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Borna S, Maniaci MJ, Haider CR, Gomez-Cabello CA, Pressman SM, Haider SA, Demaerschalk BM, Cowart JB, Forte AJ. Artificial Intelligence Support for Informal Patient Caregivers: A Systematic Review. Bioengineering (Basel) 2024; 11:483. [PMID: 38790350 DOI: 10.3390/bioengineering11050483] [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: 04/03/2024] [Revised: 05/05/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024] Open
Abstract
This study aims to explore how artificial intelligence can help ease the burden on caregivers, filling a gap in current research and healthcare practices due to the growing challenge of an aging population and increased reliance on informal caregivers. We conducted a search with Google Scholar, PubMed, Scopus, IEEE Xplore, and Web of Science, focusing on AI and caregiving. Our inclusion criteria were studies where AI supports informal caregivers, excluding those solely for data collection. Adhering to PRISMA 2020 guidelines, we eliminated duplicates and screened for relevance. From 947 initially identified articles, 10 met our criteria, focusing on AI's role in aiding informal caregivers. These studies, conducted between 2012 and 2023, were globally distributed, with 80% employing machine learning. Validation methods varied, with Hold-Out being the most frequent. Metrics across studies revealed accuracies ranging from 71.60% to 99.33%. Specific methods, like SCUT in conjunction with NNs and LibSVM, showcased accuracy between 93.42% and 95.36% as well as F-measures spanning 93.30% to 95.41%. AUC values indicated model performance variability, ranging from 0.50 to 0.85 in select models. Our review highlights AI's role in aiding informal caregivers, showing promising results despite different approaches. AI tools provide smart, adaptive support, improving caregivers' effectiveness and well-being.
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Affiliation(s)
- Sahar Borna
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA
| | - Michael J Maniaci
- Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Clifton R Haider
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN 55905, USA
| | - Cesar A Gomez-Cabello
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA
| | - Sophia M Pressman
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA
| | - Syed Ali Haider
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA
| | - Bart M Demaerschalk
- Department of Neurology, Mayo Clinic College of Medicine and Science, Phoenix, AZ 85054, USA
- Center for Digital Health, Mayo Clinic, Rochester, MN 55905, USA
| | - Jennifer B Cowart
- Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Antonio Jorge Forte
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA
- Center for Digital Health, Mayo Clinic, Rochester, MN 55905, USA
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Webster LW, Cox MD, Fazio JR, Felix HM, Greenwell HR, Botella RM, Maniaci MJ, Grek AA. Bypassing the Brick-and-Mortar Hospital: Increasing Direct Admissions from the Emergency Department to Inpatient Hospital-at-Home. Am J Med Qual 2024; 39:99-104. [PMID: 38683730 DOI: 10.1097/jmq.0000000000000186] [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] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
Home hospital programs continue to grow across the United States. There are limited studies around the process of patient selection and successful acquisition from the emergency department. The article describes how an interdisciplinary team used quality improvement methodology to significantly increase the number of admissions directly from the emergency department to the Advanced Care at Home program.
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Affiliation(s)
| | - Matt D Cox
- Quality Academy, Mayo Clinic, Rochester, MN
| | - Jacey R Fazio
- Department of Administration, Mayo Clinic, Jacksonville, FL
- Mayo Clinic College of Medicine and Science, Rochester, MNa
| | - Heidi M Felix
- Mayo Clinic College of Medicine and Science, Rochester, MNa
- Division of Community Internal Medicine, Mayo Clinic, Jacksonville, FL
| | | | - Rachel M Botella
- Mayo Clinic College of Medicine and Science, Rochester, MNa
- Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, FL
| | - Michael J Maniaci
- Mayo Clinic College of Medicine and Science, Rochester, MNa
- Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, FL
| | - Ami A Grek
- Department of Administration, Mayo Clinic, Jacksonville, FL
- Mayo Clinic College of Medicine and Science, Rochester, MNa
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Maniaci MJ, Torres-Guzman RA, Avila FR, Maita K, Garcia JP, Forte AJ, Rutledge R, Dugani SB, Campbell SM, Pritchard IJ, Paulson MR. Development and evaluation of best practice advisory alert for patient eligibility in a hospital-at-home program: A multicenter retrospective study. J Hosp Med 2024; 19:165-174. [PMID: 38243666 PMCID: PMC10923137 DOI: 10.1002/jhm.13275] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 12/09/2023] [Accepted: 12/22/2023] [Indexed: 01/21/2024]
Abstract
BACKGROUND Hospital-at-home (HaH) is a growing model of care that has been shown to improve patient outcomes, satisfaction, and cost-effectiveness. However, selecting appropriate patients for HaH is challenging, often requiring burdensome manual screening by clinicians. To facilitate HaH enrollment, electronic health record (EHR) tools such as best practice advisories (BPAs) can be used to alert providers of potential HaH candidates. OBJECTIVE To describe the development and implementation of a BPA for identifying HaH eligible patients in Mayo Clinic's Advanced Care at Home (ACH) program, and to evaluate the provider response and the patient characteristics that triggered the BPA. DESIGN, SETTING, AND PARTICIPANTS We conducted a retrospective multicenter study of hospitalized patients who triggered the BPA notification for ACH eligibility between March and December 2021 at Mayo Clinic in Jacksonville, FL and Mayo Clinic Health System in Eau Claire, WI. We extracted demographic and diagnosis data from the patients as well as characteristics of the providers who received the BPA notification. INTERVENTION The BPA was developed based on the ACH inclusion and exclusion criteria, which were derived from clinical guidelines, literature review, and expert consensus. The BPA was integrated into the EHR and displayed a pop-up message to the provider when a patient met the criteria for ACH eligibility. The provider could choose to refer the patient to ACH, dismiss the notification, or defer the decision. MAIN OUTCOMES AND MEASURES The main outcomes were the number and proportion of BPA notifications that resulted in a referral to ACH, and the number and proportion of referrals that were accepted by the ACH clinical team and transferred to ACH. We also analyzed the factors associated with the provider's decision to refer or not refer the patient to ACH, such as the provider's role, location, and specialty. RESULTS During the study period, 8962 notifications were triggered for 2847 patients. Providers opted to refer 711 (11.4%) of the total notifications linked to 324 unique patients. After review by the ACH clinical team, 31 of the 324 referrals (9.6%) met clinical and social criteria and were transferred to ACH. In multivariable analysis, Wisconsin nurses, physician assistants, and in-training personnel had lower odds of referring the patients to ACH when compared to attending physicians.
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Affiliation(s)
- Michael J. Maniaci
- Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | | | | | - Karla Maita
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - John P. Garcia
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Antonio J. Forte
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Rachel Rutledge
- Administrative Operations, Mayo Clinic, Jacksonville, Florida, USA
| | - Sagar B. Dugani
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Division of Health Care Delivery Research, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Shannon M. Campbell
- Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Ingrid J. Pritchard
- Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Margaret R. Paulson
- Division of Hospital Internal Medicine, Mayo Clinic Health Systems, Eau Claire, Wisconsin, USA
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Serrano LP, Maita KC, Avila FR, Torres-Guzman RA, Garcia JP, Eldaly AS, Haider CR, Felton CL, Paulson MR, Maniaci MJ, Forte AJ. Benefits and Challenges of Remote Patient Monitoring as Perceived by Health Care Practitioners: A Systematic Review. Perm J 2023; 27:100-111. [PMID: 37735970 PMCID: PMC10730976 DOI: 10.7812/tpp/23.022] [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] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
BACKGROUND Remote patient monitoring (RPM), or telemonitoring, offers ways for health care practitioners to gather real-time information on the physiological conditions of patients. As telemedicine, and thus telemonitoring, is becoming increasingly relevant in today's society, understanding the practitioners' opinions is crucial. This systematic review evaluates the perspectives and experiences of health care practitioners with telemonitoring technologies. METHODS A database search was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for the selection of articles measuring health care practitioners' perspectives and experiences with RPM technologies published between 2017 and 2021. Only articles written in English were included. No statistical analysis was performed and thus this is a qualitative review. RESULTS A total of 1605 studies were identified after the initial search. After applying the inclusion and exclusion criteria of this review's authors, 13 articles were included in this review. In all, 2351 practitioners' perspectives and experience utilizing RPM technology in a variety of medical specialties were evaluated through close- and open-ended surveys. Recurring themes emerged for both the benefits and challenges. Common benefits included continuous monitoring of patients to provide prompt care, improvement of patient self-care, efficient communication, increased patient confidence, visualization of health trends, and greater patient education. Challenges comprised increased workload, higher patient anxiety, data inaccuracy, disorienting technology, financial issues, and privacy concerns. CONCLUSION Health care practitioners generally believe that RPM is feasible for application. Additionally, there is a consensus that telemonitoring strategies will become increasingly relevant. However, there are still drawbacks to the technology that need to be considered.
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Affiliation(s)
| | - Karla C Maita
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | | | | | - John P Garcia
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | | | - Clifton R Haider
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | - Christopher L Felton
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | - Margaret R Paulson
- Division of Hospital Internal Medicine, Mayo Clinic Health Systems, Eau Claire, WI, USA
| | - Michael J Maniaci
- Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Antonio J Forte
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL, USA
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Chadha RM, Paulson MR, Avila FR, Torres-Guzman RA, Maita KC, Garcia JP, Forte AJ, Matcha GV, Pagan RJ, Maniaci MJ. The ASA Classification System as a Predictive Factor to Stay at the Virtual Hybrid Care Hotel. Am Surg 2023; 89:4707-4714. [PMID: 36154300 DOI: 10.1177/00031348221129524] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
INTRODUCTION The Care Hotel is a virtual hybrid care model for postoperative patients after low-risk procedures which allow recovery in an outpatient environment. This study aimed to analyze if the American Society of Anesthesiologists Physical Status (ASA PS) Classification System can be used as a predictive factor for staying at Mayo Clinic's Care Hotel. METHODS This retrospective cohort study was conducted between July 23, 2020, and June 4, 2021, at Mayo Clinic in Florida, a 306-bed community academic hospital. ASA PS Class and post-procedure care setting (Care Hotel vs inpatient ward) were collected. Patients were classified into two ASA PS groups (ASA PS Classes 1-2 and 3-4). Pearson's Chi-square test was used to determine if the ASA PS Class and having stayed or not at the Care Hotel were independent and an Odds Ratio (OR) calculated. RESULTS Out of 392 surgical and procedural patients, 272 (69.39%) chose the Care Hotel and 120 (30.61%) chose the inpatient ward. There was a statistically significant association between ASA PS Class and staying at the Care Hotel, P < .01. The OR of preferring to stay at the Care Hotel in patients with ASA PS Class 1-2 vs ASA PC Class 3-4 was 1.91 (P = .0041, 95% CI: 1.229-2.982). CONCLUSION Patients with ASA PS Classes 1-2 are almost twice as likely to elect to stay at the Care Hotel compared to those with ASA PS Classes 3-4. This finding may help care teams focus their Care hotel recruitment efforts.
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Affiliation(s)
- Ryan M Chadha
- Department of Anesthesiology, Mayo Clinic, Jacksonville, FL, USA
| | - Margaret R Paulson
- Division of Hospital Internal Medicine, Mayo Clinic Health Systems, Eau Claire, WI, USA
| | | | | | - Karla C Maita
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - John P Garcia
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Antonio J Forte
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL, USA
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Gautam V Matcha
- Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Ricardo J Pagan
- Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Michael J Maniaci
- Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
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Dugani SB, Fischer KM, Schroeder DR, Geyer HL, Maniaci MJ, Paulson M, Croghan IT, Burton MC. Global well-being, anxiety, social isolation, and emotional support among hospitalists during COVID-19 and Mpox outbreaks. Hosp Pract (1995) 2023; 51:211-218. [PMID: 37491767 PMCID: PMC10775116 DOI: 10.1080/21548331.2023.2241342] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 07/17/2023] [Indexed: 07/27/2023]
Abstract
OBJECTIVE The Coronavirus Disease-19 (COVID-19) pandemic caused a decline in hospitalist wellness. The COVID-19 pandemic has evolved, and new outbreaks (i.e. Mpox) have challenged healthcare systems. The objective of the study was to assess changes in hospitalist wellness and guide interventions. METHODS We surveyed hospitalists (physicians and advanced practice providers [APPs]), in May 2021 and September 2022, at a healthcare system's 16 hospitals in four US states using PROMIS® measures for global well-being, anxiety, social isolation, and emotional support. We compared wellness score between survey periods; in the September 2022 survey, we compared wellness scores between APPs and physicians and evaluated the associations of demographic and hospital characteristics with wellness using logistic (global well-being) and linear (anxiety, social isolation, emotional support) regression models. RESULTS In May 2021 vs. September 2022, respondents showed no statistical difference in top global well-being for mental health (68.4% vs. 57.4%) and social activities and relationships (43.8% vs. 44.3%), anxiety (mean difference: +0.8), social isolation (mean difference: +0.5), and emotional support (mean difference: -1.0) (all, p ≥ 0.05). In September 2022, in logistic regression models, APPs, compared with physicians, had lower odds for top (excellent or very good) global well-being mental health (odds ratio [95% CI], 0.31 [0.13-0.76]; p < 0.05). In linear regression models, age <40 vs. ≥40 years was associated with higher anxiety (estimate ± standard error, 2.43 ± 1.05; p < 0.05), and concern about contracting COVID-19 at work was associated with higher anxiety (3.74 ± 1.10; p < 0.01) and social isolation (3.82 ± 1.21; p < 0.01). None of the characteristics showed association with change in emotional support. In September 2022, there was low concern for contracting Mpox in the community (4.6%) or at work (10.0%). CONCLUSION In hospitalists, concern about contracting COVID-19 at work was associated with higher anxiety and social isolation. The unchanged wellness scores between survey periods identified opportunities for intervention. Mpox had apparently minor impact on wellness.
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Affiliation(s)
- Sagar B. Dugani
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN, USA
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Karen M. Fischer
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | | | - Holly L. Geyer
- Division of Hospital Internal Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | - Michael J. Maniaci
- Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Margaret Paulson
- Division of Hospital Internal Medicine, Mayo Clinic Health System, Eau Claire, Wisconsin, USA
| | - Ivana T. Croghan
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
- Department of Medicine, Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
- Department of Medicine, Research Hub, Mayo Clinic, Rochester, MN, USA
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Borna S, Maniaci MJ, Haider CR, Maita KC, Torres-Guzman RA, Avila FR, Lunde JJ, Coffey JD, Demaerschalk BM, Forte AJ. Artificial Intelligence Models in Health Information Exchange: A Systematic Review of Clinical Implications. Healthcare (Basel) 2023; 11:2584. [PMID: 37761781 PMCID: PMC10531020 DOI: 10.3390/healthcare11182584] [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: 08/07/2023] [Revised: 09/14/2023] [Accepted: 09/16/2023] [Indexed: 09/29/2023] Open
Abstract
Electronic health record (EHR) systems collate patient data, and the integration and standardization of documents through Health Information Exchange (HIE) play a pivotal role in refining patient management. Although the clinical implications of AI in EHR systems have been extensively analyzed, its application in HIE as a crucial source of patient data is less explored. Addressing this gap, our systematic review delves into utilizing AI models in HIE, gauging their predictive prowess and potential limitations. Employing databases such as Scopus, CINAHL, Google Scholar, PubMed/Medline, and Web of Science and adhering to the PRISMA guidelines, we unearthed 1021 publications. Of these, 11 were shortlisted for the final analysis. A noticeable preference for machine learning models in prognosticating clinical results, notably in oncology and cardiac failures, was evident. The metrics displayed AUC values ranging between 61% and 99.91%. Sensitivity metrics spanned from 12% to 96.50%, specificity from 76.30% to 98.80%, positive predictive values varied from 83.70% to 94.10%, and negative predictive values between 94.10% and 99.10%. Despite variations in specific metrics, AI models drawing on HIE data unfailingly showcased commendable predictive proficiency in clinical verdicts, emphasizing the transformative potential of melding AI with HIE. However, variations in sensitivity highlight underlying challenges. As healthcare's path becomes more enmeshed with AI, a well-rounded, enlightened approach is pivotal to guarantee the delivery of trustworthy and effective AI-augmented healthcare solutions.
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Affiliation(s)
- Sahar Borna
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Michael J. Maniaci
- Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Clifton R. Haider
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN 55902, USA
| | - Karla C. Maita
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL 32224, USA
| | | | | | | | - Jordan D. Coffey
- Center for Digital Health, Mayo Clinic, Rochester, MN 55902, USA
| | - Bart M. Demaerschalk
- Center for Digital Health, Mayo Clinic, Rochester, MN 55902, USA
- Department of Neurology, Mayo Clinic College of Medicine and Science, Phoenix, AZ 85054, USA
| | - Antonio J. Forte
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL 32224, USA
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Paulson N, Paulson MP, Maniaci MJ, Rutledge RA, Inselman S, Zawada SJ. Why U.S. Patients Declined Hospital-at-Home during the COVID-19 Public Health Emergency: An Exploratory Mixed Methods Study. J Patient Exp 2023; 10:23743735231189354. [PMID: 37560532 PMCID: PMC10408328 DOI: 10.1177/23743735231189354] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023] Open
Abstract
To understand why US patients refused participation in hospital-at-home (H@H) during the coronavirus disease 2019 Public Health Emergency, eligible adult patients seen at 2 Mayo Clinic sites, Mayo Clinic Health System-Northwest Wisconsin region (NWWI) and Mayo Clinic Florida (MCF), from August 2021 through March 2022, were invited to participate in a convergent-parallel study. Quantitative associations between H@H participation status and patient baseline data at hospital admission were investigated. H@H patients were more likely to have a Mayo Clinic patient portal at baseline (P-value: .014), indicating a familiarity with telehealth. Patients who refused were more likely to be from NWWI (P-value < .001) and have a higher Epic Deterioration Index score (P-value: .004). The groups also had different quarters (in terms of fiscal calendar) of admission (P-value: .040). Analyzing qualitative interviews (n = 13) about refusal reasons, 2 themes portraying the quantitative associations emerged: lack of clarity about H@H and perceived domestic challenges. To improve access to H@H and increase patient recruitment, improved education about the dynamics of H@H, for both hospital staff and patients, and inclusive strategies for navigating domestic barriers and diagnostic challenges are needed.
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Affiliation(s)
- Nels Paulson
- University of Wisconsin, Stout Department of Sociology, Menomonie, WI, USA
| | - Margaret P. Paulson
- Mayo Clinic Health System, Northwest Wisconsin Advanced Care at Home & Home Health, Menomonie, WI, USA
| | | | | | - Shealeigh Inselman
- Mayo Clinic Robert D and Patricia E Kern Center or the Science of Health Care Delivery, Rochester, MN, USA
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Haddad TC, Maita KC, Inselman JW, Avila FR, Torres-Guzman RA, Coffey JD, Christopherson LA, Leuenberger AM, Bell SJ, Pahl DF, Garcia JP, Manka L, Forte AJ, Maniaci MJ. Patient Satisfaction With a Multisite, Multiregional Remote Patient Monitoring Program for Acute and Chronic Condition Management: Survey-Based Analysis. J Med Internet Res 2023; 25:e44528. [PMID: 37343182 PMCID: PMC10415939 DOI: 10.2196/44528] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 06/13/2023] [Accepted: 06/21/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND Remote patient monitoring (RPM) is an option for continuously managing the care of patients in the comfort of their homes or locations outside hospitals and clinics. Patient engagement with RPM programs is essential for achieving successful outcomes and high quality of care. When relying on technology to facilitate monitoring and shifting disease management to the home environment, it is important to understand the patients' experiences to enable quality improvement. OBJECTIVE This study aimed to describe patients' experiences and overall satisfaction with an RPM program for acute and chronic conditions in a multisite, multiregional health care system. METHODS Between January 1, 2021, and August 31, 2022, a patient experience survey was delivered via email to all patients enrolled in the RPM program. The survey encompassed 19 questions across 4 categories regarding comfort, equipment, communication, and overall experience, as well as 2 open-ended questions. Descriptive analysis of the survey response data was performed using frequency distribution and percentages. RESULTS Surveys were sent to 8535 patients. The survey response rate was 37.16% (3172/8535) and the completion rate was 95.23% (3172/3331). Survey results indicated that 88.97% (2783/3128) of participants agreed or strongly agreed that the program helped them feel comfortable managing their health from home. Furthermore, 93.58% (2873/3070) were satisfied with the RPM program and ready to graduate when meeting the program goals. In addition, patient confidence in this model of care was confirmed by 92.76% (2846/3068) of the participants who would recommend RPM to people with similar conditions. There were no differences in ease of technology use according to age. Those with high school or less education were more likely to agree that the equipment and educational materials helped them feel more informed about their care plans than those with higher education levels. CONCLUSIONS This multisite, multiregional RPM program has become a reliable health care delivery model for the management of acute and chronic conditions outside hospitals and clinics. Program participants reported an excellent overall experience and a high level of satisfaction in managing their health from the comfort of their home environment.
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Affiliation(s)
- Tufia C Haddad
- Center For Digital Health, Mayo Clinic in Minnesota, Rochester, MN, United States
| | - Karla C Maita
- Division of Hospital Internal Medicine, Mayo Clinic in Florida, Jacksonville, FL, United States
| | - Jonathan W Inselman
- Center For Digital Health, Mayo Clinic in Minnesota, Rochester, MN, United States
| | - Francisco R Avila
- Division of Hospital Internal Medicine, Mayo Clinic in Florida, Jacksonville, FL, United States
| | - Ricardo A Torres-Guzman
- Division of Hospital Internal Medicine, Mayo Clinic in Florida, Jacksonville, FL, United States
| | - Jordan D Coffey
- Center For Digital Health, Mayo Clinic in Minnesota, Rochester, MN, United States
| | | | - Angela M Leuenberger
- Center For Digital Health, Mayo Clinic in Minnesota, Rochester, MN, United States
| | - Sarah J Bell
- Center For Digital Health, Mayo Clinic in Minnesota, Rochester, MN, United States
| | - Dominick F Pahl
- Center For Digital Health, Mayo Clinic in Minnesota, Rochester, MN, United States
| | - John P Garcia
- Division of Hospital Internal Medicine, Mayo Clinic in Florida, Jacksonville, FL, United States
| | - Lukas Manka
- Center For Digital Health, Mayo Clinic in Minnesota, Rochester, MN, United States
| | - Antonio J Forte
- Division of Hospital Internal Medicine, Mayo Clinic in Florida, Jacksonville, FL, United States
| | - Michael J Maniaci
- Division of Hospital Internal Medicine, Mayo Clinic in Florida, Jacksonville, FL, United States
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10
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Maniaci MJ, Chadha RM, Fazio JR, Maita KC, Love EA, Boyle VL, Heckman MG, Johnson PW, Paulson MR, Forte AJ. Surgical service and distance traveled drive patient preference for Care Hotel: a retrospective cohort study. Ann Med Surg (Lond) 2023; 85:1578-1583. [PMID: 37229076 PMCID: PMC10205284 DOI: 10.1097/ms9.0000000000000704] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 04/06/2023] [Indexed: 05/27/2023] Open
Abstract
Mayo Clinic's Care Hotel is a virtual hybrid care model which allows postoperative patients to recover in a comfortable environment after a low-risk procedure. Hospitals need to understand the key patient factors that promote acceptance of the Care Hotel if they are to benefit from this innovative care model. This study aims to identify factors that can predict whether a patient will stay at Care Hotel. Materials and methods This retrospective chart review of 1065 patients was conducted between 23 July 2020, and 31 December 2021. Variables examined included patient age, sex, race, ethnicity, Charlson comorbidity index, distance patient travelled to hospital, length of surgery, day of the week of surgery, and surgical service. Associations of patient and surgery characteristics with the primary outcome of staying at the Care Hotel were assessed using unadjusted and multivariable logistic regression models. Results Of the 1065 patients who met criteria for admission to the Care Hotel during the study period, 717 (67.3%) chose to stay at the Care Hotel while 328 (32.7%) choose to be admitted to the hospital. In multivariable analysis, there was a significant association between surgical service and staying at the Care Hotel (P<0.001). Specifically, there was a higher likelihood of staying at the Care Hotel for patients from Neurosurgery [odds rato (OR)=1.86, P=0.004], Otorhinolaryngology (OR=2.70, P<0.001), and General Surgery (OR=2.75, P=0.002). Additionally, there was a higher likelihood of staying at the Care Hotel with distance travelled over 110 miles [OR (per each doubling)=1.10, P=0.007]. Conclusion When developing a post-surgical care model for patients following outpatient procedures, the referring surgical service is a primary factor to consider in order to ensure patient acceptance, along with patient distance. This study can assist other healthcare organizations considering this model, as it provides guidance on which factors are most indicative of acceptance.
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Affiliation(s)
| | | | | | | | | | | | - Michael G. Heckman
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Jacksonville, FL
| | - Patrick W. Johnson
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Jacksonville, FL
| | - Margaret R. Paulson
- Division of Hospital Internal Medicine, Mayo Clinic Health Systems, Eau Claire, Wisconsin
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11
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Zawada SK, Sweat J, Paulson MR, Maniaci MJ. Staff Successes and Challenges with Telecommunications-Facilitated Patient Care in Hybrid Hospital-at-Home during the COVID-19 Pandemic. Healthcare (Basel) 2023; 11:healthcare11091223. [PMID: 37174766 PMCID: PMC10178711 DOI: 10.3390/healthcare11091223] [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: 03/01/2023] [Revised: 04/15/2023] [Accepted: 04/23/2023] [Indexed: 05/15/2023] Open
Abstract
Technology-enhanced hospital-at-home (H@H), commonly referred to as hybrid H@H, became more widely adopted during the COVID-19 pandemic. We conducted focus group interviews with Mayo Clinic staff members (n = 14) delivering hybrid H@H in three separate locations-a rural community health system (Northwest Wisconsin), the nation's largest city by area (Jacksonville, FL), and a desert metropolitan area (Scottsdale, AZ)-to understand staff experiences with implementing a new care delivery model and using new technology to monitor patients at home during the pandemic. Using a grounded theory lens, transcripts were analyzed to identify themes. Staff reported that hybrid H@H is a complex care coordination and communication initiative, that hybrid H@H faces site-specific challenges modulated by population density and state policies, and that many patients are receiving uniquely high-quality care through hybrid H@H, partly enabled by advances in technology. Participant responses amplify the need for additional qualitative research with hybrid H@H staff to identify areas for improvement in the deployment of new models of care enabled by modern technology.
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Affiliation(s)
- Stephanie K Zawada
- Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic College of Medicine and Science, 13400 E. Shea Blvd., Scottsdale, AZ 85259, USA
| | - Jeffrey Sweat
- Social Science Department, University of Wisconsin-Stout, 712 Broadway St. S, Menomonie, WI 54751, USA
| | | | - Michael J Maniaci
- Mayo Clinic Florida, 4500 San Pablo Rd., Jacksonville, FL 32224, USA
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12
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Felix HM, Paulson MR, Garcia JP, Dugani SB, Torres-Guzman RA, Avila FR, Maita K, Forte AJ, Maniaci MJ. Avoiding Escalation to the Emergency Department by Activating an In-Home Rapid Response Team in the 30 Days After Hospital-at-Home Discharge. J Emerg Med 2023; 64:455-463. [PMID: 37002160 PMCID: PMC10133039 DOI: 10.1016/j.jemermed.2023.02.023] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 02/07/2023] [Accepted: 02/17/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND Mayo Clinic's virtual hybrid hospital-at-home program, Advanced Care at Home (ACH) monitors acute and post-acute patients for signs of deterioration and institutes a rapid response (RR) system if detected. OBJECTIVE This study aimed to describe Mayo Clinic's ACH RR team and its effect on emergency department (ED) use and readmission rates. METHODS This was a retrospective review of all post-inpatient (restorative phase) ACH patients admitted from July 6, 2020 through June 30, 2021. If the restorative patient had a clinical decompensation, an RR was activated. All RR activations were analyzed for patient demographic characteristics, admitting and escalation diagnosis, time spent by virtual team on the RR, and whether the RR resulted in transport to the ED or hospital readmission. RESULTS Three hundred and twenty patients were admitted to ACH during the study interval; 230 received restorative care. Seventy-two patients (31.3%) had events that triggered an RR. Fifty (69.4%) of the RR events were related to the admission diagnosis (p < 0.001; 95% CI 0.59-0.80). Twelve patients (16.7%) required transport to an ED for further treatment and were readmitted and 60 patients (83.3%) were able to be treated successfully in the home by the RR team (p < 0.001; 95% CI 0.08-0.25). CONCLUSIONS The use of an ACH RR team was effective at limiting both escalations back to an ED and hospital readmissions, as 83% of deteriorating patients were successfully stabilized and managed in their homes. Implementing a hospital-at-home RR team can reduce the need for ED use by providing critical resources and carrying out required interventions to stabilize the patient's condition.
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Affiliation(s)
- Heidi M Felix
- Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, Florida
| | - Margaret R Paulson
- Division of Hospital Internal Medicine, Mayo Clinic Health Systems, Eau Claire, Wisconsin
| | - John P Garcia
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Sagar B Dugani
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | | | | | - Karla Maita
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Antonio J Forte
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Michael J Maniaci
- Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, Florida
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13
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Maita KC, Palmieri-Serrano L, Avila FR, Torres-Guzman RA, Garcia JP, S. Eldaly A, Haider CR, Felton CL, Paulson MR, Maniaci MJ, Forte AJ. Imaging evaluated remotely through telemedicine as a reliable alternative for accurate diagnosis: a systematic review. Health Technol 2023. [DOI: 10.1007/s12553-023-00745-3] [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: 03/29/2023]
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14
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Paulson MR, Torres-Guzman RA, Avila FR, Maita KC, Garcia JP, Forte AJ, Matcha GV, Pagan RJ, Maniaci MJ. Severity of illness and risk of mortality in Mayo Clinic's virtual hybrid advanced care at home program: a retrospective cohort study. BMC Health Serv Res 2023; 23:287. [PMID: 36973689 PMCID: PMC10041490 DOI: 10.1186/s12913-023-09333-7] [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: 08/21/2022] [Accepted: 03/23/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND In July 2020, Mayo Clinic launched Advanced Care at Home (ACH), a high-acuity virtual hybrid hospital-at-home model (HaH) of care at Mayo Clinic Florida and Northwest Wisconsin, an urban destination medical center and a rural community practice respectively. This study aims to describe demographic characteristics of ACH patients as well as their acuity of illness using severity of illness (SOI) and risk of mortality (ROM), to illustrate the complexity of patients in the program, taking into account the different diagnostic related groups. METHODS Mayo Clinic uses All Patient Refined-Diagnosis Related Groups (APR-DRG) to calculate SOI and ROM on hospitalized patients. APR-DRG data, including SOI and ROM, were gathered from individual chart reviews from July 6, 2020, to March 31, 2022. RESULTS Out of 923 patients discharged from ACH, the average APR-DRG SOI was 2.89 (SD 0.81) and ROM was 2.73. (SD 0.92). Mean age was 70.88 (SD 14.46) years, 54.6% were male patients and the average length of stay was 4.10 days. The most frequent diagnosis was COVID-19 infection with 162 patients (17.6%), followed by heart failure exacerbation (12.7%) and septicemia (10.9%). The 30-day readmission rate after discharge from ACH was 11.2% (n = 103) and the 30-day mortality rate was 1.8% (n = 17). There were no in-program patient deaths. CONCLUSIONS SOI and ROM from patients at the ACH program have been shown to be in the range of "moderate/major" according to the APR-DRG classification. The ACH program is capable of accepting and managing highly complex patients that require advanced therapeutic means. Furthermore, the ACH program has an in-program mortality rate of 0 to date. Therefore, ACH is rising as a capable alternative to the brick-and-mortar hospital.
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Affiliation(s)
- Margaret R Paulson
- Division of Hospital Internal Medicine, Mayo Clinic Health Systems, Eau Claire, WI, USA
| | | | | | - Karla C Maita
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - John P Garcia
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Antonio J Forte
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Gautam V Matcha
- Division of Hospital Internal Medicine, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - Ricardo J Pagan
- Division of Hospital Internal Medicine, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - Michael J Maniaci
- Division of Hospital Internal Medicine, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA.
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15
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Paulson MR, Shulman EP, Dunn AN, Fazio JR, Habermann EB, Matcha GV, McCoy RG, Pagan RJ, Maniaci MJ. Implementation of a virtual and in-person hybrid hospital-at-home model in two geographically separate regions utilizing a single command center: a descriptive cohort study. BMC Health Serv Res 2023; 23:139. [PMID: 36759867 PMCID: PMC9911182 DOI: 10.1186/s12913-023-09144-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 02/02/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND As providers look to scale high-acuity care in the patient home setting, hospital-at-home is becoming more prevalent. The traditional model of hospital-at-home usually relies on care delivery by in-home providers, caring for patients in urban communities through academic medical centers. Our objective is to describe the process and outcomes of Mayo Clinic's Advanced Care at Home (ACH) program, a hybrid virtual and in-person hospital-at-home model combining a single, virtual provider-staffed command center with a vendor-mediated in-person medical supply chain to simultaneously deliver care to patients living near an urban hospital-at-home command center and patients living in a rural region in a different US state and time zone. METHODS A descriptive, retrospective medical records review of all patients admitted to ACH between July 6, 2020, and December 31, 2021. Patients were admitted to ACH from an urban academic medical center in Florida and a rural community hospital in Wisconsin. We collected patient volumes, age, sex, race, ethnicity, insurance type, primary hospital diagnosis, 30-day mortality rate, in-program mortality, 30-day readmission rate, rate of return to hospital during acute phase, All Patient Refined-Diagnosis Related Groups (APR-DRG) Severity of Illness (SOI), and length of stay (LOS) in both the inpatient-equivalent acute phase and post-acute equivalent restorative phase. RESULTS Six hundred and eighty-six patients were admitted to the ACH program, 408 in Florida and 278 in Wisconsin. The most common diagnosis seen were infectious pneumonia (27.0%), septicemia / bacteremia (11.5%), congestive heart failure exacerbation (11.5%), and skin and soft tissue infections (6.3%). Median LOS in the acute phase was 3 days (IQR 2-5) and median stay in the restorative phase was 22 days (IQR 11-26). In-program mortality rate was 0% and 30-day mortality was 0.6%. The mean APR-DRG SOI was 2.9 (SD 0.79) and the 30-day readmission rate was 9.7%. CONCLUSIONS The ACH hospital-at-home model was able to provide both high-acuity inpatient-level care and post-acute care to patients in their homes through a single command center to patients in urban and rural settings in two different geographical locations with favorable outcomes of low mortality and hospital readmissions.
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Affiliation(s)
- Margaret R. Paulson
- grid.414713.40000 0004 0444 0900Division of Hospital Internal Medicine, Mayo Clinic Health System, Menomonie, WI USA
| | | | - Ajani N. Dunn
- grid.417467.70000 0004 0443 9942Administrative Operations, Mayo Clinic, Jacksonville, FL USA
| | - Jacey R. Fazio
- grid.417467.70000 0004 0443 9942Administrative Operations, Mayo Clinic, Jacksonville, FL USA
| | - Elizabeth B. Habermann
- grid.66875.3a0000 0004 0459 167XHealth Care Delivery Research, Mayo Clinic, Rochester, MN USA
| | - Gautam V. Matcha
- grid.417468.80000 0000 8875 6339Division of Hospital Internal Medicine, Mayo Clinic, 4500 San Pablo Rd. Jacksonville, Florida, Florida 32224 USA
| | - Rozalina G. McCoy
- grid.66875.3a0000 0004 0459 167XHealth Care Delivery Research, Mayo Clinic, Rochester, MN USA ,grid.66875.3a0000 0004 0459 167XDivision of Community Internal Medicine, Geriatrics, and Palliative Care, Mayo Clinic, Rochester, MN USA
| | - Ricardo J. Pagan
- grid.417468.80000 0000 8875 6339Division of Hospital Internal Medicine, Mayo Clinic, 4500 San Pablo Rd. Jacksonville, Florida, Florida 32224 USA
| | - Michael J. Maniaci
- grid.417468.80000 0000 8875 6339Division of Hospital Internal Medicine, Mayo Clinic, 4500 San Pablo Rd. Jacksonville, Florida, Florida 32224 USA
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16
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Torres-Guzman RA, Paulson MR, Avila FR, Maita K, Garcia JP, Forte AJ, Maniaci MJ. Smartphones and Threshold-Based Monitoring Methods Effectively Detect Falls Remotely: A Systematic Review. Sensors (Basel) 2023; 23:1323. [PMID: 36772364 PMCID: PMC9920087 DOI: 10.3390/s23031323] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/16/2023] [Accepted: 01/18/2023] [Indexed: 06/18/2023]
Abstract
In the US, at least one fall occurs in at least 28.7% of community-dwelling seniors 65 and older each year. Falls had medical costs of USD 51 billion in 2015 and are projected to reach USD 100 billion by 2030. This review aims to discuss the extent of smartphone (SP) usage in fall detection and prevention across a range of care settings. A computerized search was conducted on six electronic databases to investigate the use of remote sensing technology, wireless technology, and other related MeSH terms for detecting and preventing falls. After applying inclusion and exclusion criteria, 44 studies were included. Most of the studies targeted detecting falls, two focused on detecting and preventing falls, and one only looked at preventing falls. Accelerometers were employed in all the experiments for the detection and/or prevention of falls. The most frequent course of action following a fall event was an alarm to the guardian. Numerous studies investigated in this research used accelerometer data analysis, machine learning, and data from previous falls to devise a boundary and increase detection accuracy. SP was found to have potential as a fall detection system but is not widely implemented. Technology-based applications are being developed to protect at-risk individuals from falls, with the objective of providing more effective and efficient interventions than traditional means. Successful healthcare technology implementation requires cooperation between engineers, clinicians, and administrators.
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Affiliation(s)
| | - Margaret R. Paulson
- Division of Hospital Internal Medicine, Mayo Clinic Health Systems, 1221 Whipple St., Eau Claire, WI 54703, USA
| | - Francisco R. Avila
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA
| | - Karla Maita
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA
| | - John P. Garcia
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA
| | - Antonio J. Forte
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA
| | - Michael J. Maniaci
- Division of Hospital Internal Medicine, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA
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17
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Felix HM, Cowdell JC, Paulson MR, Maita KC, Dugani SB, Avila FR, Torres-Guzman RA, Forte AJ, Matcha GV, Maniaci MJ. Impact of an Acquisition Advanced Practice Provider on Home Hospital Patient Volumes and Length of Stay. Healthcare (Basel) 2023; 11:healthcare11030282. [PMID: 36766857 PMCID: PMC9914253 DOI: 10.3390/healthcare11030282] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/13/2023] [Accepted: 01/16/2023] [Indexed: 01/19/2023] Open
Abstract
In July 2020, Mayo Clinic introduced a hospital-at-home program, known as Advanced Care at Home (ACH) as an alternate option for clinically stable medical patients requiring hospital-level care. This retrospective cohort study evaluates the impact of the addition of a dedicated ACH patient acquisition Advanced Practice Provider (APP) on average length of stay (ALOS) and the number of patients admitted into the program between in Florida and Wisconsin between 6 July 2020 and 31 January 2022. Patient volumes and ALOS of 755 patients were analyzed between the two sites both before and after a dedicated acquisition APP was added to the Florida site on 1 June 2021. The addition of a dedicated acquisition APP did not affect the length of time a patient was in the emergency department or hospital ward prior to ACH transition (2.91 days [Florida] vs. 2.59 days [Wisconsin], p = 0.22), the transition time between initiation of the ACH consult to patient transfer home (0.85 days [Florida] vs. 1.16 days [Wisconsin], p = 0.28), or the total ALOS (6.63 days [Florida] vs. 6.34 days [Wisconsin], p = 0.47). The average number of patients acquired monthly was significantly increased in Florida (38.3 patients per month) compared with Wisconsin (21.6 patients per month) (p < 0.01). The addition of a dedicated patient acquisition APP resulted in significantly higher patient volumes but did not affect transition time or ALOS. Other hospital-at-home programs may consider the addition of an acquisition APP to maximize patient volumes.
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Affiliation(s)
- Heidi M. Felix
- Division of Hospital Internal Medicine, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA
| | - Jed C. Cowdell
- Division of Hospital Internal Medicine, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA
| | - Margaret R. Paulson
- Division of Hospital Internal Medicine, Mayo Clinic Health Systems, 1221 Whipple St, Eau Claire, WI 54701, USA
| | - Karla C. Maita
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA
| | - Sagar B. Dugani
- Division of Hospital Internal Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - Francisco R. Avila
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA
| | | | - Antonio J. Forte
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA
| | - Gautam V. Matcha
- Division of Hospital Internal Medicine, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA
| | - Michael J. Maniaci
- Division of Hospital Internal Medicine, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224, USA
- Correspondence: ; Tel.: +904-956-0081; Fax: +904-953-2848
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18
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Paulson MR, Torres‐Guzman RA, Matcha GV, Avila FR, Maita KC, Garcia JP, Forte AJ, Maniaci MJ. Treatment of a high healthcare utilizer with sepsis in a virtual hybrid hospital-at-home program. Clin Case Rep 2023; 11:e6806. [PMID: 36619489 PMCID: PMC9811058 DOI: 10.1002/ccr3.6806] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/16/2022] [Accepted: 12/17/2022] [Indexed: 01/05/2023] Open
Abstract
High healthcare utilizers are often chronically ill patients who require aggressive hospital and outpatient care. We describe a patient with septic shock who was stabilized in the intensive care unit, then transitioned to a virtual hybrid hospital-at-home to complete both inpatient care as well as outpatient wound and rehabilitation therapy.
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Affiliation(s)
- Margaret R. Paulson
- Division of Hospital Internal MedicineMayo Clinic Health Systems, Eau ClaireMenomonieWisconsinUSA
| | | | - Gautam V. Matcha
- Division of Hospital Internal MedicineMayo Clinic, Jacksonville, FloridaJacksonvilleFloridaUSA
| | - Francisco R. Avila
- Division of Plastic SurgeryMayo Clinic, Jacksonville, FloridaJacksonvilleFloridaUSA
| | - Karla C. Maita
- Division of Plastic SurgeryMayo Clinic, Jacksonville, FloridaJacksonvilleFloridaUSA
| | - John P. Garcia
- Division of Plastic SurgeryMayo Clinic, Jacksonville, FloridaJacksonvilleFloridaUSA
| | - Antonio J. Forte
- Division of Plastic SurgeryMayo Clinic, Jacksonville, FloridaJacksonvilleFloridaUSA
| | - Michael J. Maniaci
- Division of Hospital Internal MedicineMayo Clinic, Jacksonville, FloridaJacksonvilleFloridaUSA
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19
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Maniaci MJ, Cowdell JC, Maita K, Avila FR, Dugani SB, Torres-Guzman RA, Garcia JP, Forte AJ, Paulson MR. Diagnosis Related Groups of Patients Admitted from an Urban Academic Medical Center to a Virtual Hybrid Hospital-at-Home Program. Risk Manag Healthc Policy 2023; 16:759-768. [PMID: 37113313 PMCID: PMC10128872 DOI: 10.2147/rmhp.s402355] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 04/20/2023] [Indexed: 04/29/2023] Open
Abstract
Background The diagnosis related group (DRG) is used as an economic patient classification system based on clinical characteristics, hospital stay, and treatment costs. Mayo Clinic's virtual hybrid hospital-at-home program, advanced care at home (ACH), offers high-acuity home inpatient care for a variety of diagnosis. This study aimed to determine the DRGs admitted to the ACH program at an urban academic center. Methods A retrospective study was performed on all patients discharged from the ACH program at Mayo Clinic Florida from July 6, 2020, to February 1, 2022. DRG data were extracted from the Electronic Health Record (EHR). Categorization of DRG was done by systems. Results The ACH program discharged 451 patients with DRGs. Categorization of the DRG demonstrated that the most frequent code assigned corresponded to respiratory infections (20.2%), followed by septicemia (12.9%), heart failure (8.9%), renal failure (4.9%), and cellulitis (4.0%). Conclusion The ACH program covers a wide range of high-acuity diagnosis across multiple medical specialties at its urban academic medical campus, including respiratory infections, severe sepsis, congestive heart failure, and renal failure, all with major complications or comorbidities. The ACH model of care may be useful in taking care of patients with similar diagnosis at other urban academic medical institutions.
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Affiliation(s)
- Michael J Maniaci
- Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
- Correspondence: Michael J Maniaci, Division of Hospital Internal Medicine, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA, Tel +1 904-956-0081, Fax +1 904-953-2848, Email
| | - J Colt Cowdell
- Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Karla Maita
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | | | - Sagar B Dugani
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - John P Garcia
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Antonio J Forte
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Margaret R Paulson
- Division of Hospital Internal Medicine, Mayo Clinic Health Systems, Eau Claire, WI, USA
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Eldaly AS, Maniaci MJ, Paulson MR, Avila FR, Torres-Guzman RA, Maita K, Garcia JP, Forte AJ. Patient satisfaction with telemedicine in acute care setting: A systematic review. J Clin Transl Res 2022; 8:540-556. [PMID: 36518201 PMCID: PMC9741928] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 10/15/2022] [Accepted: 10/15/2022] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Telemedicine has revolutionized health-care services with its unprecedented abilities to connect patients with health-care professional across the distances. Patient satisfaction is an important measure of the quality and effectiveness of health-care services. AIM The goal of this systematic review is to investigate patient satisfaction with telemedicine in acute care setting. METHODS AND RESULTS Four sources of data were searched PubMed, Cumulative Index of Nursing and Allied Health Literature, Scopus, and Web of Science. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analysis as our basis of organization. Our analysis has showed that acute telemedicine was effective in managing a broad spectrum of acute medical conditions while achieving high levels of patient satisfaction. CONCLUSION Patient satisfaction is a complex product of expectations and experiences. Furthermore, it is an important indicator of the quality of the service. Despite the challenging nature of acute medicine, telemedicine services were successful in improving the quality of the service and achieving high levels of patient satisfaction. RELEVANCE FOR PATIENTS Telemedicine is rapidly evolving as an essential component of our healthcare system. Implementing telemedicine in acute care is a relatively new concept and patient satisfaction in these settings needs to be evaluated.
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Affiliation(s)
- Abdullah S. Eldaly
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, Florida, United States
| | - Michael J. Maniaci
- Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, Florida, United States
| | - Margaret R. Paulson
- Division of Hospital Internal Medicine, Mayo Clinic Health Systems, Eau Claire, Wisconsin, United States
| | - Francisco R. Avila
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, Florida, United States
| | | | - Karla Maita
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, Florida, United States
| | - John P. Garcia
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, Florida, United States
| | - Antonio J. Forte
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, Florida, United States
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Coffey JD, Christopherson LA, Williams RD, Gathje SR, Bell SJ, Pahl DF, Manka L, Blegen RN, Maniaci MJ, Ommen SR, Haddad TC. Development and implementation of a nurse-based remote patient monitoring program for ambulatory disease management. Front Digit Health 2022; 4:1052408. [PMID: 36588748 PMCID: PMC9794766 DOI: 10.3389/fdgth.2022.1052408] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 11/28/2022] [Indexed: 12/15/2022] Open
Abstract
Introduction Numerous factors are intersecting in healthcare resulting in an increased focus on new tools and methods for managing care in patients' homes. Remote patient monitoring (RPM) is an option to provide care at home and maintain a connection between patients and providers to address ongoing medical issues. Methods Mayo Clinic developed a nurse-led RPM program for disease and post-procedural management to improve patient experience, clinical outcomes, and reduce health care utilization by more directly engaging patients in their health care. Enrolled patients are sent a technology package that includes a digital tablet and peripheral devices for the collection of symptoms and vital signs. The data are transmitted from to a hub integrated within the electronic health record. Care team members coordinate patient needs, respond to vital sign alerts, and utilize the data to inform and provide individualized patient assessment, patient education, medication management, goal setting, and clinical care planning. Results Since its inception, the RPM program has supported nearly 22,000 patients across 17 programs. Patients who engaged in the COVID-19 RPM program experienced a significantly lower rate of 30-day, all-cause hospitalization (13.7% vs. 18.0%, P = 0.01), prolonged hospitalization >7 days (3.5% vs. 6.7%, P = 0.001), intensive care unit (ICU) admission (2.3% vs. 4.2%, P = 0.01), and mortality (0.5% vs. 1.7%, P = 0.01) when compared with those enrolled and unengaged with the technology. Patients with chronic conditions who were monitored with RPM upon hospital discharge were significantly less likely to experience 30-day readmissions (18.2% vs. 23.7%, P = 0.03) compared with those unmonitored. Ninety-five percent of patients strongly agreed or agreed they were likely to recommend RPM to a friend or family member. Conclusions The Mayo Clinic RPM program has generated positive clinical outcomes and is satisfying for patients. As technology advances, there are greater opportunities to enhance this clinical care model and it should be extended and expanded to support patients across a broader spectrum of needs. This report can serve as a framework for health care organizations to implement and enhance their RPM programs in addition to identifying areas for further evolution and exploration in developing RPM programs of the future.
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Affiliation(s)
- Jordan D. Coffey
- Center for Digital Health, Mayo Clinic, Rochester, MN, United States,Correspondence: Jordan D. Coffey
| | | | - Ryan D. Williams
- Center for Digital Health, Mayo Clinic, Rochester, MN, United States,Integrity & Compliance Office, Mayo Clinic, Rochester, MN, United States
| | - Shelby R. Gathje
- Research Administrative Services, Mayo Clinic, Rochester, MN, United States
| | - Sarah J. Bell
- Center for Digital Health, Mayo Clinic, Rochester, MN, United States,Department of Nursing, Mayo Clinic, Rochester, MN, United States
| | - Dominick F. Pahl
- Center for Digital Health, Mayo Clinic, Rochester, MN, United States,Department of Nursing, Mayo Clinic, Rochester, MN, United States
| | - Lukas Manka
- Center for Digital Health, Mayo Clinic, Rochester, MN, United States
| | - R. Nicole Blegen
- Center for Digital Health, Mayo Clinic, Rochester, MN, United States
| | - Michael J. Maniaci
- Center for Digital Health, Mayo Clinic, Rochester, MN, United States,Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, FL, United States
| | - Steve R. Ommen
- Center for Digital Health, Mayo Clinic, Rochester, MN, United States,Department of Cardiology, Mayo Clinic, Rochester, MN, United States
| | - Tufia C. Haddad
- Center for Digital Health, Mayo Clinic, Rochester, MN, United States,Department of Oncology, Mayo Clinic, Rochester, MN, United States
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22
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Haddad TC, Coffey JD, Deng Y, Glasgow AE, Christopherson LA, Sangaralingham LR, Bell SJ, Shah VP, Pritchett JC, Orenstein R, Speicher LL, Maniaci MJ, Ganesh R, Borah BJ. Impact of a High-Risk, Ambulatory COVID-19 Remote Patient Monitoring Program on Utilization, Cost, and Mortality. Mayo Clin Proc 2022; 97:2215-2225. [PMID: 36464463 PMCID: PMC9444887 DOI: 10.1016/j.mayocp.2022.08.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 08/30/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To evaluate care utilization, cost, and mortality among high-risk patients enrolled in a coronavirus disease 2019 (COVID-19) remote patient monitoring (RPM) program. METHODS This retrospective analysis included patients diagnosed with COVID-19 at risk for severe disease who enrolled in the RPM program between March 2020 and October 2021. The program included in-home technology for symptom and physiologic data monitoring with centralized care management. Propensity score matching established matched cohorts of RPM-engaged (defined as ≥1 RPM technology interactions) and non-engaged patients using a logistic regression model of 59 baseline characteristics. Billing codes and the electronic death certificate system were used for data abstraction from the electronic health record and reporting of care utilization and mortality endpoints. RESULTS Among 5796 RPM-enrolled patients, 80.0% engaged with the technology. Following matching, 1128 pairs of RPM-engaged and non-engaged patients comprised the analysis cohorts. Mean patient age was 63.3 years, 50.9% of patients were female, and 81.9% were non-Hispanic White. Patients who were RPM-engaged experienced significantly lower rates of 30-day, all-cause hospitalization (13.7% vs 18.0%, P=.01), prolonged hospitalization (3.5% vs 6.7%, P=.001), intensive care unit admission (2.3% vs 4.2%, P=.01), and mortality (0.5% vs 1.7%; odds ratio, 0.31; 95% CI, 0.12 to 0.78; P=.01), as well as cost of care ($2306.33 USD vs $3565.97 USD, P=0.04), than those enrolled in RPM but non-engaged. CONCLUSION High-risk COVID-19 patients enrolled and engaged in an RPM program experienced lower rates of hospitalization, intensive care unit admission, mortality, and cost than those enrolled and non-engaged. These findings translate to improved hospital bed access and patient outcomes.
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Affiliation(s)
- Tufia C Haddad
- Center for Digital Health, Mayo Clinic, Rochester, MN, USA; Department of Oncology, Mayo Clinic, Rochester, MN, USA.
| | | | - Yihong Deng
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Amy E Glasgow
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | | | | | - Sarah J Bell
- Center for Digital Health, Mayo Clinic, Rochester, MN, USA; Department of Nursing, Mayo Clinic, Rochester, MN, USA
| | - Vishal P Shah
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA; Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Joshua C Pritchett
- Department of Oncology, Mayo Clinic, Rochester, MN, USA; Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | | | | | - Michael J Maniaci
- Center for Digital Health, Mayo Clinic, Rochester, MN, USA; Department of Medicine, Mayo Clinic, Jacksonville, FL, USA
| | | | - Bijan J Borah
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA; Division of Health Care Delivery Science, Mayo Clinic, Rochester, MN, USA
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23
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Paulson MR, Eldaly AS, Avila FR, Torres-Guzman RA, Maita KC, Garcia JP, Serrano LP, Emam OS, Forte AJ, Maniaci MJ. Small Bowel Obstruction Conservatively Managed in Hospital-At-Home. Case Rep Gastrointest Med 2022; 2022:1969040. [PMID: 36398066 PMCID: PMC9666016 DOI: 10.1155/2022/1969040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 09/24/2022] [Accepted: 11/02/2022] [Indexed: 01/21/2024] Open
Abstract
In 2020, Mayo Clinic established an Advanced Care at Home (ACH) program. ACH is a virtual hybrid hospital-at-home (HaH) program that combines telemedicine with in-home care services by utilizing a state that is software-driven, vendor-mediate medical supply chain. The program initially focused on acute medical diagnosis but has expanded to oversee surgical and postsurgical patients with continued inpatient needs. Here, we report the first case of a small bowel obstruction (SBO) managed under a HaH program. A 52-year-old lady presented to the emergency department with symptoms suggestive of mechanical SBO. The diagnosis was confirmed with an abdominopelvic computed tomography (CT) scan, and the patient was admitted to the hospital. Based on the patient's presentation and laboratory results, the care team proceeded with conservative treatment including nasogastric tube (NG) placement and suctioning, intravenous (IV) fluid replacement, and daily laboratory studies. She spent the first hospital day in the physical hospital ward so that the surgical team could ensure stability clinically and no urgent need for surgical intervention. On hospital day two, she was transferred home with ACH where the NG suctioning and IV replacement therapy could continue, while the medical team conducted daily virtual visits to ensure continued improvement. Additionally, a paramedic and a nurse performed an in-person, head-to-toe assessment and administered medications to the patient twice daily. She spent 5 days in ACH getting acute care and then was discharged into a postacute phase equivalent to outpatient monitoring called the restorative phase. She was monitored remotely for the duration of the restorative phase for 10 more days, and then she recovered fully. This case highlights that high-acuity patients with SBO can receive invasive treatments like NG tube suction as well as be appropriately monitored for clinical decompensation by a virtual hybrid home hospital program which combines virtual care providers with an in-home vendor-mediated supply chain.
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Affiliation(s)
- Margaret R. Paulson
- Division of Hospital Internal Medicine, Mayo Clinic Health Systems, Eau Claire, Wisconsin 2321 Stout Road, Menomonie, Wisconsin 54751, USA
| | - Abdullah S. Eldaly
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, Florida 32224, USA
| | - Francisco R. Avila
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, Florida 32224, USA
| | | | - Karla C. Maita
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, Florida 32224, USA
| | - John P. Garcia
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, Florida 32224, USA
| | - Luiza Palmieri Serrano
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, Florida 32224, USA
| | - Omar S. Emam
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, Florida 32224, USA
| | - Antonio J. Forte
- Division of Plastic Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, Florida 32224, USA
| | - Michael J. Maniaci
- Division of Hospital Internal Medicine, Mayo Clinic, 4500 San Pablo Road, Jacksonville, Florida 32224, USA
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24
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Paulson MR, Torres‐Guzman RA, Avila FR, Maita K, Forte AJ, Butera JE, Maniaci MJ. Telemedicine allows for effective communication between a medically complex cancer patient and his virtual hospital medical team. Clin Case Rep 2022; 10:e6456. [PMID: 36245470 PMCID: PMC9552987 DOI: 10.1002/ccr3.6456] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 09/30/2022] [Indexed: 11/09/2022] Open
Abstract
Good physician-patient communication is key for effective hospital care. We describe a patient diagnosed with an acute pulmonary embolism and bacteremia who was treated in a virtual hybrid hospital-at-home program. Constant communication with the virtual and in-home healthcare teams enabled a unified knowledge of the patient's wishes.
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Affiliation(s)
- Margaret R. Paulson
- Division of Hospital Internal MedicineMayo Clinic Health SystemsEau ClaireWisconsinUSA
| | | | | | - Karla C. Maita
- Division of Plastic SurgeryMayo ClinicJacksonvilleFloridaUSA
| | | | - Julie E. Butera
- Division of Hospital Internal MedicineMayo Clinic Health SystemsEau ClaireWisconsinUSA
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25
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Yao X, Paulson M, Maniaci MJ, Dunn AN, Nelson CR, Behnken EM, Hart MS, Sangaralingham LR, Inselman SA, Lampman MA, Dunlay SM, Dowdy SC, Habermann EB. Effect of hospital-at-home vs. traditional brick-and-mortar hospital care in acutely ill adults: study protocol for a pragmatic randomized controlled trial. Trials 2022; 23:503. [PMID: 35710450 PMCID: PMC9201794 DOI: 10.1186/s13063-022-06430-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 03/04/2022] [Accepted: 05/26/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Delivering acute hospital care to patients at home might reduce costs and improve patient experience. Mayo Clinic's Advanced Care at Home (ACH) program is a novel virtual hybrid model of "Hospital at Home." This pragmatic randomized controlled non-inferiority trial aims to compare two acute care delivery models: ACH vs. traditional brick-and-mortar hospital care in acutely ill patients. METHODS We aim to enroll 360 acutely ill adult patients (≥18 years) who are admitted to three hospitals in Arizona, Florida, and Wisconsin, two of which are academic medical centers and one is a community-based practice. The eligibility criteria will follow what is used in routine practice determined by local clinical teams, including clinical stability, social stability, health insurance plans, and zip codes. Patients will be randomized 1:1 to ACH or traditional inpatient care, stratified by site. The primary outcome is a composite outcome of all-cause mortality and 30-day readmission. Secondary outcomes include individual outcomes in the composite endpoint, fall with injury, medication errors, emergency room visit, transfer to intensive care unit (ICU), cost, the number of days alive out of hospital, and patient-reported quality of life. A mixed-methods study will be conducted with patients, clinicians, and other staff to investigate their experience. DISCUSSION The pragmatic trial will examine a novel virtual hybrid model for delivering high-acuity medical care at home. The findings will inform patient selection and future large-scale implementation. TRIAL REGISTRATION ClinicalTrials.gov NCT05212077. Registered on 27 January 2022.
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Affiliation(s)
- Xiaoxi Yao
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA. .,Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.
| | - Margaret Paulson
- Division of Hospital Internal Medicine, Mayo Clinic Health Systems, Eau Claire, WI, USA
| | - Michael J Maniaci
- Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Ajani N Dunn
- Administrative Operations, Mayo Clinic, Jacksonville, FL, USA
| | - Chad R Nelson
- Division of Hospital Internal Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Emma M Behnken
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
| | - Melissa S Hart
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Lindsey R Sangaralingham
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Shealeigh A Inselman
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Michelle A Lampman
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Shannon M Dunlay
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.,Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Sean C Dowdy
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Elizabeth B Habermann
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
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26
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Dugani SB, Fischer KM, Geyer HL, Maniaci MJ, Croghan IT, Burton MC. Psychologic wellness of PA, NP, and physician hospitalists during the COVID-19 pandemic. JAAPA 2022; 35:45-53. [PMID: 35421872 PMCID: PMC9129920 DOI: 10.1097/01.jaa.0000824964.37126.d8] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Hospitalists, comprising PAs, NPs, and physicians, manage patients hospitalized with COVID-19. To guide the development of support programs, this study compared the psychologic wellness of hospitalist PAs, NPs, and physicians during the COVID-19 pandemic. METHODS We surveyed hospitalists in 16 hospitals at Mayo Clinic, from May 4 to 25, 2020. We used PROMIS surveys for self-reported global well-being (two single-item measures), anxiety, social isolation, and emotional support, before and during the pandemic. Linear and logistic regression models were adjusted for personal and professional factors. RESULTS The response rate was 52.2% (N = 154/295). In adjusted linear regression models, the change in scores (before minus during pandemic) for anxiety, social isolation, and emotional support was similar for PAs and NPs compared with physicians. In adjusted logistic regression models, physicians, compared with PAs and NPs, had a higher odds of top global well-being for mental health (adjusted odds ratio [95% confidence interval]: 2.82 [1.12, 7.13]; P = .03) and top global well-being for social activities and relationships (adjusted odds ratio 4.08 [1.38, 12.08]; P = .01). CONCLUSIONS During the COVID-19 pandemic, global well-being was lower for PAs and NPs compared with physician hospitalists. These results can guide support programs for hospitalists.
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Affiliation(s)
- Sagar B. Dugani
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN
- Division of Health Care Delivery Research, Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - Karen M. Fischer
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Holly L. Geyer
- Division of Hospital Internal Medicine, Mayo Clinic, Scottsdale, AZ
| | | | - Ivana T. Croghan
- Department of Medicine, Division of General Internal Medicine, Mayo Clinic, Rochester, MN
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
- Department of Medicine, Clinical Research Office, Mayo Clinic, Rochester, MN
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27
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Maniaci MJ, Torres-Guzman RA, Garcia JP, Avila FR, Maita KC, Forte AJ, Paulson MR. Overall patient experience with a virtual hybrid hospital at home program. SAGE Open Med 2022; 10:20503121221092589. [PMID: 35481244 PMCID: PMC9036381 DOI: 10.1177/20503121221092589] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [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: 12/25/2021] [Accepted: 03/19/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives: Traditional hospital at home models often have high patient experience scores. The purpose of this study is to look at the patient experience of a new virtual hybrid model of hospital at home called Advanced Care at Home. Methods: Patients in Mayo Clinic’s Advanced Care at Home program received a survey via email from 1 January–31 May 2021. Each survey consisted of 20 questions divided into 18 multiple-choice and two open-ended questions. Results: Ninety-nine surveys were sent and 41 partially or completely finished surveys were returned for a response rate of 41.4%. Patients responded positively, denoted by answering “strongly agree or somewhat agree,” with regard to the ability to reach the team right away 100% of the time, being kept informed 92% of the time, the command center responding promptly to their needs 95% of the time, the team providing comfort and support 98% of the time, feeling comfortable with interacting with their provider by phone or tablet 95% of the time, the ease of use from the equipment 97% of the time, the virtual and in-person staff working well together 98% of the time, the staff treating patients with courtesy and respect 100% of the time, and the ease of understanding the discharge process and feeling ready to leave the program 100% of the time. All providers received positive responses on listening ⩾88% of the time. Patients gave a top rating in likelihood to recommend the program 100% of the time. Conclusion: Overall, the Advanced Care at Home model of hospital at home was highly recommended by patients. Patients scored the program high on responsiveness, staff engagement and communication, ease of equipment use, and readiness for discharge, strengthening the overall confidence in this novel program.
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Affiliation(s)
- Michael J Maniaci
- Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | | | - John P Garcia
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | | | - Karla C Maita
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Antonio J Forte
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL, USA.,Department of Neurological Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Margaret R Paulson
- Division of Hospital Internal Medicine, Mayo Clinic Health Systems, Eau Claire, WI, USA
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28
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Chadha RM, Paulson MR, Avila FR, Torres-Guzman RA, Maita KC, Garcia JP, Forte AJ, Matcha GV, Pagan RJ, Maniaci MJ. A Virtual Hybrid Care Hotel Model Supports the Recovery of Post-procedural Patients with Mild to Severe Systemic Diseases. Am Surg 2022:31348221082271. [PMID: 35420494 DOI: 10.1177/00031348221082271] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Patients with mild to severe chronic systemic disease undergoing low-risk procedures are often hospitalized for observation. The Care Hotel is a novel virtual medicine hybrid model of care that offers patients a comfortable, out of hospital environment where they can receive both in-person and virtual care after a surgery or procedure. This study aimed to analyze if virtual hybrid post-procedure care in a hotel could be both conducted on and accepted by patients, even those with moderate to severe chronic diseases. METHODS This retrospective cohort study was conducted between July 23, 2020 and June 4, 2021 at Mayo Clinic in Florida, a 306-bed community academic hospital. We collected the sex, age, race, ethnicity, acceptance rate, ASA score, and primary procedure of patients using the Care Hotel. RESULTS Out of 392 patients, 272 (69.4%) opted for care in the program. Median patient age was 61.5 years, 59.56% were males, and 86.40% were white. We found that 50.37% had an ASA score of 2 and 43.4% had an ASA score of 3. Ten different surgical specialties were able to utilize the Care Hotel for care in 47 different procedure types. Urology had the most patients (n=70, 25.7%). Post-electrophysiologic procedures were the most common procedures (n=39, 14.3%). CONCLUSION Our virtual hybrid Care Hotel program was widely accepted by patients and could care for a multitude of post-operative procedures. Additionally, this novel program can care for patients with both mild and severe systemic diseases.
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Affiliation(s)
- Ryan M Chadha
- Department of Anesthesiology, 156400Mayo Clinic, Jacksonville, FL, USA
| | - Margaret R Paulson
- Division of Hospital Internal Medicine, 170021Mayo Clinic Health Systems, Eau Claire, WI, USA
| | - Francisco R Avila
- Division of Plastic Surgery, 156400Mayo Clinic, Jacksonville, FL, USA
| | | | - Karla C Maita
- Division of Plastic Surgery, 156400Mayo Clinic, Jacksonville, FL, USA
| | - John P Garcia
- Division of Plastic Surgery, 156400Mayo Clinic, Jacksonville, FL, USA
| | - Antonio J Forte
- Division of Plastic Surgery, 156400Mayo Clinic, Jacksonville, FL, USA.,Department of Neurological Surgery, 156400Mayo Clinic, Jacksonville, FL, USA
| | - Gautam V Matcha
- Division of Hospital Internal Medicine, 156400Mayo Clinic, Jacksonville, FL, USA
| | - Ricardo J Pagan
- Division of Hospital Internal Medicine, 156400Mayo Clinic, Jacksonville, FL, USA
| | - Michael J Maniaci
- Division of Hospital Internal Medicine, 156400Mayo Clinic, Jacksonville, FL, USA
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29
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Dugani SB, Fischer KM, Schroeder DR, Geyer HL, Maniaci MJ, Croghan IT, Kashani D, Burton MC. Wellness of hospitalists and hospital medicine advanced practice providers during the COVID-19 pandemic, 2020-2021. J Hosp Med 2022; 17:259-267. [PMID: 35535916 PMCID: PMC9088352 DOI: 10.1002/jhm.12812] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 02/11/2022] [Accepted: 02/18/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND The early phase of the coronavirus disease 2019 (COVID-19) pandemic had a negative impact on the wellness of hospitalists and hospital medicine advanced practice providers (APPs). However, the burden of the pandemic has evolved and the change in hospitalist and hospital medicine APP wellness is unknown. OBJECTIVE To evaluate the longitudinal trend in wellness of hospitalists and hospital medicine APPs during the COVID-19 pandemic and guide wellness interventions. DESIGN, SETTING AND PARTICIPANTS Between May 4, 2020, and June 6, 2021, we administered three surveys to Internal Medicine hospitalists (physicians) and hospital medicine APPs (nurse practitioners and physician assistants) at 16 Mayo Clinic hospitals in four U.S. states. MEASUREMENTS We evaluated the association of hospitalist and hospital medicine APP characteristics with PROMIS® measures of global wellbeing-mental health, global wellbeing-social activities and relationships, anxiety, social isolation, and emotional support, using logistic and linear regression models. RESULTS The response rates were 52.2% (n=154/295; May 2020), 37.1% (n=111/299; October 2020) and 35.5% (n=114/321; May 2021). In mixed models that included hospitalist and hospital medicine APP characteristics and survey period, APPs, compared with physicians, had lower odds of top global wellbeing-social activities and relationships (adjusted odds ratio 0.42 [0.22-0.82]; p = .01), whereas survey period showed no association. The survey period showed an independent association with higher anxiety (May 2020 vs. others) and higher social isolation (October 2020 vs. others), whereas profession showed no association. Concern about contracting COVID-19 at work was significantly associated with lower odds of top global wellbeing-mental health and global wellbeing-social activities and relationships, and with higher anxiety and social isolation. Hospitalist and hospital medicine APP characteristics showed no association with levels of emotional support. CONCLUSIONS In this longitudinal assessment of hospitalists and hospital medicine APPs, concern about contracting COVID-19 at work remained a determinant of wellness. The trend for global wellbeing, anxiety, and social isolation may guide wellness interventions.
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Affiliation(s)
- Sagar B. Dugani
- Division of Hospital Internal MedicineMayo ClinicRochesterMinnesotaUSA
- Kern Center for the Science of Health Care DeliveryMayo ClinicRochesterMinnesotaUSA
- Knowledge and Evaluation Research UnitMayo ClinicRochesterMinnesotaUSA
| | - Karen M. Fischer
- Department of Quantitative Health SciencesMayo ClinicRochesterMinnesotaUSA
| | | | - Holly L. Geyer
- Division of Hospital Internal MedicineMayo ClinicScottsdaleArizonaUSA
| | | | - Ivana T. Croghan
- Kern Center for the Science of Health Care DeliveryMayo ClinicRochesterMinnesotaUSA
- Knowledge and Evaluation Research UnitMayo ClinicRochesterMinnesotaUSA
- Department of Medicine, Division of General Internal MedicineMayo ClinicRochesterMinnesotaUSA
- Department of Medicine, Research HubMayo ClinicRochesterMinnesotaUSA
| | - Daniel Kashani
- Division of Hospital Internal MedicineMayo ClinicRochesterMinnesotaUSA
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30
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Jethwa TE, Moran KM, Maniaci MJ. Medication non‐adherence as a cause of apixaban failure in venous thromboembolism: The importance of pharmacist medication reconciliation. Clin Case Rep 2022; 10:e05338. [PMID: 35140953 PMCID: PMC8811178 DOI: 10.1002/ccr3.5338] [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: 12/06/2021] [Revised: 01/05/2022] [Accepted: 01/17/2022] [Indexed: 11/09/2022] Open
Abstract
Venous thromboembolism is often treated with direct oral anticoagulants. In order for direct oral anticoagulants to be effective, patients must adhere to a specific dosing strategy. We report a case of apixaban failure, the clinical workup that ensued, and the eventual discovery of unsuccessful medication adherence as the cause. Careful dosing of DOACs for the treatment of venous thromboembolism is imperative in transitions of care. A thorough medication reconciliation by a clinical pharmacist can help determine if treatment failure is due to non‐adherence.
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Affiliation(s)
- Trisha E Jethwa
- Department of Family Medicine Mayo Clinic in Florida Jacksonville Florida USA
| | - Kaitlin M Moran
- Department of Internal Medicine Mayo Clinic in Florida Jacksonville Florida USA
| | - Michael J Maniaci
- Department of Internal Medicine Mayo Clinic in Florida Jacksonville Florida USA
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31
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Maniaci MJ, Maita K, Torres-Guzman RA, Avila FR, Garcia JP, Eldaly A, Forte AJ, Matcha GV, Pagan RJ, Paulson MR. Provider Evaluation of a Novel Virtual Hybrid Hospital at Home Model. Int J Gen Med 2022; 15:1909-1918. [PMID: 35237065 PMCID: PMC8882662 DOI: 10.2147/ijgm.s354101] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 02/11/2022] [Indexed: 11/30/2022] Open
Abstract
Background Healthcare provider’s experience with new models of care is crucial for long-term success. In July 2020, Mayo Clinic implemented a novel virtual hybrid hospital at home program called Advanced Care at Home (ACH). This model allows virtual providers in a command center to care for high-acuity patients in the home setting through collaboration with a vendor-mediated supply chain. This study aims to describe the outcomes obtained from a survey applied to the ACH providers to determine their acceptance of the quality and safety of the virtual hybrid care model, their perception towards the decision-making and teamwork between the command center and supplier network, and determine if the overall experience with ACH was rewarding. Methods A 15-question anonymous survey was distributed via email quarterly to all the physicians and nurse practitioners registered in ACH program at Mayo Clinic. The survey encompassed questions related to the overall experience in ACH concerning work environment, quality of care, service reliability, teamwork, decision-making, and satisfaction. All the questions were Likert-like scale choice, and a descriptive analysis using frequency distribution and percentages of the data was performed. Results Between September 1, 2020 and April 30, 2021, three quarterly surveys were sent to a total of 21 physicians and nurse practitioners caring for patients virtually in ACH. The response rate reported was 72%, 33%, and 66%, respectively, at the first, second, and third quarters. Eighty percent or more of providers consistently gave positive scores to all three areas analyzed throughout the 8-month study. Conclusion Providers found the ACH virtual hybrid model of home hospital care very rewarding. They were able to deliver high-quality and safe care to their patients through positive teamwork with a vendor-mediated supply chain. This novel model of hospital at home has the potential to be a great provider satisfier moving forward.
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Affiliation(s)
- Michael J Maniaci
- Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
- Correspondence: Michael J Maniaci, Division of Hospital Internal Medicine, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA, Tel +1 904-956-0081, Fax +1904-953-2848, Email
| | - Karla Maita
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | | | | | - John P Garcia
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Abdullah Eldaly
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Antonio J Forte
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Gautam V Matcha
- Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Ricardo J Pagan
- Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Margaret R Paulson
- Division of Hospital Internal Medicine, Mayo Clinic Health Systems, Eau Claire, WI, USA
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Chadha RM, Paulson MR, Avila FR, Torres-Guzman RA, Maita K, Garcia JP, Forte AJ, Maniaci MJ. Surgical patient satisfaction with a virtual hybrid care hotel model: A retrospective cohort study. Ann Med Surg (Lond) 2022; 74:103251. [PMID: 35059193 PMCID: PMC8760461 DOI: 10.1016/j.amsu.2022.103251] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 01/04/2022] [Accepted: 01/06/2022] [Indexed: 12/01/2022] Open
Affiliation(s)
- Ryan M. Chadha
- Department of Anesthesiology, Mayo Clinic, Jacksonville, FL, USA
| | - Margaret R. Paulson
- Division of Hospital Internal Medicine, Mayo Clinic Health Systems, Eau Claire, WI, USA
| | | | | | - Karla Maita
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - John P. Garcia
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Antonio J. Forte
- Division of Plastic Surgery, Mayo Clinic, Jacksonville, FL, USA
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Michael J. Maniaci
- Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
- Corresponding author. Division of Hospital Internal Medicine, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA.
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Pati S, Thompson GE, Mull CJ, Allen DH, Fazio JR, Felix HM, Paulson M, Chaudhry R, Matcha GV, Maniaci MJ, Burger CD, Quest DJ. Improving Patient Selection and Prioritization for Hospital at Home Through Predictive Modeling. AMIA Annu Symp Proc 2022; 2022:856-865. [PMID: 37128392 PMCID: PMC10148353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Hospital at home is designed to offer patients hospital level care in the comfort of their own home. The process by which clinicians select eligible patients that are clinically and socially appropriate for this model of care requires labor-intensive manual chart reviews. We addressed this problem by providing a predictive model, web application, and data pipeline that produces an eligibility score based on a set of clinical and social factors that influence patients' success in the program. Providers used this predictive model to prioritize the order in which they perform chart reviews and patient screenings. Training performance area under the curve (AUC) was 0.77. Testing 'in production' had an AUC of 0.75. Admission criteria in training rapidly changed over the course of the study due to the novelty of the clinical model. The current algorithm successfully identified many inconsistencies in enrollment and has streamlined the process of patient identification.
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Affiliation(s)
- Satyabrata Pati
- Center for Digital Health - Mayo Clinic, Rochester, Minnesota
| | - Gina E Thompson
- Center for Digital Health - Mayo Clinic, Rochester, Minnesota
| | | | - Daniel H Allen
- Center for Digital Health - Mayo Clinic, Rochester, Minnesota
| | - Jacey R Fazio
- Center for Digital Health - Mayo Clinic, Rochester, Minnesota
| | - Heidi M Felix
- Division of Hospital Internal Medicine - Mayo Clinic, Jacksonville, Florida
| | - Margaret Paulson
- Division of Hospital Internal Medicine - Mayo Clinic, Eau Claire, Wisconsin
| | - Rajeev Chaudhry
- Division of Community Internal Medicine - Mayo Clinic, Rochester, Minnesota
| | - Gautam V Matcha
- Division of Hospital Internal Medicine - Mayo Clinic, Jacksonville, Florida
| | - Michael J Maniaci
- Division of Hospital Internal Medicine - Mayo Clinic, Jacksonville, Florida
| | - Charles D Burger
- Division of Pulmonary, Allergy, and Sleep Medicine - Mayo Clinic, Jacksonville, Florida
| | - Daniel J Quest
- Center for Digital Health - Mayo Clinic, Rochester, Minnesota
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Dawson NL, Hull BP, Vijapura P, Dumitrascu AG, Ball CT, Thiemann KM, Maniaci MJ, Burton MC. Home Telemonitoring to Reduce Readmission of High-Risk Patients: a Modified Intention-to-Treat Randomized Clinical Trial. J Gen Intern Med 2021; 36:3395-3401. [PMID: 33506388 PMCID: PMC8606403 DOI: 10.1007/s11606-020-06589-1] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 12/30/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Home telemonitoring has been used with discharged patients in an attempt to reduce 30-day readmissions with mixed results. OBJECTIVE To assess whether home 30-day telemonitoring after discharge for patients at high risk of readmission would reduce readmissions or mortality. DESIGN Prospective, randomized controlled trial. PATIENTS We compared 30-day readmission rates and mortality for patients at high risk for readmission who received home telemonitoring versus standard care between November 1, 2014, and November 30, 2018, in 2 tertiary care hospitals. INTERVENTIONS The intervention group received home-installed equipment to measure blood pressure, heart rate, pulse oximetry, weight if heart failure was present, and glucose if diabetes was present. Results were transmitted daily and reviewed by a nurse. Both groups received standard care. MAIN MEASURES The primary outcome was a composite end point of hospital readmission or death within 30 days after discharge. The secondary outcome was an emergency department visit within 30 days after discharge. KEY RESULTS A total of 1380 participants (mean [SD] age, 66 [14] years; 722 [52.3%] men and 658 [47.7%] women) participated in this study. Using a modified intention-to-treat analysis, the risk of readmission or death within 30 days among patients at high readmission risk was 23.7% (137/578) in the control group and 18.2% (87/477) in the telemonitoring group (absolute risk difference, - 5.5% [95% CI, - 10.4 to - 0.6%]; relative risk, 0.77 [95% CI, 0.61 to 0.98]; P = .03). Emergency department visits occurred within 30 days after discharge in 14.2% (81/570) of patients in the control group and 8.6% (40/464) of patients in the telemonitoring group (absolute risk difference, - 5.6% [95% CI, - 9.4 to - 1.8%]; relative risk, 0.61 [95% CI, 0.42 to 0.87]; P = .005). CONCLUSIONS Thirty days of postdischarge telemonitoring may reduce readmissions of high-risk patients. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02136186.
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Affiliation(s)
- Nancy L Dawson
- Division of Hospital Internal Medicine, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA.
| | - Bryan P Hull
- Division of Hospital Internal Medicine, Mayo Clinic Hospital, Phoenix, AZ, USA
| | - Priyanka Vijapura
- Division of Hospital Internal Medicine, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - Adrian G Dumitrascu
- Division of Hospital Internal Medicine, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - Colleen T Ball
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL, USA
| | - Kay M Thiemann
- Shared Services Administration, Mayo Clinic, Rochester, MN, USA
| | - Michael J Maniaci
- Division of Hospital Internal Medicine, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - M Caroline Burton
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN, USA
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Dugani SB, Geyer HL, Maniaci MJ, Fischer KM, Croghan IT, Coons TJ, Canan EL, Burton MC. Hospitalist perspectives on barriers to recommend and potential benefit of the COVID-19 vaccine. Hosp Pract (1995) 2021; 49:245-251. [PMID: 33826433 DOI: 10.1080/21548331.2021.1914465] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: Hospitalists, comprised of nurse practitioners and physician assistants (collectively, advanced practice providers [APPs]) and physicians, have opportunities to counsel patients and reduce SARS-CoV-2 related coronavirus disease 2019 (COVID-19) vaccine hesitancy. However, hospitalist perspectives on the COVID-19 vaccine and potential differences between APPs and physicians are unknown. Understanding hospitalist perspectives could help to address vaccine hesitancy among patients.Methods: We conducted an online survey of hospitalists at Mayo Clinic sites in Arizona, Florida, Minnesota, and Wisconsin from 14 December 2020 through 4 January 2021. We collected demographic information and assessed perspectives on the COVID-19 vaccine and, for comparison, on the influenza vaccine. Descriptive statistics were used to compare responses between APPs and physicians.Results: The overall response rate was 42.7% (n = 128/300) and comprised of 53.9% women (n = 69/128) and 41.4% APPs (n = 53/128). Most hospitalists reported receiving or planning to receive vaccination against COVID-19 (93.7%; n = 119/128) and influenza (97.7%; n = 125/128). Most hospitalists reported they would advise 100% of patients to receive the COVID-19 vaccine (66% for APPs; 74.7% for physicians) and influenza vaccine (83% for APPs; 80% for physicians). Barriers to recommending the COVID-19 vaccine included patient health status and vaccine safety profile. Hospitalists reported that patients and coworkers receiving the COVID-19 vaccine would reduce their anxiety (~80% of hospitalists), social isolation (~64% of hospitalists), and improve their emotional support (~40% of hospitalists). APP and physician responses were similar. The possible reduction in social isolation was associated with higher odds of hospitalists advising all patients to receive the COVID-19 vaccine (adjusted odds ratio 2.95 [95% confidence interval, 1.32-6.59]; P< .008), whereas hospitalist age, gender, and profession showed no association.Conclusion: Most hospitalists would reportedly advise patients to receive the COVID-19 vaccine. Barriers to this recommendation included patient health status and vaccine safety. Hospitalists are an important resource to provide patient education and reduce COVID-19 vaccine hesitancy.
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Affiliation(s)
- Sagar B Dugani
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Holly L Geyer
- Division of Hospital Internal Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | - Michael J Maniaci
- Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Karen M Fischer
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Ivana T Croghan
- Department of Medicine, Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA.,Robert D. And Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.,Department of Medicine, Clinical Research Office, Mayo Clinic, Rochester, MN, USA
| | - Trevor J Coons
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Elizabeth L Canan
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - M Caroline Burton
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN, USA
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Dugani SB, Geyer HL, Maniaci MJ, Fischer KM, Croghan IT, Burton C. Psychological wellness of internal medicine hospitalists during the COVID-19 pandemic. Hosp Pract (1995) 2021; 49:47-55. [PMID: 33012183 DOI: 10.1080/21548331.2020.1832792] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 10/02/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Patients with COVID-19 infection requiring in-hospital care are frequently managed by Internal Medicine hospitalists, comprised of physicians, nurse practitioners and physician assistants. There is sparse information on the psychological impact of the COVID-19 pandemic on Internal Medicine hospitalists. METHODS We surveyed Internal Medicine hospitalists at Mayo Clinic sites in four states (Arizona, Florida, Minnesota, and Wisconsin). We collected demographic information, and used Patient-Reported Outcomes Measurement Information System (PROMIS®) measures to assess global well-being, anxiety, social isolation, and emotional support. Descriptive statistics were used to compare responses between two periods: prior to the pandemic (before March 15th, 2020), and during the pandemic (March 15 through 30 April 2020). The survey was conducted from May 4-25, 2020. RESULTS Of 295 Internal Medicine hospitalists, 154 (52%) responded. Fifty-six percent were women (n = 85/154) and 54% were physicians (n = 84/154). Most hospitalists (75%; n = 115/154) reported concerns about contracting COVID-19 infection at work, and 5% (n = 8/154) reported changing where they lived during the pandemic. Most hospitalists (73%; n = 112/154) reported relying primarily on institutional resources for COVID-19 information. During the pandemic, the percentage of participants with excellent or very good global well-being decreased (90% prior to pandemic vs. 53% during pandemic), with increases in mean anxiety (-4.88 [95% confidence interval, - 5.61 to - 4.16]; P<.001) and social isolation (-3.91[95% confidence interval, - 4.68 to - 3.13]; P<.001). During the same period, there was a small decrease in mean emotional support (1.46 [95% confidence interval, 0.83 to 2.09]; P<.001). CONCLUSION During the COVID-19 pandemic, Internal Medicine hospitalists reported lower global well-being, higher anxiety and social isolation, and a small decrease in emotional support. These results provide a framework to develop programs to support hospitalists and potentially mitigate long-term psychological sequelae including burnout.
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Affiliation(s)
- Sagar B Dugani
- Division of Hospital Internal Medicine, Mayo Clinic , Rochester, MN, USA
| | - Holly L Geyer
- Division of Hospital Internal Medicine, Mayo Clinic , Scottsdale, AZ, USA
| | - Michael J Maniaci
- Division of Hospital Internal Medicine, Mayo Clinic , Jacksonville, FL, USA
| | - Karen M Fischer
- Department of Health Sciences Research, Mayo Clinic , Rochester, MN
| | - Ivana T Croghan
- Department of Medicine, Division of General Internal Medicine, Mayo Clinic , Rochester, MN
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic , Rochester, MN
- Department of Medicine, Clinical Research Office, Mayo Clinic , Rochester, MN
| | - Caroline Burton
- Division of Hospital Internal Medicine, Mayo Clinic , Rochester, MN, USA
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Lachner C, Maniaci MJ, Vadeboncoeur TF, Dawson NL, Rummans TA, Roy A, Hall LL, Burton MC. Are pre-existing psychiatric disorders the only reason for involuntary holds in the emergency department? Int J Emerg Med 2020; 13:4. [PMID: 32013869 PMCID: PMC6998304 DOI: 10.1186/s12245-020-0265-4] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 01/21/2020] [Indexed: 11/24/2022] Open
Abstract
Objectives To determine the role of previous psychiatric disorders including substance use disorders on emergency department (ED) patients on involuntary holds and compare presentations, treatment, and outcomes based on cause. Methods We conducted a retrospective study of patients ≥ 18 years old on involuntary holds in the ED of a tertiary care center from January 1, 2013, to November 30, 2015. Demographic and clinical information were collected. Those with and without prior psychiatric disorder including substance use disorder were compared. Results We identified 251 patients of which 129 (51.4%) had a psychiatric disorder, 23 (9.2%) had a substance use disorder, and 86 (34.3%) had both. Thirteen patients (5.2%) had no psychiatric disorder or substance use disorder and the majority 10 (76.9%) were on involuntary holds due to suicidal threats related to pain or another medical problem. Patients without a psychiatric or substance use disorder were older (55 years [17.8] vs 42 [19]; P = 0.01), more likely to be married (10 [76.9%] vs 64 [26.9%]; P < 0.001), and had more medical comorbidities (10 [76.9%] vs 114 [47.9%]; P = 0.049) compared with those without a psychiatric or substance use disorder. Conclusion Patients on involuntary holds most commonly have pre-existing psychiatric disorder including substance use disorder. Patients on involuntary holds without history of psychiatric disorder often have severe pain or other active medical conditions which may contribute to suicidal thoughts. Addressing these underlying medical issues may be crucial in preventing further psychiatric decompensation.
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Dugani SB, Geyer HL, Maniaci MJ, Schenzel HA, Burton MC. Perspectives on and barriers to research among advanced practice provider and physician hospitalists. Nurse Pract 2020; 45:41-47. [PMID: 32826539 DOI: 10.1097/01.npr.0000694720.63033.a5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Advanced practice providers and physicians at an academic healthcare system comprising more than 15 hospitals across four US states were surveyed to identify barriers to participation in research. Overall, barriers reported by advanced practice providers and physicians were more similar than different, highlighting system-level opportunities to build research skills and accelerate academic productivity.
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Dugani SB, Geyer HL, Maniaci MJ, Burton MC. Perception of barriers to research among internal medicine physician hospitalists by career stage. Hosp Pract (1995) 2020; 48:206-212. [PMID: 32510254 DOI: 10.1080/21548331.2020.1779537] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Physician hospitalists may participate in research and generate knowledge for evidence-based hospital practice. Despite this, physician hospitalists are primarily involved in patient care, and there is sparse information on barriers for their participation in research and if these barriers differ by career stage. METHODS We conducted a survey of physician hospitalists at Mayo Clinic sites based in four states (Arizona, Florida, Minnesota, and Wisconsin). We surveyed physician hospitalists on demographics, academic rank, current research skills, barriers for participation in research, and research skills they aspire to acquire. Responses were summarized using descriptive statistics and categorized by early-career (<10 years), mid-career (10-20 years), and later-career (≥20 years) stages at Mayo Clinic. The survey was conducted from March to April 2019. RESULTS Of 188 physician hospitalists, there was a 52% response rate with 71% in early career, 21% mid-career, and 7% late career, with 39% female. Physician hospitalists at early-career (90%), mid-career (76%), and later-career (71%) stages were interested in participating in research. Among physician hospitalists with ≤3 peer-reviewed publications, barriers for participation in research included lack of mentorship, time, research skills, and funding. Among physician hospitalists with ≥4 peer-reviewed publications, factors for research success included mentorship (89% early-career, 38% mid-career, 75% later-career; p = 0.002) and membership in a research team. Compared to mid- and later-career physician hospitalists, a higher proportion of early-career hospitalists was interested in acquiring skills to both critically review the literature (70% early-career, 43% mid-career, 0% later-career; p = 0.006) and write manuscripts (86% early-career, 57% mid-career, 50% later-career; p = 0.02); there was generally similar interest across career stages to acquire skills to conduct literature searches and write grants. CONCLUSION The generally similar responses from physician hospitalists across career stages highlight system-level opportunities to increase research mentorship, promote the acquisition of research skills, and reduce barriers for participation in research.
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Affiliation(s)
- Sagar B Dugani
- Division of Hospital Internal Medicine, Mayo Clinic , Rochester, MN, USA
| | - Holly L Geyer
- Division of Hospital Internal Medicine, Mayo Clinic , Scottsdale, AZ, USA
| | - Michael J Maniaci
- Division of Hospital Internal Medicine, Mayo Clinic , Jacksonville, FL, USA
| | - M Caroline Burton
- Division of Hospital Internal Medicine, Mayo Clinic , Rochester, MN, USA
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Boniface MP, Helgeson SA, Cowdell JC, Simon LV, Hiroto BT, Werlang ME, Robison SW, Edwards GG, Lewis MD, Maniaci MJ. A Longitudinal Curriculum In Point-Of-Care Ultrasonography Improves Medical Knowledge And Psychomotor Skills Among Internal Medicine Residents. Adv Med Educ Pract 2019; 10:935-942. [PMID: 31807108 PMCID: PMC6839571 DOI: 10.2147/amep.s220153] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 10/23/2019] [Indexed: 05/29/2023]
Abstract
PURPOSE Despite its growing popularity and clinical utility among hospital-based physicians, there are no formal competency requirements nor training standards for United States based Internal Medicine Residencies for learning point-of-care ultrasonography (POCUS). The purpose of this investigation was to study the impact and effectiveness of a novel POCUS curriculum for an Internal Medicine (IM) residency program. PATIENTS AND METHODS This was a Single-Group Educational Quasi-Experiment involving Categorical and Preliminary Internal Medicine Residents in Post-Graduate Years 1 through 3 at a single United States academic tertiary center. The study period was from January 1, 2017, through June 30, 2017, during which time the residents participated in monthly modules including didactics and hands-on ultrasound scanning skills with live models. Participants completed a comprehensive knowledge examination at the beginning and end of the six-month period. Participants were also tested regarding hands-on image acquisition and interpretation immediately before and after the hands-on skills labs. The primary outcome measure was performance improvement in a comprehensive medical knowledge assessment. RESULTS In total, 42 residents consented for participation. The residents' monthly rotations were adjusted in order to accommodate the new educational process. Among 29 participants with complete data sets for analysis, the mean (SD) comprehensive knowledge examination score improved from 60.9% before curriculum to 70.2% after curriculum completion (P<0.001). Subgroup analysis determined that improvement in medical knowledge required attending at least 2 out of the 6 (33%) educational sessions. Attendance at hands-on skills labs correlated significantly with improvement; didactics alone did not. CONCLUSION A longitudinal POCUS curriculum consisting of both didactic sessions and hands-on skills labs improves knowledge, image acquisition, and interpretation skills of residents. Having this curriculum span at least 6 months provides learners the opportunity to attend multiple classes which strengthens learning through repetition while also providing learners flexibility in schedule.
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Affiliation(s)
| | - Scott A Helgeson
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Jed C Cowdell
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Leslie V Simon
- Department of Emergency Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Brett T Hiroto
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Monia E Werlang
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Sarah W Robison
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Grace G Edwards
- Department of Education, Mayo Clinic, Jacksonville, FL, USA
- The Mayo Clinic School of Health Sciences, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Michele D Lewis
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL, USA
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Maniaci MJ, Dawson NL, Cowart JB, Richie EM, Suryaprasad AG, Hodge DO, Joyce NE, Kernan CA, Stone LA, Burton MC. Goal-Directed Achievement Through Geographic Location (GAGL) Reduces Patient Length of Stay and Adverse Events. Am J Med Qual 2019; 35:323-329. [PMID: 31581786 DOI: 10.1177/1062860619879977] [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] [Indexed: 11/15/2022]
Abstract
This prospective cohort study aimed to improve hospital outcomes through geographic location of hospitalist patients and conducting daily multidisciplinary team rounds-Goal-directed Achievements through Geographic Location (GAGL). Patients were admitted to a geographic (GAGL) study unit where daily multidisciplinary rounds took place among nursing, case management, a hospitalist, pharmacy, physical and occupational therapy, respiratory therapy, and nutrition services. A total of 985 (56.4%) patients were admitted to the GAGL study unit and 760 patients (43.6%) were admitted to non-GAGL units. Patients admitted to the GAGL study unit had a shorter average length of stay (3.64 days vs 4.35 days, P = .0001) and a lower number of risk events (91 [9.2%] vs 93 [12.2%], P = .038). There was no significant difference in 30-day readmissions, avoidable day events, or code blue team activations. GAGL provides a framework for hospital organizations to improve provider communication, hospital efficiency, and patient safety.
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Maniaci MJ, Burton MC, Lachner C, Vadeboncoeur TF, Dawson NL, Roy A, Dumitrascu AG, Lewis PC, Rummans TA. Patients Threatening Harm to Others Evaluated in the Emergency Department under the Florida Involuntary Hold Act (Baker Act). South Med J 2019; 112:463-468. [PMID: 31485582 DOI: 10.14423/smj.0000000000001019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES This study describes the specific threats of harm to others that led to the use of the Baker Act, the Florida involuntary hold act for emergency department (ED) evaluations. The study also summarizes patient demographics, concomitant psychiatric diagnoses, and emergent medical problems. METHODS This is a retrospective review of 251 patients evaluated while on involuntary hold from January 1, 2014 through November 30, 2015 at a suburban acute care hospital ED. The data that were collected included demographic information, length of stay, reason for the involuntary hold, psychiatric disorder, substance use, medical illness, and violence in the ED. The context of the homicidal threat also was collected. RESULTS We found that 13 patients (5.2%) were homicidal. Three patients had homicidal ideations alone, whereas 10 made homicidal threats toward others. Of the 10 making homicidal threats, 7 named a specific person to harm. Ten of the 13 homicidal patients (76.9%) also were suicidal. Eleven patients (84.6%) had a psychiatric disorder: 9 patients (69.2%) had a depressive disorder and 8 patients (61.5%) had a substance use disorder. Eight patients had active medical problems that required intervention in the ED. CONCLUSIONS We found that three-fourths of patients expressing homicidal threats also were suicidal. The majority of patients making threats of harm had a specific plan of action to carry out the threat. It is important to screen any patient making homicidal threats for suicidal ideation. If present, there is a need to implement immediate management appropriate to the level of the suicidal threat, for the safety of the patient. Eighty-five percent of patients making a homicidal threat had a previously documented psychiatric disorder, the most common being a depressive disorder. This finding differs from previous studies in which psychosis predominated. More than 60% of homicidal patients had an unrelated medical disorder requiring intervention. It is important not to overlook these medical disorders while focusing on the psychiatric needs of the patient; most of our homicidal patients proved to be cooperative in the ED setting.
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Affiliation(s)
- Michael J Maniaci
- From the Division of Hospital Internal Medicine, the Division of Psychiatry, and the Department of Emergency Medicine, Mayo Clinic, Jacksonville, Florida, and the Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
| | - M Caroline Burton
- From the Division of Hospital Internal Medicine, the Division of Psychiatry, and the Department of Emergency Medicine, Mayo Clinic, Jacksonville, Florida, and the Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
| | - Christian Lachner
- From the Division of Hospital Internal Medicine, the Division of Psychiatry, and the Department of Emergency Medicine, Mayo Clinic, Jacksonville, Florida, and the Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
| | - Tyler F Vadeboncoeur
- From the Division of Hospital Internal Medicine, the Division of Psychiatry, and the Department of Emergency Medicine, Mayo Clinic, Jacksonville, Florida, and the Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
| | - Nancy L Dawson
- From the Division of Hospital Internal Medicine, the Division of Psychiatry, and the Department of Emergency Medicine, Mayo Clinic, Jacksonville, Florida, and the Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
| | - Archana Roy
- From the Division of Hospital Internal Medicine, the Division of Psychiatry, and the Department of Emergency Medicine, Mayo Clinic, Jacksonville, Florida, and the Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
| | - Adrian G Dumitrascu
- From the Division of Hospital Internal Medicine, the Division of Psychiatry, and the Department of Emergency Medicine, Mayo Clinic, Jacksonville, Florida, and the Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
| | - Patricia C Lewis
- From the Division of Hospital Internal Medicine, the Division of Psychiatry, and the Department of Emergency Medicine, Mayo Clinic, Jacksonville, Florida, and the Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
| | - Teresa A Rummans
- From the Division of Hospital Internal Medicine, the Division of Psychiatry, and the Department of Emergency Medicine, Mayo Clinic, Jacksonville, Florida, and the Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
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Vijapura P, Maniaci MJ. Intracranial Hemorrhage following Lumbar Puncture in a Patient on Apixaban. Case Rep Neurol 2019; 11:277-283. [PMID: 31607894 PMCID: PMC6787409 DOI: 10.1159/000502735] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 08/06/2019] [Accepted: 08/15/2019] [Indexed: 11/19/2022] Open
Abstract
Currently, clinical practice recommendations regarding patients in need of emergent lumbar puncture who are taking direct oral anticoagulants (DOACs) are based upon expert opinion, as evidence-based guidelines are unavailable. We present the case of an 80-year-old Caucasian lady who underwent diagnostic lumbar puncture for presumed meningitis while on therapeutic apixaban for nonvalvular atrial fibrillation. She was subsequently found to have bilateral subdural hematomas. This case report reviews both the current criteria for computerized tomography brain imaging prior to lumbar puncture as well as the bleeding risks of lumbar puncture while on a DOAC.
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Affiliation(s)
- Priyanka Vijapura
- Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Michael J Maniaci
- Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, Florida, USA
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Abstract
Background An increasing number of residents and fellows have children during training. However, little is known about the specific experience of cardiology fellows who become parents during training. Methods and Results A 66‐question Internet‐based survey about experiences of pregnancy during graduate medical training was administered between May 1 and July 15, 2013, to all trainees (N=1516) in the Mayo School of Graduate Medical Education across 3 academic sites. Questions explored the experiences of new mothers, fathers, and their fellow trainees. There were 644 survey respondents overall (response rate, 42%), and of 73 cardiovascular trainees, 29 (10 women [35%]) completed the survey. Of those surveyed, 59% reported having children. All trainee mothers reported making alterations to their training schedule due to pregnancy and maternity leave. Twenty percent of trainee fathers also reported changing their training because of their partner's pregnancy. Of trainees with children, 41% reported difficulty completing research because of pregnancy and childcare obligations. Nontrainee mothers were significantly more likely to breastfeed beyond 6 months compared with trainee mothers (P=0.018). A perceived stigma attached to pregnancy was reported by 62% of trainees. Both male and female trainees felt that their programs did not promote pregnancy‐related schedule flexibility. Conclusions Our study shows that both men and women entering parenthood during cardiology training often have to change their schedule, research, and career path. Cardiology training programs should focus on curriculum design and supportive parenthood policies to both avoid negative stigma and optimize fellowship training during this time period. See Editorial Jarvie and Levy
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Affiliation(s)
| | | | | | - Janis E Blair
- 3 Department of Internal Medicine Mayo Clinic Scottsdale AZ
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Young AK, Maniaci MJ, Simon LV, Lowman PE, McKenna RT, Thomas CS, Cochuyt JJ, Vadeboncoeur TF. Use of a simulation-based advanced resuscitation training curriculum: Impact on cardiopulmonary resuscitation quality and patient outcomes. J Intensive Care Soc 2019; 21:57-63. [PMID: 32284719 DOI: 10.1177/1751143719838209] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Despite a continued focus on improved cardiopulmonary resuscitation quality, survival remains low from in-hospital cardiac arrest. Advanced Resuscitation Training has been shown to improve survival to hospital discharge and survival with good neurological outcome following in-hospital cardiac arrest at its home institution. We sought to determine if Advanced Resuscitation Training implementation would improve patient outcomes and cardiopulmonary resuscitation quality at our institution. Methods This was a prospective, before-after study of adult in-hospital cardiac arrest victims who had cardiopulmonary resuscitation performed. During phase 1, standard institution cardiopulmonary resuscitation training was provided. During phase 2, providers received the same quantity of training, but with emphasis on Advanced Resuscitation Training principles. Primary outcomes were return of spontaneous circulation, survival to hospital discharge, and neurologically favorable survival. Secondary outcomes were cardiopulmonary resuscitation quality parameters. Results A total of 156 adult in-hospital cardiac arrests occurred during the study period. Rates of return of spontaneous circulation improved from 58.1 to 86.3% with an adjusted odds ratios of 5.31 (95% CI: 2.23-14.35, P < 0.001). Survival to discharge increased from 26.7 to 41.2%, adjusted odds ratios 2.17 (95% CI: 1.02-4.67, P < 0.05). Survival with a good neurological outcome increased from 24.8 to 35.3%, but was not statistically significant. Target chest compression rate increased from 30.4% of patients in P1 to 65.6% in P2, adjusted odds ratios 4.27 (95% CI: 1.72-11.12, P = 0.002), and target depth increased from 23.2% in P1 to 46.9% in P2, adjusted odds ratios 2.92 (95% CI: 1.16-7.54, P = 0.024). Conclusions After Advanced Resuscitation Training implementation, there were significant improvements in cardiopulmonary resuscitation quality and rates of return of spontaneous circulation and survival to discharge.
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Affiliation(s)
- Amanda K Young
- Department of Emergency Medicine, University of Arkansas for Medical Sciences, Little Rock, AK, USA
| | - Michael J Maniaci
- Division of Hospital Internal Medicine, Mayo Clinic in Florida, Jacksonville, FL, USA
| | - Leslie V Simon
- Department of Emergency Medicine, Mayo Clinic in Florida, Jacksonville, FL, USA
| | - Philip E Lowman
- Department of Critical Care Medicine, Mayo Clinic in Florida, Jacksonville, FL, USA
| | - Ryan T McKenna
- Division of Emergency Medicine, University of South Florida Morsani College of Medicine and Team Health, Tampa, FL, USA
| | - Colleen S Thomas
- Department of Health Sciences Research Mayo Clinic in Florida, Jacksonville, FL, USA
| | - Jordan J Cochuyt
- Department of Health Sciences Research Mayo Clinic in Florida, Jacksonville, FL, USA
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Roy A, Lachner C, Dumitrascu A, Dawson NL, Vadeboncoeur TF, Maniaci MJ, Lamoureux IC, Lewis PC, Rummans TA, Burton MC. Patients on Involuntary Hold Status in the Emergency Department. South Med J 2019; 112:265-270. [DOI: 10.14423/smj.0000000000000968] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Heckman AJ, Alsaad AA, Stewart MW, Maniaci MJ. Acute Unilateral Vision Loss Due to Optic Neuropathy in a Patient with Systemic Lupus Erythematosus. Am J Case Rep 2019; 20:97-100. [PMID: 30670677 PMCID: PMC6350674 DOI: 10.12659/ajcr.912875] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Patient: Female, 44 Final Diagnosis: Optic neuritis Symptoms: Unilateral vision loss Medication: — Clinical Procedure: Fundoscopic examination Specialty: Ophthalmology
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Affiliation(s)
- Alexander J Heckman
- Department of Internal Medicine, Mayo Clinic in Florida, Jacksonville, FL, USA
| | - Ali A Alsaad
- Department of Internal Medicine, Mayo Clinic in Florida, Jacksonville, IL, USA.,Department of Internal Medicine, Division of Cardiology, University of Chicago, NorthShore University, Evanston, FL, USA
| | - Michael W Stewart
- Department of Ophthalmology, Mayo Clinic in Florida, Jacksonville, FL, USA
| | - Michael J Maniaci
- Department of Internal Medicine, Mayo Clinic in Florida, Jacksonville, FL, USA
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Helgeson SA, Heckman AJ, McCain JD, Cowart JB, Maniaci MJ, Garland JL. A 32-year-old man with hypoxemia and bilateral upper-lobe predominant ground-glass infiltrates on chest imaging. Oxf Med Case Reports 2018; 2018:omy072. [PMID: 30302263 PMCID: PMC6169198 DOI: 10.1093/omcr/omy072] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 07/03/2018] [Accepted: 07/17/2018] [Indexed: 11/27/2022] Open
Abstract
Diffuse alveolar hemorrhage (DAH) is a rare, but potentially fatal, complication of antiphospholipid syndrome, and may present with acute and fulminant symptoms. We report a case of DAH presenting as sudden onset dyspnea in a gentleman with known antiphospholipid syndrome. Chest computed tomography angiography with pulmonary embolism protocol showed right lower lobe segmental filling defects, upper-lobe predominant diffuse ground-glass opacities, and centrilobular nodules bilaterally. The presence of DAH can be confirmed by bronchoalveolar lavage with serial aliquots, but this procedure typically does not elucidate the specific etiology for the hemorrhage. The treatment for patients with severe disease typically consists of a combination of immunosuppressive medications in the form of high-dose intravenous glucocorticoids plus rituximab, cyclophosphamide or mycophenolate; and/or plasma exchange. This case both provides an example of high-quality diagnostic imaging of diffuse alveolar hemorrhage as well as demonstrates the clinical and image-based improvement after treatment.
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Halawa A, Burton MC, Maniaci MJ, Shapiro BP, Yip DS, Hodge DO, Vargas ER, Dawson N. Association of Anemia with Outcomes of Acute Heart Failure. South Med J 2018; 111:103-108. [PMID: 29394427 DOI: 10.14423/smj.0000000000000767] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Anemia is common in patients presenting with acute congestive heart failure (CHF); when hemoglobin (HGB) declines to low levels, it can result in worse outcomes. The aim of this study was to determine a level of HGB on admission or discharge that affects outcomes in patients with CHF and then to evaluate the effect of the low HGB levels on these outcomes. METHODS We conducted a retrospective cohort study of 756 patients admitted with acute CHF during the period January 1, 2011-December 31, 2014. We used multivariable regression analysis to evaluate the relation among HGB levels and three major outcomes: 3-year mortality, 30-day readmission rate, and length of stay (LOS). RESULTS Compared with patients with HGB ≥10 g/dL, patients with HGB <10 g/dL on discharge from the hospital had higher mortality (3-year survival 46% vs 33%, P = 0.023) and 30-day readmission rates (23% vs 14%; P = 0.008) and increased LOS (4.8 vs 3.2 days, P < 0.001). Patients with admission HGB <10 g/dL had higher mortality rates (3-year survival 45% vs 32%, P = 0.019) and increased LOS (4.5 vs 3.4 days, P = 0.014). A lower admission HGB value was associated with higher 30-day readmission rates, but it was not statistically significant (P = 0.06). CONCLUSIONS An HGB level <10 g/dL on admission or discharge in patients hospitalized with acute CHF is associated with a significantly worse outcome.
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Affiliation(s)
- Ahmad Halawa
- From the Division of Cardiovascular Medicine, University of Missouri, Columbia, Missouri, and the Division of Cardiovascular Diseases and Department of Biomedical Statistics, Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, Florida
| | - M Caroline Burton
- From the Division of Cardiovascular Medicine, University of Missouri, Columbia, Missouri, and the Division of Cardiovascular Diseases and Department of Biomedical Statistics, Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, Florida
| | - Michael J Maniaci
- From the Division of Cardiovascular Medicine, University of Missouri, Columbia, Missouri, and the Division of Cardiovascular Diseases and Department of Biomedical Statistics, Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, Florida
| | - Brian P Shapiro
- From the Division of Cardiovascular Medicine, University of Missouri, Columbia, Missouri, and the Division of Cardiovascular Diseases and Department of Biomedical Statistics, Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, Florida
| | - Daniel S Yip
- From the Division of Cardiovascular Medicine, University of Missouri, Columbia, Missouri, and the Division of Cardiovascular Diseases and Department of Biomedical Statistics, Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, Florida
| | - David O Hodge
- From the Division of Cardiovascular Medicine, University of Missouri, Columbia, Missouri, and the Division of Cardiovascular Diseases and Department of Biomedical Statistics, Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, Florida
| | - Emily R Vargas
- From the Division of Cardiovascular Medicine, University of Missouri, Columbia, Missouri, and the Division of Cardiovascular Diseases and Department of Biomedical Statistics, Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, Florida
| | - Nancy Dawson
- From the Division of Cardiovascular Medicine, University of Missouri, Columbia, Missouri, and the Division of Cardiovascular Diseases and Department of Biomedical Statistics, Division of Hospital Internal Medicine, Mayo Clinic, Jacksonville, Florida
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Dawson NL, Lachner C, Vadeboncoeur TF, Maniaci MJ, Bosworth V, Rummans TA, Roy A, Burton MC. Violent behavior by emergency department patients with an involuntary hold status. Am J Emerg Med 2018; 36:392-395. [DOI: 10.1016/j.ajem.2017.08.039] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 07/19/2017] [Accepted: 08/17/2017] [Indexed: 10/19/2022] Open
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