Preventive Primary Care Screening Patterns after Provider EHR Adoption for Michigan Medicaid Adults

Introduction It remains largely unknown how use of electronic health records (EHR) impacts ordering of preventive/screening services (PSS). These analyses examined the influence of confirmed Medicaid provider EHR adoption on primary care ordering rates of five major PSS. Sample was comprised of 10,149 continuously enrolled Michigan Medicaid adults linked to 6,587 providers. Methods The authors obtained complete office-based billing claims data from the Michigan Medicaid Data Warehouse for adults with 29 or more months of continuous state Medicaid coverage. PSS claims data were linked to patients’ Medicaid-assigned providers who either had, or had not, EHR-attested during the 60-month analytic window. Results Final predictive models with consistent EHR provider-patient dyads demonstrated both significant increases and decreases in order rates for office-based PSS compared to non-EHR dyads. Similar to the authors’ earlier work, the authors conclude that while EHR modules prompted many providers to increase some PSS ordering, their improved access to historical documentation also decreased redundant or premature orders. Conclusions Based on these results, future controlled studies examining the apparent mixed influences derived from increased use of different EHR technologies on PSS ordering rates are certainly required

Changes in practice patterns affecting in-hospital and post-discharge survival among ACS patients

BACKGROUND: Adherence to clinical practice guidelines for the treatment of specific illnesses may result in unexpected outcomes, given that multiple therapies must often be given to patients with diverse medical conditions. Yet, few studies have presented empirical evidence that quality improvement (QI) programs both change practice by improving adherence to guidelines and improve patient outcomes under the conditions of actual practice. Thus, we focus on patient survival, following hospitalization for acute coronary syndrome in three successive patient cohorts from the same community hospitals, with a quality improvement intervention occurring between cohorts two and three. METHODS: This study is a comparison of three historical cohorts of Acute Coronary Syndrome (ACS) patients in the same five community hospitals in 1994–5, 1997, 2002–3. A quality improvement project, the Guidelines Applied to Practice (GAP), was implemented in these hospitals in 2001. Study participants were recruited from community hospitals located in two Michigan communities during three separate time periods. The cohorts comprise (1) patients enrolled between December 1993 and April 1995 (N = 814), (2) patients enrolled between February 1997 and September 1997 (N = 452), and (3) patients enrolled between January 14, 2002 and April 13, 2003 (N = 710). Mortality data were obtained from Michigan's Bureau of Vital Statistics for all three patient cohorts. Predictor variables, obtained from medical record reviews, included demographic information, indicators of disease severity (ejection fraction), co-morbid conditions, hospital treatment information concerning most invasive procedures and the use of ace-inhibitors, beta-blockers and aspirin in the hospital and as discharge recommendations. RESULTS: Adjusted in-hospital mortality showed a marked improvement with a HR = 0.16 (p < 0.001) comparing 2003 patients in the same hospitals to those 10 years earlier. Large gains in the in-hospital mortality were maintained based on 1-year mortality rates after hospital discharge. CONCLUSION: Changes in practice patterns that follow recommended guidelines can significantly improve care for ACS patients. In-hospital mortality gains were maintained in the year following discharge

Quality Improvement Intervention associated with Improved Lung Protective Ventilation Settings in an Emergency Department.

INTRODUCTION: Patients requiring endotracheal intubation and mechanical ventilation in the emergency department (ED) are critically ill, and their ventilator management is crucial for their subsequent clinical outcomes. Lung-protective ventilation (LPV) setting strategies are key considerations for this care. The objectives of this 2019-2020 community-based quality improvement project were to: a) identify patients at greater risk of not receiving LPV, and b) evaluate the effectiveness of a series of brief quality improvement educational sessions to improve LPV setting protocol adherence rates. METHODS: A 15-month retrospective chart review of ventilator settings and subject characteristics (N = 200) was conducted before and after a series of 10-15-minute educational sessions were delivered to improve LPV adherence. This information was presented at a series of four educational sessions for 25 attending physicians (n = two sessions) and 27 residents at conferences (n = two sessions). Two additional materials (e.g., LPV reference charts, tape measures to gauge patients\u27 heights) were also posted in three ED resuscitation rooms and on cabinets containing emergency airway equipment. The pre and post-intervention occurrence rates of LPV setting orders were inferentially compared before and after educational sessions. RESULTS: Patients ventilated using LPV increased from 70% to 82% after the educational sessions (p = 0.04). All patients who were 67 inches or greater in height were ventilated appropriately before and after sessions. For patients under 65 inches in height, post-session LPV adherence increased from 13% to 53% (p = 0.01). CONCLUSIONS: Based on these results, a brief ED provider educational intervention can significantly improve the utilization of LPV guideline-based settings. Patients under 65 inches in height may also be especially at risk of receiving non-LPV ventilator setting orders

COMPARISON OF MIDDLE-AGED WOMEN WITH AND WITHOUT TYPE 2 DIABETES ON DEMOGRAPHIC, CLINICAL, AND SOCIAL-COGNITIVE FACTORS ASSOCIATED WITH MODERATE- TO VIGOROUS-INTENSITY PHYSICAL ACTIVITY

Aims: The purpose of this cross-sectional, exploratory study was to compare demographic, clinical, and social cognitive factors associated with minutes per day of moderate- to vigorous-intensity physical activity (MVPA) in middle-aged women with and without Type 2 diabetes. Methods: The theoretical framework was based on both the Social Cognitive Theory and the Theory of Planned Behavior used to depict the demographic, clinical, and social-cognitive factors shown to be associated with physical activity. Forty-two middle-aged women with Type 2 diabetes and 67 without diabetes met inclusion criteria at four urban primary care clinics.. Enrolled women received an accelerometer to wear for seven consecutive days and completed a survey including questions exploring various demographic, clinical, and social-cognitive factors. Height and weight were measured to calculate body mass index (BMI). After the one week of wear-time, women returned the accelerometer and completed the International Physical Activity Questionnaire (IPAQ) short-form. Data were analyzed using independent t-tests and chi-squared tests. Results: Ninety-three (86.1%) of the women were overweight or obese. A higher proportion of non-Whites was noted for women with Type 2 diabetes, compared to women without diabetes. The mean values for women with Type 2 diabetes were higher for BMI and comorbidity index, lower for perceived benefits and self-efficacy related to physical activity, and fewer for minutes per day of vigorous-intensity physical activity. Conclusions: Tailored nursing interventions are needed to enhance perceived benefits and self-efficacy of physical activity, especially in middle-aged women with Type 2 diabetes, as a means for increasing MVPA