Articles: outcome-assessment-health-care.
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American heart journal · Sep 2011
Randomized Controlled Trial Multicenter Study Comparative StudyMode of hospital presentation in patients with non-ST-elevation myocardial infarction: implications for strategic management.
Contemporary non-ST-elevation myocardial infarction-acute coronary syndrome guidelines emphasize early-risk stratification and optimizing therapy including an invasive strategy in high-risk patients. To assess the feasibility of initiating this strategy in the prehospital environment, we examined how such patients are transported to hospital, their risk profile, and the proportion potentially eligible for such a strategy. ⋯ Regional strategies using risk-based triage, early medical therapy, and timely triage to percutaneous coronary intervention centers represents an unrealized opportunity to enhance ST-segment elevation myocardial infarction care.
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Multicenter Study
Expected spinal cord independence measure, third version, scores for various neurological levels after complete spinal cord lesions.
Multicenter international cohort study. ⋯ Calculated discharge SCIM III scores can be used as target values for functional achievements at various neurological levels in patients after AIS A SCL. They are generally, but not always, inversely correlated with SCL level.
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Qual Manag Health Care · Jul 2011
Multicenter StudyThe best period for mortality rates associated with hospital stay: hospital mortality performs well for nonsurgical diagnostic groups.
Mortality is widely used to assess quality of hospital care. Inpatient mortality is easily available in administrative data. The use of periods other than length of stay is questionable. We compared different overlapping and disjunctive periods for the calculation of mortality associated with hospital care. ⋯ For nonsurgical tracers, hospital stay is the best period to assess mortality associated with hospital stay. The courses (sequences of 4 mortality rates for one tracer in a hospital) for surgical tracers, in particular colorectal carcinoma, appear as a harvesting effect with an association of high in-hospital mortality with low mortality in the medium term.
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Multicenter Study Comparative Study
Comparing the responsiveness of functional outcome assessment measures for trauma registries.
Measuring long-term disability and functional outcomes after major trauma is not standardized across trauma registries. An ideal measure would be responsive to change but not have significant ceiling effects. The aim of this study was to compare the responsiveness of the Glasgow Outcome Scale (GOS), GOS-Extended (GOSE), Functional Independence Measure (FIM), and modified FIM in major trauma patients, with and without significant head injuries. ⋯ The GOSE was the instrument with greatest responsiveness and the lowest ceiling effect in a major trauma population with and without significant head injuries and is recommended for use by trauma registries for monitoring functional outcomes and benchmarking care. The results of this study do not support the use of the modified FIM for this purpose.
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Multicenter Study Comparative Study
Care models and associated outcomes in congenital heart surgery.
Recently, there has been a shift toward care of children undergoing heart surgery in dedicated pediatric cardiac intensive care units (CICU). The impact of this trend on patient outcomes is unclear. We evaluated postoperative outcomes associated with a CICU versus other ICU models. ⋯ We were not able to detect a difference in postoperative morbidity or mortality associated with the presence of a dedicated CICU for children undergoing heart surgery. There may be a survival benefit in certain subgroups .