Documentation of Obesity on the Problem List and Referral Rates Among Children and Adults with Obesity

2021 ◽  
Author(s):  
Heidi Walls ◽  
Christina Holt ◽  
Amy Haskins ◽  
William Dexter
Keyword(s):  
Problem List ◽  
Referral Rates

scholarly journals Documentation Of Obesity On The Problem List And Referral Rates Among Obese Children And Adults

2020 ◽  
Vol 52 (7S) ◽  
pp. 645-645
Author(s):  
Heidi Walls ◽  
Christina Holt ◽  
Amy Haskins ◽  
William Dexter
Keyword(s):  
Problem List ◽  
Obese Children ◽  
Referral Rates

scholarly journals Detection of Domestic Violence and Abuse by Community Mental Health Teams Using the BRAVE Intervention: A Multicenter, Cluster Randomized Controlled Trial

2021 ◽  
pp. 088626052110041
Author(s):  
Roos Ruijne ◽  
Cornelis Mulder ◽  
Milan Zarchev ◽  
Kylee Trevillion ◽  
Roel van Est ◽  
...  
Keyword(s):  
Mental Health ◽  
Domestic Violence ◽  
Randomized Controlled Trial ◽  
Controlled Trial ◽  
Referral Rates ◽  
Randomized Controlled ◽  
Cluster Randomized ◽  
And Control ◽  
Domestic Violence And Abuse

Despite increased prevalence of domestic violence and abuse (DVA), victimization through DVA often remains undetected in mental health care. To estimate the effectiveness of a system provider level training intervention by comparing the detection and referral rates of DVA of intervention community mental health (CMH) teams with rates in control CMH teams. We also aimed to determine whether improvements in knowledge, skills and attitudes to DVA were greater in clinicians working in intervention CMH teams than those working in control teams. We conducted a cluster randomized controlled trial in two urban areas of the Netherlands. Detection and referral rates were assessed at baseline and at 6 and 12 months after the start of the intervention. DVA knowledge, skills and attitudes were assessed using a survey at baseline and at 6 and 12 months after start of the intervention. Electronic patient files were used to identify detected and referred cases of DVA. Outcomes were compared between the intervention and control teams using a generalized linear mixed model. During the 12-month follow-up, detection and referral rates did not differ between the intervention and control teams. However, improvements in knowledge, skills and attitude during that follow-up period were greater in intervention teams than in control teams: β 3.21 (95% CI 1.18-4.60). Our trial showed that a training program on DVA knowledge and skills in CMH teams can increase knowledge and attitude towards DVA. However, our intervention does not appear to increase the detection or referral rates of DVA in patients with a severe mental illness. A low detection rate of DVA remains a major problem. Interventions with more obligatory elements and a focus on improving communication between CMH teams and DVA services are recommended.

Assessment of a multi-center tele-urgent care program to decrease emergency department referral rates in the Veterans Health Administration

2021 ◽  
pp. 1357633X2110248
Author(s):  
Charlie M Wray ◽  
Myla Junge ◽  
Salomeh Keyhani ◽  
Janeen E Smith
Keyword(s):  
Emergency Department ◽  
Emergency Department Visit ◽  
Care Program ◽  
Urgent Care ◽  
Emergency Department Utilization ◽  
Emergency Department Care ◽  
Referral Rates ◽  
Care Assessment ◽  
The Impact ◽  
Care Evaluation

The use of emergency departments for non-emergent issues has led to overcrowding and decreased the quality of care. Telemedicine may be a mechanism to decrease overutilization of this expensive resource. From April to September 2020, we assessed (a) the impact of a multi-center tele-urgent care program on emergency department referral rates and (b) the proportion of individuals who had a subsequent emergency department visit within 72 h of tele-urgent care evaluation when they were not referred to the emergency department. We then performed a chart review to assess whether patients presented to the emergency department for the same reason as was stated for their tele-urgent care evaluation, whether subsequent hospitalization was needed during that emergency department visit, and whether death occurred. Among the 2510 patients who would have been referred to in-person emergency department care, but instead received tele-urgent care assessment, one in five (21%; n = 533) were subsequently referred to the emergency department. Among those not referred following tele-urgent care, 1 in 10 (11%; n = 162) visited the emergency department within 72 h. Among these 162 individuals, most (91%) returned with the same or similar complaint as what was assessed during their tele-urgent care visit, with one in five requiring hospitalization (19%, n = 31) with one individual (0.01%) dying. In conclusion, tele-urgent care may safely decrease emergency department utilization.

scholarly journals Improving early exclusion of acute coronary syndrome in primary care: the added value of point-of-care troponin as stated by general practitioners

2017 ◽  
Vol 18 (04) ◽  
pp. 386-397 ◽  
Author(s):  
Michelle M.A. Kip ◽  
Amber M. Noltes ◽  
Hendrik Koffijberg ◽  
Maarten J. IJzerman ◽  
Ron Kusters
Keyword(s):  
Primary Care ◽  
Acute Coronary Syndrome ◽  
Blood Sample ◽  
General Practitioners ◽  
Point Of Care ◽  
Added Value ◽  
Lower Sensitivity ◽  
Test Duration ◽  
Referral Rates ◽  
Coronary Syndrome

AimTo investigate general practitioners’ (GPs’) desire and perceived added value of point-of-care (POC) troponin, its effect on referral decisions, and test requirements.BackgroundExcluding acute coronary syndrome (ACS) in primary care remains a diagnostic challenges for GPs. Consequently, referral rates of chest pain patients are high, while the incidence of a cardiovascular problem is only 8–15%. Previous studies have shown that GPs are interested in a POC troponin test. This test could enhance rapid exclusion of ACS, thereby preventing unnecessary patient distress, without compromising safety and while reducing costs. However, using this test is not recommended in current guidelines due to uncertainty in the test’s potential added value, and the lower sensitivity early after symptom onset as compared with troponin tests in a regular laboratory.MethodsAn online survey containing 34 questions was distributed among 837 Dutch GPs in June 2015.FindingsA total of 126 GPs (15.1%) completed at least 75% of the questions. 67.1% of GPs believe that POC troponin tests have moderate to very high added value. Although the availability of a POC test is expected to increase the frequency at which troponin tests are used, it likely decreases (immediate) referral rates. Of the responding GPs, 78.3% only accept 10 min as the maximum test duration, 78.1% think reimbursement of the POC device is required for implementation, and 68.9% consider it necessary that it can be performed with a finger prick blood sample. In conclusion, according to GPs, the POC troponin test can be of added value to exclude ACS early on. Actual test implementation will depend on test characteristics, including test duration, type of blood sample required, and reimbursement of the analyzer.

P082 OCULAR EVALUATIONS IN INFLAMMATORY BOWEL DISEASE: STEROID USE AND PATIENT ETHNICITY INFLUENCE REFERRAL RATES

2018 ◽  
Vol 154 (1) ◽  
pp. S42-S43
Author(s):  
Jenny Dave ◽  
Abdulaziz Almedimigh ◽  
Najwan Alsulaimi ◽  
Bradley Fairfield ◽  
Aung Myint ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Steroid Use ◽  
Referral Rates ◽  
Inflammatory Bowel

scholarly journals Regional and hospital variation in commonly performed paediatric otolaryngology procedures in the Netherlands: a population-based study of healthcare utilisation between 2016 and 2019

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e046840
Author(s):  
Juliëtte J C M van Munster ◽  
Joost J G Wammes ◽  
Rolf H Bremmer ◽  
Amir H Zamanipoor Najafabadi ◽  
Raphael J Hemler ◽  
...  
Keyword(s):  
The Netherlands ◽  
Healthcare Utilisation ◽  
Care Process ◽  
Resource Utilisation ◽  
Ventilation Tube ◽  
Tube Insertion ◽  
High Quality ◽  
Cross Sectional ◽  
Referral Rates ◽  
Hospital Variation

ObjectiveIn the past few decades, there has been an increase in high-quality studies providing evidence on the effectiveness of commonly performed procedures in paediatric otolaryngology. We believe that now is the time to re-evaluate the care process. We aimed to analyse (1) the regional variation in incidence and referrals of adenoidectomies, tonsillectomies and ventilation tube insertions in children in the Netherlands between 2016 and 2019, (2) whether regional surgical rates, referral rates and in-hospital surgical rates were associated with one another, and (3) the hospital variation in healthcare costs, which indicates the utilisation of resources.DesignRepeated cross-sectional analysis.SettingFour neighbouring Dutch provinces comprising 2.8 million inhabitants and 14 hospitals.ParticipantsChildren aged 0–15 years.Outcome measuresWe analysed variation in regional surgical rates and referral rates per 1000 inhabitants and in-hospital surgical rates per 1000 clinic visitors, adjusted for age and socioeconomic status. Furthermore, the relationships between referral rates, regional surgical rates and in-hospital surgical rates were estimated. Lastly, variation in resource utilisation between hospitals was estimated.ResultsAdenoidectomy rates differed sixfold between regions. Twofold differences were observed for adenotonsillectomy rates, ventilation tube insertion rates and referral rates. Referral rates were negatively associated with in-hospital surgical rates for adenotonsillectomies, but not for adenoidectomies and ventilation tube insertions. In-hospital surgical rates were positively associated with regional rates for adenoidectomies and adenotonsillectomies. Significant variation between hospitals was observed in costs for all resources.ConclusionsWe observed low variation in tonsillectomies and ventilation tube insertion and high variation in adenoidectomies. Indications for a tonsillectomy and ventilation tube insertion are well defined in Dutch guidelines, whereas this is not the case for an adenoidectomy. Lack of agreement on indications can be expected and high-quality effectiveness research is required to improve evidence-based guidelines on this topic.

Abstract 173: A Comparison of Administrative Claims Discharge Diagnosis with Electronic Medical Record Problem List in the Diagnosis of Acute Myocardial Infarction

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Michael D McCulloch ◽  
Tim Sobol ◽  
Joy Yuhas ◽  
Bill Ahern ◽  
Eric D Hixson ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Medical Record ◽  
Chart Review ◽  
Claims Data ◽  
Administrative Claims ◽  
Problem List ◽  
Principal Diagnosis ◽  
Administrative Claims Data ◽  
Patient Admissions

Background: Administrative claims data are commonly used for measurement of mortality and readmissions in Acute Myocardial Infarction (AMI). With advent of the Electronic Medical Record (EMR), the electronic problem list offers new ways to capture diagnosis data. However, no data comparing the accuracy of administrative claims data and the EMR problem list exists. Methods: Two years of admissions at a single, quaternary medical center were analyzed to compare the presence of AMI diagnosis in administrative claims and EMR problem list data using a 2x2 matrix. To gain insights into this novel method, 25 patient admissions were randomly selected from each group to undergo physician chart review to adjudicate a clinical diagnosis of myocardial infarction based on the universal definition. Results: A total of 105,929 admissions from January 1, 2010 to December 31, 2011 were included. Where EMR problem list and administrative claims data were in agreement for or against AMI diagnosis they were highly accurate. Where administrative claims data, but not EMR problem list, reported AMI the most common explanation was true AMI with missing EMR problem list diagnoses (60%). Less common reasons for discordance in this category include: (1) administrative coding error (20%), (2) computer algorithm error (8%), (3) patient death before EMR problem list created (4%), (4) EMR problem list not used (4%) and (5) AMI diagnosis was removed from EMR problem list (4%). Where EMR problem list, but not administrative claims data, reported AMI the most common explanation was no AMI with historical diagnosis of AMI from a previous admission (60%). Less common reasons for discordance in this category include: (1) AMI present but not the principal diagnosis (32%), (2) administrative coding error (4%) and (3) erroneous EMR problem list entry (4%). Conclusion: Compared to administrative and chart review diagnoses, we found that using the EMR problem list to identify patient admissions with a principal diagnosis of AMI will overlook a subset of patients primarily due to inadequate clinical documentation. Additionally, the EMR problem list does not discriminate the admission principal diagnosis from the secondary diagnoses.

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