The Grandview Medical Center Bioethics Consultation Service Perspective on the Peril of Isolated and Vulnerable Individuals due to COVID-19

Using evidence derived from previously collected medical records to guide patient care has been a long standing vision of clinicians and informaticians, and one with the potential to transform medical practice. As a result of advances in technical infrastructure, statistical analysis methods, and the availability of patient data at scale, an implementation of this vision is now possible. Motivated by these advances, and the information needs of clinicians in our academic medical center, we offered an on-demand consultation service to derive evidence from patient data to answer clinician questions and support their bedside decision making. We describe the design and implementation of the service as well as a summary of our experience in responding to the first 100 requests. Consultation results informed individual patient care, resulted in changes to institutional practices, and motivated further clinical research. We make the tools and methods developed to implement the service publicly available to facilitate the broad adoption of such services by health systems and academic medical centers.

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A-05 Gender differences in veterans referred for neuropsychological evaluation in an outpatient neuropsychology consultation service

Archives of Clinical Neuropsychology ◽

10.1093/arclin/acz034.05 ◽

2019 ◽

Vol 34 (6) ◽

pp. 864-864

Author(s):

E Sullivan-Baca ◽

K Naylon ◽

A Zartman ◽

B Ardolf ◽

J Westhafer

Keyword(s):

Sex Differences ◽

Older Women ◽

Older Adult ◽

Medical Center ◽

Neuropsychological Evaluation ◽

Vascular Risk ◽

Consultation Service ◽

Full Sample ◽

Growing Population ◽

Demographic Features

Abstract Objective Women represent a growing population within the VA Healthcare System about which little is known from a neuropsychological perspective. The present study explored sex differences in veterans presenting for neuropsychological evaluation to delineate trends in demographics, referral questions, effort, and outcome diagnoses. Method A database derived from an outpatient neuropsychology clinic at a VA medical center spanning 2013 to 2019 was analyzed (n = 232 women/2642 men). Initial analyses explored demographic features of the full sample. Further analyses separated the sample into younger (n = 836 men, 155 women) and older adult (n = 1805 men, 77 women). Results Groups differed in age (t(1,2872) = 10.41, p < .001) and education (t(1,2830) = 6.68, p < .001). Men were older, less educated, and had greater vascular risk factors. In the younger group, men were more often referred for TBI (X2(1,1) = 7.27, p < .01) and women for multiple sclerosis (X2(1,1) = 13.56, p < .01). In the older group, men performed worse on effort measures (WMT IR: t(1,42.24) = 2.36, p < .05; WMT MC: t(1,327) = 2.57, p < .05; TOMM Trial 2: t(1,199) = 2.17, p < .05). Older women evidenced higher scores on GDS (t(1,43.04) = 2.94, p < .01) and were more commonly diagnosed with depression (X2(1,1) = 12.66, p < .01). Conclusions Sex differences in demographics, medical conditions, referral question, effort, and outcome diagnoses emerged in a large sample of veterans referred for outpatient neuropsychological assessment. These differences point to important diagnostic considerations for neuropsychologists in VA settings.

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Medicaid & Medicare: D.C. Appellate Court Denies Claim for Medicare Reimbursement of GME Cost

The Journal of Law Medicine & Ethics ◽

10.1017/s1073110500012997 ◽

1999 ◽

Vol 27 (2) ◽

pp. 205-205

Author(s):

choeffel Amy

Keyword(s):

Medical Center ◽

Federal District ◽

Federal Court ◽

University Of Pennsylvania ◽

District Court ◽

Appellate Court ◽

Court Of Appeals ◽

Department Of Health ◽

Administrative Proceedings ◽

Summary Judgment

The U.S. Court of Appeals for the District of Columbia upheld, in Presbyterian Medical Center of the University of Pennsylvania Health System v. Shalala, 170 F.3d 1146 (D.C. Cir. 1999), a federal district court ruling granting summary judgment to the Department of Health and Human Services (DHHS) in a case in which Presbyterian Medical Center (PMC) challenged Medicare's requirement of contemporaneous documentation of $828,000 in graduate medical education (GME) expenses prior to increasing reimbursement amounts. DHHS Secretary Donna Shalala denied PMC's request for reimbursement for increased GME costs. The appellants then brought suit in federal court challenging the legality of an interpretative rule that requires requested increases in reimbursement to be supported by contemporaneous documentation. PMC also alleged that an error was made in the administrative proceedings to prejudice its claims because Aetna, the hospital's fiscal intermediary, failed to provide the hospital with a written report explaining why it was denied the GME reimbursement.

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