Changes in the quality of care during progress from stage 1 to stage 2 of Meaningful Use

Background: The Centers for Medicare and Medicaid Services (CMS) canceled Meaningful Use (MU), replacing it with Advancing Care Information, which preserves many MU elements. Therefore, transitioning from MU stage 1 to MU stage 2 has important implications for the new policy, yet the quality of care provided by physicians transitioning from MU1 to MU2 is unknown. Methods: Retrospective longitudinal evaluation of the quality of care delivered by outpatient physicians at an academic medical center in the transition between MU1 and MU2. Results: Between MU1 and MU2, 4 measures improved: hypertension control (35% vs 40%), influenza immunization (63% vs 68%), tobacco use assessment/counseling (86% vs 96%), and diabetes control (93% vs 96%; P all <.01). One worsened: senior weight screening/follow-up (54% vs 49%; P < .01). Two were unchanged: chlamydia screening and adult weight screening/follow-up. Conclusion: In this single-site study, when clinicians progressed from MU1 to MU2, 4 quality measures improved, 2 were unchanged, and 1 worsened. Analysis of national data should guide policy decisions about the content of MU’s successor.

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Heart Failure Optimize Clinic: Improving Quality of Care In Heart Failure Patients In An Academic Medical Center

Journal of Cardiac Failure ◽

10.1016/j.cardfail.2020.09.381 ◽

2020 ◽

Vol 26 (10) ◽

pp. S131-S132

Author(s):

Theresa Diederich ◽

Scott Lundgren ◽

Bunny Pozehl ◽

Kelly Ferguson ◽

Kyana Holder ◽

...

Keyword(s):

Heart Failure ◽

Quality Of Care ◽

Medical Center ◽

Academic Medical Center ◽

Heart Failure Patients ◽

Academic Medical

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Measuring and Improving Quality of Care in an Academic Medical Center

Journal of Oncology Practice ◽

10.1200/jop.2013.000991 ◽

2013 ◽

Vol 9 (3) ◽

pp. 138-141 ◽

Cited By ~ 4

Author(s):

Douglas W. Blayney

Keyword(s):

Quality Of Care ◽

Clinical Research ◽

Patient Care ◽

Medical Center ◽

Academic Medical Center ◽

Medical Practices ◽

Quality Patient Care ◽

Research Mission ◽

Academic Medical

Leaders of academic medical practices need to balance the perceptions of conflict among the basic, translational, or clinical research mission; the teaching mission; and the patient care mission to deliver quality patient care.

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ICU nursing connectivity and the quality of care in an academic medical center: a network analysis

Critical Care ◽

10.1186/cc13208 ◽

2014 ◽

Vol 18 (Suppl 1) ◽

pp. P18

Author(s):

DM Kelly ◽

DC Angus ◽

D Krackhardt ◽

JM Kahn

Keyword(s):

Quality Of Care ◽

Network Analysis ◽

Medical Center ◽

Academic Medical Center ◽

Academic Medical

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Comprehensive quality of discharge summaries at an academic medical center

Journal of Hospital Medicine ◽

10.1002/jhm.2021 ◽

2013 ◽

Vol 8 (8) ◽

pp. 436-443 ◽

Cited By ~ 41

Author(s):

Leora I. Horwitz ◽

Grace Y. Jenq ◽

Ursula C. Brewster ◽

Christine Chen ◽

Sandhya Kanade ◽

...

Keyword(s):

Medical Center ◽

Academic Medical Center ◽

Academic Medical ◽

Discharge Summaries

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Abstract T P168: A Wake-up Call for Wake-up Strokes

Stroke ◽

10.1161/str.46.suppl_1.tp168 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Josephine F Huang ◽

Jennifer E Fugate ◽

Alejandro A Rabinstein

Keyword(s):

Ischemic Stroke ◽

Medical Center ◽

Academic Medical Center ◽

Stroke Treatment ◽

Good Outcome ◽

Time Period ◽

Academic Medical ◽

Younger Age ◽

Stroke Mechanism

INTRODUCTION: Studies suggest 8%-28% of ischemic strokes present as wake-up strokes (WUS). The unknown time of symptom onset precludes these patients from approved treatments for acute ischemic stroke, but a substantial proportion of patients may be deemed candidates for treatment if other factors are considered. The aim of this study was to identify characteristics associated with clinical outcomes of WUS patients. METHODS: We retrospectively reviewed the medical record of patients with ischemic stroke admitted to a large academic medical center between January 2011 and May 2012. We identified patients with stroke symptoms upon awakening or those who were found with stroke symptoms with an unknown time of onset. Baseline demographics, stroke mechanism, presenting NIHSS, Alberta Stroke Program Early Computed Tomography Score (ASPECTS), and modified Rankin Scale (mRS) scores on discharge and at 3-month follow-up were obtained. A good outcome was defined as mRS 0-2. RESULTS: WUS patients comprised 22% (162/731) of all patients with ischemic stroke at our institution during this time period. Median age was 74 years (range 15-100), median presenting NIHSS was 5 (range 0-28), and median initial ASPECTS 10 (range 0-10). A cardioembolic mechanism was identified in 68 patients (42%). Predictors of good outcome at hospital discharge were lower initial NIHSS (3.5 versus 12.0, p<0.0001) and higher ASPECTS (9.8 versus 8.1, p=0.0002). The predictors of good outcomes at 3 months were younger age (69.1 versus 75.8, p=0.009), lower initial NIHSS (5.0 versus 12.6, p<0.0001), and higher ASPECTS (9.5 versus 8.1, p=0.0006). One hundred and eleven patients (68.5%) had initial ASPECTS of 10. Of those, 19 had NIHSS≥10 and 7 were treated with acute recanalization therapies. Four of the 7 treated patients had good outcomes, and 2 of the 12 untreated patients had good outcomes. CONCLUSIONS: Few patients with strokes of unknown onset and severe deficits have good outcomes without acute stroke treatment. Patients with NIHSS≥10 and ASPECTS 10 may be candidates for acute recanalization therapy.

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Growth and Management of Repaired Complete Tracheal Rings after Slide Tracheoplasty

Otolaryngology ◽

10.1177/0194599819841893 ◽

2019 ◽

Vol 161 (1) ◽

pp. 164-170 ◽

Cited By ~ 5

Author(s):

Lyndy J. Wilcox ◽

Claudia Schweiger ◽

Catherine K. Hart ◽

Alessandro de Alarcon ◽

Nithin S. Peddireddy ◽

...

Keyword(s):

Medical Center ◽

Academic Medical Center ◽

Balloon Dilation ◽

Case Series ◽

Slide Tracheoplasty ◽

Time Period ◽

Academic Medical ◽

Operative Notes ◽

Over Time

ObjectiveThis study documents the growth and course of repaired complete tracheal rings over time after slide tracheoplasty.Study DesignCase series with review.SettingTertiary pediatric academic medical center.Subjects/MethodsMedical records of pediatric patients with confirmed tracheal rings on bronchoscopy who underwent slide tracheoplasty between January 2001 and December 2015 were reviewed. Patients who had operative notes documenting tracheal sizing over time were included. Exclusion criteria included tracheal stenosis not caused by complete tracheal rings, surgical repair prior to presentation at our institution, or lack of adequate sizing information. The postoperative follow-up was examined and airway growth over time documented.ResultsOf 197 slide tracheoplasties performed during the study time period, 139 were for complete tracheal rings, and 40 of those children met inclusion criteria. The median age at time of surgery was 7 months, and the median initial airway size was 3.9 mm (n = 34). The median growth postoperatively was 1.9 mm over a median follow-up period of 57 months (0.42 mm/year), which is similar to growth rates of unrepaired complete tracheal rings ( P = .53). Children underwent a median of 10 postoperative endoscopies, with time between endoscopies increasing further out from surgery. The most commonly performed adjunctive procedure was balloon dilation.ConclusionsThis is the first study documenting continued growth of repaired complete tracheal rings after slide tracheoplasty. Postoperative endoscopic surveillance ensures adequate growth. Intervals between airway endoscopies can be increased as the child gets older, as the airway increases in size, and as long as symptoms are minimal.

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Reducing Preventable Readmissions in a Neurosurgical Patient Population at an Academic Medical Center

Neurosurgery ◽

10.1093/neuros/nyz310_434 ◽

2019 ◽

Vol 66 (Supplement_1) ◽

Author(s):

Shayan Moosa ◽

Lindsay Bowerman ◽

Ellen Smith ◽

Mindy Bryant ◽

Natalie Krovetz ◽

...

Keyword(s):

High Risk ◽

Patient Population ◽

Medical Center ◽

Academic Medical Center ◽

Readmission Rates ◽

Academic Medical ◽

Neurosurgical Patient ◽

Neurosurgical Patients ◽

Significant Difference

Abstract INTRODUCTION Hospital readmissions are extremely costly in terms of time and resources and negatively impact patient safety and satisfaction. In this study, we performed a Pareto analysis of 30-day readmissions in a neurosurgical patient population in order to identify patients at high-risk for readmission. Using this information, we implemented a new practice parameter with the goal of reducing preventable readmissions. METHODS Patient characteristics and causes for readmission were prospectively collected for all neurosurgical patients readmitted to an academic medical center within 30 d of discharge between July and October 2018. A program was then initiated where postoperative neurosurgical spine patients were contacted by phone at standardized intervals before their 2-wk follow-up appointment, with the purpose of more quickly addressing surgical concerns and/or coordinating care for general medical issues. Finally, 30-d readmission rates were compared between the initial 4-mo period and January 2019 through April 2019. RESULTS Prior to intervention, the largest group of readmitted patients included those who had undergone recent spinal surgery (16/47, 34%). Among spine readmissions during this time, 47% were readmitted before their two-week follow-up appointment, 67% lived over 50 miles from the medical center, and 40% were Medicare-insured. There was a statistically significant difference in the mean rate of spine readmissions per month in the periods before (7.0%) and after (3.0%) the program onset (P = .029, 57% decline). The total number of surgically and medically related spine readmissions decreased between the pre- and postintervention periods from 10 to 3 (70%) and 3 to 1 (67%), respectively. CONCLUSION Our data suggests that a large number of neurosurgical readmissions may be prevented by the simple process of early follow-up and consistent communication via telephone. Readmission rates may be further reduced by standardizing the coordination of postoperative general medical follow-up and providing thorough wound care teaching for high-risk patients.

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