Hypertension control after an initial cardiac event among Medicare patients with diabetes mellitus: A multidisciplinary group practice observational study.

Patients with diabetes mellitus and cardiovascular disease have a high risk of mortality and/or recurrent cardiovascular events. Hypertension control is critical for secondary prevention of cardiovascular events. The objective was to determine rates and predictors of achieving hypertension control among Medicare patients with diabetes and uncontrolled hypertension after hospital discharge for an initial cardiac event. A retrospective analysis of linked electronic health record and Medicare data was performed. The primary outcome was hypertension control within 1 year after hospital discharge for an initial cardiac event. Cox proportional hazard models assessed sociodemographics, medications, utilization, and comorbidities as predictors of control. Medicare patients with diabetes were more likely to achieve hypertension control when prescribed beta-blockers at discharge or with a history of more specialty visits. Adults ≥ 80 were more likely to achieve control with diuretics. These findings demonstrate the importance of implementing guideline-directed multidisciplinary care in this complex and high-risk population.

Hiring your next partner: AOA critical issues.

Hiring a new partner into an orthopaedic department or group can be a daunting task. A recent American Orthopedic Association symposium sought to address three major aspects of hiring that affect orthopaedic leaders: (1) when to hire-the chairperson's role; (2) generational issues that affect hiring; and (3) the development of an initial compensation package.How does the chairperson recruit new physicians? Hiring a new partner into the academic setting requires a good deal of foresight. There must be an established game plan. Advertising and interviews need to be orchestrated. Chairpersons can find information about candidates from many unique sources. Fit within the department and community is important and must be cultivated. Spouses and families need special attention. Research candidates have individual needs. Perhaps the most important aspect of recruitment is the development of a realistic business plan. This paper provides an overview of factors to consider in managing a new hire.Generational issues are intriguing. Should they affect our hiring practices? It seems clear to established physicians that the new generation of graduates is different from their predecessors. Is this really true? Most everyone is familiar with the terms "Silent Generation," "Baby Boomers," "Generation X," and "Generation Y." Is there anything to be gained by categorizing an applicant? Is it important to hire a replica of one's self? This paper provides a thoughtful overview of generational issues as they apply to hiring new partners.Most department chairpersons are not trained as negotiators. Some preparation and experience are helpful in guiding the process of making an initial offer to a candidate. It is not all about pay. The package includes the guarantee period, expectations for the new hire, mentorship, and resources. How much should new orthopaedic academic hires be paid? Recent benchmark data from the Academic Orthopaedic Consortium suggest a mean income of $282,667 for physicians who have just finished a fellowship. New hires are concerned about call frequency and available time free from work. How much work should be expected from an academic surgeon? Recent survey data from the American Orthopaedic Consortium suggest a mean of 9200 relative value units per year. This article offers some guidelines for the chairperson who needs to formulate an initial offer for a new hire.There is a lot involved in hiring a new partner, as times are changing. This paper offers considerable food for thought about hiring.

Quality: the Mayo Clinic approach.

Developing highly reliable care for patients requires changes in some traditional beliefs of medical practice, an evolution toward a "system" of health care, the disciplined application of scientific principles, modifications in the way all future providers are trained, and a fundamental understanding by leadership that quality must become a business strategy and core work, not an expense or regulatory requirement. Quality at Mayo is defined as a composite of outcomes, safety, and service. A 4-part strategic construct focusing on Culture, Infrastructure, Engineering, and Execution has been developed to guide improvement activities and to ensure a comprehensive approach to better patient care. The Mayo Clinic experience has led to a greater understanding of the leadership commitment, organizational challenges, and the breadth of initiatives necessary to achieve highly reliable care.

Ochsner Health System Department of Anesthesiology: the first thirty years.

The Department of Anesthesiology at Ochsner Clinic Foundation was founded in 1947 at the original Ochsner Hospital at Camp Plauche in New Orleans. An anesthesiology residency training program was accredited in 1953, making Ochsner one of the early and leading producers of anesthesiologists for the Gulf South region. Staff members over the years have held prominent national leadership positions, including two American Society of Anesthesiology presidents, the founder of the Society of Cardiovascular Anesthesiology, and the president of the Society for Obstetric Anesthesiology and Perinatology.

When should a multicampus hospital be considered a single entity for public reporting on patient safety issues?

OBJECTIVE: Attempts to provide information to consumers about patient safety on specific hospitals have conflicted with organization self-perceptions and led to confusion among the general public. This article presents organizational theory framework and criteria to classify organizations as single versus multiple reporting entities. PARTICIPANTS AND METHODS: Operational definitions are presented. A case study comparing institutions both within and across state boundaries in the Mayo Clinic Health System is used to demonstrate their utility. The study includes analysis of an employee survey on employee satisfaction and patient safety climate in 2004 among nurses and physicians at the 2 Mayo Clinic hospitals in Rochester, Minn. RESULTS AND CONCLUSIONS: The criteria for a single organization are more strongly supported for the Mayo Clinic hospitals located in the same city than for hospitals in the same system but separated geographically. Although there is debate about the measurement of organizational culture, employee surveys provide some evidence of a commonality across hospitals in the same city. The case study comparing institutions both within and across state boundaries in the Mayo Clinic Health System demonstrate the utility of the proposed criteria.

Putting on a clinic in Va. Carilion, a not-for-profit hospital system based in Roanoke, is taking a $100 million risk to become a physician-run venture.

Carilion Health System needs to change or die, according to its leaders, so the Roanoke, Va., organization is converting from a typical not-for-profit system into a physician-run clinic. The switch is an extreme version of an industrywide push to employ doctors. James Thweatt Jr., left, of rival Lewis-Gale, says his hospital joined the trend when it hired 80 specialists from a failing local clinic.

Principles and process in the development of the Mayo Clinic's individual and institutional conflict of interest policy.

In 1995, federal regulations required all academic medical centers to implement policies to manage individual financial conflict of interest. At the Mayo Clinic, all staff are salaried, and all medically related intellectual property from the staff belongs to the clinic. Hence, it was necessary to develop a policy for institutional conflict of interest to complement the policy for individual conflicts of interest. This article addresses the principles and process that led to the development of the Mayo Clinic's policies that guide the management of conflict of interest of individuals and of the institution. Empowered by the Bayh-Dole Act, the Mayo Clinic participates in technology transfer through its entity Mayo Medical Ventures. Individual conflicts of interest arising from such technology transfer are associated with Institutional conflicts because all individual intellectual property belongs to the institution, per clinic policy. This policy addresses conflicts of interest that arise in research, leadership, clinical practice, investments, and purchasing. Associated with the statutory annual disclosure on personal consulting and other relationships with Industry, which are guided by federal regulations, all research protocols or grant applications require financial disclosure on initial submission and in annual progress reports. The clinic's Conflict of Interest Review Board was established to review each disclosure and recommend management of individual and institutional conflicts of interest according to policy.

Measuring productivity in medical social work.

Our purpose was to discuss the need for measuring and documenting social work services, as well as to discuss the data and statistical collection method used in Mayo Clinic's Section of Medical Social Services, which may be useful to other social service departments. The lack of empirical data showing the value of social work services may lead to decreases in staffing in medical social work departments. Mayo Clinic uses a computer application called MedSoc to gather case information and measure productivity, which is based on demand and capacity. Through use of MedSoc, our section improved communication among social work staff members and justified an increase in staffing of 38% from late 1997 to 2002.

The development and implementation of a strategic and tactical planning framework at Mayo Clinic Arizona.

This article describes the Mayo Arizona process for developing an information technology strategic plan. The background of organizational events that gave rise to this strategic planning process is presented. A cross-functional team of key IT stakeholders was convened; the team used a facilitated process to derive a pro forma set of IT strategic objectives from the larger organization's emerging strategic plan. A broad set of leadership interviews was conducted to further identify detailed objectives that would confirm, complement, or conflict with the "strawperson." The IT strategic objectives then were refined and published by the organization. The article also describes the annual process of reviewing the IT strategic plan and translating it to a set of tactical objectives. This includes the committee structure for project prioritization, which is guided by the IT strategic plan. The outcome of the prioritization process is a five-year IT tactical plan, which is used to communicate the IT action plan for achievement of the strategic objectives. The strategic and tactical plans have resulted in stronger ownership and advocacy of IT activities by organizational leadership and a clearer view of the impact of technology on the organization's strategic plan.

Inconsistencies between self-reported ethnicity and ethnicity recorded in a health maintenance organization.

PURPOSE: Information on patient ethnicity in hospital admissions databases is often used in epidemiologic and health services research. However, the extent of consistency of these data with self-reported ethnicity is not well studied, particularly for specific Asian subgroups. We examined agreement between ethnicity in records of a sample of members of five Northern California Kaiser Permanente medical centers with self-reported ethnicity. METHODS: Subjects were 3168 cases and 2413 controls aged 45 years and older from a study of fractures. Ethnicity recorded in the Kaiser admissions database (primarily inpatient) was compared with self-reported ethnicity from the study interviews. RESULTS: Among study subjects with available Kaiser ethnicity, sensitivities and positive predictive values of the Kaiser classification were high among blacks (0.95 for both measures) and whites (0.98 and 0.94, respectively), slightly lower among Asians (0.88 and 0.95, respectively), and considerably lower among Hispanics (0.55 and 0.81, respectively) and American Indians (0.47 and 0.50, respectively). Among Asian subgroups, the proportion classified as Asian was high among Chinese (0.94) and Japanese (0.99) but lower among Filipinos (0.79) and other Asians (0.74). Among the 228 (4%) subjects who self-identified with multiple ethnicities, 13 of 18 white + Hispanic subjects were classified as being white, and of the 77 subjects identifying as part American Indian, only one was classified as being American Indian in the Kaiser database. CONCLUSIONS: Given the importance of ethnicity information, medical facilities should be encouraged to adopt policies toward collecting high quality data.

One more time: improve your board through self-assessment.

Evaluating board effectiveness is a highly subjective, individualized, and potentially powerful undertaking if pursued with the proper motivation and with the ownership of the board. In this article, the authors describe one successful approach to board self-evaluation pursued by the Albert Lea Medical Center, Mayo Health System, Minnesota. The authors share evaluation methodology as well as process and outcomes. Recommendations directed toward organizations considering the self-evaluation process are formed around three themes. First, engage your board and have them own the process. Second, engage your board in developing the evaluation methodology. Third, ensure accountability in the board and the senior organization leadership for action on self-assessment outcomes. Finally, the authors discuss board development as a functional responsibility of the board. In that context, they present self-evaluation as one opportunity for a board to tangibly embrace its education and development responsibilities.