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Patel SV, Alshami A, Douedi S, Udongwo N, Hossain M, Tarina D, Walch B, Carpenter K, Kountz D, Buccellato V, Sable K, Frank E, Asif A. The Utilization of 15-Minute Multidisciplinary Rounds to Reduce Length of Stay in Patients under Observation Status. Healthcare (Basel) 2023; 11:2823. [PMID: 37957968 PMCID: PMC10648780 DOI: 10.3390/healthcare11212823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 09/28/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023] Open
Abstract
With the recent change to value-based care, institutions have struggled with the appropriate management of patients under observation. Observation status can have a huge impact on hospital and patient expenses. Institutions have implemented specialized observation units to provide better care for these patients. Starting in January 2020, coinciding with the initiation of daily multidisciplinary rounds, our study focused on patients aged 18 and older admitted to our hospital under observation status. Efforts were built upon prior initiatives at Jersey Shore University Medical Center (JSUMC) to optimize patient care and length of stay (LOS) reduction. The central intervention revolved around the establishment of daily "Observation Huddles"-succinct rounds led by hospital leaders to harmonize care for patients under observation. The primary aim was to assess the impact of daily multidisciplinary rounds (MDR) on LOS, while our secondary aim involved identifying specific barriers and interventions that contributed to the observed reduction. Our study revealed a 9-h reduction in observation time, resulting in approximately USD 187.50 saved per patient. When accounting for the period spanning 2020 to 2022, potential savings totaled USD 828,187.50 in 2020, USD 1,046,062.50 in 2021, and USD 1,243,562.50 in 2022. MDR for observation patients led to a reduction in LOS from 29 h to 20 h (p < 0.001).
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Affiliation(s)
| | | | | | - Ndausung Udongwo
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ 07753, USA; (S.V.P.); (A.A.); (S.D.); (M.H.); (D.T.); (B.W.); (K.C.); (D.K.); (V.B.); (K.S.); (E.F.); (A.A.)
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Affiliation(s)
- Herodotos Ellinas
- Herodotos Ellinas, MD, MHPE, is Co-Director of the Collaboratories, Kern Institute, Co-Chair for DEIJ, Society for Education in Anesthesia, and Professor of Anesthesiology, Medical College of Wisconsin
| | - Franklin Trimm
- Franklin Trimm, MD, is Vice President, Medical Affairs Associate Dean, Diversity and Inclusion, University of South Alabama College of Medicine
| | - David Kountz
- David Kountz, MD, is Professor of Medicine, and Senior Associate Dean, Diversity, Equity, and Inclusion, Hackensack Meridian School of Medicine
| | - Jessica Bienstock
- Jessica Bienstock, MD, MPH, is Professor, Department of Gynecology and Obstetrics, Senior Associate Dean for Graduate Medical Education, and Designated Institutional Official, Johns Hopkins University School of Medicine
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Kountz D, Rodriguez F, Vital V, Vora S, Gough R, Seyfried J. Could Clinician Sensitivity to Cultural and Historical Considerations Help Reduce COVID-19 Deaths among Blacks? South Med J 2021; 114:591-592. [PMID: 34480192 PMCID: PMC8395970 DOI: 10.14423/smj.0000000000001288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- David Kountz
- From Hackensack Meridian School of Medicine, Nutley, New Jersey, Stanford University, Stanford, California, University of Arizona College of Nursing, Tucson, Mashantucket Pequot Tribal Nation, Connecticut, and the National Minority Cardiovascular Alliance/Make Well Known Foundation, Princeton, New Jersey
| | - Fatima Rodriguez
- From Hackensack Meridian School of Medicine, Nutley, New Jersey, Stanford University, Stanford, California, University of Arizona College of Nursing, Tucson, Mashantucket Pequot Tribal Nation, Connecticut, and the National Minority Cardiovascular Alliance/Make Well Known Foundation, Princeton, New Jersey
| | - Veronica Vital
- From Hackensack Meridian School of Medicine, Nutley, New Jersey, Stanford University, Stanford, California, University of Arizona College of Nursing, Tucson, Mashantucket Pequot Tribal Nation, Connecticut, and the National Minority Cardiovascular Alliance/Make Well Known Foundation, Princeton, New Jersey
| | - Setu Vora
- From Hackensack Meridian School of Medicine, Nutley, New Jersey, Stanford University, Stanford, California, University of Arizona College of Nursing, Tucson, Mashantucket Pequot Tribal Nation, Connecticut, and the National Minority Cardiovascular Alliance/Make Well Known Foundation, Princeton, New Jersey
| | - Ryan Gough
- From Hackensack Meridian School of Medicine, Nutley, New Jersey, Stanford University, Stanford, California, University of Arizona College of Nursing, Tucson, Mashantucket Pequot Tribal Nation, Connecticut, and the National Minority Cardiovascular Alliance/Make Well Known Foundation, Princeton, New Jersey
| | - Jessica Seyfried
- From Hackensack Meridian School of Medicine, Nutley, New Jersey, Stanford University, Stanford, California, University of Arizona College of Nursing, Tucson, Mashantucket Pequot Tribal Nation, Connecticut, and the National Minority Cardiovascular Alliance/Make Well Known Foundation, Princeton, New Jersey
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Patel S, Alshami A, Douedi S, Campbell N, Hossain M, Mushtaq A, Tarina D, Sealove B, Kountz D, Carpenter K, Angelo E, Buccellato V, Sable K, Frank E, Asif A. Improving Hospital Length of Stay: Results of a Retrospective Cohort Study. Healthcare (Basel) 2021; 9:healthcare9060762. [PMID: 34205327 PMCID: PMC8234441 DOI: 10.3390/healthcare9060762] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/12/2021] [Accepted: 06/18/2021] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Jersey Shore University Medical Center (JSUMC) is a 646-bed tertiary medical center located in central New Jersey. Over the past several years, development and maturation of tertiary services at JSUMC has resulted in tremendous growth, with the inpatient volume increasing by 17% between 2016 and 2018. As hospital floors functioned at maximum capacity, the medical center was frequently forced into crisis mode with substantial increases in emergency department (ED) waiting times and a paradoxical increase in-hospital length of stay (hLOS). Prolonged hLOS can contribute to worse patient outcomes and satisfaction, as well as increased medical costs. (2) Methods: A root cause analysis was conducted to identify the factors leading to delays in providing in-hospital services. Four main bottlenecks were identified by the in-hospital phase sub-committee: incomplete orders, delays in placement to rehabilitation facilities, delays due to testing (mainly imaging), and delays in entering the discharge order. Similarly, the discharge process itself was analyzed, and obstacles were identified. Specific interventions to address each obstacle were implemented. Mean CMI-adjusted hospital LOS (CMI-hLOS) was the primary outcome measure. (3) Results: After interventions, CMI-hLOS decreased from 2.99 in 2017 to 2.84 and 2.76 days in 2018 and 2019, respectively. To correct for aberrations due to the COVID pandemic, we compared June-August 2019 to June-August 2020 and found a further decrease to 2.42 days after full implementation of all interventions. We estimate that the intervention led to an absolute reduction in costs of USD 3 million in the second half of 2019 and more than USD 7 million in 2020. On the other hand, the total expenses, represented by salaries for additional staffing, were USD 2,103,274, resulting in an estimated net saving for 2020 of USD 5,400,000. (4) Conclusions: At JSUMC, hLOS was found to be a complex and costly issue. A comprehensive approach, starting with the identification of all correctable delays followed by interventions to mitigate delays, led to a significant reduction in hLOS along with significant cost savings.
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Affiliation(s)
- Swapnil Patel
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ 07753, USA; (A.A.); (S.D.); (N.C.); (M.H.); (A.M.); (D.T.); (D.K.); (A.A.)
- Correspondence:
| | - Abbas Alshami
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ 07753, USA; (A.A.); (S.D.); (N.C.); (M.H.); (A.M.); (D.T.); (D.K.); (A.A.)
| | - Steven Douedi
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ 07753, USA; (A.A.); (S.D.); (N.C.); (M.H.); (A.M.); (D.T.); (D.K.); (A.A.)
| | - Natasha Campbell
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ 07753, USA; (A.A.); (S.D.); (N.C.); (M.H.); (A.M.); (D.T.); (D.K.); (A.A.)
| | - Mohammad Hossain
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ 07753, USA; (A.A.); (S.D.); (N.C.); (M.H.); (A.M.); (D.T.); (D.K.); (A.A.)
| | - Arman Mushtaq
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ 07753, USA; (A.A.); (S.D.); (N.C.); (M.H.); (A.M.); (D.T.); (D.K.); (A.A.)
| | - Dana Tarina
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ 07753, USA; (A.A.); (S.D.); (N.C.); (M.H.); (A.M.); (D.T.); (D.K.); (A.A.)
| | - Brett Sealove
- Department of Cardiology, Jersey Shore University Medical Center Hackensack Meridian Health, Neptune, NJ 07753, USA;
| | - David Kountz
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ 07753, USA; (A.A.); (S.D.); (N.C.); (M.H.); (A.M.); (D.T.); (D.K.); (A.A.)
- Hospital Administration, Jersey Shore University Medical Center Hackensack Meridian Health, Neptune, NJ 07753, USA; (K.C.); (E.A.); (V.B.); (K.S.)
| | - Kim Carpenter
- Hospital Administration, Jersey Shore University Medical Center Hackensack Meridian Health, Neptune, NJ 07753, USA; (K.C.); (E.A.); (V.B.); (K.S.)
| | - Ellen Angelo
- Hospital Administration, Jersey Shore University Medical Center Hackensack Meridian Health, Neptune, NJ 07753, USA; (K.C.); (E.A.); (V.B.); (K.S.)
| | - Vito Buccellato
- Hospital Administration, Jersey Shore University Medical Center Hackensack Meridian Health, Neptune, NJ 07753, USA; (K.C.); (E.A.); (V.B.); (K.S.)
| | - Kenneth Sable
- Hospital Administration, Jersey Shore University Medical Center Hackensack Meridian Health, Neptune, NJ 07753, USA; (K.C.); (E.A.); (V.B.); (K.S.)
| | - Elliot Frank
- Department of Quality Improvement, Jersey Shore University Medical Center Hackensack Meridian Health, Neptune, NJ 07753, USA;
| | - Arif Asif
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ 07753, USA; (A.A.); (S.D.); (N.C.); (M.H.); (A.M.); (D.T.); (D.K.); (A.A.)
- Hospital Administration, Jersey Shore University Medical Center Hackensack Meridian Health, Neptune, NJ 07753, USA; (K.C.); (E.A.); (V.B.); (K.S.)
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Ahmed N, Kountz D, Kuo Y. African-American and Caucasian mortalities are the same after traumatic injury: pair matched analysis from a national data. Trauma Surg Acute Care Open 2020; 5:e000436. [PMID: 32509964 PMCID: PMC7254111 DOI: 10.1136/tsaco-2019-000436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 02/12/2020] [Accepted: 03/01/2020] [Indexed: 12/05/2022] Open
Abstract
Background African–Americans have worse outcomes than Caucasians in many clinical conditions studied, including trauma. We sought to analyze if mortality is different in these groups through analysis of a national data set. Methods Recent data from the national Trauma Quality Improvement Program were assessed with analysis, including all African–American or Caucasian patients who were brought to level I or level II trauma centers for care. Propensity scores were calculated for each African–American patient using age, sex, Injury
Severity Score (ISS), Glasgow
Coma Scale (GCS), injury type, insurance information and American College of Surgeons trauma level. The primary outcome of this study was in-hospital mortality, and the secondary outcomes were hospital length of stay and discharge disposition. Results A total of 82 150 (13.65%) out of 601 768 patients who qualified for the inclusion in the study were African–American. The remaining 519 618 (86.35%) were Caucasian. The median age (IQR) of the patients was 54 (33 to 72) years old, and approximately two-thirds of the patients were male. The median ISS and GCS score were 12 (9 to 17) and 15 (15 to 15), respectively. More than 90% of patients sustained blunt injuries. Overall, there was no significant difference found in overall in-hospital mortality between Caucasians and African–American patients (3% vs. 2.9%, p=0.2); however, the median (95% CI) hospital length of stay was 1 day longer in African–American patients compared with Caucasian patients (5 (5.5) vs. 4 (4.4), p<0.001). When the discharged destinations between the two groups were compared, a higher proportion of Caucasians were discharged to home without services (66% vs. 33%). Conclusion Our study showed that trauma mortalites among African–American and Caucasians are the same. Efforts to mitigate the ethnic and racial biases in the delivery of healthcare should continue, and these results (no differences in mortality) should be validated in other clinical settings. Level of evidence Level II.
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Affiliation(s)
- Nasim Ahmed
- Surgery, Division of Trauma, Jersey Shore University Medical Center, Neptune City, New Jersey, USA
| | - David Kountz
- Diversity and Equity, Hackensack Meridian School of Medicine, Nutley, New Jersey, USA
| | - Yenhong Kuo
- Research, Jersey Shore University Medical Center, Neptune City, New Jersey, USA
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Kountz D. Helping Pre-Health Students Succeed in the Innovation Era. MedEdPublish 2016. [DOI: 10.15694/mep.2016.000137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
This article was migrated. The article was not marked as recommended. In the United States the pipeline of future healthcare providers is limited, and a shortage in the physician workforce is looming. New pipeline programs need to be established, or existing programs strengthened or expanded to address this program. We have piloted a community-based pre-profesisonal program for high school students, "Mini-Medical School", which has attracted over 500 students over the past 4 years. We believe that this model is low cost, reproducible, and can help achieve outcomes to increase the pool of future physicans and other health care providers by exposing them to positive role models in medicine in a creative, low stress setting.
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Weber MA, Schiffrin EL, White WB, Mann S, Lindholm LH, Kenerson JG, Flack JM, Carter BL, Materson BJ, Ram CVS, Cohen DL, Cadet JC, Jean-Charles RR, Taler S, Kountz D, Townsend RR, Chalmers J, Ramirez AJ, Bakris GL, Wang J, Schutte AE, Bisognano JD, Touyz RM, Sica D, Harrap SB. Clinical Practice Guidelines for the Management of Hypertension in the Community. J Clin Hypertens (Greenwich) 2013; 16:14-26. [DOI: 10.1111/jch.12237] [Citation(s) in RCA: 508] [Impact Index Per Article: 46.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Michael A. Weber
- State University of New York; Downstate College of Medicine; Brooklyn NY
| | - Ernesto L. Schiffrin
- Department of Medicine; Sir Mortimer B. Davis Jewish General Hospital; McGill University; Montreal Canada
| | - William B. White
- Calhoun Cardiology Center; University of Connecticut; Farmington CT
| | - Samuel Mann
- Department of Medicine; Weil Cornell College of Medicine; New York NY
| | - Lars H. Lindholm
- Department of Public Health and Clinical Medicine; Umea University; Umea Sweden
| | | | - John M. Flack
- Department of Medicine; Wayne State University; Detroit MI
| | - Barry L. Carter
- Department of Pharmacy Practice and Science; University of Iowa; Iowa City IA
| | - Barry J. Materson
- Department of Medicine; University of Miami Miller School of Medicine; Miami FL
| | | | - Debbie L. Cohen
- Department of Medicine; University of Pennsylvania School of Medicine; Philadelphia PA
| | | | | | - Sandra Taler
- Department of Medicine; Mayo Clinic; Rochester MN
| | - David Kountz
- Jersey Shore University Medical Center; Neptune NJ
| | | | - John Chalmers
- George Institute for Global Health; University of Sydney; Sydney NSW Australia
| | - Agustin J. Ramirez
- Arterial Hypertension and Metabolic Unit; University Hospital; Favaloro Foundation; Buenos Aires Argentina
| | - George L. Bakris
- ASH Comprehensive Hypertension Center; University of Chicago Medicine; Chicago IL
| | - Jiguang Wang
- The Shanghai Institute of Hypertension; Shanghai Jiaotong University School of Medicine; Shanghai China
| | - Aletta E. Schutte
- Hypertension in Africa Research Team; North West University; Potchefstroom South Africa
| | - John D. Bisognano
- Department of Medicine; University of Rochester Medical Center; Rochester NY
| | - Rhian M. Touyz
- Institute of Cardiovascular and Medical Sciences; University of Glasgow; Glasgow UK
| | | | - Stephen B. Harrap
- Department of Physiology; University of Melbourne; Melbourne Vic Australia
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Abstract
Treating hyperglycemia is a critical aspect of managing type 2 diabetes mellitus (T2DM), but can be especially challenging in patients from vulnerable groups such as those with chronic kidney disease, African Americans, and older people. The dipeptidyl peptidase (DPP)-4 inhibitors are relatively new oral antidiabetes drugs that have been incorporated into treatment algorithms over the past few years and have also been studied in these vulnerable patients. Clinical trials with DPP-4 inhibitors have now been reported for all these patient groups and have demonstrated significant improvements in measures of hyperglycemia, with a good safety profile. Based on the current evidence, it appears that the DPP-4 inhibitors are worthy of consideration not only for the most straightforward patients with T2DM, but also for these vulnerable patients.
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Affiliation(s)
- David Kountz
- Jersey Shore University Medical Center, Rutgers-Robert Wood Johnson Medical School, 1945 State Route 33, PO Box 397, Neptune, NJ, 07754-0397, USA,
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Abstract
It is well documented that African American populations are disproportionately affected by type 2 diabetes mellitus compared with their white counterparts. They have a higher prevalence of diabetes, a higher rate of diabetes-related complications, greater disability from these complications, and poorer control and quality of care. In order to improve diabetes care and outcomes in African Americans (and indeed all patients with diabetes), a multifactorial approach is needed to target all risk factors-not solely hyperglycemia-simultaneously. Culturally appropriate initiatives to improve lifestyle behaviors are a first step in management. Community-based programs, including those mediated through church groups, have reported varying degrees of success in effecting such beneficial lifestyle changes. If these measures fail to achieve desirable levels of blood glucose, blood pressure, and serum lipids, pharmacologic therapy is indicated. However, few evidence-based recommendations regarding the use of some drugs in African Americans currently exist due to their underrepresentation in randomized controlled clinical trials. Other essential components of diabetes care include regular screening for diabetic nephropathy and neuropathy, and eye and foot examinations, with prompt referral to specialists when important clinical changes are detected.
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Affiliation(s)
- David Kountz
- Jersey Shore University Medical Center, Neptune, New Jersey, USA.
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Costanzo EJ, Mencel P, Zamel L, Kambam M, Kountz D, Selim S, Patel PD. PULMONARY LANGERHANS CELL HISTIOCYTOSIS IN A PATIENT WITH MULTIPLE SCLEROSIS: MERE COINCIDENCE OR AN AUTOIMMUNE LINK? Chest 2008. [DOI: 10.1378/chest.134.4_meetingabstracts.c67001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Duru OK, Gerzoff RB, Brown AF, Karter AJ, Kim C, Kountz D, Narayan KMV, Schneider SH, Tseng CW, Waitzfelder B, Mangione CM. Predictors of sustained walking among diabetes patients in managed care: the Translating Research into Action for Diabetes (TRIAD) study. J Gen Intern Med 2008; 23:1194-9. [PMID: 18452046 PMCID: PMC2517953 DOI: 10.1007/s11606-008-0629-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2007] [Revised: 02/26/2008] [Accepted: 03/31/2008] [Indexed: 11/30/2022]
Abstract
BACKGROUND Although patients with diabetes may benefit from physical activity, few studies have examined sustained walking in this population. OBJECTIVE To examine the factors associated with sustained walking among managed care patients with diabetes. DESIGN Longitudinal, observational cohort study with questionnaires administered 2.5 years apart. PARTICIPANTS Five thousand nine hundred thirty-five patients with diabetes walking at least 20 minutes/day at baseline. MEASUREMENTS The primary outcome was the likelihood of sustained walking, defined as walking at least 20 minutes/day at follow-up. We evaluated a logistic regression model that included demographic, clinical, and neighborhood variables as independent predictors of sustained walking, and expressed the results as predicted percentages. RESULTS The absence of pain was linked to walking behavior, as 62% of patients with new pain, 67% with ongoing pain, and 70% without pain were still walking at follow-up (p = .03). Obese patients were less likely (65%) to sustain walking than overweight (71%) or normal weight (70%) patients (p = .03). Patients > or =65 years (63%) were less likely to sustain walking than patients between 45 and 64 (70%) or < or =44 (73%) years (p = .04). Only 62% of patients with a new comorbidity sustained walking compared with 68% of those who did not (p < .001). We found no association between any neighborhood variables and sustained walking in this cohort of active walkers. CONCLUSIONS Pain, obesity, and new comorbidities were moderately associated with decreases in sustained walking. Whereas controlled intervention studies are needed, prevention, or treatment of these adverse conditions may help patients with diabetes sustain walking behavior.
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Affiliation(s)
- O Kenrik Duru
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA.
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Duru OK, Mangione CM, Steers NW, Herman WH, Karter AJ, Kountz D, Marrero DG, Safford MM, Waitzfelder B, Gerzoff RB, Huh S, Brown AF. The association between clinical care strategies and the attenuation of racial/ethnic disparities in diabetes care: the Translating Research Into Action for Diabetes (TRIAD) Study. Med Care 2007; 44:1121-8. [PMID: 17122717 DOI: 10.1097/01.mlr.0000237423.05294.c0] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We sought to determine whether greater implementation of clinical care strategies in managed care is associated with attenuation of known racial/ethnic disparities in diabetes care. RESEARCH DESIGN AND METHODS Using cross-sectional data, we examined the quality of diabetes care as measured by frequencies of process delivery as well as medication management of intermediate outcomes, for 7426 black, Latinos, Asian/Pacific Islanders, and white participants enrolled in 10 managed care plans within 63 provider groups. We stratified models by intensity of 3 clinical care strategies at the provider group level: physician reminders, physician feedback, or use of a diabetes registry. RESULTS Exposure to clinical care strategy implementation at the provider group level varied by race and ethnicity, with <10% of black participants enrolled in provider groups in the highest-intensity quintile for physician feedback and <10% of both black and Asian/Pacific Islander participants enrolled in groups in the highest-intensity quintile for diabetes registry use. Although disparities in care were confirmed, particularly for black relative to white subjects, we did not find a consistent pattern of disparity attenuation with increasing implementation intensity for either processes of care or medication management of intermediate outcomes. CONCLUSIONS For the most part, high-intensity implementation of a diabetes registry, physician feedback, or physician reminders, 3 clinical care strategies similar to those used in many health care settings, are not associated with attenuation of known disparities of diabetes care in managed care.
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Affiliation(s)
- O Kenrik Duru
- David Geffen School of Medicine, University of California, Los Angeles, California 90024, USA.
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Rosen R, Kountz D, Post-Zwicker T, Leiblum S, Wiegel M. ORIGINAL RESEARCH—EDUCATION: Sexual Communication Skills in Residency Training: The Robert Wood Johnson Model. J Sex Med 2006; 3:37-46. [PMID: 16409216 DOI: 10.1111/j.1743-6109.2005.00135.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Few medical schools or residency programs offer adequate training in sexual medicine. Using the experience gained in our long-standing program in human sexuality for medical students, we have pilot tested a half-day intensive workshop curriculum for residents that focuses on sexual communication skills and management of sexual problems. Unlike our medical school program, this residency course was offered on an elective, one-day basis. The current report describes the successful implementation of our pilot program with 46 medical residents from subspecialty and primary care residency programs. Before the workshop, 22 (48%) residents indicated that they were uncomfortable with open discussion of sexual issues and would not feel comfortable in addressing the topic with their patients. A number of factors were identified as barriers to communication, including lack of time, inadequate training, and personal discomfort. After the workshop, the participants rated themselves as more comfortable with the topic and as more likely to address sexual issues with their patients. The participants evaluated the workshop positively overall and responded well to the interactive format and audience-response components. Most of the participants showed interest and willingness to participate in further training in sexual medicine skills. Our program offers a model for training of residents in communication skills and management of sexual problems. The difficulties in implementation and overcoming institutional barriers to curriculum reform are addressed.
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Affiliation(s)
- Raymond Rosen
- Department of Psychiatry, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, Piscataway, NJ 08854, USA.
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Abstract
The successful synthesis of a pentagonal dodecahedrane molecule has been achieved. Obtained by a sequence of 20 stereochemically controlled steps beginning with the readily available cyclopentadienide anion, the 1,16-dimethyl derivative has D(3d) symmetry and unusual physical properties. The x-ray crystal structure shows that the alkyl groups cause only small distortions from pure dodecahedral symmetry.
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