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https://www.readbyqxmd.com/read/28650922/randomized-trial-of-reducing-ambulatory-malpractice-and-safety-risk-results-of-the-massachusetts-promises-project
#1
Gordon D Schiff, Harry Reyes Nieva, Paula Griswold, Nicholas Leydon, Judy Ling, Frank Federico, Carol Keohane, Bonnie R Ellis, Cathy Foskett, E John Orav, Catherine Yoon, Don Goldmann, Joel S Weissman, David W Bates, Madeleine Biondolillo, Sara J Singer
OBJECTIVE: Evaluate application of quality improvement approaches to key ambulatory malpractice risk and safety areas. STUDY SETTING: In total, 25 small-to-medium-sized primary care practices (16 intervention; 9 control) in Massachusetts. STUDY DESIGN: Controlled trial of a 15-month intervention including exposure to a learning network, webinars, face-to-face meetings, and coaching by improvement advisors targeting "3+1" high-risk domains: test result, referral, and medication management plus culture/communication issues evaluated by survey and chart review tools...
June 23, 2017: Medical Care
https://www.readbyqxmd.com/read/28650873/perceptions-of-ambulatory-workflow-changes-in-an-academic-primary-care-setting
#2
Michael A Hanak, Colleen McDevitt, Daniel P Dunham
As health care moves to a value-based system, the need for team-based models of care becomes increasingly important to adequately address the growing number of clinical quality metrics required of health care providers. Finding ways to better engage certified medical assistants (CMAs) in the process allows providers to focus on more complex tasks while improving the efficiency of each office visit. Although the roles and responsibilities for CMAs across the specialties can vary widely, standardizing the work can be a helpful step in scaling best practices across an institution...
June 23, 2017: Health Care Manager
https://www.readbyqxmd.com/read/28650679/establishing-maximal-medical-improvement-after-arthroscopic-rotator-cuff-repair
#3
William A Zuke, Timothy S Leroux, Bonnie P Gregory, Austin Black, Brian Forsythe, Anthony A Romeo, Nikhil N Verma
BACKGROUND: As health care transitions from a pay-for-service to a pay-for-performance infrastructure, the value of orthopaedic care must be defined accurately. Significant efforts have been made in defining quality and cost in arthroplasty; however, there remains a lag in ambulatory orthopaedic care. PURPOSE: Two-year follow-up has been a general requirement for reporting outcomes after rotator cuff repair. However, this time requirement has not been established scientifically and is of increasing importance in the era of value-based health care...
June 1, 2017: American Journal of Sports Medicine
https://www.readbyqxmd.com/read/28650246/economic-outcomes-of-first-line-regimen-switching-among-stable-patients-with-hiv
#4
Lisa Rosenblatt, Ami R Buikema, Jerry Seare, Lindsay G S Bengtson, Jonathan Johnson, Feng Cao, Angelina Villasis-Keever
BACKGROUND: Although switching of antiretroviral therapy (ART) is a valid approach for addressing treatment failure in patients with human immunodeficiency virus (HIV), ART changes among those who are well maintained on their current regimens may lead to the development of new side effects or resistance. OBJECTIVE: To examine the effect of first-line regimen switching on subsequent health care utilization and cost among stable HIV patients. METHODS: This was a retrospective claims data study of adult patients with HIV who initiated ART between 2007 and 2013 and had been treated with their initial regimens for at least 6 continuous months...
July 2017: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/28650240/development-of-a-clinical-spasticity-scale-for-evaluation-of-dogs-with-chronic-thoracolumbar-spinal-cord-injury
#5
Melissa J Lewis, Natasha J Olby
OBJECTIVE To develop a spasticity scale for dogs with chronic deficits following severe spinal cord injury (SCI) for use in clinical assessment and outcome measurement in clinical trials. ANIMALS 20 chronically paralyzed dogs with a persistent lack of hind limb pain perception caused by an acute SCI at least 3 months previously. PROCEDURES Spasticity was assessed in both hind limbs via tests of muscle tone, clonus, and flexor and extensor spasms adapted from human scales. Measurement of patellar clonus duration and flexor spasm duration and degree was feasible...
July 2017: American Journal of Veterinary Research
https://www.readbyqxmd.com/read/28649873/can-you-snooze-your-way-to-an-a-exploring-the-complex-relationship-between-sleep-autonomic-activity-wellbeing-and-performance-in-medical-students
#6
Erin Cvejic, Shiny Huang, Uté Vollmer-Conna
OBJECTIVE: Medical training brings with it multiple stressors, including demanding workloads in highly competitive environments, with well-documented impact on psychiatric morbidity. This study evaluated the impact of sleep-related factors on psychological wellbeing, cognitive task performance and academic standing in medical students. METHODS: A total of 59 undergraduate medical students took part in this cross-sectional study over two consecutive days. Participants responded to questionnaires about their physical and psychological health, sleep, functioning and academic performance at the initial visit...
June 1, 2017: Australian and New Zealand Journal of Psychiatry
https://www.readbyqxmd.com/read/28649860/do-racial-ethnic-disparities-exist-in-recommended-migraine-treatments-in-us-ambulatory-care
#7
Larry Charleston Iv, James Francis Burke
Background Racial disparities in migraine have been reported in the US. Migraine in African Americans (AA) is more frequent, more severe, more likely to become chronic and associated with more depression and lower quality of life compared to non-Hispanic Whites (NHW). It is possible that racial differences in prescribing practices contribute to these differences, but little is known about the quality of migraine prescribing patterns in the US or whether racial differences exist. Objective To determine if racial differences in quality of migraine medical prescription care exist...
January 1, 2017: Cephalalgia: An International Journal of Headache
https://www.readbyqxmd.com/read/28649479/functional-outcomes-of-childhood-selective-dorsal-rhizotomy-20-to-28-years-later
#8
T S Park, Jenny L Liu, Caleb Edwards, Deanna M Walter, Matthew B Dobbs
BACKGROUND: Selective dorsal rhizotomy (SDR) is a surgical method used to treat childhood spastic cerebral palsy (CP). However, the effects of early SDR on functional outcomes and quality of life decades later in adulthood remains to be elucidated. OBJECTIVES: To evaluate the long-term outcomes in terms of satisfaction and mobility of adult patients who received childhood SDR. METHODS: Adult patients who received SDR in childhood were surveyed...
May 17, 2017: Curēus
https://www.readbyqxmd.com/read/28648784/-control-of-cardiovascular-risk-factors-in-coronary-patients-one-year-after-cardiac-rehabilitation
#9
T Denolle, M Dib, M Brune, S Nicolas, A Richard, V Auguste, S Bourdet, A Crozet, A Marivain, S Salin, F Revault d'Allonnes
OBJECTIVE: To assess risk factors monitoring in coronary patients one year after cardiac rehabilitation. METHOD: From 2015 to 2015, cardiac morbidity, total mortality and risk factors data were collected from a 4-week ambulatory cardiac rehabilitation program with a control one year later and were compared with the results of Euroaspire and Reach studies. RESULTS: Out of 1091 (87%) coronary patients, 746 (68%) were re-examined 12months later (aged 60years (ranging from 20 to 85years), 15% women, 44% hypertensive, 36% smokers, 17% diabetics, 74% with dyslipidemia)...
June 22, 2017: Annales de Cardiologie et D'angéiologie
https://www.readbyqxmd.com/read/28648740/patellofemoral-morphology-and-alignment-reference-values-and-dose-response-patterns-for-the-relation-to-mri-features-of-patellofemoral-osteoarthritis
#10
Erin M Macri, David T Felson, Yuqing Zhang, Ali Guermazi, Frank W Roemer, Kay M Crossley, Karim M Khan, Josh J Stefanik
OBJECTIVE: We aimed to (i) determine reference values for trochlear morphology and patellofemoral (PF) alignment in adults without MRI-defined PF full thickness cartilage damage or knee pain; and (ii) evaluate dose-response patterns for these measures with prevalent MRI-defined PF structural damage and/or knee pain. DESIGN: The Framingham Community Cohort is a population-based sample of ambulatory adults aged ≥50 years. We evaluated six morphology and alignment measures using MRI (n=985), and reported reference values (mean ± 2SD) in a subsample without MRI-defined PF full thickness cartilage damage or knee pain (n=563)...
June 22, 2017: Osteoarthritis and Cartilage
https://www.readbyqxmd.com/read/28648683/reliability-and-validity-analyses-of-the-north-star-ambulatory-assessment-in-brazilian-portuguese
#11
Larissa O Okama, Lívia M Zampieri, Carina L Ramos, Flávia O Toledo, Cyntia R J Alves, Ana Cláudia Mattiello-Sverzut, Anna Mayhew, Cláudia F R Sobreira
The North Star Ambulatory Assessment measures motor performance in ambulatory boys with Duchenne muscular dystrophy, a hereditary and degenerative muscle disorder. To use the North Star Ambulatory Assessment in Brazilian boys, we performed the cross-cultural adaptation to the Portuguese language spoken in Brazil and evaluated the reliability and validity of the instrument. Cross-cultural adaptation included: independent translations, synthesis, committee review, pre-testing in 12 boys, back-translation and comparison with the original instrument...
May 26, 2017: Neuromuscular Disorders: NMD
https://www.readbyqxmd.com/read/28648668/catheter-ablation-in-patients-with-pleomorphic-idiopathic-premature-ventricular-complexes
#12
Seth H Sheldon, Rakesh Latchamsetty, Fred Morady, Frank Bogun
BACKGROUND: Premature ventricular complexes (PVCs) often originate from multiple locations OBJECTIVE: The goals of this study were to assess characteristics of patients with pleomorphic, idiopathic PVCs and to determine the impact of pleomorphic PVCs on outcomes. METHODS: Records were collected from 153 consecutive patients referred for ablation of PVCs. Patients with structural heart disease (n=34) or inadequate ambulatory ECG data (n=19) were excluded. RESULTS: Among 100 consecutive patients (age 52 ± 15 years, 53% men, 31% pleomorphic vs...
June 22, 2017: Heart Rhythm: the Official Journal of the Heart Rhythm Society
https://www.readbyqxmd.com/read/28648522/are-children-born-with-birth-defects-at-increased-risk-of-injuries-in-early-childhood
#13
Rachel E Rutkowski, Jason L Salemi, Jean Paul Tanner, Suzanne Anjohrin, Philip Cavicchia, Heather Lake-Burger, Russell S Kirby
OBJECTIVE: To investigate the extent to which children with birth defects experience differential likelihood of various injuries and injury-related hospitalizations in early childhood. STUDY DESIGN: The Florida Birth Defects Registry was used to identify infants born 2006-2010 with select birth defects. Injury matrices were used to detect injuries in inpatient, ambulatory, and emergency department admissions for each infant up to their third birthday. χ(2)tests were used to compare sociodemographic and perinatal characteristics of children, by presence of an injury-related hospital admission...
June 22, 2017: Journal of Pediatrics
https://www.readbyqxmd.com/read/28648494/characteristics-and-prevalence-of-wilson-s-disease-a-2013-observational-population-based-study-in-france
#14
Aurélia Poujois, France Woimant, Solène Samson, Pascal Chaine, Nadège Girardot-Tinant, Philippe Tuppin
BACKGROUND AND AIMS: Only a few epidemiological studies on the incidence and prevalence of Wilson's disease (WD) have been performed to date, and the results vary widely according to the reports. The aim of the study was to investigate the prevalence, ambulatory care and treatments of patients with WD in France. METHODS: Among the 58 million general health scheme beneficiaries (86% of the French population), people managed for WD in 2013 were identified using hospitalisation diagnosis in 2011-2013 or specific long-term disease status with a 100% reimbursement for specific healthcare in 2013...
June 22, 2017: Clinics and Research in Hepatology and Gastroenterology
https://www.readbyqxmd.com/read/28648221/designing-and-implementing-an-electronic-patient-registry-to-improve-warfarin-monitoring-in-the-ambulatory-setting
#15
Shin-Yu Lee, Roy Cherian, Irene Ly, Claire Horton, Alaya Levi Salley, Urmimala Sarkar
BACKGROUND: Warfarin requires individualized dosing and monitoring in the ambulatory setting for protection against thromboembolic disease. Yet in multiple settings, patients spend upwards of 30% of time outside the therapeutic range, subjecting them to an increased risk of adverse events. At an urban, publicly funded clinic, the electronic health record (EHR) would not support integration with extant warfarin management software, which led to the creation and implementation of an electronic patient registry and a complementary team-based work flow to provide real-time health-system-level data for warfarin patients...
July 2017: Joint Commission Journal on Quality and Patient Safety
https://www.readbyqxmd.com/read/28647550/longitudinal-prediction-of-quality-of-life-scores-and-locomotion-in-individuals-with-traumatic-spinal-cord-injury
#16
Shivayogi V Hiremath, Nathan S Hogaboom, Melissa R Roscher, Lynn A Worobey, Michelle L Oyster, Michael L Boninger
OBJECTIVES: The study examined differences in quality of life scores for groups based on transitions in locomotion status at 1, 5, and 10 years post-discharge in a sample of people with spinal cord injury (SCI). We also investigated whether demographic factors and transitions in locomotion status can predict quality of life measures at these time points. DESIGN: Retrospective case study of the National SCI Database. SETTING: Model SCI Systems Centers...
June 21, 2017: Archives of Physical Medicine and Rehabilitation
https://www.readbyqxmd.com/read/28647442/the-impact-of-the-transition-from-volume-to-value-on-heart-failure-care-implications-of-novel-payment-models-and-quality-improvement-initiatives
#17
REVIEW
Dushyanth Srinivasan, Nihar R Desai
In response to wide variation in quality and outcomes as well as escalating health care costs, the U.S. health care system is transitioning away from a volume based payment system to a quality- and value-based system. Medicare, the largest insurer and payer of healthcare, has accelerated the movement towards value-based care with the development and implementation of myriad alternative payment models and pay for performance programs as part of the Affordable Care Act. Given that heart failure affects a significant number of Medicare patients and these patients account for a disproportionate amount of healthcare utilization and spending, heart failure has become a focal point for these initiatives...
June 21, 2017: Journal of Cardiac Failure
https://www.readbyqxmd.com/read/28647194/prediction-of-6-minute-walk-performance-in-patients-with-peripheral-artery-disease
#18
Xi Chen, Julie A Stoner, Polly S Montgomery, Ana I Casanegra, Federico Silva-Palacios, Sixia Chen, Amanda E Janitz, Andrew W Gardner
BACKGROUND: Peripheral artery disease (PAD) is a highly prevalent disease that impairs walking ability. Walking tests, such as the 6-minute walk test (6MWT) and 4-meter walk test, are commonly used to assess exercise endurance and ambulatory function over a short distance, respectively. The 6MWT performance is predictive of PAD severity and disease outcomes, but it is not feasible in many clinical settings because it requires a long walkway to serve as the test route and lengthens clinic visits...
June 21, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28646886/implementation-science-for-ambulatory-care-safety-a-novel-method-to-develop-context-sensitive-interventions-to-reduce-quality-gaps-in-monitoring-high-risk-patients
#19
Kathryn M McDonald, George Su, Sarah Lisker, Emily S Patterson, Urmimala Sarkar
BACKGROUND: Missed evidence-based monitoring in high-risk conditions (e.g., cancer) leads to delayed diagnosis. Current technological solutions fail to close this safety gap. In response, we aim to demonstrate a novel method to identify common vulnerabilities across clinics and generate attributes for context-flexible population-level monitoring solutions for widespread implementation to improve quality. METHODS: Based on interviews with staff in otolaryngology, pulmonary, urology, breast, and gastroenterology clinics at a large urban publicly funded health system, we applied journey mapping to co-develop a visual representation of how patients are monitored for high-risk conditions...
June 24, 2017: Implementation Science: IS
https://www.readbyqxmd.com/read/28646519/the-association-of-health-literacy-with-preventable-ed-visits-a-cross-sectional-study
#20
Meenakshi P Balakrishnan, Jill Boylston Herndon, Jingnan Zhang, Thomas Payton, Jonathan Shuster, Donna L Carden
BACKGROUND: Policy-makers argue that emergency department (ED) visits for conditions preventable with high-quality outpatient care contribute to waste in the healthcare system. However, access to ambulatory care is uneven, especially for vulnerable populations like minorities, the poor and those with limited health literacy. The impact of limited health literacy on ED visits that are preventable with timely, high-quality ambulatory care is unknown. OBJECTIVE: To determine the association of health literacy and preventable ED visits...
June 24, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
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