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https://www.readbyqxmd.com/read/29148333/geographic-variations-in-physician-relationships-over-time-implications-for-care-coordination
#1
Eva H DuGoff, Juhee Cho, Yajuan Si, Craig Evan Pollack
Care coordination may be more challenging when the specific physicians with whom primary care physicians (PCPs) are expected to coordinate care change over time. Using Medicare data on physician patient-sharing relationships and the Dartmouth Atlas, we explored the extent to which PCPs tend to share patients with other physicians over time. We found that 70.7% of ties between PCPs and other physicians that were present in 2012 persisted in 2013, and additional shared patients in 2012 increased the odds of being connected in 2013...
March 1, 2017: Medical Care Research and Review: MCRR
https://www.readbyqxmd.com/read/29130263/public-health-spending-and-medicare-resource-use-a-longitudinal-analysis-of-u-s-communities
#2
Glen P Mays, Cezar B Mamaril
OBJECTIVE: To examine whether local expenditures for public health activities influence area-level medical spending for Medicare beneficiaries. DATA SOURCES AND SETTING: Six census surveys of the nation's 2,900 local public health agencies were conducted between 1993 and 2013, linked with contemporaneous information on population demographics, socioeconomic characteristics, and area-level Medicare spending estimates from the Dartmouth Atlas of Health Care. DATA COLLECTION/EXTRACTION: Measures derive from agency survey data and aggregated Medicare claims...
December 2017: Health Services Research
https://www.readbyqxmd.com/read/29091043/off-label-usage-of-absorbable-beads-containing-antibiotics-for-prevention-of-surgical-site-infections
#3
Jeffrey M Trujillo, Mary E Logue, Ryan Kunkel, Christopher P Demas
Surgical site infections account for about 17% of all nosocomial infections, second only to urinary tract infections. Antibiotic beads deliver high local antibiotic concentrations and maintain low systemic levels. The authors assessed the efficacy of calcium sulfate absorbable antibiotic beads (CSAAB) in the prevention of surgical site infections (SSIs) for complex wound closures. Patient records from the University of New Mexico Hospital (UNMH; Albuquerque, NM) and Dartmouth-Hitchcock Medical Center (DHMC; Lebanon, NH) were retrospectively analyzed from 2004 to 2015...
October 2017: Wounds: a Compendium of Clinical Research and Practice
https://www.readbyqxmd.com/read/29036513/scangeo-parallel-mining-of-high-throughput-gene-expression-data
#4
Katja Koeppen, Bruce A Stanton, Thomas H Hampton
Summary: Current options to mine publicly available gene expression data deposited in NCBI's gene expression omnibus (GEO), such as the GEO web portal and related applications, are optimized to reanalyze a single study, or search for a single gene, and therefore require manual intervention to reanalyze multiple studies for user-specified gene sets. ScanGEO is a simple, user-friendly Shiny web application designed to identify differentially expressed genes across all GEO studies matching user-specified criteria, for a flexible set of genes, visualize results and provide summary statistics and other reports using a single command...
November 1, 2017: Bioinformatics
https://www.readbyqxmd.com/read/28973110/association-of-pathologic-nodal-staging-quality-with-survival-among-patients-with-non-small-cell-lung-cancer-after-resection-with-curative-intent
#5
Matthew P Smeltzer, Nicholas R Faris, Meredith A Ray, Raymond U Osarogiagbon
Importance: Pathologic nodal stage is the most significant prognostic factor in resectable non-small cell lung cancer (NSCLC). The International Association for the Study of Lung Cancer NSCLC staging project revealed intercontinental differences in N category-stratified survival. These differences may indicate differences not only in cancer biology but also in the thoroughness of the nodal examination. Objective: To determine whether survival was affected by sequentially more stringent definitions of pN staging quality in a cohort of patients with NSCLC after resection with curative intent...
September 28, 2017: JAMA Oncology
https://www.readbyqxmd.com/read/28954977/leadership-training-of-surgery-in-us
#6
Kazuaki Takabe
Surgeons in the US are trained to be leaders during their surgical residencies as part of their postgraduate education. Leadership is considered to be essential, since the surgeon directs the medical team. Every surgeon is expected to gain leadership skills. I would like to introduce the leadership training that I received as an ASCO Leadership Development Program graduate and as a Scholarship recipient of Geisel Leadership Course at Dartmouth in addition to General Surgery Residency at University of California San Diego...
2017: Keio Journal of Medicine
https://www.readbyqxmd.com/read/28953578/patient-centered-organizational-statements-merely-rhetoric-a-survey-of-health-care-leaders
#7
William A Nelson, Rachel C Forcino, Glyn Elwyn
Health care organizations have embraced the concept of patient-centered care, but there is concern that the mere inclusion of those words in mission and value statements does not equate to implementation at the health care delivery level. Despite initiatives to align the patient-clinician encounter with broader patient-centered values, there have been mixed results, often creating a gap between practice and the organization's stated position. This preliminary study aims to assess the extent to which patient-centered values are reflected in actual patient care...
October 2017: Health Care Manager
https://www.readbyqxmd.com/read/28929886/water-recycling-at-the-nova-scotia-hospital-central-laundry
#8
David Bligh, Dylan Dingwell
A water recycling system was installed at the Nova Scotia Hospital Central Laundry in Dartmouth, Nova Scotia in the spring of 2014. The consequent reductions in the consumption of water and steam at this facility have been measured over a 20-month period and are presented here in nominal units and as a financial analysis. Cumulative savings over this period have been calculated to be $351,567, representing a 53% annual return on investment after accounting for annual operating and maintenance costs.
March 2017: Healthcare Management Forum
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
#9
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
#10
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
#11
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
#12
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
#13
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
#14
MULTICENTER STUDY
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
#15
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...
August 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
#16
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
#17
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
#18
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
#19
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
#20
RANDOMIZED CONTROLLED TRIAL
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
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