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Huang J, Mazer CD, Boisen ML, Tibi P, Baker RA, Chu D, Moffatt-Bruce S, Shore-Lesserson L. Safety of Andexanet Alfa Use in Cardiac Surgery. J Cardiothorac Vasc Anesth 2023; 37:1332-1334. [PMID: 36997371 PMCID: PMC10858990 DOI: 10.1053/j.jvca.2023.02.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 02/21/2023] [Accepted: 02/25/2023] [Indexed: 03/07/2023]
Affiliation(s)
- Jiapeng Huang
- Department of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY.
| | - C David Mazer
- Department of Anesthesia, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Michael L Boisen
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Pierre Tibi
- Department of Cardiovascular Surgery, Yavapai Regional Medical Center, Prescott, AZ
| | - Robert A Baker
- Cardiac and Thoracic Surgery Quality and Outcomes Unit, and Perfusion, Flinders Medical Centre and Flinders University Adelaide, South Australia, Australia
| | - Danny Chu
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Susan Moffatt-Bruce
- Division of Thoracic Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Linda Shore-Lesserson
- Department of Anesthesiology, Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, Manhasset, NY
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Gilmore D, Harris L, Hanks C, Coury D, Moffatt-Bruce S, Garvin JH, Hand BN. "Giving the patients less work": A thematic analysis of telehealth use and recommendations to improve usability for autistic adults. Autism 2023; 27:1132-1141. [PMID: 36325713 PMCID: PMC10101865 DOI: 10.1177/13623613221132422] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
LAY ABSTRACT Real-time telehealth visits, called "virtual visits," are live video chats between patients and healthcare professionals. There are lots of steps involved in setting up a virtual visit, which may be difficult for some autistic adults. We interviewed 7 autistic adults, 12 family members of autistic adults, and 6 clinic staff from one clinic in the United States. Our goal was to understand their experiences with virtual visits and see how we can make virtual visits easier to use. We re-read text from the interviews to organize experiences and advice that was shared into topics. We found that autistic adults (or their family members) had to connect with clinic staff many times by phone or online over several days to set up a virtual visit. Participants said that having more experience with technology and using the online patient portal made virtual visits easier to use. But, having issues with technology before the visit could make autistic adults and family members anxious. Clinic staff said it was hard for them to meet the needs of people who were using virtual visits and those who were being seen in person at the clinic. Participants recommended reducing the number of calls between staff and autistic adults or family members using the online patient portal instead. Participants also recommended reminder messages, instruction videos, and approximate wait-times to help autistic adults and family members know what to expect for the virtual visit. Our results are based on peoples' experiences at one clinic, but could help other clinics make virtual visits easier to use for autistic adults and their family members.
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Affiliation(s)
| | | | - Christopher Hanks
- The Ohio State University, USA
- Center for Autism Services and Transition, The Ohio State University, USA
| | - Daniel Coury
- The Ohio State University, USA
- Nationwide Children’s Hospital, USA
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Moffatt-Bruce S. Discussion. J Thorac Cardiovasc Surg 2022:S0022-5223(22)01241-7. [DOI: 10.1016/j.jtcvs.2022.10.053] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Goff L, St. Croix R, Jing JW, Ferri D, Sivanathan M, Harris C, Pelletier F, Bénard F, Sédillot-Daniel È, Fleiszer D, Bhandari A, White A, Shah A, Zhang Y, Akbari P, Fugaru I, Aggarwal I, Zhang Y, Gold MS, Belliveau S, Lai C, Daud A, Hamdan NA, Carr L, Fazlollahi AM, Retrosi G, Del Fernandes R, Roberts S, Botelho F, Micallef J, Rathagirishnan R, Stachura N, Grewal K, Yilmaz R, Mahmood S, Tee T, Qiu R, Hindi MN, AlTinawi B, Qiu R, Tanya SM, Greene H, Munn A, Furey A, Smith N, Moffatt-Bruce S, Lefebvre G, Harvey EJ, Reindl R, Al Badi H, Berry GK, Martineau PA, Koucheki R, Lex JR, Morozova A, Hauer TM, Mirzaie S, Ferguson PC, Ballyk B, Micallef J, Franco LY, Drennan IR, Button D, Dubrowski A, Thorburn C, Skanes C, Kennedy R, Smith C, Torres A, Meloche-Dumas L, Guérard-Poirier N, Kaviani A, Kapralos B, Mercier F, Dubrowski A, Patocskai E, Habti M, Meloche-Dumas L, Bérubé S, Cadoret D, Arutiunian A, Papas Y, Torres A, Kapralos B, Mercier F, Dubrowski A, Patocskai E, Melkane A, Chiesa C, Fakhry N, Young V, Smith L, Lechien J, Guertin L, Olivier MJ, Maniakas A, Jun Lin R, Bissada É, Christopoulos A, Ayad T, Leclerc AA, Posel N, Rosenzveig A, Gariscsak P, Kemp L, Haji F, Reid A, Sidhu S, Moon M, Turner S, Zheng B, Wolfstadt JI, Hall J, Ward S, Jad A, Yee N, Ross TD, Ferguson P, Zheng B, Valiquette C, Brathwaite S, Hawley G, Martou G, Hendry M, Schouela V, Aubé-Peterkin M, Kemp L, Winthrop A, Zheng B, Belliveau S, Gold M, Lui JT, de Lotbiniere-Bassett M, Chen JM, Lin VY, Agrawal SK, Blevins NH, Ladak HM, Pirouzmand F, Hauer T, Wolfstadt J, Ferguson P, Almansouri A, Yilmaz R, Eskandari M, Tee T, Agu C, Pachchigar P, Giglio B, Balasubramniam N, Gueziri HE, Del Maestro R, McKechnie T, Hatamnejad A, Chan J, Beattie A, Yilmaz R, Alsayegh A, Bakhaidar M, Del Maestro RF, Dharamsi N, de Vries I, Mann S, McEwen L, Phillips T, Zevin B, Robart A, Brennan H, Conway J, Patey C, Harley J, Poenaru D, Sivanathan M, Clarke K, Habti M, Roy MÈ, Bedwani S, Patocskai É, Dubrowski A, Valiquette C, Zhu J, Adibfar A, Snell L, Nayak R, Malthaner R, Fortin D, Inculet R, Qiabi M, Azher S, Moreno M, Melo LP, Pekrun R, Wiseman J, Fried GM, Lajoie S, Brydges R, Hadwin A, Sun NZ, Khalil E, Harley JM, Bakhaidar M, Alsayegh A, Hamdan NA, Fazlollahi AM, Agu C, Pachchigar P, Del Maestro R, Almas S, Ryan J, Anderson B, Pachchigar P, Tarabay B, Yilmaz R, Del Maestro R, Lan L, Mao R, Kay J, Darren de SA, Blair G, Noorani A, Noorani S, Mak M, Ibrahim G, Hodaie M, van Kampen K, Domerchie E, Farrugia P, Joly-Chevrier M, Nguyen AXL, Pur DR, Power RJ, Sharma S, Costello F, Kherani F. C-CASE 2022: Competence to Excellence01. The Queen Bee phenomenon in Canadian surgical subspecialties: an evaluation of gender biases in the resident training environment02. Barriers to surgical peer coaching — What have we learned, and where do we go from here?03. Shared decision-making and evidence-based medicine: Pivotal or trivial to patient care in orthopedic trauma?04. Immersive virtual reality and cadaveric bone are equally effective in skeletal anatomy education: a randomized crossover noninferiority trial05. Development of simulators for decentralized simulation-based education IO training using design thinking and Delphi — a novel approach06. The impact of feedback on laparoscopic skills for surgical residents during COVID-1907. The role of collaborative feedback and remote practice in the acquisition of suturing skills by medical students at Université de Montréal08. Efficacy testing of an affordable and realistic small bowel simulator for hand-sewn anastomosis09. The LASER rating scale: a new teaching tool in otolaryngology10. Virtual patient case simulations: their role in undergraduate and postgraduate surgical training11. Evaluating the effectiveness of video-assisted informed consent in surgery: a systematic review12. Communication patterns in the cardiac surgery operating room are affected by task difficulty: a simulation model13. Improving adherence to postcall departure guidelines in orthopedics: a quality-improvement initiative14. Increasing familiarity among team members helps to reduce laparoscopic procedure time15. The effectiveness of a self-directed online learning module on trainee knowledge and confidence during plastic surgery clinical rotations16. Implementing an orientation handbook before a surgical rotation in urology17. An examination of equity-related experiences of surgical trainees at academic centres across Ontario: design of a targeted needs assessment18. Viewing differences between experts and trainees: implication for surgical education19. Assessment of medical student exposure to and satisfaction with surgical subspecialty education20. Assessment of student exposure to climate impacts of surgical personal protective equipment in the undergraduate medical curriculum21. Virtual reality simulation for the middle cranial fossa approach — a face, content and construct validation study22. Evaluating the Canadian Orthopaedic Surgery Medical Education Course (COSMEC)23. Subpial resection in a novel ex vivo calf brain epilepsy simulation model24. Effectiveness of the Eyesi augmented reality simulator for ophthalmology trainees: a systematic review and meta-analysis25. Learning beyond the objectives: an evidence-based analysis of AI-selected competencies in surgical simulation training26. Virtual compared with in-person surgical grand rounds: participants’ perceptions, preferences and directions for the future27. Quality of narrative feedback for entrustable professional activities assessed in the operating room: analysis of 4. years of assessments in the surgical foundations curriculum at Queen’s University28. SimOscopy: an accessible 3D-printed and laser-cut laparoscopic surgical simulator developed for a mobile device29. A debriefing tool to acquire nontechnical skills in trauma courses30. Capacity building using a hub-and-spokes model to produce customizable simulators for surgical education31. Exploring skin tone diversity in a plastic surgery resident education curriculum32. Video-based assessments of thoracic surgery trainees’ operative skills as adjuncts in competency-based medical education33. How do you feel? An examination of team leaders’ and members’ emotions in surgical simulations34. Comparing the efficacy of a real-time intelligent coaching system to human expert instruction in surgical technical skills training: randomized controlled trial35. Empowering women to pursue surgery: launching a pilot gender-congruent mentorship program for medical students36. Affective and cognitive responses to a virtual reality spine simulator37. Immersive virtual reality for patient-specific preoperative planning: a systematic review38. The categorization of surgical problems by junior and senior medical students39. The application of microlearning modules in surgical education to enhance procedural skills and surgical training40. Authorship gender disparity and trends in female authorship in 5 high-impact orthopedic journals from 2002 to 202241. The landscape of Canadian academic surgery: analysis of gender representation, academic rank, and research productivity. Can J Surg 2022. [DOI: 10.1503/cjs.014622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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McAlearney AS, Walker DM, Sieck CJ, Fareed N, MacEwan SR, Hefner JL, Di Tosto G, Gaughan A, Sova LN, Rush LJ, Moffatt-Bruce S, Rizer MK, Huerta TR. Effect of In-Person vs Video Training and Access to All Functions vs a Limited Subset of Functions on Portal Use Among Inpatients: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2231321. [PMID: 36098967 PMCID: PMC9471980 DOI: 10.1001/jamanetworkopen.2022.31321] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/22/2022] [Indexed: 11/14/2022] Open
Abstract
Importance Inpatient portals provide patients with clinical data and information about their care and have the potential to influence patient engagement and experience. Although significant resources have been devoted to implementing these portals, evaluation of their effects has been limited. Objective To assess the effects of patient training and portal functionality on use of an inpatient portal and on patient satisfaction and involvement with care. Design, Setting, and Participants This randomized clinical trial was conducted from December 15, 2016, to August 31, 2019, at 6 noncancer hospitals that were part of a single health care system. Patients who were at least 18 years of age, identified English as their preferred language, were not involuntarily confined or detained, and agreed to be provided a tablet to access the inpatient portal during their stay were eligible for participation. Data were analyzed from May 1, 2019, to March 15, 2021. Interventions A 2 × 2 factorial intervention design was used to compare 2 levels of a training intervention (touch intervention, consisting of in-person training vs built-in video tutorial) and 2 levels of portal function availability (tech intervention) within an inpatient portal (all functions operational vs a limited subset of functions). Main Outcomes and Measures The primary outcomes were inpatient portal use, measured by frequency and comprehensiveness of use, and patients' satisfaction and involvement with their care. Results Of 2892 participants, 1641 were women (56.7%) with a median age of 47.0 (95% CI, 46.0-48.0) years. Most patients were White (2221 [76.8%]). The median Charlson Comorbidity Index was 1 (95% CI, 1-1) and the median length of stay was 6 (95% CI, 6-7) days. Notably, the in-person training intervention was found to significantly increase inpatient portal use (incidence rate ratio, 1.34 [95% CI, 1.25-1.44]) compared with the video tutorial. Patients who received in-person training had significantly higher odds of being comprehensive portal users than those who received the video tutorial (odds ratio, 20.75 [95% CI, 16.49-26.10]). Among patients who received the full-tech intervention, those who also received the in-person intervention used the portal more frequently (incidence rate ratio, 1.36 [95% CI, 1.25-1.48]) and more comprehensively (odds ratio, 22.52; [95% CI, 17.13-29.62]) than those who received the video tutorial. Patients who received in-person training had higher odds (OR, 2.01 [95% CI, 1.16-3.50]) of reporting being satisfied in the 6-month postdischarge survey. Similarly, patients who received the full-tech intervention had higher odds (OR, 2.06 [95%CI, 1.42-2.99]) of reporting being satisfied in the 6-month postdischarge survey. Conclusions and Relevance Providing in-person training or robust portal functionality increased inpatient engagement with the portal during the hospital stay. The effects of the training intervention suggest that providing personalized training to support use of this health information technology can be a powerful approach to increase patient engagement via portals. Trial Registration ClinicalTrials.gov Identifier: NCT02943109.
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Affiliation(s)
- Ann Scheck McAlearney
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus
- Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus
| | - Daniel M. Walker
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus
- Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus
| | - Cynthia J. Sieck
- Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus
- Dayton Children’s Hospital Center for Health Equity, Dayton, Ohio
| | - Naleef Fareed
- Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus
| | - Sarah R. MacEwan
- Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus
- Division of General Internal Medicine, College of Medicine, The Ohio State University, Columbus
| | - Jennifer L. Hefner
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus
| | - Gennaro Di Tosto
- Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus
| | - Alice Gaughan
- Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus
| | - Lindsey N. Sova
- Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus
| | - Laura J. Rush
- Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus
| | | | - Milisa K. Rizer
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus
| | - Timothy R. Huerta
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus
- Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus
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Alain G, Gilmore D, Krantz M, Hanks C, Coury DL, Moffatt-Bruce S, Garvin JH, Hand BN. Expenditures and Healthcare Utilization of Patients Receiving Care at a Specialized Primary Care Clinic Designed with and for Autistic Adults. J Gen Intern Med 2022; 37:2413-2419. [PMID: 34990000 PMCID: PMC9360285 DOI: 10.1007/s11606-021-07180-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 09/28/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND We previously found that autistic adults who received care through a primary care embedded specialized clinic, called the Center for Autism Services and Transition (CAST), had higher satisfaction, continuity of care, and preventive care use than national samples of autistic adults. OBJECTIVE Examine the impact of CAST on healthcare utilization and expenditures. DESIGN Retrospective study of medical billing data. SAMPLE CAST patients (N = 490) were propensity score matched to Medicare-enrolled autistic adults (N = 980) and privately insured autistic adults (N = 980) using demographic characteristics. The median age of subjects was 21 years, 79% were male, and the median duration of observation was 2.2 years. MAIN MEASURES We quantified expenditures and utilization for primary care; emergency department (ED) visits; inpatient hospitalizations; mental health admissions; and outpatient visits. KEY RESULTS CAST patients had the highest primary care utilization and expenditures. However, CAST patients had significantly lower expenditures than Medicare-enrolled autistic adults for mental health admissions ($1074 vs $1903), outpatient visits ($1671 vs $2979), and total expenditures ($5893 vs $6987), as well as 57% fewer inpatient hospitalizations. Compared to privately insured autistic adults, CAST patients had significantly lower expenditures for mental health admissions ($1074 vs $1362), inpatient hospitalizations ($3851 vs $4513), and outpatient visits ($1671 vs $6070), as well as 16% fewer inpatient hospitalizations, 24% fewer ED visits, and 50% fewer outpatient visits. On average, CAST patients had more ED visits, mental health admissions, and outpatient visits than Medicare-enrolled autistic adults and more mental health admissions than privately insured autistic adults. CONCLUSIONS Although CAST patients had greater primary care utilization and expenditures, our findings suggest embedding specialized clinics within broader primary care settings could be an alternative to current standards of care and may reduce expenditures and healthcare utilization in other areas, particularly relative to standard care for privately insured autistic adults.
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Affiliation(s)
- Gabriel Alain
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, USA
| | - Daniel Gilmore
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, USA
| | - Morgan Krantz
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, USA
| | - Christopher Hanks
- Center for Autism Services and Transition, Columbus, USA.,Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, USA
| | | | | | - Jennifer H Garvin
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, USA
| | - Brittany N Hand
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, USA.
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Longo A, Gilmore D, Garvin J, Hyer JM, Coury D, Hanks C, Moffatt-Bruce S, Hess A, Hand BN. Characteristics associated with healthcare independence among autistic adults. Res Autism Spectr Disord 2022; 95:101972. [PMID: 37583680 PMCID: PMC10427137 DOI: 10.1016/j.rasd.2022.101972] [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] [Subscribe] [Scholar Register] [Indexed: 08/17/2023]
Abstract
Background Healthcare independence refers to someone's ability to assume responsibility for their own health and complete tasks like taking medication as prescribed or scheduling healthcare appointments. Prior studies have shown that autistic people tend to need more support with healthcare tasks than people with other chronic conditions. We sought to identify modifiable and non-modifiable factors linked with healthcare independence among autistic adults. Method We conducted a cross-sectional survey to examine how executive functioning skills, restrictive and repetitive behaviors, gender, education, and age were linked with healthcare independence among this population. Participants included: (a) autistic adults (n=19) who are their own legal guardian, who participated via self-report; and (b) family members of autistic adults with a legal guardian (n=11), who provided proxy-reports. Results Findings differed between self- and proxy-reports. Among autistic adults who self-reported, difficulties in executive functioning were strongly linked with less healthcare independence. Among proxy-reports, greater restrictive and repetitive behaviors were strongly linked with less healthcare independence. According to the proxy-reports, having not completed high school, being older during the healthcare transition, and being male were all independently linked with less healthcare independence. Conclusions Interventions aimed at supporting executive functioning, providing opportunities to increase independence with healthcare tasks, and reducing the extent to which restrictive and repetitive behaviors interfere with daily activities may be viable options for supporting healthcare independence among autistic adults. Our findings are an important first step for future initiatives to better identify individuals who need additional care coordination, supports, or services to maximize healthcare independence.
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Affiliation(s)
| | | | | | | | - Daniel Coury
- The Ohio State University
- Nationwide Children’s Hospital
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Hand BN, Gilmore D, Harris L, Darragh A, Hanks C, Coury D, Moffatt-Bruce S, Garvin J. "They looked at me as a person, not just a diagnosis": A qualitative study of patient and parent satisfaction with a specialized primary care clinic for autistic adults. Autism Adulthood 2022; 3:347-355. [PMID: 35252770 DOI: 10.1089/aut.2020.0082] [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: 11/12/2022]
Abstract
Background Autistic adults have complex physical and mental healthcare needs that necessitate specialized approaches to healthcare. One promising approach is to embed providers with specialized training or specialty clinics for autistic adults within general primary care facilities. We previously found that autistic adults who received their healthcare through one specialty clinic designed with and for autistic adults had better continuity of care and more preventive service utilization than national samples of autistic adults. Objective To characterize factors that increased or decreased satisfaction with healthcare received through a specialty clinic for autistic adults. Methods We conducted 30-60-minute semi-structured interviews with autistic adults (N=9) and parents of autistic adults (N=12). We conducted an inductive thematic analysis, using a phenomenological approach. Results Factors that increased participants' satisfaction included: (1) receiving personalized care from the provider; (2) spending quality time with the provider; and (3) having strong, positive patient-provider relationships. Factors that decreased participants' satisfaction included: (1) lack of access to services due to scarcity of trained providers; (2) difficulty at times communicating with the provider; and (3) system-level barriers such as policies, practices, or procedures. Conclusion Our findings highlight the importance of providers using personalized approaches to care that meet patients' sensory and communication needs and spending quality time with patients to establish strong, positive patient-provider relationships. Our findings also underscore the critical scarcity of healthcare providers who are trained to deliver care for the growing population of autistic adults.
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Affiliation(s)
| | | | | | | | - Christopher Hanks
- The Ohio State University.,The Center for Autism Services and Transition
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Harris L, Gilmore D, Hanks C, Coury D, Moffatt-Bruce S, Garvin JH, Hand BN. "It was surprisingly equivalent to the appointment I had in person": Advantages and disadvantages of synchronous telehealth for delivering primary care for autistic adults. Autism 2021; 26:1573-1580. [PMID: 34847744 DOI: 10.1177/13623613211060589] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
LAY ABSTRACT Autistic adults face many barriers to receiving quality primary health care like clinics that are far away and sensory sensitivities. Real-time telehealth visits, called "virtual visits," are live video chats between the patient and provider. Virtual visits may minimize barriers to care for autistic adults. We wanted to describe advantages and disadvantages of using virtual visits for delivering primary health care for autistic adults. We interviewed 7 autistic adults and 12 caregivers of autistic adults who receive primary care through one clinic. Autistic adults and caregivers said advantages to virtual visits were that (1) patients were more comfortable at home, (2) patients could get health care while avoiding physical contact with other people during the pandemic, and (3) virtual visits were similar to or better than in-person visits. The disadvantages included that (1) there could be technology problems like grainy video, (2) the doctor could not physically examine the patient (e.g. look in ears), and (3) patients sometimes participated less in the virtual visit than they would in person. Virtual visits may be beneficial for autistic adults by eliminating travel to the clinic and avoiding stressful sensory stimuli. We recognize that virtual visits may not work for all patients or in all situations. However, our study shows that primary care virtual visits may be beneficial for autistic adults during and beyond the pandemic.
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Huang J, Firestone S, Moffatt-Bruce S, Tibi P, Shore-Lesserson L. 2021 Clinical Practice Guidelines for Anesthesiologists on Patient Blood Management in Cardiac Surgery. J Cardiothorac Vasc Anesth 2021; 35:3493-3495. [PMID: 34654633 DOI: 10.1053/j.jvca.2021.09.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 09/20/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Jiapeng Huang
- Department of Anesthesiology & Perioperative Medicine, University of Louisville, Louisville, KY; Department of Cardiovascular & Thoracic Surgery, University of Louisville, Louisville, KY; Center for Integrative Environmental Health Sciences, University of Louisville, Louisville, KY; Department of Pharmacology & Toxicology, University of Louisville, Louisville, KY; Department of Medicine, University of Louisville, Louisville, KY.
| | | | - Susan Moffatt-Bruce
- Division of Thoracic Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Pierre Tibi
- Department of Cardiovascular Surgery, Yavapai Regional Medical Center, Prescott, AZ
| | - Linda Shore-Lesserson
- Department of Anesthesiology, Zucker School of Medicine at Hofstra/Northwell Northshore University Hospital, Manhasset, NY
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Tibi P, McClure RS, Huang J, Baker RA, Fitzgerald D, Mazer CD, Stone M, Chu D, Stammers AH, Dickinson T, Shore-Lesserson L, Ferraris V, Firestone S, Kissoon K, Moffatt-Bruce S. STS/SCA/AmSECT/SABM Update to the Clinical Practice Guidelines on Patient Blood Management. Ann Thorac Surg 2021; 112:981-1004. [PMID: 34217505 DOI: 10.1016/j.athoracsur.2021.03.033] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/01/2021] [Accepted: 03/03/2021] [Indexed: 01/25/2023]
Affiliation(s)
- Pierre Tibi
- Department of Cardiovascular Surgery, Yavapai Regional Medical Center, Prescott, Arizona
| | - R Scott McClure
- Division of Cardiac Surgery, Libin Cardiovascular Institute, Foothills Medical Center, University of Calgary, Calgary, Alberta, Canada
| | - Jiapeng Huang
- Department of Anesthesiology & Perioperative Medicine, University of Louisville, Louisville, Kentucky
| | - Robert A Baker
- Cardiac Surgery Research and Perfusion, Flinders University and Flinders Medical Centre, Adelaide, South Australia, Australia
| | - David Fitzgerald
- Division of Cardiovascular Perfusion, Medical University of South Carolina, Charleston, South Carolina
| | - C David Mazer
- Department of Anesthesia, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Marc Stone
- Department of Anesthesia, Mount Sinai Medical Center, New York, New York
| | - Danny Chu
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | - Tim Dickinson
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Linda Shore-Lesserson
- Department of Anesthesiology, Zucker School of Medicine at Hofstra/Northwell Northshore University Hospital, Manhasset, New York
| | - Victor Ferraris
- Division of Cardiovascular and Thoracic Surgery, University of Kentucky, Lexington, Kentucky
| | | | | | - Susan Moffatt-Bruce
- Division of Thoracic Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada.
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Tibi P, McClure RS, Huang J, Baker RA, Fitzgerald D, Mazer CD, Stone M, Chu D, Stammers AH, Dickinson T, Shore-Lesserson L, Ferraris V, Firestone S, Kissoon K, Moffatt-Bruce S. STS/SCA/AmSECT/SABM Update to the Clinical Practice Guidelines on Patient Blood Management. J Cardiothorac Vasc Anesth 2021; 35:2569-2591. [PMID: 34217578 DOI: 10.1053/j.jvca.2021.03.011] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Pierre Tibi
- Department of Cardiovascular Surgery, Yavapai Regional Medical Center, Prescott, Arizona
| | - R Scott McClure
- Division of Cardiac Surgery, Libin Cardiovascular Institute, Foothills Medical Center, University of Calgary, Calgary, Alberta, Canada
| | - Jiapeng Huang
- Department of Anesthesiology & Perioperative Medicine, University of Louisville, Louisville, Kentucky
| | - Robert A Baker
- Cardiac Surgery Research and Perfusion, Flinders University and Flinders Medical Centre, Adelaide, South Australia, Australia
| | - David Fitzgerald
- Division of Cardiovascular Perfusion, Medical University of South Carolina, Charleston, South Carolina
| | - C David Mazer
- Department of Anesthesia, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Marc Stone
- Department of Anesthesia, Mount Sinai Medical Center, New York, New York
| | - Danny Chu
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | - Tim Dickinson
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Linda Shore-Lesserson
- Department of Anesthesiology, Zucker School of Medicine at Hofstra/Northwell Northshore University Hospital, Manhasset, New York
| | - Victor Ferraris
- Division of Cardiovascular and Thoracic Surgery, University of Kentucky, Lexington, Kentucky
| | | | | | - Susan Moffatt-Bruce
- Division of Thoracic Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada.
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13
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Hand BN, Gilmore D, Coury DL, Darragh AR, Moffatt-Bruce S, Hanks C, Garvin JH. Effects of a Specialized Primary Care Facility on Preventive Service Use Among Autistic Adults: a Retrospective Claims Study. J Gen Intern Med 2021; 36:1682-1688. [PMID: 33469770 PMCID: PMC8175546 DOI: 10.1007/s11606-020-06513-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 11/17/2020] [Accepted: 12/20/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND While in some studies, the patient-centered medical home has been linked with increased receipt of preventive services among other populations, there is a paucity of literature testing the effectiveness of medical homes in serving the healthcare needs of autistic adults. OBJECTIVE To compare the receipt of preventive services by patients at a patient-centered medical home specifically designed for autistic adults (called the Center for Autism Services and Transition "CAST") to US national samples of autistic adults with private insurance or Medicare. DESIGN Retrospective study of medical billing data. SAMPLE The study sample included CAST patients (N = 490) who were propensity score matched to Medicare-enrolled autistic adults (N = 980) and privately insured autistic adults (N = 980) using demographic characteristics. The median age of subjects was 21 years old, 79% were male, and the median duration of observation was 2.2 years. MAIN MEASURES The primary outcome measure was the receipt of any preventive service, as defined by the Medicare Learning Network and AAPC (formerly the American Academy of Professional Coders). Secondary outcome measures included receipt of specific preventive service types (i.e., general health and wellness services, screenings, counseling and therapies, vaccinations, and sexual/reproductive health services). KEY RESULTS CAST patients had significantly greater odds of receiving any preventive service than Medicare-enrolled (OR = 10.3; 95% CI = 7.6-13.9) and privately insured (OR = 3.1; 95% CI = 2.3-4.2) autistic adults. CAST patients were also significantly more likely to receive screenings and vaccinations than either Medicare beneficiaries (screenings OR = 20.3; 95% CI = 14.7-28.0; vaccinations OR = 5.5; 95% CI = 4.3-7.0) or privately insured beneficiaries (screenings OR = 2.0; 95% CI = 1.6-2.5; vaccinations OR = 3.3; 95% CI = 2.6-4.1). CONCLUSIONS Autistic adults receiving care through CAST were significantly more likely to recieve preventive care services than national samples of autistic adults. Future comparative effectiveness trials are needed to rigorously assess the impact of primary care-based initiatives to improve care for autistic adults.
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Affiliation(s)
| | | | - Daniel L Coury
- The Ohio State University, Columbus, OH, USA
- Nationwide Children's Hospital, Columbus, OH, USA
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14
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Hand BN, Coury DL, White S, Darragh AR, Moffatt-Bruce S, Harris L, Longo A, Garvin JH. Specialized primary care medical home: A positive impact on continuity of care among autistic adults. Autism 2021; 25:258-265. [PMID: 32907353 PMCID: PMC7854931 DOI: 10.1177/1362361320953967] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
LAY ABSTRACT There is a nationally recognized need for innovative healthcare delivery models to improve care continuity for autistic adults as they age out of pediatric and into adult healthcare systems. One possible model of care delivery is called the "medical home". The medical home is not a residential home, but a system where a patient's healthcare is coordinated through a primary care physician to ensure necessary care is received when and where the patient needs it. We compared the continuity of care among autistic adult patients at a specialized primary care medical home designed to remove barriers to care for autistic adults, called the CAST, to matched national samples of autistic adults with private insurance or Medicare. Continuity of primary care among CAST patients was significantly better than that of matched national samples of autistic adult Medicare beneficiaries and similar to that of privately insured autistic adults. Our findings suggest that medical homes, like CAST, are a promising solution to improve healthcare delivery for the growing population of autistic adults.
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Affiliation(s)
| | | | - Susan White
- The Ohio State University Wexner Medical Center
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15
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Hand BN, Coury DL, Darragh AR, White S, Moffatt-Bruce S, Harris L, Longo A, Gilmore D, Garvin JH. Patient and caregiver experiences at a specialized primary care center for autistic adults. J Comp Eff Res 2020; 9:1131-1140. [PMID: 32914649 PMCID: PMC7842246 DOI: 10.2217/cer-2020-0155] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 09/02/2020] [Indexed: 01/22/2023] Open
Abstract
Background: Little is known about the extent to which patient-centered medical homes meet the needs of autistic adults. Materials & methods: We conducted a cross-sectional survey of autistic adult patients (n = 47) and caregivers of autistic adult patients (n = 66) receiving care through one patient-centered medical home specifically designed to meet the needs of this population. We performed post hoc comparisons of our results to previously published data from a national sample of autistic adults. Results: Participants reported high levels of satisfaction with care, frequent preventive healthcare use and few unmet healthcare needs. Autistic adults in our sample reported significantly higher satisfaction and fewer unmet healthcare needs. Conclusion: A patient-centered medical home tailored to the needs of autistic adults is a promising approach to healthcare delivery for meeting this population's needs.
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Affiliation(s)
- Brittany N Hand
- School of Health and Rehabilitation Sciences, The Ohio State University, OH 43210, USA
| | - Daniel L Coury
- Developmental Behavioral Pediatrics, Nationwide Children’s Hospital, OH 43205, USA
- College of Medicine, The Ohio State University, OH 43210, USA
| | - Amy R Darragh
- Division of Occupational Therapy, The Ohio State University, OH 43210, USA
| | - Susan White
- The Ohio State University Wexner Medical Center, OH 43210, USA
| | | | - Lauren Harris
- School of Health and Rehabilitation Sciences, The Ohio State University, OH 43210, USA
| | - Anne Longo
- School of Health and Rehabilitation Sciences, The Ohio State University, OH 43210, USA
| | - Daniel Gilmore
- School of Health and Rehabilitation Sciences, The Ohio State University, OH 43210, USA
| | - Jennifer H Garvin
- Division of Health Information Management and Systems, The Ohio State University, OH 43210, USA
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16
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Moffatt-Bruce S, Harris KA, Karpinski J, Fulford J, Frank JR. Implementing Time Variable, Competency-Based Training in Canadian Surgical Disciplines. J Am Coll Surg 2020. [DOI: 10.1016/j.jamcollsurg.2020.08.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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17
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Hyun S, Kaewprag P, Cooper C, Hixon B, Moffatt-Bruce S. Exploration of critical care data by using unsupervised machine learning. Comput Methods Programs Biomed 2020; 194:105507. [PMID: 32403049 DOI: 10.1016/j.cmpb.2020.105507] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 03/05/2020] [Accepted: 04/08/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND AND OBJECTIVE Identification of subgroups may be useful to understand the clinical characteristics of ICU patients. The purposes of this study were to apply an unsupervised machine learning method to ICU patient data to discover subgroups among them; and to examine their clinical characteristics, therapeutic procedures conducted during the ICU stay, and discharge dispositions. METHODS K-means clustering method was used with 1503 observations and 9 types of laboratory test results as features. RESULTS Three clusters were identified from this specific population. Blood urea nitrogen, creatinine, potassium, hemoglobin, and red blood cell were distinctive between the clusters. Cluster Three presented the highest blood products transfusion rate (19.8%), followed by Cluster One (15.5%) and cluster Two (9.3%), which was significantly different. Hemodialysis was more frequently provided to Cluster Three while bronchoscopy was done to Cluster One and Two. Cluster Three showed the highest mortality (30.4%), which was more than two-fold compared to Cluster One (14.1%) and Two (12.2%). CONCLUSION Three subgroups were identified and their clinical characteristics were compared. These findings may be useful to anticipate treatment strategies and probable outcomes of ICU patients. Unsupervised machine learning may enable ICU multi-dimensional data to be organized and to make sense of the data.
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Affiliation(s)
- Sookyung Hyun
- College of Nursing, Pusan National University, 49 Busandaehak-ro Mulgeum-eup, Yangsan-si, 50612, South Korea.
| | - Pacharmon Kaewprag
- Department of Computer Engineering, Ramkhamhaeng University, Bangkok, Thailand
| | - Cheryl Cooper
- Central Quality and Education, The Ohio State University Wexner Medical Center, Ohio, United States
| | - Brenda Hixon
- Department of Health Services Nursing Education, The Ohio State University Wexner Medical Center, Ohio, United States
| | - Susan Moffatt-Bruce
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
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18
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Patterson ES, Papautsky EL, Krok-Schoen JL, Lee C, Park KU, White JR, Moffatt-Bruce S, Chirumamilla V, Lustberg M. SCHEDULING DELAYED TREATMENT AND SURGERIES POST-PANDEMIC: A STAKEHOLDER ANALYSIS. ACTA ACUST UNITED AC 2020; 9:10-14. [PMID: 33062798 DOI: 10.1177/2327857920091066] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Many are interested in how to safely ramp up elective surgeries after national, state, and voluntary shutdowns of operating rooms to minimize the spread of COVID-19 infections to patients and providers. We conducted an analysis of diverse perspectives from stakeholders regarding how to trade off risks and benefits to patients, healthcare providers, and the local community. Our findings indicate that there are a large number of different categories of stakeholders impacted by the post-pandemic decisions to reschedule delayed treatments and surgeries. For a delayed surgery, the primary stakeholders are the surgeon with expertise about the clinical benefits of undergoing an operation and the patient's willingness to tolerate uncertainty and the increased risk of infection. For decisions about how much capacity in the operating rooms and in the inpatient setting after the surgery, the primary considerations are minimizing staff infections, preventing patients from getting COVID-19 during operations and during post-surgical recovery at the hospital, conserving critical resources such as PPE, and meeting the needs of hospital staff for quality of life, such as child care needs and avoiding infecting members of their household. The timing and selection of elective surgery cases has an impact on the ability of hospitals to steward finances, which in turns affects decisions about maintaining employment of staff when operating rooms and inpatient rooms are not being used.
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Affiliation(s)
- Emily S Patterson
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH
| | | | - Jessica L Krok-Schoen
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH
| | - Clara Lee
- Department of Plastic Surgery, The Ohio State University, Columbus, OH
| | - Ko Un Park
- Department of Surgical Oncology, The Ohio State University, Columbus, OH
| | - Julia R White
- Department of Radiation Oncology, The Ohio State University, Columbus, OH
| | | | - Varshita Chirumamilla
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH
| | - Maryam Lustberg
- Department of Medical Oncology, The Ohio State University, Columbus, OH
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Cua S, Humeidan M, Beal EW, Brethauer S, Pervo V, Papio J, Husain S, Moffatt-Bruce S. The Effect of an Enhanced Recovery Protocol on Colorectal Surgery Patients With Diabetes. J Surg Res 2020; 257:153-160. [PMID: 32828999 DOI: 10.1016/j.jss.2020.07.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 07/12/2020] [Accepted: 07/17/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND The effect of an enhanced recovery protocol including preoperative carbohydrate loading on patients with diabetes is unclear. This study investigated the effect of both on perioperative glucose management and postoperative outcomes in patients with diabetes undergoing colorectal surgery. MATERIALS AND METHODS A retrospective study was conducted on patients undergoing elective colorectal surgery before and after implementation of an enhanced recovery protocol. Ninety-nine patients with type 2 diabetes (DM, 41 control versus 58 enhanced recovery) and 366 patients without diabetes (NDM, 158 control versus 158 enhanced recovery) were included. Multivariate analyses were run to compare mean peak perioperative serum glucose and postoperative outcomes in enhanced recovery and control cohorts with (DM) and without diabetes (NDM). RESULTS Mean peak preoperative glucose was elevated in DM enhanced recovery compared with DM control patients (192.2 [72.2] versus 139.8 [41.4]; P < 0.001). Mean peak intraoperative (162.3 [43.1] versus 163.8 [39.6]; P = 0.869) and postoperative glucose (207.7 [75.8] versus 217.8 [78.5]; P = 0.523) were similar in DM enhanced recovery compared with DM control group. Enhanced recovery led to decreased LOS in DM (P = 0.001) and NDM enhanced recovery patients (P < 0.000) compared with their control groups. CONCLUSIONS An enhanced recovery protocol may lead to increased peak preoperative glucose levels and 30-d readmissions in patients with type 2 diabetes undergoing colorectal surgery. However, the ultimate clinical significance of transiently elevated preoperative glucose in DM patients is uncertain. Our results suggest that an enhanced recovery protocol and preoperative carbohydrate loading does not lead to poorer postoperative glycemic control overall in patients with diabetes undergoing colorectal surgery.
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Affiliation(s)
- Santino Cua
- Medical Student Research Program, The Ohio State University College of Medicine, Columbus, Ohio.
| | | | - Eliza W Beal
- The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Stacy Brethauer
- The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Valerie Pervo
- The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Joe Papio
- Cancer Program Analytics, OSU-CCC The James Cancer Hospital, Columbus, Ohio
| | - Syed Husain
- The Ohio State University Wexner Medical Center, Columbus, Ohio
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20
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McAlearney AS, Walker DM, Gaughan A, Moffatt-Bruce S, Huerta TR. Helping Patients Be Better Patients: A Qualitative Study of Perceptions About Inpatient Portal Use. Telemed J E Health 2020; 26:1184-1187. [PMID: 31990635 DOI: 10.1089/tmj.2019.0198] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: As more hospitals introduce inpatient portals, it is increasingly important to understand their impact on patient experience and the care process. We conducted this study to learn from patients and care team members about their experience with an inpatient portal. Methods: We interviewed 120 patients and 433 care team members across a seven-hospital academic medical center that offers an inpatient portal to hospitalized patients. Interviewees were asked about their use of the inpatient portal and its impact on patient experience. Recorded interviews were transcribed and rigorously analyzed using both inductive and deductive methods. Results: We found that the inpatient portal was perceived to help patients be "better patients" by improving their ability to be informed about their health and by enabling them to be more involved in the care process. Care team members suggested portal use could be improved by addressing challenges with tablet administration, use of the patient education feature, and the functionality of the scheduling feature. Conclusions: Across interviewees, we found that inpatient portals were perceived to improve the hospital experience and increase empowerment for patients by offering information about care in a manner that allowed patients to join their care teams as active, participating members.
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Affiliation(s)
- Ann Scheck McAlearney
- Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, USA
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, USA
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio, USA
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, Ohio, USA
| | - Daniel M Walker
- Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, USA
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, USA
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio, USA
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, Ohio, USA
| | - Alice Gaughan
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Susan Moffatt-Bruce
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, USA
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio, USA
- Department of Surgery, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Timothy R Huerta
- Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, USA
- CATALYST, Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, USA
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio, USA
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21
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Walker DM, Gaughan A, Fareed N, Moffatt-Bruce S, McAlearney AS. Facilitating Organizational Change to Accommodate an Inpatient Portal. Appl Clin Inform 2019; 10:898-908. [PMID: 31777056 DOI: 10.1055/s-0039-1700867] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Patient portals are becoming more commonly used in the hospital inpatient setting. While the potential benefits of inpatient portals are acknowledged, there is a need for research that examines the challenges of portal implementation and the development of best practice approaches for successful implementation. OBJECTIVE We conducted this study to improve our understanding of the impact of the implementation of an inpatient portal on care team members in the context of a large academic medical center. Our study focused on the perspectives of nursing care team members about the inpatient portal. METHODS We interviewed care team members (n = 437) in four phases throughout the 2 years following implementation of an inpatient portal to learn about their ongoing perspectives regarding the inpatient portal and its impact on the organization. RESULTS The perspectives of care team members demonstrated a change in acceptance of the inpatient portal over time in terms of buy-in, positive workflow changes, and acknowledged benefits of the portal for both care team members and patients. There were also changes over time in perspectives of the care team in regards to (1) challenges with new technology, (2) impact of the portal on workflow, and (3) buy-in. Six strategies were identified as important for implementation success: (1) convene a stakeholder group, (2) offer continual portal training, (3) encourage shared responsibility, (4) identify champions, (5) provide provisioning feedback, and (6) support patient use. CONCLUSION Inpatient portals are recognized as an important tool for both patients and care team members, but the implementation of such a technology can create challenges. Given the perspectives care team members had about the impact of the inpatient portal, our findings suggest implementation requires attention to organizational changes that are needed to accommodate the tool and the development of strategies that can address challenges associated with the portal.
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Affiliation(s)
- Daniel M Walker
- Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, United States.,Center for the Advancement of Team Science, Analytics, and Systems Thinking (CATALYST), College of Medicine, The Ohio State University, Columbus, Ohio, United States.,Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio, United States.,Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, Ohio, United States
| | - Alice Gaughan
- Center for the Advancement of Team Science, Analytics, and Systems Thinking (CATALYST), College of Medicine, The Ohio State University, Columbus, Ohio, United States
| | - Naleef Fareed
- Center for the Advancement of Team Science, Analytics, and Systems Thinking (CATALYST), College of Medicine, The Ohio State University, Columbus, Ohio, United States.,Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio, United States
| | - Susan Moffatt-Bruce
- Center for the Advancement of Team Science, Analytics, and Systems Thinking (CATALYST), College of Medicine, The Ohio State University, Columbus, Ohio, United States.,Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio, United States.,Department of Surgery, College of Medicine, The Ohio State University, Columbus, Ohio, United States
| | - Ann Scheck McAlearney
- Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, United States.,Center for the Advancement of Team Science, Analytics, and Systems Thinking (CATALYST), College of Medicine, The Ohio State University, Columbus, Ohio, United States.,Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio, United States.,Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, Ohio, United States
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22
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McHaney-Lindstrom M, Hebert C, Miller H, Moffatt-Bruce S, Root E. Network analysis of intra-hospital transfers and hospital onset clostridium difficile infection. Health Info Libr J 2019; 37:26-34. [PMID: 31628725 DOI: 10.1111/hir.12274] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 02/15/2019] [Accepted: 07/09/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To explore how social network analysis (SNA) can be used to analyse intra-hospital patient networks of individuals with a hospital acquired infection (HAI) for further analysis in a geographical information systems (GIS) environment. METHODS A case and control study design was used to select 2008 patients. We retrieved locational data for the patients, which was then translated into a network with the SNA software and then GIS software. Overall metrics were calculated for the SNA based on three datasets and further analysed with a GIS. RESULTS The SNA analysis compared cases to control indicating significant differences in the overall structure of the networks. A GIS visual representation of these metrics was developed, showing spatial variation across the example hospital floor. DISCUSSION This study confirmed the importance that intra-hospital patient networks play in the transmission of HAIs, highlighting opportunities for interventions utilising these data. Due to spatial variation differences, further research is necessary to confirm this is not a localised phenomenon, but instead a common situation occurring within many hospitals. CONCLUSION Utilising SNA and GIS analysis in conjunction with one another provided a data-rich environment in which the risk inherent in intra-hospital transfer networks was quantified, visualised and interpreted for potential interventions.
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Affiliation(s)
| | - Courtney Hebert
- Department of Biomedical Informatics, Ohio State University, Columbus, OH, USA
| | - Harvey Miller
- Department of Geography, Ohio State University, Columbus, OH, USA
| | - Susan Moffatt-Bruce
- Department of Biomedical Informatics, Ohio State University, Columbus, OH, USA
| | - Elisabeth Root
- Department of Geography, Ohio State University, Columbus, OH, USA
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23
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Kneuertz P, D'Souza D, Richardson M, Abdel-Rasoul M, Moffatt-Bruce S, Merritt R. P1.16-03 Incidence and Risk Factors of Metachronous Non-Pulmonary Malignancies in Resected Lung Adenocarcinoma. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Hospital nurses are inundated by numerous non-actionable and false telemetry alarms from bedside monitors, central nursing stations, and, in some cases, also from alarms escalated to hospital-provided cellphones after a short time period. There is widespread that patients electing to have DNR/comfort care status do not require telemetry monitoring, and an increasing awareness of the interference of these alarms with valuable end-of-life conversations and interactions with family members. In this project, we instituted policy changes, changes to the electronic health record, and educational interventions for physicians and nurses in order to reduce the proportion of DNR-CC patients with active telemetry monitoring. Overall, we learned that many bedside nurses prefer to turn down the volume or turn off the display inside rooms, which addresses the interference with family interactions but does not reduce the volume of unnecessary alarms and associated documentation requirements and inclusion of alarms in population-based analyses.
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Affiliation(s)
- Emily S. Patterson
- Division of Health Information Management and Systems School of Health and Rehabilitation Sciences The Ohio State University Columbus, Ohio, USA
| | - Christopher Hritz
- Department of Palliative Care Medicine The Ohio State University Columbus, Ohio, USA
| | - Susan Moffatt-Bruce
- Department of Surgery Department of Biomedical Informatics Wexner Medical Center The Ohio State University Columbus, Ohio, USA
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25
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Hyun S, Moffatt-Bruce S, Cooper C, Hixon B, Kaewprag P. Prediction Model for Hospital-Acquired Pressure Ulcer Development: Retrospective Cohort Study. JMIR Med Inform 2019; 7:e13785. [PMID: 31322127 PMCID: PMC6670273 DOI: 10.2196/13785] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 02/22/2019] [Revised: 04/15/2019] [Accepted: 06/29/2019] [Indexed: 12/18/2022] Open
Abstract
Background A pressure ulcer is injury to the skin or underlying tissue, caused by pressure, friction, and moisture. Hospital-acquired pressure ulcers (HAPUs) may not only result in additional length of hospital stay and associated care costs but also lead to undesirable patient outcomes. Intensive care unit (ICU) patients show higher risk for HAPU development than general patients. We hypothesize that the care team’s decisions relative to HAPU risk assessment and prevention may be better supported by a data-driven, ICU-specific prediction model. Objective The aim of this study was to determine whether multiple logistic regression with ICU-specific predictor variables was suitable for ICU HAPU prediction and to compare the performance of the model with the Braden scale on this specific population. Methods We conducted a retrospective cohort study by using the data retrieved from the enterprise data warehouse of an academic medical center. Bivariate analyses were performed to compare the HAPU and non-HAPU groups. Multiple logistic regression was used to develop a prediction model with significant predictor variables from the bivariate analyses. Sensitivity, specificity, positive predictive values, negative predictive values, area under the receiver operating characteristic curve (AUC), and Youden index were used to compare with the Braden scale. Results The total number of patient encounters studied was 12,654. The number of patients who developed an HAPU during their ICU stay was 735 (5.81% of the incidence rate). Age, gender, weight, diabetes, vasopressor, isolation, endotracheal tube, ventilator episode, Braden score, and ventilator days were significantly associated with HAPU. The overall accuracy of the model was 91.7%, and the AUC was .737. The sensitivity, specificity, positive predictive value, negative predictive value, and Youden index were .650, .693, .211, 956, and .342, respectively. Male patients were 1.5 times more, patients with diabetes were 1.5 times more, and patients under isolation were 3.1 times more likely to have an HAPU than female patients, patients without diabetes, and patients not under isolation, respectively. Conclusions Using an extremely large, electronic health record–derived dataset enabled us to compare characteristics of patients who develop an HAPU during their ICU stay with those who did not, and it also enabled us to develop a prediction model from the empirical data. The model showed acceptable performance compared with the Braden scale. The model may assist with clinicians’ decision on risk assessment, in addition to the Braden scale, as it is not difficult to interpret and apply to clinical practice. This approach may support avoidable reductions in HAPU incidence in intensive care.
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Affiliation(s)
- Sookyung Hyun
- College of Nursing, Pusan National University, Yangsan-si, Republic of Korea
| | - Susan Moffatt-Bruce
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, United States.,Department of Biomedical Informatics, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Cheryl Cooper
- Central Quality and Education, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Brenda Hixon
- Health System Nursing Education, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Pacharmon Kaewprag
- Department of Computer Engineering, Ramkhamhaeng University, Bangkok, Thailand
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Yu SC, Lai AM, Smyer J, Flaherty J, Mangino JE, McAlearney AS, Yen PY, Moffatt-Bruce S, Hebert CL. Novel Visualization of Clostridium difficile Infections in Intensive Care Units. ACI open 2019; 3:e71-e77. [PMID: 33598637 DOI: 10.1055/s-0039-1693651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Accurate and timely surveillance and diagnosis of healthcare-facility onset Clostridium difficile infection (HO-CDI) is vital to controlling infections within the hospital, but there are limited tools to assist with timely outbreak investigations. OBJECTIVES To integrate spatiotemporal factors with HO-CDI cases and develop a map-based dashboard to support infection preventionists (IPs) in performing surveillance and outbreak investigations for HO-CDI. METHODS Clinical laboratory results and Admit-Transfer-Discharge data for admitted patients over two years were extracted from the Information Warehouse of a large academic medical center and processed according to Center for Disease Control (CDC) National Healthcare Safety Network (NHSN) definitions to classify Clostridium difficile infection (CDI) cases by onset date. Results were validated against the internal infection surveillance database maintained by IPs in Clinical Epidemiology of this Academic Medical Center (AMC). Hospital floor plans were combined with HO-CDI case data, to create a dashboard of intensive care units. Usability testing was performed with a think-aloud session and a survey. RESULTS The simple classification algorithm identified all 265 HO-CDI cases from 1/1/15-11/30/15 with a positive predictive value (PPV) of 96.3%. When applied to data from 2014, the PPV was 94.6% All users "strongly agreed" that the dashboard would be a positive addition to Clinical Epidemiology and would enable them to present Hospital Acquired Infection (HAI) information to others more efficiently. CONCLUSIONS The CDI dashboard demonstrates the feasibility of mapping clinical data to hospital patient care units for more efficient surveillance and potential outbreak investigations.
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Affiliation(s)
- Sean C Yu
- Washington University, St. Louis, MO, USA
| | | | - Justin Smyer
- Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | - Julie E Mangino
- Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | - Po-Yin Yen
- Washington University, St. Louis, MO, USA
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Guzman-Pruneda FA, Husain SG, Jones CD, Beal EW, Porter E, Grove M, Moffatt-Bruce S, Schmidt CR. Compliance with preoperative care measures reduces surgical site infection after colorectal operation. J Surg Oncol 2018; 119:497-502. [PMID: 30582613 DOI: 10.1002/jso.25346] [Citation(s) in RCA: 12] [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] [Received: 07/08/2018] [Accepted: 12/07/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Surgical site infections (SSIs) are a major cause of morbidity complicating colorectal operations. Several evidence-based preoperative strategies are associated with decreased SSI rates. We hypothesize that compliance with multiple strategies is associated with lower incidence of SSI after the elective colorectal operation. METHODS Preoperative care measure compliance before colorectal operations were assessed. Measures included antiseptic wash the night before and day of operation, oral antibiotic, and mechanical bowel preparation, antibiotic prophylaxis, Chloraprep skin preparation, and hair clipping. Rates of SSI after colectomy and other pertinent outcomes were stratified by full and partial compliance with preoperative measures. Exclusion criteria included bowel perforation, ischemia, complete obstruction, intra-abdominal abscess, and no intraoperative skin closure. RESULTS Eight hundred twenty-six subjects underwent colectomy between 2010 and 2016; 469 met inclusion criteria. Compliance with all measures occurred in 214 (46%) and was independently associated with lower postoperative infection rates (odds ratio [OR], 0.37; confidence interval [CI], 0.16-0.85; P = 0.02). SSI occurred in 51 (11%): was superficial in 35 (7%); deep in 5 (1%); and organ space in 11 (2%). SSI rates were reduced from 16% (partial or no compliance group) to 5% (full compliance group). No stand-alone intervention was independently associated with decreased SSI rate. Multivariate analysis found the following factors associated with a lower risk of SSI: full compliance with all five process measures, lower BMI, nonsmoker, and minimally invasive operation. DISCUSSION AND CONCLUSION Compliance with preoperative care strategies reduces rates of SSI after colectomy with a cumulative effect more pronounced than any single intervention reinforcing the need for protocol-driven and evidence-based care for patients undergoing colorectal operations.
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Affiliation(s)
- Francisco A Guzman-Pruneda
- Department of Surgery, Division of Surgical Oncology, Wexner Medical Center, James Cancer Hospital, Solove Research Institute, The Ohio State University, Columbus, Ohio
| | - Syed G Husain
- Department of Surgery, Division of Colorectal Surgery, Wexner Medical Center, James Cancer Hospital, Solove Research Institute, The Ohio State University, Columbus, Ohio
| | - Christian D Jones
- Department of Surgery, Division of Trauma, Critical Care and Burn, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Eliza W Beal
- Department of Surgery, Division of Trauma, Critical Care and Burn, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Erica Porter
- Department of Quality and Patient Safety, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Michele Grove
- Department of Quality and Patient Safety, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Susan Moffatt-Bruce
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Carl R Schmidt
- Department of Surgery, Division of Surgical Oncology, Wexner Medical Center, James Cancer Hospital, Solove Research Institute, The Ohio State University, Columbus, Ohio
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Kneuertz P, Carbone D, Luo L, D'Souza D, Moffatt-Bruce S, Merritt R. P3.16-06 Does Comprehensive Mutation Analysis Add Prognostic Value in Resected Early Stage Lung Adenocarcinoma? J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.1913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Gabbe SG, Hagan Vetter M, Nguyen MC, Moffatt-Bruce S, Fowler JM. Changes in the burnout profile of chairs of academic departments of obstetrics and gynecology over the past 15 years. Am J Obstet Gynecol 2018; 219:303.e1-303.e6. [PMID: 29959932 DOI: 10.1016/j.ajog.2018.06.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 06/18/2018] [Accepted: 06/20/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND While many studies have documented the high prevalence of burnout in practicing physicians and medical trainees, fewer reports describe burnout in academic leaders. In 2002, we observed a moderate-high to high level of burnout in 41.4% of chairs of academic departments of obstetrics and gynecology. OBJECTIVE The purpose of this study was to identify trends in burnout and associated factors in today's obstetrics and gynecology chairs as they face complex changes to the current health care environment. STUDY DESIGN This was a cross-sectional study. A survey was developed based on the questionnaire used in our first investigation and sent electronically to all members of the Council of University Chairs of Obstetrics and Gynecology. Burnout was measured using an abbreviated Maslach Burnout Inventory-Human Sciences Survey. In addition to demographic data, we assessed perceived stressors, job satisfaction, spousal/partner support, self-efficacy, depression, suicidal ideation, and stress management. RESULTS The response rate was 60% (84/139). Almost 30% of chairs were women, increased from 7.6% in 2002. Hospital and department budget deficits and loss of key faculty remain major stressors noted by participants. The Maslach Burnout Inventory results have changed dramatically over the past 15 years. Today's chairs demonstrated less burnout but with an "ineffective" profile. Subscale scores for emotional exhaustion and depersonalization were reduced but >50% reported low personal accomplishment. Spousal support remained important in preventing burnout. CONCLUSION Chairs of academic departments of obstetrics and gynecology continue to face significant job-related stress. Burnout has decreased; however, personal accomplishment scores have also declined most likely due to administrative factors that are beyond the chairs' perceived control.
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McHaney-Lindstrom M, Hebert C, Flaherty J, Mangino JE, Moffatt-Bruce S, Dowling Root E. Analysis of intra-hospital transfers and hospital-onset Clostridium difficile infection. J Hosp Infect 2018; 102:168-169. [PMID: 30172746 DOI: 10.1016/j.jhin.2018.08.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 08/24/2018] [Indexed: 01/21/2023]
Affiliation(s)
| | - C Hebert
- Department of Biomedical Informatics, Ohio State University, Columbus, OH, USA
| | - J Flaherty
- Department of Clinical Epidemiology, Ohio State University, Columbus, OH, USA
| | - J E Mangino
- Department of Clinical Epidemiology, Ohio State University, Columbus, OH, USA
| | - S Moffatt-Bruce
- Department of Biomedical Informatics, Ohio State University, Columbus, OH, USA
| | - E Dowling Root
- Department of Geography, Ohio State University, Columbus, OH, USA
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Sarkhel R, Socha JJ, Mount-Campbell A, Moffatt-Bruce S, Fernandez S, Patel K, Nandi A, Patterson ES. HOW NURSES IDENTIFY HOSPITALIZED PATIENTS ON THEIR PERSONAL NOTES: FINDINGS FROM ANALYZING 'BRAINS' HEADERS WITH MULTIPLE RATERS. ACTA ACUST UNITED AC 2018; 7:205-209. [PMID: 30069493 DOI: 10.1177/2327857918071045] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The overarching objective of this research is to reduce the burden of documentation in electronic health records by registered nurses in hospitals. Registered nurses have consistently reported that e-documentation is a concern with the introduction of electronic health records. As a result, many nurses use handwritten notes in order to avoid using electronic health records to access information about patients. At the top of these notes are patient identifiers. By identifying aspects of good and suboptimal headers, we can begin to form a model of how to effectively support identifying patients during assessments and care activities. The primary finding is that nurses use room number as the primary patient identifier in the hospital setting, not the patient's last name. In addition, the last name, gender, and age are sufficiently important identifiers that they are frequently recorded at the top of handwritten notes. Clearly distinguishable field labels and values are helpful in quickly scanning the identifier for identifying information. A web based annotator was designed as a first step towards machine learning approaches to recognize handwritten or printed data on paper sheets in future research.
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Schmidt CR, Hefner J, McAlearney AS, Graham L, Johnson K, Moffatt-Bruce S, Huerta T, Pawlik TM, White S. Development and prospective validation of a model estimating risk of readmission in cancer patients. J Surg Oncol 2018; 117:1113-1118. [DOI: 10.1002/jso.24968] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 12/08/2017] [Indexed: 01/29/2023]
Affiliation(s)
- Carl R. Schmidt
- Department of Surgery, College of Medicine; The Ohio State University; Columbus Ohio
- James Caner Hospital and Solove Research Institute, Comprehensive Cancer Center; The Ohio State University; Columbus Ohio
| | - Jennifer Hefner
- Department of Family Medicine, College of Medicine; The Ohio State University; Columbus Ohio
| | - Ann S. McAlearney
- James Caner Hospital and Solove Research Institute, Comprehensive Cancer Center; The Ohio State University; Columbus Ohio
- Department of Family Medicine, College of Medicine; The Ohio State University; Columbus Ohio
- Division of Health Services Management and Policy, College of Public Health; The Ohio State University; Columbus Ohio
| | - Lisa Graham
- James Caner Hospital and Solove Research Institute, Comprehensive Cancer Center; The Ohio State University; Columbus Ohio
| | - Kristen Johnson
- James Caner Hospital and Solove Research Institute, Comprehensive Cancer Center; The Ohio State University; Columbus Ohio
| | - Susan Moffatt-Bruce
- Department of Surgery, College of Medicine; The Ohio State University; Columbus Ohio
- James Caner Hospital and Solove Research Institute, Comprehensive Cancer Center; The Ohio State University; Columbus Ohio
| | - Timothy Huerta
- Department of Family Medicine, College of Medicine; The Ohio State University; Columbus Ohio
- Division of Health Services Management and Policy, College of Public Health; The Ohio State University; Columbus Ohio
- Department of Biomedical Informatics, College of Medicine; The Ohio State University; Columbus Ohio
| | - Timothy M. Pawlik
- Department of Surgery, College of Medicine; The Ohio State University; Columbus Ohio
- James Caner Hospital and Solove Research Institute, Comprehensive Cancer Center; The Ohio State University; Columbus Ohio
| | - Susan White
- James Caner Hospital and Solove Research Institute, Comprehensive Cancer Center; The Ohio State University; Columbus Ohio
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Moffatt-Bruce S, Clark S, DiMaio M, Fann J. Leadership Oversight for Patient Safety Programs: An Essential Element. Ann Thorac Surg 2018; 105:351-356. [DOI: 10.1016/j.athoracsur.2017.11.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 11/15/2017] [Indexed: 10/18/2022]
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Abstract
Leveraging opportunities to learn and then improve the delivery of care using experiences throughout the health care system is essential in efforts to transform health care delivery. The authors present the approach of one academic medical center in becoming a research-oriented Learning Healthcare System (ro-LHS). By reframing the role of research in improving outcomes, the organization was able to move beyond its focus on quality improvement to foster a culture in which feedback informs practice and research drives improvement. The patient safety learning laboratory, the Institute for the Design of Environments Aligned for Patient Safety, funded by the Agency for Healthcare Research and Quality, has provided foundational infrastructure to connect stakeholders across the medical center and university and conduct rigorous research in the context of practice. With this new focus, research now informs operations in a cycle of continuous improvement across the authors' ro-LHS.
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Patterson ES, Anders S, Moffatt-Bruce S. CLUSTERING AND PRIORITIZING PATIENT SAFETY ISSUES DURING EHR IMPLEMENTATION AND UPGRADES IN HOSPITAL SETTINGS. ACTA ACUST UNITED AC 2017; 6:125-131. [PMID: 30035145 DOI: 10.1177/2327857917061028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Our aim was to elicit, label, and prioritize clusters of de-identified patient safety issues experienced during the implementation and upgrade installations of Electronic Health Records (EHRs) in hospitals. Conference participants included clinical personnel (physicians, nurses, pharmacists), human factors experts, patient safety experts, information technology experts from vendors and hospitals, academic experts, graduate students, and other attendees. De-identified reports of patient safety issues were shared via share4safety@gmail.com by conference and non-conference attendees before and during a 90-minute session featured at the Human Factors in Healthcare International Symposium on March 8, 2017. One submitted example of a reported patient safety issue was provided to the group. During the session, each attendee shared with a partner five concerns and identified their top concern. Subsequently, each two-person group shared with the larger group these issues, which were written by a facilitator onto sticky paper and placed on the walls. The issues were grouped using pre-defined categories and new categories were identified. Next, each participant voted for the highest priority cluster and/or individual patient safety issue using stickers. This paper reports the results of the interactive session, including the labeled and prioritized clusters and illustrative examples for each cluster. These clusters may inform reporting systems and quality improvement initiatives with health information technology where choices made during implementation and upgrades as well as design flaws with EHR technology both contribute and interact to produce potential patient safety issues.
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Affiliation(s)
- Emily S Patterson
- Division of Health Information Management and Systems, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio, USA
| | - Shilo Anders
- Center for Research and Innovation in Systems Safety, Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Lester NA, Thompson LR, Herget K, Stephens JA, Campo JV, Adkins EJ, Terndrup TE, Moffatt-Bruce S. CALM Interventions: Behavioral Health Crisis Assessment, Linkage, and Management Improve Patient Care. Am J Med Qual 2017; 33:65-71. [DOI: 10.1177/1062860617696154] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | - Kendal Herget
- The Ohio State University Wexner Medical Center, Columbus, OH
| | | | - John V. Campo
- The Ohio State University Wexner Medical Center, Columbus, OH
| | - Eric J. Adkins
- The Ohio State University Wexner Medical Center, Columbus, OH
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Abstract
U.S. News & World Report’s annual Best Hospital Rankings are determined by an index of quality based on objective and subjective measures. This study investigates relationships between U.S. News score and its individual subjective and objective components that ultimately determine the relative ranking of the top 50 hospitals in the 2015 Best Hospital Rankings for the study’s selected specialties—cancer, cardiology, gastroenterology, neurology, and orthopedics. A 2-step linear regression model was employed; first, to control for objective components’ influence on U.S. News score ( R2 = 0.365; P < .001), then, to isolate the subjective component of reputation’s effect on U.S. News score ( R2 = 0.565; P < .001). The second model confirmed that reputation has a more significant influence on total U.S. News score than its objective counterparts. This indicates that a hospital’s U.S. News score and relative ranking in the Best Hospital Rankings may be disproportionately influenced by its reputation.
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Affiliation(s)
- Santino Cua
- The Ohio State University Wexner Medical Center, Columbus, OH
| | | | - Susan White
- The Ohio State University Wexner Medical Center, Columbus, OH
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Ross P, Skabla P, Moffatt-Bruce S. P3.04-009 Photodynamic Therapy (PDT) Turns 21: Indications, Applications and Outcomes for NSCLC. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2016.11.2124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Affiliation(s)
- William E Smoyer
- The Research Institute at Nationwide Children's Hospital, Columbus, Ohio2The Ohio State University, Columbus
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Firstenberg M, Vasiliou E, Welch K, Moffatt-Bruce S. Retained surgical items: Accurate reporting is critical to institutional protocols. Int J Acad Med 2016. [DOI: 10.4103/wkmp-0107.183334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Firstenberg M, Vasiliou E, Welch K, Moffatt-Bruce S. Retained surgical items: Accurate reporting is critical to institutional protocols. Int J Acad Med 2016. [DOI: 10.4103/2455-5568.183334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Moffatt-Bruce S, Bacchetta M, Cypel M. Discussion. J Thorac Cardiovasc Surg 2015; 151:566-7. [PMID: 26621321 DOI: 10.1016/j.jtcvs.2015.10.034] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Moffatt-Bruce S, Hefner JL, Nguyen MC. What is new in critical illness and injury science? Patient safety amidst chaos: Are we on the same team during emergency and critical care interventions? Int J Crit Illn Inj Sci 2015; 5:135-7. [PMID: 26557481 PMCID: PMC4613410 DOI: 10.4103/2229-5151.164909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Susan Moffatt-Bruce
- The Ohio State University Wexner Medical Center, Department of Surgery, Columbus, Ohio, USA
| | - Jennifer L Hefner
- The Ohio State University Wexner Medical Center, Department of Family Medicine, Columbus, Ohio, USA
| | - Michelle C Nguyen
- The Ohio State University Wexner Medical Center, Department of Surgery, Columbus, Ohio, USA
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Affiliation(s)
| | - Jennifer L. Hefner
- Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, OH
| | - Ann Scheck McAlearney
- Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, OH
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, OH
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Hyun S, Li X, Vermillion B, Newton C, Fall M, Kaewprag P, Moffatt-Bruce S, Lenz ER. Body mass index and pressure ulcers: improved predictability of pressure ulcers in intensive care patients. Am J Crit Care 2014; 23:494-500; quiz 501. [PMID: 25362673 DOI: 10.4037/ajcc2014535] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Obesity contributes to immobility and subsequent pressure on skin surfaces. Knowledge of the relationship between obesity and development of pressure ulcers in intensive care patients will provide better understanding of which patients are at high risk for pressure ulcers and allow more efficient prevention. OBJECTIVES To examine the incidence of pressure ulcers in patients who differ in body mass index and to determine whether inclusion of body mass index enhanced use of the Braden scale in the prediction of pressure ulcers. METHODS In this retrospective cohort study, data were collected from the medical records of 4 groups of patients with different body mass index values: underweight, normal weight, obese, and extremely obese. Data included patients' demographics, body weight, score on the Braden scale, and occurrence of pressure ulcers. RESULTS The incidence of pressure ulcers in the underweight, normal weight, obese, and extremely obese groups was 8.6%, 5.5%, 2.8%, and 9.9%, respectively. When both the score on the Braden scale and the body mass index were predictive of pressure ulcers, extremely obese patients were about 2 times more likely to experience an ulcer than were normal weight patients. In the final model, the area under the curve was 0.71. The baseline area under the curve for the Braden scale was 0.68. CONCLUSIONS Body mass index and incidence of pressure ulcers were related in intensive care patients. Addition of body mass index did not appreciably improve the accuracy of the Braden scale for predicting pressure ulcers.
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Affiliation(s)
- Sookyung Hyun
- Sookyung Hyun is an assistant professor, College of Nursing, Department of Biomedical Informatics, Elizabeth R. Lenz is professor emeritus, College of Nursing, and Pacharmon Kaewprag is a PhD candidate, Department of Computer Science and Engineering, Ohio State University, Columbus, Ohio. Brenda Vermillion is director of health system nursing education and Cheryl Newton is a clinical nurse specialist, Department of Critical Care Nursing, Xiaobai Li is an assistant professor, Center for Biostatistics, Monica Fall is staff dietician, Department of Nutrition Services, and Susan Moffatt-Bruce is chief quality and patient safety officer, associate dean of clinical affairs for quality and patient safety, and associate professor, Department of Surgery, Wexner Medical Center, Ohio State University
| | - Xiaobai Li
- Sookyung Hyun is an assistant professor, College of Nursing, Department of Biomedical Informatics, Elizabeth R. Lenz is professor emeritus, College of Nursing, and Pacharmon Kaewprag is a PhD candidate, Department of Computer Science and Engineering, Ohio State University, Columbus, Ohio. Brenda Vermillion is director of health system nursing education and Cheryl Newton is a clinical nurse specialist, Department of Critical Care Nursing, Xiaobai Li is an assistant professor, Center for Biostatistics, Monica Fall is staff dietician, Department of Nutrition Services, and Susan Moffatt-Bruce is chief quality and patient safety officer, associate dean of clinical affairs for quality and patient safety, and associate professor, Department of Surgery, Wexner Medical Center, Ohio State University
| | - Brenda Vermillion
- Sookyung Hyun is an assistant professor, College of Nursing, Department of Biomedical Informatics, Elizabeth R. Lenz is professor emeritus, College of Nursing, and Pacharmon Kaewprag is a PhD candidate, Department of Computer Science and Engineering, Ohio State University, Columbus, Ohio. Brenda Vermillion is director of health system nursing education and Cheryl Newton is a clinical nurse specialist, Department of Critical Care Nursing, Xiaobai Li is an assistant professor, Center for Biostatistics, Monica Fall is staff dietician, Department of Nutrition Services, and Susan Moffatt-Bruce is chief quality and patient safety officer, associate dean of clinical affairs for quality and patient safety, and associate professor, Department of Surgery, Wexner Medical Center, Ohio State University.
| | - Cheryl Newton
- Sookyung Hyun is an assistant professor, College of Nursing, Department of Biomedical Informatics, Elizabeth R. Lenz is professor emeritus, College of Nursing, and Pacharmon Kaewprag is a PhD candidate, Department of Computer Science and Engineering, Ohio State University, Columbus, Ohio. Brenda Vermillion is director of health system nursing education and Cheryl Newton is a clinical nurse specialist, Department of Critical Care Nursing, Xiaobai Li is an assistant professor, Center for Biostatistics, Monica Fall is staff dietician, Department of Nutrition Services, and Susan Moffatt-Bruce is chief quality and patient safety officer, associate dean of clinical affairs for quality and patient safety, and associate professor, Department of Surgery, Wexner Medical Center, Ohio State University
| | - Monica Fall
- Sookyung Hyun is an assistant professor, College of Nursing, Department of Biomedical Informatics, Elizabeth R. Lenz is professor emeritus, College of Nursing, and Pacharmon Kaewprag is a PhD candidate, Department of Computer Science and Engineering, Ohio State University, Columbus, Ohio. Brenda Vermillion is director of health system nursing education and Cheryl Newton is a clinical nurse specialist, Department of Critical Care Nursing, Xiaobai Li is an assistant professor, Center for Biostatistics, Monica Fall is staff dietician, Department of Nutrition Services, and Susan Moffatt-Bruce is chief quality and patient safety officer, associate dean of clinical affairs for quality and patient safety, and associate professor, Department of Surgery, Wexner Medical Center, Ohio State University
| | - Pacharmon Kaewprag
- Sookyung Hyun is an assistant professor, College of Nursing, Department of Biomedical Informatics, Elizabeth R. Lenz is professor emeritus, College of Nursing, and Pacharmon Kaewprag is a PhD candidate, Department of Computer Science and Engineering, Ohio State University, Columbus, Ohio. Brenda Vermillion is director of health system nursing education and Cheryl Newton is a clinical nurse specialist, Department of Critical Care Nursing, Xiaobai Li is an assistant professor, Center for Biostatistics, Monica Fall is staff dietician, Department of Nutrition Services, and Susan Moffatt-Bruce is chief quality and patient safety officer, associate dean of clinical affairs for quality and patient safety, and associate professor, Department of Surgery, Wexner Medical Center, Ohio State University
| | - Susan Moffatt-Bruce
- Sookyung Hyun is an assistant professor, College of Nursing, Department of Biomedical Informatics, Elizabeth R. Lenz is professor emeritus, College of Nursing, and Pacharmon Kaewprag is a PhD candidate, Department of Computer Science and Engineering, Ohio State University, Columbus, Ohio. Brenda Vermillion is director of health system nursing education and Cheryl Newton is a clinical nurse specialist, Department of Critical Care Nursing, Xiaobai Li is an assistant professor, Center for Biostatistics, Monica Fall is staff dietician, Department of Nutrition Services, and Susan Moffatt-Bruce is chief quality and patient safety officer, associate dean of clinical affairs for quality and patient safety, and associate professor, Department of Surgery, Wexner Medical Center, Ohio State University
| | - Elizabeth R Lenz
- Sookyung Hyun is an assistant professor, College of Nursing, Department of Biomedical Informatics, Elizabeth R. Lenz is professor emeritus, College of Nursing, and Pacharmon Kaewprag is a PhD candidate, Department of Computer Science and Engineering, Ohio State University, Columbus, Ohio. Brenda Vermillion is director of health system nursing education and Cheryl Newton is a clinical nurse specialist, Department of Critical Care Nursing, Xiaobai Li is an assistant professor, Center for Biostatistics, Monica Fall is staff dietician, Department of Nutrition Services, and Susan Moffatt-Bruce is chief quality and patient safety officer, associate dean of clinical affairs for quality and patient safety, and associate professor, Department of Surgery, Wexner Medical Center, Ohio State University
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Bansal S, Moffatt-Bruce S, Joseph A, Whitson B, Sai-Sudhakar C. Cardiac cachexia as a predictor of length of stay in mechanical circulatory support. J Card Fail 2014. [DOI: 10.1016/j.cardfail.2014.06.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Bansal S, Moffatt-Bruce S, Joseph A, Higgins R, Whitson BA, Sai-Sudhakar C. Composite Risk Score Predicts Long-term Survival in Left Ventricular Assist Devices: A Move beyond INTERMACS. J Card Fail 2014. [DOI: 10.1016/j.cardfail.2014.06.298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Hyun S, Vermillion B, Newton C, Fall M, Li X, Kaewprag P, Moffatt-Bruce S, Lenz ER. Predictive validity of the Braden scale for patients in intensive care units. Am J Crit Care 2013; 22:514-20. [PMID: 24186823 DOI: 10.4037/ajcc2013991] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Patients in intensive care units are at higher risk for development of pressure ulcers than other patients. In order to prevent pressure ulcers from developing in intensive care patients, risk for development of pressure ulcers must be assessed accurately. OBJECTIVES To evaluate the predictive validity of the Braden scale for assessing risk for development of pressure ulcers in intensive care patients by using 4 years of data from electronic health records. Methods Data from the electronic health records of patients admitted to intensive care units between January 1, 2007, and December 31, 2010, were extracted from the data warehouse of an academic medical center. Predictive validity was measured by using sensitivity, specificity, positive predictive value, and negative predictive value. The receiver operating characteristic curve was generated, and the area under the curve was reported. RESULTS A total of 7790 intensive care patients were included in the analysis. A cutoff score of 16 on the Braden scale had a sensitivity of 0.954, specificity of 0.207, positive predictive value of 0.114, and negative predictive value of 0.977. The area under the curve was 0.672 (95% CI, 0.663-0.683). The optimal cutoff for intensive care patients, determined from the receiver operating characteristic curve, was 13. CONCLUSIONS The Braden scale shows insufficient predictive validity and poor accuracy in discriminating intensive care patients at risk of pressure ulcers developing. The Braden scale may not sufficiently reflect characteristics of intensive care patients. Further research is needed to determine which possibly predictive factors are specific to intensive care units in order to increase the usefulness of the Braden scale for predicting pressure ulcers in intensive care patients.
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Affiliation(s)
- Sookyung Hyun
- Sookyung Hyun is an assistant professor in the College of Nursing and the Department of Biomedical Informatics at The Ohio State University, Columbus, Ohio. Brenda Vermillion is director of nursing education in the Department of Health Services Nursing Education, Wexner Medical Center and clinical assistant professor at the College of Nursing at The Ohio State University. Cheryl Newton is a clinical nurse specialist in the Department of Critical Care Nursing, Wexner Medical Center at The Ohio State University. Monica Fall is a dietitian in the Department of Nutrition Services, Wexner Medical Center at The Ohio State University. Xiaobai Li is a bio-statistician in the Center for Biostatistics, Wexner Medical Center at The Ohio State University. Pacharmon Kaewprag is a doctoral candidate in the Department of Computer Science and Engineering, The Ohio State University. Susan Moffatt-Bruce is an associate professor in the Department of Surgery, Wexner Medical Center at The Ohio State University. Elizabeth R. Lenz is a professor emeritus in the College of Nursing at The Ohio State University
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Bonkowski J, Carnes C, Melucci J, Mirtallo J, Prier B, Reichert E, Moffatt-Bruce S, Weber R. Effect of barcode-assisted medication administration on emergency department medication errors. Acad Emerg Med 2013; 20:801-6. [PMID: 24033623 DOI: 10.1111/acem.12189] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Revised: 03/04/2013] [Accepted: 03/11/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Barcode-assisted medication administration (BCMA) is technology with demonstrated benefit in reducing medication administration errors in hospitalized patients; however, it is not routinely used in emergency departments (EDs). EDs may benefit from BCMA, because ED medication administration is complex and error-prone. METHODS A naïve observational study was conducted at an academic medical center implementing BCMA in the ED. The rate of medication administration errors was measured before and after implementing an integrated electronic medical record (EMR) with BCMA capacity. Errors were classified as wrong drug, wrong dose, wrong route of administration, or a medication administration with no physician order. The error type, severity of error, and medications associated with errors were also quantified. RESULTS A total of 1,978 medication administrations were observed (996 pre-BCMA and 982 post-BCMA). The baseline medication administration error rate was 6.3%, with wrong dose errors representing 66.7% of observed errors. BCMA was associated with a reduction in the medication administration error rate to 1.2%, a relative rate reduction of 80.7% (p < 0.0001). Wrong dose errors decreased by 90.4% (p < 0.0001), and medication administrations with no physician order decreased by 72.4% (p = 0.057). Most errors discovered were of minor severity. Antihistamine medications were associated with the highest error rate. CONCLUSIONS Implementing BCMA in the ED was associated with significant reductions in the medication administration error rate and specifically wrong dose errors. The results of this study suggest a benefit of BCMA on reducing medication administration errors in the ED.
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Affiliation(s)
| | - Cynthia Carnes
- College of Pharmacy; The Ohio State University; Columbus; OH
| | | | - Jay Mirtallo
- College of Pharmacy; The Ohio State University; Columbus; OH
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Bonkowski J, Weber RJ, Melucci J, Pesavento T, Henry M, Moffatt-Bruce S. Improving Medication Administration Safety in Solid Organ Transplant Patients Through Barcode-Assisted Medication Administration. Am J Med Qual 2013; 29:236-41. [DOI: 10.1177/1062860613492374] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - Robert J. Weber
- The Ohio State University Wexner Medical Center, Columbus, OH
| | - Joseph Melucci
- The Ohio State University Wexner Medical Center, Columbus, OH
| | - Todd Pesavento
- The Ohio State University Wexner Medical Center, Columbus, OH
| | - Mitchell Henry
- The Ohio State University Wexner Medical Center, Columbus, OH
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