viernes, 20 de octubre de 2017

NOTICE TO READERS

the blog´s editor says: between the days Sunday 22 (included) October and Sunday October 29 (included), the blog will not be updated. Personal issues will keep me away from any possibility of updating since I will undergo surgery that will require a long recovery. I hope you know how to understand, just as I hope to find you on my/your return, next week, sometime, always. A hug to all of you and thank you for accompanying me day after day unconditionally . OCTOBER 20, 2017.-

Trends in Emergency Department Visits, 2006-2014 #227

Trends in Emergency Department Visits, 2006-2014 #227

AHRQ News Now



AHRQ Stats: Trends in Emergency Department Visits

Emergency department (ED) visits increased 15 percent from 2006 to 2014. During that time, ED visits for injuries decreased by 13 percent while ED visits for mental health/substance abuse increased by 44 percent. (Source: AHRQ, Healthcare Cost and Utilization Project Statistical Brief #227: Trends in Emergency Department Visits, 2006-2014.)
Trends in Emergency Department Visits, 2006-2014


Brian J. Moore, Ph.D., Carol Stocks, Ph.D., R.N., and Pamela L. Owens, Ph.D. 
Highlights
  • There were 137.8 million emergency department (ED) visits in 2014, with a rate of 432 per 1,000 population.


  • The number of ED visits increased 14.8 percent from 2006 to 2014. Comparing the 2 years, the U.S. population grew 6.9 percent.


  • The number of ED visits covered by Medicaid and Medicare increased between 2006 and 2014 (66.4 percent and 28.5 percent, respectively), whereas the number of ED visits covered by private insurance decreased (10.1 percent).


  • The rate of ED visits for medical conditions increased 11.7 percent from 2006 to 2014. Diagnoses involving abdominal pain were the most frequent medical diagnoses for ED visits in 2014 (6.0 million visits).


  • The rate of injury-related ED visits decreased 12.9 percent from 2006 to 2014. Among injury-related ED visits, sprains and strains were the most frequent first-listed diagnoses in 2014 (5.8 million visits).


  • The rate of mental health / substance abuse-related ED visits increased 44.1 percent from 2006 to 2014, with suicidal ideation growing the most (414.6 percent increase in number of visits). Among mental health/substance abuse-related ED visits, alcohol-related disorders were the most frequent diagnoses in 2014 (1.5 million visits).

Postoperative Bleeding and Associated Utilization following Tonsillectomy in Children. - PubMed - NCBI

Postoperative Bleeding and Associated Utilization following Tonsillectomy in Children. - PubMed - NCBI





 2017 Mar;156(3):442-455. doi: 10.1177/0194599816683915. Epub 2017 Jan 17.

Postoperative Bleeding and Associated Utilization following Tonsillectomy in Children.

Abstract

Objective To assess posttonsillectomy hemorrhage (PTH), associated nonoperative readmissions/revisits, and reoperations in children. Data Sources MEDLINE, EMBASE, and the Cochrane Library. Review Methods Two investigators independently screened studies against predetermined criteria and extracted key data. Investigators independently assessed study risk of bias and the strength of the evidence of the body of literature. We calculated unadjusted pooled estimates of PTH frequency and conducted a Bayesian meta-analysis to estimate frequency of primary and secondary PTH and PTH-associated reoperation and revisits/readmissions by partial and total tonsillectomy and surgical approach. Results In meta-analysis, the frequency of primary and secondary PTH associated with total and partial tonsillectomy was <4% for any technique and with overlapping confidence bounds. Pooled frequencies of PTH were also <5% overall (4.2% for total tonsillectomy, 1.5% for partial tonsillectomy) in comparative studies. Fewer PTH episodes occurred with tonsillectomy for obstructive sleep-disordered breathing than for throat infection. In meta-analysis, frequency of PTH-associated nonoperative revisits/readmission or reoperation ranged from 0.2% to 5.7% for total tonsillectomy and from 0.1% to 3.7% for partial tonsillectomy. At least 4 deaths were reported in case series including 1,778,342 children. Conclusions PTH occurred in roughly 4% of tonsillectomies in studies included in this review. Although studies typically did not report bleeding severity or amount, relatively few episodes of PTH necessitated reoperation for hemostasis. Nonetheless, tonsillectomy is not without risk of harm. Frequency of PTH across techniques was similar; thus, we cannot conclude that a given technique is superior.

KEYWORDS:

adenotonsillectomy; postoperative bleeding; posttonsillectomy hemorrhage; tonsillectomy

PMID:
 
28094660
 
PMCID:
 
PMC5639328
 [Available on 2018-03-01]
 
DOI:
 
10.1177/0194599816683915

[Indexed for MEDLINE]

Leveraging user's performance in reporting patient safety events by utilizing text prediction in narrative data entry. - PubMed - NCBI

Leveraging user's performance in reporting patient safety events by utilizing text prediction in narrative data entry. - PubMed - NCBI



 2016 Jul;131:181-9. doi: 10.1016/j.cmpb.2016.03.031. Epub 2016 Apr 8.

Leveraging user's performance in reporting patient safety events by utilizing text prediction in narrative data entry.

Abstract

BACKGROUND:

Narrative data entry pervades computerized health information systems and serves as a key component in collecting patient-related information in electronic health records and patient safety event reporting systems. The quality and efficiency of clinical data entry are critical in arriving at an optimal diagnosis and treatment. The application of text prediction holds potential for enhancing human performance of data entry in reporting patient safety events.

OBJECTIVE:

This study examined two functions of text prediction intended for increasing efficiency and data quality of text data entry reporting patient safety events.

METHODS:

The study employed a two-group randomized design with 52 nurses. The nurses were randomly assigned into a treatment group or a control group with a task of reporting five patient fall cases in Chinese using a web-based test system, with or without the prediction functions. T-test, Chi-square and linear regression model were applied to evaluating the outcome differences in free-text data entry between the groups.

RESULTS:

While both groups of participants exhibited a good capacity for accomplishing the assigned task of reporting patient falls, the results from the treatment group showed an overall increase of 70.5% in text generation rate, an increase of 34.1% in reporting comprehensiveness score and a reduction of 14.5% in the non-adherence of the comment fields. The treatment group also showed an increasing text generation rate over time, whereas no such an effect was observed in the control group.

CONCLUSION:

As an attempt investigating the effectiveness of text prediction functions in reporting patient safety events, the study findings proved an effective strategy for assisting reporters in generating complementary free text when reporting a patient safety event. The application of the strategy may be effective in other clinical areas when free text entries are required.

KEYWORDS:

Data entry; Incident reporting; Patient safety; Text prediction; Two-group randomized design; Usability evaluation

PMID:
 
27265058
 
PMCID:
 
PMC4899837
 
DOI:
 
10.1016/j.cmpb.2016.03.031

[Indexed for MEDLINE] 
Free PMC Article

The Shifting Landscape in Utilization of Inpatient, Observation, and Emergency Department Services Across Payers. - PubMed - NCBI

The Shifting Landscape in Utilization of Inpatient, Observation, and Emergency Department Services Across Payers. - PubMed - NCBI

AHRQ News Now



While Hospital Admissions Decline, Observation Stays and Emergency Department Visits on the Rise

Trends showing fewer hospital admissions and more treat-and-release observation stays or emergency department (ED) visits have occurred among patients across all insurance categories, according to a recent AHRQ-funded study. “The Shifting Landscape in Utilization of Inpatient, Observation, and Emergency Department Services Across Payers,” published in the Journal of Hospital Medicine, showed hospital admissions decreased while observation and ED visits increased from 2009 to 2013 among patients who were uninsured or covered by Medicare, Medicaid or private insurance. Among Medicare patients, for example, admissions fell by 17 percent while observation stays increased by 33 percent. The study analyzed data from AHRQ's Healthcare Cost and Utilization Project for 10 common conditions in four states. Access the abstract.


 2017 Jun;12(6):443-446. doi: 10.12788/jhm.2751.

The Shifting Landscape in Utilization of InpatientObservation, and Emergency DepartmentServices Across Payers.

Abstract

Recent policies by public and private payers have increased incentives to reduce hospital admissions. Using data from four states from the Agency for Healthcare Research and Quality Healthcare Cost and Utilization Project, this study compared the payer-specific population-based rates of adults using inpatientobservation, and emergency department (ED) services for 10 common medical conditions in 2009 and in 2013. Patients had an expected primary payer of private insurance, Medicare, Medicaid, or no insurance. Across all four payer populations, inpatient admissions declined, and care shifted toward treat-and-release observation stays and ED visits. The percentage of hospitalizations that began with an observation stay increased. Implications for quality of care and costs to patients warrant further examination. Journal of Hospital Medicine 2017;12:443-446.

PMID:
 
28574534
 
DOI:
 
10.12788/jhm.2751

Disparities in TKA Outcomes: Census Tract Data Show Interactions Between Race and Poverty. - PubMed - NCBI

Disparities in TKA Outcomes: Census Tract Data Show Interactions Between Race and Poverty. - PubMed - NCBI



 2016 Sep;474(9):1986-95. doi: 10.1007/s11999-016-4919-8. Epub 2016 Jun 8.

Disparities in TKA Outcomes: Census Tract Data Show Interactions Between Race and Poverty.

Abstract

BACKGROUND:

Race is an important predictor of TKA outcomes in the United States; however, analyses of race can be confounded by socioeconomic factors, which can result in difficulty determining the root cause of disparate outcomes after TKA.

QUESTIONS/PURPOSES:

We asked: (1) Are race and socioeconomic factors at the individual level associated with patient-reported pain and function 2 years after TKA? (2) What is the interaction between race and community poverty and patient-reported pain and function 2 years after TKA?

METHODS:

We identified all patients undergoing TKA enrolled in a hospital-based registry between 2007 and 2011 who provided 2-year outcomes and lived in New York, Connecticut, or New Jersey. Of patients approached to participate in the registry, more than 82% consented and provided baseline data, and of these patients, 72% provided 2-year data. Proportions of patients with complete followup at 2 years were lower among blacks (57%) than whites (74%), among patients with Medicaid insurance (51%) compared with patients without Medicaid insurance (72%), and among patients without a college education (67%) compared with those with a college education (71%). Our final study cohort consisted of 4035 patients, 3841 (95%) of whom were white and 194 (5%) of whom were black. Using geocoding, we linked individual-level registry data to US census tracts data through patient addresses. We constructed a multivariate linear mixed-effect model in multilevel frameworks to assess the interaction between race and census tract poverty on WOMAC pain and function scores 2 years after TKA. We defined a clinically important effect as 10 points on the WOMAC (which is scaled from 1 to 100 points, with higher scores being better).

RESULTS:

Race, education, patient expectations, and baseline WOMAC scores are all associated with 2-year WOMAC pain and function; however, the effect sizes were small, and below the threshold of clinical importance. Whites and blacks from census tracts with less than 10% poverty have similar levels of pain and function 2 years after TKA (WOMAC pain, 1.01 ± 1.59 points lower for blacks than for whites, p = 0.53; WOMAC function, 2.32 ± 1.56 lower for blacks than for whites, p = 0.14). WOMAC pain and function scores 2 years after TKA worsen with increasing levels of community poverty, but do so to a greater extent among blacks than whites. Disparities in pain and function between blacks and whites are evident only in the poorest communities; decreasing in a linear fashion as poverty increases. In census tracts with greater than 40% poverty, blacks score 6 ± 3 points lower (worse) than whites for WOMAC pain (p = 0.03) and 7 ± 3 points lower than whites for WOMAC function (p = 0.01).

CONCLUSIONS:

Blacks and whites living in communities with little poverty have similar patient-reported TKA outcomes, whereas in communities with high levels of poverty, there are important racial disparities. Efforts to improve TKA outcomes among blacks will need to address individual- and community-level socioeconomic factors.

LEVEL OF EVIDENCE:

Level III, therapeutic study.

PMID:
 
27278675
 
PMCID:
 
PMC4965380
 
DOI:
 
10.1007/s11999-016-4919-8

[Indexed for MEDLINE] 
Free PMC Article

Perpetuating stigma or reducing risk? Perspectives from naloxone consumers and pharmacists on pharmacy-based naloxone in 2 states. - PubMed - NCBI

Perpetuating stigma or reducing risk? Perspectives from naloxone consumers and pharmacists on pharmacy-based naloxone in 2 states. - PubMed - NCBI



 2017 Mar - Apr;57(2S):S19-S27.e4. doi: 10.1016/j.japh.2017.01.013. Epub 2017 Feb 14.

Perpetuating stigma or reducing risk? Perspectives from naloxone consumers and pharmacists on pharmacy-based naloxone in 2 states.

Abstract

OBJECTIVES:

Little is known about attitudes of pharmacists and consumers to pharmacy naloxone. We examined perceptions and experiences of pharmacy naloxone from people with opioid use disorder, patients taking chronic opioids for pain, caregivers of opioid users, and pharmacists from 2 early pharmacy naloxone adopter states: Massachusetts and Rhode Island.

DESIGN:

Eight focus groups (4 per state) were held in October to December 2015.

SETTING AND PARTICIPANTS:

Participants were recruited from pharmacies, health clinics, and community organizations; pharmacists were recruited from professional organizations and pharmacy colleges.

OUTCOME MEASURES:

Focus groups were led by trained qualitative researchers using a topic guide, and recorded and transcribed for analysis. Five analysts developed and applied a coding scheme to transcripts. Thematic analysis involved synthesis of coded data and connections between key themes, with comparisons across the groups.

RESULTS:

Sixty-one participants included patients with chronic pain (n = 15), people with opioid use disorders (n = 19), caregivers (n = 16), and pharmacists (n = 11). A majority of pharmacists had dispensed naloxone to patients; a minority of all consumer participants had obtained pharmacy naloxone. Four themes emerged: consumer fear of future consequences if requesting naloxone; pharmacists' concerns about practice logistics related to naloxone; differing perceptions of how opioid safety is addressed in the pharmacy; and solutions to addressing these barriers. Whereas consumer groups differed in awareness of naloxone and availability at pharmacies, all groups expressed support for the pharmacist's role and preferences for a universal offer of naloxone based on clear criteria.

CONCLUSION:

Pharmacies complement community naloxone provision to patients and caregivers. To overcome stigma of naloxone receipt, increased public awareness of naloxone and pharmacist training about naloxone and addiction are required. Pharmacists should offer naloxone via universal opt-out strategies-where all patients meeting evidence-based criteria are offered naloxone-rather than targeted or opt-in strategies-where only patients perceived as high risk or patients who request it are offered naloxone.

PMID:
 
28214219
 
DOI:
 
10.1016/j.japh.2017.01.013

[Indexed for MEDLINE]

Participatory design of ehealth solutions for women from vulnerable populations with perinatal depression. - PubMed - NCBI

Participatory design of ehealth solutions for women from vulnerable populations with perinatal depression. - PubMed - NCBI



 2016 Jan;23(1):105-9. doi: 10.1093/jamia/ocv109. Epub 2015 Sep 5.

Participatory design of ehealth solutions for women from vulnerable populations with perinatal depression.

Abstract

OBJECTIVE:

Cultural and health service obstacles affect the quality of pregnancy care that women from vulnerable populations receive. Using a participatory design approach, the Stress in Pregnancy: Improving Results with Interactive Technology group developed specifications for a suite of eHealth applications to improve the quality of perinatal mental health care.

MATERIALS AND METHODS:

We established a longitudinal participatory design group consisting of low-income women with a history of antenatal depression, their prenatal providers, mental health specialists, an app developer, and researchers. The group met 20 times over 24 months. Applications were designed using rapid prototyping. Meetings were documented using field notes.

RESULTS AND DISCUSSION:

The group achieved high levels of continuity and engagement. Three apps were developed by the group: an app to support high-risk women after discharge from hospital, a screening tool for depression, and a patient decision aid for supporting treatment choice.

CONCLUSION:

Longitudinal participatory design groups are a promising, highly feasible approach to developing technology for underserved populations.

KEYWORDS:

depression; low socioeconomic status; participatory design; patient decision aid; pregnancy

PMID:
 
26342219
 
DOI:
 
10.1093/jamia/ocv109

[Indexed for MEDLINE]

Detecting naloxone prejudices in the pharmacy setting. - PubMed - NCBI

Detecting naloxone prejudices in the pharmacy setting. - PubMed - NCBI



 2017 Mar - Apr;57(2S):S10-S11. doi: 10.1016/j.japh.2016.12.068. Epub 2017 Jan 31.

Detecting naloxone prejudices in the pharmacy setting.


PMID:
 
28159504
 
DOI:
 
10.1016/j.japh.2016.12.068

Chiari malformation Type I surgery in pediatric patients. Part 2: complications and the influence of comorbid disease in California, Florida, and N... - PubMed - NCBI

Chiari malformation Type I surgery in pediatric patients. Part 2: complications and the influence of comorbid disease in California, Florida, and N... - PubMed - NCBI



 2016 May;17(5):525-32. doi: 10.3171/2015.10.PEDS15369. Epub 2016 Jan 22.

Chiari malformation Type I surgery in pediatric patients. Part 2: complications and the influence of comorbid disease in California, Florida, and New York.

Abstract

OBJECTIVE Chiari malformation Type I (CM-I) is a common and often debilitating pediatric neurological disease. However, efforts to guide preoperative counseling and improve outcomes research are impeded by reliance on small, single-center studies. Consequently, the objective of this study was to investigate CM-I surgical outcomes using population-level administrative billing data. METHODS The authors used Healthcare Cost and Utilization Project State Inpatient Databases (SID) to study pediatric patients undergoing surgical decompression for CM-I from 2004 to 2010 in California, Florida, and New York. They assessed the prevalence and influence of preoperative complex chronic conditions (CCC) among included patients. Outcomes included medical and surgical complications within 90 days of treatment. Multivariate logistic regression was used to identify risk factors for surgical complications. RESULTS A total of 936 pediatric CM-I surgeries were identified for the study period. Overall, 29.2% of patients were diagnosed with syringomyelia and 13.7% were diagnosed with scoliosis. Aside from syringomyelia and scoliosis, 30.3% of patients had at least 1 CCC, most commonly neuromuscular (15.2%) or congenital or genetic (8.4%) disease. Medical complications were uncommon, occurring in 2.6% of patients. By comparison, surgical complications were diagnosed in 12.7% of patients and typically included shunt-related complications (4.0%), meningitis (3.7%), and other neurosurgery-specific complications (7.4%). Major complications (e.g., stroke or myocardial infarction) occurred in 1.4% of patients. Among children with CCCs, only comorbid hydrocephalus was associated with a significantly increased risk of surgical complications (OR 4.5, 95% CI 2.5-8.1). CONCLUSIONS Approximately 1 in 8 pediatric CM-I patients experienced a surgical complication, whereas medical complications were rare. Although CCCs were common in pediatric CM-I patients, only hydrocephalus was independently associated with increased risk of surgical events. These results may inform patient counseling and guide future research efforts.

KEYWORDS:

CCC = complex chronic condition; CM-I = Chiari malformation Type I; CM-II = Chiari malformation Type II; Chiari malformation Type I; HCUP = Healthcare Cost and Utilization Project; ICD-9-CM = International Classification of Diseases, Ninth Revision, Clinical Modification; SID = State Inpatient Databases; health services research; neurosurgery; postoperative complications

PMID:
 
26799408
 
PMCID:
 
PMC4876706
 
DOI:
 
10.3171/2015.10.PEDS15369

[Indexed for MEDLINE] 
Free PMC Article

Periodic Screening Pelvic Examination: Evidence Report and Systematic Review for the US Preventive Services Task Force. - PubMed - NCBI

Periodic Screening Pelvic Examination: Evidence Report and Systematic Review for the US Preventive Services Task Force. - PubMed - NCBI



 2017 Mar 7;317(9):954-966. doi: 10.1001/jama.2016.12819.

Periodic Screening Pelvic Examination: Evidence Report and Systematic Review for the US Preventive Services Task Force.

Abstract

IMPORTANCE:

Recent changes in the periodicity of cervical cancer screening have led to questions about the role of screening pelvic examinations among asymptomatic women.

OBJECTIVE:

To systematically review literature on health benefits, accuracy, and harms of the screening pelvic examination for gynecologic conditions for the US Preventive Services Task Force (USPSTF).

DATA SOURCES:

MEDLINE, PubMed, and Cochrane Central Register of Controlled Trials for relevant English-language studies published through January 13, 2016, with surveillance through August 3, 2016.

STUDY SELECTION:

Two reviewers independently screened abstracts and studies. The search yielded 8678 unique citations; 316 full-text articles were reviewed, and 9 studies including 27 630 patients met inclusion criteria.

DATA EXTRACTION AND SYNTHESIS:

Two reviewers rated study quality using USPSTF criteria.

MAIN OUTCOMES AND MEASURES:

Morbidity; mortality; diagnostic accuracy for any gynecologic cancer or condition except cervical cancer, gonorrhea, and chlamydia, which are covered by other USPSTF screening recommendations; harms (false-positive rates, false-negative rates, surgery rates).

RESULTS:

No trials examined the effectiveness of the pelvic examination in reducing all-cause mortality, reducing cancer- and disease-specific morbidity and mortality, or improving quality of life. Eight studies reported accuracy for the screening pelvic examination: ovarian cancer (4 studies; n = 26 432), bacterial vaginosis (2 studies; n = 930), trichomoniasis (1 study; n = 779), and genital herpes (1 study; n = 779). In the 4 ovarian cancer screening studies, low prevalence of ovarian cancer consistently resulted in low positive predictive values (PPVs) and false-positive rates, with a lack of precision in accuracy estimates (sensitivity range, 0%-100%; specificity range, 91%-99%; PPV range, 0%-3.6%; negative predictive value [NPV] range, ≥99%). Each diagnostic accuracy study for bacterial vaginosis, trichomoniasis, and genital herpes was performed in a high-prevalence population with substantial proportions of symptomatic patients and reported accuracy characteristics for individual physical examination findings (bacterial vaginosis, homogeneous discharge: sensitivity range, 69%-79%; specificity range, 54%-97%; PPV range, 52%-95%; NPV range, 79%-80%; herpes simplex virus, vulvar ulcerations: sensitivity, 20%; specificity, 98%; PPV, 88%; NPV, 57%; trichomoniasis, colpitis macularis: sensitivity, 2%; specificity, 100%; PPV, 100%; NPV, 85%). Surgery rates resulting from an abnormal screening pelvic examination for ovarian cancer ranged from 5% to 36% at 1 year, with the largest study reporting an 11% surgery rate and 1% complication rate within 1 year of a screening pelvic examination with abnormal findings.

CONCLUSIONS AND RELEVANCE:

No direct evidence was identified for overall benefits and harms of the pelvic examination as a 1-time or periodic screening test. Limited evidence was identified regarding the diagnostic accuracy and harms of routine screening pelvic examinations in asymptomatic primary care populations.

PMID:
 
28267861
 
DOI:
 
10.1001/jama.2016.12819

[Indexed for MEDLINE]