scholarly journals Patient portal use and hospital outcomes

2017 ◽  
Vol 25 (4) ◽  
pp. 447-453 ◽  
Author(s):  
Adrian G Dumitrascu ◽  
M Caroline Burton ◽  
Nancy L Dawson ◽  
Colleen S Thomas ◽  
Lisa M Nordan ◽  
...  
Keyword(s):  
Propensity Score ◽  
Future Research ◽  
Inpatient Setting ◽  
Patient Portal ◽  
Inpatient Mortality ◽  
Hospital Outcomes ◽  
Severity Scores ◽  
Significant Difference ◽  
Improve Hospital ◽  
Matched Study

Abstract Objectives To determine whether use of a patient portal during hospitalization is associated with improvement in hospital outcomes, 30-day readmissions, inpatient mortality, and 30-day mortality. Materials and Methods We performed a retrospective propensity score–matched study that included all adult patients admitted to Mayo Clinic Hospital in Jacksonville, Florida, from August 1, 2012, to July 31, 2014, who had signed up for a patient portal account prior to hospitalization (N = 7538). Results Out of the admitted patients with a portal account, 1566 (20.8%) accessed the portal while in the hospital. Compared to patients who did not access the portal, patients who accessed the portal were younger (58.8 years vs 62.3 years), had fewer elective admissions (54.2% vs 64.1%), were more frequently admitted to medical services (45.8% vs 35.2%), and were more likely to have liver disease (21.9% vs 12.9%) and higher disease severity scores (0.653 vs 0.456). After propensity score matching, there was no statistically significant difference between the 2 cohorts with respect to 30-day readmission (P = .13), inpatient mortality (P = .82), or 30-day mortality (P = .082). Conclusion Use of the patient portal in the inpatient setting may not improve hospital outcomes. Future research should examine the association of portal use with more immediate inpatient health outcomes such as patient experience, patient engagement, medication reconciliation, and prevention of adverse events.

FA03.04: ACTIVE SURVEILLANCE VS SURGERY IN CLINICALLY COMPLETE RESPONDERS AFTER NEOADJUVANT CHEMORADIOTHERAPY FOR ESOPHAGEAL CANCER: A PROPENSITY-MATCHED STUDY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 7-7
Author(s):  
Berend Van Der Wilk ◽  
Lisanne Neijenhuis ◽  
B Noordman ◽  
Grard A P Nieuwenhuijzen ◽  
M N Sosef ◽  
...  
Keyword(s):  
Overall Survival ◽  
Esophageal Cancer ◽  
Propensity Score ◽  
Active Surveillance ◽  
Neoadjuvant Chemoradiotherapy ◽  
Complete Response ◽  
Surgery Group ◽  
Significant Difference ◽  
Matched Study ◽  
Dissemination Rate

Abstract Background Nearly one third of esophageal cancer patients show a pathologically complete response in their resection specimens after neoadjuvant chemoradiotherapy (nCRT) according to CROSS regimen. This raises questions whether all patients benefit from surgery or if active surveillance can be applied to patients with a clinically complete response (cCR) after nCRT. This retrospective-multicenter propensity matched study compared outcomes of patients with a cCR after nCRT undergoing active surveillance or standard surgery. Methods Patients that refused surgery after nCRT between 2012–2017 from 4 hospitals were included. For the standard surgery group, patients from the preSANO trial were enrolled. A cCR was defined as endoscopies with multiple (bite-on-bite) biopsies, EUS-FNA and PET-CT showing no residual disease 6 and 12 weeks after completion of nCRT. Optimal propensity-score matching generated a matched cohort (1:2) matched for age, comorbidities, cT, cN, histology of the tumor and biopsy type. For comparison of severity of complications according to Clavien-Dindo (CD) classification, a separate optimal propensity-score matching cohort was generated (1:2) for all patients in the active surveillance group that underwent surgery. Primary outcome was overall survival, secondary outcomes were rate of radically resected tumors, distant dissemination rate and rate of postoperative complications according to the CD-classification. Results 75 patients were identified of whom 50 patients underwent standard surgery and 25 patients underwent active surveillance. 13 of 25 patients in the active surveillance group underwent surgery for locoregional recurrent disease. Median follow-up was 23.7 months for the standard surgery group and 18.8 months for the active surveillance group. There was no statistically significant difference between the groups in overall survival (HR = 0.48, 95%C.I. 0.10–2.2, P = 0.96). In both groups, all tumors were radically resected. There were no statistically significant differences in distant dissemination rate between the active surveillance and standard surgery group (16.0% versus 22.0%, P = 0.76) or in severity of complications (CD ≥ 3;46.2% versus 23.1%, P = 0.16). Conclusion There was no statistically significant difference in overall survival, distant dissemination rate and severity of complications between patients undergoing standard surgery or active surveillance after nCRT. However, since sample sizes were small, especially for the severity of complications, these results should be interpreted with caution. Disclosure All authors have declared no conflicts of interest.

scholarly journals Association of Opium Consumption and Coronary Artery Ectasia: A Propensity Score-matched Study

2020 ◽  
Author(s):  
Mahan Shafie ◽  
Arya Aminorroaya ◽  
Ali Vasheghani-Farahani ◽  
Arash Jalali ◽  
Abdolvahab Baradaran
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Propensity Score ◽  
Control Group ◽  
Coronary Artery Ectasia ◽  
Increased Risk ◽  
Significant Difference ◽  
Artery Disease ◽  
Matched Study ◽  
Coronary Angiograms

Abstract Background: Opium consumption is associated with an increased risk of atherosclerosis and a hyper-inflammatory state that are suggested as contributing factors to the development of coronary artery ectasia (CAE). We aimed to determine if opium consumption is an independent risk factor of CAE. Methods: In this propensity score-matched study, we enrolled patients who underwent elective coronary angiography between September 2004 and March 2017 in Tehran Heart Center. We studied patients with CAE and without coronary artery disease as cases. The control group, patients with normal coronary angiograms, were selected after applying the propensity score matching to match for age, sex, diabetes mellitus, hypertension, hyperlipidemia, family history of coronary artery disease, and cigarette smoking.Results: We studied 242 patients with pure CAE and selected 968 control patients. The prevalence of opium consumption was not significantly different across these groups, 17 (7.5%) in the pure CAE group compared to 76 (8.6%) in the control group (Odds ratio: 0.81; p=0.455). Amongst the patients with pure CAE, Markis scores were not significantly different between opium consumers and non-consumers (p=0.136).Conclusions: We found no significant difference regarding opium consumption between patients with pure CAE and patients with normal coronary angiograms. In addition, there is no correlation between opium consumption and Markis scores in patients with pure CAE.

scholarly journals Evaluation of Thiamine as Adjunctive Therapy in COVID-19 Critically Ill Patients: A Multicenter Propensity Score Matched Study

2021 ◽  
Author(s):  
Khalid Al Sulaiman ◽  
Ohoud Aljuhani ◽  
Maram Al Dossari ◽  
Asma Alshahrani ◽  
Aisha Alharbi ◽  
...  
Keyword(s):  
Propensity Score ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Adjunctive Therapy ◽  
Thiamine Pyrophosphate ◽  
P Value ◽  
Immune System Function ◽  
Severity Scores ◽  
Matched Study

Abstract Background: Thiamine is a precursor of the essential coenzyme thiamine pyrophosphate (TPP) required for glucose metabolism; it improves the immune system function and has been shown to reduce the risk of several diseases. The role of thiamine in COVID-19 critically ill patients is still unclear, however, its role in the critically ill septic patient has been addressed in multiple studies. The objective of this study was to evaluate the use of thiamine as adjunctive therapy on the mortality in COVID 19 critically ill patients. Methods: This is a multicenter, non-interventional, retrospective cohort study for all critically ill patients admitted to intensive care units (ICUs) with a confirmed diagnosis of COVID19. All patients aged 18 years or older who were admitted to ICUs between March 1st to December 31st, 2020 with positive PCR COVID-19 were included in the study. We investigated the association between thiamine use as an adjunctive therapy and clinical outcomes in COVID -19 after propensity score matching using baseline severity scores, systemic use of corticosteroids and study centers. Results: A total of 738 critically ill patients with COVID-19 who had been admitted in ICUs at the two governmental hospitals included in the study. Among 166 patients matched using propensity score, 83 had received thiamine as adjunctive therapy. There was significant association between thiamine use with in-hospital mortality (OR=0.49; 95% CI = 0.25- 0.97; P=0.04) as well with 30-day ICU mortality (OR=0.45; 95% CI = 0.215- 0.935; P=0.03). Moreover, patients who received thiamine as an adjunctive therapy were less likely to have thrombosis during ICU stay by 81 % (OR (95%CI): 0.19 (0.040,0.884), p-value=0.034).Conclusion: Thiamine use as an adjunctive therapy may have potential survival benefits in critically ill patients with COVID-19.

scholarly journals Incidence and Outcomes of Hemorrhagic Stroke among Adults in Spain (2016–2018) According to Sex: A Retrospective, Cohort, Observational, Propensity Score Matched Study

2021 ◽  
Vol 10 (16) ◽  
pp. 3753
Author(s):  
Jose M. de Miguel-Yanes ◽  
Ana Lopez-de-Andres ◽  
Rodrigo Jimenez-Garcia ◽  
Valentin Hernandez-Barrera ◽  
Javier de Miguel-Diez ◽  
...  
Keyword(s):  
Propensity Score ◽  
Decompressive Craniectomy ◽  
Retrospective Cohort ◽  
Hemorrhagic Stroke ◽  
Antiplatelet Agents ◽  
Incidence Rates ◽  
Hospital Outcomes ◽  
Men And Women ◽  
Intracerebral Hemorrhages ◽  
Matched Study

(1) Background: We aim to analyze sex differences in the incidence, clinical characteristics and in-hospital outcomes of hemorrhagic stroke (HS) in Spain (2016–2018) using the National Hospital Discharge Database. (2) Methods: Retrospective, cohort, observational study. We estimated the incidence of HS in men and women. We analyzed comorbidity, treatments, procedures, and hospital outcomes. We matched each woman with a man by age, type of HS and medical conditions using propensity score matching. (3) Results: HS was coded in 57,227 patients aged ≥18 years (44.3% women). Overall, men showed higher incidence rates (57.3/105 vs. 43.0/105; p < 0.001; IRR = 1.60; 95% CI: 1.38–1.83). Women suffered more subarachnoid hemorrhages (25.2% vs. 14.6%), whereas men more often had intracerebral hemorrhages (55.7% vs. 54.1%). In-hospital mortality (IHM) was higher for intracerebral hemorrhage in both men and women. Women underwent decompressive craniectomy less often than men (5.0% vs. 6.2%; p < 0.001). After matching, IHM among women was higher (29.0% vs. 23.7%; p < 0.001). Increments in age, comorbidity and use of anticoagulants and antiplatelet agents prior to hospitalization were associated were higher IHM, and decompressive craniectomy was associated with lower IHM in both sexes. After multivariable adjustment, women had higher IHM (OR = 1.23; 95% CI: 1.18–1.28). (4) Conclusion: Men had higher incidence rates of HS than women. Women less often underwent decompressive craniectomy. IHM was higher among women admitted for HS than among men.

Abstract 14875: Chronic Obstructive Pulmonary Disease Negatively Affects In-hospital Outcomes in Patients With Takotsubo Cardiomyopathy

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Pengyang Li ◽  
Catherine Teng ◽  
Mark Kranis ◽  
Peng Cai ◽  
Qiying Dai ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Propensity Score ◽  
Cardiogenic Shock ◽  
Takotsubo Cardiomyopathy ◽  
Primary Diagnosis ◽  
Chronic Obstructive ◽  
Inpatient Mortality ◽  
Hospital Outcomes ◽  
Obstructive Pulmonary Disease ◽  
Hospitalization Costs

Introduction: Chronic obstructive pulmonary disease (COPD) is a known comorbidity of takotsubo cardiomyopathy (TCM), and COPD exacerbation is a potential trigger of TCM. The association between COPD and in-hospital outcomes and complications in TCM patients is not well established. Aim: We aimed to assess the effect of COPD on hospitalized patients with a primary diagnosis of TCM. Methods: Using the latest National Inpatient Sample from 2016-2017, we conducted a retrospective cohort study in patients with a primary diagnosis of TCM with or without COPD. The diagnosis was identified by the ICD-10-CM coding system. We identified 3,139 patients admitted with a primary diagnosis of TCM; 684 of those patients also had a diagnosis of COPD. We performed propensity score matching in a 1:2 ratio (n=678 patients, matched COPD group; n=1,070, matched non-COPD group) and compared in-hospital outcomes and complications between TCM patients with and without a COPD diagnosis. Results: Before matching, the COPD group had worse outcomes compared with the non-COPD group in inpatient death (2.9% vs. 1.3%, p=0.006), length of stay (LOS) (4.02±2.99 days vs. 3.27±3.39 days, p<0.001), hospitalization costs ($55,242.68±47,637.40 vs. $48,316.97±47,939.84, p=0.001), and acute respiratory failure (ARF) (22.5% vs. 7.7%, p<0.001), respectively. After propensity score matching, the matched COPD group, compared with the matched non-COPD group, had a higher inpatient mortality rate (2.9% vs.1.0%, p=0.005), longer LOS (4.02±3.00 days vs. 3.40±3.54 days, p<0.001), higher hospitalization costs ($55,409.23±47,809.13 vs. $44,6469.60±42,209.10, p<0.001), and a higher incidence of ARF (22.6% vs. 8.2%, p<0.001) and cardiogenic shock (5.6% vs. 3.3%, p=0.024), respectively. Conclusions: Patients who are hospitalized for TCM and have COPD have higher rates of inpatient mortality, ARF, and cardiogenic shock, as well as a longer LOS and a higher cost of stay than TCM patients without COPD. Prospective studies are warranted to examine the effect of early intervention or treatment of COPD on short and long-term outcomes of TCM.

scholarly journals The association between method of solicitation and patient permissions for use of surplus tissues and contact for future research

JAMIA Open ◽  
2018 ◽  
Vol 1 (2) ◽  
pp. 195-201 ◽  
Author(s):  
Azza Shoaibi ◽  
Jihad S Obeid ◽  
Jim C Oates ◽  
Melissa L Habrat ◽  
Leslie A Lenert
Keyword(s):  
Propensity Score ◽  
Research Participation ◽  
Population Based ◽  
Future Research ◽  
Patient Questionnaire ◽  
Patient Portal ◽  
Patient Portals ◽  
Clinical Workflow ◽  
Propensity Score Model ◽  
The Difference

AbstractObjectiveObtaining patient permissions for research contact and for surplus tissue use as part of routine clinical practice can improve research participation. This study aims to investigate the difference in patient permissions for use of surplus tissues, and for direct contact for research, using 2 different methods of solicitation.MethodsAn opt-in, population-based approach for gathering research permissions was implemented in 2 methods. The first method, applied a 2-item patient questionnaire delivered through the electronic health record patient portal. The questionnaire composed of 2 questions (1) whether de-identified surplus specimens may be used for research and (2) whether patients could be contacted about research. In the second method, the same questionnaire was physically presented in clinic within the clinical workflow. We used 1 to 1 propensity score matching and multivariate logistic regression to estimate the odds of obtaining permission and the difference between the 2 methods of solicitation.ResultsThe propensity score model matched 8044 observations (4114 submissions in each group). Among the in-clinic submission group, 70.13% provided permission for surplus tissue compared with 66.65% in the patient portal submission group (odds ratio [OR] = 1.20; 95% confidence interval [CI] 1.09–1.32; P &lt; 0.001). Permission for future research contact was similar among in-clinic (65.07%) and patient portal submission (66.65%) groups (OR = 0.94; 95% CI 0.85–1.03; P = 0.175). These trends were consistent among European Americans and African American patients. However, among patients of other race, higher permission for both future contact (OR = 0.58; 95% CI 0.39–0.86; P &lt; 0.007) and surplus tissue use (OR = 0.65; 95% CI 0.43–0.97; P = 0.036) was observed among patient portal submission.DiscussionOur findings suggest that in-clinic solicitation of patient permissions may provide the same opportunity to patients who do not use patient portals and may be associated with higher permission rate for surplus tissue. However, this was primary true for European American and African Americans patients. Patients of other race minorities might respond better to online approaches.ConclusionAdopting a patient-centric approach that combines in-clinic and portal-based administration may be feasible and promising. Further research is required in this area.

scholarly journals General vs. Regional Anesthesia and Neonatal Data (GRAND). A Retrospective Propensity Score Matched Study.

2021 ◽  
Author(s):  
Liviu Cojocaru ◽  
Cristiana Salvatori ◽  
Sharon Amir ◽  
Hyunuk Seung ◽  
Katherine Nyman ◽  
...  
Keyword(s):  
Propensity Score ◽  
Regional Anesthesia ◽  
Apgar Score ◽  
Neonatal Intensive Care ◽  
Neonatal Outcomes ◽  
Retrospective Case ◽  
Maternal Characteristics ◽  
Significant Difference ◽  
Matched Study ◽  
Control Study

Objective To evaluate whether there is a difference in immediate neonatal outcomes with general anesthesia (GA) vs. regional anesthesia (RA) when induction of anesthesia to delivery time (IADT) is prolonged (≥10 minutes). Methods This is a retrospective case-control study that included cases from July 2014 until August 2020. We reviewed all singleton pregnancies delivered between 24 and 42 weeks of gestation with IADT ≥ 10 minutes. The propensity score (PS) matching method was performed using baseline characteristics. Analyses were performed with SAS software version 9.4. Results During the study period, we identified 258 cases meeting inclusion criteria. After the PS matching was applied, the study sample was reduced to 60 cases in each group. The median IADT was similar between groups [41.5m (30.5,52) vs. 46m (38-53.5), p=0.2]. There was no significant difference between groups with respect to arterial cord pH [7.24 (7.21,7.26) vs. 7.23 (7.2,7.27), p=0.7]. Nor were there any associations between maternal characteristics and Apgar score at 5 minutes except Apgar score at 1 minute (p<0.001). No significant difference was identified in the rate of admission to the neonatal intensive care unit (NICU) [11 (52.4) vs. 10 (47.60], p=0.8] or NICU length of stay between GA vs. RA [4(3-14) vs. 4.5(3-11), p=0.9]. Conclusion Our data indicate that with prolonged IADT, favorable neonatal outcomes are seen with both GA and RA, in contrast with previous studies performed decades ago. This underscores the need for re-appraisal of historic outcomes reflecting new modalities, techniques, and advances in the medical field.

Impact of intrawound vancomycin powder on prevention of surgical site infection after posterior spinal surgery

2021 ◽  
pp. 1-9
Author(s):  
Hiroki Ushirozako ◽  
Tomohiko Hasegawa ◽  
Yu Yamato ◽  
Go Yoshida ◽  
Tatsuya Yasuda ◽  
...  
Keyword(s):  
Propensity Score ◽  
Spinal Surgery ◽  
Control Group ◽  
Control Groups ◽  
Propensity Score Model ◽  
Significant Difference ◽  
Surgical Data ◽  
Vancomycin Powder ◽  
Vancomycin Group ◽  
And Control

OBJECTIVESurgical site infection (SSI) after posterior spinal surgery is one of the severe complications that may occur despite administration of prophylactic antibiotics and the use of intraoperative aseptic precautions. The use of intrawound vancomycin powder for SSI prevention is still controversial, with a lack of high-quality and large-scale studies. The purpose of this retrospective study using a propensity score–matched analysis was to clarify whether intrawound vancomycin powder prevents SSI occurrence after spinal surgery.METHODSThe authors analyzed 1261 adult patients who underwent posterior spinal surgery between 2010 and 2018 (mean age 62.3 years; 506 men, 755 women; follow-up period at least 1 year). Baseline and surgical data were assessed. After a preliminary analysis, a propensity score model was established with adjustments for age, sex, type of disease, and previously reported risk factors for SSI. The SSI rates were compared between patients with intrawound vancomycin powder treatment (vancomycin group) and those without (control group).RESULTSIn a preliminary analysis of 1261 unmatched patients (623 patients in the vancomycin group and 638 patients in the control group), there were significant differences between the groups in age (p = 0.041), body mass index (p = 0.013), American Society of Anesthesiologists classification (p < 0.001), malnutrition (p = 0.001), revision status (p < 0.001), use of steroids (p = 0.019), use of anticoagulation (p = 0.033), length of surgery (p = 0.003), estimated blood loss (p < 0.001), and use of instrumentation (p < 0.001). There was no significant difference in SSI rates between the vancomycin and control groups (21 SSIs [3.4%] vs 33 SSIs [5.2%]; OR 0.640, 95% CI 0.368–1.111; p = 0.114). Using a one-to-one propensity score–matched analysis, 444 pairs of patients from the vancomycin and control groups were selected. There was no significant difference in the baseline and surgical data, except for height (p = 0.046), between both groups. The C-statistic for the propensity score model was 0.702. In the score-matched analysis, 12 (2.7%) and 24 (5.4%) patients in the vancomycin and control groups, respectively, developed SSIs (OR 0.486, 95% CI 0.243–0.972; p = 0.041). There were no systemic complications related to the use of vancomycin.CONCLUSIONSThe current study showed that intrawound vancomycin powder was useful in reducing the risk of SSI after posterior spinal surgery by half, without adverse events. Intrawound vancomycin powder use is a safe and effective procedure for SSI prevention.

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