Wisconsin Medical Journal最新文献

Introduction: As refugees adjust to a new country, their health care can take a toll. Refugees may have difficulty navigating a new health care system and experience low health self-efficacy. Another potential contributor is inadequate medical trainee curriculum addressing refugee health.

Methods: We devised simulated clinic experiences called mock medical visits. Surveys were utilized before and after the mock medical visits to assess the Health Self-Efficacy Scale for refugees and the Personal Report of Intercultural Communication Apprehension for trainees.

Results: Health Self-Efficacy Scale scores increased from 13.67 to 15.47 (P = 0.08, n = 15). Personal Report of Intercultural Communication Apprehension scores decreased from 27.1 to 25.4 (P = 0.40, n = 10).

Discussion: While our study did not reach statistical significance, the overall trends suggest mock medical visits can be a valuable tool to increase health self-efficacy in refugee community members and decrease intercultural communication apprehension in medical trainees.

Introduction: Creating and implementing programs aimed at reducing readmissions for high-risk patients is critical to demonstrate quality and avoid financial penalties. Intensive, multidisciplinary interventions providing care to high-risk patients utilizing telehealth have not been explored in the literature. This study seeks to explain the quality improvement process, structure, intervention, lessons learned, and early outcomes of such a program.

Methods: Patients were identified prior to discharge with a multicomponent risk score. The enrolled population was managed intensively for 30 days after discharge through a suite of services, including weekly video visits with an advanced practice provider, pharmacist, and home nurse; regular lab monitoring; telemonitoring of vital signs; and intensive home health visits. The process was iterative, including a successful pilot phase followed by an expanded health system-wide intervention analyzing multiple outcomes including satisfaction with video visits, self-rated improvement in health, and readmissions compared to matched populations.

Results: The expanded program resulted in improvements in self-reported health (68.9% reported health was some or greatly improved) and high satisfaction with video visits (89% rated satisfaction with video visits 8-10). Thirty-day readmissions were reduced compared to individuals with similar readmission risk scores discharged from the same hospital (18.3% vs 31.1%) and individuals who declined to participate in the program (18.3% vs 26.4%).

Conclusions: This novel model using telehealth to provide intensive, multidisciplinary care to high-risk patients has been successfully developed and deployed. Key areas for growth and exploration include developing an intervention that captures a greater percentage of discharged high-risk patients, including non-homebound patients, improving the electronic interface with home health care, and reducing costs while serving more patients. Data show that the intervention results in high patient satisfaction, improvements in self-reported health, and preliminary data showing reductions in readmission rates.

Background: We wanted to assess whether a regional approach to bed management and staffing could improve financial sustainability without reducing services in rural communities.

Methods: Regional approaches to patient placement, hospital throughput, and staffing were coupled with enhanced services at 1 hub hospital and 4 critical access hospitals.

Results: We improved the use of patient beds in the 4 critical access hospitals, increased hub hospital capacity, and improved the health system's financial performance while maintaining or enhancing services at the critical access hospitals.

Discussion: Sustainability of critical access hospitals can be attained without a decrease in services for rural patients and communities. One way to achieve this result is to invest in and enhance care at the rural site.

Background: Abortion legislation in the United States determines people's access to services, including the abortion modality of their choice. In 2012, Wisconsin legislators passed Act 217, banning telemedicine for medication abortion and requiring the same physician to be physically present when patients signed state-mandated abortion consent forms and to administer abortion medications over 24 hours later.

Objective: No research documented real-time outcomes of 2011 Act 217 in Wisconsin; this study documents providers' descriptions of the effects of Wisconsin abortion regulations on providers, patients, and abortion care in the state.

Methods: We interviewed 22 Wisconsin abortion care providers (18 physicians and 4 staff members) about how Act 217 affected abortion provision. We coded transcripts using a combined deductive and inductive approach, then identified themes about how this legislation affects patients and providers.

Results: Providers interviewed universally reported that Act 217 negatively affected abortion care, with the same-physician requirement especially increasing risk to patients and demoralizing providers. Interviewees emphasized the lack of medical need for this legislation and explained that Act 217 and the previously enacted 24-hour waiting period worked synergistically to decrease access to medication abortion, disproportionately affecting rural and low-income Wisconsinites. Finally, providers felt Wisconsin's legislative ban on telemedicine medication abortion should be lifted.

Conclusion: Wisconsin abortion providers interviewed underscored how Act 217, alongside previous regulations, limited medication abortion access in the state. This evidence helps build a case for the harmful effects of non-evidence-based abortion restrictions, which is crucial considering recent deferral to state law after the fall of Roe v Wade in 2022.

Introduction: The treatment for pediatric orbital cellulitis/abscess is trending towards intravenous antibiotic management alone in appropriate cases. Without cultures to guide therapy, knowing the local microbiology is of utmost importance in managing these patients.

Methods: We conducted a retrospective case series for patients age 2 months to 17 years, who were hospitalized between January 1, 2013, and December 31, 2019, to evaluate the local microbiology and pattern of antibiotic prescribing in pediatric orbital cellulitis.

Results and discussion: Of 95 total patients, 69 (73%) received intravenous antibiotics only and 26 (27%) received intravenous antibiotics plus surgery. The most common organism cultured was Streptococcus anginosus, followed by Staphylococcus aureus, and group A streptococcus. Methicillin-resistant Staphylococcus aureus (MRSA) prevalence was 9%. MRSA-active antibiotics remain the most frequently used antibiotics.

Background: Bell's palsy is the most common cause of acute facial nerve paresis and paralysis with devastating disability yet high rate of spontaneous recovery. Patients who do not fully recover have functional disability that may require reconstructive surgery. The Clinical Practice Guideline: Bell's Palsy recommends treatment with high-dose steroids as it shows a higher likelihood of complete recovery. However, guideline adherence rates are inconsistent and unstudied.

Objective: To identify the frequency at which hospital-based clinicians at the University of Wisconsin-Madison follow recommended clinical guidelines and prescribe high-dose steroid medication.

Methods: Charts were reviewed from a single hospital (University Hospital) to evaluate Bell's palsy guideline adherence. All hospital-based encounters from 2008 through 2018 with primary diagnosis of Bell's palsy (ICD-9 351.0 and ICD-10 G51.0) were identified. Encounters were excluded if they had a diagnosis of Bell's palsy within 1 year prior (n=250) and did not have a medication list available (n=353). We examined patient demographics, common comorbidities, and any radiology and lab orders.

Results: We identified 565 patients with a primary diagnosis of Bell's palsy with available medication lists; 77.70% received the recommended treatment. The patients' median age was 47 (interquartile range 34-59), 52.16% were male, and 82.46% were treated by emergency medicine clinicians. Other treating clinicians were hospital-based primary care, otolaryngology and plastic surgery, and others. Multivariate analysis showed that treating clinician specialty was the only significant positive predictor.

Conclusions: A significant portion of clinicians followed treatment guidelines for Bell's palsy. Further and larger research is needed to better identify points of intervention to improve guideline adherence.

Background: Primary care physicians are overburdened with growing complexities and increasing expectations for primary care visits. To meet expectations, primary care physicians must multitask during visits and spend extra hours in the office for charting, billing, and documentation. This impacts the physician's quality of life and may affect the quality of patient care. Many of the administrative tasks performed by physicians could, alternatively, be performed by nonphysician staff, leading to the adoption of team-based collaborative models.

Methods: Mayo Clinic Health System piloted a team-based collaborative model in a small physician practice in Osseo, Wisconsin, where which staff could be trained quickly and efficiently. The model used medical assistants/licensed practical nurses (MA/LPN) to partner with primary care physicians during a patient visit. The LPN/MA, under physician supervision, ordered and monitored pending orders/labs, coordinated patient care, provided after-visit educational needs, and communicated other urgent messages to team members.

Results: After 6 months, a comparison of pre- and posttrial data showed improved staff and patient satisfaction, decreased physician administrative work, and no cost-effectiveness improvement. Screening of medical conditions in the elderly improved, but no change was noted with chronic disease metrics.

Conclusions: Data showed improved staff and patient satisfaction, decreased physician clerical burden, increased appointment slots, mixed clinical outcomes, and did not demonstrate cost-effectiveness. The authors recommend that similar models be conducted in large settings to see if these results are reproducible.