Alcohol Interventions for Trauma Patients Treated in Emergency Departments and Hospitals: A Cost Benefit Analysis

Summarizes a study of whether screening for problem drinking and interventions to reduce alcohol intake in hospital trauma centers reduce the direct cost of injury-related health care. Compares the costs of injury recidivism with and without intervention

Centers for Medicare and Medicaid services quality indicators do not correlate with risk-adjusted mortality at trauma centers.

OBJECTIVES: The Centers for Medicare and Medicaid Services (CMS) publicly reports hospital compliance with evidence-based processes of care as quality indicators. We hypothesized that compliance with CMS quality indicators would correlate with risk-adjusted mortality rates in trauma patients. METHODS: A previously validated risk-adjustment algorithm was used to measure observed-to-expected mortality ratios (O/E with 95% confidence interval) for Level I and II trauma centers using the National Trauma Data Bank data. Adult patients (\u3eor=16 years) with at least one severe injury (Abbreviated Injury Score \u3eor=3) were included (127,819 patients). Compliance with CMS quality indicators in four domains was obtained from Hospital Compare website: acute myocardial infarction (8 processes), congestive heart failure (4 processes), pneumonia (7 processes), surgical infections (3 processes). For each domain, a single composite score was calculated for each hospital. The relationship between O/E ratios and CMS quality indicators was explored using nonparametric tests. RESULTS: There was no relationship between compliance with CMS quality indicators and risk-adjusted outcomes of trauma patients. CONCLUSIONS: CMS quality indicators do not correlate with risk-adjusted mortality rates in trauma patients. Hence, there is a need to develop new trauma-specific process of care quality indicators to evaluate and improve quality of care in trauma centers

Engage in the Process of Change. : Facts and Methods

This textbook advocates patients’ empowerment for improving health outcomes and health system performance. It emphasizes the important implications of improving communication between patient and health professionals and the adherence to treatment regimens. Based on research including theories of Stages of Change and Decision Balance, and by incorporating examples from daily clinical practice, this document sets out the guiding principles to support health professionals in better understanding and empowering patients to change lifestyle and behaviour. These principles describe a general approach to patients’ empowerment, consisting of three main tools: the LINE, the BOX and the CIRCLE. It specifically addresses the major risk factors such as smoking, diet, alcohol consumption and physical activity by putting the focus of action upstream to the causes of these types of lifestyle and behaviour. It is built on accumulating evidence, which shows that tailoring interventions to the characteristics of the target audience is key for success