scholarly journals Evaluation of outcome relevance of quality indicators in the emergency department (ENQuIRE): study protocol for a prospective multicentre cohort study

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e038776
Author(s):  
Susanne Drynda ◽  
Wencke Schindler ◽  
Anna Slagman ◽  
Johannes Pollmanns ◽  
Dirk Horenkamp-Sonntag ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Quality Indicators ◽  
Patient Outcomes ◽  
Claims Data ◽  
Quality Measures ◽  
Patient Questionnaire ◽  
Multicentre Cohort Study ◽  
Multicentre Cohort

IntroductionQuality of emergency department (ED) care affects patient outcomes substantially. Quality indicators (QIs) for ED care are a major challenge due to the heterogeneity of patient populations, health care structures and processes in Germany. Although a number of quality measures are already in use, there is a paucity of data on the importance of these QIs on medium-term and long-term outcomes. The evaluation of outcome relevance of quality indicators in the emergency department study (ENQuIRE) aims to identify and investigate the relevance of QIs in the ED on patient outcomes in a 12-month follow-up.Methods and analysisThe study is a prospective non-interventional multicentre cohort study conducted in 15 EDs throughout Germany. Included are all patients in 2019, who were ≥18 years of age, insured at the Techniker Krankenkasse (statutory health insurance (SHI)) and gave their written informed consent to the study.The primary objective of the study is to assess the effect of selected quality measures on patient outcome. The data collected for this purpose comprise medical records from the ED treatment, discharge (claims) data from hospitalised patients, a patient questionnaire to be answered 6–8 weeks after emergency admission, and outcome measures in a 12-month follow-up obtained as claims data from the SHI.Descriptive and analytical statistics will be applied to provide summaries about the characteristics of QIs and associations between quality measures and patient outcomes.Ethics and disseminationApproval of the leading ethics committee at the Medical Faculty of the University of Magdeburg (reference number 163/18 from 19 November 2018) has been obtained and adapted by responsible local ethics committees.The findings of this work will be disseminated by publication of peer-reviewed manuscripts and presentations as conference contributions (abstracts, poster or oral presentations).Moreover, results will be discussed with clinical experts and medical associations before being proposed for implementation into the quality management of EDs.Trial registration numberGerman Clinical Trials Registry (DRKS00015203); Pre-results.

scholarly journals Statin therapy and recurrent venous thromboembolism in the elderly: a prospective cohort study

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Regula Monika Kronenberg ◽  
Shanthi Beglinger ◽  
Odile Stalder ◽  
Marie Méan ◽  
Andreas Limacher ◽  
...  
Keyword(s):  
Cohort Study ◽  
Venous Thromboembolism ◽  
Propensity Scores ◽  
The Elderly ◽  
Confounding By Indication ◽  
Multicentre Cohort Study ◽  
Recurrent Venous Thromboembolism ◽  
Reduce Risk ◽  
Multicentre Cohort

Abstract Previous studies reported lower rates of recurrent venous thromboembolism (rVTE) among statin users, but this association could be influenced by concurrent anticoagulation and confounding by statin indication. This study aimed to confirm the beneficial association between statins and rVTE, stratified according to periods with and without anticoagulation, and additionally employ propensity score weighted approach to reduce risk of confounding by indication. The setting was a prospective multicentre cohort study and the outcome was time to first rVTE in statin vs. non-statin users. 980 participants with acute VTE were enrolled (mean age 75.0 years, 47% women), with median follow-up of 2.5 years. Of 241 (24.3%) statin users, 21 (8.7%) suffered rVTE vs. 99 (13.4%) among 739 non-users. The overall adjusted sub-hazard ratio (aSHR) for rVTE comparing statin users to non-users was 0.72 (95%CI 0.44 to 1.19, p = 0.20). This association was only apparent during periods without anticoagulation (aSHR 0.50, 95%CI 0.27 to 0.92, p = 0.03; vs. with anticoagulation: aSHR 1.34, 95%CI 0.54 to 3.35, p = 0.53). Using propensity scores, the rVTE risk during periods without anticoagulation fell further (aSHR 0.20, 95%CI 0.08 to 0.49, p < 0.001). In conclusion, statin use is associated with a more pronounced risk reduction for rVTE than previously estimated, but only during periods without anticoagulation.

scholarly journals Incidence of delirium in the Canadian emergency department and its consequences on hospital length of stay: a prospective observational multicentre cohort study

BMJ Open ◽  
2018 ◽  
Vol 8 (3) ◽  
pp. e018190 ◽  
Author(s):  
Marcel Émond ◽  
Valérie Boucher ◽  
Pierre-Hugues Carmichael ◽  
Philippe Voyer ◽  
Mathieu Pelletier ◽  
...  
Keyword(s):  
Older Adults ◽  
Emergency Department ◽  
Cohort Study ◽  
Length Of Stay ◽  
Hospital Length ◽  
Cognitive Status ◽  
Hospital Ward ◽  
Hospital Length Of Stay ◽  
Multicentre Cohort Study ◽  
Multicentre Cohort

ObjectiveWe aim to determine the incidence of delirium and describe its impacts on hospital length of stay (LOS) among non-delirious community-dwelling older adults with an 8-hour exposure to the emergency department (ED) environment.DesignThis is a prospective observational multicentre cohort study (March–July 2015). Patients were assessed two times per day during their entire ED stay and up to 24 hours on hospital ward.SettingThe study took place in four Canadian EDs.Participants338 included patients: (1) aged ≥65 years; (2) who had an ED stay ≥8 hours; (3) were admitted to hospital ward and (4) were independent/semi-independent.Main outcome(s) and measure(s)The primary outcomes of this study were incident delirium in the ED or within 24 hours of ward admission and ED and hospital LOS. Functional and cognitive status were assessed using validated Older Americans Resources and Services and the modified Telephone Interview for Cognitive Status tools. The Confusion Assessment Method was used to detect incident delirium. Univariate and multivariate analyses were conducted to evaluate outcomes.ResultsMean age was 76.8 (±8.1), 17.7% were aged >85 years old and 48.8% were men. The mean incidence of delirium was 12.1% (n=41). Median IQR ED LOS was 32.4 (24.5–47.9) hours and hospital LOS was 146.6 (75.2–267.8) hours. Adjusted mean hospital LOS was increased by 105.4 hours (4.4 days) (95% CI 25.1 to 162.0, P<0.001) for patients who developed an episode of delirium compared with non-delirious patient.ConclusionsAn incident delirium was observed in one of eight independent/semi-independent older adults after an 8-hour ED exposure. An episode of delirium increases hospital LOS by 4 days and therefore has important implications for patients and could contribute to ED overcrowding through a deleterious feedback loop.

scholarly journals Secukinumab and ustekinumab treatment in psoriatic arthritis: results of a direct comparison

Rheumatology ◽  
2020 ◽  
Author(s):  
Jean-Guillaume Letarouilly ◽  
Benoît Flachaire ◽  
Céline Labadie ◽  
Maéva Kyheng ◽  
Nicolas Cohen ◽  
...  
Keyword(s):  
Adverse Event ◽  
Cohort Study ◽  
Psoriatic Arthritis ◽  
Subgroup Analysis ◽  
Confounding Factors ◽  
Propensity Score Methods ◽  
Multicentre Cohort Study ◽  
Persistence Rate ◽  
Multicentre Cohort

Abstract Objectives To evaluate the characteristics of patients (pts) with PsA treated by ustekinumab (UST) or secukinumab (SEK) and to compare real-world persistence of UST and SEK in PsA. Methods In this retrospective, national, multicentre cohort study, pts with PsA (CASPAR criteria or diagnosis confirmed by the rheumatologist) initiating UST or SEK with a follow-up ≥6 months were included from January 2011 to April 2019. The persistence between SEK and UST was assessed after considering the potential confounding factors by using pre-specified propensity-score methods. Causes of discontinuation and tolerance were also collected. Results A total of 406 pts were included: 245 with UST and 161 with SEK. The persistence rate was lower in the UST group compared with the SEK group [median persistence 9.4 vs 14.7 months; 26.4% vs 38.0% at 2 years; weighted hazard ratio (HR) = 1.42; 95% CI: 1.07, 1.92; P =0.015]. In subgroup analysis, the persistence rate of SEK associated with MTX was significantly higher than that of UST associated with MTX: HR = 2.20; 95% CI: 1.30, 3.51; P =0.001, in contrast to SEK vs UST monotherapy: HR = 1.06; 95% CI: 0.74, 1.53; P =0.75. Discontinuation due to inefficacy was reported in 91.7% (SEK) and 82.4% (UST) of pts. Discontinuation due to an adverse event was reported in 12.2% (SEK) and 7.7% (UST) of pts. Conclusion In this first study comparing UST and SEK, the persistence of SEK was higher than that of UST in PsA. In subgroup analysis, this difference was only found in association with MTX.

scholarly journals CD4 count at antiretroviral therapy initiation and the risk of loss to follow-up: results from a multicentre cohort study

2015 ◽  
Vol 70 (6) ◽  
pp. 549-555 ◽  
Author(s):  
Anna Grimsrud ◽  
Morna Cornell ◽  
Michael Schomaker ◽  
Matthew P Fox ◽  
Catherine Orrell ◽  
...  
Keyword(s):  
Cohort Study ◽  
Antiretroviral Therapy ◽  
Cd4 Count ◽  
Loss To Follow Up ◽  
Therapy Initiation ◽  
Multicentre Cohort Study ◽  
Multicentre Cohort

scholarly journals Long-term follow-up of patients undergoing auto-SCT for advanced germ cell tumour: a multicentre cohort study

2010 ◽  
Vol 46 (6) ◽  
pp. 852-857
Author(s):  
M D Seftel ◽  
K Paulson ◽  
R Doocey ◽  
K Song ◽  
P Czaykowski ◽  
...  
Keyword(s):  
Cohort Study ◽  
Germ Cell ◽  
Germ Cell Tumour ◽  
Cell Tumour ◽  
Multicentre Cohort Study ◽  
Long Term Follow Up ◽  
Multicentre Cohort

scholarly journals Impact of baseline SARS–CoV–2 antibody status on syndromic surveillance and the risk of subsequent Covid-19 — a prospective multicentre cohort study

2021 ◽  
Author(s):  
Philipp Kohler ◽  
Sabine Guesewell ◽  
Marco Seneghini ◽  
Thomas Egger ◽  
Onicio Leal-Neto ◽  
...  
Keyword(s):  
Cohort Study ◽  
Muscle Pain ◽  
Syndromic Surveillance ◽  
Median Number ◽  
Limb Muscle ◽  
Multicentre Cohort Study ◽  
Antigen Tests ◽  
Electronic Questionnaires ◽  
Multicentre Cohort

Objectives In a prospective healthcare worker (HCW) cohort, we assessed the risk of SARS-CoV-2 infection according to baseline serostatus. Methods Baseline serologies were performed among HCW from 23 Swiss healthcare institutions between June and September 2020, before the second COVID-19 wave. Participants answered weekly electronic questionnaires covering information about nasopharyngeal swabs (PCR/rapid antigen tests) and symptoms compatible with Coronavirus Disease 2019 (COVID-19). Screening of symptomatic staff by nasopharyngeal swabs was routinely performed in participating facilities. We compared numbers of positive nasopharyngeal tests and occurrence of COVID-19 symptoms between HCW with and without anti-nucleocapsid antibodies. Results A total of 4′818 HCW participated, whereof 144 (3%) were seropositive at baseline. We analysed 107′820 questionnaires with a median follow-up of 7.9 months. Median number of answered questionnaires was similar (24 vs. 23 per person, P=0.83) between those with and without positive baseline serology. Among 2′713 HCW with ≥1 SARS-CoV-2 test during follow-up, 3/67 (4.5%) seropositive individuals reported a positive result (one of whom asymptomatic), compared to 547/2646 (20.7%) seronegative participants, 12 of whom asymptomatic (risk ratio [RR] 0.22; 95% confidence interval [CI] 0.07 to 0.66). Seropositive HCWs less frequently reported impaired olfaction/taste (6/144, 4.2% vs. 588/4674, 12.6%, RR 0.33, 95%-CI: 0.15-0.73), chills (19/144, 13.2% vs. 1040/4674, 22.3%, RR 0.59, 95%-CI: 0.39-0.90), and limb/muscle pain (28/144, 19.4% vs. 1335/4674, 28.6%, RR 0.68 95%-CI: 0.49-0.95). Impaired olfaction/taste and limb/muscle pain also discriminated best between positive and negative SARS-CoV-2 results. Conclusions Having SARS-CoV-2 anti-nucleocapsid antibodies provides almost 80% protection against SARS-CoV-2 re-infection for a period of at least eight months.

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