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Knight LMJ, Tanabe P, Blewer AL, Goodrich J, King AA, Reuter-Rice K, Crego N. Association of hydroxyurea adherence with transcranial Doppler screenings in children with sickle cell disease. Pediatr Blood Cancer 2024:e31017. [PMID: 38706206 DOI: 10.1002/pbc.31017] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 03/11/2024] [Accepted: 03/25/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND National sickle cell disease (SCD) guidelines recommend oral hydroxyurea (HU) starting at 9 months of age, and annual transcranial Doppler (TCD) screenings to identify stroke risk in children aged 2-16 years. We examined prevalence and proportion of TCD screenings in North Carolina Medicaid enrollees to identify associations with sociodemographic factors and HU adherence over 3 years. STUDY DESIGN We conducted a longitudinal study with children ages 2-16 years with SCD enrolled in NC Medicaid from years 2016-2019. Prevalence of TCD screening claims was calculated for 3 years, and proportion was calculated for 12, 24, and 36 months of Medicaid enrollment. Enrollee HU adherence was categorized using HU proportion of days covered. Multivariable Poisson regression assessed for TCD screening rates by HU adherence, controlling for age, sex, and rurality. RESULTS The prevalence of annual TCD screening was between 39.5% and 40.1%. Of those with 12-month enrollment, 77.8% had no TCD claims, compared to 22.2% who had one or higher TCD claims. Inversely, in children with 36 months of enrollment, 36.7% had no TCD claims compared to 63.3% who had one or higher TCD claims. The proportion of children with two or higher TCD claims increased with longer enrollment (10.5% at 12 months, 33.7% at 24 months, and 52.6% at 36 months). Children with good HU adherence were 2.48 (p < .0001) times more likely to have TCD claims than children with poor HU adherence. CONCLUSION While overall TCD screening prevalence was low, children with better HU adherence and longer Medicaid enrollment had more TCD screenings. Multilevel interventions are needed to engage healthcare providers and families to improve both evidence-based care and annual TCD screenings in children with SCD.
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Affiliation(s)
| | - Paula Tanabe
- Duke University School of Nursing and Medicine, Durham, North Carolina, USA
| | - Audrey L Blewer
- Duke University School of Nursing, Durham, North Carolina, USA
- Department of Family Medicine, Community Health, and Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - James Goodrich
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Allison A King
- Departments of Pediatrics, Hematology and Oncology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Karin Reuter-Rice
- Duke University School of Nursing, Durham, North Carolina, USA
- Departments of Pediatrics and Neurosurgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Nancy Crego
- Duke University School of Nursing, Durham, North Carolina, USA
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Crego N, Douglas C, Bonnabeau E, Eason K, Earls M, Tanabe P, Shah N. Opioid Use Among Children and Adults With Sickle Cell Disease in North Carolina Medicaid Enrollees in the Era of Opioid Harm Reduction. J Pediatr Hematol Oncol 2024; 46:181-187. [PMID: 38551912 DOI: 10.1097/mph.0000000000002852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 02/12/2024] [Indexed: 04/24/2024]
Abstract
Adults and children with sickle cell disease (SCD) are predominantly African American, with pain-related health disparities. We examined opioid prescription fill patterns in adults and children with SCD and compared factors associated with fills in North Carolina Medicaid enrollees. Our retrospective cohort study included 955 enrollees diagnosed with SCD having at least one opioid fill. Associations were measured between two cohorts (12 and 24 mo of continuous enrollment) for the following characteristics: sex, age, enrollee residence, hydroxyurea adherence, comanagement, enrollment in Community Care North Carolina, prescription for short versus short and long-acting opioids, and emergency department reliance. The majority of individuals did not have an opioid claim over a 12 or 24-month period. Claims increased at ages 10 to 17, peaking at ages 18 to 30. The increased number of claims was associated with the following factors: increasing age, male, short versus long-acting opioids, and Medicaid enrollment for 24 versus 12 months. Community Care North Carolina enrollees in the 12-month cohort had higher opioid days of supply per month; the inverse was true of the 24-month cohort.
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Affiliation(s)
| | | | | | - Kern Eason
- School of Medicine, Duke University, Durham
| | | | - Paula Tanabe
- School of Nursing
- School of Medicine, Duke University, Durham
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Frush JM, Ming DY, Crego N, Paden ME, Jones-Hepler B, Misiewicz R, Jarrett VA, Docherty SL. Caregiver Perspectives on Telemedicine for Postdischarge Care for Children With Medical Complexity: A Qualitative Study. J Pediatr Health Care 2023:S0891-5245(22)00358-3. [PMID: 36670018 DOI: 10.1016/j.pedhc.2022.12.009] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 12/29/2022] [Indexed: 01/20/2023]
Abstract
INTRODUCTION The objectives of this study were to describe the perspectives of caregivers of children with medical complexity on telemedicine video visits (TMVV) for posthospitalization care and determine whether TMVV may be a viable alternative to in-person follow-up. METHOD Our qualitative descriptive study included semistructured telephone interviews with 12 caregivers. Data analysis was conducted using an adapted Colaizzi's descriptive phenomenological method for thematic construction. RESULTS Results were organized into four themes describing caregivers' experiences with TMVV: (1) promoted caregiver self-efficacy and sense of independence; (2) TMVV as convenient, cost-effective, comprehensive, and acceptable; (3) supported caregiver decision-making and problem-solving; and (4) fostered delivery of family-centered care. DISCUSSION Although in-person visits are necessary for some circumstances, TMVV can serve as a convenient and acceptable alternative for posthospitalization follow-up in children with medical complexity. Overall, caregivers in this study were satisfied with the quality of care and individualized experience of TMVV.
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Affiliation(s)
- Jennifer M Frush
- Jennifer M. Frush, Housestaff, Department of Emergency Medicine, Boston Medical Center, Boston, MA.
| | - David Y Ming
- David Y. Ming, Associate Professor, Department of Pediatrics, Department of Medicine, and Department of Population Health, School of Medicine, Duke University, Durham, NC
| | - Nancy Crego
- Nancy Crego, Assistant Professor, School of Nursing, Duke University, Durham, NC
| | - Mary E Paden
- Mary E. Paden, Consulting Associate, School of Nursing, Duke University, Durham, NC
| | - Bonnie Jones-Hepler
- Bonnie Jones-Hepler, PhD Student, School of Nursing, Duke University, Durham, NC
| | - Remi Misiewicz
- Remi Misiewicz, PhD Student, School of Nursing, Duke University, Durham, NC
| | - Valerie A Jarrett
- Valerie A. Jarrett, Program Coordinator, Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | - Sharron L Docherty
- Sharron L. Docherty, Associate Professor, Department of Pediatrics, Duke University School of Medicine, and Duke University School of Nursing, Durham, NC
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Longoria JN, Pugh NL, Gordeuk V, Hsu LL, Treadwell M, King AA, Gibson R, Kayle M, Crego N, Glassberg J, Melvin CL, Hankins JS, Porter J. Patient-reported neurocognitive symptoms influence instrumental activities of daily living in sickle cell disease. Am J Hematol 2021; 96:1396-1406. [PMID: 34350622 PMCID: PMC8855994 DOI: 10.1002/ajh.26315] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 07/29/2021] [Accepted: 08/02/2021] [Indexed: 12/12/2022]
Abstract
Individuals with sickle cell disease (SCD) experience neurocognitive decline, low medication adherence, increased unemployment, and difficulty with instrumental activities of daily living (IADL). The relationship between self-perceived cognitive difficulties and IADLs, including employment, school enrollment, independence, engagement in leisure activities, and medication adherence is unknown. We hypothesized that self-reported difficulties across neurocognitive areas would predict lower IADL skills. Adolescent and adult participants of the multi-site Sickle Cell Disease Implementation Consortium (SCDIC) (n = 2436) completed patient-reported outcome (PRO) measures of attention, executive functioning, processing speed, learning, and comprehension. Cognitive symptoms were analyzed as predictors in multivariable modeling. Outcome variables included 1) an IADL composite that consisted of employment, participation in school, reliance on others, and leisure pursuits, and 2) hydroxyurea adherence. Participants reported cognitive difficulty across areas of attention (55%), executive functioning (51%), processing speed (57%), and reading comprehension (65%). Executive dysfunction (p < 0.001) and sometimes or often experiencing learning difficulties (p < 0.001 and p = 0.04) and poor comprehension (p = 0.000 and p = 0.001), controlled for age (p < 0.001), pain (p < 0.001), and hydroxyurea use (p = 0.001), were associated with poor IADL skills. Executive functioning difficulties (p = 0.021), controlled for age (p = 0.013 for ages 25-34), genotype (p = 0.001), and hemoglobin (p = 0.004), predicted hydroxyurea non-adherence. Analysis of PRO measures indicated that cognitive dysfunction is prevalent in adolescents and adults with SCD. Cognitive dysfunction translated into clinically meaningful outcomes. PRO of cognitive symptoms can be used as an important adjunct clinical tool to monitor symptoms that impact functional skills, including engagement in societal activities and medication adherence.
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Affiliation(s)
- Jennifer N Longoria
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Norma L Pugh
- Center for Clinical Research Network Coordination, RTI International, Research Triangle Park, North Carolina, USA
| | - Victor Gordeuk
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Lewis L Hsu
- Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Marsha Treadwell
- Department of Pediatrics, University of California San Francisco Benioff Children's Hospital Oakland, San Francisco, California, USA
| | - Allison A King
- Program in Occupational Therapy and Departments of Pediatrics and Medicine, Washington University, St. Louis, Missouri, USA
| | - Robert Gibson
- Department of Emergency Medicine and Hospitalist Services, Augusta University, Augusta, Georgia, USA
| | - Mariam Kayle
- Clinical Health Systems and Analytics Division, Duke University, Durham, North Carolina, USA
| | - Nancy Crego
- Women, Children and Families Division, Duke University School of Nursing, Durham, NC
| | - Jeffrey Glassberg
- Department of Emergency Medicine, Icahn School of Medicine at Mt. Sinai, New York, New York, USA
| | - Cathy L Melvin
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jane S Hankins
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Jerlym Porter
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
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Masese RV, Crego N, Douglas C, Rains G, Bonnabeau E, DeMartino T, Shah N, Tanabe P. A Needs Assessment of Persons With Sickle Cell Disease in a Major Medical Center in North Carolina. N C Med J 2021; 82:312-320. [PMID: 34544765 PMCID: PMC10564552 DOI: 10.18043/ncm.82.5.312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/11/2022]
Abstract
BACKGROUND Sickle cell disease (SCD) is a complex disease associated with many complications and a shortened lifespan. In 2016, the National Heart, Lung and Blood Institute funded 8 centers in the United States to form the Sickle Cell Disease Implementation Consortium, with the goal of improving SCD care. The aim of our study was to describe SCD self-efficacy, pain interference, and barriers to care from the perspective of persons with SCD in the North Carolina center.METHODS Persons with SCD, aged 15 and older were recruited from a large SCD center in North Carolina. Surveys, focus groups, and interviews were completed.RESULTS Fifty-one people completed a survey, and 14 people completed an interview or focus group. Barriers identified in the survey included self-care barriers, misconceptions related to hydroxyurea (an oral medication that reduces rates of pain crisis), limited provider knowledge, and stigma. Concerning self-efficacy, participants reported that they were able to manage their pain symptoms most of the time. Pain interfered most with the ability to participate in social and day-to-day activities.Common themes from the focus groups and interviews included misconceptions about hydroxyurea, pain, provider knowledge, stigma, co-management, transportation, and insurance. Recommendations to improve care included the use of case managers, utilization of treatment guidelines, individualized pain protocols, and effective co-management by providers.LIMITATIONS Participants were recruited from 1 SCD center and may not be representative of the entire SCD population in North Carolina.CONCLUSIONS Participants described many perceived barriers to care, and their responses suggest a need for improvements in patient hydroxyurea education, provider knowledge, and care coordination.
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Affiliation(s)
- Rita V Masese
- School of Nursing, Duke University, Durham, North Carolina.
| | - Nancy Crego
- School of Nursing, Duke University, Durham, North Carolina
| | | | - Gary Rains
- Duke Office of Clinical Research, Duke University School of Medicine, Durham, North Carolina
| | | | | | - Nirmish Shah
- Duke University Medical Center, Duke Health, Durham, North Carolina
| | - Paula Tanabe
- School of Nursing, Duke University, Durham, North Carolina
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Goode V, Cary M, Crego N, Thornlow D. Using Clinical Data to Improve the Quality of Health Care. J Perianesth Nurs 2021; 36:207-208. [PMID: 33812506 DOI: 10.1016/j.jopan.2021.01.001] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 01/13/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Victoria Goode
- Atlantic Anesthesia Inc, Virginia Beach, VA; Old Dominion University, Virginia Beach, VA.
| | | | - Nancy Crego
- Duke University School of Nursing, Durham, NC
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Keathley V, Crego N, Paden M, Heuckel R, Kayle M. Redesigning clinical education to transition pre-licensure students from all-virtual to in-person clinical. Teaching and Learning in Nursing 2021. [DOI: 10.1016/j.teln.2021.02.004] [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: 10/21/2022]
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Tanabe P, Blewer AL, Bonnabeau E, Bosworth HB, Clayton DH, Crego N, Earls MF, Eason K, Forlines G, Rains G, Young M, Shah N. Dissemination of Evidence-Based Recommendations for Sickle Cell Disease to Primary Care and Emergency Department Providers in North Carolina: A Cost Benefit Analysis. J Health Econ Outcomes Res 2021; 8:18-28. [PMID: 33829067 PMCID: PMC8016663 DOI: 10.36469/jheor.2021.21535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 03/10/2021] [Indexed: 06/12/2023]
Abstract
Background: Sickle cell disease (SCD) is a genetic condition affecting primarily individuals of African descent, who happen to be disproportionately impacted by poverty and who lack access to health care. Individuals with SCD are at high likelihood of high acute care utilization and chronic pain episodes. The multiple complications seen in SCD contribute to significant morbidity and premature mortality, as well as substantial costs to the healthcare system. Objectives: SCD is a complex chronic disease resulting in the need for primary, specialty and emergency care. Many providers do not feel prepared to care for individuals with SCD, despite the existence of evidence-based guidelines. We report the development of a SCD toolbox and the dissemination process to primary care and emergency department (ED) providers in North Carolina (NC). We report the effect of this dissemination on health-care utilization, cost of care, and overall cost-benefit. Methods: The SCD toolbox was adapted from the National Heart, Lung, and Blood Institute recommendations. Toolbox training was provided to quality improvement specialists who then disseminated the toolbox to primary care providers (PCPs) affiliated with the only NC managed care coordination system and ED providers. Tools were made available in paper, online, and in app formats to participating managed care network practices (n=1 800). Medicaid claims data were analyzed for total costs and benefits of the toolbox dissemination for a 24-month pre- and 18-month post-intervention period. Results: There was no statistically significant shift in the number of outpatient specialty visits, ED visits or hospitalizations. There was a small decrease in the number of PCP visits in the post-implementation period. The dissemination resulted in a net cost-savings of $361 414 ($14.03 per-enrollee per-month on average). However, the estimated financial benefit associated with the dissemination of the SCD toolbox was not statistically significant. Conclusions: Although we did not find the expected shift to increased PCP visits and decreased ED visits and hospitalizations, there were many lessons learned.
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Affiliation(s)
- Paula Tanabe
- School of Nursing, Duke University, Durham, NC, USA; Duke University School of Medicine, Durham, NC, USA
| | - Audrey L Blewer
- Department of Family Medicine and Community Health, School of Medicine, Duke University, Durham, NC, USA; Department of Population Health Sciences, School of Medicine, Duke University, Durham, NC, USA
| | | | - Hayden B Bosworth
- School of Nursing, Duke University, Durham, NC, USA; Duke University School of Medicine, Durham, NC, USA; Department of Population Health Sciences, School of Medicine, Duke University, Durham, NC, USA; Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Medical Center (DVAMC), Durham, NC, USA
| | | | - Nancy Crego
- School of Nursing, Duke University, Durham, NC, USA
| | | | - Kern Eason
- Previously - Community Care North Carolina, Cary, NC, USA
| | | | - Gary Rains
- Duke University School of Medicine, Durham, NC, USA
| | | | - Nirmish Shah
- Duke University School of Medicine, Durham, NC, USA
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Abstract
Sickle cell disease (SCD) is a common genetic blood disorder predominantly affecting African Americans in the United States. The objective of this study was to use a multimethods approach to describe how patients with SCD in North Carolina perceive the care they receive in emergency departments (EDs). Fourteen participants completed an interview (n = 10) or 2 focus groups (n = 2 per focus group) and 51 completed surveys. Sixty percent of participants with pain attack "very much" or "quite a bit" avoided going to the ED for care because of prior bad experiences and 50% of participants reported waiting 120 minutes or more in the ED for treatment of their sickle cell pain. Participants reported that stigma associated with provider perception of drug-seeking behavior is a persistent problem in the ED. Participant recommendations warrant further investigation to address persistent SCD quality-of-care concerns in the ED.
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Affiliation(s)
- Nancy Crego
- Duke University School of Nursing, Durham, North Carolina (Drs Crego, Masese, and Tanabe and Ms Bonnabeau); Social & Scientific Systems, Inc, Durham, North Carolina (Dr Douglas); Duke Office of Clinical Research, Durham, North Carolina (Mr Rains); and Duke University Medicine, Durham, North Carolina (Dr Shah)
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Abstract
PURPOSE To examine the family communication experience of Korean adolescents with cancer and their parents, including how adolescents and their parents verbally share feelings and concerns related to the adolescent's cancer diagnosis with one another, and how emotional communication affects parent-adolescent relationships and the family's coping abilities. PARTICIPANTS & SETTING 20 participants (10 adolescents with cancer, aged 13-19 years, and their parents) at a university-affiliated hospital in Seoul, South Korea. METHODOLOGIC APPROACH Individual, semistructured interviews were conducted and analyzed based on a qualitative descriptive approach. Conventional content analysis was employed to analyze the data. FINDINGS The overarching core theme developed from the content analysis and theme generation was "I cannot share my feelings." This core theme is represented by three main themes. IMPLICATIONS FOR NURSING Increased need for nursing awareness and culturally relevant assessment of emotional family communication needs between Korean adolescents with cancer and their family caregivers are necessary.
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Cary MP, Goode V, Crego N, Thornlow D, Colón-Emeric C, van Houtven C, Merwin EI. Hospital Readmission and Costs of Total Knee Replacement Surgery in 2009 and 2014: Potential Implications for Health Care Managers. Health Care Manag (Frederick) 2019; 38:24-28. [PMID: 30640242 PMCID: PMC6662912 DOI: 10.1097/hcm.0000000000000246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
The purpose of this article is to describe changes in hospital readmissions and costs for US hospital patients who underwent total knee replacement (TKR) in 2009 and 2014. Data came from the Healthcare Cost and Utilization Project net-Nationwide Readmissions Database. Compared with 2009, overall 30-day rates of readmissions after TKR decreased by 15% in 2014. Rates varied by demographics: readmission rates were lower for younger patients, males, Medicare recipients, and those with higher incomes. Overall, costs rose 20% across TKR groups. This report is among the first to describe changes in hospital readmissions and costs for TKR patients in a national sample of US acute care hospitals. Findings offer hospital managers a mechanism to benchmark their facilities' performances.
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Affiliation(s)
- Michael P Cary
- Author Affiliations: Duke University School of Nursing (Drs Cary, Goode, Crego, Thornlow, and Merwin); Geriatric Research, Education and Clinical Center, Durham Veterans Affairs Medical Center (Dr Colón-Emeric); and Department of Medicine, Duke University School of Medicine (Drs Colón-Emeric and van Houtven), Durham, North Carolina
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Cary MP, Goode V, Crego N, Thornlow D, Colón-Emeric CS, Hoenig HM, Baba K, Fellingham S, Merwin EI. Hospital Readmission in Total Hip Replacement Patients in 2009 and 2014. Arch Phys Med Rehabil 2018; 99:1213-1216. [PMID: 29407518 DOI: 10.1016/j.apmr.2017.12.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 08/02/2017] [Revised: 12/14/2017] [Accepted: 12/21/2017] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To document changes in 30-day hospital readmission rates and causes for returning to the hospital for care in THR patients. DESIGN Retrospective cross-sectional descriptive design. SETTING Community-based acute care hospitals. PARTICIPANTS Total sample size (N=142,022) included THR patients (identified as ICD-9-CM procedure code 81.51) in 2009 (n=31,232) and (n=32,863) in 2014. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES 30-Day hospital readmission. RESULTS The overall readmission rate decreased by 1.3% from 2009 to 2014. The decrease in readmission rates varied by groups, with lesser improvements seen in THR patients who were younger, with private insurance, and residing in lower-income and rural communities. Device complications were the leading cause of readmission in THR patients, increasing from 19.8% in 2009 to 23.9% in 2014. CONCLUSIONS There has been little decrease in hospital 30-day readmission rates for US community hospitals between 2009 and 2014. Findings from this brief report indicate patient groups at greater risk for 30-day hospital readmission as well as leading causes for readmission in THR patients which can inform the development of tailored interventions for reduction.
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Affiliation(s)
- Michael P Cary
- Healthcare in Adult Populations Division, Duke University School of Nursing, Durham, NC.
| | - Victoria Goode
- Healthcare in Adult Populations Division, Duke University School of Nursing, Durham, NC
| | - Nancy Crego
- Healthcare in Adult Populations Division, Duke University School of Nursing, Durham, NC
| | - Deirdre Thornlow
- Healthcare in Adult Populations Division, Duke University School of Nursing, Durham, NC
| | - Cathleen S Colón-Emeric
- Geriatric Research, Education and Clinical Center, Durham Veterans Affairs Medical Center, Durham, NC; Division of Geriatrics, Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Helen M Hoenig
- Geriatric Research, Education and Clinical Center, Durham Veterans Affairs Medical Center, Durham, NC; Division of Geriatrics, Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Kayla Baba
- Healthcare in Adult Populations Division, Duke University School of Nursing, Durham, NC
| | - Scarlet Fellingham
- Healthcare in Adult Populations Division, Duke University School of Nursing, Durham, NC
| | - Elizabeth I Merwin
- Healthcare in Adult Populations Division, Duke University School of Nursing, Durham, NC
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Crego N, Baernholdt M, Merwin E. Differences in Pediatric Non-Interventional Radiology Procedural Sedation Practices and Adverse Events by Registered Nurses and Physicians. J Pediatr Nurs 2017; 35:129-133. [PMID: 27717624 PMCID: PMC5378685 DOI: 10.1016/j.pedn.2016.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 07/23/2016] [Accepted: 09/13/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE The purpose of this study was to determine differences in sedation-related adverse events according to the type of provider monitoring and delivering sedation. DESIGN AND METHODS A retrospective, cross-sectional, correlational design using secondary data from the Pediatric Sedation Research Consortium database was used for this study. RESULTS A sample of 36,352 cases (0-14 years of age) sedated and monitored for diagnostic radiology procedures by three types of providers (registered nurses [RNs] alone, physicians (MDs) alone, or registered nurse + physician [RN+MD sedation teams]) were compared. Patients sedated by RNs alone or MDs alone had lower odds of unanticipated adverse events (odds ratios 0.46 and 0.53, respectively; p<0.0001) compared with RN+MD sedation provider teams. CONCLUSIONS Team skills may be an important competency for RN+MD sedation teams in the non-interventional radiology setting. PRACTICE IMPLICATIONS This study can inform clinicians, administrators, and quality-improvement managers of the differences in adverse event outcomes of pediatric radiology procedures when RN+MD teams provide sedation compared with RNs or MDs alone.
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Affiliation(s)
- Nancy Crego
- Duke University School of Nursing, Durham, NC.
| | - Marianne Baernholdt
- Langston Center for Quality, Safety, and Innovation, Nursing Alumni Endowed Distinguished Professor, School of Nursing, Virginia Commonwealth University, Richmond, VA
| | - Elizabeth Merwin
- Ann Henshaw Gardiner Professor of Nursing, Executive Vice Dean, Duke University School of Nursing, Durham, NC
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Abstract
Researchers need to evaluate the strengths and weaknesses of data sets to choose a secondary data set to use for a health care study. This research method review informs the reader of the major issues necessary for investigators to consider while incorporating secondary data into their repertoire of potential research designs and shows the range of approaches the investigators may take to answer nursing research questions in a variety of context areas. The researcher requires expertise in locating and judging data sets and in the development of complex data management skills for managing large numbers of records. There are important considerations such as firm knowledge of the research question supported by the conceptual framework and the selection of appropriate databases, which guide the researcher in delineating the unit of analysis. Other more complex issues for researchers to consider when conducting secondary data research methods include data access, management and security, and complex variable construction.
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Terry KL, Crego N. Addressing Differences and Challenges in the Pediatric Perioperative Setting. AORN J 2016; 104:1-3. [DOI: 10.1016/j.aorn.2016.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 05/23/2016] [Indexed: 12/31/2022]
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Abstract
Children, often require sedation for procedures due to their developmental level and difficulty complying with positioning. There are few studies that describe nurse sedation practices or adverse events. Studies of pediatric sedation care have small sample sizes that are inadequate to detect adverse events. This study reports practices and outcomes of sedation delivered to children from infancy up to 14 years of age, that were monitored only by registered nurses (RNs) during diagnostic radiology procedures drawn from a sample of 12,584 cases from the Pediatric Sedation Research Consortium (PSRC) database. There were 727 adverse events (5.78%). However, no deaths, cardiac arrests, intubations or aspirations were reported in this sample. The most common adverse event was inadequate sedation/agitation/delirium 196 (155.8/10,000) and desaturation below baseline for greater than 30 seconds 173 (138/10,000). Further research comparing sedation practices and outcomes by type of providers, including nurses, are necessary to improve practice.
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Cohen SS, Crego N, Cuming RG, Smyth M. The synergy model and the role of clinical nurse specialists in a multihospital system. Am J Crit Care 2002; 11:436-46. [PMID: 12233969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
The role of clinical nurse specialists was formalized in the 1950s; the goal was to prepare inpatient, bedside nurses who would serve acutely ill patients via consultation and direct care. Clinical nurse specialists were to be expert clinicians, consultants, educators, and researchers. In the early stages of practice development, the focus was the specific needs of the assigned unit or floor. Organizational restructuring led to the elimination of many positions for clinical nurse specialists, with a shift of some of the nurses' responsibilities to others (ie, managers) or the abandonment of some of the traditional roles. Recently, a reversal occurred in this trend, evidenced by a steady growth in the demand for these advanced practice nurses by organizations seeking to improve patients' outcomes while remaining fiscally responsible. This demand led to changes in role expectations and expanded the responsibilities of clinical nurse specialists to a system-wide or organization-wide level. Contemporary practice of clinical nurse specialists is not well reflected in traditional role definitions or commonly accepted practice models. The Synergy Model, developed by the AACN Certification Corporation, was introduced as a way of linking certified practice to patients' outcomes. The model describes 8 nurse characteristics and 3 spheres of influence. This article describes how a group of clinical nurse specialists applied the model to successfully change from a unit-based to a multisystem practice.
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Abstract
The role of clinical nurse specialists was formalized in the 1950s; the goal was to prepare inpatient, bedside nurses who would serve acutely ill patients via consultation and direct care. Clinical nurse specialists were to be expert clinicians, consultants, educators, and researchers. In the early stages of practice development, the focus was the specific needs of the assigned unit or floor. Organizational restructuring led to the elimination of many positions for clinical nurse specialists, with a shift of some of the nurses’ responsibilities to others (ie, managers) or the abandonment of some of the traditional roles. Recently, a reversal occurred in this trend, evidenced by a steady growth in the demand for these advanced practice nurses by organizations seeking to improve patients’ outcomes while remaining fiscally responsible. This demand led to changes in role expectations and expanded the responsibilities of clinical nurse specialists to a system-wide or organization-wide level. Contemporary practice of clinical nurse specialists is not well reflected in traditional role definitions or commonly accepted practice models. The Synergy Model, developed by the AACN Certification Corporation, was introduced as a way of linking certified practice to patients’ outcomes. The model describes 8 nurse characteristics and 3 spheres of influence. This article describes how a group of clinical nurse specialists applied the model to successfully change from a unit-based to a multisystem practice.
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Affiliation(s)
| | - Nancy Crego
- North Broward Hospital District, Fort Lauderdale, Fla
| | | | - Melinda Smyth
- North Broward Hospital District, Fort Lauderdale, Fla
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