Articles: outcome-assessment-health-care.
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Multicenter Study
The Leapfrog volume criteria may fall short in identifying high-quality surgical centers.
The original Leapfrog Initiative recommends selective referral based on procedural volume thresholds (500 coronary artery bypass graft [CABG] surgeries, 30 abdominal aortic aneurysm [AAA] repairs, 100 carotid endarterectomies [CEA], and 7 esophagectomies annually). We tested the volume-mortality relationship for these procedures in the University HealthSystem Consortium (UHC) Clinical DatabaseSM, a database of all payor discharge abstracts from UHC academic medical center members and affiliates. We determined whether the Leapfrog thresholds represent the optimal cutoffs to discriminate between high- and low-mortality hospitals. ⋯ In this group of academic medical centers and their affiliated hospitals, we demonstrated a significant relationship between volume and mortality for CABG and AAA but not for CEA and esophagectomy, based on the Leapfrog thresholds. We described a new methodology to identify optimal data-based volume thresholds that may serve as a more rational basis for selective referral.
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Outcomes management · Oct 2003
Multicenter StudyExploring outcomes after critical illness in the elderly.
Outcomes for elderly patients after critical illness have been examined predominantly in terms of survival and selected aspects of functional status. The objectives of this study were to explore and compare the impact of intensive care unit treatment on health and functional status outcomes among 196 elderly and middle-age patients. ⋯ Severity of illness, not age, was the best predictor of physical functioning. Despite having more documented discharge planning, elderly patients reported concern about managing their care at home and knowing less about their medications, which have direct implications for care.
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J Pain Symptom Manage · Aug 2003
Randomized Controlled Trial Multicenter Study Clinical TrialThe efficacy of acupressure and acustimulation wrist bands for the relief of chemotherapy-induced nausea and vomiting. A University of Rochester Cancer Center Community Clinical Oncology Program multicenter study.
As an adjunct to standard antiemetics for the relief of chemotherapy-induced nausea and vomiting (NV), 739 patients were randomly assigned to either: 1) acupressure bands, 2) an acustimulation band, or 3) a no band control condition. Patients in the acupressure condition experienced less nausea on the day of treatment compared to controls (P<0.05). There were no significant differences in delayed nausea or vomiting among the three treatment conditions. ⋯ Men in the acustimulation condition, but not the acupressure condition, had less NV compared to controls (P<0.05). No significant differences among the three treatment conditions were observed in women, although the reduction in nausea on the day of treatment in the acupressure, compared to the no band condition, closely approached statistical significance (P=0.052). Expected efficacy of the bands was related to outcomes for the acupressure but not the acustimulation conditions.
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Critical care medicine · Aug 2003
Multicenter Study Clinical Trial Controlled Clinical TrialResults of a clinical trial on care improvement for the critically ill.
To develop, deploy, and evaluate an intervention designed to identify and mitigate conflict in decision making in the intensive care unit. ⋯ Although there was no impact on patient or surrogate satisfaction with care provided in the intensive care unit, the intervention did facilitate deliberative decision making in cases deemed at high risk for conflict. The lessons learned from the experience with this intervention should be helpful in ongoing efforts to improve care and to achieve outcomes desired by critically ill patients, their families, and critical care clinicians.
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Multicenter Study
Incidence and risk factors for ventilator-associated pneumonia in 4 multidisciplinary intensive care units in Athens, Greece.
Ventilator-associated pneumonia (VAP) is the most common nosocomial infection among intensive care unit (ICU) patients. ⋯ VAP is a common infection and certain interventions might affect the incidence of VAP. ICU clinicians should be aware of the risk factors for VAP, which could prove useful in identifying patients at high risk for VAP and modifying patient care to minimize the risk of VAP, such as avoiding unnecessary bronchoscopy or modulating enteral feeding.