Articles: outcome-assessment-health-care.
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Multicenter Study Comparative Study
Image-guided resection of high-grade glioma: patient selection factors and outcome.
In patients with glioma, image-guided surgery helps to define the radiographic limits of the tumor to maximize safety and the extent of resection while minimizing damage to eloquent brain tissue. The authors hypothesize that image-guided resection (IGR) techniques are associated with improved outcomes in patients with malignant glioma. ⋯ Selection bias occurs regarding patients who receive IGR; these biases include younger age, presentation with seizure and normal level of consciousness, tumor diameter less than 4 cm, and non-GBM on histopathological studies. Outcome appears to be improved in patients who undergo IGRs of high-grade gliomas. It is unclear if these improved outcomes are due to the selection of a more favorable patient population or to the IGR techniques themselves. It is likely that the full potential of image guidance in glioma surgery will not be realized until it is applied to a wider range of patients.
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Pediatr Crit Care Me · Jan 2006
Multicenter StudyVariation in pediatric intensive care therapies and outcomes by race, gender, and insurance status.
The differential allocation of medical resources to adult patients according to characteristics such as race, gender, and insurance status raises the serious concern that such issues apply to critically ill children as well. ⋯ Risk-adjusted mortality and resource use for critically ill children did not differ according to race, gender, or insurance status. Policies to expand health insurance to children appear more likely to affect physiologic derangement on admission rather than technical quality of care in the pediatric intensive care unit setting.
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Multicenter Study
Lowest hematocrit on cardiopulmonary bypass impairs the outcome in coronary surgery: An Italian Multicenter Study from the National Cardioanesthesia Database.
Severe hemodilutional anemia on cardiopulmonary bypass increases morbidity and mortality after coronary surgery. The present study focuses on the lowest hematocrit values during extracorporeal circulation and on allogenic blood transfusions as mortality and morbidity risk factors. The records of 1,766 consecutive adult patients undergoing isolated coronary artery bypass graft surgery at 3 institutions have been analyzed retrospectively for in-hospital mortality and adverse outcomes. ⋯ The risk of renal failure doubled when the nadir-on-cardiopulmonary-bypass hematocrit occurred in transfused patients. Anemia upon cardiopulmonary bypass was not associated with death. Our findings confirm that both severe anemia and blood transfusions were significantly associated with renal failure and low-output syndrome.
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Health services research · Dec 2005
Randomized Controlled Trial Multicenter StudyPractice-level effects of interventions to improve asthma care in primary care settings: the Pediatric Asthma Care Patient Outcomes Research Team.
To assess the practice-level effects of (1) a physician peer leader intervention and (2) peer leaders in combination with the introduction of asthma education nurses to facilitate care improvement. And, to compare findings with previously reported patient-level outcomes of trial enrollees. ⋯ This analysis showed a slight increase in ambulatory asthma visits as a result of asthma care improvement interventions, using automated data. The absence of detectable impact on medication use at the practice level differs from the positive intervention effect observed in patient self-reported data from trial enrollees. Analysis of automated data on nonenrollees adds information about practice-level impact of care improvement strategies. Benefits of practice-level interventions may accrue disproportionately to the subgroup of trial enrollees. The effect of such interventions may be less apparent at the level of practices or health plans.
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Multicenter Study Comparative Study
Surgical resident supervision in the operating room and outcomes of care in Veterans Affairs hospitals.
There has been concern that a reduced level of surgical resident supervision in the operating room (OR) is correlated with worse patient outcomes. Until September 2004, Veterans' Affairs (VA) hospitals entered in the surgical record level 3 supervision on every surgical case when the attending physician was available but not physically present in the OR or the OR suite. In this study, we assessed the impact of level 3 on risk-adjusted morbidity and mortality in the VA system. ⋯ Between 1998 and 2004, the level of resident supervision in the OR did not affect clinical outcomes adversely for surgical patients in the VA teaching hospitals.