 patients who completed both pre-and postintervention questionnaires. Baseline measures of completers and noncompleters were similar. Comparison of pre and post mean scores on completers showed statistically significant findings (P = .004) based on the Bonferroni correction. The medium and large effect sizes (Cohen’s d) indicated clinically significant improvements for veterans who completed the program. Veterans reported high levels of satisfaction with the program. Conclusion: Veterans with chronic high-impact noncancer pain who completed the EVP had reduced pain intensity, pain interference, pain catastrophizing as well as improved quality of life and satisfaction with their health.","PeriodicalId":15393,"journal":{"name":"Journal of Clinical Outcomes Management","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44094529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 3
Acute STEMI During the COVID-19 Pandemic at a Regional Hospital: Incidence, Clinical Characteristics, and Outcomes 地区医院COVID-19大流行期间的急性STEMI:发病率、临床特征和结局
Q4 Medicine Pub Date : 2022-03-28 DOI: 10.12788/jcom.0085
Ali
Objectives: The aim of this study was to describe the characteristics and in-hospital outcomes of patients with acute ST-segment elevation myocardial infarction (STEMI) during the early COVID-19 pandemic at Piedmont Athens Regional (PAR), a 330-bed tertiary referral center in Northeast Georgia. Methods: A retrospective study was conducted at PAR to evaluate patients with acute STEMI admitted over an 8-week period during the initial COVID-19 outbreak. This study group was compared to patients admitted during the corresponding period in 2019. The primary endpoint of this study was defined as a composite of sustained ventricular arrhythmia, congestive heart failure (CHF) with pulmonary congestion, and/or in-hospital mortality. Results: This study cohort was composed of 64 patients with acute STEMI;30 patients (46.9%) were hospitalized during the COVID-19 pandemic. Patients with STEMI in both the COVID-19 and control groups had similar comorbidities, Killip classification score, and clinical presentations. The median (interquartile range) time from symptom onset to reperfusion (total ischemic time) increased from 99.5 minutes (84.8- 132) in 2019 to 149 minutes (96.3-231.8;P=.032) in 2020. Hospitalization during the COVID-19 period was associated with an increased risk for combined inhospital outcome (odds ratio, 3.96;P=.046). Conclusion: Patients with STEMI admitted during the first wave of the COVID-19 outbreak experienced longer total ischemic time and increased risk for combined in-hospital outcomes compared to patients admitted during the corresponding period in 2019.
目的:本研究的目的是描述在乔治亚州东北部拥有330个床位的三级转诊中心Piedmont Athens Regional (PAR)的COVID-19大流行早期急性st段抬高型心肌梗死(STEMI)患者的特征和住院结局。方法:在PAR进行了一项回顾性研究,评估在最初的COVID-19爆发期间8周内入院的急性STEMI患者。将该研究组与2019年同期入院的患者进行比较。本研究的主要终点被定义为持续性室性心律失常、充血性心力衰竭(CHF)伴肺充血和/或住院死亡率的组合。结果:本研究队列由64例急性STEMI患者组成,其中30例(46.9%)患者在COVID-19大流行期间住院。COVID-19组和对照组的STEMI患者具有相似的合并症、Killip分类评分和临床表现。从症状发作到再灌注(总缺血时间)的中位数(四分位间距)时间从2019年的99.5分钟(84.8- 132)增加到2020年的149分钟(96.3-231.8;P= 0.032)。在COVID-19期间住院与院内综合预后的风险增加相关(优势比为3.96;P= 0.046)。结论:与2019年同期入院的STEMI患者相比,2019年第一波COVID-19疫情期间入院的STEMI患者总缺血时间更长,住院综合预后风险更高。
{"title":"Acute STEMI During the COVID-19 Pandemic at a Regional Hospital: Incidence, Clinical Characteristics, and Outcomes","authors":"Ali","doi":"10.12788/jcom.0085","DOIUrl":"https://doi.org/10.12788/jcom.0085","url":null,"abstract":"Objectives: The aim of this study was to describe the characteristics and in-hospital outcomes of patients with acute ST-segment elevation myocardial infarction (STEMI) during the early COVID-19 pandemic at Piedmont Athens Regional (PAR), a 330-bed tertiary referral center in Northeast Georgia. Methods: A retrospective study was conducted at PAR to evaluate patients with acute STEMI admitted over an 8-week period during the initial COVID-19 outbreak. This study group was compared to patients admitted during the corresponding period in 2019. The primary endpoint of this study was defined as a composite of sustained ventricular arrhythmia, congestive heart failure (CHF) with pulmonary congestion, and/or in-hospital mortality. Results: This study cohort was composed of 64 patients with acute STEMI;30 patients (46.9%) were hospitalized during the COVID-19 pandemic. Patients with STEMI in both the COVID-19 and control groups had similar comorbidities, Killip classification score, and clinical presentations. The median (interquartile range) time from symptom onset to reperfusion (total ischemic time) increased from 99.5 minutes (84.8- 132) in 2019 to 149 minutes (96.3-231.8;P=.032) in 2020. Hospitalization during the COVID-19 period was associated with an increased risk for combined inhospital outcome (odds ratio, 3.96;P=.046). Conclusion: Patients with STEMI admitted during the first wave of the COVID-19 outbreak experienced longer total ischemic time and increased risk for combined in-hospital outcomes compared to patients admitted during the corresponding period in 2019.","PeriodicalId":15393,"journal":{"name":"Journal of Clinical Outcomes Management","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45991620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
A Practical and Cost-Effective Approach to the Diagnosis of Heparin-Induced Thrombocytopenia: A Single-Center Quality Improvement Study 一种实用且经济有效的诊断肝素诱导的血小板减少症的方法:单中心质量改进研究
Q4 Medicine Pub Date : 2022-03-28 DOI: 10.12788/jcom.0087
Cusick
{"title":"A Practical and Cost-Effective Approach to the Diagnosis of Heparin-Induced Thrombocytopenia: A Single-Center Quality Improvement Study","authors":"Cusick","doi":"10.12788/jcom.0087","DOIUrl":"https://doi.org/10.12788/jcom.0087","url":null,"abstract":"","PeriodicalId":15393,"journal":{"name":"Journal of Clinical Outcomes Management","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49372265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 2
Aiming for System Improvement While Transitioning to the New Normal 在向新常态过渡的同时力求系统改进
Q4 Medicine Pub Date : 2022-03-28 DOI: 10.12788/jcom.0092
Barkoudah
As we transition out of the Omicron surge, the lessons we’ve learned from the prior surges carry forward and add to our knowledge foundation. Medical journals have published numerous research and perspectives manuscripts on all aspects of COVID-19 over the past 2 years, adding much-needed knowledge to our clinical practice during the pandemic. However, the story does not stop there, as the pandemic has impacted the usual, non-COVID-19 clinical care we provide. The value-based health care delivery model accounts for both COVID-19 clinical care and the usual care we provide our patients every day. Clinicians, administrators, and health care workers will need to know how to balance both worlds in the years to come. In this issue of JCOM, the work of balancing the demands of COVID-19 care with those of system improvement continues. Two original research articles address the former, with Liesching et al1 reporting data on improving clinical outcomes of patients with COVID-19 through acute care oxygen therapies, and Ali et al2 explaining the impact of COVID-19 on STEMI care delivery models. Liesching et al’s study showed that patients admitted for COVID-19 after the first surge were more likely to receive high-flow nasal cannula and had better outcomes, while Ali et al showed that patients with STEMI yet again experienced worse outcomes during the first wave. On the system improvement front, Cusick et al3 report on a quality improvement (QI) project that addressed acute disease management of heparin-induced thrombocytopenia (HIT) during hospitalization, Sosa et al4 discuss efforts to improve comorbidity capture at their institution, and Uche et al5 present the results of a nonpharmacologic initiative to improve management of chronic pain among veterans. Cusick et al’s QI project showed that a HIT testing strategy could be safely implemented through an evidence-based process to nudge resource utilization using specific management pathways. While capturing and measuring the complexity of diseases and comorbidities can be challenging, accurate capture is essential, as patient acuity has implications for reimbursement and quality comparisons for hospitals and physicians; Sosa et al describe a series of initiatives implemented at their institution that improved comorbidity capture. Furthermore, Uche et al report on a 10-week complementary and integrative health program for veterans with noncancer chronic pain that reduced pain intensity and improved quality of life for its participants. These QI reports show that, though the health care landscape has changed over the past 2 years, the aim remains the same: to provide the best care for patients regardless of the diagnosis, location, or time. Conducting QI projects during the COVID-19 pandemic has been difficult, especially in terms of implementing consistent processes and management pathways while contending with staff and supply shortages. The pandemic, however, has highlighted the importance of continuing
随着我们从奥密克戎激增中过渡出来,我们从之前的激增中吸取的教训将继续下去,并增加我们的知识基础。在过去的两年里,医学杂志发表了大量关于新冠肺炎各个方面的研究和观点手稿,为我们在大流行期间的临床实践增加了急需的知识。然而,故事并不止于此,因为大流行影响了我们提供的常规非COVID-19临床护理。基于价值的医疗保健提供模式既考虑了新冠肺炎临床护理,也考虑了我们每天为患者提供的常规护理。临床医生、管理人员和医护人员需要知道如何在未来几年平衡这两个世界。在本期JCOM中,平衡新冠肺炎护理需求与系统改进需求的工作仍在继续。两篇原创研究文章针对前者,Liesching等人1报告了通过急性护理氧气疗法改善新冠肺炎患者临床结果的数据,Ali等人2解释了新冠肺炎对STEMI护理提供模型的影响。Liesching等人的研究表明,第一次激增后因新冠肺炎入院的患者更有可能接受高流量鼻插管,并有更好的结果,而Ali等人表明,STEMI患者在第一波期间再次经历更糟糕的结果。在系统改进方面,Cusick等人3报告了一个质量改进(QI)项目,该项目涉及住院期间肝素诱导的血小板减少症(HIT)的急性疾病管理,Sosa等人4讨论了在他们的机构中改善共病捕获的努力,Uche等人5提出了一项旨在改善退伍军人慢性疼痛管理的非药物倡议的结果。Cusick等人的QI项目表明,HIT测试策略可以通过循证过程安全实施,以使用特定的管理途径来推动资源利用。虽然捕捉和测量疾病和合并症的复杂性可能具有挑战性,但准确捕捉至关重要,因为患者的敏锐度对医院和医生的报销和质量比较有影响;Sosa等人描述了他们机构实施的一系列举措,这些举措改善了共病捕获。此外,Uche等人报告了一项针对患有非癌症慢性疼痛的退伍军人的为期10周的补充和综合健康计划,该计划降低了疼痛强度,提高了参与者的生活质量。这些QI报告显示,尽管医疗保健环境在过去两年中发生了变化,但目标仍然不变:无论诊断、地点或时间如何,都要为患者提供最佳护理。在新冠肺炎大流行期间开展QI项目一直很困难,尤其是在实施一致的流程和管理途径方面,同时应对员工和供应短缺。然而,这场疫情凸显了持续QI努力的重要性,特别是围绕传染病预防和良好临床实践。此外,最近围绕新冠肺炎患者护理的持续学习和实施是一项重大成就,临床医生和管理人员不断努力了解和改进流程,创建支持文化,并重新设计即时护理。新冠肺炎护理和我们的常规护理QI工作的管理应纳入从大流行中吸取的经验教训,并利用系统重新设计为未来的步骤。正如我们所看到的,自疫情开始以来,随着临床试验变得更具适应性和效率,公共卫生应对中的远程医疗和数字技术等系统升级取得了重大进展,新冠肺炎的存活率大幅提高。在新常态下,改善诊所和床边护理的工作将通过一种集体方法继续进行。
{"title":"Aiming for System Improvement While Transitioning to the New Normal","authors":"Barkoudah","doi":"10.12788/jcom.0092","DOIUrl":"https://doi.org/10.12788/jcom.0092","url":null,"abstract":"As we transition out of the Omicron surge, the lessons we’ve learned from the prior surges carry forward and add to our knowledge foundation. Medical journals have published numerous research and perspectives manuscripts on all aspects of COVID-19 over the past 2 years, adding much-needed knowledge to our clinical practice during the pandemic. However, the story does not stop there, as the pandemic has impacted the usual, non-COVID-19 clinical care we provide. The value-based health care delivery model accounts for both COVID-19 clinical care and the usual care we provide our patients every day. Clinicians, administrators, and health care workers will need to know how to balance both worlds in the years to come. In this issue of JCOM, the work of balancing the demands of COVID-19 care with those of system improvement continues. Two original research articles address the former, with Liesching et al1 reporting data on improving clinical outcomes of patients with COVID-19 through acute care oxygen therapies, and Ali et al2 explaining the impact of COVID-19 on STEMI care delivery models. Liesching et al’s study showed that patients admitted for COVID-19 after the first surge were more likely to receive high-flow nasal cannula and had better outcomes, while Ali et al showed that patients with STEMI yet again experienced worse outcomes during the first wave. On the system improvement front, Cusick et al3 report on a quality improvement (QI) project that addressed acute disease management of heparin-induced thrombocytopenia (HIT) during hospitalization, Sosa et al4 discuss efforts to improve comorbidity capture at their institution, and Uche et al5 present the results of a nonpharmacologic initiative to improve management of chronic pain among veterans. Cusick et al’s QI project showed that a HIT testing strategy could be safely implemented through an evidence-based process to nudge resource utilization using specific management pathways. While capturing and measuring the complexity of diseases and comorbidities can be challenging, accurate capture is essential, as patient acuity has implications for reimbursement and quality comparisons for hospitals and physicians; Sosa et al describe a series of initiatives implemented at their institution that improved comorbidity capture. Furthermore, Uche et al report on a 10-week complementary and integrative health program for veterans with noncancer chronic pain that reduced pain intensity and improved quality of life for its participants. These QI reports show that, though the health care landscape has changed over the past 2 years, the aim remains the same: to provide the best care for patients regardless of the diagnosis, location, or time. Conducting QI projects during the COVID-19 pandemic has been difficult, especially in terms of implementing consistent processes and management pathways while contending with staff and supply shortages. The pandemic, however, has highlighted the importance of continuing ","PeriodicalId":15393,"journal":{"name":"Journal of Clinical Outcomes Management","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44137086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Early Hospital Discharge Following PCI for Patients With STEMI STEMI患者PCI术后早期出院
Q4 Medicine Pub Date : 2022-03-28 DOI: 10.12788/jcom.0091
William W. Hung
Setting and participants: An EHD group comprised of 600 patients who were discharged at <48 hours between April 2020 and June 2021 was compared to a control group of 700 patients who met EHD criteria but were discharged at >48 hour between October 2018 and June 2021. Patients were selected into the EHD group based on the following criteria, in accordance with recommendations from the European Society of Cardiology, and all patients had close follow-up with a combination of structured telephone follow-up at 48 hours post discharge and virtual visits at 2, 6, and 8 weeks and at 3 months: • Left ventricular ejection fraction ≥40% • Successful primary PCI (that achieved thrombolysis in myocardial infarction flow grade 3) • Absence of severe nonculprit disease requiring further inpatient revascularization • Absence of ischemic symptoms post PCI • Absence of heart failure or hemodynamic instability • Absence of significant arrhythmia (ventricular fibrillation, ventricular tachycardia, or atrial fibrillation or atrial flutter requiring prolonged stay) • Mobility with suitable social circumstances for discharge
设置和参与者:EHD组由600名患者组成,他们在2018年10月至2021年6月的48小时内出院。根据欧洲心脏病学会的建议,根据以下标准将患者选入EHD组,所有患者都进行了密切随访,出院后48小时进行结构化电话随访,以及8周和3个月时:•左心室射血分数≥40%•成功的初次经皮冠状动脉介入治疗(在3级心肌梗死流量中实现溶栓)•没有需要进一步住院血运重建的严重非心脏病•经皮冠状静脉介入治疗后没有缺血性症状•没有心力衰竭或血液动力学不稳定•没有严重心律失常(需要长时间停留的心室颤动、室性心动过速或心房颤动或房扑)•在适当的社会环境下活动以出院
{"title":"Early Hospital Discharge Following PCI for Patients With STEMI","authors":"William W. Hung","doi":"10.12788/jcom.0091","DOIUrl":"https://doi.org/10.12788/jcom.0091","url":null,"abstract":"Setting and participants: An EHD group comprised of 600 patients who were discharged at <48 hours between April 2020 and June 2021 was compared to a control group of 700 patients who met EHD criteria but were discharged at >48 hour between October 2018 and June 2021. Patients were selected into the EHD group based on the following criteria, in accordance with recommendations from the European Society of Cardiology, and all patients had close follow-up with a combination of structured telephone follow-up at 48 hours post discharge and virtual visits at 2, 6, and 8 weeks and at 3 months: • Left ventricular ejection fraction ≥40% • Successful primary PCI (that achieved thrombolysis in myocardial infarction flow grade 3) • Absence of severe nonculprit disease requiring further inpatient revascularization • Absence of ischemic symptoms post PCI • Absence of heart failure or hemodynamic instability • Absence of significant arrhythmia (ventricular fibrillation, ventricular tachycardia, or atrial fibrillation or atrial flutter requiring prolonged stay) • Mobility with suitable social circumstances for discharge","PeriodicalId":15393,"journal":{"name":"Journal of Clinical Outcomes Management","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48708505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 14
Improving Hospital Metrics Through the Implementation of a Comorbidity Capture Tool and Other Quality Initiatives 通过实施合并症捕获工具和其他质量举措改善医院指标
Q4 Medicine Pub Date : 2022-03-28 DOI: 10.12788/jcom.0088
Sosa
Background: Case mix index (CMI) and expected mortality are determined based on comorbidities. Improving documentation and coding can impact performance indicators. During and prior to 2018, our patient acuity was under-represented, with low expected mortality and CMI. Those metrics motivated our quality team to develop the quality initiatives reported here. Objectives: We sought to assess the impact of quality initiatives on number of comorbidities, diagnoses, CMI, and expected mortality at the University of Miami Health System. Design: We conducted an observational study of a series of quality initiatives: (1) education of clinical documentation specialists (CDS) to capture comorbidities (10/2019); (2) facilitating the process for physician query response (2/2020); (3) implementation of computer logic to capture electrolyte disturbances and renal dysfunction (8/2020); (4) development of a tool to capture Elixhauser comorbidities (11/2020); and (5) provider education and electronic health record reviews by the quality team. Setting and participants: All admissions during 2019 and 2020 at University of Miami Health System. The health system includes 2 academic inpatient facilities, a 560-bed tertiary hospital, and a 40-bed cancer facility. Our hospital is 1 of the 11 PPS-Exempt Cancer Hospitals and is the South Florida’s only NCI-Designated Cancer Center. Measures: Number of coded diagnoses and Elixhauser comorbidities; CMI and expected mortality were compared between the pre-intervention and the intervention periods using t -tests and Chi-square test. Results: There were 33 066 admissions during the study period—13 689 before the intervention and 19 377 during the intervention period. From pre-intervention to intervention, the mean (SD) number of comorbidities increased from 2.5 (1.7) to 3.1 (2.0) ( P < .0001), diagnoses increased from 11.3 (7.3) to 18.5 (10.4) ( P < .0001), CMI increased from 2.1 (1.9) to 2.4 (2.2) ( P < .0001), and expected mortality increased from 1.8% (6.1) to 3.1% (9.2) ( P < .0001). Conclusion: The number of comorbidities, diagnoses, and CMI all improved, and expected mortality increased in the year of implementation of the quality initiatives.
背景:病例混合指数(CMI)和预期死亡率是根据合并症确定的。改进文档和编码可以影响性能指标。在2018年期间及之前,我们的患者视力不足,预期死亡率和CMI较低。这些指标促使我们的质量团队制定此处报告的质量计划。目的:我们试图在迈阿密大学卫生系统评估质量举措对合并症数量、诊断、CMI和预期死亡率的影响。设计:我们对一系列质量举措进行了观察性研究:(1)对临床文献专家(CDS)进行教育,以了解合并症(10/2019);(2) 促进医生查询响应过程(2/2020);(3) 实现计算机逻辑以捕捉电解质紊乱和肾功能障碍(8/2020);(4) 开发一种捕捉Elixhauser合并症的工具(2020年11月);以及(5)质量小组对提供者教育和电子健康记录的审查。设置和参与者:2019年和2020年迈阿密大学卫生系统的所有招生。卫生系统包括2个学术住院设施、一个拥有560个床位的三级医院和一个拥有40个床位的癌症设施。我们的医院是11家PPS豁免癌症医院之一,也是南佛罗里达州唯一一家NCI指定的癌症中心。测量:编码诊断和Elixhauser合并症的数量;使用t检验和卡方检验比较干预前和干预期的CMI和预期死亡率。结果:研究期间共有33066人入院,干预前为13689人,干预期间为19377人。从干预前到干预,合并症的平均(SD)数从2.5(1.7)增加到3.1(2.0)(P<.0001),诊断从11.3(7.3)增加到18.5(10.4)(P<0.0001),CMI从2.1(1.9)增加到2.4(2.2),预期死亡率在实施高质量举措的那一年有所上升。
{"title":"Improving Hospital Metrics Through the Implementation of a Comorbidity Capture Tool and Other Quality Initiatives","authors":"Sosa","doi":"10.12788/jcom.0088","DOIUrl":"https://doi.org/10.12788/jcom.0088","url":null,"abstract":"Background: Case mix index (CMI) and expected mortality are determined based on comorbidities. Improving documentation and coding can impact performance indicators. During and prior to 2018, our patient acuity was under-represented, with low expected mortality and CMI. Those metrics motivated our quality team to develop the quality initiatives reported here. Objectives: We sought to assess the impact of quality initiatives on number of comorbidities, diagnoses, CMI, and expected mortality at the University of Miami Health System. Design: We conducted an observational study of a series of quality initiatives: (1) education of clinical documentation specialists (CDS) to capture comorbidities (10/2019); (2) facilitating the process for physician query response (2/2020); (3) implementation of computer logic to capture electrolyte disturbances and renal dysfunction (8/2020); (4) development of a tool to capture Elixhauser comorbidities (11/2020); and (5) provider education and electronic health record reviews by the quality team. Setting and participants: All admissions during 2019 and 2020 at University of Miami Health System. The health system includes 2 academic inpatient facilities, a 560-bed tertiary hospital, and a 40-bed cancer facility. Our hospital is 1 of the 11 PPS-Exempt Cancer Hospitals and is the South Florida’s only NCI-Designated Cancer Center. Measures: Number of coded diagnoses and Elixhauser comorbidities; CMI and expected mortality were compared between the pre-intervention and the intervention periods using t -tests and Chi-square test. Results: There were 33 066 admissions during the study period—13 689 before the intervention and 19 377 during the intervention period. From pre-intervention to intervention, the mean (SD) number of comorbidities increased from 2.5 (1.7) to 3.1 (2.0) ( P < .0001), diagnoses increased from 11.3 (7.3) to 18.5 (10.4) ( P < .0001), CMI increased from 2.1 (1.9) to 2.4 (2.2) ( P < .0001), and expected mortality increased from 1.8% (6.1) to 3.1% (9.2) ( P < .0001). Conclusion: The number of comorbidities, diagnoses, and CMI all improved, and expected mortality increased in the year of implementation of the quality initiatives.","PeriodicalId":15393,"journal":{"name":"Journal of Clinical Outcomes Management","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43044164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Differences in COVID-19 Outcomes Among Patients With Type 1 Diabetes: First vs Later Surges 1型糖尿病患者新冠肺炎结局的差异:首次手术与后期手术
Q4 Medicine Pub Date : 2022-01-01 DOI: 10.12788/jcom.0084
Gallagher
Background: Patient outcomes of COVID-19 have improved throughout the pandemic. However, because it is not known whether outcomes of COVID-19 in the type 1 diabetes (T1D) population improved over time, we investigated differences in COVID-19 outcomes for patients with T1D in the United States. Methods: We analyzed data collected via a registry of patients with T1D and COVID-19 from 56 sites between April 2020 and January 2021. We grouped cases into first surge (April 9, 2020, to July 31, 2020, n=188) and late surge (August 1, 2020, to January 31, 2021, n=410), and then compared outcomes between both groups using descriptive statistics and logistic regression models. Results: Adverse outcomes were more frequent during the first surge, including diabetic ketoacidosis (32% vs 15%, P<.001), severe hypoglycemia (4% vs 1%, P=.04), and hospitalization (52% vs 22%, P<.001). Patients in the first surge were older (28 [SD,18.8] years vs 18.0 [SD, 11.1] years, P<.001), had higher median hemoglobin A1c levels (9.3 [interquartile range {IQR}, 4.0] vs 8.4 (IQR, 2.8), P<.001), and were more likely to use public insurance (107 [57%] vs 154 [38%], P<.001). The odds of hospitalization for adults in the first surge were 5 times higher compared to the late surge (odds ratio, 5.01;95% CI, 2.11-12.63). Conclusion: Patients with T1D who presented with COVID-19 during the first surge had a higher proportion of adverse outcomes than those who presented in a later surge. Keywords: TD1, diabetic ketoacidosis, hypoglycemia.
背景:在整个大流行期间,COVID-19患者的预后有所改善。然而,由于尚不清楚COVID-19在1型糖尿病(T1D)人群中的结局是否会随着时间的推移而改善,我们研究了美国T1D患者COVID-19结局的差异。方法:我们分析了2020年4月至2021年1月期间来自56个地点的T1D和COVID-19患者登记处收集的数据。我们将病例分为首次高峰(2020年4月9日至2020年7月31日,n=188)和晚期高峰(2020年8月1日至2021年1月31日,n=410),然后使用描述性统计和逻辑回归模型比较两组结果。结果:不良结局在第一次高潮时更为频繁,包括糖尿病酮症酸中毒(32%比15%,P< 0.001)、严重低血糖(4%比1%,P= 0.04)和住院(52%比22%,P< 0.001)。第一次激增的患者年龄较大(28 [SD,18.8]岁对18.0 [SD, 11.1]岁,P<.001),中位血红蛋白A1c水平较高(9.3[四分位数间距{IQR}, 4.0]对8.4 (IQR, 2.8), P<.001),并且更有可能使用公共保险(107[57%]对154 [38%],P<.001)。成人在第一次高峰中住院的几率是晚期高峰的5倍(优势比,5.01;95% CI, 2.11-12.63)。结论:在第一次高峰期间出现COVID-19的T1D患者的不良结局比例高于在随后的高峰中出现的患者。关键词:TD1,糖尿病酮症酸中毒,低血糖。
{"title":"Differences in COVID-19 Outcomes Among Patients With Type 1 Diabetes: First vs Later Surges","authors":"Gallagher","doi":"10.12788/jcom.0084","DOIUrl":"https://doi.org/10.12788/jcom.0084","url":null,"abstract":"Background: Patient outcomes of COVID-19 have improved throughout the pandemic. However, because it is not known whether outcomes of COVID-19 in the type 1 diabetes (T1D) population improved over time, we investigated differences in COVID-19 outcomes for patients with T1D in the United States. Methods: We analyzed data collected via a registry of patients with T1D and COVID-19 from 56 sites between April 2020 and January 2021. We grouped cases into first surge (April 9, 2020, to July 31, 2020, n=188) and late surge (August 1, 2020, to January 31, 2021, n=410), and then compared outcomes between both groups using descriptive statistics and logistic regression models. Results: Adverse outcomes were more frequent during the first surge, including diabetic ketoacidosis (32% vs 15%, P<.001), severe hypoglycemia (4% vs 1%, P=.04), and hospitalization (52% vs 22%, P<.001). Patients in the first surge were older (28 [SD,18.8] years vs 18.0 [SD, 11.1] years, P<.001), had higher median hemoglobin A1c levels (9.3 [interquartile range {IQR}, 4.0] vs 8.4 (IQR, 2.8), P<.001), and were more likely to use public insurance (107 [57%] vs 154 [38%], P<.001). The odds of hospitalization for adults in the first surge were 5 times higher compared to the late surge (odds ratio, 5.01;95% CI, 2.11-12.63). Conclusion: Patients with T1D who presented with COVID-19 during the first surge had a higher proportion of adverse outcomes than those who presented in a later surge. Keywords: TD1, diabetic ketoacidosis, hypoglycemia.","PeriodicalId":15393,"journal":{"name":"Journal of Clinical Outcomes Management","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46183346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 5
期刊
Journal of Clinical Outcomes Management
全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1