17 research outputs found
TCT-545 Contemporary Safety and Effectiveness of Peripheral Endovascular Interventions and Lower Extremity Bypass Surgery in the Treatment of Symptomatic Peripheral Arterial Disease
Transition to Virtual Asthma Care During the COVID-19 Pandemic: An Observational Study
BACKGROUND: The COVID-19 pandemic increased reliance
on virtual care for patients with persistent asthma.
OBJECTIVE: This retrospective cohort study assessed changes
from in-person to virtual care during the pandemic. In patients
with persistent asthma, compared with the same period before
the pandemic.
METHODS: Kaiser Permanente Colorado members aged 18 to
99 years with persistent asthma were evaluated during two
periods (March to October 2019 and March to October 2020).
Comparison of asthma exacerbations (hospitalizations,
emergency department visits, and courses of oral prednisone)
and asthma medication metrics were evaluated between the two
periods and by type of care received during the pandemic (no
care, virtual care only, in-person care only, or a mix of virtual
and in-person care). Population characteristics by type of care
received during the pandemic were also evaluated.
RESULTS: Among 7,805 adults with persistent asthma, those
who used more virtual care or sought no care during the
pandemic were younger and had fewer comorbidities, mental
health diagnoses, or financial barriers. Exacerbations decreased
(0.264 to 0.214; P <.001) as did courses of prednisone (0.213 to
0.169). Asthma medication adherence (0.53 to 0.54; P <.001)
and the asthma medication ratio, a quality-of-care metric (0.755
to 0.762; P [ .019), increased slightly. Patients receiving a mix
of in-person and virtual care had the highest rate of exacerbations (0.83) and a lower asthma medication ratio (0.74) despite
having the highest adherence (.57).
CONCLUSIONS: Despite an increase in virtual care, asthma
exacerbations decreased except among individuals who received
both in-person and virtual care, likely because they had more severe disease.Ye
POST-DISCHARGE BLEEDING IS ASSOCIATED WITH EARLY MYOCARDIAL INFARCTION AND DEATH AFTER DRUG-ELUTING STENT IMPLANTATION: INSIGHTS FROM THE HMO RESEARCH NETWORK- STENT REGISTRY (HMORN-STENT)
C-A2-02: Virtual Consult Use in an Electronic Medical Record: Descriptive Statistics at Mid-Point of Study
Background/Aims: Secure messaging within electronic medical records (EMR) between primary and specialty providers (virtual consults) may lead to streamlined care processes
Modifiable Risks of Incident Functional Dependence in Hispanic and Non-Hispanic White Elders
Randomized Clinical Trial of a Clinical Decision Support Tool for Improving the Appropriateness Scores for Ordering Imaging Studies in Primary and Specialty Care Ambulatory Clinics
POST-DISCHARGE BLEEDING IS ASSOCIATED WITH EARLY MYOCARDIAL INFARCTION AND DEATH AFTER DRUG-ELUTING STENT IMPLANTATION: INSIGHTS FROM THE HMO RESEARCH NETWORK- STENT REGISTRY (HMORN-STENT)
Guideline concordance of testing for hyperkalemia and kidney dysfunction during initiation of mineralocorticoid receptor antagonist therapy in patients with heart failure
BACKGROUND: Mineralocorticoid receptor antagonists (MRA) reduce morbidity and mortality in heart failure with reduced ejection fraction but can cause hyperkalemia and acute kidney injury. Guidelines recommend measurement of serum potassium (K) and creatinine (Cr) before and serially after MRA initiation, but the extent to which this occurs is unknown.
METHODS AND RESULTS: Using electronic data from 3 health systems 2005 to 2008, we performed a retrospective review of laboratory monitoring among 490 patients hospitalized for heart failure with reduced ejection fraction who were subsequently initiated on MRA therapy. Median age at time of MRA initiation was 73 years, and 37.1% were women. Spironolactone accounted for 99.4% of MRA use. Initial ambulatory MRA dispensing occurred at hospital discharge in 70.0% of cases. In the 30 days before MRA initiation, 94.3% of patients had a K or Cr measurement. Preinitiation K was \u3e5.0 mmol/L in 1.4% and Cr\u3e2.5 mg/dL in 1.7%. In the 7 days after MRA initiation among patients who remained alive and out of the hospital, 46.5% had no evidence of K measurement; by 30 days, 13.6% remained untested. Patient factors explained a small portion of postinitiation K testing (c-statistic, 0.67).
CONCLUSIONS: Although laboratory monitoring before MRA initiation for heart failure with reduced ejection fraction is common, laboratory monitoring after MRA initiation frequently does not meet guideline recommendations, even in patients at higher risk for complications. Quality improvement efforts that encourage the use of MRA should also include mechanisms to address recommended monitoring