Quality Improvement Report: Design and Implementation of a Radiology E-Consult Service.

Electronic consultations (e-consults) mediated through an electronic health record system or web-based platform allow synchronous or asynchronous physician-to-physician communication. E-consults have been explored in various clinical specialties, but relatively few instances in the literature describe e-consults to connect health care providers directly with radiologists.The authors outline how a radiology department can implement an e-consult service and review the development of such a service in a large academic health system. They describe the logistics, workflow, turnaround time expectations, stakeholder management, and pilot implementation and highlight challenges and lessons learned.

Visual-perceptual function of children using the developmental test of visual perception-3.

Clinical relevance: The development of region-specific norms for the Developmental Test of Visual Perception, third edition (DTVP-3), from a group of children from South India will contribute to the assessment of visual-perceptual skills in children.Background: Visual-perceptual skills are crucial for children to understand their environment, perform activities of daily living, and cope with their learning environment. These perceptual skills also influence children's behavioural characteristics. Well-constructed, norm-referenced standardised tools are vital for assessing visual-perceptual skills. Since ethnicity and cultural background may influence the performance of perceptual tasks, the proposed norms for any assessment tool need to be validated for specific populations. Hence, the current study aimed to develop norms in the Indian context for the Developmental Test of Visual Perception, third edition (DTVP-3), and compare the obtained norms with the norms established in the United States of America.Methods: One hundred and thirty-seven healthy children (mean age: 9.5 ± 1.7 years, range: 7-12 years, 67 females) participated in the study. Visual-perceptual functions including eye-hand coordination, copying, figure-ground, visual closure, and form constancy, were assessed and compared with age-matched norms provided in the test manual. Internal consistency of DTVP-3 was evaluated using Cronbach's Alpha correlation coefficients.Results: Significant differences were observed between the study groups and the given norms for assessment of the abilities of eye-hand coordination, copying skills and visual figure-ground (p < 0.05). No significant difference was found for visual closure and form constancy subtests. Cronbach's alpha coefficients for the five subtests ranged from 0.70 to 0.91 while the composite indexes had coefficients from 0.90 to 0.93.Conclusion: The DTVP-3 showed acceptable limits of internal consistency when tested in a group of children from South India. Region-specific norms need to be used for each of the subtests.

Relationship between quality of care of hospitalized vulnerable elders and postdischarge mortality.

OBJECTIVES: To assess the relationship between quality of hospital care, as measured by Assessing Care of Vulnerable Elders (ACOVE) quality indicators (QI), and postdischarge mortality for hospitalized seniors. DESIGN: Observational cohort study. SETTING: Single academic medical center. PARTICIPANTS: Patients aged 65 and older who were identified as "vulnerable" using the Vulnerable Elder Survey (VES-13). MEASUREMENTS: Adherence to 16 ACOVE measures through chart audit; postdischarge mortality obtained from Social Security Death Index. RESULTS: One thousand eight hundred fifty-six inpatient vulnerable older adults were enrolled. Mean quality-of-care score was 59.5 ± 19.2%, and 495 (26.7%) died within 1 year of discharge. In multivariate logistic regression, controlling for sociodemographic and disease severity variables (Charlson comorbidity score, VES-13 score, number of QIs triggered, length of stay, baseline activity of daily living limitations, code status), higher quality of care appeared to be associated with lower risk of death at 1 year. For each 10% increase in quality score, patients were 7% less likely to die (odds ratio=0.93, 95% confidence interval (CI)=0.87-1.00; P=.045). In Cox proportional hazard models, hospitalized patients receiving quality of care better than the median quality score were less likely to die during the 1-year period after discharge (hazard ratio (HR)=0.82, 95% CI=0.68-1.00; P=.05). Patients who received a nutritional status assessment were less likely to die during the year after discharge (HR=0.61, 95% CI=0.40-0.93; P=.02). CONCLUSION: Higher quality of care for hospitalized seniors, as measured using ACOVE measures, may be associated with a lower likelihood of death 1 year after discharge. Given these findings, future work testing interventions to improve adherence to these QIs is warranted.