scholarly journals Changes in Patient Visits and Diagnoses seen in an Academic Ophthalmology Department during the COVID-19 pandemic

2020 ◽  
Author(s):  
Meghan K Berkenstock ◽  
Paulina Liberman ◽  
Peter J McDonnell ◽  
Benjamin C Chaon
Keyword(s):  
Practice Patterns ◽  
Low Vision ◽  
The United States ◽  
Viral Transmission ◽  
Pediatric Ophthalmology ◽  
Face To Face ◽  
Diagnostic Codes ◽  
Before And After ◽  
Icd 10 ◽  
The Impact

Abstract BACKGROUND: To minimize the risk of viral transmission, ophthalmology practices limited face to face encounters to only patients with urgent and emergent ophthalmic conditions, in the weeks after the start of the COVID-19 epidemic in the United States. The impact of this is unknown. METHODS: We did a retrospective analysis of the change in the frequency of ICD-10 code use and patient volumes in the six weeks before and after the changes in clinical practice associated with COVID-19.RESULTS: The total number of encounters decreased four-fold after the implementation of clinic changes associated with COVID-19. The low vision, pediatric ophthalmology, general ophthalmology, and cornea divisions had the largest decrease of in-person visits. Conversely, telemedicine visits increased sixty-fold. The number of diagnostic codes associated with ocular malignancies, most ocular inflammatory disorders, and retinal conditions requiring intravitreal injections increased. ICD-10 codes associated with ocular screening exams for systemic disorders decreased during the weeks post COVID-19. CONCLUSION: Ophthalmology practices need to be prepared to experience changes in practice patterns, implementation of telemedicine, and decreased patient volumes during a pandemic. Knowing the changes specific to each subspecialty clinic is vital to redistribute available resources correctly.

scholarly journals Changes in Patient Visits and Diagnoses seen in an Academic Ophthalmology Department during the COVID-19 pandemic

2020 ◽  
Author(s):  
Meghan K Berkenstock ◽  
Paulina Liberman ◽  
Peter J McDonnell ◽  
Benjamin C Chaon
Keyword(s):  
Practice Patterns ◽  
Low Vision ◽  
The United States ◽  
Viral Transmission ◽  
Pediatric Ophthalmology ◽  
Face To Face ◽  
Diagnostic Codes ◽  
Before And After ◽  
Icd 10 ◽  
The Impact

Abstract BACKGROUND: To minimize the risk of viral transmission, ophthalmology practices limited face to face encounters to only patients with urgent and emergent ophthalmic conditions, in the weeks after the start of the COVID-19 epidemic in the United States. The impact of this is unknown. METHODS: We did a retrospective analysis of the change in the frequency of ICD-10 code use and patient volumes in the six weeks before and after the changes in clinical practice associated with COVID-19.RESULTS: The total number of encounters decreased four-fold after the implementation of clinic changes associated with COVID-19. The low vision, pediatric ophthalmology, general ophthalmology, and cornea divisions had the largest total decrease of in-person visits. Conversely, the number of telemedicine visits increased sixty-fold. The number of diagnostic codes associated with ocular malignancies, most ocular inflammatory disorders, and retinal conditions requiring intravitreal injections increased. ICD-10 codes associated with ocular screening exams for systemic disorders decreased during the weeks post COVID-19. CONCLUSION: Ophthalmology practices need to be prepared to experience changes in practice patterns, implementation of telemedicine, and decreased patient volumes during a pandemic. Knowing the changes specific to each subspecialty clinic is vital to redistribute available resources correctly.

scholarly journals Changes in Patient Visits and Diagnoses seen in an Academic Ophthalmology Department during the COVID-19 pandemic

2021 ◽  
Author(s):  
Meghan K Berkenstock ◽  
Paulina Liberman ◽  
Peter J McDonnell ◽  
Benjamin C Chaon
Keyword(s):  
Practice Patterns ◽  
Low Vision ◽  
The United States ◽  
Viral Transmission ◽  
Pediatric Ophthalmology ◽  
Face To Face ◽  
Diagnostic Codes ◽  
Before And After ◽  
Icd 10 ◽  
The Impact

Abstract BACKGROUND: To minimize the risk of viral transmission, ophthalmology practices limited face to face encounters to only patients with urgent and emergent ophthalmic conditions, in the weeks after the start of the COVID-19 epidemic in the United States. The impact of this is unknown. METHODS: We did a retrospective analysis of the change in the frequency of ICD-10 code use and patient volumes in the six weeks before and after the changes in clinical practice associated with COVID-19.RESULTS: The total number of encounters decreased four-fold after the implementation of clinic changes associated with COVID-19. The low vision, pediatric ophthalmology, general ophthalmology, and cornea divisions had the largest total decrease of in-person visits. Conversely, the number of telemedicine visits increased sixty-fold. The number of diagnostic codes associated with ocular malignancies, most ocular inflammatory disorders, and retinal conditions requiring intravitreal injections increased. ICD-10 codes associated with ocular screening exams for systemic disorders decreased during the weeks post COVID-19. CONCLUSION: Ophthalmology practices need to be prepared to experience changes in practice patterns, implementation of telemedicine, and decreased patient volumes during a pandemic. Knowing the changes specific to each subspecialty clinic is vital to redistribute available resources correctly.

scholarly journals Changes in patient visits and diagnoses in a large academic center during the COVID-19 pandemic

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Meghan K. Berkenstock ◽  
Paulina Liberman ◽  
Peter J. McDonnell ◽  
Benjamin C. Chaon
Keyword(s):  
Practice Patterns ◽  
Low Vision ◽  
The United States ◽  
Pediatric Ophthalmology ◽  
Face To Face ◽  
Diagnostic Codes ◽  
Academic Center ◽  
Before And After ◽  
Icd 10 ◽  
The Impact

Abstract Background To minimize the risk of viral transmission, ophthalmology practices limited face-to-face encounters to only patients with urgent and emergent ophthalmic conditions in the weeks after the start of the COVID-19 epidemic in the United States. The impact of this is unknown. Methods We did a retrospective analysis of the change in the frequency of ICD-10 code use and patient volumes in the 6 weeks before and after the changes in clinical practice associated with COVID-19. Results The total number of encounters decreased four-fold after the implementation of clinic changes associated with COVID-19. The low vision, pediatric ophthalmology, general ophthalmology, and cornea divisions had the largest total decrease of in-person visits. Conversely, the number of telemedicine visits increased sixty-fold. The number of diagnostic codes associated with ocular malignancies, most ocular inflammatory disorders, and retinal conditions requiring intravitreal injections increased. ICD-10 codes associated with ocular screening exams for systemic disorders decreased during the weeks post COVID-19. Conclusion Ophthalmology practices need to be prepared to experience changes in practice patterns, implementation of telemedicine, and decreased patient volumes during a pandemic. Knowing the changes specific to each subspecialty clinic is vital to redistribute available resources correctly.

scholarly journals Development of an Electronic Algorithm to Target Outpatient Antimicrobial Stewardship Efforts for Acute Bronchitis

2020 ◽  
Vol 41 (S1) ◽  
pp. s32-s32
Author(s):  
Ebbing Lautenbach ◽  
Keith Hamilton ◽  
Robert Grundmeier ◽  
Melinda Neuhauser ◽  
Lauri Hicks ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Predictive Value ◽  
Gold Standard ◽  
Chart Review ◽  
Acute Bronchitis ◽  
Antibiotic Use ◽  
Antibiotic Prescribing ◽  
Diagnostic Codes ◽  
Icd 10 ◽  
The Impact

Background: Antibiotic resistance has increased at alarming rates, driven predominantly by antibiotic overuse. Although most antibiotic use occurs in outpatients, antimicrobial stewardship programs have primarily focused on inpatient settings. A major challenge for outpatient stewardship is the lack of accurate and accessible electronic data to target interventions. We sought to develop and validate an electronic algorithm to identify inappropriate antibiotic use for outpatients with acute bronchitis. Methods: This study was conducted within the University of Pennsylvania Health System (UPHS). We used ICD-10 diagnostic codes to identify encounters for acute bronchitis at any outpatient UPHS practice between March 15, 2017, and March 14, 2018. Exclusion criteria included underlying immunocompromising condition, other comorbidity influencing the need for antibiotics (eg, emphysema), or ICD-10 code at the same visit for a concurrent infection (eg, sinusitis). We randomly selected 300 (150 from academic practices and 150 from nonacademic practices) eligible subjects for detailed chart abstraction that assessed patient demographics and practice and prescriber characteristics. Appropriateness of antibiotic use based on chart review served as the gold standard for assessment of the electronic algorithm. Because antibiotic use is not indicated for this study population, appropriateness was assessed based upon whether an antibiotic was prescribed or not. Results: Of 300 subjects, median age was 61 years (interquartile range, 50–68), 62% were women, 74% were seen in internal medicine (vs family medicine) practices, and 75% were seen by a physician (vs an advanced practice provider). On chart review, 167 (56%) subjects received an antibiotic. Of these subjects, 1 had documented concern for pertussis and 4 had excluding conditions for which there were no ICD-10 codes. One received an antibiotic prescription for a planned dental procedure. Thus, based on chart review, 161 (54%) subjects received antibiotics inappropriately. Using the electronic algorithm based on diagnostic codes, underlying and concurrent conditions, and prescribing data, the number of subjects with inappropriate prescribing was 170 (56%) because 3 subjects had antibiotic prescribing not noted based on chart review. The test characteristics of the electronic algorithm (compared to gold standard chart review) for identification of inappropriate antibiotic prescribing were the following: sensitivity, 100% (161 of 161); specificity, 94% (130 of 139); positive predictive value, 95% (161 of 170); and negative predictive value, 100% (130 of 130). Conclusions: For outpatients with acute bronchitis, an electronic algorithm for identification of inappropriate antibiotic prescribing is highly accurate. This algorithm could be used to efficiently assess prescribing among practices and individual clinicians. The impact of interventions based on this algorithm should be tested in future studies.Funding: NoneDisclosures: None

scholarly journals The Impact of Social Role Identity on Communication in Hospital-Based Antimicrobial Stewardship

2021 ◽  
Vol 1 (S1) ◽  
pp. s14-s14
Author(s):  
Julia Szymczak ◽  
Brandi Muller ◽  
Nikitha Shakamuri ◽  
Keith Hamilton ◽  
Elizabeth Dodds Ashley ◽  
...  
Keyword(s):  
Social Identity ◽  
Antimicrobial Stewardship ◽  
Role Theory ◽  
Social Role ◽  
The United States ◽  
Role Identity ◽  
Clinical Team ◽  
Face To Face ◽  
Group Orientation ◽  
The Impact

Background: Evidence-based hospital antimicrobial stewardship interventions, such as postprescription review with feedback, prior authorization, and handshake stewardship, involve communication between stewards and frontline prescribers. Hierarchy, asymmetric responsibility, prescribing etiquette, and autonomy can obstruct high-quality communication in stewardship. Little is known about the strategies that stewards use to overcome these barriers. The objective of this study was to identify how stewards navigate communication challenges when interacting with prescribers. Methods: We conducted semistructured interviews with antimicrobial stewards recruited from hospitals across the United States. Interviews were audio recorded, transcribed, and analyzed using a flexible coding approach and the framework method. Social identity theory and role theory were used to interpret framework matrices. Results: Interviews were conducted with 58 antimicrobial stewards (25 physicians and 33 pharmacists) from 10 hospitals (4 academic medical centers, 4 community hospitals, and 2 children’s hospitals). Respondents who felt empowered in their interactions with prescribers explicitly adopted a social identity that conceptualized stewards and prescribers as being on the “same team” with shared goals (in-group orientation). Drawing on the meaning conferred via this social role identity, respondents engaged in communication strategies to build and maintain common bonds with prescribers. These strategies included moderating language to minimize defensive recommendations when delivering stewardship recommendations, aligning the goals of stewardship with the goals of the clinical team, communicating with prescribers about things other than stewardship, compromising for the sake of future interactions, and engaging in strategic face-to-face interaction. Respondents who felt less empowered in their interactions thought of themselves as outsiders to the clinical team and experienced a heightened sense of “us versus them” mentality with the perception that stewards primarily serve a gate-keeping function (ie, outgroup orientation). These respondents expressed deference to hierarchy, a reluctance to engage in face-to-face interaction, a feeling of cynicism about the impact of stewardship, and a sense of low professional accomplishment within the role. Respondents who exhibited an in-group orientation were more likely than those who did not to describe the positive impact of stewardship mentors or colleagues on their social role identity. Conclusions: The way antimicrobial stewards perceive their role and identity within the social context of their healthcare organization influences how they approach communication with prescribers. Social role identity in stewardship is shaped by the influence of mentors and colleagues, indicating the importance of supportive relationships for the development of steward skill and confidence.Funding: NoDisclosures: None

scholarly journals Impact of the first COVID-19 shelter-in-place order in the United States on emergency department utilization, Marin County, California

2020 ◽  
Author(s):  
Brett R. Bayles ◽  
Michaela F George ◽  
Haylea Hannah ◽  
Patti Culross ◽  
Rochelle R. Ereman ◽  
...  
Keyword(s):  
United States ◽  
San Francisco ◽  
Large Scale ◽  
Temporal Dynamics ◽  
The United States ◽  
Emergency Department Utilization ◽  
Marin County ◽  
Before And After ◽  
Ed Visits ◽  
The Impact

Background: The first shelter-in-place (SIP) order in the United States was issued across six counties in the San Francisco Bay Area to reduce the impact of COVID-19 on critical care resources. We sought to assess the impact of this large-scale intervention on emergency departments (ED) in Marin County, California. Methods: We conducted a retrospective descriptive and trend analysis of all ED visits in Marin County, California from January 1, 2018 to May 4, 2020 to quantify the temporal dynamics of ED utilization before and after the March 17, 2020 SIP order. Results: The average number of ED visits per day decreased by 52.3% following the SIP order compared to corresponding time periods in 2018 and 2019. Both respiratory and non-respiratory visits declined, but this negative trend was most pronounced for non-respiratory admissions. Conclusions: The first SIP order to be issued in the United States in response to COVID-19 was associated with a significant reduction in ED utilization in Marin County.

scholarly journals ‘If a fight starts, watch the crowd’: The effect of violence on popular support for social movements

2019 ◽  
Vol 56 (4) ◽  
pp. 485-498 ◽  
Author(s):  
Jordi Muñoz ◽  
Eva Anduiza
Keyword(s):  
Social Movements ◽  
Causal Effect ◽  
The Other ◽  
Popular Support ◽  
Face To Face ◽  
Percentage Points ◽  
Street Violence ◽  
Wide Range ◽  
Before And After ◽  
The Impact

Social movements often face tactic diversification. In otherwise nonviolent movements, some groups or radical flanks may resort to violent actions such as street rioting. This article analyzes the impact that these violent episodes can have on popular support for the movement as a whole. To estimate the causal effect of violence, it exploits an unexpected riot outbreak that occurred during the fieldwork of a face-to-face survey in Barcelona in May 2016, led by a squat group linked to the anti-austerity movement known as the 15-M or indignados that emerged during the financial crisis. By comparing respondents interviewed before and after the riots, it finds that the street violence episode reduced support for the 15-M movement by 12 percentage points on average. However, the magnitude of the effect is highly conditional on the respondents’ predispositions towards the movement. Core supporters, that are expected to share the frame of the movement in justifying violent actions, are the least affected by the violent outbreak. On the other extreme, weak supporters, opposers, and non-aligned citizens reduce their support to a larger extent. Results are robust to different specifications and a wide range of robustness checks. These findings have potentially important implications for movements concerned with broadening their support base.

scholarly journals A Therapeutic Educational Program in Oral Health for Persons with Schizophrenia: A Qualitative Feasibility Study

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Audrey Peteuil ◽  
Corinne Rat ◽  
Sahar Moussa-Badran ◽  
Maud Carpentier ◽  
Jean-François Pelletier ◽  
...  
Keyword(s):  
Oral Health ◽  
Educational Program ◽  
Periodontal Diseases ◽  
Level Of Evidence ◽  
Face To Face ◽  
Before And After ◽  
Health Quality ◽  
Persons With Schizophrenia ◽  
High Level ◽  
The Impact

Objective. The aim of this study was to test the feasibility of a therapeutic educational program in oral health (TEPOH) for persons with schizophrenia (PWS). Design. In a qualitative study, we explored the representation of oral health before and after a TEPOH. Clinical Setting: PWS are at greater risk of decayed and missing teeth and periodontal diseases. In a previous publication, we described the different steps in building a TEPOH by taking into account the experiences of PWS concerning oral health quality of life. This TEPOH aimed at promoting a global health approach. Participants: Voluntary PWS and their caregivers were recruited during face-to-face interviews at “Les Boisseaux” (a psychiatric outpatient centre) in Auxerre (France) and were included in the study between November and December 2016. Intervention: We explored the experiences of participants and their perceptions of oral health before and after the TEPOH with focus group meetings. Results. Four females and three males participated in the study, and the mean age was 29.4 ± 5. Before the TEPOH, the PWS produced 28 ideas about oral health perception and 37 after the TEPOH. After the TEPOH, elements relating to the determinants of oral health (smoking and poor diet) emerged. Conclusions. These results show an evolution in oral health representation, and after some adjustments to the TEPOH, the second step will be to test this program in a large sample to generate a high level of evidence of the impact of TEPOH in the long term.

Disentangling the Interaction of Migration, Mobility, and Labor-Force Participation

2002 ◽  
Vol 34 (5) ◽  
pp. 923-945 ◽  
Author(s):  
William A V Clark ◽  
Suzanne Davies Withers
Keyword(s):  
Labor Force ◽  
Labor Force Participation ◽  
Panel Study ◽  
The United States ◽  
Family Migration ◽  
Labor Force Status ◽  
Dual Earner ◽  
Before And After ◽  
The Impact ◽  
Status Of Women

The authors examine the impact of mobility on the labor-force status of two-earner households in the United States, in a longitudinal context. There has recently been a resurgence of interest within industry and academia in the impact of family migration on the labor-force status of women, and on dual-earner families in general. Much of the research in this field has documented the disruptive effects of migration on the labor-force status of women, particularly with respect to unemployment, under-employment, and interrupted careers. However, there is another body of research that has challenged the disruption assumption with findings that many women benefit from family migration. The conflicting results persist when the modeling procedures account for the selectivity of migrants. Missing from the literature is a comparison of the impact of mobility on the labor-force status of men as well as women at varying geographical scales. The authors have used a new methodology to extend previous work on the impact of family migration by directly comparing the labor-force status of dual-earner households who migrate long distances, with that of households who move within the same labor market, and with that of households who remain residentially stable. The authors have used data from the Panel Study of Income Dynamics to show conclusively that, although there are disruptive effects, these are relatively short lived for most households. In addition, the results suggest that average changes mask very large variations in what happens to husbands and wives who relocate. This study emphasizes the dynamic nature of wives' labor-force participation relative to their husbands' immediately before and after a move, a finding that has not been established by other work on migration and labor-force participation.

scholarly journals The Impact of the “Muslim Ban” Executive Order on Healthcare Utilization in Minneapolis-St. Paul, Minnesota

2020 ◽  
Author(s):  
Elizabeth A. Samuels ◽  
Lilla Orr ◽  
Elizabeth B. White ◽  
Altaf Saadi ◽  
Aasim I. Padela ◽  
...  
Keyword(s):  
United States ◽  
Primary Care ◽  
Emergency Department ◽  
Healthcare Utilization ◽  
The United States ◽  
Emergency Department Visits ◽  
Executive Order ◽  
Before And After ◽  
Muslim Majority ◽  
The Impact

AbstractObjectiveDetermine whether the 2017 “Muslim Ban” Executive Order impacted healthcare utilization by people born in Order-targeted nations living in the United States.MethodsWe conducted a retrospective cohort study of people living in Minneapolis-St. Paul, MN in 2016-2017 who were: 1) born in Order-targeted nations, 2) born in Muslim-majority nations not listed in the Order, and 3) born in the United States and non-Latinx. Primary outcomes were: 1) primary care visits, 2) missed primary care appointments, 3) primary care diagnoses for stress-responsive conditions, 4) emergency department visits, and 5) emergency department visits for stress-responsive diagnoses. We evaluated visit trends before and after Order issuance using linear regression and differences between study groups using a difference-in-difference analyses.ResultsIn early 2016, primary care visits and stress-responsive diagnoses increased among individuals from Muslim majority nations. Following the Order, there was an immediate increase in emergency department visits among individuals from Order-targeted nations.ConclusionsIncreases in healthcare utilization among people born in Muslim majority countries before and after the “Muslim Ban” likely reflect elevated cumulative stress including the impact of the Order.

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