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1.
R I Med J (2013) ; 103(8): 62-68, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-33003683

RESUMO

STUDY OBJECTIVE: To characterize oral health practices using data from statewide, multi-stakeholder surveys. STUDY DESIGN AND METHODS: We analyzed data from two Rhode Island surveys. Together, the surveys targeted all nursing homes, residents, and resident representatives in Rhode Island, and asked about staff training on mouth care, frequency of dental provider visits, enrollment in nursing home dental programs, and barriers to oral health. Primary Results: Responding nursing home administrators reported high levels of commitment to oral health. Among residents enrolled in a nursing home dental care program, 76.1% had a preventive visit in the prior six months, compared to 31.0% of residents not enrolled. The majority of facilities (71.8%) reported that staff received training on routine mouth care at the time of hire. CONCLUSIONS: Our findings highlight opportunities to better support nursing homes in providing residents with high-quality oral health, including acquiring staff skills to manage care-resistant behaviors, and routinely assessing residents' ability to provide their own mouth care.

2.
R I Med J (2013) ; 103(6): 75-79, 2020 Aug 03.
Artigo em Inglês | MEDLINE | ID: mdl-32752573

RESUMO

BACKGROUND: To quantify changes to the electronic health record (EHR) market in Rhode Island and to assess the degree of EHR market consolidation between 2009 and 2017. METHODS: The EHR market in Rhode Island is represented by three measures: the proportion of physicians who have adopted an EHR, the number of EHR vendors in use, and EHR market competitiveness, captured by the Herfindahl-Hirschman Index (HHI). RESULTS: The EHR market became more consolidated overall between 2009 and 2017. Among outpatient physicians, the market has remained competitive, despite ongoing consolidation. In contrast, the EHR market among inpatient physicians crossed into the "highly concentrated" zone in 2015. DISCUSSION: While consolidation in the EHR market may facilitate the exchange of data across health systems, potentially reducing duplicative testing and facilitating timely diagnosis, limiting competition may affect vendors' responsiveness to calls for improved usability and innovation.

4.
J Am Med Inform Assoc ; 27(9): 1401-1410, 2020 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-32719859

RESUMO

OBJECTIVE: The study sought to examine the association between clinician burnout and measures of electronic health record (EHR) workload and efficiency, using vendor-derived EHR action log data. MATERIALS AND METHODS: We combined data from a statewide clinician survey on burnout with Epic EHR data from the ambulatory sites of 2 large health systems; the combined dataset included 422 clinicians. We examined whether specific EHR workload and efficiency measures were independently associated with burnout symptoms, using multivariable logistic regression and controlling for clinician characteristics. RESULTS: Clinicians with the highest volume of patient call messages had almost 4 times the odds of burnout compared with clinicians with the fewest (adjusted odds ratio, 3.81; 95% confidence interval, 1.44-10.14; P = .007). No other workload measures were significantly associated with burnout. No efficiency variables were significantly associated with burnout in the main analysis; however, in a subset of clinicians for whom note entry data were available, clinicians in the top quartile of copy and paste use were significantly less likely to report burnout, with an adjusted odds ratio of 0.22 (95% confidence interval, 0.05-0.93; P = .039). DISCUSSION: High volumes of patient call messages were significantly associated with clinician burnout, even when accounting for other measures of workload and efficiency. In the EHR, "patient calls" encompass many of the inbox tasks occurring outside of face-to-face visits and likely represent an important target for improving clinician well-being. CONCLUSIONS: Our results suggest that increased workload is associated with burnout and that EHR efficiency tools are not likely to reduce burnout symptoms, with the exception of copy and paste.

5.
R I Med J (2013) ; 103(1): 21-24, 2020 Feb 03.
Artigo em Inglês | MEDLINE | ID: mdl-32013299

RESUMO

BACKGROUND: The Rhode Island Department of Health (RIDOH) has administered the Health Information Technology (HIT) Survey since 2009 to report clinician-level process measures relating to HIT adoption and use. METHODS: RIDOH administers the Rhode Island HIT Survey to all licensed independent practitioners. Descriptive analyses examined HIT adoption and the clinician experience working with HIT. RESULTS: Most physician and Advanced Practice Provider (APP) respondents report using an EHR (92.5% and 94.3%) and e-prescribing medications (84.1% and 81.6%). Less than half of physicians (40.9% or n=565) and APPs (35.4% or n=195) who prescribe controlled substances currently submit controlled substance prescriptions electronically. A higher percentage of physicians, compared to APPs, reported experiencing HIT-related stress (80.9% and 66.6%). The overall prevalence of physicians reporting symptoms of burnout was 29.7% (n=539) but varied between specialties. DISCUSSION: As of 2019, the majority of Rhode Island physicians have adopted EHRs and e-prescribing. Adoption plateaued after 2012, and challenges persist in integrating existing technology into practice.


Assuntos
Esgotamento Profissional/etiologia , Registros Eletrônicos de Saúde , Informática Médica , Médicos/psicologia , Prescrição Eletrônica/estatística & dados numéricos , Pesquisas sobre Serviços de Saúde , Humanos , Estresse Ocupacional , Rhode Island
6.
J Am Med Dir Assoc ; 21(4): 508-512, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31812334

RESUMO

OBJECTIVE: To determine if implementation of Project Re-Engineered Discharge (RED), designed for hospitals but adapted for skilled nursing facilities (SNFs), reduces hospital readmissions after SNF discharge to the community in residents admitted to the SNF following an index hospitalization. DESIGN: A pragmatic trial. SETTING AND PARTICIPANTS: SNFs in southeastern Massachusetts, and residents discharged to the community. METHODS: We compared SNFs that deployed an adapted RED intervention to a matched control group from the same region. The primary outcome was hospital readmission within 30 days after SNF discharge, among residents who had been admitted to the SNF following an index hospitalization and then discharged home. January 2016 through March 2017 was the baseline period; April 2017 through June 2018 was the follow-up period (after implementation of the intervention). We used a difference-in-differences analysis to compare the intervention SNFs to the control group, using generalized estimating equation regression and controlling for facility characteristics. RESULTS: After implementation of RED, readmission rates were lower across all 4 measures in the intervention group; control facilities' readmission rates remained stable or increased. The relative decrease was 0.9% for the primary outcome of hospital readmission within 30 days after SNF discharge and 1.7% for readmission within 30 days of the index hospitalization discharge date (P ≤ .001 for both comparisons). CONCLUSIONS AND IMPLICATIONS: We found that a systematic discharge process developed for the hospital can be adapted to the SNF environment and can reduce readmissions back to the hospital, perhaps through improved self-management skills and better engagement with community services. This work is particularly timely because of Medicare's new Value-Based Purchasing Program, in which nursing homes can receive incentive payments if their hospital readmission rates are low relative to their peers. To verify its scalability and broad potential, RED should be validated across a broader diversity of SNFs nationally.

7.
J Gen Intern Med ; 34(11): 2542-2548, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31463685

RESUMO

IMPORTANCE: Physician attitudes about websites that publicly report health care quality and experience data have not been recently described. OBJECTIVES: To examine physician attitudes about the accuracy of websites that report information about quality of care and patient experience and to describe physician beliefs about the helpfulness of these data for patients choosing a physician. DESIGN, PARTICIPANTS, AND MEASURES: The Rhode Island Department of Health (RIDOH) and a multi-stakeholder group developed and piloted two questions that were added to RIDOH's biennial physician survey of all 4197 practicing physicians in Rhode Island: (1) "How accurate of a picture do you feel that the following types of online resources give about the quality of care that physicians provide?" (with choices) and (2) "Which types of physician-specific information (i.e., not about the practice overall) would be helpful to include in online resources for patients to help them choose a new physician? (Select all that apply)." Responses were stratified by primary care vs. subspecialty clinicians. Summary statistics and chi-squared tests were used to analyze the results. RESULTS: Among 1792 respondents (response rate 43%), 45% were unaware of RIDOH's site and 54% were unaware of the Centers for Medicare & Medicaid Services (CMS)' quality reporting sites. Only 2% felt that Medicare sites were "very accurate" in depicting physician quality. Most physicians supported public reporting of general information about physicians (e.g., board certification), but just over one-third of physicians felt that performance-based quality measures are "helpful" (and a similar percentage reported that patient reviews felt are "helpful") for patients choosing a physician. CONCLUSIONS: Physician-respondents were either uninformed or skeptical about public reporting websites. In contrast to prior reports that a majority of patients value some forms of publicly reported data, most physicians do not consider quality metrics and patient-generated reviews helpful for patients who are choosing a physician.


Assuntos
Atitude do Pessoal de Saúde , Satisfação do Paciente , Médicos/psicologia , Inquéritos e Questionários/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Internet , Masculino , Pessoa de Meia-Idade , Médicos/normas , Rhode Island
8.
J Am Med Inform Assoc ; 26(2): 106-114, 2019 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-30517663

RESUMO

Objective: To quantify how stress related to use of health information technology (HIT) predicts burnout among physicians. Methods: All 4197 practicing physicians in Rhode Island were surveyed in 2017 on their HIT use. Our main outcome was self-reported burnout. The presence of HIT-related stress was defined by report of at least 1 of the following: poor/marginal time for documentation, moderately high/excessive time spent on the electronic health record (EHR) at home, and agreement that using an EHR adds to daily frustration. We used logistic regression to assess the association between each HIT-related stress measure and burnout, adjusting for respondent demographics, practice characteristics, and the other stress measures. Results: Of the 1792 physician respondents (43% response rate), 26% reported burnout. Among EHR users (91%), 70% reported HIT-related stress, with the highest prevalence in primary care-oriented specialties. After adjustment, physicians reporting poor/marginal time for documentation had 2.8 times the odds of burnout (95% CI: 2.0-4.1; P < .0001), compared to those reporting sufficient time. Physicians reporting moderately high/excessive time on EHRs at home had 1.9 times the odds of burnout (95% CI: 1.4-2.8; P < .0001), compared to those with minimal/no EHR use at home. Those who agreed that EHRs add to their daily frustration had 2.4 times the odds of burnout (95% CI: 1.6-3.7; P < .0001), compared to those who disagreed. Conclusion: HIT-related stress is measurable, common (about 70% among respondents), specialty-related, and independently predictive of burnout symptoms. Identifying HIT-specific factors associated with burnout may guide healthcare organizations seeking to measure and remediate burnout among their physicians and staff.


Assuntos
Esgotamento Profissional/etiologia , Registros Eletrônicos de Saúde , Informática Médica , Médicos/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Satisfação no Emprego , Masculino , Medicina , Pessoa de Meia-Idade , Estresse Ocupacional , Rhode Island , Inquéritos e Questionários , Carga de Trabalho
9.
J Gen Intern Med ; 33(11): 1892-1898, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30030734

RESUMO

BACKGROUND: Physicians spend significant time outside of regular office visits caring for complex patients, and this work is often uncompensated. In 2015, the Centers for Medicare & Medicaid Services (CMS) introduced a billing code for care coordination between office visits for beneficiaries with multiple chronic conditions. OBJECTIVE: Characterize use of the Chronic Care Management (CCM) code in New England in 2015. DESIGN: Retrospective observational analysis. PARTICIPANTS: All Medicare fee-for-service beneficiaries in New England continuously enrolled in Parts A and B in 2015. INTERVENTION: None. MAIN MEASURES: The primary outcome was the number of beneficiaries with a CCM claim per 1000 eligible beneficiaries. Secondary outcomes included the total number of CCM claims, total reimbursement, mean number of claims per beneficiary, and beneficiary characteristics independently associated with receiving CCM services. KEY RESULTS: Of the more than two million Medicare fee-for-service beneficiaries in New England, almost 1.7 million were potentially eligible for CCM services. Among eligible beneficiaries, 10,951 (0.65%) had a CCM claim in 2015. Massachusetts had the highest penetration of CCM use (9.40 claims per 1000 eligible beneficiaries); Vermont had the lowest (0.54 claims per 1000 eligible beneficiaries). Mean reimbursement per physician was $1745.98. Age, race/ethnicity, dual-eligible status, income, number of chronic conditions, and state of residence were associated with receiving CCM services in an adjusted model. CONCLUSIONS: The CCM code is likely underutilized in New England; the program may therefore not be achieving its intended goal of encouraging consistent, team-based chronic care management for Medicare's most complex beneficiaries. Or practices may be foregoing reimbursement for care coordination that they are already providing. Recently implemented revisions may improve uptake of CCM services; it will be important to compare our results with future utilization.


Assuntos
Doença Crônica/epidemiologia , Benefícios do Seguro/métodos , Classificação Internacional de Doenças , Medicare , Administração dos Cuidados ao Paciente/métodos , Adolescente , Adulto , Criança , Pré-Escolar , Doença Crônica/tendências , Feminino , Humanos , Lactente , Recém-Nascido , Benefícios do Seguro/tendências , Classificação Internacional de Doenças/tendências , Masculino , Medicare/tendências , Pessoa de Meia-Idade , New England/epidemiologia , Administração dos Cuidados ao Paciente/tendências , Estudos Retrospectivos , Estados Unidos/epidemiologia , Adulto Jovem
10.
J Innov Health Inform ; 24(2): 894, 2017 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-28749316

RESUMO

nBACKGROUND: Electronic health records (EHRs) may reduce medical errors and improve care, but can complicate clinical encounters. OBJECTIVE: To describe hospital-based physicians' perceptions of the impact of EHRs on patient-physician interactions and contrast these findings against office-based physicians' perceptionsMethods: We performed a qualitative analysis of comments submitted in response to the 2014 Rhode Island Health Information Technology Survey. Office- and hospital-based physicians licensed in Rhode Island, in active practice, and located in Rhode Island or neighboring states completed the survey about their Electronic Health Record use. RESULTS: The survey's response rate was 68.3% and 2,236 (87.1%) respondents had EHRs. Among survey respondents, 27.3% of hospital-based and 37.8% of office-based physicians with EHRs responded to the question about patient interaction. Five main themes emerged for hospital-based physicians, with respondents generally perceiving EHRs as negatively altering patient interactions. We noted the same five themes among office-based physicians, but the rank-order of the top two responses differed by setting: hospital-based physicians commented most frequently that they spend less time with patients because they have to spend more time on computers; office-based physicians commented most frequently on EHRs worsening the quality of their interactions and relationships with patients. CONCLUSION: In our analysis of a large sample of physicians, hospital-based physicians generally perceived EHRs as negatively altering patient interactions, although they emphasized different reasons than their office-based counterparts. These findings add to the prior literature, which focuses on outpatient physicians, and can shape interventions to improve how EHRs are used in inpatient settings.


Assuntos
Registros Eletrônicos de Saúde/estatística & dados numéricos , Hospitais , Relações Médico-Paciente , Médicos/psicologia , Adulto , Atitude Frente aos Computadores , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Rhode Island
11.
R I Med J (2013) ; 98(10): 29-32, 2015 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-26422543

RESUMO

We used data from the mandatory statewide Rhode Island (RI) Health Information Technology (HIT) Survey to characterize office-based PCPs' adoption and use of EHRs from 2009-2014. We found accelerated adoption of EHRs in the five years since state and federal incentive programs began targeting PCPs' adoption of HIT. There was room for improvement, however; for example, when asked to indicate the proportion of patients with whom they used various functionalities, only 13.4% of office-based PCPs said they "almost always" communicated with patients using secure messaging and 22.3% "almost always" used secure clinical messaging with outside providers. Results suggest uneven use of EHR functionalities, with low rates and slower uptake in some areas. These findings highlight opportunities to increase use of functionalities related to improved patient care and quality-based payment models.


Assuntos
Registros Eletrônicos de Saúde/estatística & dados numéricos , Médicos de Atenção Primária/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Registros Eletrônicos de Saúde/normas , Pesquisas sobre Serviços de Saúde , Humanos , Pessoa de Meia-Idade , Rhode Island , Autorrelato
12.
Jt Comm J Qual Patient Saf ; 40(7): 319-24, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25130015

RESUMO

BACKGROUND: Although high-quality care transitions require timely and accurate communication of clinical information between providers, such communication is inconsistent, and there are few established guidelines outside the hospital setting. METHODS: Using a systematic, collaborative quality improvement process, Healthcentric Advisors (Providence, Rhode Island) undertook a multistage approach to define best practices for care transitions in the urgent care setting. This approach entailed review of the medical literature to identify processes that improve care transitions outcomes, gathering of information about clinicians' preferences, and a statewide community meeting with urgent care clinicians and other stakeholders to vet draft guidelines and obtain consensus on the concepts. RESULTS: Because of an inability to identify any guidelines or research that globally addressed care transitions from the urgent care setting, information was gathered from studies on patient discharge instructions and extrapolated from the evidence base available for related settings. The resulting set of eight best practices for urgent care center transitions focuses on clinician-to-clinician communication and patient activation, which can be implemented to establish measurable, communitywide expectations for communication. CONCLUSION: This set of best practices constitutes the first known guidelines to establish expectations and measures tailored specifically to transitions from the urgent care setting to the emergency department or primary care office. They can serve as a resource and a framework for urgent care clinicians expanding their collaboration with community partners, such as emergency departments and primary care providers, particularly in the context of emerging payment models.


Assuntos
Instituições de Assistência Ambulatorial/organização & administração , Comunicação , Continuidade da Assistência ao Paciente/organização & administração , Melhoria de Qualidade/organização & administração , Comportamento Cooperativo , Humanos , Relações Interprofissionais
13.
Am J Med ; 127(10): 1010.e21-7, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24945882

RESUMO

OBJECTIVES: Although electronic health record use improves healthcare delivery, adoption into clinical practice is incomplete. We sought to identify the extent of adoption in Rhode Island and the characteristics of physicians and electronic health records associated with positive experience. METHODS: We performed a cross-sectional study of data collected by the Rhode Island Department of Health for the Health Information Technology Survey 2009 to 2013. Survey questions included provider and practice demographics, health record information, and Likert-type scaled questions regarding how electronic health record use affected clinical practice. RESULTS: The survey response rate ranged from 50% to 65%, with 62% in 2013. Increasing numbers of physicians in Rhode Island use an electronic health record. In 2013, 81% of physicians used one, and adoption varied by clinical subspecialty. Most providers think that electronic health record use improves billing and quality improvement but has not improved job satisfaction. Physicians with longer and more sophisticated electronic health record use report positive effects of introduction on all aspects of practice examined (P < .001). Older physician age is associated with worse opinion of electronic health record introduction (P < .001). Of the 18 electronic health record vendors most frequently used in Rhode Island, 5 were associated with improved job satisfaction. CONCLUSIONS: We report the largest statewide study of electronic health record adoption to date. We found increasing physician use in Rhode Island, and the extent of adoption varies by subspecialty. Although older physicians are less likely to be positive about electronic health record adoption, longer and more sophisticated use are associated with more positive opinions, suggesting acceptance will grow over time.


Assuntos
Atitude do Pessoal de Saúde , Registros Eletrônicos de Saúde/estatística & dados numéricos , Implementação de Plano de Saúde/estatística & dados numéricos , Médicos/psicologia , Fatores Etários , American Recovery and Reinvestment Act , Estudos Transversais , Registros Eletrônicos de Saúde/economia , Registros Eletrônicos de Saúde/legislação & jurisprudência , Pesquisas sobre Serviços de Saúde , Humanos , Satisfação no Emprego , Pessoa de Meia-Idade , Crédito e Cobrança de Pacientes , Qualidade da Assistência à Saúde , Rhode Island , Especialização/estatística & dados numéricos , Fatores de Tempo , Estados Unidos , Fluxo de Trabalho
14.
Am J Manag Care ; 19(6): 450-3, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23844707

RESUMO

OBJECTIVES: To propose a new measurement strategy to evaluate the intended impact of hospital readmission reduction programs on healthcare utilization. STUDY DESIGN: In Rhode Island, Healthcentric Advisors, the Medicare Quality Improvement Organization, has implemented a readmissions reduction program since 2008. We use data fromthis program to illustrate our proposed use of a bundled measure of unplanned post-hospital care. METHODS: We examined Medicare Part A claims for all Rhode Island fee-for-service Medicare beneficiaries from January 1, 2009, through December 31, 2011.To capture potential cost shifting, we evaluated emergency department (ED) visits, observation stays, and hospital admission and readmission rates annually, and in the 30 days after discharge from an inpatient stay. We also aggregated these data into 2 composite measures: acute-care utilization and post-hospital unplanned care. RESULTS: From 2009 through 2011 Rhode Island's annual and post-hospital ED and inpatient admissions rates decreased, while the corresponding observation stay rates (annual and post-hospital) increased. Both the acute-care utilization and post-hospital unplanned care decreased. CONCLUSIONS: These data highlight the need to examine impact in the context of temporal trends and other environmental factors. Because readmissions are common and costly, national readmission reduction programs are proliferating. However, readmission rates provide an incomplete picture of unplanned care and costs and may lead to unintended consequences, such as increased observation stay rates. Our findings strengthen our argument that payers and policy makers should broaden their focus from readmission measures to unplanned care composite measures.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Serviços de Saúde/estatística & dados numéricos , Readmissão do Paciente/tendências , Idoso , Serviço Hospitalar de Emergência/economia , Humanos , Revisão da Utilização de Seguros , Medicare Part A , Admissão do Paciente/tendências , Readmissão do Paciente/estatística & dados numéricos , Garantia da Qualidade dos Cuidados de Saúde , Rhode Island , Estados Unidos
15.
Am J Emerg Med ; 31(9): 1297-301, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23816191

RESUMO

PURPOSE: This study aimed to develop emergency department best practice guidelines for improved communication during patient care transitions. BASIC PROCEDURES: To our knowledge, there are no specific guidelines for communication at the point of transition from the emergency department to the community. In Rhode Island, we used a multistage collaborative quality improvement process to define best practices for emergency department care transitions. We reviewed the medical literature, consensus statements, and materials from national campaigns; gathered preferences from emergency medicine and primary care clinicians; and created guidelines that we vetted with emergency medicine clinicians and other key stakeholders. MAIN FINDINGS: Because we did not find any guidelines that globally addressed care transitions from the emergency department, we drew from studies on patient discharge instructions and extrapolated from the evidence base available for other, related settings. Our key outcome is a set of care transition best practices for emergency departments, which can be implemented to establish measurable, communitywide expectations for cross-setting clinician-to-clinician communication. They include obtaining information about patients' outpatient clinicians, sending summary clinical information to downstream clinicians, performing modified medication reconciliation, and providing patients with effective education and written discharge instructions. PRINCIPAL CONCLUSIONS: The best practices provide feasible standards for evaluating and improving how patients transition out of the emergency department and can provide a framework for emergency department leaders expanding their collaboration with community partners, particularly in the context of emerging payment models. They also catalyze introspection and debate about how to improve communication and accountability across the care continuum.


Assuntos
Serviço Hospitalar de Emergência/normas , Alta do Paciente/normas , Comunicação , Humanos , Reconciliação de Medicamentos/normas , Educação de Pacientes como Assunto/normas , Transferência da Responsabilidade pelo Paciente/normas , Guias de Prática Clínica como Assunto
16.
Med Care Res Rev ; 69(2): 231-45, 2012 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-22156836

RESUMO

Information on state-level health information technology (HIT) adoption will become increasingly important with the implementation of incentive payments to accelerate uptake. Recognizing this, the Rhode Island Department of Health selected physician HIT adoption as a subject for its legislatively mandated quality reporting program. This article discusses the state's process for developing HIT adoption measures, including the importance of stakeholder involvement in the development of a survey and the difficulty of accurately defining electronic medical record (EMR) adoption. This article describes the challenges in defining "true" EMRs, which may be addressed, in part, by ensuring local consensus about EMR measures and by piloting the survey and measures, prior to public reporting or the calculation of a statewide baseline. It also presents results from the 2009 administration of this survey to all 3,883 Rhode Island-licensed physicians providing direct patient care.


Assuntos
Atitude Frente aos Computadores , Difusão de Inovações , Registros Eletrônicos de Saúde/estatística & dados numéricos , Pesquisas sobre Serviços de Saúde , Médicos de Atenção Primária/psicologia , Adulto , Idoso , Prescrição Eletrônica , Humanos , Pessoa de Meia-Idade , Rhode Island , Governo Estadual
17.
J Emerg Med ; 39(3): 275-81, 2010 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-18993017

RESUMO

Prior studies have suggested gender-based differences in the care of elderly patients with acute medical conditions such as myocardial infarction and stroke, but it is unknown whether these differences are seen in the care of abdominal pain. The objective of this study was to examine differences in evaluation, management, and diagnoses between elderly men and women presenting to the Emergency Department (ED) with abdominal pain. For this observational cohort study, a chart review was conducted of consecutive patients aged 70 years or older presenting with a chief complaint of abdominal pain. Primary outcomes were care processes (e.g., receipt of pain medications, imaging) and clinical outcomes (e.g., hospitalization, etiology of pain, and mortality). Of 131 patients evaluated, 60% were women. Groups were similar in age, ethnicity, insurance status, and predicted mortality. Men and women did not differ in the frequency of medical (56% vs. 57%, respectively), surgical (25% vs. 18%, respectively), or non-specific abdominal pain (19% vs. 25%, respectively, p = 0.52) diagnoses. Similar proportions underwent abdominal imaging (62% vs. 68%, respectively, p = 0.42), received antibiotics (29% vs. 30%, respectively, p = 0.85), and opiates for pain (35% vs. 41%, respectively, p = 0.50). Men had a higher rate of death within 3 months of the visit (19% vs. 1%, respectively, p < 0.001). Unlike prior research in younger patients with abdominal pain and among elders with other acute conditions, we noted no difference in management and diagnoses between older men and women who presented with abdominal pain. Despite a similar predicted mortality and ED evaluation, men had a higher rate of death within 3 months.


Assuntos
Dor Abdominal/etiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Dor Abdominal/diagnóstico , Dor Abdominal/mortalidade , Dor Abdominal/terapia , Idoso , Idoso de 80 Anos ou mais , California/epidemiologia , Distribuição de Qui-Quadrado , Estudos de Coortes , Diagnóstico por Imagem , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Fatores Sexuais , Estatísticas não Paramétricas , Resultado do Tratamento
19.
Arch Intern Med ; 168(15): 1671-7, 2008 Aug 11.
Artigo em Inglês | MEDLINE | ID: mdl-18695081

RESUMO

BACKGROUND: Hospitalization may cause bone loss and decrease physical function; however, the risk of fracture following hospitalization is not known. METHODS: A prospective study of a cohort of 3075 white and black women and men, aged 70 to 79 years, recruited from 2 communities from 1997 to 1998. Incident hospitalizations and fractures were validated by medical records by investigators blinded to patient groupings. Analyses of the association between hospitalization, length of stay, number of admissions, and risk of fracture were adjusted for age, race, sex, and other potential confounding factors. RESULTS: During follow-up with a mean duration of 6.6 years, 2030 (66%) of the 3075 participants were admitted to a hospital and 809 (26%) were admitted 3 or more times; 285 experienced a fracture, including 74 hip fractures. After adjusting for age, race, and sex, those who had any hospitalization had a 2-fold increased risk of fracture (hazard ratio [HR], 2.01; 95% confidence interval [CI], 1.57-2.57), including an increased risk of hip fracture (HR, 2.15; 95% CI, 1.32-3.50). Those who were hospitalized twice during the follow-up period had a 2.42-fold increased risk of hip fracture (95% CI, 1.16-5.05), and 3 or more hospital stays indicated a 3.66-fold increased relative hazard for hip fracture (95% CI, 1.78-7.53). CONCLUSIONS: Hospitalizations, particularly multiple admissions, are very common in elderly individuals and are strongly associated with an increased risk of hip and other types of fracture. Hospitalizations present opportunities to take measures to reduce the risk of fractures.


Assuntos
Fraturas Ósseas/epidemiologia , Hospitalização/estatística & dados numéricos , Medição de Risco , Idoso , Grupos de Populações Continentais , Feminino , Seguimentos , Humanos , Incidência , Masculino , Estudos Prospectivos , Distribuição por Sexo , Estados Unidos/epidemiologia
20.
Am J Emerg Med ; 25(6): 643-50, 2007 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-17606089

RESUMO

OBJECTIVE: The aim of the study was to identify and quantify patient, physician, hospital, and system factors that are associated with a longer ED length of stay. METHODS: Data were from the 2001-2003 National Hospital Ambulatory Medical Care Survey. The primary outcome was length of stay in minutes. Predictor variables were patient level (eg, age, triage score), physician level (eg, level of training), and hospital/system level (eg, geographic location, ownership). RESULTS: Admitted patients' median length of stay was 255 minutes (interquartile range, 160-400); discharged patients stayed a median of 120 minutes (interquartile range, 70-199). Factors independently associated with longer ED stays for admitted patients were Hispanic ethnicity (+20 minutes), computed tomography scan or magnetic resonance imaging (+36 minutes), and hospital location in a metropolitan area (+32 minutes). Intensive care unit admissions had a shorter length of stay (-30 minutes). CONCLUSION: Several factors are associated with significant increases in ED length of stay and may be important factors in strategies to reduce length of stay.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Tempo de Internação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Testes Diagnósticos de Rotina/estatística & dados numéricos , Emergências/classificação , Feminino , Pesquisas sobre Serviços de Saúde , Hispano-Americanos , Hospitais/classificação , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Triagem , Estados Unidos
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