Associations Between In-Hospital Mortality, Health Care Utilization, and Inpatient Costs With the 2011 Resident Duty Hour Revision

ABSTRACT Background The Accreditation Council for Graduate Medical Education (ACGME) has mandated revisions to residents' work hours to improve patient safety and enhance resident education and wellness. The impact on clinical outcomes on a national level is poorly understood. Objective We examined data from before and after the ACGME 2011 duty hour revision and looked for differences between teaching and nonteaching US hospitals. Methods A retrospective observational study of patients admitted to hospitals in the 2-year periods before and after the 2011 duty hour revision was conducted, utilizing a nationally representative data set. We compared patient and hospital characteristics using standardized differences. With nonteaching hospitals serving as the control group, we used multiple group interrupted time series segmented regression analysis to test for postrevision level and trend changes in mortality, length of stay (LOS), and costs. Results We examined more than 117 million hospitalizations. At teaching and nonteaching hospitals, trends in mortality and LOS in prerevision and postrevision periods were not significantly different (all P > .05). A significant monthly reduction in cost per hospitalization was noted postrevision at teaching hospitals (P = .019) but not at nonteaching hospitals (P = .62). In the 2 years following the 2011 revision, there was a monthly reduction in cost per hospitalization (–$52.28; 95% confidence interval –$116.90 to –$12.32; P = .026) at teaching relative to nonteaching hospitals. Conclusions There were no differences in mortality or LOS between teaching and nonteaching hospitals. However, there was a small decrease in cost per hospitalization at teaching hospitals following the 2011 revision.

Download Full-text

Causal Effect of Honorary Titles on Physicians’ Service Volumes in Online Health Communities: Retrospective Study

Journal of Medical Internet Research ◽

10.2196/18527 ◽

2020 ◽

Vol 22 (7) ◽

pp. e18527

Author(s):

Haiyan Yu ◽

Yali Wang ◽

Jying-Nan Wang ◽

Ya-Ling Chiu ◽

Hang Qiu ◽

...

Keyword(s):

Treatment Effect ◽

Causal Effect ◽

Home Page ◽

Differential Treatment ◽

Control Group ◽

Data Set ◽

Incentive Policy ◽

Before And After ◽

Health Communities ◽

The Impact

Background An OHC online health community (OHC) is an interactive platform for virtual communication between patients and physicians. Patients can typically search, seek, and share their experience and rate physicians, who may be involved in giving advice. Some OHC providers provide incentives in form of honorary titles to encourage the web-based involvement of physicians, but it is unclear whether the award of honorary titles has an impact on their consultation volume in an OHC. Objective This study is designed to identify the differential treatment effect of the incentive policy on the service volumes for the subgroups of treatment and control in an OHC. This study aims to answer the following questions: Does an honorary title for physicians impact their service volumes in an OHC? During the period of discontinuity, can we identify the sharp effect of the incentive award on the outcomes of physicians’ service volumes? Methods We acquired the targeted samples based on treatment, namely, physicians with an honorary title or not and outcomes measured before and after the award of the 2 subgroups. A regression discontinuity design was applied to investigate the impact of the honorary titles incentive as a treatment in an OHC. There was a sharply discontinuous effect of treatment on physicians’ online health service performance. The experimental data set consisted of 346 physicians in the treatment group (with honorary titles). Applying the propensity score matching method, the same size of physicians (n=346) was matched and selected as the control group. Results A sharp discontinuity was found at the time of the physician receiving the honorary title. The results showed that the parametric estimates of the coefficient were significantly positively (P<.001) associated with monthly home page views. The jump in the monthly volumes of home page views was much sharper than that of the monthly consultations. Conclusions The changes in the volumes of monthly consultations and home page views reflect the differential treatment effect of honorary titles on physicians’ service volumes. The effect of the incentive policy with honorary titles is objectively estimated from both the perspective of online and offline medical services in an OHC. Being named with honorary titles significantly multiplied monthly home page views, yet it did not significantly impact monthly consultations. This may be because consultation capacity is limited by the physician's schedule for consultations.

Download Full-text

Causal Effect of Honorary Titles on Physicians’ Service Volumes in Online Health Communities: Retrospective Study (Preprint)

10.2196/preprints.18527 ◽

2020 ◽

Cited By ~ 1

Author(s):

Haiyan Yu ◽

Yali Wang ◽

Jying-Nan Wang ◽

Ya-Ling Chiu ◽

Hang Qiu ◽

...

Keyword(s):

Treatment Effect ◽

Causal Effect ◽

Home Page ◽

Differential Treatment ◽

Control Group ◽

Data Set ◽

Incentive Policy ◽

Before And After ◽

Health Communities ◽

The Impact

BACKGROUND An OHC online health community (OHC) is an interactive platform for virtual communication between patients and physicians. Patients can typically search, seek, and share their experience and rate physicians, who may be involved in giving advice. Some OHC providers provide incentives in form of honorary titles to encourage the web-based involvement of physicians, but it is unclear whether the award of honorary titles has an impact on their consultation volume in an OHC. OBJECTIVE This study is designed to identify the differential treatment effect of the incentive policy on the service volumes for the subgroups of treatment and control in an OHC. This study aims to answer the following questions: Does an honorary title for physicians impact their service volumes in an OHC? During the period of discontinuity, can we identify the sharp effect of the incentive award on the outcomes of physicians’ service volumes? METHODS We acquired the targeted samples based on treatment, namely, physicians with an honorary title or not and outcomes measured before and after the award of the 2 subgroups. A regression discontinuity design was applied to investigate the impact of the honorary titles incentive as a treatment in an OHC. There was a sharply discontinuous effect of treatment on physicians’ online health service performance. The experimental data set consisted of 346 physicians in the treatment group (with honorary titles). Applying the propensity score matching method, the same size of physicians (n=346) was matched and selected as the control group. RESULTS A sharp discontinuity was found at the time of the physician receiving the honorary title. The results showed that the parametric estimates of the coefficient were significantly positively (<i>P</i><.001) associated with monthly home page views. The jump in the monthly volumes of home page views was much sharper than that of the monthly consultations. CONCLUSIONS The changes in the volumes of monthly consultations and home page views reflect the differential treatment effect of honorary titles on physicians’ service volumes. The effect of the incentive policy with honorary titles is objectively estimated from both the perspective of online and offline medical services in an OHC. Being named with honorary titles significantly multiplied monthly home page views, yet it did not significantly impact monthly consultations. This may be because consultation capacity is limited by the physician's schedule for consultations.

Download Full-text

The impact of a music education program on meta-musical awareness, logical-mathematical, and notational skills in preschoolers

International Journal of Music Education ◽

10.1177/02557614211027247 ◽

2021 ◽

pp. 025576142110272

Author(s):

Oriana Incognito ◽

Laura Scaccioni ◽

Giuliana Pinto

Keyword(s):

Music Education ◽

Education Program ◽

Cognitive Abilities ◽

Musical Training ◽

Control Group ◽

Transfer Of Knowledge ◽

General Domain ◽

Music Program ◽

Before And After ◽

The Impact

A number of studies suggest a link between musical training and both specific and general cognitive abilities, but despite some positive results, there is disagreement about which abilities are improved. This study aims to investigate the effects of a music education program both on a domain-specific competence (meta-musical awareness), and on general domain competences, that is, cognitive abilities (logical-mathematical) and symbolic-linguistic abilities (notational). Twenty 4- to 6-year-old children participated in the research, divided into two groups (experimental and control) and the measures were administered at two different times, before and after a 6-month music program (for the experimental group) and after a sports training program (for the control group). Children performed meta-musical awareness tasks, logical-mathematical tasks, and emergent-alphabetization tasks. Non-parametric statistics show that a music program significantly improves the development of notational skills and meta-musical awareness while not the development of logical-mathematical skills. These results show that a musical program increases children’s meta-musical awareness, and their ability to acquire the notational ability involved in the invented writing of words and numbers. On the contrary, it does not affect the development of logical skills. The results are discussed in terms of transfer of knowledge processes and of specific versus general domain effects of a musical program.

Download Full-text

Changes in the Use of Broad-Spectrum Antibiotics after Cefepime Shortage: a Time Series Analysis

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.05560-11 ◽

2011 ◽

Vol 56 (2) ◽

pp. 989-994 ◽

Cited By ~ 12

Author(s):

C. Plüss-Suard ◽

A. Pannatier ◽

C. Ruffieux ◽

A. Kronenberg ◽

K. Mühlemann ◽

...

Keyword(s):

Time Series ◽

Pseudomonas Aeruginosa ◽

Broad Spectrum ◽

Interrupted Time Series ◽

Antibiotic Policy ◽

Content Type ◽

Broad Spectrum Antibiotics ◽

Before And After ◽

Alternative Antibiotic ◽

The Impact

ABSTRACTThe original cefepime product was withdrawn from the Swiss market in January 2007 and replaced by a generic 10 months later. The goals of the study were to assess the impact of this cefepime shortage on the use and costs of alternative broad-spectrum antibiotics, on antibiotic policy, and on resistance ofPseudomonas aeruginosatoward carbapenems, ceftazidime, and piperacillin-tazobactam. A generalized regression-based interrupted time series model assessed how much the shortage changed the monthly use and costs of cefepime and of selected alternative broad-spectrum antibiotics (ceftazidime, imipenem-cilastatin, meropenem, piperacillin-tazobactam) in 15 Swiss acute care hospitals from January 2005 to December 2008. Resistance ofP. aeruginosawas compared before and after the cefepime shortage. There was a statistically significant increase in the consumption of piperacillin-tazobactam in hospitals with definitive interruption of cefepime supply and of meropenem in hospitals with transient interruption of cefepime supply. Consumption of each alternative antibiotic tended to increase during the cefepime shortage and to decrease when the cefepime generic was released. These shifts were associated with significantly higher overall costs. There was no significant change in hospitals with uninterrupted cefepime supply. The alternative antibiotics for which an increase in consumption showed the strongest association with a progression of resistance were the carbapenems. The use of alternative antibiotics after cefepime withdrawal was associated with a significant increase in piperacillin-tazobactam and meropenem use and in overall costs and with a decrease in susceptibility ofP. aeruginosain hospitals. This warrants caution with regard to shortages and withdrawals of antibiotics.

Download Full-text

The Use of Procalcitonin as a Sepsis Marker in a Community Hospital

The Journal of Applied Laboratory Medicine ◽

10.1373/jalm.2018.026955 ◽

2019 ◽

Vol 3 (4) ◽

pp. 545-552

Author(s):

Nathalia De Oro ◽

Maria E Gauthreaux ◽

Julie Lamoureux ◽

Joseph Scott

Keyword(s):

Lactic Acid ◽

Length Of Stay ◽

Community Hospital ◽

Unit Length ◽

Hospital Setting ◽

Control Group ◽

Before And After ◽

Quasi Experimental ◽

Current Cutoff ◽

The Impact

Abstract Background Procalcitonin (PCT) is a biomarker that shows good sensitivity and specificity in identifying septic patients. Methods This study investigated the diagnostic accuracy of PCT in a community hospital setting and how it compared to that of lactic acid. It explored the impact on patient care before and after PCT implementation regarding costs and length of stay. Two comparative groups were analyzed using an exploratory descriptive case–control study with data from a 19-month period after PCT implementation and a retrospective quasi-experimental study using a control group of emergency department patients diagnosed with sepsis using data before PCT implementation. Results Post-procalcitonin implementation samples included 165 cases and pre-procalcitonin implementation sample included 69 cases. From the 165 sepsis cases who had positive blood cultures, PCT had a sensitivity of 89.7%. In comparison, lactic acid's sensitivity at the current cutoff of 18.02 mg/dL (2.0 mmol/L) was 64.9%. There was a 32% decrease in median cost before and after PCT implementation, even with the length of stay remaining at 5 days in both time periods. Conclusions There was a significant decrease after the implementation of PCT in cost of hospitalization compared to costs before implementation. This cost is highly correlated with length of stay; neither the hospital nor the intensive care unit length of stay showed a difference with before and after implementation. There was a positive correlation between lactic acid and PCT values. PCT values had a higher predictive usefulness than the lactic acid values.

Download Full-text

Controlled Study of the Impact of a Virtual Program to Reduce Stigma Among University Students Toward People With Mental Disorders

Frontiers in Psychiatry ◽

10.3389/fpsyt.2021.632252 ◽

2021 ◽

Vol 12 ◽

Author(s):

Matías E. Rodríguez-Rivas ◽

Adolfo J. Cangas ◽

Daniela Fuentes-Olavarría

Keyword(s):

Mental Disorders ◽

University Students ◽

Intervention Group ◽

Project Based Learning ◽

Controlled Study ◽

Control Group ◽

Global Score ◽

Stigma Reduction ◽

Before And After ◽

The Impact

Stigma toward mental disorders is one of today's most pressing global issues. The Covid-19 pandemic has exacerbated the barriers to social inclusion faced by individuals with mental disorders. Concurrently, stigma reduction interventions, especially those aimed at university students, have been more difficult to implement given social distancing and campus closures. As a result, alternative delivery for programs contributing to stigma reduction is required, such as online implementation. This paper reports the results of a controlled study focused on an online multi-component program on reducing stigma toward mental illness that included project-based learning, clinical simulations with standardized patients and E-Contact with real patients. A total of 40 undergraduate students from the Universidad del Desarrollo in Santiago, Chile, participated in the study. They were randomly divided between an intervention and control group. The intervention group participated in the online multi-component program, while the control group participated in an online educational program on cardiovascular health. We assessed the impact of the program by using the validated Spanish-language versions of the Attribution Questionnaire AQ-27 and the Questionnaire on Student Attitudes toward Schizophrenia with both groups, before and after the intervention. In addition, an ad hoc Likert scale ranging from 0 to 5 was used with the intervention group in order to assess the learning strategies implemented. Following the intervention, the participants belonging to the intervention group displayed significantly lower levels of stereotypes, perception of dangerousness, and global score toward people with schizophrenia (p < 0.001). In addition, participants presented lower levels of dangerousness-fear, avoidance, coercion, lack of solidarity, and global score (p < 0.001). The control group displayed no statistically significant differences in the level of stigma before and after the evaluation, for all of the items assessed. Finally, the overall assessment of each of the components of the program was highly positive. In conclusion, the study shows that online programs can contribute to reducing stigma toward mental disorders. The program assessed in this study had a positive impact on all the dimensions of stigma and all of the components of the program itself were positively evaluated by the participants.

Download Full-text

(A296) Psychosocial Disaster Preparedness Program Form School Children

Prehospital and Disaster Medicine ◽

10.1017/s1049023x11002809 ◽

2011 ◽

Vol 26 (S1) ◽

pp. s83-s83 ◽

Cited By ~ 1

Author(s):

E.A. Raj ◽

K. Sekar

Keyword(s):

School Children ◽

Disaster Preparedness ◽

Tamil Nadu ◽

Control Group ◽

Care Givers ◽

Effective Manner ◽

Before And After ◽

Teachers And Students ◽

The Individual ◽

The Impact

The impact of natural disasters on individuals is substantial. Among the affected population in any disaster, children are identified as the most vulnerable group along with women, aged and disabled people. An estimated 77 million children under 15, on average, had their lives severely disrupted by a natural disaster or an armed conflict, each year, between 1991 and 2000 (Plan UK, 2003). Children are most affected since they loose the familiar environment, loss of parents, witness death of their loved ones, fear of reoccurrence of the disaster event. The impact of disaster on children of different age group is multiple times greater than that of the adults. This leads to various psychological problems in children (Dave et al., 2003). Disaster preparedness, through care givers, is one among the ways to reduce the distress of individuals followed by any disaster because it reduces the vulnerability factor that minimizes the impact of any disaster on the individual. A disaster preparedness program with special reference to psychosocial aspects was developed and implemented among the school children through teachers in Kanniyakumari District, Tamil Nadu, India, one of the severely affected areas in Tsunami. The current attempt was to standardize a disaster preparedness module focusing on preparing children to deal with their psychosocial issues before and after disaster in an effective manner. The outcome of disaster preparedness input through teachers and its reach out to the students was determined through an experimental research. The results reveal that the teachers and students from the experimental group gained significantly more knowledge on psychosocial disaster preparedness after implementation of the program in comparison to control group where the program was not implemented. The implications of the study points out the need to integrate psychosocial component of disaster preparedness in to the broader Community Based Disaster Preparedness (CBDP) programs.

Download Full-text

Effects of Comorbid Alcohol Use Disorder on the Clinical Outcomes of Schizophrenia: A Nationwide Population-based Study

10.21203/rs.3.rs-322353/v1 ◽

2021 ◽

Author(s):

Soojin Ahn ◽

Youngjae Choi ◽

Woohyeok Choi ◽

Young Tak Jo ◽

Harin Kim ◽

...

Keyword(s):

Alcohol Use ◽

Clinical Outcomes ◽

Alcohol Use Disorder ◽

Medication Possession Ratio ◽

Small Sample ◽

Control Group ◽

Diagnostic Code ◽

Psychiatric Admissions ◽

Before And After ◽

The Impact

Abstract BackgroundAlcohol use disorder (AUD) is a common psychiatric comorbidity in schizophrenia, associated with poor clinical outcomes and medication noncompliance. Most previous studies on the effect of alcohol use in patients with schizophrenia had limitations of small sample size and a cross-sectional design. Therefore, this study aimed to use a nationwide population database to investigate the impact of AUD on clinical outcomes of schizophrenia.MethodsData from the Health Insurance Review Agency database in South Korea from January 1, 2007 to December 31, 2016 was used. Among 64,442 patients with incident schizophrenia, 1,598 with comorbid AUD were selected based on the diagnostic code F10. We performed between- and within-group analyses to compare the rates of psychiatric admissions and emergency room (ER) visits and medication possession ratio (MPR) with control patients having schizophrenia matched for the onset age, sex, and observation period.ResultsThe rates of psychiatric admissions and ER visits decreased after the diagnosis of AUD in both groups; however, the decrease was significantly greater in patients with comorbid AUD compared to the control group. While the case group showed an increase in MPR after the diagnosis of AUD, MPR decreased in the control patients. The rates of psychiatric admissions, ER visits and MPR were worse in the schizophrenia group with comorbid AUD both before and after the diagnosis of AUD.ConclusionsClinical outcomes were worse in the comorbid AUD group than in the control group before and after the diagnosis of AUD. Considering that patients with schizophrenia with comorbid AUD had poorer clinical outcomes even before the diagnosis of AUD, schizophrenia with comorbid AUD could be a distinct subtype of schizophrenia.

Download Full-text

Quiet time: a nursing intervention to promote sleep in neurocritical care units

American Journal of Critical Care ◽

10.4037/ajcc2001.10.2.74 ◽

2001 ◽

Vol 10 (2) ◽

pp. 74-78 ◽

Cited By ~ 78

Author(s):

DM Olson ◽

CO Borel ◽

DT Laskowitz ◽

DT Moore ◽

ES McConnell

Keyword(s):

Neurocritical Care ◽

Control Period ◽

Intervention Group ◽

Nursing Intervention ◽

Control Group ◽

Quiet Time ◽

Sleep Behavior ◽

Environmental Stimuli ◽

Before And After ◽

The Impact

BACKGROUND: Patients in intensive care units are often sleep deprived, yet little research exists on the impact of nursing care on promoting sleep. OBJECTIVES: To determine if implementing a "quiet time" protocol to reduce external environmental stimuli is associated with increased frequency of sleep among patients in a neurocritical care unit. METHODS: Patients were observed 8 times each day before and after implementation of a protocol in which environmental sounds and lights were decreased from 2 AM to 4 AM and from 2 PM to 4 PM. Data collected at 2:45 AM, 3:30 AM, 2:45 PM, and 3:30 PM on patients with scores of 10 or greater on the Glasgow Coma Scale were analyzed. A total of 2975 observations were made on a total of 239 patients: 1446 observations on 118 patients in the control group and 1529 observations on 121 patients in the intervention group. RESULTS: The percentage of patients observed asleep was significantly higher during the months the quite-time period was implemented than during the control period before the intervention was started. The increase in sleep behavior was associated with decreased sound and light levels achieved during the quiet time. Patients observed during the intervention period were 1.6 times more likely to be asleep during the quiet time than were patients observed during the control period (P < .001). CONCLUSIONS: A concentrated effort by staff to reduce environmental stimuli at discrete preset intervals increases the likelihood of sleep during scheduled quiet time in the neurocritical care unit.

Download Full-text

Health Outcomes of an Integrated Behaviour-Centred Water, Sanitation, Hygiene and Food Safety Intervention–A Randomised before and after Trial

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17082648 ◽

2020 ◽

Vol 17 (8) ◽

pp. 2648 ◽

Cited By ~ 2

Author(s):

Tracy Morse ◽

Elizabeth Tilley ◽

Kondwani Chidziwisano ◽

Rossanie Malolo ◽

Janelisa Musaya

Keyword(s):

Low Income ◽

Diarrhoeal Disease ◽

Control Group ◽

Food Hygiene ◽

Children Under Five ◽

Under Five ◽

Cluster Group ◽

Point Reduction ◽

Before And After ◽

The Impact

Diarrhoeal disease in children under five in low income settings has been associated with multiple environmental exposure pathways, including complementary foods. Conducted from February to December 2018 in rural Malawi, this before and after trial with a control used diarrhoeal disease as a primary outcome, to measure the impact of a food hygiene intervention (food hygiene + handwashing) relative to a food hygiene and water, sanitation and hygiene (WASH) intervention (food hygiene + handwashing + faeces management + water management). The 31-week intervention was delivered by community-based coordinators through community events (n = 2), cluster group meetings (n = 17) and household visits (n = 14). Diarrhoeal disease was self-reported and measured through an end line survey, and daily diaries completed by caregivers. Difference-in-differences results show a 13-percentage point reduction in self-reported diarrhoea compared to the control group. There were also significant increases in the presence of proxy measures in each of the treatment groups (e.g., the presence of soap). We conclude that food hygiene interventions (including hand washing with soap) can significantly reduce diarrhoeal disease prevalence in children under five years in a low-income setting. Therefore, the promotion of food hygiene practices using a behaviour-centred approach should be embedded in nutrition and WASH policies and programming.

Download Full-text