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

{"title":"Blood Stream Infections in COVID-19 Patients From a Tertiary Care Center in Lebanon: Causative Pathogens and Rates of Multi-Drug Resistant Organisms","authors":"Sarah B. Nahhal MD ,&nbsp;Johnny Zakhour MD ,&nbsp;Abdel Hadi Shmoury MD ,&nbsp;Tedy Sawma MD ,&nbsp;Sara F. Haddad MD ,&nbsp;Tamara Abdallah MSc ,&nbsp;Nada Kara Zahreddine CIC ,&nbsp;Joseph Tannous MHRM ,&nbsp;Nisrine Haddad Pharm D ,&nbsp;Nesrine Rizk MD ,&nbsp;Souha S. Kanj MD","doi":"10.1016/j.mayocpiqo.2023.10.001","DOIUrl":"https://doi.org/10.1016/j.mayocpiqo.2023.10.001","url":null,"abstract":"<div><h3>Objective</h3><p>To report the microbiological profile of the pathogens implicated in blood stream infections (BSI) in hospitalized coronavirus disease 2019 (COVID-19) patients and to examine the risk factors associated with multidrug-resistant organisms (MDROs) causing BSI.</p></div><div><h3>Patients and Methods</h3><p>Between March 2020 and September 2021, 1647 patients were hospitalized with COVID-19 at the American University of Beirut. From 85 patients, 299 positive blood cultures were reported to the Infection Control and Prevention Program. The BSI was defined as 1 positive blood culture for bacterial or fungal pathogens. The following organisms were considered MDROs: methicillin-resistant <em>Staphylococcus aureus</em>, vancomycin-resistant <em>Enterococcus</em> spp, carbapenem-resistant <em>Enterobacterales</em> spp., carbapenem-resistant <em>Pseudomonas aeruginosa</em>, MDR <em>Acinetobacter baumannii</em> only susceptible to colistin or tigecycline, and <em>Candida auris.</em></p></div><div><h3>Results</h3><p>We identified 99 true positive BSI events. Gram-negative bacteria accounted for 38.4 %, followed by Gram-positive bacteria (37.4%), and fungi (24.2%). The most isolated species were <em>Candida</em> spp. (23%), 3 of which were <em>C. auris</em>, followed by <em>Enterobacterales</em> spp. (13%), <em>Enterococcus</em> spp. (12%), <em>S. aureus</em> (9%), <em>P. aeruginosa</em> (9%), and <em>A. baumannii</em> (3%). The MDROs represented 26% of the events. The overall mortality rate was 78%. The time to acquisition of BSI in patients with MDROs was significantly longer compared with that of non-MDROs (20.2 days vs 11.2 days). And there was a significantly shorter time from acquisition of BSI to mortality between MDROs and non-MDROs (1.5 vs 8.3 days).</p></div><div><h3>Conclusion</h3><p>Rigorous infection prevention and control measures and antimicrobial stewardship are important to prevent antimicrobial resistance progression, especially in low-resource settings.</p></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2542454823000681/pdfft?md5=b0a82eabdc062d57635e0b37f75841c8&pid=1-s2.0-S2542454823000681-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138413007","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":"Impact of a Wellness Leadership Intervention on the Empathy, Burnout, and Resting Heart Rate of Medical Faculty","authors":"Debra A. Gilin PhD ,&nbsp;Gregory G. Anderson MSc ,&nbsp;Seyedehsan Etezad MSc ,&nbsp;Dayna Lee-Baggley PhD ,&nbsp;Angela M. Cooper PhD, RPsych ,&nbsp;Roberta J. Preston EdD","doi":"10.1016/j.mayocpiqo.2023.09.005","DOIUrl":"https://doi.org/10.1016/j.mayocpiqo.2023.09.005","url":null,"abstract":"<div><h3>Objective</h3><p>To evaluate the efficacy of a wellness leadership intervention for improving the empathy, burnout, and physiological stress of medical faculty leaders.</p></div><div><h3>Participants and Methods</h3><p>Participants were 49 medical faculty leaders (80% physicians, 20% basic scientists; 67% female). The 6-week course was evaluated with a 15-week longitudinal waitlist-control quasi-experiment from September 1, 2021, through December 20, 2021 (during the COVID-19 pandemic). We analyzed 3 pretest-posttest-posttest and 6 weekly survey measurements of affective empathy and burnout, and mean=85 (SD=31) aggregated daily resting heart rates per participant, using 2-level hierarchical linear modeling.</p></div><div><h3>Results</h3><p>The course found a preventive effect for leaders’ burnout escalation. As the control group awaited the course, their empathy decreased (coefficient_Time=−1.27; <em>P</em>=.02) and their resting heart rates increased an average of 1.4 beats/min (coefficient_Time=0.18; <em>P</em>&lt;.001), reflecting the toll of the pandemic. Intervention group leaders reported no empathy decrements (coefficient_Time=.33; <em>P</em>=.59) or escalated resting heart rate (coefficient_Time=−0.05; <em>P</em>=.27) during the same period. Dose-response analysis revealed that both groups reduced their self-rated burnout over the 6 weeks of the course (coefficient_Time=−0.28; <em>P</em>=.007), and those who attended more of the course showed less heart rate increase (coefficient_{Time∗Dosage}=−0.05; <em>P</em>&lt;.001). In addition, 12.73% of the within-person fluctuation in empathy was associated with burnout and resting heart rate.</p></div><div><h3>Conclusion</h3><p>A wellness leadership intervention helped prevent burnout escalation and empathy decrement in medical faculty leaders during the COVID-19 pandemic, showing potential to improve the supportiveness and psychological safety of the medical training environment.</p></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2542454823000632/pdfft?md5=06b08332fb7a367a7844d8925992f219&pid=1-s2.0-S2542454823000632-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138413122","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":"Reviewers for Mayo Clinic Proceedings: Innovations, Quality & Outcomes (2023)","authors":"","doi":"10.1016/j.mayocpiqo.2023.11.001","DOIUrl":"https://doi.org/10.1016/j.mayocpiqo.2023.11.001","url":null,"abstract":"","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2542454823000693/pdfft?md5=70fcc57497e954d787a2150e0af9d0d0&pid=1-s2.0-S2542454823000693-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138430365","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":"Safety and Feasibility of a Fast-Track Pathway for Neurosurgical Craniotomy Patients: Bypassing the Intensive Care Unit","authors":"Carlos Perez-Vega MD ,&nbsp;Devang K. Sanghavi MBBS, MD ,&nbsp;Pablo Moreno Franco MD ,&nbsp;Ryan M. Chadha MD ,&nbsp;Alberto E. Ardon MD ,&nbsp;Elird Bojaxhi MD ,&nbsp;Klaus D. Torp MD ,&nbsp;Lisa A. Marshall RN ,&nbsp;Tiffany M. Halstead RN ,&nbsp;Valentino E. Ford RN ,&nbsp;Lynda M. Christel ,&nbsp;Sanjeet S. Grewal MD ,&nbsp;Kaisorn L. Chaichana MD ,&nbsp;Alfredo Quinones-Hinojosa MD ,&nbsp;Levi W. Howard DO ,&nbsp;W. Christopher Fox MD ,&nbsp;William D. Freeman MD ,&nbsp;NPCU Group","doi":"10.1016/j.mayocpiqo.2023.09.002","DOIUrl":"https://doi.org/10.1016/j.mayocpiqo.2023.09.002","url":null,"abstract":"<div><h3>Objective</h3><p>To describe the safety and feasibility of a fast-track pathway for neurosurgical craniotomy patients receiving care in a neurosciences progressive care unit (NPCU).</p></div><div><h3>Patients and Methods</h3><p>Traditionally, most craniotomy patients are admitted to the neurosciences intensive care unit (NSICU) for postoperative follow-up. Decreased availability of NSICU beds during the coronavirus disease-2019 delta surge led our team to establish a de-novo NPCU to preserve capacity for patients requiring high level of care and would bypass routine NSICU admissions. Patients were selected a priori by treating neurosurgeons on the basis of the potential need for high-level ICU services. After operation, selected patients were transferred to the postoperative care unit, where suitability for NPCU transfer was reassessed with checklist-criteria. This process was continued after the delta surge.</p></div><div><h3>Results</h3><p>From July 1, 2021 to September 30, 2022, 57 patients followed the NPCU protocol. Thirty-four (59.6%) were women, and the mean age was 56 years. Fifty-seven craniotomies for 34 intra-axial and 23 extra-axial lesions were performed. After assessment and application of the checklist-criteria, 55 (96.5%) were transferred to NPCU, and only 2 (3.5%) were transferred to ICU. All 55 patients followed in NPCU had good safety outcomes without requiring NSICU transfer. This saved $143,000 and led to 55 additional ICU beds for emergent admissions.</p></div><div><h3>Conclusion</h3><p>This fast-track craniotomy protocol provides early experience that a surgeon-selected group of patients may be suitably monitored outside the traditional NSICU. This system has the potential to reduce overall health care expenses, increase capacity for NSICU bed availability, and change the paradigm of NSICU admission.</p></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2542454823000607/pdfft?md5=a56a283ce489e0ca2e6be377689ea371&pid=1-s2.0-S2542454823000607-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136592881","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":"The Faces of Financial Toxicity: A Qualitative Interview Study of Financial Toxicity in Advanced Cancer Patients in Phase I Oncology Trials","authors":"Colt Williams MD ,&nbsp;Leigh Meyer BA ,&nbsp;Omar Kawam BS ,&nbsp;Konstantinos Leventakos MD, PhD ,&nbsp;Erin S. DeMartino MD","doi":"10.1016/j.mayocpiqo.2023.09.003","DOIUrl":"https://doi.org/10.1016/j.mayocpiqo.2023.09.003","url":null,"abstract":"<div><h3>Objective</h3><p>To characterize the financial toxicity experienced by advanced cancer patients enrolled in phase I oncology trials.</p></div><div><h3>Patients and Methods</h3><p>We conducted structured interviews with cancer patients participating in phase I clinical trials. Using a thematic analysis approach, we identified recurring themes in patients’ experiences of financial toxicity resulting from trial participation.</p></div><div><h3>Results</h3><p>Seven major themes emerged from the interviews: (1) the burden of travel, (2) a willingness to pursue treatment despite financial risk, (3) fear of destitution, (4) financial toxicity equaling physical toxicity, (5) changes in food spending, (6) reluctance to confide in the study investigator about financial toxicity, and (7) difficulty navigating financial aid. These themes highlight the multifaceted financial challenges faced by patients in early phase clinical trials and the need for targeted support services.</p></div><div><h3>Conclusion</h3><p>Our findings underscore the relevance of financial toxicity in the context of phase I clinical trials and provide insights into the diverse challenges faced by advanced cancer patients. These challenges likely augment the disparities seen in trial enrollment for historically marginalized populations. Addressing financial toxicity in this population is crucial for improving patient outcomes and quality of life. Future research should focus on developing effective interventions and support services tailored to the needs of patients in early phase clinical trials.</p></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2542454823000619/pdfft?md5=cd60d1b204c8779198cb8220d6ff9acd&pid=1-s2.0-S2542454823000619-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136592880","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":"Organizational Intent, Organizational Structures, and Reviewer Mental Models Influence Mortality Review Processes","authors":"Inas S. Khayal PhD ,&nbsp;Rebecca L. Butcher MS, MPH ,&nbsp;Colin H. McLeish MD, MBA ,&nbsp;Yujia Shentu MD, MS ,&nbsp;Amber E. Barnato MD, MPH, MS","doi":"10.1016/j.mayocpiqo.2023.09.004","DOIUrl":"https://doi.org/10.1016/j.mayocpiqo.2023.09.004","url":null,"abstract":"<div><h3>Objective</h3><p>To identify the factors that influence the mortality review process at health systems, including how mortality review is conducted, cases are adjudicated, and results are used.</p></div><div><h3>Methods</h3><p>We conducted a qualitative analysis of the mortality review processes of 6 US health systems from February 1, 2021 to June 31, 2021. The data sources included individual and small-group semi-structured interviews with mortality review team members and a content analysis of site artifacts (eg, guiding principles, chart abstraction forms, review workflows, and clinical pathways developed from past mortality reviews). We analyzed each site’s mortality review process, goals and incentives for mortality review, historical and evolving aspects of mortality review, personnel involved, and post-review use of findings.</p></div><div><h3>Results</h3><p>Across the 6 systems, we interviewed a total of 24 mortality review experts and analyzed 26 site documents. We identified 3 thematic factors that influence mortality review processes: organizational intent, organizational structures for mortality review, and the mental models of individuals involved in the review process. Two subthemes emerged within organizational intent: (1) identifying preventable deaths to lower (clinical or financial) risk and (2) using death cases to guide system improvement. Sites varied in governance and decision rights concerning mortality review and adjudication, with 2 subthemes within organizational structures: (1) centralized-hierarchical and (2) decentralized or multidisciplinary. The analysis of mental models of participating reviewers revealed 2 themes: (1) confirmation of preventability and (2) identification of patterns or “signals.”</p></div><div><h3>Conclusion</h3><p>Understanding the factors that influence mortality review allows health systems to better leverage mortality review for institutional improvement and to develop training that builds shared mental models to enhance the review process.</p></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71765500","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":"Preoperative Epidural Steroid Injections and Postoperative Infections After Lumbar or Cervical Spine Surgery: A Systematic Review and Meta-Analysis","authors":"W. Michael Hooten MD ,&nbsp;Nathan D. Eberhart ,&nbsp;Fei Cao MD, PhD ,&nbsp;Danielle J. Gerberi MLIS ,&nbsp;Rajat N. Moman MD, MA ,&nbsp;Salman Hirani MD","doi":"10.1016/j.mayocpiqo.2023.07.007","DOIUrl":"10.1016/j.mayocpiqo.2023.07.007","url":null,"abstract":"<div><h3>Objective</h3><p>To determine the risk difference and 95% prediction intervals (PIs) for postoperative infections (POIs) associated with preoperative epidural steroid injections (ESIs) in adults undergoing lumbar or cervical spine surgery.</p></div><div><h3>Methods</h3><p>Comprehensive database searches were conducted from inception dates through December 2023. Inclusion criteria included all study designs involving adults receiving a preoperative ESI before lumbar or cervical decompression or fusion spine surgery. Risk of bias was assessed using a modified tool developed for uncontrolled studies. The summary estimates of risk difference and the corresponding PIs were reported.</p></div><div><h3>Results</h3><p>A total of 12 studies were included in the systematic review, of which 9 were included in the meta-analysis. Preoperative ESIs within 1 month of lumbar spine decompression or fusion surgery were associated with a 0.6% and 2.31% greater risk of a POI, respectively. In adults ≥65 years of age, ESIs within 1 or 1-3 months of lumbar spine decompression or fusion surgery were associated with a 1.3% and 0.6% greater risk of a POI, respectively. Preoperative ESIs within 3 months of cervical spine fusion were not associated with an increased risk of a POI. The bounds of all corresponding 95% PIs were nonsignificant.</p></div><div><h3>Conclusion</h3><p>The observations of this study provide summary estimates of risk difference and 95% PIs, which could be used to support shared decision-making about the use of ESIs before cervical or lumbar spine surgery.</p></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/08/ca/main.PMC10466430.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10138094","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":"Associations Between Management Pathway and Opioid Prescriptions for Patients Entering the Emergency Department With Neck and Back Pain","authors":"Maggie E. Horn DPT, MPH, PhD ,&nbsp;Corey B. Simon DPT, PhD ,&nbsp;Hui-Jie Lee PhD ,&nbsp;Stephanie A. Eucker MD, PhD","doi":"10.1016/j.mayocpiqo.2023.08.001","DOIUrl":"10.1016/j.mayocpiqo.2023.08.001","url":null,"abstract":"<div><h3>Objective</h3><p>To determine associations between post-emergency department (ED) management pathways and downstream opioid prescriptions in patients seeking care for incident neck and/or back pain.</p></div><div><h3>Patients and Methods</h3><p>We identified patients seeking first-time ED care for neck and/or back pain from January 1, 2013, through November 6, 2017. We reported demographic characteristics and opioid prescriptions across management pathways using descriptive statistics and assessed the relative risk of any opioid prescription 12 months post-ED visit among 5 different post-ED management pathways using Poisson regression adjusted for patient demographic characteristics.</p></div><div><h3>Results</h3><p>Within 12 months after the index ED visit, 58.0% (n=10,949) were prescribed an opioid, with most patients prescribed an opioid within the first week (average daily morphine milligram equivalents of 6.8 mg (SD 9.6 mg). The morphine milligram equivalents decreased to 0.7 mg (SD 8.2 mg) by week 4 and remained consistently less than 1 mg between week 4 and 12 months. Compared with the ED to primary care provider pathway, the relative risk of opioid prescription between 7 days and 12 months after the index ED visit was similar for the ED to physical therapy pathway, higher for both the ED to hospital admission or repeat ED visit pathway (30% increase; relative risk (RR), 1.3; 95% CI, 1.17-1.44) and the ED to specialist pathway (19% increase; RR, 1.19; 95% CI, 1.07-1.33), and lower in the ED with no follow-up visits pathway (41% decrease; RR, 0.59; 95% CI, 0.54-0.65).</p></div><div><h3>Conclusion</h3><p>In general, more conservative care was associated with lower opioid prescription rates, and escalated care was associated with higher opioid prescription rates.</p></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/3b/8d/main.PMC10568062.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41242723","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":"Real-world Duration of Use and Dosing Frequency of Daratumumab in Patients With Multiple Myeloma in the United States","authors":"Rafael Fonseca MD ,&nbsp;Eric E. Chinaeke PhD ,&nbsp;Niodita Gupta-Werner MD, MPH, PhD ,&nbsp;Alex Z. Fu PhD ,&nbsp;Shuchita Kaila PhD","doi":"10.1016/j.mayocpiqo.2023.07.001","DOIUrl":"10.1016/j.mayocpiqo.2023.07.001","url":null,"abstract":"<div><p>Daratumumab (DARA) is an anti-CD38 monoclonal antibody approved as a combination therapy for newly diagnosed multiple myeloma (MM) and as monotherapy and combination therapy for relapsed or refractory MM cases. We assessed the length of DARA use across lines of therapy and the probabilities of treatment discontinuation in patients with MM in the real-world. We used the deidentified Clinformatics Data Mart database from Optum to identify patients with MM (n=2124) who received DARA-containing treatment between November 1, 2015 and March 31, 2021 in the United States. Patients were excluded if they had received a stem cell transplant. The duration of DARA use was defined as the time interval between the first initiation and discontinuation of DARA as a time-to-event outcome using the Kaplan-Meier method. A gap of more than 60 days between 2 consequent DARA claim dates was defined as DARA discontinuation. The median duration of continuous DARA use was 16.6 months. By 24 months, 33.1% of patients remained on DARA treatment. In a subgroup analysis of patients with 12 months or more continuous insurance coverage (n=1246), the median length of DARA use was 24.7 months; by 24 months, 51.8% remained on DARA treatment. The dose adherence ratios (observed DARA doses relative to the label) were close to 1.0, particularly among patients with longer follow-up, indicating that real-world DARA dosing frequency was similar to that on the approved label. In summary, this real-world analysis reported that the median duration of continuous DARA use is 16.6 months, with high dosing adherence in patients who have MM.</p></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/5b/e8/main.PMC10507479.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41161674","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":"Association of Primary Care Risk Mitigation Visits and Nonelective Emergency Department Visits in Patients Using Long-term Opioid Therapy","authors":"Nancy V. Koch MD ,&nbsp;Richard J. Butterfield III MA","doi":"10.1016/j.mayocpiqo.2023.07.008","DOIUrl":"10.1016/j.mayocpiqo.2023.07.008","url":null,"abstract":"<div><h3>Objective</h3><p>To determine risk factors for nonelective emergency department visits <strong>(</strong>NEDVs) and whether primary care visits incorporating risk mitigation tools prevented NEDVs among patients using long-term opioid therapy (LOT).</p></div><div><h3>Patients and Methods</h3><p>We retrospectively searched the electronic health records at Mayo Clinic primary care outpatient practices in Arizona and Florida in all of 2018 and 2019 for the records of individual adult patients using LOT. Patient and clinician demographic characteristics and patient risk factors were compared between patients with and without risk mitigation visits. Univariate and multivariable logistic regression was used to determine risk factors for NEDVs.</p></div><div><h3>Results</h3><p>Among 457 patients using LOT identified during the study period, most were women (n=266, 58.2%), and the median age was 69 years. Long-term opioid therapy risk mitigation visits were performed equally by family medicine and internal medicine clinicians and by a significantly higher proportion of Florida clinicians than Arizona clinicians (87.0% vs 70.5%; <em>P</em>&lt;.001). Older age, falls, and mental health care utilization all increased the risk of NEDVs. Risk mitigation visits were protective against NEDVs (odds ratio, 0.56; 95% CI, 0.35-0.89; <em>P</em>=.01) after adjustment for older age, falls, and mental health care utilization.</p></div><div><h3>Conclusion</h3><p>Risk mitigation visits are effective in preventing NEDVs, and all patients using LOT should have such visits when possible.</p></div>","PeriodicalId":94132,"journal":{"name":"Mayo Clinic proceedings. Innovations, quality & outcomes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/5d/52/main.PMC10466427.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10193633","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}