Analysis of antibiotic use in a large network of emergency departments

2019 ◽  
Vol 76 (21) ◽  
pp. 1753-1761 ◽  
Author(s):  
Fredrick O’Neal ◽  
Joan Kramer ◽  
Mandelin Cooper ◽  
Edward Septimus ◽  
Sanya Sharma ◽  
...  
Keyword(s):  
United States ◽  
Health System ◽  
Emergency Departments ◽  
The United States ◽  
Evidence Based ◽  
Prescribing Practices ◽  
Evidence Based Practices ◽  
Infectious Origin ◽  
Tract Infections ◽  
Susceptibility Patterns

Abstract Purpose To assess antibiotic selection, administration, and prescribing practices in emergency departments across a large hospital system using evidence-based practices and susceptibility patterns. Methods This retrospective data review was conducted using health system–level electronic data compiled from 145 emergency departments (EDs) across the United States. Data were examined for national generalizability, most common diagnoses of infectious origin seen in nonadmitted patients in the ED, most commonly administered antibiotics in the ED, and geographically defined areas’ unique patterns of antibiotic resistance and susceptibility. Results More than 627,000 unique patient encounters and 780,000 antibiotic administrations were assessed for trends in patient demographics, antibiotics administered for a diagnosis of infectious origin, and corresponding susceptibility patterns. Results indicated that practices in the EDs of this health system aligned with evidence-based practices for streptococcal pharyngitis, otitis media, cellulitis, and uncomplicated urinary tract infections. Conclusion These results provide a representative sample of the current state of practices within many EDs across the United States for nonadmitted patients. A similar data reconstruction can be completed by other health systems to assess their prescribing practices in the ED to improve and elevate care for patients visiting the emergency room and treated as outpatients.

Unhealthy Politics

2020 ◽  
Author(s):  
Eric M. Patashnik ◽  
Alan S. Gerber ◽  
Conor M. Dowling
Keyword(s):  
United States ◽  
Health Care ◽  
Scientific Evidence ◽  
The United States ◽  
Evidence Base ◽  
Medical Industry ◽  
Evidence Based ◽  
Evidence Based Practices ◽  
Delivery Of Medical Care ◽  
Based Medicine

The U.S. medical system is touted as the most advanced in the world, yet many common treatments are not based on sound science. This book sheds new light on why the government's response to this troubling situation has been so inadequate, and why efforts to improve the evidence base of U.S. medicine continue to cause so much political controversy. The book paints a portrait of a medical industry with vast influence over which procedures and treatments get adopted, and a public burdened by the rising costs of health care yet fearful of going against “doctor's orders.” It offers vital insights into the limits of science, expertise, and professionalism in American politics. The book explains why evidence-based medicine is important. First, the delivery of unproven care can expose patients to serious risks. Second, the slow integration of evidence can lead to suboptimal outcomes for patients who receive treatments that work less well for their conditions than alternatives. Third, the failure to implement evidence-based practices encourages wasteful spending, causing the health care system to underperform relative to its level of investment. This book assesses whether the delivery of medical care in the United States is evidence based. It argues that by systematically ignoring scientific evidence (or the lack thereof), the United States is substantially out of balance.

Who gets coached? A qualitative inquiry into community clinicians’ decisions to use caregiver coaching

Autism ◽  
2021 ◽  
pp. 136236132110594
Author(s):  
Liza Tomczuk ◽  
Rebecca E Stewart ◽  
Rinad S Beidas ◽  
David S Mandell ◽  
Melanie Pellecchia
Keyword(s):  
United States ◽  
Early Intervention ◽  
The United States ◽  
Evidence Based ◽  
Autistic Children ◽  
Evidence Based Practices ◽  
Quality Of Evidence ◽  
Marginalized Groups ◽  
Vulnerable Families

Clinicians’ beliefs about an intervention’s fit with an individual family influence whether they use it with that family. The factors that influence clinicians’ decisions to implement evidence-based practices for young autistic children have yet to be evaluated systematically. These factors may partially account for the significant disparities in quality of and access to early intervention. We examined disparities in clinicians’ reported use of caregiver coaching, an evidence-based practice, with families from minoritized or structurally marginalized groups, and the perceived reasons for those disparities, to assess the factors that influence clinicians’ use of caregiver coaching. We conducted semi-structured interviews with 36 early intervention clinicians from publicly funded early intervention agencies in two distinct geographic regions in the United States. Clinicians identified social and structural factors, including perceived family characteristics and stigma, that influenced their beliefs about the fit of coaching with families from minoritized or structurally marginalized groups. These findings point to the presence of beliefs that likely exacerbate disparities in access to evidence-based practices and reduce the quality of care for minoritized families of young autistic children. These findings highlight the need to develop and deploy equity-focused implementation strategies to improve both access to and quality of evidence-based practices for young autistic children from minoritized groups. Lay abstract Providers’ beliefs about an intervention’s fit with a family can affect whether or not they use that intervention with a family. The factors that affect providers’ decisions to use evidence-based practices for young autistic children have not been studied. These factors may play a role in the major differences we see in the quality of and access to early intervention services in the community. We looked at differences in providers’ use of caregiver coaching, an evidence-based practice, with families from minority or vulnerable backgrounds, and the possible reasons for those differences. We did this to figure out what factors affect providers’ use of caregiver coaching. We interviewed 36 early intervention providers from early intervention agencies in two different parts of the United States. Providers pointed out things like what they thought about a family’s circumstances that affected their beliefs about how well coaching fits with minority and vulnerable families. Our findings bring attention to these beliefs that likely make accessing evidence-based practices for minority and vulnerable families harder and lessen the quality of care for these families of young autistic children. These findings highlight the need to come up with and use strategies to improve both access to and the quality of evidence-based practices for young autistic children from minority and vulnerable groups.

Introduction

2020 ◽  
pp. 1-20
Author(s):  
Eric M. Patashnik ◽  
Alan S. Gerber ◽  
Conor M. Dowling
Keyword(s):  
United States ◽  
Health Care ◽  
Resource Allocation ◽  
Scientific Evidence ◽  
The United States ◽  
Evidence Based ◽  
Evidence Based Practices ◽  
Delivery Of Medical Care ◽  
Based Medicine

This introductory chapter explains why evidence-based medicine is important. The sluggish incorporation of medical evidence into clinical practice is a concern for three key reasons: safety, quality, and the efficiency of resource allocation. First, the delivery of unproven care can expose patients to serious risks. Second, the slow integration of evidence can lead to suboptimal outcomes for patients who receive treatments that work less well for their conditions than alternatives. Third, the failure to implement evidence-based practices encourages wasteful spending, causing the health care system to underperform relative to its level of investment. This book assesses whether the delivery of medical care in the United States is evidence based. It argues that by systematically ignoring scientific evidence (or the lack thereof), the United States is substantially out of balance.

Juvenile Homicide in the United States: Sizing Up the Problem and Moving Forward

2021 ◽  
pp. 108876792110438
Author(s):  
Kathleen M. Heide
Keyword(s):  
United States ◽  
The United States ◽  
Evidence Based ◽  
Court Cases ◽  
Evidence Based Practices ◽  
Juvenile Violence ◽  
Us Supreme Court ◽  
Juvenile Homicide ◽  
Juvenile Arrests ◽  
Juvenile Murderers

Juvenile murder arrests in the United States increased dramatically from 1984 to 1993, leading experts to forecast an epidemic of continued violence. Juvenile arrests for murder from 1995 to 2019 are examined to assess whether this prediction was correct. Changes in the laws in response to juvenile violence and US Supreme Court cases that addressed constitutional limitations to the punishment of juvenile murderers are synthesized. The evolution of research on juvenile homicide offenders over the last two decades is highlighted. Recommendations about ways to move forward by using evidence-based practices to prevent juvenile violence and to reduce recidivism are discussed.

scholarly journals Outpatient Antibiotic Prescription Trends in the United States: A National Cohort Study

2018 ◽  
Vol 39 (5) ◽  
pp. 584-589 ◽  
Author(s):  
Michael J. Durkin ◽  
S. Reza Jafarzadeh ◽  
Kevin Hsueh ◽  
Ya Haddy Sallah ◽  
Kiraat D. Munshi ◽  
...  
Keyword(s):  
United States ◽  
Inappropriate Prescribing ◽  
The United States ◽  
Antibiotic Consumption ◽  
Antibiotic Prescribing ◽  
Administrative Claims ◽  
Upper Respiratory Tract ◽  
Prescribing Practices ◽  
Amoxicillin Clavulanate ◽  
Tract Infections

OBJECTIVETo characterize trends in outpatient antibiotic prescriptions in the United StatesDESIGNRetrospective ecological and temporal trend study evaluating outpatient antibiotic prescriptions from 2013 to 2015SETTINGNational administrative claims data from a pharmacy benefits manager PARTICIPANTS. Prescription pharmacy beneficiaries from Express Scripts Holding CompanyMEASUREMENTSAnnual and seasonal percent change in antibiotic prescriptionsRESULTSApproximately 98 million outpatient antibiotic prescriptions were filled by 39 million insurance beneficiaries during the 3-year study period. The most commonly prescribed antibiotics were azithromycin, amoxicillin, amoxicillin/clavulanate, ciprofloxacin, and cephalexin. No significant changes in individual or overall annual antibiotic prescribing rates were found during the study period. Significant seasonal variation was observed, with antibiotics being 42% more likely to be prescribed during February than September (peak-to-trough ratio [PTTR], 1.42; 95% confidence interval [CI], 1.39–1.61). Similar seasonal trends were found for azithromycin (PTTR, 2.46; 95% CI, 2.44–3.47), amoxicillin (PTTR, 1.52; 95% CI, 1.42–1.89), and amoxicillin/clavulanate (PTTR, 1.78; 95% CI, 1.68–2.29).CONCLUSIONSThis study demonstrates that annual national outpatient antibiotic prescribing practices remained unchanged during our study period. Furthermore, seasonal peaks in antibiotics generally used to treat viral upper respiratory tract infections remained unchanged during cold and influenza season. These results suggest that inappropriate prescribing of antibiotics remains widespread, despite the concurrent release of several guideline-based best practices intended to reduce inappropriate antibiotic consumption; however, further research linking national outpatient antibiotic prescriptions to associated medical conditions is needed to confirm these findings.Infect Control Hosp Epidemiol 2018;39:584–589

Intervention Techniques Used With Autism Spectrum Disorder by Speech-Language Pathologists in the United States and Taiwan: A Descriptive Analysis of Practice in Clinical Settings

2018 ◽  
Vol 27 (3) ◽  
pp. 1091-1104 ◽  
Author(s):  
Ming-Yeh Hsieh ◽  
Georgina Lynch ◽  
Charles Madison
Keyword(s):  
United States ◽  
Autism Spectrum Disorder ◽  
The United States ◽  
Autism Spectrum ◽  
Spectrum Disorder ◽  
Evidence Based ◽  
Speech Language Pathologists ◽  
Preparation Programs ◽  
Evidence Based Practices ◽  
Common Intervention

Purpose This study examined intervention techniques used with children with autism spectrum disorder (ASD) by speech-language pathologists (SLPs) in the United States and Taiwan working in clinic/hospital settings. The research questions addressed intervention techniques used with children with ASD, intervention techniques used with different age groups (under and above 8 years old), and training received before using the intervention techniques. Method The survey was distributed through the American Speech-Language-Hearing Association to selected SLPs across the United States. In Taiwan, the survey (Chinese version) was distributed through the Taiwan Speech-Language Pathologist Union, 2018, to certified SLPs. Results Results revealed that SLPs in the United States and Taiwan used 4 common intervention techniques: Social Skill Training, Augmentative and Alternative Communication, Picture Exchange Communication System, and Social Stories. Taiwanese SLPs reported SLP preparation program training across these common intervention strategies. In the United States, SLPs reported training via SLP preparation programs, peer therapists, and self-taught. Conclusions Most SLPs reported using established or emerging evidence-based practices as defined by the National Professional Development Center (2014) and the National Standards Report (2015). Future research should address comparison of SLP preparation programs to examine the impact of preprofessional training on use of evidence-based practices to treat ASD.

scholarly journals De-evolution of expectations for evidence-based practices in public education in the United States

2019 ◽  
Vol 27 ◽  
pp. 137
Author(s):  
Michael P. Brady ◽  
Michael Hazelkorn
Keyword(s):  
United States ◽  
Social Context ◽  
Public Education ◽  
The United States ◽  
Data Driven ◽  
Evidence Based ◽  
Research Practice ◽  
Evidence Based Practices ◽  
State Regulations ◽  
Gradual Shift

Public education in the United States has been undergoing a shift from an empirical tradition in which practices and policies are derived from research, practice, reflection, and implementation. In this empirical tradition, professionals embrace a culture and commitment to evidence-based practices (EBPs) and expect that practices and policies in the field are supported by rational, data-driven models. In this paper, we present an argument and three cases that illustrate how educators have been undergoing a gradual shift away from empiricism toward a de-evolution of EBP. We propose that this gradual shift is based on a political-social context, in which practices and policies are implemented using the language of an accountability model of reform, in which national and state regulations, and accreditation bodies, establish expectations often devoid of an empirical basis for the practices they mandate.

scholarly journals Use of A Community of Practice For The Implementation of Evidence-Based Practices For Heart Failure Within The United States Department of Veterans Affairs

2021 ◽  
Author(s):  
Anju Sahay ◽  
Paul A. Heidenreich ◽  
Brian S Mittman ◽  
Parisa Gholami ◽  
Shoutzu Lin
Keyword(s):  
United States ◽  
Heart Failure ◽  
Quality Of Care ◽  
The United States ◽  
Veterans Affairs ◽  
Evidence Based ◽  
Department Of Veterans Affairs ◽  
Clinical Practices ◽  
Evidence Based Practices

Abstract Communities of Practice (CoPs) are a promising approach to facilitate the implementation of evidence-based practices (EBPs) to improve care for chronic conditions like heart failure (HF). COPs involve a complex process of acquiring and converting both explicit and tacit knowledge into clinical activities. Formation: In July 2006, a CoP called the Heart Failure Provider Network (HF Network) was established in the United States (US) Department of Veterans Affairs (VA) with the overarching goal of improving the quality of care for HF patients. The CoP has involved a total of 1,341 multidisciplinary and multilevel members at all 144 VA Health Care Systems (sites). Examples of CoP activities include discussions of interventions to decrease hospitalization rates and to empower patients and caregivers for self-management. Goals of the CoP include networking facilitation, information dissemination and exchange, collaboration and implementation of EBPs. Assessment: We conceptualized the assessment (formative evaluation) of the HF Network in terms of its various activities (inputs) and proximal impacts (mediators) at the individual-level, and its distal and ultimate impacts (outcomes) at the site-level leading to an improved culture of implementation of new/improved EBPs at the system-wide level. The HF Network membership grew steadily over the nine years. Most members were practicing clinicians (n = 891, 66.4%), followed by administrators (n = 342, 25.5%), researchers (n = 70, 5.2%), and others (n = 38, 2.8%). Participation was “active” for 70.9% versus “passive” for 29.4% of members. The distribution of active members (clinicians 64.7%, administrators 21.6%) was similar to the distribution of overall membership. Survey respondents perceived the HF Network as useful in terms of its varied activities and resources relevant for patient care. Members, particularly those that consider themselves influential in improving quality of care, noted multiple benefits of membership. These included confirmation of one’s own clinical practices, evidence-based changes to their practice and help in understanding facilitators and barriers in setting up or running HF clinics and other programs.

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