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Matulis JC, Manning DM. Supporting the Pursuit of Quality Improvement Publication: What Your Organization Can Do Now. Qual Manag Health Care 2023; 32:53-58. [PMID: 35622432 PMCID: PMC9797197 DOI: 10.1097/qmh.0000000000000377] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Many health care organizations encourage frontline staff to pursue quality improvement (QI), local spread of those improvements, and publication of their work. Although much has been written about building and sustaining a culture of continuous QI, less is known about how to support success in QI rigor, credibility, spread, and publication. In this perspective article, we offer QI leaders practical suggestions to identify challenges in publishing QI and strategies to overcome these challenges. Health care organizations can assist QI teams with publication by intentionally formalizing scholarship early in their QI project work, providing accountability, and connecting the QI team to necessary resources. A carefully designed program supporting QI publication can both improve the rigor of QI work and enhance the professional development of QI professionals.
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Affiliation(s)
- John C. Matulis
- Divisions of Community Internal Medicine, Geriatrics and Palliative Care (Dr Matulis) and Hospital Internal Medicine (Dr Manning), Mayo Clinic, Rochester, Minnesota
| | - Dennis M. Manning
- Divisions of Community Internal Medicine, Geriatrics and Palliative Care (Dr Matulis) and Hospital Internal Medicine (Dr Manning), Mayo Clinic, Rochester, Minnesota
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Pagali SR, Miller D, Fischer K, Schroeder D, Egger N, Manning DM, Lapid MI, Pignolo RJ, Burton MC. Predicting Delirium Risk Using an Automated Mayo Delirium Prediction Tool: Development and Validation of a Risk-Stratification Model. Mayo Clin Proc 2021; 96:1229-1235. [PMID: 33581839 PMCID: PMC8106623 DOI: 10.1016/j.mayocp.2020.08.049] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 05/15/2020] [Revised: 08/09/2020] [Accepted: 08/28/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To develop a delirium risk-prediction tool that is applicable across different clinical patient populations and can predict the risk of delirium at admission to hospital. METHODS This retrospective study included 120,764 patients admitted to Mayo Clinic between January 1, 2012, and December 31, 2017, with age 50 and greater. The study group was randomized into a derivation cohort (n=80,000) and a validation cohort (n=40,764). Different risk factors were extracted and analyzed using least absolute shrinkage and selection operator (LASSO) penalized logistic regression. RESULTS The area under the receiver operating characteristic curve (AUROC) for Mayo Delirium Prediction (MDP) tool using derivation cohort was 0.85 (95% confidence interval [CI], .846 to .855). Using the regression coefficients obtained from the derivation cohort, predicted probability of delirium was calculated for each patient in the validation cohort. For the validation cohort, AUROC was 0.84 (95% CI, .834 to .847). Patients were classified into 1 of the 3 risk groups, based on their predicted probability of delirium: low (≤5%), moderate (6% to 29%), and high (≥30%). In the derivation cohort, observed incidence of delirium was 1.7%, 12.8%, and 44.8% (low, moderate, and high risk, respectively), which is similar to the incidence rates in the validation cohort of 1.9%, 12.7%, and 46.3%. CONCLUSION The Mayo Delirium Prediction tool was developed from a large heterogeneous patient population with good validation results and appears to be a reliable automated tool for delirium risk prediction with hospitalization. Further prospective validation studies are required.
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Affiliation(s)
- Sandeep R Pagali
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN; Division of Geriatric Medicine and Gerontology, Mayo Clinic, Rochester, MN.
| | - Donna Miller
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN; Division of Geriatric Medicine and Gerontology, Mayo Clinic, Rochester, MN
| | - Karen Fischer
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Darrell Schroeder
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Norman Egger
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN; Division of Geriatric Medicine and Gerontology, Mayo Clinic, Rochester, MN
| | - Dennis M Manning
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN; Division of Geriatric Medicine and Gerontology, Mayo Clinic, Rochester, MN
| | - Maria I Lapid
- Division of Geriatric Medicine and Gerontology, Mayo Clinic, Rochester, MN; Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - Robert J Pignolo
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN; Division of Geriatric Medicine and Gerontology, Mayo Clinic, Rochester, MN
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Pagali SR, Miller DM, Manning DM. Predicting When a Patient Would Be "Out of the Furrow"-A Perspective on Delirium Prediction. Mayo Clin Proc 2019; 94:2145-2146. [PMID: 31585588 DOI: 10.1016/j.mayocp.2019.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 08/02/2019] [Indexed: 11/26/2022]
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Daniels PR, Manning DM, Moriarty JP, Bingener-Casey J, Ou NN, O'Meara JG, Roellinger DL, Naessens JM. Improving inpatient warfarin therapy safety using a pharmacist-managed protocol. BMJ Open Qual 2018; 7:e000290. [PMID: 29713691 PMCID: PMC5922568 DOI: 10.1136/bmjoq-2017-000290] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 02/27/2018] [Accepted: 03/24/2018] [Indexed: 12/19/2022] Open
Abstract
Introduction Safe management of warfarin in the inpatient setting can be challenging. At the Mayo Clinic hospitals in Rochester, Minnesota, we set out to improve the safety of warfarin management among surgical and non-surgical inpatients. Methods A multidisciplinary team designed a pharmacist-managed warfarin protocol (PMWP) which designated warfarin dosing to inpatient pharmacists with guidance from computerised dosing algorithms. Ordering this protocol was ultimately designed as an ‘opt out’ practice. The primary improvement measure was frequency of international normalised ratio (INR) greater than 5; secondary measures included adoption rate of the protocol, a counterbalance INR metric (INR <1.7 three days after first inpatient warfarin dose), and complication rates, including bleeding and thrombosis events. An interrupted time series analysis was conducted to compare outcomes. Results Among over 50 000 inpatient warfarin recipients, the PMWP was adopted for the majority of both surgical and non-surgical inpatients during the study period (1 January 2005 to 31 December 2011). The primary improvement measure decreased from 5.6% to 3.4% for medical patients and from 5.2% to 2.4% for surgical patients during the preimplementation and postimplementation periods, respectively. The INR counterbalance measure did not change. Postoperative bleeding decreased from 13.5% to 11.1% among surgical patients, but bleeding was unchanged among medical patients. Conclusion Our PMWP led to achievement of improved INR control for inpatient warfarin recipients and to less near-term bleeding among higher risk, surgical patients.
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Affiliation(s)
- Paul R Daniels
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Dennis M Manning
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - James P Moriarty
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Narith N Ou
- Department of Pharmacy Services, Mayo Clinic, Rochester, Minnesota, USA
| | - John G O'Meara
- Department of Pharmacy Services, Mayo Clinic, Rochester, Minnesota, USA
| | - Daniel L Roellinger
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - James M Naessens
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
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Romero-Brufau S, Whitford D, Whitford KJ, Manning DM, Huddleston JM. Identifying patients at risk of inhospital death or hospice transfer for early goals of care discussions in a US referral center: the HELPS model derived from retrospective data. BMJ Open 2018; 8:e015550. [PMID: 29358415 PMCID: PMC5780692 DOI: 10.1136/bmjopen-2016-015550] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Create a score to identify patients at risk of death or hospice placement who may benefit from goals of care discussion earlier in the hospitalisation. DESIGN Retrospective cohort study to develop a risk index using multivariable logistic regression. SETTING Two tertiary care hospitals in Southeastern Minnesota. PARTICIPANTS 92 879 adult general care admissions (50% male, average age 60 years). PRIMARY AND SECONDARY OUTCOME MEASURES Our outcome measure was an aggregate of inhospital death or discharge to hospice. Predictor variables for the model encompassed comorbidities, nutrition status, functional status, demographics, fall risk, mental status, Charlson Comorbidity Index and acuity of illness on admission. Resuscitation status, race, geographic area of residence and marital status were added as covariates to account for confounding. RESULTS Inhospital mortality and discharge to hospice were rare, with incidences of 1.2% and 0.8%, respectively. The Hospital End-of-Life Prognostic Score (HELPS) demonstrated good discrimination (C-statistic=0.866 in derivation set and 0.834 in validation set). The patients with the highest 5% of scores had an 8% risk of the outcome measure, relative risk 12.9 (10.9-15.4) when compared to the bottom 95%. CONCLUSIONS HELPS is able to identify patients with a high risk of inhospital death or need for hospice at discharge. These patients may benefit from early goals of care discussions.
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Affiliation(s)
| | - Daniel Whitford
- Center for Innovation, Mayo Clinic, Rochester, Minnesota, USA
| | - Kevin J Whitford
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Dennis M Manning
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jeanne M Huddleston
- Center for Innovation, Mayo Clinic, Rochester, Minnesota, USA
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Borreggine KL, Hosker DK, Rummans TA, Manning DM. Psychiatric Manifestations of Hyperammonemic Encephalopathy Following Roux-en-Y Gastric Bypass. Psychosomatics 2017; 59:90-94. [PMID: 28844450 DOI: 10.1016/j.psym.2017.07.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 07/24/2017] [Accepted: 07/24/2017] [Indexed: 12/12/2022]
Affiliation(s)
| | - Daniel K Hosker
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN.
| | - Teresa A Rummans
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN
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Moriarty JP, Daniels PR, Manning DM, O’Meara JG, Ou NN, Berg TM, Haag JD, Roellinger DL, Naessens JM. Going Beyond Administrative Data: Retrospective Evaluation of an Algorithm Using the Electronic Health Record to Help Identify Bleeding Events Among Hospitalized Medical Patients on Warfarin. Am J Med Qual 2016; 32:391-396. [DOI: 10.1177/1062860616660757] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
To reliably assess quality, a standardized electronic approach is needed to identify bleeding events. The study aims were the following: (1) clinically validate an electronic health record–based algorithm for bleeding and (2) assess interrater results to determine validity and reliability. Data were analyzed before and after implementation of a pharmacist-managed warfarin protocol. Bleeding was based on ≥2 of 3 criteria: (1) diagnosis indicating bleeding, (2) lab value decrease suggesting bleeding, and (3) blood product use. All suspected bleeds (234) and a sample (58) not meeting criteria were compared with clinical review. There were 234 bleeding cases identified electronically. Reviewer agreement was 78.2% (κ = 0.565). Algorithm sensitivity was 93.9% and positive predictive value 46.2%. Algorithm identification was least accurate for those with only 2 criteria but good for those with all criteria. This study supports using multiple electronic criteria to identify bleeding events. However, cases having exactly 2 criteria may require manual review for validation.
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Kashiwagi DT, Burton MC, Hakim FA, Manning DM, Klocke DL, Caine NA, Hembre KM, Varkey P. Reflective Practice: A Tool for Readmission Reduction. Am J Med Qual 2015; 31:265-71. [PMID: 25661842 DOI: 10.1177/1062860615571000] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Factors intrinsic to local practice, but not captured by the medical record, contribute to readmissions. Frontline providers familiar with their practice systems can identify these. The objective was to decrease 30-day hospital readmissions. The intervention involved retrospective review by hospitalists of their own patients' readmissions, using reflective practice guided by a chart review tool. Subjects were patients discharged by hospitalists and readmitted to a tertiary care academic medical center. Hospitalists reviewed 193 readmissions of 170 patients. Factors contributing to readmission were grouped under patient characteristics, operational factors, and care transition. After reflection, physicians scheduled earlier follow-up appointments while nurse practitioners and physician assistants improved discharge instructions. Readmissions decreased during the review period, and the decrease sustained for one year after the review period. Hospitalists reflected on and identified local practice factors that contributed to their own patients' 30-day readmissions. Reflective practice may be an effective strategy to decrease hospital readmissions.
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Caraballo PJ, Naessens JM, Klarich MJ, Leutink DJ, Peterson JA, Wagie AE, Manning DM, Qian Q. Decline in ACEI/ARB Prescribing as Heart Failure Core Metrics Improve During Computer-Based Clinical Decision Support. Am J Med Qual 2013; 29:300-7. [PMID: 24249835 DOI: 10.1177/1062860613509265] [Citation(s) in RCA: 3] [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] [Indexed: 11/16/2022]
Abstract
Computer-based clinical decision-support systems are effective interventions to improve compliance with guidelines and quality measures. However, understanding of their long-term impact, including unintended consequences, is limited. The authors assessed the clinical impact of the sequential implementation of 2 such systems to improve the use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEIs/ARBs) in inpatients with heart failure. Compliance with the core measure improved from 91.0% at baseline to 93.6% with the Pharmacy Care (P-Care) Rule and to 96.4% with the Centricity-Blaze (CE-Blaze) Rule. At the same time, prescriptions for ACEIs/ARBs documented in the hospital discharge summary decreased from 83.2% at baseline to 75.8% with the P-Care rule and to 64.1% with the CE-Blaze Rule. The inpatient mortality rate and the 30-day readmission rate did not change significantly. Better documentation of contraindications in the electronic medical record seems to account for the core measure improvement, even as ACEI/ARB therapy has unexpectedly declined.
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Cook DJ, Manning DM, Holland DE, Prinsen SK, Rudzik SD, Roger VL, Deschamps C. Patient Engagement and Reported Outcomes in Surgical Recovery: Effectiveness of an e-Health Platform. J Am Coll Surg 2013; 217:648-55. [DOI: 10.1016/j.jamcollsurg.2013.05.003] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 05/03/2013] [Accepted: 05/03/2013] [Indexed: 11/26/2022]
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Berg TM, O'Meara JG, Ou NN, Daniels PR, Moriarty JP, Bergstrahl EJ, Dierkhising RA, Manning DM. Risk Factors for Excessive Anticoagulation Among Hospitalized Adults Receiving Warfarin Therapy Using a Pharmacist-Managed Dosing Protocol. Pharmacotherapy 2013; 33:1165-74. [DOI: 10.1002/phar.1280] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Tamara M. Berg
- Department of Pharmacy Services; Mayo Clinic; Rochester Minnesota
| | - John G. O'Meara
- Department of Pharmacy Services; Mayo Clinic; Rochester Minnesota
| | - Narith N. Ou
- Department of Pharmacy Services; Mayo Clinic; Rochester Minnesota
| | - Paul R. Daniels
- Division of General Internal Medicine, Department of Medicine; Mayo Clinic; Rochester Minnesota
| | - James P. Moriarty
- Division of Health Care Policy and Research, Department of Health Sciences Research; Mayo Clinic; Rochester Minnesota
| | - Eric J. Bergstrahl
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research; Mayo Clinic; Rochester Minnesota
| | - Ross A. Dierkhising
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research; Mayo Clinic; Rochester Minnesota
| | - Dennis M. Manning
- Division of Hospital Internal Medicine, Department of Medicine; Mayo Clinic; Rochester Minnesota
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Allen CS, Deyle GD, Wilken JM, Gill NW, Baker SM, Rot JA, Cook CE, Beaty S, Kissenberth M, Siffri P, Hawkins R, Cook CE, Hegedus EJ, Ross MD, Cook CE, Beaty S, Kissenberth M, Siffri P, Pill S, Hawkins R, Erhardt JW, Harris KD, Deyle GD, Gill NW, Howes RR, Koch WK, Kramer CD, Kumar SP, Adhikari P, Jeganathan PS, D’Souza SC, Misri ZK, Manning DM, Dedrick GS, Sizer PS, Brismée JM, Matthijs OC, Dedrick GS, Brismée JM, McGalliard MK, James CR, Sizer PS, Ross MD, Childs JD, Middel C, Kujawa J, Brown D, Corrigan M, Parsons N, Schmidt SG, Grant R, Spryopolous P, Dansie D, Taylor J, Wang H, Silvernail JL, Gill NW, Teyhen DS, Allison SC, Sueki DG, Almaria SM, Bender MA, Kamara M, Magpali A, Mancilla A, McConnell BJ, Montoya RC, Murphy AW, Romero ML, Viti JA, Rot JA, Augustsson H, Werstine RJ, Birmingham T, Jenkyn T, Yung EY, Tonley JC. AAOMPT platform presentations selection. J Man Manip Ther 2011; 19:239-46. [DOI: 10.1179/106698111x12998437860712] [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: 10/31/2022] Open
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Qian Q, Manning DM, Ou N, Klarich MJ, Leutink DJ, Loth AR, Lopez-Jimenez F. ACEi/ARB for systolic heart failure: closing the quality gap with a sustainable intervention at an academic medical center. J Hosp Med 2011; 6:156-60. [PMID: 20652962 DOI: 10.1002/jhm.803] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [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] [Indexed: 11/08/2022]
Abstract
BACKGROUND National guidelines recommend angiotensin converting enzyme inhibitor (ACEi) or angiotensinogen receptor blocker (ARB) therapy for patients with left ventricular systolic dysfunction (LVSD), including those with symptomatic heart failure (HF). However, guideline adherence has not been optimal. The goal of this quality improvement project is to devise and implement a sustainable care-delivery model in a 920-bed academic hospital center that would improve ACEi/ARB adherence before hospital discharge. METHODS The Model of intervention is: (1) a computer-based daily screening program; (2) inpatient pharmacist e-flag message; and (3) alerts for inpatient care teams. Its operating algorithm: If eligible adult HF/LVSD inpatients are not on ACEi or ARB nor documentation of contraindications, a flag alert is generated; deficiency is confirmed by a pharmacist and conveyed to the patient-care teams; if alert is acted on and care brought into adherence, the screening program would not re-flag the same patients the succeeding day; if not, the patients would be re-flagged daily until reaching adherence. We compared ACEi/ARB adherence before, during, and after the intervention. RESULTS Baseline performance (percentage of eligible HF/LVSD patients receiving ACEi/ARB) was 87.5%. After implementation of the Model the ACEi/ARB adherence rate at the time of hospital discharge rose to 96.7% (P < 0.002) and was sustained for 21 months without needing additional personnel. CONCLUSIONS A carefully designed, computer-based care-delivery model is highly efficient and sustainable for enhancing ACEi/ARB adherence.
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Affiliation(s)
- Qi Qian
- Department of Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
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Manning DM. Respiratory rate and diagnosis of pleural effusion. JAMA 2009; 301:1989; author reply 1989-90. [PMID: 19454635 DOI: 10.1001/jama.2009.653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Abstract
Hospitalists are often confronted with discharge planning responsibility and decisions for elderly patients who live alone. The absence of an in-home helper (spouse, partner, or care-giver) reduces the margin of safety and resilience to any new debility. Research has documented that during hospital stays elderly patients tend to become deconditioned, even if there is no new specific neurologic or motor deficit. In the patient whose pre-hospital mobility independence is not robust, and perhaps marginally compensated, inpatient stays for any diagnosis may result in critical decrements in mobility independence. The present study is an effort to design a bedside tool for the hospitalist by which to discern, or screen, for such debility. The tool is a hierarchical performance test we named I-MOVE (Independent Mobility Validation Examination). It is a quick series of bedside mobility requests to demonstrate capability of fundamental movements critical to independent living. We describe manner in which I-MOVE can be performed. Moreover, we describe the face validity and the high interrater reliability (> 0.90 intra-class correlation coefficient) of two RNs who independently administered and scored I-MOVE for 41 patients on a General Medical Care Unit. Although not yet studied in correlation with outcomes, nor with validated mobility assessment tools, we believe I-MOVE can serve as a useful extension of the nurse's assessment, or the Hospitalist's physical examination. Discerning the continued capability of mobility independence is a desirable, on-going insight for discharge planning of the elderly patient who resides alone.
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Affiliation(s)
- Dennis M Manning
- Department of Medicine, Mercy Hospital of Pittsburgh, Pittsburgh, PA, USA.
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Abstract
BACKGROUND At the time of transition from hospital to home, many patients are challenged by multi-drug regimens. The authors' standard patient education tool is a personalised Medication Discharge Worksheet (MDW) that includes a list of medications and administration times. Nonetheless, patient understanding, satisfaction, and safety remain suboptimal. Therefore, the authors designed a new tool: Durable Display at Discharge (3D). Unlike MDW, 3D features (1) space in which a tablet or pill is to be affixed and displayed, (2) trade name (if apt), (3) unit strength, (4) number (and/or fraction) of units to be taken, (5) purpose (indication), (6) comment/caution, (7) larger font, (8) card stock durability and (9) a reconciliation feature. METHODS The authors conducted an exploratory, randomised trial (n = 138) to determine whether 3D, relative to MDW, improves patient satisfaction, improves patient understanding and reduces self-reported medication errors. Trained survey research personnel, blinded to hypotheses, interviewed patients by telephone 7-14 days after discharge. RESULTS Both tools were similarly associated with high satisfaction and few self-reported errors. However, 3D subjects demonstrated greater understanding of their medications. CONCLUSIONS Although both tools are associated with similarly high levels of patient satisfaction and low rates of self-reported medication error, 3D appears to promote patient understanding of the medications, and warrants further study.
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Affiliation(s)
- Dennis M Manning
- Department of Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
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Manning DM, Tammel KJ, Blegen RN, Larson LA, Steffens FL, Rosenman DJ, Mundell WC, Naessens JM, Resar RK, Huddleston JM. In-room display of day and time patient is anticipated to leave hospital: a "discharge appointment". J Hosp Med 2007; 2:13-6. [PMID: 17274043 DOI: 10.1002/jhm.146] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [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] [Indexed: 11/07/2022]
Abstract
BACKGROUND We learned from a focus group that many patients find discharge to be one of the least satisfying elements of the hospital experience. Patients cited insufficient communication about the day and time of the impending discharge as a cause of dissatisfaction. OBJECTIVE In partnership with the Institute for Healthcare Improvement, Improvement Action Network collaborative, we tested the practicality of an in-room "discharge appointment" (DA) display. SETTING AND PATIENTS Eight inpatient care units in 2 hospitals at an academic medical center (Mayo Clinic, Rochester, MN). INTERVENTION DA displayed on a specially designed bedside dry-erase board. MEASUREMENTS The primary outcome was the proportion of discharged patients who had been given a DA, including same-day DAs. Secondary outcomes were (1) the proportion of DAs scheduled before the actual dismissal day and (2) the timeliness of the actual departure compared with the DA. RESULTS During the 4-month period, 2046 patients were discharged. Of those, 1256 patients (61%) were given a posted DA, of which 576 (46%) were scheduled at least a day in advance and 752 (60%) departed from the care unit within 30 minutes of the appointed time. CONCLUSIONS With a program for in-room display of a DA in various hospital units, more than half the patients had a DA set, and most of the DA patients departed on time. Further investigation is needed to determine the effect of DAs on patient and provider satisfaction.
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Affiliation(s)
- Dennis M Manning
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
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Abstract
OBJECTIVES To determine whether the level of presence of faculty in the afternoon or evening influences residents' perception of learning, "autonomy," or satisfaction, and if so whether the effect is positive or negative. SUBJECTS AND METHODS A survey of internal medicine residents was conducted from January 1 through June 30, 1999. Primary outcome was residents' satisfaction and its relationship to the degree of (resident-observed) faculty presence. RESULTS A total of 156 (86.7%) of the 180 surveys distributed were returned. Residents rated the individual faculty members' frequency of afternoon or evening presence as "most/all of the time" (47%), "occasionally" (32%), or "never/rarely" (21%). Increased faculty presence was positively associated with higher resident "satisfaction with faculty" (P < .001), "educational value of time spent with the faculty member" (P = .001), "team dynamics" (P = .002), "(quality of) overall medical care provided" (P = .03), and "sufficient autonomy" (P = .04). Residents were less likely to report concerns (difficulties) with teaching (P < .001) and efficiency (P = .008) of faculty whose level of presence was increased. CONCLUSION Contrary to some concerns expressed, increased faculty presence is associated with higher resident satisfaction and a more favorable learning experience.
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Affiliation(s)
- Michael P Phy
- Inpatient Internal Medicine Program, Mayo Clinic College of Medicine, Rochester, Minn 55905, USA
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Affiliation(s)
- P J Olmesdahl
- Medical Educational Development, Medical School, Private Bag 7, Congella 4013, South Africa
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Manning DM. Thrombolysis for acute transmural myocardial infarction. Ann Intern Med 1987; 107:120-1. [PMID: 3296897 DOI: 10.7326/0003-4819-107-1-120_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
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Manning DM. Early repair of mechanical complications after acute myocardial infarction. JAMA 1986; 256:2816. [PMID: 3773191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Abstract
For the accurate indirect measurement of blood pressure (BP), the American Heart Association (AHA) now recommends that cuff size should be based solely on limb circumference. We studied prevailing cuffing habits and compared them with newly revised AHA guidelines. Monitoring our staff's cuff applications, we found that "miscuffing" occurred in 65 (32%) of 200 BP determinations on 167 unselected adult outpatients, including 61 (72%) of 85 readings taken on "nonstandard" size arms. Undercuffing large arms was the most frequent error, accounting for 84% of the miscuffings. Considering that miscuffing distorts BP readings by an average of 8.5 mm Hg systolic and 4.6 mm Hg diastolic, we can improve the accuracy of our BP determinations by remarking our cuffs and using the new AHA guidelines.
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Abstract
A patient with chronic myelogenous leukemia, treated for two years with busulfan, presented with increasing dyspnea of several months' duration. Despite a normal chest radiograph, there was a markedly reduced carbon monoxide (CO) diffusing capacity (41% of predicted normal) and a restrictive ventilatory pattern on pulmonary function testing. Gallium-67 scanning revealed diffuse uptake in both lungs. The busulfan was discontinued and therapy was changed to hydroxyurea. Three months later the patient was without symptoms, the CO diffusing capacity had risen to 64% (of predicted), and the Ga-67 scan had returned to normal. The chest radiograph remained normal. Despite the lack of biopsy proof, we believe Ga-67 scanning was an aid in the early detection of cytotoxic-induced lung disease in a reversible stage. Gallium-67 scanning may be useful in the early deagnosis of pulmonary injury from cytotoxic agents.
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Manning DM, Luparello FJ, Arena VC. Herpes zoster after splenectomy. A study of patients without malignancy. JAMA 1980; 243:56-8. [PMID: 6965312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Follow-up information was obtained on 102 unselected patients who had undergone splenectomy for nonmalignant disease (ie, trauma, surgical complications, and hematologic indications). In 422 postsplenectomy years, three cases of herpes zoster were observed, two of which were associated with generalized cutaneous dissemination. This incidence is no greater than that reported elsewhere for age-matched normal population. We conclude that in patients without malignancy, splenectomy does not predispose to herpes zoster, but may play a role in cutaneous dissemination.
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Cooper E, Manning DM, MacLennan AH, Burke CW. Thyroid hormones in human amniotic fluid: detection of tri-iodothyronine and free levels of thyroxine, tri-iodothyronine and 3,3',5'-tri-iodothyronine [proceedings]. J Endocrinol 1977; 73:44P. [PMID: 874398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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