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Elisabeth F Beaber, Anna N A Tosteson, Jennifer S Haas, Tracy Onega, Brian L Sprague, Donald L Weaver, Anne Marie McCarthy, Chyke A Doubeni, Virginia P Quinn, Celette Sugg Skinner, Ann G Zauber, William E Barlow
PURPOSE: Although United States clinical guidelines differ, the earliest recommended age for average risk breast cancer screening is 40 years. Little is known about factors influencing screening initiation. METHODS: We conducted a cohort study within the National Cancer Institute-funded Population-based Research Optimizing Screening through Personalized Regimens (PROSPR) consortium. We identified 3413 women on their 40th birthday in primary care networks at Geisel School of Medicine at Dartmouth (DH) and Brigham and Women's Hospital (BWH) during 2011-2013 with no prior breast imaging or breast cancer...
November 2016: Breast Cancer Research and Treatment
Gregory Curfman, Carmel Shachar, Amol Navathe
No abstract text is available yet for this article.
September 2016: Healthcare
Yunfeng Shi, Dennis P Scanlon, Raymond Kang, Megan McHugh, Jessica Greene, Jon B Christianson, Muriel Jean-Jacques, Yasmin Mahmud, Jeffrey A Alexander
OBJECTIVE: To summarize the results from the quantitative analyses conducted during the summative evaluation of the Aligning Forces for Quality (AF4Q) initiative. STUDY DESIGN: Longitudinal design using linear difference-in-difference (DD) regression models with fixed effects. Outcomes were selected based on the AF4Q program logic model and organized according to the categories of the Triple Aim: improving population health, improving quality and experience of care, and reducing the cost of care...
August 2016: American Journal of Managed Care
Kyo Kobayashi, Ruhong Dong, Roberto Javier Nicolalde, Benjamin B Williams, Gaixin Du, Harold M Swartz, Ann Barry Flood
Testing and verification are an integral part of any cycle to design, manufacture and improve a novel device intended for use in humans. In the case of testing Dartmouth's electron paramagnetic resonance (EPR) in vivo tooth dosimetry device, in vitro studies are needed throughout its development to test its performance, i.e. to verify its current capability for assessing dose in individuals potentially exposed to ionizing radiation. Since the EPR device uses the enamel of human teeth to assess dose, models that include human teeth have been an integral mechanism to carry out in vitro studies during development and testing its ability to meet performance standards for its ultimate intended in vivo use...
August 22, 2016: Radiation Protection Dosimetry
Ruth Kleinpell, Eduard E Vasilevskis, Louis Fogg, E Wesley Ely
OBJECTIVE: To examine the association of the use of hospice care on patient experience and outcomes of care. Promoting high-value, safe and effective care is an international healthcare imperative. However, the extent to which hospice care may improve the value of care is not well characterised. METHODS: A secondary analysis of variations in care was conducted using the Dartmouth Atlas Report, matched to the American Hospital Association Annual Survey Database to abstract organisational characteristics for 236 US hospitals to examine the relationship between hospice usage and a number of variables that represent care value, including hospital care intensity index, hospital deaths, intensive care unit (ICU) deaths, patient satisfaction and a number of patient quality indicators...
August 16, 2016: BMJ Supportive & Palliative Care
Minoru Miyake, Yasuhiro Nakai, Ichiro Yamaguchi, Hiroshi Hirata, Naoki Kunugita, Benjamin B Williams, Harold M Swartz
The aim of this study was to make direct measurements of the possible radiation-induced EPR signals in the teeth of volunteers who were residents in Fukushima within 80 km distance from the Fukushima Nuclear Power plant at the time of the disaster, and continued to live there for at least 3 month after the disaster. Thirty four volunteers were enrolled in this study. These measurements were made using a portable L-band EPR spectrometer, which was originally developed in the EPR Center at Dartmouth. All measurements were performed using surface loop resonators that have been specifically designed for the upper incisor teeth...
August 13, 2016: Radiation Protection Dosimetry
N Marcus Thygeson, Meinong Wang, David O'Riordan, Steven Z Pantilat
BACKGROUND: California hospitals report palliative care (PC) program characteristics to the California Office of Statewide Health Planning and Development (OSHPD), but the significance of this information is unknown. OBJECTIVE: Our objective was to determine whether self-reported California hospital PC program characteristics are associated with lower end-of-life (EoL) Medicare utilization. DESIGN: We performed a cross-sectional study of hospitals submitting 2012 data to OSHPD and included in the 2012 Dartmouth Atlas of Healthcare (DAHC) dataset, using statistical hypothesis testing, multivariate regression, and fuzzy set qualitative comparative analysis...
August 10, 2016: Journal of Palliative Medicine
Matthew Toth, Mark Holmes, Courtney Van Houtven, Mark Toles, Morris Weinberger, Pam Silberman
OBJECTIVE: To assess rural-urban differences in quality of postdischarge care among Medicare beneficiaries, controlling for selection bias of postdischarge services. DATA SOURCES: The Medicare Current Beneficiary Survey (MCBS), Cost and Use Files from 2000 to 2010, the Area Resource File, Provider of Services File, and the Dartmouth Atlas of Health Care. STUDY DESIGN: Retrospective analysis of 30- and 60-day hospital readmission, emergency department (ED) use, and mortality using two-stage residual inclusion; receipt of 14-day follow-up care was the main independent variable...
August 8, 2016: Health Services Research
Zsolt Kulcsar, Daniel Albert, Ellyn Ercolano, John N Mecchella
BACKGROUND/PURPOSE: Telerheumatology services were developed at Dartmouth-Hitchcock Medical Center (DHMC) to bring specialty care to New Hampshire (NH) and Vermont (VT) where a large proportion of the population lives in rural areas (60%) with limited resources and access to care. We sought to learn what challenges and accomplishments our early telemedicine program has encountered since inception. METHODS: As part of a quality improvement initiative we performed an IRB-exempt retrospective review of patients seen in the telerheumatology clinic at DHMC from October 2011 to December 2014...
June 3, 2016: Seminars in Arthritis and Rheumatism
Matthew G Crowson, Kristine Schulz, Kourosh Parham, Andrea Vambutas, David Witsell, Walter T Lee, Jennifer J Shin, Melissa A Pynnonen, Anh Nguyen-Huynh, Sheila E Ryan, Alan Langman
OBJECTIVE: (1) Integrate practice-based patient encounters using the Dartmouth Atlas Medicare database to understand practice treatments for Ménière's disease (MD). (2) Describe differences in the practice patterns between academic and community providers for MD. STUDY DESIGN: Practice-based research database review. SETTING: CHEER (Creating Healthcare Excellence through Education and Research) network academic and community providers. SUBJECTS AND METHODS: MD patient data were identified with ICD-9 and CPT codes...
July 2016: Otolaryngology—Head and Neck Surgery
Eric M Padegimas, Kushagra Verma, Benjamin Zmistowski, Richard H Rothman, James J Purtill, Michael Howley
BACKGROUND: Total joint arthroplasty is a large and growing part of the U.S. Medicare budget, drawing attention to how much providers are paid for their services. The purpose of this study was to examine the variables that affect total joint arthroplasty reimbursement. Along with standard economic variables, we include unique health-care variables. Given the focus on value in the Affordable Care Act, the model examines the relationship of the quality of care to total joint arthroplasty reimbursement...
June 15, 2016: Journal of Bone and Joint Surgery. American Volume
Kathryn Y Noonan, Cong Rang, Katherine Callahan, Nathan E Simmons, Kadir Erkmen, James E Saunders
OBJECTIVES: This study compares the functional outcomes of nevus intermedius impairment following surgery, radiation, or observation for the treatment of vestibular schwannoma. STUDY DESIGN: Retrospective cohort study. SETTINGS: Tertiary care medical center. SUBJECTS AND METHODS: We retrospectively examined 141 charts of patients with a vestibular schwannoma seen in the Dartmouth-Hitchcock Acoustic Neuroma Clinic between 2012 and 2014...
October 2016: Otolaryngology—Head and Neck Surgery
Susan P McGrath, Andreas H Taenzer, Nancy Karon, George Blike
BACKGROUND: The growing number of monitoring devices, combined with suboptimal patient monitoring and alarm management strategies, has increased "alarm fatigue," which have led to serious consequences. Most reported alarm man- agement approaches have focused on the critical care setting. Since 2007 Dartmouth-Hitchcock (Lebanon, New Hamp- shire) has developed a generalizable and effective design, implementation, and performance evaluation approach to alarm systems for continuous monitoring in general care settings (that is, patient surveillance monitoring)...
July 2016: Joint Commission Journal on Quality and Patient Safety
Dawn J Brooks
BACKGROUND: Significant discordance arose between screening mammography clinical practice guidelines published by different national health care organizations following the release of the U.S. Preventive Services Task Force (USPSTF) guidelines in 2009. This allowed for greater interprovider variation in clinical practice while remaining within standard of care. The objective of this study was to determine how differences in patient screening mammography rates between internal medicine physician subgroups defined by gender and level of training changed, if at all, following the release of the new guidelines...
June 2016: Journal of the National Comprehensive Cancer Network: JNCCN
Matthew D Koff, Jeremiah R Brown, Emily J Marshall, A James O'Malley, Jens T Jensen, Stephen O Heard, Karen Longtine, Melissa O'Neill, Jaclyn Longtine, Donna Houston, Cindy Robison, Eric Moulton, Hetal M Patel, Randy W Loftus
BACKGROUND Healthcare provider hands are an important source of intraoperative bacterial transmission events associated with postoperative infection development. OBJECTIVE To explore the efficacy of a novel hand hygiene improvement system leveraging provider proximity and individual and group performance feedback in reducing 30-day postoperative healthcare-associated infections via increased provider hourly hand decontamination events. DESIGN Randomized, prospective study. SETTING Dartmouth-Hitchcock Medical Center in New Hampshire and UMass Memorial Medical Center in Massachusetts...
August 2016: Infection Control and Hospital Epidemiology
Jay R Horton, R Sean Morrison, Elizabeth Capezuti, Jennifer Hill, Eric J Lee, Amy S Kelley
BACKGROUND: Palliative care is associated with decreased treatment intensity and improved quality for individual patients at the end of life, but little is known about how hospital-wide outcomes are affected by the diffusion of palliative care principles. OBJECTIVE: We examined the relationship between presence of palliative care programs and hospitals' average treatment intensity, as indicated by mean intensive care unit (ICU) length of stay (LOS) and days under Medicare hospice coverage, in the last six months of life among Medicare beneficiaries aged 67 and over with serious chronic illness...
September 2016: Journal of Palliative Medicine
Andrea N Leep Hunderfund, Liselotte N Dyrbye, Stephanie R Starr, Jay Mandrekar, James M Naessens, Jon C Tilburt, Paul George, Elizabeth G Baxley, Jed D Gonzalo, Christopher Moriates, Susan D Goold, Patricia A Carney, Bonnie M Miller, Sara J Grethlein, Tonya L Fancher, Darcy A Reed
PURPOSE: To examine medical student attitudes toward cost-conscious care and whether regional health care intensity is associated with reported exposure to physician role-modeling behaviors related to cost-conscious care. METHOD: Students at 10 U.S. medical schools were surveyed in 2015. Thirty-five items assessed attitudes toward, perceived barriers to and consequences of, and observed physician role-modeling behaviors related to cost-conscious care (using scales for cost-conscious and potentially wasteful behaviors; Cronbach alphas of 0...
May 17, 2016: Academic Medicine: Journal of the Association of American Medical Colleges
Joseph A Paydarfar, Benoit J Gosselin, Annette M Tietz
OBJECTIVE: The urgent nature of head and neck cancer referrals often results in overbooked schedules, access delays, and patient, physician, and staff dissatisfaction. The goal of this study is to examine how incorporation of associate providers (APs) into a head and neck tumor clinic (HNTC) can improve access. METHODS: Scheduling data for the Dartmouth-Hitchcock HNTC 2 years prior (January 2011 to December 2012) and 2 years subsequent (January 2013 to December 2014) to program initiation were abstracted, including number of new patients seen per month, third available for new and established patients, overbooked hours, surgeon productivity, and patient satisfaction scores...
May 17, 2016: Otolaryngology—Head and Neck Surgery
Alexander J Titus, E Andrés Houseman, Kevin C Johnson, Brock C Christensen
UNLABELLED: : The public availability of high throughput molecular data provides new opportunities for researchers to advance discovery, replication and validation efforts. One common challenge in leveraging such data is the diversity of measurement approaches and platforms and a lack of utilities enabling cross-platform comparisons among data sources for analysis. We present a method to map DNA methylation data from bisulfite sequencing approaches to CpG sites measured with the widely used Illumina methylation bead-array platforms...
August 15, 2016: Bioinformatics
Jane Price
In recent years, a number of shortcomings in the NHS have been identified in end-of-life care delivered in hospital for people with long-term conditions other than terminal cancer. This article gives an overview of the findings of a Dignity in Care travel scholarship, which was undertaken to establish whether an American shared informed decision aid, specifically designed to initiate therapeutic conversations for this patient group, might reasonably be adopted in an NHS setting. One tool specifically for this purpose was in use in the USA at the time, and its efficacy formed part of a broader research study being carried out at Dartmouth Hitchcock Medical Center (DHMC) in New England...
April 14, 2016: British Journal of Nursing: BJN
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