A Statistically Significant Reduction in Length of Stay and Hospital Costs with Equivalent Quality of Care Metrics for ERCPs Performed During the Weekend Versus Postponed to Weekdays: A 6-Year Study of 533 ERCPs at Four Teaching Hospitals

Introduction Intracerebral hemorrhage (ICH) can be a devastating condition, requiring intensive intervention. Yet, few studies have examined whether patient insurance status is associated with ICH care or acute outcomes. Methods Using data from 1,711 sites participating in GWTG-Stroke database from April 2003 to April 2011, we identified 156,848 non-transferred subjects with ICH who had known discharge status. Insurance status was categorized as private, Medicaid, Medicare or none. We explored associations between lack of insurance (using private insurance status as the reference group) and in-hospital outcomes (mortality, ambulatory status, & length of stay) and quality of care measures (DVT prophylaxis, smoking cessation, dysphagia screening, stroke education, imaging times, & rehabilitation). We utilized multiple individual (including demographics and medical history) and hospital (including size, geographic region and academic teaching status)lcharacteristics as covariates. Results Subjects without insurance (n=10647) were younger (54.4 v. 71 years), more likely men (60.6 v. 50.8%), more likely black (33.2 v. 17.4%) or Hispanic (15.8 v. 7.9%), from the South (50.6 v. 38.9%), and had fewer vascular risk factors with the exception of smoking when compared with the overall subject population. Further, subjects without insurance were more likely to experience in-hospital mortality (25.9 v. 23.9%; adjusted OR 1.29) and longer length of stay (11.4 v. 7.8 days), but were more likely to receive all quality measures of care, be discharged home (52.1 v. 36.1%), and ambulate independently (47.5 v. 38.5%) at discharge compared with subjects with private insurance (n=40033). Conclusions Among GWTG-Stroke participating hospitals, ICH patients without insurance were more likely to die while in the hospital but experienced higher quality measures of care and were more likely to ambulate independently at discharge should they survive.

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Abstract 282: Assessing Levels of Active Participation through a VA Provider Network to Improve Quality of Care for Veterans with Heart Failure

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.7.suppl_1.282 ◽

2014 ◽

Vol 7 (suppl_1) ◽

Author(s):

Anju Sahay ◽

Paul Heidenreich

Keyword(s):

Heart Failure ◽

Quality Of Care ◽

Active Participation ◽

Teaching Hospitals ◽

Evidence Based Practices ◽

Provider Network ◽

Participation Level ◽

Level Data ◽

Facility Level

Objective: The goal of the Dept. of Veterans Affairs (VA) Chronic Heart Failure (CHF) QUERI program is to improve the quality of care for heart failure (HF) patients and implement evidence-based practices throughout the VA system. One strategy to achieve this goal was to create a VA heart failure provider Network which occurred in 2006. We sought to characterize provider participation in this mature network. Method: We tracked all members of the HF Network including their title, location at one of 144 VA facilities; date joined and if applicable, date left the HF Network. We considered the following activities to be evidence of “active” participation: attended a web-based meeting or the annual in-person meeting, requested meeting materials, or completed a periodic survey of providers. Participation of all other members is considered “passive”. For this project we assessed each facility’s level of participation in the HF Network from July 2006 till June 2013 (7 years). Facility participation level was characterized as “None” (no member at that facility with active participation), “Low” (at least one member at that facility attended 1-2 activities) and “High” (at least one member at that facility participated in ≥3 activities). Data were linked to existing facility-level data that included presence of an HF clinic, cardiac cath lab, use of pharmacist, bed size, membership in Council on Teaching Hospitals (COTH), and presence of an Accredited Graduate Medical Education (ACGME) program. Results: Altogether, 1205 providers have participated in the HF Network. As of June 2013, 987 providers from 144 VA facilities participate in this network. They include VACO leadership (1%), VISN leadership (4%), facility leadership (9%), Chiefs of Cardiology (7%), staff physicians (32%), nurses (28%), pharmacists (5%) and others (14%). Participation at the facility-level has increased from 2008 (None=37, Low=43 and High=64) to 2013 (None=8, Low=16 and High=120, (p <0.001). High participating facilities were more likely to be classified as tertiary (p <.016), COTH members (p <0.001), having ACGME programs (p <0.001), and located in the West or Southeast United States (p =.03). High participating facilities are also more likely to have a HF clinic (p <0.001), a cardiac catheterization lab (<0.001), and use a pharmacist in routine HF care (p <.03). Conclusions: Involvement and active participation in the VA HF Network has grown and is more likely at academic facilities and those providing more intensive services.

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Chest tube removal after cardiac surgery

Critical Care Nurse ◽

10.4037/ccn1997.17.1.34 ◽

1997 ◽

Vol 17 (1) ◽

pp. 34-38 ◽

Cited By ~ 6

Author(s):

SC Thomson ◽

S Wells ◽

M Maxwell

Keyword(s):

Cardiac Surgery ◽

Quality Of Care ◽

Length Of Stay ◽

Chest Tube ◽

Chest Tubes ◽

Tube Removal ◽

Chest Tube Removal

Prompt remove of chest tubes by RNs has allowed earlier and more aggressive ambulation of our patients and, along with other interventions, has decreased length of stay by 1.5 days while improving quality of care. Proper education, both didactic and clinical, is the key component in preparing RNs to safely and effectively perform this procedure.

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