Other search tools

About this data

The publication data currently available has been vetted by Vanderbilt faculty, staff, administrators and trainees. The data itself is retrieved directly from NCBI's PubMed and is automatically updated on a weekly basis to ensure accuracy and completeness.

If you have any questions or comments, please contact us.

Results: 1 to 10 of 17

Publication Record

Connections

Racial/Ethnic Disparities in Diabetes Quality of Care: the Role of Healthcare Access and Socioeconomic Status.
Canedo JR, Miller ST, Schlundt D, Fadden MK, Sanderson M
(2018) J Racial Ethn Health Disparities 5: 7-14
MeSH Terms: Adolescent, Adult, African Americans, Asian Continental Ancestry Group, Cross-Sectional Studies, Diabetes Mellitus, Type 2, Female, Health Services Accessibility, Healthcare Disparities, Hispanic Americans, Humans, Male, Middle Aged, Quality Indicators, Health Care, Social Class, United States
Show Abstract · Added August 22, 2017
INTRODUCTION - Blacks, Hispanics, and Asians are disproportionately affected by diabetes. We assessed the state of racial/ethnic disparities in diabetes quality of care in the USA.
METHODS - We analyzed cross-sectional data of adults diagnosed with Type 2 diabetes in the nationally representative 2013 Medical Expenditure Panel Survey. Differences in adherence to five diabetes quality of care recommendations (HbA1c twice yearly, yearly foot exam, dilated eye exam, blood cholesterol test, and flu vaccination) were examined by race/ethnicity while controlling for three social determinants of health (health insurance status, poverty, and education) and other demographic variables.
RESULTS - Among adults with diabetes in the USA, 74.9% received two or more HbA1c tests, 69.0% had a foot exam, 64.9% had an eye exam, 85.4% had a cholesterol test, and 65.1% received flu vaccination in 2013. Compared to Whites, all were lower for Hispanics; HbA1c tests, eye exam, and flu vaccination were lower for Blacks; HbA1c tests, foot exam, and eye exam were lower for Asians. In adjusted models, the only remaining disparities in quality of care indicators were HbA1c tests for Hispanics (AOR 0.67, CI = 0.47-0.97), Blacks (AOR 0.59, CI = 0.40-0.88), and Asians (AOR 0.47, CI = 0.42-0.99); foot exams for Hispanics (AOR 0.65, CI = 0.47-0.90); and flu vaccination for Blacks (AOR 0.68, CI = 0.49-0.93).
CONCLUSION - Lack of insurance coverage and education explained some of the racial/ethnic disparities observed in diabetes quality of care. Improving quality of diabetes care could help reduce rates of diabetes complications, healthcare costs, and mortality.
0 Communities
1 Members
0 Resources
16 MeSH Terms
Improving the quality of cancer staging.
Asare EA, Washington MK, Gress DM, Gershenwald JE, Greene FL
(2015) CA Cancer J Clin 65: 261-3
MeSH Terms: Guideline Adherence, Humans, Neoplasm Staging, Practice Guidelines as Topic, Quality Assurance, Health Care, Quality Indicators, Health Care, Registries, United States
Added April 12, 2016
0 Communities
1 Members
0 Resources
8 MeSH Terms
Hospitals' adoption of targeted cognitive and functional status quality indicators for vulnerable elders.
Maxwell CA, Mion LC, Dietrich MS, Fallon WF, Minnick A
(2014) J Nurs Care Qual 29: 354-62
MeSH Terms: Aged, Cognition Disorders, Geriatric Assessment, Health Care Surveys, Hospitals, Humans, Quality Indicators, Health Care, United States, Vulnerable Populations
Show Abstract · Added January 20, 2015
Cognitive and functional impairments are leading predictors of poor outcomes in hospitalized older adults. This study reports adoption rates of 9 Assessing Care of Vulnerable Elders quality indicators in a sample of US hospitals (N = 128). Chief nursing officers were surveyed using a 6-point scale (no activity to full implementation) for each Assessing Care of Vulnerable Elders quality indicator. Adoption rates were low, highlighting the need for greater efforts to heighten awareness among senior executives and nursing leaders.
0 Communities
1 Members
0 Resources
9 MeSH Terms
Using present-on-admission coding to improve exclusion rules for quality metrics: the case of failure-to-rescue.
Needleman J, Buerhaus PI, Vanderboom C, Harris M
(2013) Med Care 51: 722-30
MeSH Terms: Hospital Bed Capacity, Hospital Mortality, Humans, Insurance Claim Review, International Classification of Diseases, Nursing Staff, Hospital, Patient Admission, Quality Indicators, Health Care, Quality of Health Care, Risk Adjustment, United States, United States Agency for Healthcare Research and Quality
Show Abstract · Added March 7, 2014
BACKGROUND - The Agency for Healthcare Research and Quality (AHRQ) patient safety indicator "death among surgical inpatients with serious treatable complications" (failure-to-rescue) uses rules to exclude complications presumed to be present-on-admission (POA). Like other administrative data-based quality measures, exclusion rules were developed with limited information on whether complications were POA. We examine whether the accuracy of failure-to-rescue exclusion rules can be improved with data with good POA indicators.
METHODS - POA-coded data from 243,825 discharges from a large academic medical center were used to develop 3 failure-to-rescue exclusion rules. Data from 82,871 discharges from California hospitals screened for good POA coding practices was used as a validation sample. The AHRQ failure-to-rescue measure and 3 new measures based on alternative exclusion rules were compared on sensitivity, specificity, and C-statistics for prediction of POA status. Using data from the AHRQ HCUP National Inpatient Sample, the alternative specifications were tested for sensitivity to nurse staffing.
RESULTS - The AHRQ exclusion rules had sensitivity of 18.5%, specificity 92.1%, and a C-statistic of 0.553. All POA-informed specifications of exclusion rules improved the C-statistic of the failure-to-rescue measure and its sensitivity, with modest losses of specificity. For all tested specifications, higher licensed hours and proportions of registered nurse were statistically significant and associated with lower risk of death.
CONCLUSIONS - Failure-to-rescue is a robust quality measure, sensitive to nursing across alternative exclusion rule specifications. Despite expanded POA coding, exclusion-based rules are needed to analyze datasets not coded for POA, legacy datasets, and datasets with poor POA coding. POA-informed construction of exclusions significantly improves rules identifying POA complications.
0 Communities
1 Members
0 Resources
12 MeSH Terms
Critical and honest conversations: the evidence behind the "Choosing Wisely" campaign recommendations by the American Society of Nephrology.
Williams AW, Dwyer AC, Eddy AA, Fink JC, Jaber BL, Linas SL, Michael B, O'Hare AM, Schaefer HM, Shaffer RN, Trachtman H, Weiner DE, Falk AR, American Society of Nephrology Quality, and Patient Safety Task Force
(2012) Clin J Am Soc Nephrol 7: 1664-72
MeSH Terms: Anti-Inflammatory Agents, Non-Steroidal, Catheterization, Central Venous, Cost Savings, Cost-Benefit Analysis, Evidence-Based Medicine, Guideline Adherence, Health Care Costs, Health Promotion, Health Services Misuse, Hematinics, Humans, Mass Screening, Nephrology, Patient Safety, Physician-Patient Relations, Practice Guidelines as Topic, Professional-Family Relations, Program Development, Quality Indicators, Health Care, Renal Dialysis, Renal Insufficiency, Chronic, Societies, Medical, United States
Show Abstract · Added February 25, 2014
Estimates suggest that one third of United States health care spending results from overuse or misuse of tests, procedures, and therapies. The American Board of Internal Medicine Foundation, in partnership with Consumer Reports, initiated the "Choosing Wisely" campaign to identify areas in patient care and resource use most open to improvement. Nine subspecialty organizations joined the campaign; each organization identified five tests, procedures, or therapies that are overused, are misused, or could potentially lead to harm or unnecessary health care spending. Each of the American Society of Nephrology's (ASN's) 10 advisory groups submitted recommendations for inclusion. The ASN Quality and Patient Safety Task Force selected five recommendations based on relevance and importance to individuals with kidney disease.Recommendations selected were: (1) Do not perform routine cancer screening for dialysis patients with limited life expectancies without signs or symptoms; (2) do not administer erythropoiesis-stimulating agents to CKD patients with hemoglobin levels ≥10 g/dl without symptoms of anemia; (3) avoid nonsteroidal anti-inflammatory drugs in individuals with hypertension, heart failure, or CKD of all causes, including diabetes; (4) do not place peripherally inserted central catheters in stage 3-5 CKD patients without consulting nephrology; (5) do not initiate chronic dialysis without ensuring a shared decision-making process between patients, their families, and their physicians.These five recommendations and supporting evidence give providers information to facilitate prudent care decisions and empower patients to actively participate in critical, honest conversations about their care, potentially reducing unnecessary health care spending and preventing harm.
0 Communities
1 Members
0 Resources
23 MeSH Terms
Dialysis at a crossroads--Part II: A call for action.
Parker TF, Straube BM, Nissenson A, Hakim RM, Steinman TI, Glassock RJ
(2012) Clin J Am Soc Nephrol 7: 1026-32
MeSH Terms: Evidence-Based Medicine, Government Regulation, Guideline Adherence, Health Policy, Hospitalization, Humans, Kidney Failure, Chronic, Outcome and Process Assessment, Health Care, Patient Care Team, Practice Guidelines as Topic, Program Development, Quality Improvement, Quality Indicators, Health Care, Quality of Life, Renal Dialysis, Treatment Outcome, United States
Show Abstract · Added May 20, 2014
A previous commentary pointed out that the renal community has led American healthcare in the development and continuous improvement of quality outcomes. However, survival, hospitalization, and quality of life for US dialysis patients is still not optimal. This follow-up commentary examines the obstacles, gaps, and metrics that characterize this unfortunate state of affairs. It posits that current paradigms are essential contributors to quality outcomes but are no longer sufficient to improve quality. New strategies are needed that arise from a preponderance of evidence, in addition to beyond a reasonable doubt standard. This work offers an action plan that consists of new pathways of care that will lead to improved survival, fewer hospitalizations and rehospitalizations, and better quality of life for patients undergoing dialysis therapy. Nephrologists in collaboration with large and small dialysis organizations and other stakeholders, including the Centers for Medicare and Medicaid Services, can implement these proposed new pathways of care and closely monitor their effectiveness. We suggest that our patients deserve nothing less and must receive even more.
0 Communities
1 Members
0 Resources
17 MeSH Terms
Developing an action plan for patient radiation safety in adult cardiovascular medicine: proceedings from the Duke University Clinical Research Institute/American College of Cardiology Foundation/American Heart Association Think Tank held on February 28, 2011.
Douglas PS, Carr JJ, Cerqueira MD, Cummings JE, Gerber TC, Mukherjee D, Taylor AJ
(2012) J Am Coll Cardiol 59: 1833-47
MeSH Terms: Adult, Cardiology, Cardiovascular Diseases, Education, Humans, Interprofessional Relations, Organizational Culture, Patient Safety, Quality Indicators, Health Care, Radiation Protection, Radiography, Radiometry, Radionuclide Imaging, United States
Show Abstract · Added February 28, 2014
Technological advances and increased utilization of medical testing and procedures have prompted greater attention to ensuring the patient safety of radiation use in the practice of adult cardiovascular medicine. In response, representatives from cardiovascular imaging societies, private payers, government and nongovernmental agencies, industry, medical physicists, and patient representatives met to develop goals and strategies toward this end; this report provides an overview of the discussions. This expert “think tank” reached consensus on several broad directions including: the need for broad collaboration across a large number of diverse stakeholders; clarification of the relationship between medical radiation and stochastic events; required education of ordering and providing physicians, and creation of a culture of safety; development of infrastructure to support robust dose assessment and longitudinal tracking; continued close attention to patient selection by balancing the benefit of cardiovascular testing and procedures against carefully minimized radiation exposures; collation, dissemination, and implementation of best practices; and robust education, not only across the healthcare community, but also to patients, the public, and media. Finally, because patient radiation safety in cardiovascular imaging is complex, any proposed actions need to be carefully vetted (and monitored) for possible unintended consequences.
1 Communities
1 Members
0 Resources
14 MeSH Terms
Developing an action plan for patient radiation safety in adult cardiovascular medicine: proceedings from the Duke University Clinical Research Institute/American College of Cardiology Foundation/American Heart Association think tank held on February 28, 2011.
Douglas PS, Carr JJ, Cerqueira MD, Cummings JE, Gerber TC, Mukherjee D, Taylor AJ
(2012) Circ Cardiovasc Imaging 5: 400-14
MeSH Terms: Adult, Cardiology, Cardiovascular Diseases, Education, Humans, Interprofessional Relations, Organizational Culture, Patient Safety, Quality Indicators, Health Care, Radiation Protection, Radiography, Radiometry, Radionuclide Imaging, United States
Show Abstract · Added February 15, 2014
Technological advances and increased utilization of medical testing and procedures have prompted greater attention to ensuring the patient safety of radiation use in the practice of adult cardiovascular medicine. In response, representatives from cardiovascular imaging societies, private payers, government and nongovernmental agencies, industry, medical physicists, and patient representatives met to develop goals and strategies toward this end; this report provides an overview of the discussions. This expert "think tank" reached consensus on several broad directions including: the need for broad collaboration across a large number of diverse stakeholders; clarification of the relationship between medical radiation and stochastic events; required education of ordering and providing physicians, and creation of a culture of safety; development of infrastructure to support robust dose assessment and longitudinal tracking; continued close attention to patient selection by balancing the benefit of cardiovascular testing and procedures against carefully minimized radiation exposures; collation, dissemination, and implementation of best practices; and robust education, not only across the healthcare community, but also to patients, the public, and media. Finally, because patient radiation safety in cardiovascular imaging is complex, any proposed actions need to be carefully vetted (and monitored) for possible unintended consequences.
0 Communities
1 Members
0 Resources
14 MeSH Terms
Automated identification of postoperative complications within an electronic medical record using natural language processing.
Murff HJ, FitzHenry F, Matheny ME, Gentry N, Kotter KL, Crimin K, Dittus RS, Rosen AK, Elkin PL, Brown SH, Speroff T
(2011) JAMA 306: 848-55
MeSH Terms: Automation, Cross-Sectional Studies, Diagnosis-Related Groups, Electronic Health Records, Hospitalization, Hospitals, Veterans, Humans, Information Storage and Retrieval, Inpatients, International Classification of Diseases, Myocardial Infarction, Natural Language Processing, Patient Discharge, Pneumonia, Population Surveillance, Postoperative Complications, Pulmonary Embolism, Quality Indicators, Health Care, Renal Insufficiency, Safety, Sensitivity and Specificity, Sepsis, Surgical Procedures, Operative, United States, Venous Thrombosis
Show Abstract · Added March 5, 2014
CONTEXT - Currently most automated methods to identify patient safety occurrences rely on administrative data codes; however, free-text searches of electronic medical records could represent an additional surveillance approach.
OBJECTIVE - To evaluate a natural language processing search-approach to identify postoperative surgical complications within a comprehensive electronic medical record.
DESIGN, SETTING, AND PATIENTS - Cross-sectional study involving 2974 patients undergoing inpatient surgical procedures at 6 Veterans Health Administration (VHA) medical centers from 1999 to 2006.
MAIN OUTCOME MEASURES - Postoperative occurrences of acute renal failure requiring dialysis, deep vein thrombosis, pulmonary embolism, sepsis, pneumonia, or myocardial infarction identified through medical record review as part of the VA Surgical Quality Improvement Program. We determined the sensitivity and specificity of the natural language processing approach to identify these complications and compared its performance with patient safety indicators that use discharge coding information.
RESULTS - The proportion of postoperative events for each sample was 2% (39 of 1924) for acute renal failure requiring dialysis, 0.7% (18 of 2327) for pulmonary embolism, 1% (29 of 2327) for deep vein thrombosis, 7% (61 of 866) for sepsis, 16% (222 of 1405) for pneumonia, and 2% (35 of 1822) for myocardial infarction. Natural language processing correctly identified 82% (95% confidence interval [CI], 67%-91%) of acute renal failure cases compared with 38% (95% CI, 25%-54%) for patient safety indicators. Similar results were obtained for venous thromboembolism (59%, 95% CI, 44%-72% vs 46%, 95% CI, 32%-60%), pneumonia (64%, 95% CI, 58%-70% vs 5%, 95% CI, 3%-9%), sepsis (89%, 95% CI, 78%-94% vs 34%, 95% CI, 24%-47%), and postoperative myocardial infarction (91%, 95% CI, 78%-97%) vs 89%, 95% CI, 74%-96%). Both natural language processing and patient safety indicators were highly specific for these diagnoses.
CONCLUSION - Among patients undergoing inpatient surgical procedures at VA medical centers, natural language processing analysis of electronic medical records to identify postoperative complications had higher sensitivity and lower specificity compared with patient safety indicators based on discharge coding.
0 Communities
1 Members
0 Resources
25 MeSH Terms
Outcomes associated with in-center nocturnal hemodialysis from a large multicenter program.
Lacson E, Wang W, Lester K, Ofsthun N, Lazarus JM, Hakim RM
(2010) Clin J Am Soc Nephrol 5: 220-6
MeSH Terms: Adult, Aged, Case-Control Studies, Chi-Square Distribution, Cross-Sectional Studies, Female, Hospitalization, Humans, Kaplan-Meier Estimate, Kidney Diseases, Logistic Models, Male, Middle Aged, North America, Outcome and Process Assessment, Health Care, Program Evaluation, Proportional Hazards Models, Quality Indicators, Health Care, Renal Dialysis, Risk Assessment, Risk Factors, Time Factors, Treatment Outcome
Show Abstract · Added May 20, 2014
BACKGROUND AND OBJECTIVES - The objective of this study was to evaluate epidemiology and outcomes of a large in-center nocturnal hemodialysis (INHD) program.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS - This case-control study compared patients who were on thrice-weekly INHD from 56 Fresenius Medical Care, North America facilities with conventional hemodialysis patients from 244 facilities within the surrounding geographic area. All INHD cases and conventional hemodialysis control subjects who were active as of January 1, 2007, were followed until December 31, 2007, for evaluation of mortality and hospitalization.
RESULTS - As of January 1, 2007, 655 patients had been on INHD for 51 +/- 73 d. Patients were younger, there were more male and black patients, and vintage was longer, but they had less diabetes compared with 15,334 control subjects. Unadjusted hazard ratio was 0.59 for mortality and 0.76 for hospitalization. After adjustment for case mix and access type, only hospitalization remained significant. Fewer INHD patients were hospitalized (48 versus 59%) with a normalized rate of 9.6 versus 13.5 hospital days per patient-year. INHD patients had greater interdialytic weight gains but lower BP. At baseline, hemoglobin values were similar, whereas albumin and phosphorus values favored INHD. Mean equilibrated Kt/V was higher in INHD patients related to longer treatment time, despite lower blood and dialysate flow rates.
CONCLUSIONS - Patients who were on INHD exhibited excellent quality indicators, with better survival and lower hospitalization rates. The relative contributions of patient selection versus effect of therapy on outcomes remain to be elucidated in prospective clinical trials.
0 Communities
1 Members
0 Resources
23 MeSH Terms