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https://www.readbyqxmd.com/read/28808668/physician-preferences-for-aggressive-treatment-at-the-end-of-life-and-area-level-health-care-spending-the-johns-hopkins-precursors-study
#1
Joseph J Gallo, Martin S Andersen, Seungyoung Hwang, Lucy Meoni, Ravishankar Jayadevappa
Objective: To determine whether physician preferences for end-of-life care were associated with variation in health care spending. Method: We studied 737 physicians who completed the life-sustaining treatment questionnaire in 1999 and were linked to end-of-life care data for the years 1999 to 2009 from Medicare-eligible beneficiaries from the Dartmouth Atlas of Health Care (in hospital-related regions [HRRs]). Using latent class analysis to group physician preferences for end-of-life treatment into most, intermediate, and least aggressive categories, we examined how physician preferences were associated with health care spending over a 7-year period...
January 2017: Gerontology & Geriatric Medicine
https://www.readbyqxmd.com/read/28798017/regional-variation-in-30-day-ischemic-stroke-outcomes-for-medicare-beneficiaries-treated-in-get-with-the-guidelines-stroke-hospitals
#2
Michael P Thompson, Xin Zhao, Kimon Bekelis, Daniel J Gottlieb, Gregg C Fonarow, Phillip J Schulte, Ying Xian, Barbara L Lytle, Lee H Schwamm, Eric E Smith, Mathew J Reeves
BACKGROUND: We explored regional variation in 30-day ischemic stroke mortality and readmission rates and the extent to which regional differences in patients, hospitals, healthcare resources, and a quality of care composite care measure explain the observed variation. METHODS AND RESULTS: This ecological analysis aggregated patient and hospital characteristics from the Get With The Guidelines-Stroke registry (2007-2011), healthcare resource data from the Dartmouth Atlas of Health Care (2006), and Medicare fee-for-service data on 30-day mortality and readmissions (2007-2011) to the hospital referral region (HRR) level...
August 2017: Circulation. Cardiovascular Quality and Outcomes
https://www.readbyqxmd.com/read/28759696/structured-coaching-programs-to-develop-staff
#3
Susan MacLeod Dyess, Rose Sherman, Andra Opalinski, Terry Eggenberger
Health care environments are complex and chaotic, therein challenging patients and professionals to attain satisfaction, well-being, and exceptional outcomes. These chaotic environments increase the stress and burnout of professionals and reduce the likelihood of optimizing success in many dimensions. Coaching is evolving as a professional skill that may influence the optimization of the health care environment. This article reflects on three coaching programs: Gallup Strengths-Based Coaching, Dartmouth Microsystem Coaching, and Health and Wellness Nurse Coaching...
August 1, 2017: Journal of Continuing Education in Nursing
https://www.readbyqxmd.com/read/28717699/opportunistic-breast-cancer-education-and-screening-in-rural-honduras
#4
Linda S Kennedy, Suyapa A Bejarano, Tracy L Onega, Derek S Stenquist, Mary D Chamberlin
PURPOSE: In Honduras, the breast cancer burden is high, and access to women's health services is low. This project tested the connection of community-based breast cancer detection with clinical diagnosis and treatment in a tightly linked and quickly facilitated format. METHODS: The Norris Cotton Cancer Center at Dartmouth College partnered with the Honduran cancer hospital La Liga Contra el Cancer to expand a cervical cancer screening program, which included self-breast exam (SBE) education and clinical breast exams (CBEs), to assess patient attitudes about and uptake of breast cancer education and screening services...
August 2016: Journal of Global Oncology
https://www.readbyqxmd.com/read/28684387/sharing-annotated-audio-recordings-of-clinic-visits-with-patients-development-of-the-open-recording-automated-logging-system-orals-study-protocol
#5
Paul J Barr, Michelle D Dannenberg, Craig H Ganoe, William Haslett, Rebecca Faill, Saeed Hassanpour, Amar Das, Roger Arend, Meredith C Masel, Sheryl Piper, Haley Reicher, James Ryan, Glyn Elwyn
BACKGROUND: Providing patients with recordings of their clinic visits enhances patient and family engagement, yet few organizations routinely offer recordings. Challenges exist for organizations and patients, including data safety and navigating lengthy recordings. A secure system that allows patients to easily navigate recordings may be a solution. OBJECTIVE: The aim of this project is to develop and test an interoperable system to facilitate routine recording, the Open Recording Automated Logging System (ORALS), with the aim of increasing patient and family engagement...
July 6, 2017: JMIR Research Protocols
https://www.readbyqxmd.com/read/28684006/evolution-in-the-surgical-care-of-patients-with-non-small-cell-lung-cancer-in-the-mid-south-quality-of-surgical-resection-cohort
#6
Nicholas R Faris, Matthew P Smeltzer, Fujin Lu, Carrie L Fehnel, Nibedita Chakraborty, Cheryl L Houston-Harris, E Todd Robbins, Raymond S Signore, Laura M McHugh, Bradley A Wolf, Lynn Wiggins, Paul Levy, Vishal Sachdev, Raymond U Osarogiagbon
Surgery is the most important curative treatment modality for patients with early-stage non-small cell lung cancer (NSCLC). We examined the pattern of surgical resection for NSCLC in a high incidence and mortality region of the United States over a 10-year period (2004-2013) in the context of a regional surgical quality improvement initiative. We abstracted patient-level data on all resections at 11 hospitals in 4 contiguous Dartmouth Hospital Referral Regions in North Mississippi, East Arkansas, and West Tennessee...
April 2017: Seminars in Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/28655815/geographic-variation-in-the-use-of-oral-anticoagulation-therapy-in-stroke-prevention-in-atrial-fibrillation
#7
Inmaculada Hernandez, Samir Saba, Yuting Zhang
BACKGROUND AND PURPOSE: Underuse of oral anticoagulation in stroke prevention in atrial fibrillation is common; however, it remains unknown how it varies geographically. The objective of this study was to evaluate geographic variation in oral anticoagulation use and in the initiation of new oral anticoagulants (NOACs). METHODS: Using 2013 to 2014 claims data from a 5% random sample of Medicare beneficiaries, we identified patients newly diagnosed with atrial fibrillation who initiated NOACs (n=8659), warfarin (n=11 771) or no oral anticoagulation therapy (n=18 226) in 2013 to 2014...
June 27, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28628393/early-national-dissemination-of-abiraterone-and-enzalutamide-for-advanced-prostate-cancer-in-medicare-part-d
#8
Megan E V Caram, Tudor Borza, Hye-Sung Min, Jennifer J Griggs, David C Miller, Brent K Hollenbeck, Bhramar Mukherjee, Ted A Skolarus
INTRODUCTION: Abiraterone and enzalutamide were approved by the Food and Drug Administration in 2011 and 2012 to treat men with metastatic castration-resistant prostate cancer (mCRPC). Most men with mCRPC are > 65 years of age and thus eligible for Medicare Part D. We conducted a study to better understand the early dissemination of these drugs across the United States using national Medicare Part D data. METHODS: We evaluated the number of prescriptions for abiraterone and enzalutamide by provider specialty and hospital referral region (HRR) using Medicare Part D and Dartmouth Atlas data...
August 2017: Journal of Oncology Practice
https://www.readbyqxmd.com/read/28607678/choosing-wisely-a-quality-improvement-initiative-to-decrease-unnecessary-preoperative-testing
#9
John Matulis, Stephen Liu, John Mecchella, Frederick North, Alison Holmes
Dartmouth-Hitchcock Medical Center is a rural, academic medical center in the northeastern United States; its General Internal Medicine (GIM) division performs about 900 low and intermediate surgical risk preoperative evaluations annually. Routine preoperative testing in these evaluations is widely considered a low-value service. Our baseline data sample showed unnecessary testing rates of approximately 36%. A multi-disciplinary team used a micro-systems approach to analyze the existing process and formulate a rapid cycle improvement strategy...
2017: BMJ Quality Improvement Reports
https://www.readbyqxmd.com/read/28595934/secular-trends-in-prostate-biopsy-criteria-and-outcomes-the-dartmouth-experience
#10
Lael Reinstatler, Cody Rissman, John D Seigne, Elias S Hyams
OBJECTIVE: To evaluate trends in prostate biopsy and cancer diagnosis at a center with conservative screening practices in the pre- and post-2012 era. More restrictive prostate-specific antigen (PSA) screening guidelines have led to lower rates of screening, biopsy, and diagnosis of prostate cancer. It is not clear, however, how regions with low baseline screening rates (the Lebanon, New Hampshire hospital referral region centered on Dartmouth-Hitchcock Medical Center had the lowest rate of screening among Medicare patients in 2012) have responded to these guidelines...
July 10, 2017: Urology
https://www.readbyqxmd.com/read/28586090/the-association-of-qrs-duration-with-atrial-fibrillation-in-a-heart-failure-with-preserved-ejection-fraction-population-a-pilot-study
#11
Joseph N Gigliotti, Mandeep S Sidhu, Alina M Robert, Jonathan S Zipursky, Jeremiah R Brown, Salvatore P Costa, Robert T Palac, David A Steckman, David J Malenka, Alan T Kono, Mark L Greenberg
BACKGROUND: Heart failure is a significant cause of morbidity and mortality, yet patient risk stratification may be difficult. Prevention or treatment of atrial fibrillation (AF) may be an important strategy in these patients that could positively affect their outcome. It has been demonstrated that in patients with systolic dysfunction, prolonged QRS duration (QRSd), an easily measured electrocardiographic parameter, is associated with AF. HYPOTHESIS: Prolonged QRSd is associated with an increase in prevalence of AF in patients with heart failure with preserved ejection fraction(HFPEF)...
June 6, 2017: Clinical Cardiology
https://www.readbyqxmd.com/read/28498853/safety-and-immunogenicity-of-an-inactivated-whole-cell-tuberculosis-vaccine-booster-in-adults-primed-with-bcg-a-randomized-controlled-trial-of-dar-901
#12
C Fordham von Reyn, Timothy Lahey, Robert D Arbeit, Bernard Landry, Leway Kailani, Lisa V Adams, Brenda C Haynes, Todd Mackenzie, Wendy Wieland-Alter, Ruth I Connor, Sue Tvaroha, David A Hokey, Ann M Ginsberg, Richard Waddell
BACKGROUND: Development of a tuberculosis vaccine to boost BCG is a major international health priority. SRL172, an inactivated whole cell booster derived from a non-tuberculous mycobacterium, is the only new vaccine against tuberculosis to have demonstrated efficacy in a Phase 3 trial. In the present study we sought to determine if a three-dose series of DAR-901 manufactured from the SRL172 master cell bank by a new, scalable method was safe and immunogenic. METHODS: We performed a single site, randomized, double-blind, controlled, Phase 1 dose escalation trial of DAR-901 at Dartmouth-Hitchcock Medical Center in the United States...
2017: PloS One
https://www.readbyqxmd.com/read/28441679/the-drivers-of-discretionary-utilization-clinical-history-versus-physician-supply
#13
COMPARATIVE STUDY
Gregory W Ruhnke, Willard G Manning, David T Rubin, David O Meltzer
PURPOSE: Because the effect of physician supply on utilization remains controversial, literature based on non-Medicare populations is sparse, and a physician supply expansion is under way, the potential for physician-induced demand across diverse populations is important to understand. A substantial proportion of gastrointestinal endoscopies may be inappropriate. The authors analyzed the impact of physician supply, practice patterns, and clinical history on esophagogastroduodenoscopy (EGD, defined as discretionary) among patients hospitalized with lower gastrointestinal bleeding (LGIB)...
May 2017: Academic Medicine: Journal of the Association of American Medical Colleges
https://www.readbyqxmd.com/read/28378409/diffusion-of-digital-breast-tomosynthesis-among-women-in-primary-care-associations-with-insurance-type
#14
Cheryl R Clark, Tor D Tosteson, Anna N A Tosteson, Tracy Onega, Julie E Weiss, Kimberly A Harris, Jennifer S Haas
Digital breast tomosynthesis (DBT) has shown potential to improve breast cancer screening and diagnosis compared to digital mammography (DM). The FDA approved DBT use in conjunction with conventional DM in 2011, but coverage was approved by CMS recently in 2015. Given changes in coverage policies, it is important to monitor diffusion of DBT by insurance type. This study examined DBT trends and estimated associations with insurance type. From June 2011 to September 2014, DBT use in 22 primary care centers in the Dartmouth -Brigham and Women's Hospital Population-based Research Optimizing Screening through Personalized Regimens research center (PROSPR) was examined among women aged 40-89...
May 2017: Cancer Medicine
https://www.readbyqxmd.com/read/28370856/validation-of-adapted-dartmouth-operative-conditions-scale-for-sedation-during-pediatric-esophagogastroduodenoscopy
#15
Vanmathi Chandran, Barath Jagadisan, Barani Ganth
AIMS: Pediatric esophagogastroduodenoscopy requires deep sedation as it involves stimulation of the airway. Frequency of adverse events is higher with esophagogastroduodenoscopy. Hence, monitoring needs sedation scales like the Dartmouth Operative Condition Scale that identifies safe states of sedation. This study aims at validating the Adapted Dartmouth Operative Condition Scale for sedation rating by pediatricians during pediatric esophagogastroduodenoscopy. METHODS: Items in the Dartmouth Operating Conditions Scale were adapted for pediatric esophagogastroduodenoscopy...
June 2017: Paediatric Anaesthesia
https://www.readbyqxmd.com/read/28366464/prognostic-value-of-national-comprehensive-cancer-network-lung-cancer-resection-quality-criteria
#16
Raymond U Osarogiagbon, Meredith A Ray, Nicholas R Faris, Matthew P Smeltzer, Carrie Fehnel, Cheryl Houston-Harris, Raymond S Signore, Laura M McHugh, Paul Levy, Lynn Wiggins, Vishal Sachdev, Edward T Robbins
BACKGROUND: The National Comprehensive Cancer Network (NCCN) surgical resection guidelines for non-small cell lung cancer recommend anatomic resection, negative margins, examination of hilar/intrapulmonary lymph nodes, and examination of three or more mediastinal nodal stations. We examined the survival impact of these criteria. METHODS: A population-based observational study was done using patient-level data from all curative-intent, non-small cell lung cancer resections from 2004 to 2013 at 11 institutions in four contiguous Dartmouth Hospital referral regions in three US states...
May 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28343174/mirna-analysis-in-pancreatic-cancer-the-dartmouth-experience
#17
REVIEW
Francine B de Abreu, Xiaoying Liu, Gregory J Tsongalis
Pancreatic cancer is considered one of the most lethal cancers being the fourth leading cause of cancer deaths in adults in the United States because of the lack of early signs and symptoms and the lack of early detection. Pancreatic ductal adenocarcinoma (PDAC) is the most common histological type among pancreatic cancers, representing 80%-90% of all solid tumors of the pancreas. The majority of PDAC develops from three precursor lesions: pancreatic intraepithelial neoplasia, intraductual papillary mucinous neoplasm and mucinous cystic neoplasm...
May 1, 2017: Clinical Chemistry and Laboratory Medicine: CCLM
https://www.readbyqxmd.com/read/28338572/the-drivers-of-medicare-reimbursement-for-thoracolumbar-fusion-an-analysis-of-data-from-the-centers-for-medicare-and-medicaid-services
#18
Krishn Khanna, Eric M Padegimas, Benjamin Zmistowski, Michael Howley, Kushagra Vema
STUDY DESIGN: Retrospective observational OBJECTIVE.: The purpose of this study is to examine the variation in Thoracolumbar Fusion (TLF) payment and determine the drivers of this variation. SUMMARY OF BACKGROUND DATA: As healthcare spending continues to increase, variation in surgical procedures reimbursements has come under more scrutiny. TLF is an example of a high-cost, proven-benefit procedure that is often the focus of Centers for Medicare and Medicaid Services (CMS) administrators...
March 23, 2017: Spine
https://www.readbyqxmd.com/read/28328708/long-term-outcomes-of-melanoma-in-situ-treated-with-topical-5-imiquimod-cream-a-retrospective-review
#19
Andrew J Park, Joan Paul, M Shane Chapman, Faramarz H Samie
BACKGROUND: Melanoma in situ (MIS) is a noninvasive form of melanoma for which nonsurgical therapeutic options continue to be explored. The off-label use of topical 5% imiquimod cream in the management of MIS has shown potential but reported recurrence rates vary considerably between 0% and 40%. Furthermore, the long-term efficacy of imiquimod is not well established. OBJECTIVE: To determine the recurrence rate of MIS among patients treated with topical 5% imiquimod cream at Dartmouth-Hitchcock Medical Center with at least 1 year of follow-up...
March 21, 2017: Dermatologic Surgery: Official Publication for American Society for Dermatologic Surgery [et Al.]
https://www.readbyqxmd.com/read/28289113/the-effects-of-training-institution-practice-costs-quality-and-other-characteristics-on-future-practice
#20
Robert L Phillips, Stephen M Petterson, Andrew W Bazemore, Peter Wingrove, James C Puffer
PURPOSE: Medicare beneficiary spending patterns reflect those of the 306 Hospital Referral Regions where physicians train, but whether this holds true for smaller areas or for quality is uncertain. This study assesses whether cost and quality imprinting can be detected within the 3,436 Hospital Service Areas (HSAs), 82.4 percent of which have only 1 teaching hospital, and whether sponsoring institution characteristics are associated. METHODS: We conducted a secondary, multi-level, multivariable analysis of 2011 Medicare claims and American Medical Association Masterfile data for a random, nationally representative sample of family physicians and general internists who completed residency between 1992 and 2010 and had more than 40 Medicare patients (3,075 physicians providing care to 503,109 beneficiaries)...
March 2017: Annals of Family Medicine
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