Understanding the Payer Dilemma with Biosimilar Mabs: Striking the Right Balance Between Budget Needs and Patient Outcomes

Abstract Background In the era of widespread resistance, there are two events in the course of a hospitalized septic patient where the majority of empiric prescription errors occur: (1) infections upon admission (UA) due to multi-drug-resistant organisms (MDRO) and (2) nosocomial infections due to extensively drug-resistant organisms (XDRO). These errors seriously impact patient outcomes and the ecological burden of resistance. Our objective was to develop a tool, to calculate the probability of MDRO UA, and nosocomial XDRO infections, in order to reduce delays in initiating appropriate therapy to the “right population,” i.e., with “resistant pathogens,” while avoiding overuse of broader (frequently more toxicת less efficacious) therapeutics to the “wrong population,” i.e., with “susceptible pathogens.” Methods Retrospective case–control analyses were conducted for septic adults at Shamir Medical Center, Israel (2016). Logistic regression was used to develop models of risk factors. All parameters incorporated into the models were readily accessible at the point of care. The performances of the development cohorts, and on 8 other validation cohorts, were assessed by the area under the receiver operating characteristic curve (ROC AUC). A web calculator (mobile modifiable) was generated. Results A total of 4,199 patients were enrolled: 2,472 with sepsis UA, and 1,727 with nosocomial sepsis. The “MDR UA score” included 10 parameters and with a cutoff of ≥22 points, had a ROC AUC of 0.85 (sensitivity 86%, NPV 98%). The “Nosocomial XDR score” included 7 parameters and with a cutoff of ≥36 points, had a ROC AUC of 0.88 (sensitivity 90%, NPV 96%). The median ROC AUC was 0.75 among the validation cohorts of the “MDR UA score,” and 0.66 among the “Nosocomial XDR score.” A free web tool was generated: https://assafharofe.azurewebsites.net/. Conclusion A simple electronic calculator was generated to aid in bedside empiric prescription practices. The tool is composed of two scores to assist in common scenarios where the majority of errors occur. Prospective interventional investigations, should trial the performances of this tool in improving patient outcomes and the ecological burden in the facility. Disclosures All authors: No reported disclosures.

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Avoiding harm: central venous access in Kartagener syndrome and other vascular anomalies

The Southwest Respiratory and Critical Care Chronicles ◽

10.12746/swrccc.v9i41.939 ◽

2021 ◽

Vol 9 (41) ◽

pp. 40-43

Author(s):

Brad Snodgrass ◽

Victoria Chu

Keyword(s):

Patient Outcomes ◽

Superior Vena ◽

Central Venous Access ◽

Vena Cava ◽

Venous Access ◽

Central Venous ◽

Kartagener Syndrome ◽

Internal Jugular Vein Catheterization ◽

The Right ◽

Landmark Technique

Placement of internal jugular catheters is more likely to be complicated if a left-sided approach is used, assuming normal anatomy. Kartagener syndrome is the sine qua non of sidedness confusion and results in cognitive challenges that increase the risk of adverse patient outcomes. The altered anatomy can cause profound disorientation from our usual processes. In normal circumstances the right-sided approach is used for placement of internal jugular catheters, but in Kartagener syndrome the left-sided approach should be preferred. Surgical volume and use of ultrasound guided techniques are positively correlated with better outcomes. Clinical experience may be a detriment to performance. Knowledge of these issues will help clinicians maintain vigilance and avoid error. Keywords: Kartagener syndrome, central venous access, superior vena cava, landmark technique, internal jugular vein catheterization cognitive bias

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Modern communications technology: An essential tool for optimizing hospital operations and improving outcomes

Healthcare Management Forum ◽

10.1177/08404704211038215 ◽

2021 ◽

pp. 084047042110382

Author(s):

Benjamin Kanter

Keyword(s):

Real Time ◽

Health Systems ◽

Patient Outcomes ◽

Organizational Knowledge ◽

Communications Technology ◽

Clinical Communication ◽

Hospital Operations ◽

Hospital Systems ◽

The Right ◽

Different Sources

An ability to rapidly convert data from multiple different sources into actionable information is embodied in a concept called Real-time Health Systems (RTHS). The foundational component of RTHS is a modern Clinical Communication and Collaboration (CC&C) Platform, which translates organizational knowledge into action. Effective communication is the key. A CC&C Platform that can receive data from multiple hospital systems, analyze the data, arbitrate any resulting actions and determine the relative priorities to distribute work to the right person or teams–can lead to improved operational efficiencies and better patient outcomes.

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Medical Education in the 21st Century

Online and Distance Learning ◽

10.4018/978-1-59904-935-9.ch046 ◽

2011 ◽

pp. 528-535

Author(s):

Stefane M. Kabene ◽

Jatinder Takhar ◽

Raymond Leduc ◽

Rick Burjaw

Keyword(s):

Medical Education ◽

Quality Of Care ◽

Patient Outcomes ◽

21St Century ◽

Healthcare Professionals ◽

New Technologies ◽

Healthcare Delivery ◽

The Right

As with many disciplines, the fields of healthcare in general and medicine, in particular, have made vast strides in improving patient outcomes and healthcare delivery. But, have healthcare professionals and medical academia been able to maximize the utilization of new technologies to improve the delivery of the right knowledge, to the right people, at the right time across geographical boundaries? In order to provide the best quality of care, regardless of patient or provider location, specific issues must be addressed.

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Medical Education in the 21st Century

Encyclopedia of Developing Regional Communities with Information and Communication Technology ◽

10.4018/978-1-59140-575-7.ch086 ◽

2005 ◽

pp. 488-493

Author(s):

Stefane M. Kaben ◽

Jatinder Takhar ◽

Raymond Leduc ◽

Rick Burjaw

Keyword(s):

Medical Education ◽

Quality Of Care ◽

Patient Outcomes ◽

21St Century ◽

Healthcare Professionals ◽

New Technologies ◽

Healthcare Delivery ◽

The Right

As with many disciplines, the fields of healthcare in general and medicine, in particular, have made vast strides in improving patient outcomes and healthcare delivery. But, have healthcare professionals and medical academia been able to maximize the utilization of new technologies to improve the delivery of the right knowledge, to the right people, at the right time across geographical boundaries? In order to provide the best quality of care, regardless of patient or provider location, specific issues must be addressed.

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Achieving effective patient outcomes with PolyMem® Silicone Border

British Journal of Community Nursing ◽

10.12968/bjcn.2021.26.10.498 ◽

2021 ◽

Vol 26 (10) ◽

pp. 498-509

Author(s):

Linda Rafter ◽

Mark Rafter

Keyword(s):

Patient Outcomes ◽

Chronic Wounds ◽

Wound Care ◽

Evidence Based ◽

Evidence Based Treatment ◽

Healing Environment ◽

Good Patient ◽

Community Staff ◽

The Right ◽

Improve Patient

Clinicians are under increasing pressure to provide high-quality patient outcomes at a reduced cost. Increasingly, community staff must acquire knowledge on advanced wound care products to cope with the growing caseload demands. This article describes the use of PolyMem® dressings to reduce pain, inflammation, oedema and bruising and their ability to debride and absorb exudate while providing an optimum healing environment. The PolyMem range includes multifunctional dressings for various painful chronic wounds. This article also presents five case studies with particularly good patient outcomes where PolyMem dressings were the primary dressing. All five patients were holistically assessed to enable consistent evidence-based treatment decisions. In four cases, the new PolyMem Silicone Border dressing was used. The patients found the PolyMem Silicone Border dressing comfortable and gentle on removal even when the skin was extremely fragile. The right dressing used at the right time on the right patient can improve patient outcomes.

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Precision Medicine for Rheumatoid Arthritis: The Right Drug for the Right Patient-Companion Diagnostics

Diagnostics ◽

10.3390/diagnostics11081362 ◽

2021 ◽

Vol 11 (8) ◽

pp. 1362

Author(s):

Richard Thomas Meehan ◽

Isabelle Anne Amigues ◽

Vijaya Knight

Keyword(s):

Rheumatoid Arthritis ◽

Precision Medicine ◽

Patient Outcomes ◽

New Technologies ◽

Genomic Analysis ◽

Early Results ◽

Drug Responsiveness ◽

The Right ◽

Toxic Drugs ◽

Review Current

Despite the growing number of biologic and JAK inhibitor therapeutic agents available to treat various systemic autoimmune illnesses, the lack of a validated companion diagnostic (CDx) to accurately predict drug responsiveness for an individual results in many patients being treated for years with expensive, ineffective, or toxic drugs. This review will focus primarily on rheumatoid arthritis (RA) therapeutics where the need is greatest due to poor patient outcomes if the optimum drug is delayed. We will review current FDA-approved biologic and small molecule drugs and why RA patients switch these medications. We will discuss the sampling of various tissues for potential CDx and review early results from studies investigating drug responsiveness utilizing advanced technologies including; multiplex testing of cytokines and proteins, autoantibody profiling, genomic analysis, proteomics, miRNA analysis, and metabolomics. By using these new technologies for CDx the goal is to improve RA patient outcomes and achieve similar successes like those seen in oncology using precision medicine guided therapeutics.

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Abstract 12589: Quantitative Assessment of Mid-Systolic Deceleration and Notching in the Right Ventricular Ejection Doppler Envelope is Useful in Predicting Hemodynamics and Patient Outcomes in Pulmonary Arterial Hypertension

Circulation ◽

10.1161/circ.130.suppl_2.12589 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Hiroko Takahama ◽

Garvan C Kane

Keyword(s):

Pulmonary Artery ◽

Patient Outcomes ◽

Quantitative Assessment ◽

Peak Velocity ◽

Systolic Pressure ◽

Right Heart Catheterization ◽

Pulmonary Artery Hypertension ◽

Heart Catheterization ◽

Pulsed Wave Doppler ◽

The Right

Background: Increased reflective wave from pulmonary artery (PA) causes mid-systolic deceleration (MSD) and notching in Doppler flow velocity envelope of RV ejection flow. Our aim is to test whether profile of MSD and notching provides insight into hemodynamics and patient outcomes in pulmonary artery hypertension (PAH), using quantitative measurements. We hypothesized that the deceleration time of the MSD slope (DTMSD), meaning the steepness of the slope, reflects interaction between RV ejection and reflective wave, and that peak velocity of post-notching flow (Vpost) reflects RV function. Methods: We reviewed RV ejection flow envelope recordings by pulsed wave Doppler for 157 consecutive patients with PAH between 1/2008 and 3/2013 (age 57 ± 14) with an estimated RV systolic pressure of 79 ± 23 mmHg. DTMSD was measured as the time between the first peak acceleration wave and MSD slope extrapolated to zero line. We also reviewed right heart catheterization performed within one month from echocardiography in 78 of the 157 patients. Results: We identified MSD and notching in 148 patients. On multivariate regression analyses, PA capacitance was the key determinant of DTMSD (beta = -0.49, p <0.0001). Vpost was determined by cardiac index (beta = -0.36, p = 0.0014). During a median follow-up period of 30 months, there were 47 deaths from all causes and 7 lung transplantations. On Cox hazard analyses, shorter DTMSD and smaller Vpost are significant predictors of higher mortality independently of each other (HR 0.92 / 10ms, p = 0.045 and HR 0.97, p = 0.028, respectively). Conclusion: Mid-systolic deceleration of RV ejection flow became steeper in the setting of lower PA compliance causing a greater reflectance wave. Reduced peak velocity of post-notching flow reflected impaired RV with reduced cardiac output. Quantitative assessment of profile of mid-systolic deceleration and notching in RV ejection flow envelope is useful in predicting hemodynamics and patient outcomes in PAH.

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