Developing and Testing a Chart Abstraction Tool for ICU Quality Measurement

Quality measures are increasingly used to measure the performance of providers, hospitals, and health care systems. Intensive care units (ICUs) are an important clinical area in hospitals, given that they generate high costs and present high risks to patients. Yet, currently, few valid and clinically significant ICU-specific outcome measures are reported nationally. This study reports on the creation and evaluation of new abstraction tools that evaluate ICU patients for the following clinically important outcomes: central line–associated bloodstream infection, methicillin-resistant Staphylococcus aureus, gastrointestinal bleed, and pressure ulcer. To allow ICUs and institutions to compare their outcomes, the tools include risk-adjustment variables that can be abstracted from the chart.

Download Full-text

Comprehensive Review of Cardiovascular Involvement in COVID-19

AACN Advanced Critical Care ◽

10.4037/aacnacc2021302 ◽

2021 ◽

pp. e1-e19

Author(s):

Ruff Joseph Macale Cajanding

Keyword(s):

Cardiac Involvement ◽

Health Care Systems ◽

The Body ◽

Cardiac Pathology ◽

Current State ◽

Global Pandemic ◽

Cardiovascular Involvement ◽

Disease Causation ◽

Care Systems ◽

Clinically Significant

COVID-19 has emerged as one of the most devastating and clinically significant infectious diseases of the last decade. It has reached global pandemic status at an unprecedented pace and has placed significant demands on health care systems worldwide. Although COVID-19 primarily affects the lungs, epidemiologic reports have shown that the disease affects other vital organs of the body, including the heart, vasculature, kidneys, brain, and the hematopoietic system. Of importance is the emerging awareness of the effects of COVID-19 on the cardiovascular system. The current state of knowledge regarding cardiac involvement in COVID-19 is presented in this article, with particular focus on the cardiovascular manifestations and complications of COVID-19 infection. The mechanistic insights of disease causation and the relevant pathophysiology involved in COVID-19 as they affect the heart are explored and described. Relevant practice essentials and clinical management implications for patients with COVID-19 with a cardiac pathology are presented in light of recent evidence.

Download Full-text

HSR19-105: The Role of Chemotherapy in Elderly Colorectal Cancer Survivors: An Observational Study

Journal of the National Comprehensive Cancer Network ◽

10.6004/jnccn.2018.7203 ◽

2019 ◽

Vol 17 (3.5) ◽

pp. HSR19-105

Author(s):

Pamala A. Pawloski ◽

Gabriela Vazquez-Benitez ◽

Jeanette Y. Ziegenfuss ◽

Terese A. DeFor ◽

Elisabeth M. Seburg

Keyword(s):

Colorectal Cancer ◽

Observational Study ◽

Cancer Survivors ◽

Health Care Systems ◽

Cancer Registries ◽

Factors Associated ◽

Colon Cancers ◽

Chart Abstraction ◽

Care Systems ◽

Chemotherapy Initiation

Background: Older patients diagnosed with colorectal cancer are not routinely included in clinical trials and are frequently treated with less aggressive chemotherapy. To identify factors associated with treatment initiation in older adults, we conducted an observational study of patients diagnosed with stage I–IV colon or rectal cancer at 65 years and older between 2010 and 2014 across 6 integrated health care systems. Methods: Data were obtained from cancer registries based on chart abstraction and medical records. Time from diagnosis to surgery, chemotherapy, and radiation was measured in weeks and censored when disenrollment, death, or the end of the study period occurred. We assessed patient factors associated with time to chemotherapy initiation using survival analysis methods. Results: Among 8,088 patients diagnosed after the age of 65 with colon cancer, the mean age at diagnosis was 76 years (SD 7.7), 4,150 (51%) were female, and 34% were stage 3 or greater. More than half, 55% (n=4,434) of colon cancers were right-sided (RCC), 23% (n=1833) were left-sided (LCC), and 19% (n=1,559) were rectal cancers. Two-thirds (n=5,201) had moderately differentiated disease. Most (57%) received surgery within 4 weeks and 89% within 6 months of diagnosis (median, 3.4 weeks). At 6 months following diagnosis, 33% of patients had received chemotherapy, and only 4% received radiation. Factors associated with the receipt of chemotherapy were assessed in a multivariable survival model that included age, gender, stage, and site. Patients of older age were less likely to receive chemotherapy (HR, 0.49; 95%CI, 0.45–.53 for 75–79 vs 65–69 years), and more likely for advanced stage, and rectal site. No difference was observed between men and women. Refusal of chemotherapy was reported for only 6% of patients and was associated with age, stage, and site. Six month mortality was 13.3%. Conclusions: Factors associated with the receipt of treatment among older cancer survivors are similar to those in the general population.

Download Full-text

Clinical pathways and quality metrics.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.30_suppl.273 ◽

2014 ◽

Vol 32 (30_suppl) ◽

pp. 273-273

Author(s):

Peter G. Ellis ◽

Kathleen Lokay

Keyword(s):

Decision Support ◽

Clinical Pathways ◽

Point Of Care ◽

Quality Measurement ◽

Reporting Quality ◽

Quality Measures ◽

Complete Data ◽

Time Period ◽

Chart Abstraction ◽

Quality Programs

273 Background: UPMC CancerCenter (UPMC) participates in a number of nationally recognized quality programs and strives to maximize quality through continuous improvement of the quality measures endorsed by these programs. Clinical pathways are potential aid in driving quality improvement through decision support and measurement. Methods: When deficiencies are identified, UPMC’s quality team develops improvement strategies including working with its pathways vendor (Via Oncology) on the placement of key decision support prompts and required data fields within its physician-facing pathways portal. Gaps in data completeness have also been identified as an opportunity to use pathways for more complete data collection during chart abstraction as well as interim reporting. Results: Due to the success above, UPMC continues to actively engage with pathways as a tool to drive adherence to and capture complete data for quality measures. If release of the UPMC data is approved by the quality measurement organization(s), UPMC will share the results of its quality measures in the full poster. Conclusions: Pathways are a tool for promoting adherence to quality measures by oncologists through the use of a point of care decision support system. Pathways are also a source of reporting quality measures across all patients in time period which allows for interim measurements and proactive identification of improvement areas. [Table: see text]

Download Full-text

Use of imaging for staging of early breast cancer in two integrated health care systems.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.30_suppl.184 ◽

2014 ◽

Vol 32 (30_suppl) ◽

pp. 184-184

Author(s):

Erin Elizabeth Hahn ◽

Tania Tang ◽

Janet S. Lee ◽

Corrine Munoz-Plaza ◽

Joyce O Adesina ◽

...

Keyword(s):

Breast Cancer ◽

Health Care ◽

Cancer Patients ◽

Early Stage ◽

Health Care Systems ◽

Integrated Health Care ◽

Low Risk ◽

Breast Cancer Patients ◽

Chart Abstraction ◽

Care Systems

184 Background: The initial ASCO “Top 5” list, created as part of the Choosing Wisely campaign, recommends against use of imaging for staging of early stage breast cancer in asymptomatic women at low risk for metastasis. The objective of this study was to measure and compare use of imaging for staging in two large integrated health care systems, Kaiser Permanente (KP) and Intermountain Healthcare (IH). We also sought to distinguish whether imaging was used for routine staging or for diagnostic purposes. Methods: We identified stage 0-IIB breast cancer patients diagnosed between January 1, 2010 and December 31, 2012 with first primary malignancy from tumor registries in three KP regions (Southern California, Northwest, and Mid-Atlantic) and IH. Using the KP and IH electronic health records, we identified use of imaging tests (PET, CT, bone scan) during the staging window (30 days prior to diagnosis up to initial surgery). We performed chart abstraction on a random sample of patients who received an imaging test to identify indication. Results: For the total sample of 10,014, mean age at diagnosis was 60 (range 22-99); with 21% stage 0, 47% stage I, 32% stage II. Overall, 8% of patients (792 patients) received at least one imaging test during the staging window, including 8% at KP and 6% at IH (p=0.0005). Chart abstraction (N=129) revealed that overall, almost half of all imaging tests (48%) were performed to evaluate a symptom, sign or prior imaging finding, including 55% at KP and 32% at IH. Conclusions: Use of imaging for staging of low-risk breast cancer was very low in both health care systems, with clinically trivial differences between them. Approximately half of imaging services were in response to a sign or symptom. Strategies to reduce use of imaging at staging for early stage breast cancer patients within these health care systems are unlikely to yield meaningful improvement. [Table: see text]

Download Full-text

1419 Targeted Use of Physiotherapy Resources in The COVID Era: How Does Face to Face Physiotherapy Compare with Simple Advice Sheets After Manipulation Under Anaesthetic for Frozen Shoulder?

British Journal of Surgery ◽

10.1093/bjs/znab259.1051 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

R Castelhano ◽

J Woods ◽

H Akehurst ◽

A Mitra ◽

M James ◽

...

Keyword(s):

Health Care Systems ◽

Descriptive Analysis ◽

Frozen Shoulder ◽

Analysis Of Covariance ◽

Excellent Outcome ◽

Care Systems ◽

Shoulder Scores ◽

Group 2 ◽

Clinically Significant ◽

Group 1

Abstract Introduction This study compares two pathways for patients undergoing MUA for FS, one where physiotherapy advice is only given to the patient (Group 1), and the other where supervised hydrotherapy and physiotherapy occur post operatively (Group 2). Method A descriptive analysis of pre- and post-operative Oxford Shoulder Scores and change scores were performed. Analysis of covariance (ANCOVA) was used to measure the effect of physiotherapy on post-operative OSS, with pre-operative OSS as the only covariate. Results The results for post-operative OSS were significantly greater for Group 2 than for Group 1 (40.7 for NHS and 44.7 for private, improvement of 17.32 for NHS and 18.23 for Private). The effect of physiotherapy was significant (p < 0.001). The estimated effect of physiotherapy on postoperative OSS was an increase of 3.2 (95% confidence interval 1.5 – 4.8). Conclusions We detected a statistically significant increase in post-operative OSS in patients treated for frozen shoulder with MUA + physiotherapy compared with patients receiving MUA plus advice alone. These results suggest that physiotherapy does confer a real benefit, however the increased OSS is below the clinically significant level. Therefore, in a resource poor environment, such as may exist during and after COVID in many health care systems, MUA plus physio advice alone gives an excellent outcome for the treatment of FS.

Download Full-text

18 Manipulation Under Anaesthetic for Frozen Shoulder: Does Post-Operative Supervised Physiotherapy Affect the Outcome?

British Journal of Surgery ◽

10.1093/bjs/znab134 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

R Castelhano ◽

J Woods ◽

H Akehurst ◽

A Mitra ◽

M James ◽

...

Keyword(s):

Health Care Systems ◽

Descriptive Analysis ◽

Frozen Shoulder ◽

Analysis Of Covariance ◽

Excellent Outcome ◽

Care Systems ◽

Shoulder Scores ◽

Group 2 ◽

Clinically Significant ◽

Group 1

Abstract Introduction This study compares two pathways for patients undergoing MUA for FS, one where physiotherapy advice is only given to the patient (Group 1), and the other where supervised hydrotherapy and physiotherapy occur post operatively (Group 2). Method A descriptive analysis of pre- and post-operative Oxford Shoulder Scores and change scores were performed. Analysis of covariance (ANCOVA) was used to measure the effect of physiotherapy on post-operative OSS, with pre-operative OSS as the only covariate. Results The results for post-operative OSS were significantly greater for Group 2 than for Group 1 (40.7 for NHS and 44.7 for private, improvement of 17.32 for NHS and 18.23 for Private). The estimated effect of physiotherapy on postoperative OSS was an increase of 3.2 (95% confidence interval 1.5 – 4.8). Conclusions We detected a statistically significant increase in post-operative OSS in patients treated for frozen shoulder with MUA + physiotherapy compared with patients receiving MUA plus advice alone. These results suggest that physiotherapy does confer a real benefit, however the increased OSS is below the clinically significant level. Therefore, in a resource poor environment, such as may exist after COVID in many health care systems, MUA plus physio advice alone gives an excellent outcome for the treatment of FS.

Download Full-text