C102. USING ANALOG OR TECHNOLOGY TOOLS TO EVALUATE AND INTERVENE TO IMPROVE HEALTHCARE DELIVERY最新文献

{"title":"Use of Technology Among Patients with Chronic Obstructive Pulmonary Disease Who Currently Smoke: A Mixed Methods Evaluation","authors":"A. Melzer, H. Hagedorn, D. Nelson, A. Kaplan, J. Wisdom, M. Campbell, S. Fu","doi":"10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a4853","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a4853","url":null,"abstract":"","PeriodicalId":429370,"journal":{"name":"C102. USING ANALOG OR TECHNOLOGY TOOLS TO EVALUATE AND INTERVENE TO IMPROVE HEALTHCARE DELIVERY","volume":"46 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123150895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"Give Us More of a Chance to Participate in Decision Making\": A Qualitative Study Evaluating a Treatment Decision Support Tool and Patients' Decision Making Experiences","authors":"D. Sullivan, S. Golden, N. Disher, K. Vranas, K. Eden, N.F. Dieckmann, C. Slatore","doi":"10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a4863","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a4863","url":null,"abstract":"","PeriodicalId":429370,"journal":{"name":"C102. USING ANALOG OR TECHNOLOGY TOOLS TO EVALUATE AND INTERVENE TO IMPROVE HEALTHCARE DELIVERY","volume":"57 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114866823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Big Data Approach to Predicting Lung Cancer in a Younger, Real World Cohort","authors":"U. Chandran, J. Reps, R. Yang, A. Vachani, I. Kalsekar","doi":"10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a4872","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a4872","url":null,"abstract":"","PeriodicalId":429370,"journal":{"name":"C102. USING ANALOG OR TECHNOLOGY TOOLS TO EVALUATE AND INTERVENE TO IMPROVE HEALTHCARE DELIVERY","volume":"96 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122651822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of the Electronic Health Record to Determine Nurse-Patient Assignments in the Intensive Care Unit","authors":"K. Riman, B. Davis, J. Seaman, J. Kahn","doi":"10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a4871","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a4871","url":null,"abstract":"","PeriodicalId":429370,"journal":{"name":"C102. USING ANALOG OR TECHNOLOGY TOOLS TO EVALUATE AND INTERVENE TO IMPROVE HEALTHCARE DELIVERY","volume":"157 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131645358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Behavioral Impact on E-cig/Vape Use AfteraBrief 15-minute Education","authors":"A. Kandhola, T. Williams, N. Daher, D. Lopez, L. Tan, A. Alismail","doi":"10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a4852","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a4852","url":null,"abstract":"","PeriodicalId":429370,"journal":{"name":"C102. USING ANALOG OR TECHNOLOGY TOOLS TO EVALUATE AND INTERVENE TO IMPROVE HEALTHCARE DELIVERY","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122022728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of a Clinical Decision Support Tool for Improving Adherence to Lung Protective Ventilation Strategies","authors":"R. Logue, J.P. Bedruz, S. Cammarata, C. Tanabe, N. Rao, S. Klahn, D. Gotur, C.J. Cortes, A. Zainab","doi":"10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a4864","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a4864","url":null,"abstract":"RATIONALE: Pre-pandemic, ARDS accounted for approximately 10% of all ICU admissions and 25% of ICU patients requiring mechanical ventilation (MV). Surges in severe Covid-19 cases have increased the number of ICU patients requiring MV for ARDS. It has been estimated that only 60% of ARDS cases are identified at any time during the clinical course, and only 34% of ARDS cases are identified when initial criteria are met. Additionally, it is estimated that only 60% of ARDS patients are managed with evidence based MV settings, including low tidal volume ventilation (LTV) of <6 cc/kg ideal body weight, plateau pressure <30 cm H2O, and low driving pressure <15 cm H2O. Adherence to lung protective ventilation strategies have been linked to decreased mortality in ARDS. We implemented a clinical decision support tool (CDST) to aid clinicians in the early recognition of ARDS and aid in implementation of lung protective ventilation strategies. METHODS: From March 2020 to March 2021 we used medical informatics (SickbayTM) to identify ICU patients requiring MV that met criteria for ARDS based on the Berlin Criteria. We monitored documentation of ARDS, MV tidal volume as cc/kg ideal body weight, plateau pressure, driving pressure, MV settings, arterial blood gas values (ABG), and PaO2 / FiO2. From March 2021 to October 2021, we implemented a CDST outlining above variables to aide ICU clinicians in 1) recognition of ARDS and 2) utilization of MV and ABG data to make evidence based MV changes. Lung protective strategies were automatically recorded every two hours via informatics software. The results were analyzed using a chi-squared test. RESULTS: There were 207 patients reviewed preimplementation of the CDST and 88 patients reviewed during implementation of the CDST. Implementation of the CDST resulted in improved detection and documentation of ARDS (63.8% vs 100%, p=.0001), improved adherence to LTV (53.9% vs 64.9%, p = .0005), and improved adherence to low plateau pressure (67.7% vs 71.8%, p=.20). There was a decrease in adherence to low driving pressure (36.6% vs 23.9%, p=.0003).CONCLUSIONS: Implementation of CDST is a low-cost, efficacious measure to aide clinicians in the detection and documentation of ARDS. Using CDST was associated with improved adherence to LTV and low plateau pressure MV strategies. We hypothesize that difficulty with adherence to low driving pressure is related to the respiratory mechanics of Covid-19 ARDS differing from other forms of ARDS. A validation cohort is needed to further support our findings.","PeriodicalId":429370,"journal":{"name":"C102. USING ANALOG OR TECHNOLOGY TOOLS TO EVALUATE AND INTERVENE TO IMPROVE HEALTHCARE DELIVERY","volume":"55 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114855456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of Standardized Care Path for COPD Exacerbations","authors":"U. Majumdar, C. Cuvillier Padilla, A. Attaway, U. Hatipoğlu","doi":"10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a4862","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a4862","url":null,"abstract":"Introduction: Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD) is a major cause of hospitalization and re-admissions. Lack of standardized management and non-adherence to guideline-directed treatment may lead to poor outcomes and increase cost. Interventions implemented by health systems to reduce readmissions have had varied success. Heterogeneity in the target patient population is a significant challenge. The Cleveland Clinic COPD Care Path consists of an admission order set that incorporates multi-disciplinary management, evidence-based medications, and postdischarge integrated care. In this study, we examined impact of this Care Path on quality metrics and 30-day readmissions of patients with proven COPD on spirometry. Methods: We studied patients with spirometry proven persistent airflow obstruction (postbronchodilator FEV1/FVC<70) admitted to the general nursing floor with AECOPD during the 3 years prior to the COVID pandemic (February 2, 2017 to January 31, 2020), excluding those who left against medical advice, hospice and transplant patients. Patient's Care Path status (On vs Off), age, gender, BMI, baseline lung function and comorbidities were recorded. We measured process metrics such as appropriate use of antibiotics and corticosteroids, and post-discharge integrated disease management (rates of prescribing long-acting bronchodilator, follow-up appointments). 30-day readmission rate, length of stay (LOS) observed to expected (O: E) ratio and cost per case were recorded. For continuous variables, we used means and standard deviations and the ANOVA test for statistical analysis. For categorical variables, percentages, and the t- test were used. The level of statistical significance was set at p < 0.05. Results: Of the total of 857 patients with airflow obstruction, the Care Path was utilized in 52.8% and 21.94% were readmitted within 30 days. Lower re-admissions were associated with lower comorbidity index and completed follow-up appointments. Lung function, long acting bronchodilator prescription and cost or length of index hospitalization did not affect readmission. The care path was utilized more among patients with lower FEV1/FVC ratio but less in patients with concomitant heart failure. Use of the care path was associated with more follow-up appointments (scheduled and completed), long-acting bronchodilator prescription on discharge, lower cost but not length of stay. On-Care-Path patients did not have a reduced risk of readmission on univariate analysis. Conclusions: The findings from this retrospective study of patients with spirometry proven COPD suggest that using standardized care path for AECOPD hospitalizations is associated with lower cost and facilitates transitions of care. However, length of stay and 30-day readmission rates are unaffected. (Figure Presented).","PeriodicalId":429370,"journal":{"name":"C102. USING ANALOG OR TECHNOLOGY TOOLS TO EVALUATE AND INTERVENE TO IMPROVE HEALTHCARE DELIVERY","volume":"39 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133825410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictive Value of the STOP BANG Questionnaire and the Epworth Sleepiness Scale for the Diagnosis of Obstructive Sleep Apnea in a Resource Limited Setting","authors":"O. Ekete, S. Dede, O. Ojo, O. Ozoh","doi":"10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a4868","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a4868","url":null,"abstract":"","PeriodicalId":429370,"journal":{"name":"C102. USING ANALOG OR TECHNOLOGY TOOLS TO EVALUATE AND INTERVENE TO IMPROVE HEALTHCARE DELIVERY","volume":"121 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121810362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Impact of a Sepsis Alert System Using the Epic Sepsis Prediction Model","authors":"A. Schertz, S. Smith, K. Lenoir, K. Thomas","doi":"10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a4874","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a4874","url":null,"abstract":"","PeriodicalId":429370,"journal":{"name":"C102. USING ANALOG OR TECHNOLOGY TOOLS TO EVALUATE AND INTERVENE TO IMPROVE HEALTHCARE DELIVERY","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129944107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"One Size Does Not Fit All: Adding Granularity to COPD Self-Management","authors":"M. Benzo, P. Novotný, R. Benzo","doi":"10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a4858","DOIUrl":"https://doi.org/10.1164/ajrccm-conference.2022.205.1_meetingabstracts.a4858","url":null,"abstract":"","PeriodicalId":429370,"journal":{"name":"C102. USING ANALOG OR TECHNOLOGY TOOLS TO EVALUATE AND INTERVENE TO IMPROVE HEALTHCARE DELIVERY","volume":"14 15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124740738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}