Painful losses

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/134073/1/jhm2610-sup-0001-suppinfo.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/134073/2/jhm2610.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/134073/3/jhm2610-sup-0002-suppinfo.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/134073/4/jhm2610-sup-0005-suppinfo.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/134073/5/jhm2610-sup-0003-suppinfo.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/134073/6/jhm2610-sup-0004-suppinfo.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/134073/7/jhm2610_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/134073/8/jhm2610-sup-0007-suppinfo.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/134073/9/jhm2610-sup-0006-suppinfo.pd

Subcutaneous insulin order sets and protocols: Effective design and implementation strategies

No abstract.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/61216/1/354_ftp.pd

Effects of an educational program and a standardized insulin order form on glycemic outcomes in non-critically ill hospitalized patients

BACKGROUND: The optimal approach to managing hyperglycemia in noncritically ill hospital patients is unclear. OBJECTIVE: To investigate the effects of targeted quality improvement interventions on insulin prescribing and glycemic control. DESIGN: A cohort study comparing an intervention group (IG) to a concurrent control group (CCG) and an historic control group (HCG). SETTING: University of Michigan Hospital. PATIENTS: Hyperglycemic, noncritically ill hospital patients treated with insulin. INTERVENTION: Physician and nurse education and a standardized insulin order form based on the principles of physiologic insulin use. MEASUREMENTS: Glycemic control and insulin prescribing patterns. RESULTS: Patients in the IG were more likely to be treated with a combination of scheduled basal and nutritional insulin than in the other groups. In the final adjusted regression model, patients in the IG were more likely to be in the target glucose range (odds ratio [OR], 1.72; P = 0.01) and less likely to be severely hyperglycemic (OR, 0.65; P < 0.01) when compared to those in the CCG. Patients in the IG were also less likely to experience hypoglycemia than those in the CCG ( P = 0.06) or the HCG ( P = 0.01). Over 80% of all patient-days for all groups contained glucose readings outside of the target range. CONCLUSIONS: Standardized interventions encouraging the physiologic use of subcutaneous insulin can lead to significant improvements in glycemic control and patient safety in hospitalized patients. However, the observed improvements are modest, and poor metabolic control remains common, despite these interventions. Additional research is needed to determine the best strategy for safely achieving metabolic control in these patients. Journal of Hospital Medicine 2010. © 2010 Society of Hospital Medicine.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/78247/1/780_ftp.pd

The medical malpractice insurance “crises” and federal medical malpractice tort reform: Collection and analysis of bills passed by the United States House of Representatives from 1995–2005

There have been three medical malpractice insurance crises in the United States over a time spanning roughly the past three decades (Poisson, 2004, p. 759-760). Each crisis is characterized by a number of common features, including rapidly increasing medical malpractice insurance premiums, cancellation of existing insurance policies, and a decreased willingness of insurers to offer or renew medical malpractice insurance policies (Poisson, 2004, p. 759-760). Given the recurrent crises, many sources argue that medical malpractice insurance coverage has become too expensive a commodity—one that many physicians simply cannot afford (U.S. Department of Health and Human Services [HHS], 2002, p. 1-2; Physician Insurers Association of America [PIAA], 2003, p. 1; Jackiw, 2004, p. 506; Glassman, 2004, p. 417; Padget, 2003, p. 216). The prohibitively high cost of medical liability insurance is said to limit the geographical areas and medical specializations in which physicians are willing to practice. As a result, the high costs of medical liability insurance are ultimately said to affect whether or not people have access to health care services. In an effort to control the medical liability insurance crises—and to preserve or restore peoples\u27 access to health care—every state in the United States has passed at least some laws designed to reduce medical malpractice premium rates (GAO, 2003, p.5-6). More recently, however, the United States has witnessed a push to implement federal reform of the medical malpractice tort system. Accordingly, this project focuses on federal medical malpractice tort reform. This project was designed to investigate the following specific question: Do the federal medical malpractice tort reform bills which passed in the House of Representatives between 1995 and 2005 differ in respect to their principle features? To answer this question, the text of the bills, law review articles, and reports from government and private agencies were analyzed. Further, a matrix was compiled to concisely summarize the principle features of the proposed federal medical malpractice tort reform bills. Insight gleaned from this investigation and matrix compilation informs discussion about the potential ramifications of enacting federal medical malpractice tort reform legislation