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Vasilevskis E.E.,Center for Health Services Research | Vasilevskis E.E.,Geriatric Research | Girard T.D.,Center for Health Services Research | Girard T.D.,Geriatric Research | And 2 more authors.
Critical Care Medicine | Year: 2010

We face a profound and emerging public health problem in the form of acute and chronic brain dysfunction. This affects both young and elderly intensive care unit survivors and is altering the landscape of society. Two-thirds of intensive care unit patients develop delirium, and this is associated with longer stays, increased costs, and excess mortality. In addition, over half of intensive care unit survivors suffer a dementia-like illness that impacts their physical and cognitive functional abilities and which appears to be related to the duration of their intensive care unit delirium. A new paradigm of how intensivists handle the brain is required. We propose a three-step approach to address this emerging epidemic, which includes Screening, Prevention, and Restoration of brain function (SPR). Screening combines risk factor identification and delirium assessment using validated instruments. Prevention of acute and chronic brain dysfunction requires implementation of a core model of care that combines evidence-based practices: awakening and breathing, coordination with target-based sedation, delirium monitoring, and exercise/early mobility (ABCDE). Restoration introduces strategies of ongoing screening and treatment for intensive care unit survivors at high risk of ongoing brain dysfunction. This practical system applying many evidence-based concepts incorporates personalized medicine, systems-based practice, and continuing research and development toward improving acute and chronic cognitive outcomes. Copyright © 2010 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins.


Du X.L.,Center for Health Services Research
Journal of Health Care for the Poor and Underserved | Year: 2010

To determine whether racial disparities persist in Medicare-insured elderly patients with head and neck cancer, we studied 7,480 patients diagnosed with head and neck cancer at age 65 or older in 1991-2002, identifed from tumor registries maintained by the 16 areas participating in the Surveillance, Epidemiology and End Results program. Patients receiving cancer-directed surgery had signifcantly lower risks of both all-cause and diseasespecifc mortality than others; those with lower socioeconomic status were more likely to die of all causes than patients with higher socioeconomic status. African Americans had a marginally higher risk of all-cause mortality (hazard ratio = 1.19, 95% CI: 1.07-1.33), but had no signifcantly different risk of disease-specifc mortality compared with Whites (1.09, 0.91-1.30). In conclusion, the risk of mortality was not signifcantly different among African Americans and Hispanics compared with Whites in specifc tumor sites of head and neck cancer except a marginally elevated risk of all-cause mortality in African Americans with oral cavity tumor.


News Article | November 23, 2016
Site: www.eurekalert.org

INDIANAPOLIS -- Peter J. Embi, MD, MS, who joins the Regenstrief Institute as president and CEO on December 15, has been selected as the chair-elect of the board of directors of the American Medical Informatics Association, the largest international professional biomedical and health informatics association. The four-year term includes a one-year term as chair-elect, two years as the chair of the association's 21-person board of directors, and a final year as chair-emeritus. Dr. Embi is an internationally respected expert in biomedical informatics -- the application of computer and information sciences to health care and biomedical research. He has been a member of the American Medical Informatics Association since October 2000, and a board member since January 2015. In 2012 he was also inducted as a fellow of the American College of Medical Informatics, joining a select elected group of individuals who have made significant and sustained contributions to the field of biomedical informatics. "This is a critical time for health care in our country and for informatics in particular," Dr. Embi said. "As informaticians we are working to improve health care through the optimal use of information and information technology. "That couldn't be more important than it is today. We need to improve quality of care for individuals, accelerate biomedical discoveries, and keep our populations healthier. By leveraging health IT and health care data, we can better prevent, diagnose and treat disease -- with more precision and at lower cost to society - and learn from every patient to improve care well into the future. Informatics professionals are key to achieving this vision for a learning health care system." Dr. Embi notes that as a professional society, the American Medical Informatics Association is uniquely positioned to draw upon the expertise of its varied informatician membership -- physicians, nurses, pharmacists, computer scientists, technologists, physicists, biologists and others -- to determine how to optimize the use of health information technology and biomedical computing to improve health and the delivery of care. This fall he chaired the association's 2016 Annual Health Policy Invitational Meeting on health information policy. He anticipates that he, like past AMIA board chairs, will represent the association in many settings, including on Capitol Hill, and across a range of issues including electronic medical record systems, health information exchange, patient participation in their care, and accelerating biomedical research and innovation. Dr. Embi joins the Regenstrief Institute following six years at the Ohio State University, most recently as associate dean for research informatics at Ohio State's medical school. Regenstrief is recognized for pioneering work in the fields of medical informatics, aging, and health services research and for the practical application of this research to global needs -- present and future. The institute is composed of three research centers -- the William M. Tierney Center for Health Services Research, the Indiana University Center for Aging Research and the Clem McDonald Center for Biomedical Informatics. The institute's new Industry Research Office facilitates and supports industry-funded research partnerships leveraging Regenstrief's extensive resources. The institute's focal areas currently include applied health information technology, patient outcomes and safety, population and public health, precision medicine, global health informatics, brain health, health data standards, healthcare data analytics, patient outcomes, implementation science, drug safety, decision making, symptom management, nursing home care, physical fitness and health communication. Regenstrief's faculty and affiliated scientists include representatives of numerous disciplines including medical informatics, geriatrics, general internal medicine, pediatrics, family medicine, public health, emergency medicine, gastroenterology, psychiatry, neurology, sociology, global health, palliative care, communications and a variety of engineering disciplines including software and human factors engineering. In addition to his leadership position at the Regenstrief Institute, commencing next month Dr. Embi will serve as Sam Regenstrief Professor of Informatics and Health Services and as associate dean for informatics and health services research at Indiana University School of Medicine, associate director for informatics at the Indiana Clinical and Translational Sciences Institute and vice president for learning health systems at Indiana University Health.


Griffith M.L.,Vanderbilt University | Griffith M.L.,University of Pittsburgh | Boord J.B.,Center for Health Services Research | Boord J.B.,Vanderbilt Heart and Vascular Institute | And 3 more authors.
Journal of Clinical Endocrinology and Metabolism | Year: 2012

Objective: We examined the effect of hospital admissions on the medical treatment of poorly controlled diabetes mellitus among Veterans Affairs (VA) patients. Research Design and Methods: This retrospective cohort study included male patients admitted to one of three VA hospitals from July 1, 2002, to August 31, 2009, who were receiving medication therapy for diabetes with hemoglobin A1c (HgbA1c) greater than 8.0%. The primary outcome was a change in preadmission and outpatient prescriptions for diabetes at hospital discharge. Covariates for multivariable logistic regression analysis of the primary outcome were defined a priori and retrieved from the electronic health record. Results: Of 2025 admissions for 1359 patients, 454 had some change in diabetes medications at discharge (rate of change 22.4%). In an adjusted analysis, higher preadmission HgbA1c [odds ratio (OR) 1.12 per 1.0 U increase; 95% confidence interval (CI) 1.12-1.05; P < 0.001], higher mean blood glucose during admission (OR 1.07 per 10 mg/dl increase;95%CI 1.05-1.10; P < 0.0001), occurrence of inpatient hypoglycemia (blood glucose < 50 mg/dl; OR 1.82, 95% CI 1.32-2.51, P < 0.001), and inpatient basal insulin therapy (OR 1.71; 95% CI 1.25-2.35; P < 0.001) were associated with higher odds of change in therapy. A total of 656 admissions (32%) demonstrated aggregate clinical inertia with no change in therapy, no documentation of HgbA1c within 60 d of discharge, and no follow-up appointment within 30 d of discharge. Conclusions: In this multicenter, retrospective study of patients with poorly controlled diabetes and at least one hospitalization, less than a quarter received a change in outpatient diabetes therapy upon discharge, suggesting widespread clinical inertia. Nearly one third had no change in therapy or subsequent follow-up scheduled. Copyright © 2012 by The Endocrine Society.


Morandi A.,Center for Health Services Research | Morandi A.,Vanderbilt University | Brummel N.E.,Center for Health Services Research | Ely E.W.,Center for Health Services Research | And 2 more authors.
Current Opinion in Critical Care | Year: 2011

Purpose of Review: Delirium and ICU-acquired weakness are frequent in critically ill mechanically ventilated patients. The number of mechanically ventilated patients is increasing, placing more patients at risk for these adverse outcomes. Sedation is given to ensure comfort and to minimize distress, but is linked to delirium and immobility. We review recent findings on the management of mechanically ventilated patients focusing on strategies that may improve neurologic and functional outcomes in critically ill patients. Recent Findings: We present the evidence-based 'ABCDE' bundle, an integrated and interdisciplinary approach to the management of mechanically ventilated patients. Spontaneous awakening and breathing trials have been combined into 'awake and breathing coordination', shortening the duration of mechanical ventilation, ICU and hospital length of stay and improving survival. The choice of α-2 agonists reduces ICU delirium and duration of mechanical ventilation. Delirium monitoring improves recognition of this disorder, but data on pharmacologic treatment are mixed. Early mobility and exercise may reduce physical dysfunction and delirium rates. Summary: Outcomes of critically ill patients can be improved by applying evidence-based therapies for the 'liberation' from mechanical ventilation and sedation, and the 'animation' through early mobilization. Clinicians should be aware of organizational approaches such as the 'ABCDE' bundle to improve the management of mechanically ventilated patients. © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.


Russ S.,Vanderbilt University | Jones I.,Vanderbilt University | Aronsky D.,Vanderbilt University | Dittus R.S.,Center for Health Services Research | Slovis C.M.,Vanderbilt University
Annals of Emergency Medicine | Year: 2010

Study objective: Emergency department (ED) crowding is a significant problem nationwide, and numerous strategies have been explored to decrease length of stay. Placing a physician in the triage area to rapidly disposition low-acuity patients and begin evaluations on more complex patients is one strategy that can be used to lessen the effect of ED crowding. The goal of this study is to assess the effect of order placement by a triage physician on length of stay for patients ultimately treated in a bed within the ED. Methods: We conducted a pre-experimental study with retrospective data to evaluate patients with and without triage physician orders at a single academic institution. A matched comparison was performed by pairing patients with the same orders and similar propensity scores. Propensity scores were calculated with demographic and triage data, chief complaint, and ED capacity on the patient's arrival. Results: During the 23-month study period, a total of 66,909 patients were sent to the waiting room after triage but still eventually spent time in an ED bed. A quarter of these patients (23%) had physician orders placed at triage. After a matched comparison, patients with triage orders had a 37-minute (95% confidence interval 34 to 40 minutes) median decrease in time spent in an ED bed, with an 11-minute (95% confidence interval 7 to 15 minutes) overall median increase in time until disposition. Conclusion: Our study suggests that early orders placed by a triage physician have an effect on ED operations by reducing the amount of time patients spend occupying an ED bed. © 2009 American College of Emergency Physicians.


Malacova E.,Center for Health Services Research | Kemp A.,Center for Health Services Research | Hart R.,University of Western Australia | Jama-Alol K.,Center for Health Services Research | Preen D.B.,Center for Health Services Research
Fertility and Sterility | Year: 2014

Objective To evaluate the risk of ectopic pregnancy (EP) associated with different methods of tubal sterilization. Design Population-based retrospective cohort study. Setting Hospitals in Western Australia. Patient(s) All women aged 18-44 years undergoing tubal sterilization between 1990 and 2010 at Western Australian hospitals (n = 44,829). Intervention(s) Data on tubal sterilization were extracted from hospital records. Main Outcome Measure(s) Long-term risk of EP. Result(s) There were 89 EPs recorded during the observation period in women previously sterilized. The 10-year and 15-year cumulative probability of EP for all methods of tubal sterilization were 2.4/1,000 and 2.9/1,000 procedures, respectively. The 10-year cumulative probability of EP was 3.5 times higher in women sterilized before the age of 28 years than in those sterilized after the age of 33 years. An increased risk of EP existed in women who received laparoscopic partial salpingectomy (adjusted hazard ratio = 14.57, 95% confidence interval 3.50-60.60) and electrodestruction (adjusted hazard ratio = 5.65, 95% confidence interval 2.38-13.40), compared with those who had laparoscopic unspecified destruction of fallopian tubes. Conclusion(s) Women undergoing tubal sterilization at a young age are at particular risk for subsequent EP. The risk among younger women doubled between 5 and 15 years after sterilization. Laparoscopic electrodestruction and partial salpingectomy carried the highest risk of EP. © 2014 American Society for Reproductive Medicine, Published by Elsevier Inc.


Meyer A.-M.,University of North Carolina at Chapel Hill | Wheeler S.B.,University of North Carolina at Chapel Hill | Weinberger M.,University of North Carolina at Chapel Hill | Weinberger M.,Center for Health Services Research | And 2 more authors.
Seminars in Radiation Oncology | Year: 2014

Comparative effectiveness research (CER) is a broad category of outcomes research encompassing many different methods employed by researchers and clinicians from numerous disciplines. The goal of cancer-focused CER is to generate new knowledge to assist cancer stakeholders in making informed decisions that will improve health care and outcomes of both individuals and populations. There are numerous CER methods that may be used to examine specific questions, including randomized controlled trials, observational studies, systematic literature reviews, and decision sciences modeling. Each has its strengths and weaknesses. To both inform and serve as a reference for readers of this issue of Seminars in Radiation Oncology as well as the broader oncology community, we describe CER and several of the more commonly used approaches and analytical methods. © 2014 Elsevier Inc.


Buhi E.R.,University of South Florida | Daley E.M.,University of South Florida | Oberne A.,Center for Health Services Research | Smith S.A.,University of South Florida | And 2 more authors.
Journal of Adolescent Health | Year: 2010

We assessed online sexual health information quality and accuracy and the utility of web site quality indicators. In reviewing 177 sexual health web sites, we found below average quality but few inaccuracies. Web sites with the most technically complex information and/or controversial topics contained the most inaccuracies. We found no association between inaccurate information and web site quality. © 2010 Society for Adolescent Health and Medicine. All rights reserved.


Blackmore C.C.,Center for Health Services Research
Emergency Radiology | Year: 2015

Quality can be seen as the link between what we do as radiologists and patient health. The radiology quality movement represents an opportunity for radiologists to have more direct influence on patient health, including the quality domains of safety, effectiveness, patient centeredness, timeliness, efficiency, and equitability. Focusing on quality allows emergency radiologists to extend outside of the confines of the reading room, thereby enhancing a rewarding and clinically relevant practice. © 2015, American Society of Emergency Radiology.

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