Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 8.091
Filtrar
1.
Healthc Manage Forum ; 33(1): 39-46, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31370716

RESUMO

First Nations and other health leaders are looking to Electronic Health Records (EHRs) to improve the quality of health information, efficiency of health services, and health outcomes for Indigenous people in Canada. This study used qualitative and quantitative methods to identify the success factors in an EHR implementation at a First Nations health centre in British Columbia, Canada. The Best Practices EHR Implementation Framework (EHRIF) was used to analyze the success factor data and found that all of the success factors from the planning and implementation phases in the framework were important. Provincial and federal government commitment and collaboration with key stakeholders including a local physician champion were also critically important for the electronic medical record implementation to proceed. This study suggests the EHRIF can be used to promote successful EHR implementations in Aboriginal communities and can contribute to building health informatics expertise and capacity in First Nations communities.

2.
Am J Prev Med ; 57(6): 757-764, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31753257

RESUMO

INTRODUCTION: The 2012 national cervical cancer screening guidelines recommended cessation of screening after age 65 years in women with adequate prior screening. In this retrospective cohort study, adherence to these screening exit guidelines was examined. METHODS: Women who turned age 66 years in 2012-2013 at Kaiser Permanente Southern California were followed through age 68 years for cervical cancer screening uptake. Adequacy of prior screening was assessed between age 56 and 65 years using electronic medical records. Guideline adherence was determined based on screening pattern between age 66 and 68 years. Patient- and physician-level correlates for guideline adherence were examined using multivariable logistic regression. Data collection and analyses were conducted in 2018. RESULTS: A total of 14,778 women were included; 24% did not have adequate prior screening by age 65 years. Among those without adequate prior screening, the proportion screened after age 65 years ranged from 71% (177 of 249) in those whose most recent test was abnormal to 3% (34 of 1,330) in those who did not have any testing in 10 years. Prior screening pattern was the only factor associated with screening after age 65 years. Of those with adequate prior screening, 10% (1,135 of 11,295) continued to receive screening after age 65 years. Frequent office visits and having a male primary care physician were associated with continuing screening after age 65 years. CONCLUSIONS: A considerable proportion of women did not have adequate prior screening by age 65 years. Of these, a large proportion did not receive screening after age 65 years, except those who had a recent abnormal screening result. Further research is needed to understand barriers for guideline adherence and rationales for clinical decision making.

3.
J Acad Nutr Diet ; 2019 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-31685413

RESUMO

Provision of nutrition care is vital to the health and well-being of any patient who enters the health care system, whether in the ambulatory, inpatient, or long-term care setting. Interdisciplinary professionals-nurses, physicians, advanced practice providers, pharmacists, and dietitians-identify and treat nutrition problems or clinical conditions in each of these health care settings. The documentation of nutrition care in a structured format from screening and assessment to discharge allows communication of the nutrition treatment plans. The goal of this document is to provide recommendations to clinicians for working with an organization's Information Systems department to create tools for documentation of nutrition care in the electronic health record. These recommendations can also serve as guidance for health care organizations choosing and implementing health care software.

4.
Am J Emerg Med ; 2019 Oct 14.
Artigo em Inglês | MEDLINE | ID: mdl-31718956

RESUMO

OBJECTIVE: Overdose from opioids has reached epidemic proportions. Large healthcare systems can utilize existing technology to encourage responsible opioid prescribing practices. Our study measured the effects of using the electronic medical record (EMR) with direct clinician feedback to standardize opioid prescribing practices within a large healthcare system. METHODS: This retrospective multicenter study compared a 12 month pre- and post-intervention in 14 emergency departments after four interventions utilizing the EMR were implemented: (1) deleting clinician preference lists, (2) defaulting dose, frequency, and quantity, (3) standardizing formulary to encourage best practices, and (4) creating dashboards for clinician review with current opioid prescribing practices. Outlying clinicians received feedback through email and direct counseling. Total number of opioid prescriptions per 100 discharges pre- and post-intervention were recorded as primary outcome. Secondary outcomes included number of prescriptions per 100 discharges/clinician exceeding 3-day supply (defined as 12 tablets), number exceeding 30 morphine equivalent daily dose (MEDD)/day, and number of non-formulary prescriptions. RESULTS: There were >700,000 discharges during pre- and post-intervention periods. Percentage of total number opioid prescriptions per 100 discharges decreased from 14.4% to 7.4%, a 7.0% absolute reduction, (95% CI,6.9%-7.2%). There was a 5.9% to 0.7% reduction in prescriptions exceeding 3-days, (95% CI, 5.1%-5.3%), a 4.3% to 0.3% reduction in prescriptions exceeding 30 MEDD, (95% CI, 3.9%-4.0%), and a 0.3% to 0.1% reduction in non-formulary prescriptions, (95% CI, 0.2%-0.3%). CONCLUSIONS: A multi modal approach using EMR interventions which provide real time data and direct feedback to clinicians can facilitate appropriate opioid prescribing.

5.
Obstet Gynecol ; 134(6): 1227-1233, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31764733

RESUMO

OBJECTIVE: To provide U.S. case-based preeclampsia health care cost estimates for mothers and infants from a U.S. payer perspective, with comparisons with both uncomplicated and hypertensive pregnancies. METHODS: Electronic health record and billing data from a large regional integrated health care system in Pennsylvania were used to identify mother-singleton infant pairs with deliveries between 2010 and 2015. Data on clinical care and costs using actual payment amounts were compiled from 20 weeks of gestation to 6 weeks postdelivery for mothers and birth to 12 months for infants. Three defined pregnancy study cohorts, uncomplicated, hypertension and preeclampsia, were matched using a 1:1:1 ratio on the basis of maternal age, parity, body mass index, and comorbidities. Costs per pregnancy were calculated in 2015 dollars and preeclampsia incremental costs estimated by subtracting the average cost of the matched cohorts. RESULTS: The final study population included 712 matched mother-infant pairs in each cohort. The mean combined maternal and infant medical care costs in the preeclampsia cohort of $41,790 were significantly higher than those for the uncomplicated cohort of $13,187 (P<.001) and hypertension cohort of $24,182 (P<.001), and were largely driven by differences in the infant costs. The mean infant cost in the preeclampsia cohort were $28,898, in the uncomplicated cohort $3,669 and $12,648 in the hypertension cohort (P<.001). Mothers with preeclampsia delivered 3 weeks earlier (median 36.5 weeks of gestation) than women in the uncomplicated cohort and more than 2 weeks earlier than women in the hypertension cohort. A significantly larger percentage of women with preeclampsia and their infants experienced adverse events (13.9% for mothers and 14.6% for infants) compared with unaffected women (4.1% and 0.7%) and those with hypertension (9.4% and 4.8%), respectively (P<.001). CONCLUSION: The economic burden of preeclampsia health care is significant with the main cost drivers being infant health care costs associated with lower gestational age at birth and greater adverse outcomes. FUNDING SOURCE: This study is funded by Progenity, Inc.

6.
J Comp Eff Res ; 2019 Oct 31.
Artigo em Inglês | MEDLINE | ID: mdl-31670598

RESUMO

Aim: This study compared real-world complication rates, hospitalization duration and costs, among patients undergoing arterial repair using the Perclose ProGlide (ProGlide) versus surgical cutdown (Cutdown). Materials & methods: Retrospective study of matched patients who underwent transcatheter aortic valve replacement/repair, endovascular abdominal aortic aneurysm repair, thoracic endovascular aortic repair or balloon aortic valvuloplasty with arterial repair by either ProGlide or Cutdown between 1 January 2013 and 24 April 2017. Results: Infections and blood transfusions were lower in the ProGlide cohort. Patients in the ProGlide cohort had a 42.5% shorter index hospitalization, which corresponded to $14,687 lower costs. Conclusion: The use of ProGlide for arterial repair was associated with significantly lower transfusion rates, shorter index hospitalization and lower hospitalization costs compared with surgical cutdown.

7.
Int J Med Inform ; 133: 104015, 2019 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-31683142

RESUMO

OBJECTIVE: A clinical pathway is one of the tools used to support clinical decision making that provides a standardized care process in a specific context. The objective of this research was to develop a method for building data-driven clinical pathways using electronic health record data. MATERIALS AND METHODS: We proposed a matching rate-based clinical pathway mining algorithm that produces the optimal set of clinical orders for each clinical stage by employing matching rates. To validate the approach, we utilized two different datasets of deidentified inpatient records directly related to total laparoscopic hysterectomy (TLH) and rotator cuff tears (RCTs) from a hospital in South Korea. The derived data-driven clinical pathways were evaluated with knowledge-based models by health professionals using a delta analysis. RESULTS: Two different data-driven clinical pathways, i.e., TLH and RCTs, were produced by applying the matching rate-based clinical pathway mining algorithm. We identified that there were significant differences in clinical orders between the data-driven and knowledge-based models. Additionally, the data-driven clinical pathways based on our algorithm outperformed the models by clinical experts, with average matching rates of 82.02% and 79.66%, respectively. CONCLUSION: The proposed algorithm will be helpful for supporting clinical decisions and directly applicable in medical practices.

8.
Int J Cardiol ; 2019 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-31748189

RESUMO

BACKGROUND: Follow-up costs among heart failure (HF) patients place a heavy burden on healthcare. We sought to quantify follow-up costs after a HF hospitalization, as well as, length of stay (LOS), time to readmission and mortality for patients with preserved (HFpEF) versus reduced (HFrEF) left ventricular ejection fractions. METHODS: We developed a retrospective cohort of consecutively admitted acutely decompensated HF patients who had at least 1 follow-up visit. We extracted baseline clinical data from electronic medical records, and collected follow-up data on number of readmissions, length of stay, mortality over a 2-year period, and cost data from our hospital's accounting system. Kaplan-Meier curves and log rank tests were used to evaluate survival and time to first readmission in the two HF groups. RESULTS: Our study included 444 patients, of whom 224 (51%) had HFrEF. Patients with HFrEF compared to HFpEF had higher median total costs per month alive during the 2-year follow-up period ($1684 vs. $1496, p = 0.02), and median inpatient costs per month alive ($1368 vs. $991, p = 0.03). HFrEF patients had higher total mean LOS per month alive post index hospitalization discharge (1.6 vs 1 days, p = 0.003). Similarly, HF related mean LOS per month alive was higher for HFrEF patients than for HFpEF patients (1.3 vs 0.3 days, p = 0.003). Patients with HFrEF had a trend for shorter time to first readmission and survival compared to those with HFpEF. CONCLUSIONS: At 2 years following their index HF admission, patients with HFrEF have higher costs and longer LOS compared to HFpEF patients.

9.
Jt Comm J Qual Patient Saf ; 45(12): 822-828, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31672660

RESUMO

BACKGROUND: In 2018 the Agency for Healthcare Research and Quality (AHRQ) Evidence-based Practice Center (EPC) Program issued a call for strategies to disseminate AHRQ EPC systematic reviews. In this pilot, findings from the 2016 AHRQ EPC report on Clostridioides difficile infection were translated into a treatment pathway and disseminated via a cloud-based platform and electronic health record (EHR). METHODS: An existing 10-step framework was used for developing and disseminating evidence-based clinical pathways. The development of the EHR intervention was informed by the Five Rights model for clinical decision support and human-computer interaction design heuristics. The researchers used observations and time measurements to describe the impact of the EPC report on pathway development and examined provider adoption using counts of pathway views. RESULTS: Two main themes emerged: (1) discrepancies between the EPC report and existing guidelines prompted critical discussions about available treatments, and (2) lack of guideline and pathway syntheses in the EPC report necessitated a rapid literature review. Pathway development required 340 hours: 205 for the rapid literature review, 63 for pathway development and EHR intervention design, and 5 for technical implementation of the intervention. Pathways were viewed 1,069 times through the cloud-based platform and 47 times through a hyperlink embedded in key EHR ordering screens. CONCLUSION: Pathways can be an approach for disseminating AHRQ EPC report findings within health care systems; however, reports should include guideline and pathway syntheses to meet their full potential. Embedding hyperlinks to pathway content within the EHR may be a viable and low-effort solution for promoting awareness of evidence-based resources.

10.
Age Ageing ; 2019 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-31732735

RESUMO

BACKGROUND: care in the final year of life accounts for 10% of inpatient hospital costs in UK. However, there has been little analysis of costs in other care settings. We investigated the publicly funded costs associated with the end of life across different health and social care settings. METHOD: we performed cross-sectional analysis of linked electronic health records of residents aged over 50 in a locality in East London, UK, between 2011 and 2017. Those who died during the study period were matched to survivors on age group, sex, deprivation, number of long-term conditions and time period. Mean costs were calculated by care setting, age and months to death. RESULTS: across 8,720 matched patients, the final year of life was associated with £7,450 (95% confidence interval £7,086-£7,842, P < 0.001) of additional health and care costs, 57% of which related to unplanned hospital care. Whilst costs increased sharply over the final few months of life in emergency and inpatient hospital care, in non-acute settings costs were less concentrated in this period. Patients who died at older ages had higher social care costs and lower healthcare costs than younger patients in their final year of life. CONCLUSIONS: the large proportion of costs relating to unplanned hospital care suggests that end-of-life planning could direct care towards more appropriate settings and lead to system efficiencies. Death at older ages results in an increasing proportion of care costs relating to social care than to healthcare, which has implications for an ageing society.

11.
Obstet Gynecol ; 2019 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-31698380

RESUMO

OBJECTIVE: To provide U.S. case-based preeclampsia health care cost estimates for mothers and infants from a U.S. payer perspective, with comparisons with both uncomplicated and hypertensive pregnancies. METHODS: Electronic health record and billing data from a large regional integrated health care system in Pennsylvania were used to identify mother-singleton infant pairs with deliveries between 2010 and 2015. Data on clinical care and costs using actual payment amounts were compiled from 20 weeks of gestation to 6 weeks postdelivery for mothers and birth to 12 months for infants. Three defined pregnancy study cohorts, uncomplicated, hypertension and preeclampsia, were matched using a 1:1:1 ratio on the basis of maternal age, parity, body mass index, and comorbidities. Costs per pregnancy were calculated in 2015 dollars and preeclampsia incremental costs estimated by subtracting the average cost of the matched cohorts. RESULTS: The final study population included 712 matched mother-infant pairs in each cohort. The mean combined maternal and infant medical care costs in the preeclampsia cohort of $41,790 were significantly higher than those for the uncomplicated cohort of $13,187 (P<.001) and hypertension cohort of $24,182 (P<.001), and were largely driven by differences in the infant costs. The mean infant cost in the preeclampsia cohort were $28,898, in the uncomplicated cohort $3,669 and $12,648 in the hypertension cohort (P<.001). Mothers with preeclampsia delivered 3 weeks earlier (median 36.5 weeks of gestation) than women in the uncomplicated cohort and more than 2 weeks earlier than women in the hypertension cohort. A significantly larger percentage of women with preeclampsia and their infants experienced adverse events (13.9% for mothers and 14.6% for infants) compared with unaffected women (4.1% and 0.7%) and those with hypertension (9.4% and 4.8%), respectively (P<.001). CONCLUSION: The economic burden of preeclampsia health care is significant with the main cost drivers being infant health care costs associated with lower gestational age at birth and greater adverse outcomes.

12.
Diabetes Metab J ; 2019 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-31701686

RESUMO

BACKGROUND: We aimed to describe the outcome of a computerized intravenous insulin infusion (CII) protocol integrated to the electronic health record (EHR) system and to improve the CII protocol in silico using the EHR-based predictors of the outcome. METHODS: Clinical outcomes of the patients who underwent the CII protocol between July 2016 and February 2017 and their matched controls were evaluated. In the CII protocol group (n=91), multivariable binary logistic regression analysis models were used to determine the independent associates with a delayed response (taking ≥6.0 hours for entering a glucose range of 70 to 180 mg/dL). The CII protocol was adjusted in silico according to the EHR-based parameters obtained in the first 3 hours of CII. RESULTS: Use of the CII protocol was associated with fewer subjects with hypoglycemia alert values (P=0.003), earlier (P=0.002), and more stable (P=0.017) achievement of a glucose range of 70 to 180 mg/dL. Initial glucose level (P=0.001), change in glucose during the first 2 hours (P=0.026), and change in insulin infusion rate during the first 3 hours (P=0.029) were independently associated with delayed responses. Increasing the insulin infusion rate temporarily according to these parameters in silico significantly reduced delayed responses (P<0.0001) without hypoglycemia, especially in refractory patients. CONCLUSION: Our CII protocol enabled faster and more stable glycemic control than conventional care with minimized risk of hypoglycemia. An EHR-based adjustment was simulated to reduce delayed responses without increased incidence of hypoglycemia.

13.
Crit Care Med ; 2019 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-31743226

RESUMO

OBJECTIVES: To determine whether best practice advisories improved sedation protocol compliance and could mitigate potential propofol-related hazardous conditions. DESIGN: Retrospective observational cohort study. SETTING: Two adult ICUs at two academic medical centers that share the same sedation protocol. PATIENTS: Adults 18 years old or older admitted to the ICU between January 1, 2016, and January 31, 2018, who received a continuous infusion of propofol. INTERVENTIONS: Two concurrent best practice advisories built in the electronic health record as a clinical decision support tool to enforce protocol compliance with triglyceride and lipase level monitoring and mitigate propofol-related hazardous conditions. MEASUREMENTS AND MAIN RESULTS: The primary outcomes were baseline and day 3 compliance with triglyceride and lipase laboratory monitoring per protocol and time to discontinuation of propofol in the setting of triglyceride and/or lipase levels exceeding protocol cutoffs. A total of 1,394 patients were included in the study cohort (n = 700 in the pre-best practice advisory group; n = 694 in the post-best practice advisory group). In inverse probability weighted regression analyses, implementing the best practice advisory was associated with a 56.6% (95% CI, 52.6-60.9) absolute increase and a 173% relative increase (risk ratio, 2.73; 95% CI, 2.45-3.04) in baseline laboratory monitoring. The best practice advisory was associated with a 34.0% (95% CI, 20.9-47.1) absolute increase and a 74% (95% CI, 1.39-2.19) relative increase in day 3 laboratory monitoring after inverse probability weighted analyses. Among patients with laboratory values exceeding protocol cutoffs, implementation of the best practice advisory resulted in providers discontinuing propofol an average of 16.6 hours (95% CI, 4.8-28.3) sooner than pre-best practice advisory. Findings from alternate analyses using interrupted time series were consistent with the inverse probability weighted analyses. CONCLUSIONS: Best practice advisories can be effectively used in ICUs to improve sedation protocol compliance and may mitigate potential propofol-related hazardous conditions. Best practice advisories should undergo continuous quality assurance and optimizations to maximize clinical utility and minimize alert fatigue.

14.
BMC Med Inform Decis Mak ; 19(1): 216, 2019 Nov 08.
Artigo em Inglês | MEDLINE | ID: mdl-31703675

RESUMO

BACKGROUND: Electronic health records (EHRs) with embedded clinical decision support systems (CDSSs) have the potential to improve healthcare delivery. This study was conducted to explore merits, features, and desiderata to be considered when planning for, designing, developing, implementing, piloting, evaluating, maintaining, upgrading, and/or using EHRs with CDSSs. METHODS: A mixed-method combining the Delphi technique and Analytic Hierarchy Process was used. Potentially important items were collected after a thorough search of the literature and from interviews with key contact experts (n = 19). Opinions and views of the 76 panelists on the use of EHRs were also explored. Iterative Delphi rounds were conducted to achieve consensus on 122 potentially important items by a panel of 76 participants. Items on which consensus was achieved were ranked in the order of their importance using the Analytic Hierarchy Process. RESULTS: Of the 122 potentially important items presented to the panelists in the Delphi rounds, consensus was achieved on 110 (90.2%) items. Of these, 16 (14.5%) items were related to the demographic characteristics of the patient, 16 (14.5%) were related to prescribing medications, 16 (14.5%) were related to checking prescriptions and alerts, 14 (12.7%) items were related to the patient's identity, 13 (11.8%) items were related to patient assessment, 12 (10.9%) items were related to the quality of alerts, 11 (10%) items were related to admission and discharge of the patient, 9 (8.2%) items were general features, and 3 (2.7%) items were related to diseases and making diagnosis. CONCLUSIONS: In this study, merits, features, and desiderata to be considered when planning for, designing, developing, implementing, piloting, evaluating, maintaining, upgrading, and/or using EHRs with CDSSs were explored. Considering items on which consensus was achieved might promote congruence and safe use of EHRs. Further studies are still needed to determine if these recommendations can improve patient safety and outcomes in Palestinian hospitals.

15.
Diabetes Obes Metab ; 2019 Nov 19.
Artigo em Inglês | MEDLINE | ID: mdl-31742844

RESUMO

AIMS: Statin-treated patients have substantial residual cardiovascular disease risk despite control of low-density lipoprotein cholesterol. Other modifiable atherogenic lipids and lipoproteins, such as triglycerides and triglyceride-rich lipoproteins, are likely responsible for some residual risk. Here we describe real-world prevalence and consequences of hypertriglyceridemia. METHODS AND MATERIALS: We used large patient databases: NHANES (2007-2014), Optum Research Database, and electronic medical records from two Kaiser Permanente regions. RESULTS: NHANES data revealed that ~26% of US adults, including nearly one-third of statin users, have at least borderline hypertriglyceridemia (triglycerides ≥150 mg/dL), and ~40% of adults with diabetes have levels of ≥150 mg/dL despite statin use. Optum analyses demonstrated that patients with triglycerides ≥150 mg/dL on statins have significantly increased risk of composite initial major cardiovascular events (HR, 1.26; 95% CI, 1.19-1.34; P<0.001 versus patients with triglycerides <150 mg/dL). This was accompanied by increased healthcare utilization and direct healthcare costs (HR, 1.12; 95% CI, 1.08-1.16; P<0.001). In the Kaiser analyses, patients with diabetes and triglycerides 200-499 mg/dL had significantly higher adjusted incidences of non-fatal myocardial infarction (rate ratio 1.30; 95% CI 1.08-1.58; P=0.006), non-fatal stroke (1.23; 1.01-1.49; P=0.037), and coronary revascularization (1.21; 1.02-1.43; P=0.027), but not unstable angina (1.33; 0.87-2.03; P=0.185) compared with patients with triglycerides <150 mg/dL. CONCLUSIONS: Real-world analyses suggest that elevated triglycerides are prevalent and commonly associated with increased cardiovascular risk. Cardiovascular outcomes trials in patients with established hypertriglyceridemia will clarify if strategies to reduce triglycerides can ameliorate residual cardiovascular risk in patients taking statins. This article is protected by copyright. All rights reserved.

16.
Artigo em Inglês | MEDLINE | ID: mdl-31750912

RESUMO

OBJECTIVE: To systematically review published literature and identify consistency and variation in the aims, measures, and methods of studies using electronic health record (EHR) audit logs to observe clinical activities. MATERIALS AND METHODS: In July 2019, we searched PubMed for articles using EHR audit logs to study clinical activities. We coded and clustered the aims, measures, and methods of each article into recurring categories. We likewise extracted and summarized the methods used to validate measures derived from audit logs and limitations discussed of using audit logs for research. RESULTS: Eighty-five articles met inclusion criteria. Study aims included examining EHR use, care team dynamics, and clinical workflows. Studies employed 6 key audit log measures: counts of actions captured by audit logs (eg, problem list viewed), counts of higher-level activities imputed by researchers (eg, chart review), activity durations, activity sequences, activity clusters, and EHR user networks. Methods used to preprocess audit logs varied, including how authors filtered extraneous actions, mapped actions to higher-level activities, and interpreted repeated actions or gaps in activity. Nineteen studies validated results (22%), but only 9 (11%) through direct observation, demonstrating varying levels of measure accuracy. DISCUSSION: While originally designed to aid access control, EHR audit logs have been used to observe diverse clinical activities. However, most studies lack sufficient discussion of measure definition, calculation, and validation to support replication, comparison, and cross-study synthesis. CONCLUSION: EHR audit logs have potential to scale observational research but the complexity of audit log measures necessitates greater methodological transparency and validated standards.

17.
Am J Crit Care ; 28(6): 434-440, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31676518

RESUMO

BACKGROUND: To promote the use of appropriate testing, and decrease unnecessary treatments, the ABIM Foundation established the Choosing Wisely campaign in 2012. Initially targeting physicians, the campaign has evolved to encourage all providers to promote high-value care; however, information related to critical care nursing is limited. OBJECTIVES: To assess nurses' reports of the use of Choosing Wisely recommendations in critical care settings. METHODS: Responses from nurses were examined as part of a critical care survey of members of 4 societies in order to assess awareness and use of the Choosing Wisely recommendations. RESULTS: Of the 1651 acute and critical care nurses who were members of the American Association of Critical-Care Nurses and responded to the survey, 632 (38.3%) reported being familiar with the Choosing Wisely campaign. Of these respondents, 200 identified as advanced practice nurses. A total of 620 reported implementing the 5 Critical Care Society Collaborative recommendations, including reducing diagnostic testing (n = 311 [50.2%]), reducing the number of red blood cell transfusions (n = 530 [85.5%]), not using parenteral nutrition in adequately nourished patients (n = 293 [47.3%]), not using deep sedation in patients receiving mechanical ventilation (n = 499 [80.5%]), and offering comfort care for patients at high risk for death (n = 416 [67.1%]). Staff education, specific protocols, electronic medical record alerts, and order sets all raised nurses' awareness of the recommendations. CONCLUSIONS: Acute and critical care nurses are directly involved with measures to reduce unnecessary testing and treatments. Greater awareness and championing of the Choosing Wisely recommendations by acute and critical care nurses can help to promote high-value care for acute and critically ill patients.

18.
J Digit Imaging ; 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31677010

RESUMO

As resources in the healthcare environment continue to wane, leaders are seeking ways to continue to provide quality care bounded by the constraints of a reduced budget. This manuscript synthesizes the experience from a number of institutions to provide the healthcare leadership with an understanding of the value of an enterprise imaging program. The value of such a program extends across the entire health system. It leads to operational efficiencies through infrastructure and application consolidation and the creation of focused support capabilities with increased depth of skill. An enterprise imaging program provides a centralized foundation for all phases of image management from every image-producing specialty. Through centralization, standardized image exchange functions can be provided to all image producers. Telehealth services can be more tightly integrated into the electronic medical record. Mobile platforms can be utilized for image viewing and sharing by patients and providers. Mobile tools can also be utilized for image upload directly into the centralized image repository. Governance and data standards are more easily distributed, setting the stage for artificial intelligence and data analytics. Increased exposure to all image producers provides opportunities for cybersecurity optimization and increased awareness.

19.
Vaccine ; 2019 Oct 31.
Artigo em Inglês | MEDLINE | ID: mdl-31677947

RESUMO

BACKGROUND: The Accelerated Development of VAccine beNefit-risk Collaboration in Europe (ADVANCE) is a public-private collaboration aiming to develop and test a system for rapid benefit-risk (B/R) monitoring of vaccines using electronic health record (eHR) databases in Europe. Proof-of-concept studies were designed to assess the proposed processes and system for generating the required evidence to perform B/R assessment and near-real time monitoring of vaccines. We aimed to test B/R methodologies for vaccines, using the comparison of the B/R profiles of whole-cell (wP) and acellular pertussis (aP) vaccine formulations in children as an example. METHODS: We used multi-criteria decision analysis (MCDA) to structure the B/R assessment combined with individual-level state transition modelling to build the B/R effects table. In the state transition model, we simulated the number of events in two hypothetical cohorts of 1 million children followed from first pertussis dose till pre-school-entry booster (or six years of age, whichever occurred first), with one cohort receiving wP, and the other aP. The benefits were reductions in pertussis incidence and complications. The risks were increased incidences of febrile convulsions, fever, hypotonic-hyporesponsive episodes, injection-site reactions and persistent crying. Most model parameters were informed by estimates (coverage, background incidences, relative risks) from eHR databases from Denmark (SSI), Spain (BIFAP and SIDIAP), Italy (Pedianet) and the UK (RCGP-RSC and THIN). Preferences were elicited from clinical and epidemiological experts. RESULTS: Using state transition modelling to build the B/R effects table facilitated the comparison of different vaccine effects (e.g. immediate vaccine risks vs long-term vaccine benefits). Estimates from eHR databases could be used to inform the simulation model. The model results could be easily combined with preference weights to obtain B/R scores. CONCLUSION: Existing B/R methodology, modelling and estimates from eHR databases can be successfully used for B/R assessment of vaccines.

20.
J Korean Acad Nurs ; 49(5): 575-585, 2019 Oct.
Artigo em Coreano | MEDLINE | ID: mdl-31672951

RESUMO

PURPOSE: The purpose of this study was to develop predictive models for pressure ulcer incidence using electronic health record (EHR) data and to compare their predictive validity performance indicators with that of the Braden Scale used in the study hospital. METHODS: A retrospective case-control study was conducted in a tertiary teaching hospital in Korea. Data of 202 pressure ulcer patients and 14,705 non-pressure ulcer patients admitted between January 2015 and May 2016 were extracted from the EHRs. Three predictive models for pressure ulcer incidence were developed using logistic regression, Cox proportional hazards regression, and decision tree modeling. The predictive validity performance indicators of the three models were compared with those of the Braden Scale. RESULTS: The logistic regression model was most efficient with a high area under the receiver operating characteristics curve (AUC) estimate of 0.97, followed by the decision tree model (AUC 0.95), Cox proportional hazards regression model (AUC 0.95), and the Braden Scale (AUC 0.82). Decreased mobility was the most significant factor in the logistic regression and Cox proportional hazards models, and the endotracheal tube was the most important factor in the decision tree model. CONCLUSION: Predictive validity performance indicators of the Braden Scale were lower than those of the logistic regression, Cox proportional hazards regression, and decision tree models. The models developed in this study can be used to develop a clinical decision support system that automatically assesses risk for pressure ulcers to aid nurses.

SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA