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J Addict Dis ; 37(3-4): 252-258, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-31573412


The purpose of the study was to describe patient outcomes with a 3-day tramadol taper for acute opioid withdrawal on the detoxification unit at Summa Health System. The primary endpoint was the change in Clinical Institute Narcotic Assessment (CINA) score from the start of the taper until completion or discharge. Secondary endpoints were length of stay, use of adjuvant medications, taper completion rates, highest CINA score, adverse events, and 30-day readmission rates. A retrospective, quality improvement, cohort study was performed describing outcomes of opioid dependent patients in acute withdrawal admitted on the detoxification unit between September 2014 and September 2016 receiving the 3-day tramadol taper. All patients ≥18 years of age admitted for opioid dependence were included. Pregnant patients were excluded. Forty-five patients were included in the analysis. Patient ages ranged from 18-67 and 25 (55.6%) were male. The full taper was completed in 67.7% of admissions and 75.8% of patients were discharged by the physician. There was a statistically significant change of the pre-taper score compared to the score at completion or discharge in the per protocol group (-1.58, p = 0.010). There were no reported seizures or falls. The 3-day tramadol taper proved to be safe and effective therapy for treating acute opioid withdrawal. In the Summa Health System detoxification unit, patients treated with a 3-day tramadol taper for acute opioid withdrawal had their pre-taper CINA scores reduced by over 25% at the completion of the taper or discharge.

Popul Health Manag ; 17(2): 106-11, 2014 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-24156664


The specific aim of the PEACE pilot study was to determine the feasibility of a fully powered study to test the effectiveness of an in-home geriatrics/palliative care interdisciplinary care management intervention for improving measures of utilization, quality of care, and quality of life in enrollees of Ohio's community-based long-term care Medicaid waiver program, PASSPORT. This was a randomized pilot study (n=40 intervention [IG], n=40 usual care) involving new enrollees into PASSPORT who were >60 years old. This was an in-home interdisciplinary chronic illness care management intervention by PASSPORT care managers collaborating with a hospital-based geriatrics/palliative care specialist team and the consumer's primary care physician. This pilot was not powered to test hypotheses; instead, it was hypothesis generating. Primary outcomes measured symptom control, mood, decision making, spirituality, and quality of life. Little difference was seen in primary outcomes; however, utilization favored the IG. At 12 months, the IG had fewer hospital visits (50% vs. 55%, P=0.65) and fewer nursing facility admissions (22.5% vs. 32.5%, P=0.32). Using hospital-based specialists interfacing with a community agency to provide a team-based approach to care of consumers with chronic illnesses was found to be feasible. Lack of change in symptom control or quality of life outcome measures may be related to the tools used, as these were validated in populations closer to the end of life. Data from this pilot study will be used to calculate the sample size needed for a fully powered trial.

Planificación Anticipada de Atención/organización & administración , Servicios de Atención de Salud a Domicilio/organización & administración , Cuidados a Largo Plazo/organización & administración , Calidad de Vida , Anciano , Anciano de 80 o más Años , Femenino , Anciano Frágil , Evaluación Geriátrica/métodos , Promoción de la Salud , Servicios de Salud para Ancianos/organización & administración , Humanos , Comunicación Interdisciplinaria , Masculino , Ohio , Cuidados Paliativos/organización & administración , Proyectos Piloto , Evaluación de Programas y Proyectos de Salud , Valores de Referencia , Resultado del Tratamiento
Popul Health Manag ; 15(2): 71-7, 2012 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-22088165


Practice guidelines are available for hospice and palliative medicine specialists and geriatricians. However, these guidelines do not adequately address the needs of patients who straddle the 2 specialties: homebound chronically ill patients. The purpose of this article is to describe the theoretical basis for the Promoting Effective Advance Care for Elders (PEACE) randomized pilot study. PEACE is an ongoing 2-group randomized pilot study (n=80) to test an in-home interdisciplinary care management intervention that combines palliative care approaches to symptom management, psychosocial and emotional support, and advance care planning with geriatric medicine approaches to optimizing function and addressing polypharmacy. The population comprises new enrollees into PASSPORT, Ohio's community-based, long-term care Medicaid waiver program. All PASSPORT enrollees have geriatric/palliative care crossover needs because they are nursing home eligible. The intervention is based on Wagner's Chronic Care Model and includes comprehensive interdisciplinary care management for these low-income frail elders with chronic illnesses, uses evidence-based protocols, emphasizes patient activation, and integrates with community-based long-term care and other community agencies. Our model, with its standardized, evidence-based medical and psychosocial intervention protocols, will transport easily to other sites that are interested in optimizing outcomes for community-based, chronically ill older adults.

Enfermedad Crónica , Anciano Frágil , Promoción de la Salud/organización & administración , Servicios de Atención de Salud a Domicilio/organización & administración , Personas Imposibilitadas , Planificación de Atención al Paciente/organización & administración , Anciano , Anciano de 80 o más Años , Determinación de la Elegibilidad , Medicina Basada en la Evidencia , Femenino , Evaluación Geriátrica , Humanos , Masculino , Medicaid , Ohio , Cuidados Paliativos , Proyectos Piloto , Pobreza , Proyectos de Investigación , Apoyo Social , Estados Unidos
J Ambul Care Manage ; 25(3): 26-33, 2002 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-12141016


The Indigent Patient Care Program (legislatively enacted in 1915) provides comprehensive health care to indigent Iowans without health insurance. The University of Iowa Hospitals and Clinics, a leading academic medical center, was designated as the health care provider for these medically and socially complex patients. The Care Management Program of the University of Iowa (CMPUI) is an innovative care delivery model responsible for total health management of patients enrolled in the indigent program. The CMPUI is a solution to preserve the tripartite missions of an academic medical center while ensuring the preservation of the historic Indigent Patient Care Program in Iowa.

Centros Médicos Académicos/organización & administración , Manejo de Caso/organización & administración , Indigencia Médica , Modelos Organizacionales , Innovación Organizacional , Atención no Remunerada , Centros Médicos Académicos/estadística & datos numéricos , Atención Integral de Salud/organización & administración , Atención Integral de Salud/estadística & datos numéricos , Humanos , Iowa , Estudios de Casos Organizacionales , Objetivos Organizacionales , Atención Primaria de Salud/organización & administración , Atención Primaria de Salud/estadística & datos numéricos , Evaluación de Programas y Proyectos de Salud