An international pilot study of asynchronous teleconsultation for oropharyngeal dysphagia

2013 ◽  
Vol 19 (2) ◽  
pp. 75-79 ◽  
Author(s):  
Georgia A Malandraki ◽  
Vasiliki Markaki ◽  
Voula C Georgopoulos ◽  
Jaime L Bauer ◽  
Ioannis Kalogeropoulos ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Treatment Options ◽  
Oropharyngeal Dysphagia ◽  
Severity Index ◽  
Rater Agreement ◽  
Point Scale ◽  
The Us ◽  
Independent Review ◽  
Greek Hospital

We investigated whether an expert's consultation provided via telemedicine could improve the quality of care for patients with dysphagia. A trained clinician completed videofluoroscopic swallowing studies (VFSS) of 17 consecutive patients in a Greek hospital. The videofluoroscopic images were then stored on a website for independent review by an expert Speech and Language Pathologist in the US. An extra Rater evaluated 20% of all data for additional reliability testing. Eight diagnostic indicators of swallowing impairment and an overall subjective severity index were recorded for each study. Clinicians were also asked to choose from ten common treatment options for patients with dysphagia. There was good inter-rater agreement for most of the diagnostic indicators examined (ranging from 78% to 90%; kappa = 0.52-0.71) between all three Raters. Agreement on overall severity ratings was exact for more than half of the patients and within one-point on the 4-point scale for all other patients except one. However, the quality of care would have been substandard for more than half of the patients if teleconsultation had not been employed. In settings where a swallowing expert is not available and real-time telemedicine is not feasible, the use of asynchronous teleconsultation can produce better quality of care for patients with dysphagia.

scholarly journals Interaction of race and pathology for neuroendocrine tumors: Epidemiology, natural history, or racial disparity?

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 376-376
Author(s):  
Rachel M Lee ◽  
Danielle K DePalo ◽  
Alexandra G Lopez-Aguiar ◽  
Mohammad Yahya Zaidi ◽  
Flavio G. Rocha ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Neuroendocrine Tumors ◽  
Prognostic Value ◽  
Oncologic Outcomes ◽  
Gastroenteropancreatic Neuroendocrine Tumors ◽  
Curative Intent ◽  
Black And White ◽  
The Us

376 Background: The prognostic value of pathologic variables is not consistent for gastroenteropancreatic neuroendocrine tumors (GEP-NETs). We previously demonstrated a limited prognostic role of lymph node (LN) positivity in small bowel NETs (SBNET) compared to pancreatic NETs (panNET). Although minority race is often associated with worse cancer outcomes, the interaction of race with pathologic and oncologic outcomes of pts with GEP-NETS is not known. Methods: Pts with GEP-NETs who underwent curative intent resection at eight institutions of the US NET Study Group from 2000-16 were included. Given few pts of other races, only Black and White race pts were analyzed. Results: Of 2,182 pts, 1,143 met inclusion criteria. Median age was 58 yrs, median follow up was 3 yrs, 48% were male, 14% (n = 157) were Black, and 86% (n = 986) were White. Black pts were more likely uninsured (7 vs 2%, p = 0.005), had symptomatic bleeding (13 vs 7%, p = 0.006), required emergency surgery (7 vs 3%, p = 0.003), and had LN positive disease (47 vs 36%, p = 0.016). Despite this, Black pts had improved 5 yr recurrence free survival (RFS) compared to White pts (90 vs 80%, p = 0.008). The quality of care received was comparable between both groups, demonstrated by similar LN yield at surgery, neg margin resection rate, post-op complications, and need for reoperation or readmission (all p > 0.05). Black pts were more likely to have SBNET (22 vs 13%) and less likely to have panNET (43 vs 68%) compared to White pts (p < 0.001). Consistent with prior data, pts with LN pos panNET had decreased 5yr RFS (67 vs 83%, p = 0.001); however, for SBNET, LN involvement was not prognostic (77 vs 96%, p = 0.08). The prognostic value of LN pos disease was similar between Black and White pts in both SBNET (p = 0.34) and panNET (p = 0.95). Conclusions: Black pts with GEP-NET present with more advanced disease, including higher LN positivity. Despite this, Black pts have improved RFS compared to White pts. Although there may be delays in seeking or reaching care, Black pts received similar quality of care compared to White pts. The improved RFS seen in Black pts may be attributed to the epidemiologic differences in the site of presentation of GEP-NETs and variable prognostic value of LN pos disease.

scholarly journals Article Commentary: A Research Agenda for Appearance Changes Due to Breast Cancer Treatment

2008 ◽  
Vol 2 ◽  
pp. BCBCR.S784 ◽  
Author(s):  
Mugdha Dabeer ◽  
Michelle Cororve Fingeret ◽  
Fatima Merchant ◽  
Gregory P. Reece ◽  
Elisabeth K. Beahm ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Survivors ◽  
Breast Cancer Survivors ◽  
Treatment Options ◽  
Breast Cancer Treatment ◽  
Cancer Treatments ◽  
Detection Techniques ◽  
The Us ◽  
Women’S Perceptions

Breast cancer is one of the most prevalent forms of cancer in the US. It is estimated that more than 180,000 American women will be diagnosed with invasive breast cancer in 2008. Fortunately, the survival rate is relatively high and continually increasing due to improved detection techniques and treatment methods. However, maintaining quality of life is a factor often under emphasized for breast cancer survivors. Breast cancer treatments are invasive and can lead to deformation of the breast. Breast reconstruction is important for restoring the survivor's appearance. However, more work is needed to develop technologies for quantifying surgical outcomes and understanding women's perceptions of changes in their appearance. A method for objectively measuring breast anatomy is needed in order to help both the breast cancer survivors and their surgeons take expected changes to the survivor's appearance into account when considering various treatment options. In the future, augmented reality tools could help surgeons reconstruct a survivor's breasts to match her preferences as much as possible.

scholarly journals 3200 Balancing Cost and Quality of Care in the US and Denmark: Lessons for Nations Transitioning from Volume-Based to Value-Based Care

2019 ◽  
Vol 3 (s1) ◽  
pp. 140-140
Author(s):  
Negin Fouladi ◽  
Margit Malmmose
Keyword(s):  
Decision Making ◽  
Quality Of Care ◽  
Control Strategies ◽  
Decision Makers ◽  
Sources Of Information ◽  
Healthcare Organizations ◽  
Regulatory Oversight ◽  
Physician Practices ◽  
The Us

OBJECTIVES/SPECIFIC AIMS: Promote knowledge translation and evidence-informed decision-making by assessing barriers and facilitators to balancing cost and quality of care within the US state of Maryland and nation of Denmark. METHODS/STUDY POPULATION: Open-ended and semi-structured key-informant interviews were conducted in 2016 and 2017 among high level decision-makers in Maryland (N=21) and the Danish (N=17) healthcare systems, including hospital, local, regional, and cross-organizational administrators and elected officials. The interviews consisted of questions related to: (1) currently practiced and preferred approaches to resource allocation and development and use of quality performance measures, and (2) preferred sources, formats/styles, modes of information, and decision-making strategies based on a shift from volume to quality-driven care. RESULTS/ANTICIPATED RESULTS: Decision-makers in Maryland expressed the need for collaboration in a changing environment, yet increasingly rely on cost and quality outcomes data to drive decisions and note the struggle to identify credible and useful information. Maryland decision-makers also face challenges in regulating utilization and costs without mandated participation of physician practices within the global budget cap model, which is perceived to be a primary driver of healthcare utilization in the hospital sector. Similarly, decision-makers in Denmark conveyed the importance of quantitative data to aid decisions, however, stress collaboration and dialogue as driving factors and important sources of information. Danish decision-makers also express challenges to wide-spread adoption of a quality-driven approach due to unsustained quality assurance regulatory bodies. DISCUSSION/SIGNIFICANCE OF IMPACT: The findings suggest implementation of value-based healthcare is highly driven and influenced by availability of credible data, which may significantly impact development of policies and innovative cost control strategies, and regulatory oversight to promote adoption of quality measures in decision-making. Furthermore, collaboration within and across healthcare organizations remains a key component to health system improvement as it fosters dialogue and sharing of best practices among stakeholders.

Cost Containment and Mental Health Outcomes: Experiences from US Studies

1995 ◽  
Vol 166 (S27) ◽  
pp. 43-51 ◽  
Author(s):  
Kenneth B. Wells
Keyword(s):  
Mental Health ◽  
Quality Of Care ◽  
Cost Containment ◽  
Cost Savings ◽  
Poor People ◽  
Fee For Service ◽  
Us Studies ◽  
Outcomes Of Care ◽  
The Us

Background. Cost containment mechanisms, such as prepayment, are being considered or implemented in the US and elsewhere, but there have been few studies of the effects of such mechanisms on quality or outcomes of care for individuals with serious psychiatric disorders.Method. Key results from US studies on cost containment and their implications are reviewed.Results. Cost savings in out-patient mental health care can be achieved through increasing the share of costs paid by the covered individual or through prepayment, but individuals with the greatest psychological distress or poor people may achieve worse outcomes under greater cost containment. Quality of care may be poorer under some forms of prepayment than under fee-for-service care, yet a national prospective payment mechanism for depressed elderly in-patients was not associated with a marked drop in quality or outcomes of care among those admitted.Conclusions. Prepayment, relative to fee-for-service is not always associated with lower outcomes or quality of care for affective disorders. Under cost containment, quality and outcomes of care, especially for the sick poor, should be monitored to identify adverse consequences.

scholarly journals PATTERNS OF PERFORMANCE ON QUALITY OF CARE AMONG U.S. HOME HEALTH AGENCIES, 2015-2017

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S494-S494
Author(s):  
Chenjuan Ma
Keyword(s):  
Quality Of Care ◽  
Home Health ◽  
Community Dwelling ◽  
Home Healthcare ◽  
Healthcare Sector ◽  
Star Rating ◽  
Health Agencies ◽  
The Us ◽  
Home Health Agencies

Abstract Home healthcare is a critical care source for community-dwelling older adults. As the fastest growing healthcare sector in the US, quality of home healthcare is under increasing scrutiny. The purpose of this study is to examine patterns of performance on quality of care among US home health agencies. This is a 3-year cohort study using 2015-2017 Home Health Compare data and Provider of Services (POS) Files. In the dataset, each HHA was assigned a star rating (1-5) to reflect the overall quality of care. This indicator was calculated based on two process measures (timely initiation of care and drug education) and six outcome measures (e.g., hospitalization). We examined 8,020 HHAs in the US. Over the 3-year period, the number of HHAs receiving a star rating of 4 or 5 increased from 27% in 2015, 31% in 2016, to 32% in 2017. Roughly, 32% of the HHAs received a lower star rating and another 32% received a higher star rating from 2015 to 2016. Similarly, 30% of the HHAs received a lower star rating and 29% of the HHAs received a higher star rating from 2016 to 2017. Hospital-based HHAs were less likely to receive a star rating of 4 or 5. Larger HHAs (OR 1.34; 95% CI, 1.13-1.59) and HHAs with ownership changes (OR, 1.38; 95% CI 1.20-1.59) were more likely to improve their star ratings overtime. Our finding indicates dynamic changes in the quality of care within the US home healthcare sector.

Charitable contributions and quality in the us hospice care setting

2014 ◽  
Vol 26 (4) ◽  
pp. 539-556 ◽  
Author(s):  
Kelly Noe ◽  
Dana A. Forgione
Keyword(s):  
Quality Of Care ◽  
Hospice Care ◽  
The United States ◽  
Charitable Contributions ◽  
The Us ◽  
Home Health Aide ◽  
Report Data ◽  
Worker Quality ◽  
Cost Report

This paper examines the association of charitable donations with quality of care proxies for nonprofit hospice providers in the United States (US). An estimated 1.45 million patients received hospice care in the US in 2008. Medicare hospice spending exceeded $10 billion in 2007 and is expected to more than double over the next 10 years. Using Guidestar and Medicare Hospice Cost Report data, we find donations are positively associated with proxies for nurse and social worker quality of care, but not with our home-health aide quality proxy. This research adds to our understanding of charitable contributions in hospice provider organizations.

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