Global Trends of Medical Misadventures Using International Classification of Diseases, Tenth Revision Cluster Y62-Y69 Comparing Pre-, Intra-, and Post-COVID-19 Pandemic Phases: Protocol for a Retrospective Analysis Using the TriNetX Platform.

BACKGROUND: The COVID-19 pandemic has sharpened the focus on health care safety and quality, underscoring the importance of using standardized metrics such as the International Classification of Diseases, Tenth Revision (ICD-10). In this regard, the ICD-10 cluster Y62-Y69 serves as a proxy assessment of safety and quality in health care systems, allowing researchers to evaluate medical misadventures. Thus far, extensive research and reports support the need for more attention to safety and quality in health care. The study aims to leverage the pandemic's unique challenges to explore health care safety and quality trends during prepandemic, intrapandemic, and postpandemic phases, using the ICD-10 cluster Y62-Y69 as a key tool for their evaluation. OBJECTIVE: This research aims to perform a comprehensive retrospective analysis of incidence rates associated with ICD-10 cluster Y62-Y69, capturing both linear and nonlinear trends across prepandemic, intrapandemic, and postpandemic phases over an 8-year span. Therefore, it seeks to understand how these trends inform health care safety and quality improvements, policy, and future research. METHODS: This study uses the extensive data available through the TriNetX platform, using an observational, retrospective design and applying curve-fitting analyses and quadratic models to comprehend the relationships between incidence rates over an 8-year span (from 2015 to 2023). These techniques will enable the identification of nuanced trends in the data, facilitating a deeper understanding of the impacts of the COVID-19 pandemic on medical misadventures. The anticipated results aim to outline complex patterns in health care safety and quality during the COVID-19 pandemic, using global real-world data for robust and generalizable conclusions. This study will explore significant shifts in health care practices and outcomes, with a special focus on geographical variations and key clinical conditions in cardiovascular and oncological care, ensuring a comprehensive analysis of the pandemic's impact across different regions and medical fields. RESULTS: This study is currently in the data collection phase, with funding secured in November 2023 through the Ricerca Corrente scheme of the Italian Ministry of Health. Data collection via the TriNetX platform is anticipated to be completed in May 2024, covering an 8-year period from January 2015 to December 2023. This dataset spans pre-pandemic, intra-pandemic, and early post-pandemic phases, enabling a comprehensive analysis of trends in medical misadventures using the ICD-10 cluster Y62-Y69. The final analytics are anticipated to be completed by June 2024. The study's findings aim to provide actionable insights for enhancing healthcare safety and quality, reflecting on the pandemic's transformative impact on global healthcare systems. CONCLUSIONS: This study is anticipated to contribute significantly to health care safety and quality literature. It will provide actionable insights for health care professionals, policy makers, and researchers. It will highlight critical areas for intervention and funding to enhance health care safety and quality globally by examining the incidence rates of medical misadventures before, during, and after the pandemic. In addition, the use of global real-world data enhances the study's strength by providing a practical view of health care safety and quality, paving the way for initiatives that are informed by data and tailored to specific contexts worldwide. This approach ensures the findings are applicable and actionable across different health care settings, contributing significantly to the global understanding and improvement of health care safety and quality. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/54838.

Second Victim Phenomenon Educational Program Evaluation.

Second victim phenomenon (SVP) occurs when nurses who are involved in an unanticipated adverse event become victimized and traumatized by the event. Following a needs assessment, an SVP education program was implemented, including adverse events and SVP experiences, available support, and a case study. Evaluation indicated nurses had improved knowledge and attitude and increased practice intent. Education that promotes awareness is the first step to support nurses who experience events that can precipitate SVP.

Octogenarians' post-acute care use after cardiac valve surgery and recovery: clinical implications.

Octogenarians receiving cardiac valve surgery is increasing and recovery is challenging. Post-acute care (PAC) services assist with recovery, yet services provided in facilities do not provide adequate cardiac-focused care or long-term self-management support. The purpose of the paper was to report post-acute care discharge rates in octogenarians and propose clinical implications to improve PAC services. Using a 2003 Medicare Part A database, we studied post-acute care service use in octogenarians after cardiac valve surgery. We propose expansion of the Geriatric Cardiac Care model to include broader clinical therapy dynamics. The sample (n = 10,062) included patients over 80 years discharged from acute care following valve surgery. Post-acute care services were used by 68% of octagarians following cardiac valve surgery (1% intermediate rehabilitation, 35% skilled nursing facility, 32% home health). The large percentage of octagarians using PAC point to the importance of integrating geriatric cardiac care into post-acute services to optimize recovery outcomes.

Association Between Poorer Cognitive Function and Reduced Objectively Monitored Medication Adherence in Patients With Heart Failure.

BACKGROUND: Subclinical cognitive impairment is prevalent in heart failure (HF); however, its role in important clinical outcomes, such as HF treatment adherence, is unclear. Given the complex polypharmacy in HF treatment, cognitive deficits may be important in predicting medication management. Thus, the objective of the current study was to examine the impact of cognitive function on medication adherence among community-dwelling patients with HF using objective assessments. METHODS AND RESULTS: A prospective observational cohort design of 309 community-dwelling patients with HF (59.7% male, 68.7±9.7 years) and no history of dementia or neurological disease. Cognition was assessed using a neuropsychological battery at baseline. Medication adherence was objectively measured for 21 days using an electronic pillbox. Regression analyses tested whether attention, executive function, or memory predicted 21-day medication adherence. In unadjusted analyses, lower scores on all 3 cognitive domains predicted poorer medication adherence (ß=0.52-85; P=0.001-0.009). After adjusting for demographic, clinical, and psychosocial variables, memory continued to predict medication adherence (ß=0.51; P=0.008), whereas executive function (ß=0.24; P=0.075) and attention were no longer a predictor (ß=0.34; P=0.131). CONCLUSIONS: Poorer cognitive function, especially in regard to memory, predicted reduced medication adherence among patients with HF and no history of dementia. This effect remained after adjustment for factors known to predict adherence, such as depressed mood, social support, and disease severity level. Future studies should examine the link from cognitive impairment and medication nonadherence to clinical outcomes (eg, hospitalization and mortality). CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01461629.

Post-acute care services received by older adults following a cardiac event: a population-based analysis.

BACKGROUND: Post-acute care (PAC) is available for older adults who need additional services after hospitalization for acute cardiac events. With the aging population and an increase in the prevalence of cardiac disease, it is important to determine current PAC use for cardiac patients to assist health care workers to meet the needs of older cardiac patients. The purpose of this study was to determine the current PAC use and factors associated with PAC use for older adults following hospitalization for a cardiac event that includes coronary artery bypass graft and valve surgeries, myocardial infarction (MI), percutaneous coronary intervention (PCI), and heart failure (HF). METHODS AND RESULTS: A cross-sectional design and the 2003 Medicare part A database were used for this study. The sample (n = 1493521) consisted of patients 65 years and older discharged after their first cardiac event. Multinomial logistic regression was used to examine factors associated with PAC use. Overall, PAC use was 55% for cardiac valve surgery, 50% for MI, 45% for HF, 44% for coronary artery bypass graft, and 5% for PCI. Medical patients use more skilled nursing facility care, and surgical patients use more home health care. Only 0.1% to 3.4% of the cardiac patients use intermediate rehabilitation facilities. Compared with those who do not use PAC, those who use home health care and skilled nursing facility care are older and female, have a longer hospital length of stay, and have more comorbidity. Asians, Hispanics, and Native Americans were less likely to use PAC after hospitalization for an MI or HF. CONCLUSIONS: The current rate of PAC use indicates that almost half of nondisabled Medicare patients discharged from the hospital following a cardiac event use one of these services. Health care professionals can increase PAC use for Asians, Hispanics, and Native Americans by including culturally targeted communication. Optimizing recovery for cardiac patients who use PAC may require focused cardiac rehabilitation strategies.

Cardiac rehabilitation, health behaviors, and body mass index post-myocardial infarction.

PURPOSE: Cardiac rehabilitation (CR) is a multifactorial program that encourages healthy behaviors in persons with a recent cardiovascular event or procedure. Research on the association between CR and health-behavior maintenance has focused on physical activity. Therefore, the purpose of this research was to examine the association of health behaviors (fruit/vegetable consumption and physical activity) and body mass index (BMI) with CR attendance and time since participation in respondents reporting history of myocardial infarction (MI). METHODS: This was a cross-sectional study using the 2003 Behavioral Risk Factor Surveillance System (n = 1,374). Eligible respondents were those with a history of MI. Outcomes were fruit/vegetable consumption, physical activity, and BMI. Time since CR was based on age at MI and age at survey. Logistic (polytomous) regression was used to identify predictors. RESULTS: CR attendees were 69% more likely to meet fruit/vegetable guidelines than were nonattendees (P = .02). CR was not associated with meeting physical activity guidelines. CR had a protective, yet nonsignificant effect on BMI. Meeting fruit/vegetable guidelines was associated with CR attendance in the past year (odds ratio = 4.64, confidence interval, CI: 1.03-20.95). CR attendees were 75% less likely to be overweight 1 to 2 years post-CR (CI: 0.08-0.73) and 59% less likely to be obese 2 to 5 years post-CR than were nonattendees (CI: 0.20-0.85). CONCLUSIONS: CR attendance was associated with healthy behaviors, though maintenance diminished over time. Understanding the factors associated with healthy behaviors, and the time when behavior performance decreases, will assist with program planning directed at behavior maintenance.

Older adults' early disability following a cardiac event.

Using the disablement model, the authors examined the following questions in adults 70 years of age and older during the 6 weeks following hospitalization for a cardiac event: (a) What are the patterns in physical performance, self-report of functional limitations, and disability, and (b) to what extent does physical performance in the hospital and self-report of functional limitations pre-event predict 6-week disability? Data were collected before discharge and 3 and 6 weeks later on a sample of 60 older adults after a cardiac event. Results show that although the majority of participants improved in their objective physical performance, 70% self-reported no improvement or worsening. Physical performance during hospitalization is a better predictor of disability than a pre-event self-report of functional limitations, even when controlling for depression, gender, and comorbidity. Assessment of objective physical performance prior to discharge will help to identify older adults at risk for progressive disability.

Effects of cardiac rehabilitation on the recovery outcomes of older adults after coronary artery bypass surgery.

PURPOSE: This study aimed to examine differences in lower extremity function as well as perception of physical and mental function between adults 70 years of age or older who participated in a phase 2 cardiac rehabilitation program (CRP) (n = 32) and those who did not participate in a CRP (n = 33) after coronary artery bypass surgery (CABS). METHODS: In this two-group longitudinal comparative study, recovery outcomes measured at baseline (6 weeks) and 6 months after CABS were compared between older adults who participated and those who did not participate in a CRP. RESULTS: In study groups that were equivalent before the CRP, analysis of covariance (controlling for baseline scores) showed that 6 months after hospital discharge, those who participated in a CRP had greater lower extremity strength (F = 3.9; P =.04), greater ankle range of motion (F = 4.2; P =.02), better dynamic balance (F = 8.2; P =.003), better static balance (F = 3.3; P =.04), better gait (F = 4.7; P =.02), and perceptions of better physical function (F = 14.8; P =.00). The results remained the same when control was used for the effects of social support, self-efficacy, depression, comorbidity, cardiac functional status, and gender for all the variables except static balance. No difference related to perception of mental function was found between the study groups (F =.10; P =. 74). CONCLUSIONS: Participation in a CRP by older individuals improves lower extremity function (an important dimension in preventing disability) and perception of physical function. Cardiac rehabilitation programs can be used to optimize the recovery outcomes of older individuals after CABS.

Predictors of women's exercise maintenance after cardiac rehabilitation.

PURPOSE: Less than 50% of persons who participate in cardiac rehabilitation (CR) programs maintain an exercise regimen for as long as 6 months after completion. This study was conducted to identify factors that predict women's exercise following completion of a CR program. METHODS: In this prospective, descriptive study, a convenience sample of 60 women were recruited at completion of a phase II CR program. Exercise was measured using a heart rate wristwatch monitor over 3 months. Predictor variables collected at the time of the subjects' enrollment were age, body mass index, cardiac functional status, comorbidity, muscle or joint pain, motivation, mood state, social support, self-efficacy, perceived benefits or barriers, and prior exercise. RESULTS: Of women, 25% did not exercise at all following completion of a CR program and only 48% of the subjects were exercising at 3 months. Different predictors were found of the various dimensions of exercise maintenance. Predictors of exercise frequency were comorbidity and instrumental social support. Instrumental social support was the only predictor of exercise persistence. Comorbidity was the only predictor of exercise intensity. The only predictor of the total amount of exercise was benefits or barriers. CONCLUSIONS: Interventions aimed at increasing women's exercise should focus on increasing their problem-solving abilities to reduce barriers to exercise and increase social support by family and friends. Because comorbidity was a significant predictor of exercise, women should be encouraged to use exercise techniques that reduce impact on muscles and joints (eg, swimming) or exercising for short periods several times a day.