A Practice Redesign Collaborative for Reducing Hospital Readmission for Chronic Obstructive Pulmonary Disease in an Affiliated Network of Health Care Organizations.

BACKGROUND: Patients discharged following admissions for acute exacerbations of chronic obstructive pulmonary disease (AE-COPD) frequently require unplanned readmissions, increasing costs and morbidity for thousands of patients suffering from COPD. The Hospital Readmissions Reduction Program provided financial incentives to reduce 30-day readmissions for AE-COPD, but although risk factors for readmission are known, few evidence-based interventions achieve this goal. Members of the Mayo Clinic Care Network (MCCN) formed a collaborative to seek ways to reduce 30-day readmission for patients admitted with AE-COPD. METHODS: Seventeen MCCN organizations participated in an improvement collaborative in 2016 and 2017. Mayo Clinic subject matter experts shared improvement webinars, protocols, and educational materials related to AE-COPD and delivered individualized coaching to facilitate improvement at each site over a six-month engagement. Among other recommended interventions, organizations worked to increase the proportion of COPD patients who had a standardized disease severity staging during admission, inhaler appropriateness evaluations, a COPD treatment action plan, and clinical contact at < 48 hours and 10 ± 4 days postdischarge. RESULTS: Same-hospital readmission rates improved from 17.7% ± 3.6 to 14.5% ± 4.0 (weighted difference -4.38, p = 0.008, paired t-test). In addition, participating teams stated that the collaborative framework helped them develop strategies that improved patient care and organizational capacity for improvement in other domains. CONCLUSION: The collaborative framework, beginning with education delivered in person and via webinars, combined with telephonically delivered coaching and knowledge sharing, assisted most members to improve care. Fourteen of 17 participating sites experienced a reduced AE-COPD readmission rate.

Characteristics and Consequences of Work-Related Musculoskeletal Pain among Cardiac Sonographers Compared with Peer Employees: A Multisite Cross-Sectional Study.

BACKGROUND: Work-related musculoskeletal pain (WRMSP) among cardiac sonographers has been incompletely studied. The aim of this study was to compare the frequency, magnitude, and impact of WRMSP among cardiac sonographers with those of a control group of peer employees. METHODS: An electronic survey was sent to cardiac sonographers and peer employees assigned to different occupational exposures within the Department of Cardiovascular Medicine at 10 Mayo Clinic facilities in four states. RESULTS: A total of 416 subjects completed the survey: 111 sonographers (27%) and 305 peer-employee control subjects (73%). The mean age was 43 ± 11 years, and 307 subjects (74%) were women. The sonographers' response rate was 86%. WRMSP was experienced by a large majority of sonographers (95 [86%] vs 140 [46%] for control subjects, P < .001). This association persisted after multivariate adjustment (odds ratio, 8.18; 95% confidence interval, 4.33-15.46; P < .001). Compared with coworkers, sonographers' pain was perceived as more severe (pain score > 5 on a 10-point scale; 62% vs 29%, P < .001) and as getting worse (14% vs 2%, P < .001). The neck (58% vs 25%), shoulder (51% vs 11%), lower back (44% vs 26%), and hand (42% vs 9%) were the most frequently affected body regions (P < .001 for each). The presence of WRMSP in sonographers was more often associated with interference in performance of daily (37% vs 12%, P < .001) and work-related (42% vs 11%, P < .001) activities. Because of pain, sonographers more often sought medical evaluation (27% vs 12%, P < .001), missed work (13% vs 4%, P < .001), had work restrictions (5% vs 0.6%, P = .005), and were considering changing employment (9% vs 0.5%, P < .001) compared with control subjects. CONCLUSIONS: WRMSP in cardiac sonographers is much more prevalent and severe compared with peer employees. WRMSP in sonographers affects daily and work-related activities, as well as future employment plans. Further studies assessing the potential role of preventive interventions are needed.