Kansas journal of medicine最新文献

Introduction: Stay-at-home orders during the first wave of the COVID-19 pandemic encouraged individuals, especially the elderly, to stock up on food and supplies and remain home to limit exposure to the SARS-CoV-2 virus. However, individuals with food insecurity may be able only to afford a few days of food at a time, causing frequent outings to obtain food. An emergency food delivery system decreases the need for frequent outings. This study investigated: (1) whether elderly family medicine patients with previously reported food insecurity were making frequent trips to obtain food during the lockdown, and (2) if social determinants of health screening data could be used successfully to identify patients in need of emergency food delivery during the pandemic.

Methods: Primary care patients 65 years and older with previously reported food insecurity were screened for referral to a community food delivery program. A cross-sectional secondary analysis of screening and referral data were conducted.

Results: Clinic staff called 52 patients and completed screening of 30. For 23/30 respondents (76.7%), reported monthly outings to obtain food exceeded the recommended stay-at-home guidelines. In our sample, 22/30 (73.3%) reported current food need, 14/30 (46.7%) reported two or fewer days of food, 28/30 (93.3%) reported receiving home food delivery would keep them from going out, 24/30 (80.0%) agreed to food delivery, and 17 patients received a food delivery.

Conclusions: Targeted screening and referral for food delivery may reduce the need for patients experiencing food insecurity to leave home during a pandemic or other disaster, potentially decreasing community exposure for a high-risk population. Primary care practices can utilize previously collected food insecurity and other social determinants of health data to identify and assist high-risk patients in a pandemic.

Introduction: Modern laboratory techniques cannot differentiate between Clostridium difficile colonization and infection; therefore, testing must be indicated clinically. To reduce hospital-onset of C. difficile infections (HO-CDI), Ascension Via Christi Hospitals (AVCH) in Wichita intervened in three stages by introducing: 1) a C. diflcile testing algorithm; 2) an electronic medical record (EMR)-based decision support system to enforce said algorithm; and 3) phone calls from the infection prevention department to providers to discontinue tests not collected within 24 hours of the order. The goal of this study was to determine if these interventions improved the HO-CDI rate.

Methods: At AVCH, the three study periods were compared: baseline with algorithm training only, the EMR intervention, and the EMR intervention with additional phone calls (EMR with phone calls). Data were abstracted from the hospital EMR.

Results: A total of 311 charts were reviewed. Adherence to the algorithm increased from 34% at baseline to 52% after the EMR intervention (p = 0.010). During the EMR with phone calls period, more tests were discontinued (87%; n = 39) compared to baseline (54%; n = 15) and EMR (54%; n = 15; p = 0.003). The HO-CDI rate ranged from 8.5 cases per 10,000 patient-days at baseline, to 7.9 during EMR, to 4.0 during EMR with phone calls (p = 0.007).

Conclusions: The EMR and EMR with phone call interventions were associated with a significant decrease in the HO-CDI rate and an increase in provider adherence to the algorithm.