Mayo Clinic proceedings. Innovations, quality & outcomes最新文献

{"title":"Stool-Based Colorectal Cancer Screening Test Performance Characteristics in Those With and Without Hemorrhoids","authors":"Derek W. Ebner MD ,&nbsp;David Rushlow MD ,&nbsp;Joshua Mou MD ,&nbsp;Kyle Porter MAS ,&nbsp;Lila J. Finney Rutten MPH, PhD ,&nbsp;Paul Limburg MD ,&nbsp;Feyza Sancar PhD ,&nbsp;Thomas F. Imperiale MD","doi":"10.1016/j.mayocpiqo.2023.06.003","DOIUrl":"10.1016/j.mayocpiqo.2023.06.003","url":null,"abstract":"<div><h3>Objective</h3><p>To evaluate the effect of hemorrhoids on noninvasive stool test performance for colorectal cancer (CRC) screening.</p></div><div><h3>Patients and Methods</h3><p>We conducted a retrospective cohort study of test characteristics for the fecal immunochemical test (FIT) and the multitarget stool DNA (mt-sDNA) test, on the basis of hemorrhoid status, recorded at the time of colonoscopy, among patients enrolled in the pivotal prospective study for mt-sDNA that was conducted from June 2011, to May 2013. Test characteristics (sensitivity, specificity, positive, and negative predictive values) for FIT and mt-sDNA (performed &lt; 90 days before colonoscopy) were stratified by the presence of hemorrhoids and compared.</p></div><div><h3>Results</h3><p>Hemorrhoids were found in 51.7% (5163 of 9989) of the study cohort. Across all test characteristics, there were no statistically significant differences for FIT or mt-sDNA when stratified by hemorrhoid status. Analysis revealed mt-sDNA sensitivity of 44% and 41% for advanced precancerous lesions in nonhemorrhoidal and hemorrhoid patients, respectively (<em>P</em>=.41). The FIT sensitivity among the same lesion category was 24.9% in patients without hemorrhoids and 22.8% in those with hemorrhoids (<em>P</em>=.48). The mt-sDNA specificity was 86.4% in patients without hemorrhoids vs 87.7% in those with hemorrhoids (<em>P</em>=.67), although FIT specificity was 95.0% among patients without hemorrhoids vs 94.7% in those with hemorrhoids (<em>P</em>=.44).</p></div><div><h3>Conclusion</h3><p>The presence of asymptomatic hemorrhoids did not adversely affect test performance in this large clinical study. These findings suggest that in the absence of overt gastrointestinal bleeding, FIT and mt-sDNA are options for CRC screening, irrespective of hemorrhoid status.</p></div><div><h3>Trial Registration</h3><p>clinicaltrials.gov Identifier: NCT01397747</p></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/73/86/main.PMC10371761.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9887084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving Communication in the Medical Intensive Care Unit Through Standardization of Handoff Format: A Quality Improvement Project","authors":"Lindsey A. Wallace DScPAS, PA-C ,&nbsp;Kelsey K. Schuder CNP, MSN, MPH ,&nbsp;Vicki Loeslie DNP ,&nbsp;Andrew C. Hanson MS ,&nbsp;Clifford Ongubo DNP ,&nbsp;Elaine Chiarelly CNP, MSN ,&nbsp;Gregory Schalla PA-C ,&nbsp;Kathleen Hinson Meek PA-C ,&nbsp;Donald Springer CNP","doi":"10.1016/j.mayocpiqo.2023.05.006","DOIUrl":"10.1016/j.mayocpiqo.2023.05.006","url":null,"abstract":"<div><h3>Objective</h3><p>To decrease interruptions in handoff, increase compliance with a structured verbal handoff format, and increase compliance with handoff template completion in electronic medical records without increasing the length of handoff time.</p></div><div><h3>Patients and Methods</h3><p>The project timeline was from April 1, 2019, to February 1, 2020. Define phase data were obtained through a survey of stakeholders to identify the gap in needs. The baseline data included components from the illness severity, patient summary, action list, situational awareness and contingency plans, and synthesis by receiver (IPASS) handoff tool because this tool best aligned with information identified in the define phase. Observational data were collected in person and reviewed via audio recording for accuracy. Results were analyzed to determine adherence to the chosen intervention, the IPASS handoff tool, on which the stakeholders were educated and assessed prior to implementation. Five plan-do-study-act cycles were completed over 3 months to optimize the intervention. Final data were collected and analyzed using the same method as baseline data.</p></div><div><h3>Results</h3><p>After implementation of the IPASS handoff tool, there were more care plan components mentioned in the provider handoffs across all unique IPASS components, there were fewer observed distracting events, and there was increased compliance with electronic medical record handoff completion. The time of handover increased by 3 minutes.</p></div><div><h3>Conclusion</h3><p>A standardized handoff tool improved communication during provider handoffs by increasing the mention of pertinent details and reducing distracting events during handoff.</p></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/da/d7/main.PMC10345749.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9823671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Ambulatory Quality Measures Between Shared Practice Panels and Independent Practice Panels","authors":"Adria Whiting APRN, CNP ,&nbsp;April E. Poolman APRN, CNP, MSN ,&nbsp;Artika Misra MD ,&nbsp;Joel E. Gordon MD ,&nbsp;Kurt B. Angstman MD","doi":"10.1016/j.mayocpiqo.2023.05.005","DOIUrl":"10.1016/j.mayocpiqo.2023.05.005","url":null,"abstract":"<div><h3>Objective</h3><p>To assess for differences in patient care outcomes in the primary care setting for patients assigned to an independent practice panel (IPP) or a shared practice panel (SPP).</p></div><div><h3>Patients and Methods</h3><p>We retrospectively reviewed the electronic health records of patients of 2 Mayo Clinic family medicine primary care clinics from January 1, 2019 to December 31, 2019. Patients were assigned to either an IPP (physician or advanced practice provider [APP]) or an SPP (physician and ≥1 APP). We assessed 6 measures of quality care and compared them between IPP and SPP groups: diabetes optimal care, hypertension control, depression remission at 6 months, breast cancer screening, cervical cancer screening, and colon cancer screening.</p></div><div><h3>Results</h3><p>The study included 114,438 patients assigned to 140 family medicine panels during the study period: 87 IPPs and 53 SPPs. The IPP clinicians showed improved quality metrics compared with the SPP clinicians for the percentage of assigned patients achieving depression remission (16.6% vs 11.1%; <em>P</em>&lt;.01). The SPP clinicians showed improved quality metrics compared with that of the IPP clinicians for the percentage of patients with cervical cancer screening (79.1% vs 74.2%; <em>P</em>&lt;.01). The mean percentage of the panels achieving optimal diabetes control, hypertension control, colon cancer screening, and breast cancer screening were not significantly different between IPP and SPP panels.</p></div><div><h3>Conclusion</h3><p>This study shows a considerable improvement in depression remission among IPP panels and in cervical cancer screening rates among SPP panels. This information may help to inform primary care team configuration.</p></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/fd/78/main.PMC10300043.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9736042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving Neurology Inpatient Fall Rate: Effect of a Collaborative Interdisciplinary Quality Improvement Initiative","authors":"Michael P. Skolka MD ,&nbsp;Bryan J. Neth MD, PhD ,&nbsp;Andrew Brown MD ,&nbsp;Stephanie J. Steel MD ,&nbsp;Katrina Hacker APRN, CNS, MS ,&nbsp;Catherine Arnold MD ,&nbsp;Michel Toledano MD ,&nbsp;Rafid Mustafa MD","doi":"10.1016/j.mayocpiqo.2023.05.004","DOIUrl":"10.1016/j.mayocpiqo.2023.05.004","url":null,"abstract":"<div><h3>Objective</h3><p>To reduce unwitnessed inpatient falls on the neurology services floor at an academic medical center by 20% over 15 months.</p></div><div><h3>Patients and Methods</h3><p>A 9-item preintervention survey was administered to neurology nurses, resident physicians, and support staff. Based on survey data, interventions targeting fall prevention were implemented. Providers were educated during monthly in-person training sessions regarding the use of patient bed/chair alarms. Safety checklists were posted inside each patient’s room reminding staff to ensure that bed/chair alarms were on, call lights and personal items were within reach, and patients’ restroom needs were addressed. Preimplementation (January 1, 2020, to March 31, 2021) and postimplementation (April 1, 2021, to June 31, 2022) rates of falls in the neurology inpatient unit were recorded. Adult patients hospitalized in 4 other medical inpatient units not receiving the intervention served as a control group.</p></div><div><h3>Results</h3><p>Rates of falls, unwitnessed falls, and falls with injury all decreased after intervention in the neurology unit, with rates of unwitnessed falls decreasing by 44% (2.74 unwitnessed falls per 1000 patient-days before intervention to 1.53 unwitnessed falls per 1000 patient-days after intervention; <em>P</em>=.04). Preintervention survey data revealed a need for education and reminders on inpatient fall prevention best practices given a lack of knowledge on how to operate fall prevention devices, driving the implemented intervention. All staff reported significant improvement in operating patient bed/chair alarms after intervention (<em>P</em>&lt;.001).</p></div><div><h3>Conclusion</h3><p>A collaborative, multidisciplinary approach focusing on provider fall prevention education and staff checklists is a potential technique to reduce neurology inpatient fall rates.</p></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e4/52/main.PMC10302162.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9736040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inadequate Reporting of Cointerventions, Other Methodological Factors, and Treatment Estimates in Cardiovascular Trials: A Meta-Epidemiological Study","authors":"Jonas Bührer MD ,&nbsp;Cinzia Del Giovane PhD ,&nbsp;Baris Gencer MD, MPH ,&nbsp;Luise Adam MD ,&nbsp;Christina Lyko MD ,&nbsp;Martin Feller MD, MSc ,&nbsp;Bruno R. Da Costa PhD ,&nbsp;Drahomir Aujesky MD, MSc ,&nbsp;Douglas C. Bauer MD ,&nbsp;Nicolas Rodondi MD, MAS ,&nbsp;Elisavet Moutzouri MD, PhD","doi":"10.1016/j.mayocpiqo.2023.04.010","DOIUrl":"10.1016/j.mayocpiqo.2023.04.010","url":null,"abstract":"<div><h3>Objective</h3><p>To assess how inadequate reporting of cointerventions influences estimated treatment effects in recent cardiovascular trials.</p></div><div><h3>Methods</h3><p>Medline/Embase were systematically searched from January 1, 2011 to July 1, 2021 for trials evaluating pharmacologic interventions on clinical cardiovascular outcomes published in 5 high-impact journals. Information on adequate vs inadequate reporting of cointerventions, blinding, risk of bias due to deviations of intended interventions (low vs high/some concerns), funding (nonindustry vs industry), design (superiority vs noninferiority), and results were assessed by 2 reviewers. The association with effect sizes was assessed using meta-regression random-effect analysis, expressed as ratios of odds ratios (ROR). RORs of &gt;1.0 indicated that trials with the methodological factor pointing to lower quality report larger treatment estimates.</p></div><div><h3>Results</h3><p>In total, 164 trials were included. Of the 164 trials, 124 (74%) did not adequately report cointerventions; 89 of the 164 trials (54%) provided no information regarding cointerventions, and 70 of the 164 (43%) were at risk of bias due to inadequate blinding. Moreover, 86 of the 164 (53%) were at risk of bias due to deviation of intended interventions. Of the 164 trials, 144 (88%) were funded by the industries. Trials with inadequate reporting of cointerventions had larger treatment estimates for the primary end point (ROR, 1.08; 95% CI, 1.01-1.15; <em>I</em>^<em>2</em>=0%). No significant association with results for blinding (ROR, 0.97; 95% CI, 0.91-1.03; <em>I</em>^<em>2</em>=66%), deviation of intended interventions (ROR, 0.98; 95% CI, 0.92-1.04; <em>I</em>^<em>2</em>=0%), or funding (ROR, 1.01; 95% CI, 0.93-1.09; <em>I</em>^<em>2</em>=0%) was found.</p></div><div><h3>Conclusion</h3><p>We conclude that trials with inadequate reporting of cointerventions showed larger treatment effect estimates, potentially indicating overestimation of therapeutic benefit.</p></div><div><h3>Trial Registration</h3><p>Prospero Identifier: CRD42017072522</p></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10250579/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9992423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contemporary Monoclonal Antibody Utilization in Glomerular Diseases","authors":"Iyad Mansour MD,&nbsp;Sangeetha Murugapandian MD,&nbsp;Bekir Tanriover MD, MPH, MBA, FAST,&nbsp;Bijin Thajudeen MD","doi":"10.1016/j.mayocpiqo.2023.04.009","DOIUrl":"10.1016/j.mayocpiqo.2023.04.009","url":null,"abstract":"<div><p>Therapeutic monoclonal antibodies (MAbs) have been one of the fastest growing drug classes in the past 2 decades and are indicated in the treatment of cancer, autoimmune disorders, solid organ transplantation, and glomerular diseases. The Food and Drug Administration has approved 100 MAbs between 1986 and 2021, and MAbs account for 20% of Food and Drug Administration’s new drug approval every year. MAbs are preferred over traditional immunosuppressive agents because of their high specificity, reduced number of drug-drug interactions, and low toxicity, which make them a prime example of personalized medicine. In this review article, we provide an overview of the taxonomy, pharmacology, and therapeutic applications of MAbs in glomerular diseases. We searched the literature through PubMed using the following search terms: <em>monoclonal antibodies, glomerular diseases, pharmacokinetics, pharmacodynamics, immunoglobulin, murine, chimeric,</em> <em>humanized</em><em>, and fully human</em>, and limited our search to years 2018-2023. We selected peer-reviewed journal articles with an evidence-based approach, prioritizing randomized control trials in specific glomerular diseases, if available. Advances in the MAb field have resulted in a significant paradigm shift in targeted treatment of immune-mediated glomerular diseases, and multiple randomized control trials are currently being conducted. Increased recognition is critical to expand their use in experimental research and personalized medicine.</p></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/cf/c7/main.PMC10338194.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9813394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Collaborative Diagnostic Conversations Between Clinicians, Patients, and Their Families: A Way to Avoid Diagnostic Errors","authors":"Nataly R. Espinoza Suarez MD ,&nbsp;Ian Hargraves PhD ,&nbsp;Naykky Singh Ospina MD, MSc ,&nbsp;Angela Sivly ,&nbsp;Andrew Majka MD ,&nbsp;Juan P. Brito MD, MSc","doi":"10.1016/j.mayocpiqo.2023.06.001","DOIUrl":"10.1016/j.mayocpiqo.2023.06.001","url":null,"abstract":"<div><h3>Objective</h3><p>To identify the components of the collaborative diagnostic conversations between clinicians, patients, and their families and how deficiencies in these conversations can lead to diagnostic errors.</p></div><div><h3>Patients and Methods</h3><p>We purposively selected 60 video recordings of clinical encounters that included diagnosis conversations. These videos were obtained from the internal medicine, and family medicine services at Mayo Clinic’s campus in Rochester, Minnesota. These clinical encounters were recorded between November 2017, and December 2021, during the conduct of studies aiming at developing or testing shared decision-making interventions. We followed a critically reflective approach model for data analysis.</p></div><div><h3>Results</h3><p>We identified 3 components of diagnostic conversations as follows: (1) recognizing diagnostic situations, (2) setting priorities, and (3) creating and reconciling a diagnostic plan. Deficiencies in diagnostic conversations could lead to framing issues in a way that sets diagnostic activities off in an incorrect or undesirable direction, incorrect prioritization of diagnostic concerns, and diagnostic plans of care that are not feasible, desirable, or productive.</p></div><div><h3>Conclusion</h3><p>We identified 3 clinician-and-patient diagnostic conversation components and mapped them to potential diagnostic errors. This information may inform additional research to identify areas of intervention to decrease the frequency and harm associated with diagnostic errors in clinical practice.</p></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a9/d5/main.PMC10344690.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9823669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychophysiologic Symptom Relief Therapy for Post-Acute Sequelae of Coronavirus Disease 2019","authors":"Michael Donnino MD ,&nbsp;Patricia Howard BS ,&nbsp;Shivani Mehta BA ,&nbsp;Jeremy Silverman BA ,&nbsp;Maria J. Cabrera BA ,&nbsp;Jolin B. Yamin PhD ,&nbsp;Lakshman Balaji MPH ,&nbsp;Katherine M. Berg MD ,&nbsp;Stanley Heydrick PhD ,&nbsp;Robert Edwards PhD ,&nbsp;Anne V. Grossestreuer PhD, MSc","doi":"10.1016/j.mayocpiqo.2023.05.002","DOIUrl":"https://doi.org/10.1016/j.mayocpiqo.2023.05.002","url":null,"abstract":"<div><h3>Objective</h3><p>To determine if psychophysiologic symptom relief therapy (PSRT) will reduce symptom burden in patients suffering from post-acute sequelae of coronavirus disease 2019 (COVID-19) (PASC) who had mild/moderate acute COVID-19 disease without objective evidence of organ injury.</p></div><div><h3>Patients and Methods</h3><p>Twenty-three adults under the age of 60 years with PASC for at least 12 weeks after COVID-19 infection were enrolled in an interventional cohort study conducted via a virtual platform between May 18, 2021 and August 7, 2022. Participants received PSRT during a 13-week (approximately 44-hour) course. Participants were administered validated questionnaires at baseline and at 4, 8, and 13 weeks. The primary outcome was a change in somatic symptoms from baseline, measured using the Somatic Symptom Scale-8, at 13 weeks.</p></div><div><h3>Results</h3><p>The median duration of symptoms before joining the study was 267 days (interquartile range: 144, 460). The mean Somatic Symptom Scale-8 score of the cohort decreased from baseline by 8.5 (95% CI: 5.7-11.4), 9.4 (95% CI: 6.9-11.9), and 10.9 (95% CI: 8.3-13.5) at 4, 8, and 13 weeks, respectively (all <em>P</em>&lt;.001). Participants also experienced statistically significant improvements across other secondary outcomes including changes in dyspnea, fatigue, and pain (all <em>P</em>&lt;.001).</p></div><div><h3>Conclusion</h3><p>PSRT may effectively decrease symptom burden in patients suffering from PASC without evidence of organ injury. The study was registered on <span>clinicaltrials.gov</span><svg><path></path></svg> (NCT 04854772).</p></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49879418","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":"Potentially Preventable Hospitalization Among Adults with Hearing, Vision, and Dual Sensory Loss: A Case and Control Study","authors":"Samantha Ratakonda ,&nbsp;Paul Lin MS ,&nbsp;Neil Kamdar MA ,&nbsp;Michelle Meade PhD ,&nbsp;Michael McKee MD ,&nbsp;Elham Mahmoudi PhD","doi":"10.1016/j.mayocpiqo.2023.06.004","DOIUrl":"10.1016/j.mayocpiqo.2023.06.004","url":null,"abstract":"<div><h3>Objective</h3><p>To evaluate the risk of potentially preventable hospitalizations (PPHs) among adults with sensory loss. We hypothesized a greater PPH risk among people with a sensory loss (hearing, vision, and dual) compared with controls.</p></div><div><h3>Patients and Methods</h3><p>Using 2007-2016 Medicare fee-for-service claims, this retrospective, case-control study examined the risk of PPH among adults aged 65 years and older with hearing, vision, and dual sensory loss compared with their corresponding counterparts without sensory loss (between June 1, 2022, and February 1, 2023). We ran 3 step-in regression models for the 3 case and control cohorts examining PPH risk. Our generalized linear regression models controlled for age, sex, race, Elixhauser comorbidity count, rurality, neighborhood characteristics, and the number of primary care physicians and hospitals at the county level.</p></div><div><h3>Results</h3><p>People with vision (adjusted odds ratio [aOR], 1.21; 95% CI, 0.84-0.87) and dual sensory loss (aOR, 1.26; 95% CI, 1.14-1.40) showed a higher PPH risks than their corresponding controls. For people with hearing loss, our unadjusted models showed a higher PPH risk (OR, 1.40; 95% CI, 1.38-1.43) but after adjustment, hearing loss showed a protective association against PPH risk (OR, 0.85; 95% CI, 0.84-0.87). Moreover, in all models, annual wellness visits reduced the PPH risk by about half (eg, aOR, 0.54; 95% CI, 0.52-0.55), whereas living in disadvantaged neighborhood increased the PPH risk (eg, aOR, 1.13; 95% CI, 1.10-1.15) for cases and controls.</p></div><div><h3>Conclusion</h3><p>People with vision and dual sensory loss were at greater PPH risk. This study has important health policy implications in reducing PPH and is indicative of a need for more incentivized and systematic approaches to facilitating the use of preventive care, particularly among older adults living in a disadvantaged neighborhood.</p></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/85/2d/main.PMC10391598.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10307905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Closer Look—Who Are We Screening for Lung Cancer?","authors":"Kristine Galang MD ,&nbsp;Efstathia Polychronopoulou MPH, RS, PhD ,&nbsp;Gulshan Sharma MD ,&nbsp;Shawn P.E. Nishi MD","doi":"10.1016/j.mayocpiqo.2023.04.002","DOIUrl":"10.1016/j.mayocpiqo.2023.04.002","url":null,"abstract":"<div><h3>Objective</h3><p>To evaluate the characteristics of individuals receiving lung cancer screening (LCS) and identify those with potentially limited benefit owing to coexisting chronic illnesses and/or comorbidities.</p></div><div><h3>Patients and Methods</h3><p>In this retrospective study in the United States, patients were selected from a large clinical database who received LCS from January 1, 2019, through December 31, 2019, with at least 1 year of continuous enrollment. We assessed for potentially limited benefit in LCS defined strictly as not meeting the traditional risk factor inclusion criteria (age &lt;55 years or &gt;80 years, previous computed tomography scan within 11 months before an LCS examination, or a history of nonskin cancer) or liberally as having the potential exclusion criteria related to comorbid life-limiting conditions, such as cardiac and/or respiratory disease.</p></div><div><h3>Results</h3><p>A total of 51,551 patients were analyzed. Overall, 8391 (16.3%) individuals experienced a potentially limited benefit from LCS. Among those who did not meet the strict traditional inclusion criteria, 317 (3.8%) were because of age, 2350 (28%) reported a history of nonskin malignancy, and 2211 (26.3%) underwent a previous computed tomography thorax within 11 months before an LCS examination. Of those with potentially limited benefit owing to comorbidity, 3680 (43.9%) were because of severe respiratory comorbidity (937 [25.5%] with any hospitalization for coronary obstructive pulmonary disease, interstitial lung disease, or respiratory failure; 131 [3.6%] with hospitalization for respiratory failure requiring mechanical ventilation; or 3197 [86.9%] with chronic obstructive disease/interstitial lung disease requiring outpatient oxygen) and 721 (8.59%) with cardiac comorbidity.</p></div><div><h3>Conclusion</h3><p>Up to 1 of 6 low-dose computed tomography examinations may have limited benefit from LCS.</p></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c6/fb/main.PMC10244365.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9663805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}