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Gardner C, Rubinfeld I, Gupta AH, Johnson JL. Inter-Hospital Transfer Is an Independent Risk Factor for Hospital-Associated Infection. Surg Infect (Larchmt) 2024; 25:125-132. [PMID: 38117608 DOI: 10.1089/sur.2023.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023] Open
Abstract
Background: Regionalization of surgical care shifts higher acuity patients to larger centers. Hospital-associated infections (HAIs) are important quality measures with financial implications. In our ongoing efforts to eliminate HAIs, we examined the potential role for inter-hospital transfer in our cases of HAI across a multihospital system. Hypothesis: Surgical patients transferred to a regional multihospital system have a higher risk of National Healthcare Safety Network (NHSN)-labeled HAIs. Patients and Methods: The analysis cohort of adult surgical inpatients was filtered from a five-hospital health system administration registry containing encounters from 2014 to 2021. The dataset contained demographics, health characteristics, and acuity variables, along with the NHSN defined HAIs of central line-associated blood stream infection (CLABSI), catheter-associated urinary tract infection (CAUTI), and Clostridioides difficile infection (CDI). Univariable and multivariable statistics were performed. Results: The surgical cohort identified 92,832 patients of whom 3,232 (3.5%) were transfers. The overall HAI rate was 0.6% (528): 86 (0.09%) CLABSI, 133 (0.14%) CAUTI, and 325 (0.35%) CDI. Across the three HAIs, the rate was higher in transfer patients compared with non-transfer patients (CLABSI: n = 18 (1.3%); odds ratio [OR], 4.79; CAUTI: n = 25 (1.8%); OR, 4.20; CDI: n = 37 (1.1%); OR, 3.59); p < 0.001 for all. Multivariable analysis found transfer patients had an increased rate of HAIs (OR, 1.56; p < 0.001). Conclusions: There is an increased risk-adjusted rate of HAIs in transferred surgical patients as reflected in the NHSN metrics. This phenomenon places a burden on regional centers that accept high-risk surgical transfers, in part because of the downstream effects of healthcare reimbursement programs.
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Affiliation(s)
- Camden Gardner
- Henry Ford Hospital, Detroit, Michigan, USA
- Henry Ford Health, Detroit, Michigan, USA
| | - Ilan Rubinfeld
- Henry Ford Hospital, Detroit, Michigan, USA
- Henry Ford Health, Detroit, Michigan, USA
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Wang QP, Chang WY, Han MM, Hu YX, Lin SS, Gu YC. Application of telemedicine system for older adults postoperative patients in community: a feasibility study. Front Public Health 2024; 12:1291916. [PMID: 38435285 PMCID: PMC10904463 DOI: 10.3389/fpubh.2024.1291916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 02/06/2024] [Indexed: 03/05/2024] Open
Abstract
Purpose In response to the growing challenges posed by an aging society, a telemedicine system was developed specifically for older adults postoperative patients, and its effectiveness was thoroughly investigated. Methods Between May 2020 and May 2022, a total of 88 older adults postoperative patients were enrolled and randomly allocated into an experimental group and a control group. The experimental group received telemedicine services after discharge, while the control group received conventional medical services following the traditional protocol. One month after discharge, various indicators were evaluated for both groups, including number of visits, medical expenditures, postoperative recovery, anxiety, depression and satisfaction. Results The number of visits and medical expenditures of the experimental group were less than those of the control group [1 (0, 1) vs. 1 (1, 2), Z = -3.977, p < 0.001; 25.25 (0.00, 277.40) yuan vs. 174.65 (49.63, 446.10) yuan, Z = -2.150, p = 0.032]. In both groups, there were 2 cases of incision infection, respectively. No significant difference was observed between the two groups (Fisher χ2, p = 0.259). In both groups, there was no instance of incision bleeding, incision dehiscence, readmission, or reoperation. Additionally, there was no significant difference in physical status between the two groups at discharge and after discharge (66.06 ± 8.92 vs. 65.45 ± 7.39 t = 0.287, p = 0.775; 73.33 ± 9.97 vs. 70.91 ± 7.50, t = 1.202, p = 0.235). And there was no significant difference in the change of physical status between the two groups after discharge [10.00 (0.00, 10.00) vs. 5.00 (0.00, 10.00), Z = -1.077, p = 0.281]. There was no significant difference in body weight change between the two groups after discharge [1.05 (0.38, 1.60) Kg vs. 0.80 (0.50, 1.43) Kg, Z = -0.265, p = 0.791]. There was no significant difference in the levels of anxiety and depression between the two groups at discharge (45.64 ± 8.10 vs. 44.60 ± 8.24, t = 0.520, p = 0.604, 48.33 ± 8.46 vs. 47.50 ± 6.85, t = 0.418, p = 0.677). But the levels of anxiety and depression in the experimental group were lower than those in the control group after discharge (34.92 ± 7.38 vs. 39.03 ± 8.42, t = -2.183, p = 0.032, 37.86 ± 7.29 vs. 41.93 ± 7.13, t = -2.281, p = 0.025); The change of anxiety level and depression level of the experimental group were more than those of the control group [-10.00 (-11.25, -8.75) vs. -5.00 (-7.81, -3.75), Z = -5.277, p < 0.001; -10.00 (-12.50, -7.50) vs. -5.00 (-7.75, -3.44), Z = -4.596, p < 0.001]. The level of satisfaction regarding medical services, daily care, and psychological comfort was higher in the experimental group compared to the control group [3 (3, 3.25) vs. 2 (1, 2), Z = -5.931, p < 0.001; 3 (3, 4) vs. 3 (2, 3), Z = -2.286, p = 0.022; 2 (1, 3) vs. 1 (0.75, 2), Z = -2.081, p = 0.037]. Conclusion In the context of an aging society, telemedicine system can offer improved healthcare to older adults postoperative patients. This includes benefits such as reducing number of visits, saving medical expenditures, enhancing psychological comfort and daily care.
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Affiliation(s)
- Quan-Peng Wang
- General Surgery Department, Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine, Wenzhou, China
| | - Wan-Ying Chang
- Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Man-Man Han
- General Surgery Department, Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine, Wenzhou, China
| | - Ye-Xiao Hu
- General Surgery Department, Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine, Wenzhou, China
| | - Sai-Sai Lin
- General Surgery Department, Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine, Wenzhou, China
| | - Ye-Chun Gu
- General Surgery Department, Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine, Wenzhou, China
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Gleason F, Baker SJ, Gleason L, Wei B, Donahue J. Patient factors related to patient engagement technology (PET) usage in thoracic surgery. Am J Surg 2024; 228:242-246. [PMID: 37932188 DOI: 10.1016/j.amjsurg.2023.10.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/07/2023] [Accepted: 10/10/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND We evaluated using Patient Engagement Technology (PET) to capture Patient Reported Outcomes (PROs) in thoracic surgery patients. METHODSY: atients using a PET received surveys including the Patient-Reported Outcomes Measurement Information System Global-10 (PROMIS-10) and a health literacy (HL) screen. The relationship of patient-level factors with survey completion was assessed through univariate and logistic regression analyses. RESULTS 703 patients enrolled in a PET. 52 % were female and 83 % were white with a median age of 63.72 % had adequate HL. 81 % completed the PROMIS-10 survey. Univariate analysis found lower rates of PROMIS-10 completion in male patients and those with inadequate HL. Logistic regression analysis showed adequate HL (OR 1.76) and white race (OR 1.72) were associated with PROMIS-10 survey completion, while male gender (OR 0.65) had the opposite effect. CONCLUSIONS PETs are an effective means of collecting PROs, but use is affected by gender, race, and health literacy.
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Affiliation(s)
- Frank Gleason
- Department of Surgery, Division of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, AL, 35233, USA
| | - Samantha J Baker
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, 35233, USA
| | - Lauren Gleason
- Birmingham Veterans Administration Medical Center, Birmingham, AL, 35233, USA
| | - Benjamin Wei
- Department of Surgery, Division of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, AL, 35233, USA; Birmingham Veterans Administration Medical Center, Birmingham, AL, 35233, USA
| | - James Donahue
- Department of Surgery, Division of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, AL, 35233, USA; Birmingham Veterans Administration Medical Center, Birmingham, AL, 35233, USA.
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Ede CJ, Kruger D, Libhaber E, Moeng M, Crawford R, Achilleos K, Kodisang C, Pabu R, Stavrou C, Uzonwa G, Njiba B, Iwuji E, Nxumalo H, Moore R. A comparative study of outcomes of burns across multiple levels of care. Burns 2023; 49:1879-1885. [PMID: 37827938 DOI: 10.1016/j.burns.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 02/13/2023] [Accepted: 03/05/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND Burn injuries are a significant contributor to the burden of diseases. The management of burns at specialised burn centres has been shown to improve survival. However, in low- and middle-income countries (LMICs) major burns are managed at non-specialised burn centres due to resource constraints. There is insufficient data on survival from treatment at non-specialised burn centres in LMICs. This study aimed to compare the outcomes of burns treatment between a specialised burn centre and five non-specialised centres. METHODS A prospective cohort study was conducted on patients aged 18 years or above from January 1, 2021 to September 30, 2021. Participants were selected from the admission register at the emergency department. All burns irrespective of the mechanism of injury or %TBSA were included. Data were entered into REDCap. Statistical analysis of outcomes such as positive blood culture, length of hospital stay (LOHS) and 90-day mortality between specialised burn versus non-specialised centres was performed. Furthermore, an analysis of risk factors for mortality was performed and survival data computed. RESULTS Of the 488 study participants, 36% were admitted to a specialised burn centre compared to 64% admitted to non-specialised centres. The demographic characteristics were similar between centres. Patients at the specialised burn centre compared to non-specialised centres had a significantly higher inhalation injury of 30.9% vs 7.7% (p < 0.001), > 10%TBSA at 83.4% vs 45.7% (p < 0.001), > 20%TBSA at 46.9% vs 16.6% (p < 0.001), and a median (IQR) ABSI score of 6 (5-7) vs 5 (4-6) (p < 0.0001). Furthermore, patients from specialised burn vs non-specialised centres had a longer median (IQR) time from injury to first burn excision at 7 (4-11) vs 5 (2-10) days, higher rate of burn sepsis 69% vs 35%, increased LOHS 17 (11-27) vs 12 (6-22) days, and 90-day mortality rates at 19.4% vs 6.4%. After adjusting for cofounding variables, survival data showed no difference between specialised burn and non-specialised centres (HR 1.8 95% CI 1.0-3.2, p = 0.05). CONCLUSION Although it appears that the survival of burn patients managed at non-specialised centres in a middle-income country is comparable to those managed at specialised burn centres, there is uncounted bias in our survival data. Hence, a change in practice is not advocated. However, due to resource constraint specialised burn centres in addition to managing major burns should provide training and support to the non-specialised centres.
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Affiliation(s)
- Chikwendu J Ede
- Johnson and Johnson Adult Burn Treatment Centre, Department of Surgery, Chris Hani Baragwanath Academic Hospital, Soweto, South Africa; Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Deirdre Kruger
- Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Elena Libhaber
- Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Maeyane Moeng
- Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Charlotte Maxeke Johannesburg Academic Hospital, 7 York Road, Parktown, Johannesburg, South Africa
| | - Richard Crawford
- Johnson and Johnson Adult Burn Treatment Centre, Department of Surgery, Chris Hani Baragwanath Academic Hospital, Soweto, South Africa
| | - Katerina Achilleos
- Johnson and Johnson Adult Burn Treatment Centre, Department of Surgery, Chris Hani Baragwanath Academic Hospital, Soweto, South Africa
| | - Chris Kodisang
- Leratong Hospital,1 Adcock Street, Chamdor, Krugersdorp, South Africa
| | - Remy Pabu
- Pholosong Hospital, 1067 Indaba Street Extension One, Brakpan, Johannesburg, South Africa
| | - Christopher Stavrou
- Tambo Memorial Hospital, Cnr Hospital Road and Railway Street, Boksburg, South Africa
| | - Godson Uzonwa
- Thelle Mogoerane Regional Hospital, Nguza Street, Extension 14, Vosloorus 12390, South Africa
| | - Busanga Njiba
- Thelle Mogoerane Regional Hospital, Nguza Street, Extension 14, Vosloorus 12390, South Africa
| | - Eunice Iwuji
- Wits Health Consortium, 31 Princess of Wales Terrace, Parktown, Johannesburg, South Africa
| | - Hlengiwe Nxumalo
- Wits Health Consortium, 31 Princess of Wales Terrace, Parktown, Johannesburg, South Africa
| | - Rachel Moore
- Johnson and Johnson Adult Burn Treatment Centre, Department of Surgery, Chris Hani Baragwanath Academic Hospital, Soweto, South Africa; Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Cunha AS, Pedro AR, Cordeiro JV. Facilitators and barriers to access hospital medical specialty telemedicine consultations during the COVID-19 pandemic: Systematic Review. J Med Internet Res 2023. [PMID: 37262124 DOI: 10.2196/44188] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND COVID-19 pandemic accelerated the digital transition in healthcare, which required a rapid adaptation of stakeholders. Telemedicine has emerged as an ideal tool to ensure continuity of care by allowing remote access to specialized medical services. However, its rapid implementation has exacerbated disparities in healthcare access, especially for the most vulnerable populations. OBJECTIVE To characterize the determinants factors (facilitators and barriers) of access to hospital medical specialty telemedicine consultations during the COVID-19 pandemic; to identify the main opportunities and challenges (technological, ethical, legal and/or social) generated by the use of telemedicine in the context of the COVID-19 pandemic. METHODS A systematic review was conducted according to PRISMA guidelines. Four databases (Scopus, Web of Science, PubMed and Cochrane COVID-19 Study Register) were searched for empirical studies published between January 3rd, 2020, and December 31st, 2021, using established criteria. The protocol of this review was registered and published in PROSPERO (CRD42022302825). A methodological quality assessment was performed, and results were integrated into a thematic synthesis. The identification of main opportunities and challenges was done by interpreting and aggregating the thematic synthesis results. RESULTS Of the 106 studies identified, 9 met the inclusion criteria and the intended quality characteristics. All studies were originally from the United States of America (USA). The following facilitating factors of telemedicine use were identified: health insurance coverage; prevention of SARS-CoV-2 infection; access to Internet services; access to technological devices; better management of work-life balance; and savings in travel costs. We identified the following barriers to telemedicine use: lack of access to Internet services; lack of access to technological devices; racial and ethnic disparities; low digital literacy; low income; age; language barriers; health insurance coverage; concerns about data privacy and confidentiality; geographic disparities; and need for complementary diagnostic tests or for the delivery of test results. CONCLUSIONS The facilitating factors and barriers identified in this systematic review present different opportunities and challenges, including those of technological nature (access to technological devices and internet services, level of digital literacy), sociocultural and demographic nature (ethnic and racial disparities, geographical disparities, language barriers, age), socioeconomic nature (income level and health insurance coverage), and ethical and legal nature (data privacy and confidentiality). To expand telemedicine access to hospital-based specialty medical consultations and provide high-quality care to all, including the most vulnerable communities, the challenges identified must be thoroughly researched and addressed with informed and dedicated responses. CLINICALTRIAL
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Affiliation(s)
- Ana Soraia Cunha
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal, Avenida Padre Cruz, Lisbon, PT
| | - Ana Rita Pedro
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal, Lisbon, PT
| | - João Valente Cordeiro
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal, Lisbon, PT
- Interdisciplinary Centre of Social Sciences (CICS.NOVA), Universidade NOVA de Lisboa, Lisbon, Portugal, Lisbon, PT
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Ginzberg SP, Soegaard Ballester JM, Wirtalla CJ, Pryma DA, Mandel SJ, Kelz RR, Wachtel H. Insurance-Based Disparities in Guideline-Concordant Thyroid Cancer Care in the Era of De-Escalation. J Surg Res 2023; 289:211-219. [PMID: 37141704 DOI: 10.1016/j.jss.2023.03.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 02/20/2023] [Accepted: 03/21/2023] [Indexed: 05/06/2023]
Abstract
INTRODUCTION Prior studies have demonstrated insurance-based disparities in the treatment of well-differentiated thyroid cancer. However, it remains unclear whether these disparities have persisted in the era of the 2015 American Thyroid Association (ATA) management guidelines. The goal of this study was to assess whether insurance type is associated with the receipt of guideline-concordant and timely thyroid cancer treatment in a modern cohort. METHODS Patients diagnosed with well-differentiated thyroid cancer between 2016 and 2019 were identified from the National Cancer Database. Appropriateness of surgical and radioactive iodine treatment (RAI) was determined based on the 2015 ATA guidelines. Multivariable logistic regression and Cox proportional hazard regression analyses, stratified at age 65, were used to evaluate the associations between insurance type and appropriateness and timeliness of the treatment. RESULTS 125,827 patients were included (private = 71%, Medicare = 19%, Medicaid = 10%). Compared to privately insured patients, patients with Medicaid more frequently presented with tumors >4 cm in size (11% versus 8%, P < 0.001) and regional metastases (29% versus 27%, P < 0.001). However, patients with Medicaid were also less likely to undergo appropriate surgical treatment (odds ratio 0.69, P < 0.001), less likely to undergo surgery within 90 d of diagnosis (hazard ratio 0.80, P < 0.001), and more likely to be undertreated with RAI (odds ratio 1.29, P < 0.001). There were no differences in the likelihood of guideline-concordant surgical or medical treatment by insurance type in patients ≥65 y old. CONCLUSIONS In the era of the 2015 ATA guidelines, patients with Medicaid remain less likely to receive guideline-concordant, timely surgery and more likely to be undertreated with RAI compared to privately insured patients.
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Affiliation(s)
- Sara P Ginzberg
- Department of Surgery, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania.
| | | | - Chris J Wirtalla
- Department of Surgery, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania
| | - Daniel A Pryma
- Department of Radiology, Division of Nuclear Medicine, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania
| | - Susan J Mandel
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Perelman Center for Advanced Medicine, Philadelphia, Pennsylvania
| | - Rachel R Kelz
- Department of Surgery, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania
| | - Heather Wachtel
- Department of Surgery, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania
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Sridhar S, Mouat-Hunter A, McCrory B. Rural implementation of the perioperative surgical home: A case-control study. World J Orthop 2023; 14:123-135. [PMID: 36998383 PMCID: PMC10044325 DOI: 10.5312/wjo.v14.i3.123] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 01/01/2023] [Accepted: 02/15/2023] [Indexed: 03/17/2023] Open
Abstract
BACKGROUND Perioperative surgical home (PSH) is a novel patient-centric surgical system developed by American Society of Anesthesiologist to improve outcomes and patient satisfaction. PSH has proven success in large urban health centers by reducing surgery cancellation, operating room time, length of stay (LOS), and readmission rates. Yet, only limited studies have assessed the impact of PSH on surgical outcomes in rural areas.
AIM To evaluate the newly implemented PSH system at a community hospital by comparing the surgical outcomes using a longitudinal case-control study.
METHODS The research study was conducted at an 83-bed, licensed level-III trauma rural community hospital. A total of 3096 TJR procedures were collected retrospectively between January 2016 and December 2021 and were categorized as PSH and non-PSH cohorts (n = 2305). To evaluate the importance of PSH in the rural surgical system, a case-control study was performed to compare TJR surgical outcomes (LOS, discharge disposition, and 90-d readmission) of the PSH cohort against two control cohorts [Control-1 PSH (C1-PSH) (n = 1413) and Control-2 PSH (C2-PSH) (n = 892)]. Statistical tests including Chi-square test or Fischer’s exact test were performed for categorical variables and Mann-Whitney test or Student’s t-test were performed for continuous variables. The general linear models (Poisson regression and binomial logistic regression) were performed to fit adjusted models.
RESULTS The LOS was significantly shorter in PSH cohort compared to two control cohorts (median PSH = 34 h, C1-PSH = 53 h, C2-PSH = 35 h) (P value < 0.05). Similarly, the PSH cohort had lower percentages of discharges to other facilities (PSH = 3.5%, C1-PSH = 15.5%, C2-PSH = 6.7%) (P value < 0.05). There was no statistical difference observed in 90-d readmission between control and PSH cohorts. However, the PSH implementation reduced the 90-d readmission percentage (PSH = 4.7%, C1-PSH = 6.1%, C2-PSH = 3.6%) lower than the national average 30-d readmission percentage which is 5.5%. The PSH system was effectively established at the rural community hospital with the help of team-based coordinated multi-disciplinary clinicians or physician co-management. The elements of PSH including preoperative assessment, patient education and optimization, and longitudinal digital engagement were vital for improving the TJR surgical outcomes at the community hospital.
CONCLUSION Implementation of the PSH system in a rural community hospital reduced LOS, increased direct-to-home discharge, and reduced 90-d readmission percentages.
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Affiliation(s)
- Srinivasan Sridhar
- Center for Health Outcomes and Policy Evaluation, College of Public Health, The Ohio State University, Columbus, OH 43210, United States
| | - Amy Mouat-Hunter
- Preanesthesia Clinic, Bozeman Health, Bozeman, MT 59715, United States
| | - Bernadette McCrory
- Mechanical and Industrial Engineering, Montana State University, Bozeman, MT 59715, United States
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Getting Your Foot in the Door: Access to Surgical Care for Thyroid Disease. J Surg Res 2023; 283:344-350. [PMID: 36427444 DOI: 10.1016/j.jss.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/19/2022] [Accepted: 11/02/2022] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Access to specialty care can be challenging for patients, often involving multiple evaluations, laboratory tests, and referrals. To better understand the different pathways to specialty care, we examined the outcomes of patients evaluated for surgical thyroid disease at a single tertiary referral clinic. METHODS We reviewed 691 patients seen in the endocrine surgery clinic for thyroid disease (2018-2021). Patient demographics, referral source, referral reason, and reason for not receiving an operation were collected. The number of days from referral to initial clinic visit and from initial clinic visit to an operation were also collected. The Chi-square test, the independent t-test, the Kruskal-Wallis test, the Dunn-Bonferroni post hoc test, and multiple logistic regression tests were performed using SPSS. RESULTS The top reasons for referral were thyroid nodules (54.4%), hyperthyroidism (26.5%), and multinodular goiter (10.3%). Specialty clinic referrals came from endocrinologists (56.0%), self-referrals (15.5%), and primary care physicians (PCP; 14.4%). Self-referred patients had a shorter waiting time for an appointment than those referred by endocrinologists and PCPs. [median (IQR) (days) 12 (6-17) versus 16 (9-24) versus 16 (9-25), P < 0.001]. Overall, 450 (72.7%) patients underwent thyroid surgery. For those who underwent thyroidectomy, self-referred patients had a shorter time between initial clinic visit and the operation compared to those referred by endocrinologists and PCPs [median (IQR) (days) 2 (1-19) versus 19 (8-33) versus 16 (1-48), P < 0.001]. Patients referred for hyperthyroidism (odds ratio [OR] = 2.2, 95% confidence interval [CI] 1.3-10.5, P = 0.012 were more likely to undergo an operation than those referred for other reasons. CONCLUSIONS Access to specialty care for thyroid disease is facilitated and optimized when self-referrals are permitted. Reducing or eliminating the requirement for a provider referral may improve patients' access.
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Eruchalu CN, Bergmark RW, Smink DS, Tavakkoli A, Nguyen LL, Bates DW, Cooper Z, Ortega G. Demographic Disparity in Use of Telemedicine for Ambulatory General Surgical Consultation During the COVID-19 Pandemic: Analysis of the Initial Public Health Emergency and Second Phase Periods. J Am Coll Surg 2022; 234:191-202. [PMID: 35213441 DOI: 10.1097/xcs.0000000000000030] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Surgical patients with limited digital literacy may experience reduced telemedicine access. We investigated racial/ethnic and socioeconomic disparities in telemedicine compared with in-person surgical consultation during the coronavirus disease 2019 (COVID-19) pandemic. STUDY DESIGN Retrospective analysis of new visits within the Division of General & Gastrointestinal Surgery at an academic medical center occurring between March 24 through June 23, 2020 (Phase I, Massachusetts Public Health Emergency) and June 24 through December 31, 2020 (Phase II, relaxation of restrictions on healthcare operations) was performed. Visit modality (telemedicine/phone vs in-person) and demographic data were extracted. Bivariate analysis and multivariable logistic regression were performed to evaluate associations between patient characteristics and visit modality. RESULTS During Phase I, 347 in-person and 638 virtual visits were completed. Multivariable modeling demonstrated no significant differences in virtual compared with in-person visit use across racial/ethnic or insurance groups. Among patients using virtual visits, Latinx patients were less likely to have video compared with audio-only visits than White patients (OR, 0.46; 95% CI 0.22-0.96). Black race and insurance type were not significant predictors of video use. During Phase II, 2,922 in-person and 1,001 virtual visits were completed. Multivariable modeling demonstrated that Black patients (OR, 1.52; 95% CI 1.12-2.06) were more likely to have virtual visits than White patients. No significant differences were observed across insurance types. Among patients using virtual visits, race/ethnicity and insurance type were not significant predictors of video use. CONCLUSION Black patients used telemedicine platforms more often than White patients during the second phase of the COVID-19 pandemic. Virtual consultation may help increase access to surgical care among traditionally under-resourced populations.
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Affiliation(s)
- Chukwuma N Eruchalu
- From the Harvard Medical School, Boston, MA (Eruchalu)
- Center for Surgery and Public Health, Department of Surgery (Eruchalu, Bergmark, Smink, Nguyen, Cooper, Ortega), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Regan W Bergmark
- Center for Surgery and Public Health, Department of Surgery (Eruchalu, Bergmark, Smink, Nguyen, Cooper, Ortega), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Douglas S Smink
- Center for Surgery and Public Health, Department of Surgery (Eruchalu, Bergmark, Smink, Nguyen, Cooper, Ortega), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- Division of General and Gastrointestinal Surgery, Department of Surgery (Smink, Tavakkoli), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Ali Tavakkoli
- Division of General and Gastrointestinal Surgery, Department of Surgery (Smink, Tavakkoli), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- Laboratory for Surgical and Metabolic Research (Tavakkoli), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Louis L Nguyen
- Center for Surgery and Public Health, Department of Surgery (Eruchalu, Bergmark, Smink, Nguyen, Cooper, Ortega), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- Division of Vascular and Endovascular Surgery, Department of Surgery (Nguyen), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - David W Bates
- Division of General Internal Medicine, Department of Medicine (Bates), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- the Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA (Bates)
| | - Zara Cooper
- Center for Surgery and Public Health, Department of Surgery (Eruchalu, Bergmark, Smink, Nguyen, Cooper, Ortega), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- Division of Trauma, Burn, and Surgical Critical Care, Department of Surgery (Cooper), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Gezzer Ortega
- Center for Surgery and Public Health, Department of Surgery (Eruchalu, Bergmark, Smink, Nguyen, Cooper, Ortega), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Mignault A, Tchouaket Nguemeleu É, Robins S, Maillet É, Matetsa E, Dupuis S. Automated intra-operative SMS message updates: a quality improvement initiative to relieve caregivers’ worries (Preprint). JMIR Perioper Med 2022; 5:e36208. [PMID: 35436760 PMCID: PMC9084444 DOI: 10.2196/36208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/11/2022] [Accepted: 04/14/2022] [Indexed: 12/27/2022] Open
Affiliation(s)
- Alexandre Mignault
- Bloc Opératoire, Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | | | - Stephanie Robins
- Département des sciences infirmières, Université du Québec en Outaouais, St-Jérome, QC, Canada
| | - Éric Maillet
- École des sciences infirmières, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Edwige Matetsa
- Bloc Opératoire, Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Stéphane Dupuis
- Bloc Opératoire, Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada
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11
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eHealth and mHealth Development in Spain: Promise or Reality? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413055. [PMID: 34948664 PMCID: PMC8700823 DOI: 10.3390/ijerph182413055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 11/28/2021] [Accepted: 12/08/2021] [Indexed: 02/06/2023]
Abstract
In the last decades, the use of Information and Communication Technologies (ICTs) has progressively spread to society and public administration. Health is one of the areas in which the use of ICTs has more intensively developed through what is now known as eHealth. That area has recently included mHealth. Spanish health system has stood out as one of the benchmarks of this technological revolution. The development of ICTs applied to health, especially since the outbreak of the pandemic caused by SARS Cov-2, has increased the range of health services delivered through smartphones and the development of subsequent specialized apps. Based on the data of a Survey on Use and Attitudes regarding eHealth in Spain, the aim of this research was to conduct a comparative analysis of the different eHealth and mHealth user profiles. The results show that the user profile of eHealth an mHealth services in Spain is not in a majority. Weaknesses are detected both in the knowledge and use of eHealth services among the general population and in the usability or development of their mobile version. Smartphones can be a democratizing vector, as for now, access to eHealth services is only available to wealthy people, widening inequality.
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Gabinet NM, Shama H, Portnov BA. Using mobile phones as light at night and noise measurement instruments: a validation test in real world conditions. Chronobiol Int 2021; 39:26-44. [PMID: 34465262 DOI: 10.1080/07420528.2021.1964520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Exposure to noise from road traffic and industries is known to be linked to various health dysfunctions, including hypertension, cardiovascular diseases and hearing loss. Exposure to artificial light at night (ALAN) is also increasingly recognized as being associated with ecosystem damage and various illnesses, including cancers, excessive weight gain and sleep disorders. However, measuring and monitoring these environmental risk factors by professional equipment are laborious and expensive, which impede large-scale research and various citizen science initiatives. In this study, we test a possibility that reliable noise and ALAN exposure estimates can be gathered using smartphones (SPs) sensors. To verify this assumption, we develop a standardized testing protocol, and use Andro-Sensor app, installed on three different Samsung Galaxy SPs - S7, S20FE5G, and SM520F, - to perform measurements of ALAN and noise in real-world conditions while comparing these measurements with measurements performed by professional (type 2) equipment - SL814 for noise and LX-1330B for illumination. The analysis of 3450 measurements, performed in two different locations in Israel, reveals that the SPs measurements and measurements performed by control instruments correlate strongly for noise (r = 0.76-0.94) and are nearly identical for ALAN (r = 0.998-0.999). The association between the two types of measurements is also found to be close to linear, with the slope of the trend line being close to 45° for ALAN and varying between 30° and 45° for noise, depending on the SPs used. Our conclusion is that the level of accuracy of ALAN measurements by SPs is greater for ALAN than for noise, which can make SPs a useful tool for large-scale ALAN studies that do not require the accuracy of professional instruments.
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Affiliation(s)
- Nahum M Gabinet
- Department of Natural Resources and Environmental Management, Faculty of Social Sciences, University of Haifa, Haifa, Israel
| | - Hassan Shama
- Department of Natural Resources and Environmental Management, Faculty of Social Sciences, University of Haifa, Haifa, Israel
| | - Boris A Portnov
- Department of Natural Resources and Environmental Management, Faculty of Social Sciences, University of Haifa, Haifa, Israel
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