A Review of Multifaceted Care Approaches for the Prevention and Mitigation of Delirium in Intensive Care Units.

Objective: The objective of this review is to examine the effectiveness, implementation, and costs of multifaceted care approaches, including care bundles, for the prevention and mitigation of delirium in patients hospitalized in intensive care units (ICUs).

Data Sources: A systematic search using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted utilizing PubMed, EMBASE, and CINAHL. Searches were limited to studies published in English from January 1, 1988, to March 31, 2014.

Quality of care in a low-income consumer-driven health plan: assessment of healthcare effectiveness data information set (HEDIS) scores for secondary prevention.

The passage of the Patient Protection and Affordable Care Act of 2010 (PPACA) may create an estimated 16 million new Medicaid enrollees. This underscores the need to develop innovative strategies to provide efficient care to this population without compromising quality. To address concerns that consumer-driven health plans (CDHPs) and cost sharing discourage individuals from seeking needed care, we examined the Healthcare Effectiveness Data Information Set (HEDIS) measures of secondary prevention for a CDHP offered to uninsured, non-Medicaid eligible adults with incomes under 200% of the federal poverty level and compared them to the National Committee for Quality Assurance (NCQA) benchmarks achieved by national Medicaid and commercially insured health plans.

Impact of hypoglycemia associated with antihyperglycemic medications on vascular risks in veterans with type 2 diabetes.

Objective: Hypoglycemia is associated with failure to show cardiovascular benefit and increased mortality of intensive glycemic control in randomized clinical trials. This retrospective cohort study aimed to examine the impact of hypoglycemia on vascular events in clinical practice.

Research Design And Methods: Patients with type 2 diabetes were identified by ICD-9-CM codes (250.

Effect of illness severity and comorbidity on patient safety and adverse events.

The objective was to investigate the effect of admission health status on hospital adverse events and added costs. Secondary data were from merged administrative and clinical sources for Mayo Clinic Rochester, Minnesota hospital discharges in 2005 (N = 60,599). This was a retrospective cross-sectional study of the effect of demographics, diagnosis group, comorbidity, and admission illness severity on adverse events, incremental costs, and length of stay (LOS) using the Agency for Healthcare Research and Quality Patient Safety Indicators and provider-reported events with harm.

A comparison of hospital adverse events identified by three widely used detection methods.

Objective: Determine the degree of congruence between several measures of adverse events.

Design: Cross-sectional study to assess frequency and type of adverse events identified using a variety of methods.

Setting: Mayo Clinic Rochester hospitals.

Effect of premium, copayments, and health status on the choice of health plans.

Objective: Explore effects of comorbidity and prior health care utilization on choice of employee health plans with different levels of cost sharing.

Data Sources/study Setting: Mayo Clinic employees in Rochester, Minnesota (MCR) under age 65 in January 2004; N = 20,379.

Study Design: Assessment of a natural experiment where self-funded medical care benefit options were changed to contain costs within a large medical group practice.

Characteristics of physician relocation following Hurricane Katrina.

Introduction: On August 29, 2005, Hurricane Katrina made landfall along the US Gulf Coast, resulting in the evacuation of >1.5 million people, including nearly 6000 physicians. This article examines the relocation patterns of physicians following the storm, determines the impact that the disaster had on their lives and practices, and identifies lessons learned.

Training practitioners in evidence-based chronic disease prevention for global health.

Too often, public health decisions are based on short-term demands rather than long-term research and objectives. Policies and programmes are sometimes developed around anecdotal evidence. The Evidence-Based Public Health (EBPH) programme trains public health practitioners to use a comprehensive, scientific approach when developing and evaluating chronic disease programmes.

Impact of diagnosis-timing indicators on measures of safety, comorbidity, and case mix groupings from administrative data sources.

Context: Many attempts to identify hospital complications rely on secondary diagnoses from billing data. To be meaningful, diagnosis codes must distinguish between diagnoses after admission and those existing before admission.

Objective: To assess the influence of diagnoses at admission on patient safety, comorbidity, severity measures, and case mix groupings for Medicare reimbursement.

When should a multicampus hospital be considered a single entity for public reporting on patient safety issues?

Objective: Attempts to provide information to consumers about patient safety on specific hospitals have conflicted with organization self-perceptions and led to confusion among the general public. This article presents organizational theory framework and criteria to classify organizations as single versus multiple reporting entities.

Participants And Methods: Operational definitions are presented.

Competency-based healthcare management education: the Saint Louis University experience.

As a follow up to a school-wide initiative to create a common set of competencies for all degree programs in the Saint Louis University School of Public Health, in January 2000 the Department of Health Management and Policy (HMP, renamed from the Department of Health Administration in 2002) began a process to develop a competency-based curriculum for its Master of Health Administration (MHA) degree program with the goal of establishing a foundation for systematically measuring the learning outcomes of its students as they progressed through the program. This article describes how the department developed a set of competencies most appropriate for graduate training in healthcare management, how it incorporated these into its overall MHA program curriculum and content, and how effective this approach has been in measuring student progress in mastering these competencies over the first two years of this initiative. The problems and challenges encountered during this process are discussed, as are the next steps for effectively using competencies to assess healthcare management program learning outcomes.

Predicting persistently high primary care use.

Purpose: We wanted to identify risk factors for persistently high use of primary care.

Methods: We analyzed outpatient office visits to practitioners in family medicine, general internal medicine, general pediatrics, and obstetrics for 1997-1999 among patients in a small Midwestern city covered by a fee-for-service insurance plan with no co-payments for physician visits and no requirement for referral to specialty care. Logistic regression was used to predict which patients with 10 or more primary care visits in 1997 would repeat high use in 1998 based on demographic and diagnostic categories (adjusted clinical groups [ACGs]).

Strategies for more efficient performance through hospital merger.

This article compares the operating performance of merged and non-merged local hospitals during the late 1980s and early 1990s, a period not unlike that being experienced in hospitals today. A matched case-control design is employed to create "synthetically" merged hospitals--to represent them as if they had effected a merger--and compares their performance to a group of similar hospitals that did merge.