Quality of care in elder emergency department patients with pneumonia: a prospective cohort study

<p>Abstract</p> <p>Background</p> <p>The goals of the study were to assess the relationship between age and processes of care in emergency department (ED) patients admitted with pneumonia and to identify independent predictors of failure to meet recommended quality care measures.</p> <p>Methods</p> <p>This was a prospective cohort study of a pre-existing database undertaken at a university hospital ED in the Midwest. ED patients ≥18 years of age requiring admission for pneumonia, with no documented use of antibiotics in the 24 hours prior to ED presentation were included. Compliance with Pneumonia National Quality Measures was assessed including ED antibiotic administration, antibiotics within 4 hours, oxygenation assessment, and obtaining of blood cultures. Odds ratios were calculated for elders and non-elders. Logistic regression was used to identify independent predictors of process failure.</p> <p>Results</p> <p>One thousand, three hundred seventy patients met inclusion criteria, of which 560 were aged ≥65 years. In multiple variable logistic regression analysis, age ≥65 years was independently associated with receiving antibiotics in the ED (odds ratio [OR] = 2.03, 95% CI 1.28–3.21) and assessment of oxygenation (OR = 2.10, 95% CI, 1.18–3.32). Age had no significant impact on odds of receiving antibiotics within four hours of presentation (OR 1.10, 95% CI 0.84–1.43) or having blood cultures drawn (OR 1.02, 95%CI 0.78–1.32). Certain other patient characteristics were also independently associated with process failure.</p> <p>Conclusion</p> <p>Elderly patients admitted from the ED with pneumonia are more likely to receive antibiotics while in the ED and to have oxygenation assessed in the ED than younger patients. The independent association of certain patient characteristics with process failure provides an opportunity to further increase compliance with recommended quality measures in admitted patients diagnosed with pneumonia.</p

Yergan Application

Max Yergen's application to the Secretarial Course of the International YMCA Training School (now Springfield College) from 1914.Beginning as a student secretary while in college, Max Yergan worked to promote the YMCA movement at colleges in the Southwest. After graduating, he became a teacher in Raleigh, N.C., but reconvened his YMCA work as a war work secretary in 1916. He spent two years accompanying the Indian Troops in Dar-Es-Salaam, German East Africa, and then went to France to work with the African-American units of the Expeditionary Army. After the war, he returned to the United States and was ordained a minister. In 1921, he set out for South Africa to develop a YMCA for black South Africans. A fierce advocate for the rights of black South Africans, Yergan lectured before the white Student Christian Associations in South Africa on the inclusive nature of the Kingdom of God, forcing them to re-examine the racial conditions of their country. Yergan’s work got a boost when John D. Rockefeller Jr., donated $25,000 toward the construction of a YMCA building, which Yergan called the South African Training Center. In 1936, he returned to the United States and became the first teacher of African-American studies at City College of New York. Yergan was a controversial activist whose politics, over the years, shifted from communist to anti-communist, but his pioneering YMCA work in South Africa stands as his monumental legacy

Max Yergan Letter to Ralph Cheney (April 4, 1918)

A two-page letter from Max Yergan to Springfield College professor, R.L. Cheney dated April 4, 1918. In his letter, Yergan apologizes for his lack of correspondence but explains that because of the uncertainty of the mail system during the war he wrote very few letters. Yergan summarizes what he's been doing since leaving Springfield - enlisting in the war and traveling to India, East Africa and France. He tells about the Springfield College men that he saw while overseas including Dr. McCurdy. Yergan closes his letter by promising to write a full letter soon. Of note in this letter is the letterhead which indicates that Yergan was writing from the International Committe of the YMCA's Colored Men's Department.After graduating from Springfield College, Max Yergan continues his YMCA work as a war work secretary in 1916. He spent two years accompanying the Indian Troops in Dar-Es-Salaam, German East Africa, and then went to France to work with the African-American units of the Expeditionary Army. After the war, he returned to the United States and was ordained a minister. In 1921, he set out for South Africa to develop a YMCA for black South Africans. A fierce advocate for the rights of black South Africans, Yergan lectured before the white Student Christian Associations in South Africa on the inclusive nature of the Kingdom of God, forcing them to re-examine the racial conditions of their country. Yergan’s work got a boost when John D. Rockefeller Jr., donated $25,000 toward the construction of a YMCA building, which Yergan called the South African Training Center. In 1936, he returned to the United States and became the first teacher of African-American studies at City College of New York. Yergan was a controversial activist whose politics, over the years, shifted from communist to anti-communist, but his pioneering YMCA work in South Africa stands as his monumental legacy.YMCA work with and by blacks began in 1853 and continued until 1946 when, after growing realization that racial discrimination was incompatible with the YMCA's Christian ideals, the YMCA's Jim Crow policies were reexamined and the organization called for desegregation and the end of racial discrimination

Physician Referral Patterns and Race Differences in Receipt of Coronary Angiography

OBJECTIVE: This study addresses the following research questions: (1) Is race a predictor of obtaining a referral for coronary angiography (CA) among patients who are appropriate candidates for the procedure? (2) Is there a race disparity in obtaining CA among patients who obtain a referral for the procedure? STUDY SETTING: Three community hospitals in Baltimore, Maryland. STUDY DESIGN: We abstracted hospital records of 7,927 patients from three hospitals to identify 2,653 patients who were candidates for CA. Patients were contacted by telephone to determine if they received a referral for CA. Logistic regression was used to assess whether racial differences in obtaining a referral were affected by adjustment for several potential confounders. A second set of analyses examined race differences in use of the procedure among a subsample of patients that obtained a referral. PRINCIPAL FINDINGS: After controlling for having been hospitalized at a hospital with in-house catheterization facilities, ACC/AHA (American College of Cardiology/American Heart Association) classification, sex, age, and health insurance status, race remained a significant determinant of referral (OR=3.0, p<.05). Additionally, we found no significant race differences in receipt of the procedure among patients who obtained a referral. CONCLUSIONS: Our results demonstrate that race differences in utilization of CA tend to occur during the process of determining the course of treatment. Once a referral is obtained, African American patients are not less likely than white patients to follow through with the procedure. Thus, future research should seek to better understand the process by which the decision is made to refer or not refer patients