Publications by authors named "Glance L"
Background: Sepsis disproportionately affects marginalized communities. This study aims to evaluate racial and ethnic disparities in failure-to-rescue (FTR) after postoperative sepsis.
Methods: This cross-sectional study used data from the American College of Surgeons National Surgical Quality Improvement Program for patients who underwent inpatient noncardiac surgery between 2018 and 2021.
Article Synopsis
- Delaying elective noncardiac surgery after an acute myocardial infarction (NSTEMI) leads to better health outcomes, but existing guidelines are outdated and based on old data.
- A study analyzed Medicare data from surgeries between 2015 and 2020, focusing on patients 67 and older, to determine how the time since an NSTEMI affects postoperative risks.
- Results showed that surgeries performed within 30 days of an NSTEMI significantly increased the chances of major cardiovascular and cerebrovascular events, with risks leveling off after 30 days for those who had heart procedures, but increasing again after 180 days.
Article Synopsis
- Marginalized populations, especially racial and ethnic minorities, faced worse health outcomes during the COVID-19 pandemic, particularly in hospitals under strain.
- The study aimed to understand the impact of hospital conditions on older patients with sepsis, comparing those from minority groups with White individuals.
- Results showed that during high COVID-19 patient weeks, White patients' risk of poor outcomes nearly doubled, while minority groups also experienced significant increases in mortality and morbidity, indicating larger disparities in healthcare access and outcomes.
Article Synopsis
- This study investigates the relationship between mortality rates for patients undergoing extracorporeal cardiopulmonary resuscitation (ECPR) based on where in the hospital their cardiac arrest occurs, as well as the effect of moving patients for cannulation on their outcomes.
- The research analyzed data from 2,515 patients who experienced in-hospital cardiac arrest between 2020 and 2023 at hospitals reporting to the Extracorporeal Life Support Organization (ELSO).
- Results showed significantly higher odds of mortality for patients who had cardiac arrests in the ICU or acute care beds compared to those in the cardiac catheterization lab, while relocating patients for cannulation did not have a notable impact on survival rates.
Differences in Timely Goals of Care Discussions in Nursing Homes Among Black Residents.
Am J Hosp Palliat Care
September 2024
Article Synopsis
- Disparities in end-of-life care exist between Black and White residents in nursing homes, particularly regarding how infections are managed, with timely goals of care (TGOC) discussions playing a critical role in improving outcomes.
- A study analyzing data from nearly 900 nursing homes found that facilities with a higher percentage of Black residents (2.1% to over 15%) had significantly lower TGOC discussion scores related to infection management compared to those with 2% or fewer Black residents.
- The findings indicate that racial composition impacts care discussions, suggesting a need for targeted interventions to enhance equity in end-of-life care across different regions.
Article Synopsis
- The study systematically reviews trends in post-acute care (PAC) use related to race, ethnicity, and rurality for patients who underwent major joint replacement (MJR) in the US over the past two decades.
- It finds that while discharges to skilled nursing facilities (SNFs) and nursing homes (NHs) have decreased, racial and ethnic minorities, particularly Black individuals, are more likely to be discharged to these institutional PAC settings compared to white individuals.
- The research suggests that to reduce these disparities, policymakers need to focus on social support and address issues like multimorbidity affecting these communities.
Importance: Nursing home (NH) transfers to hospitals are common and have been associated with cognitive decline; approximately 45% of NH hospital transfers are potentially avoidable hospitalizations (PAHs).
Objective: To determine PAH incidence for historically marginalized NH residents with severe cognitive impairment compared with non-Hispanic White residents.
Design, Setting, And Participants: This cross-sectional study merged 2018 Centers for Medicaid & Medicare Services datasets and LTCFocus, a public dataset on US NH care, for US NH residents aged 65 years and older who had a hospitalization.
Background: The objective of this study was to examine insurance-based disparities in mortality, nonhome discharges, and extracorporeal membrane oxygenation utilization in patients hospitalized with COVID-19.
Methods: Using a national database of U.S.
Background: Nursing home (NH) residents' vulnerability to COVID-19 underscores the importance of infection preventionists (IPs) within NHs. Our study aimed to determine whether training and credentialing of NH IPs were associated with resident COVID-19 deaths.
Methods: This retrospective observational study utilized data from the Centers for Disease Control and Prevention's National Healthcare Safety Network NH COVID-19 Module and USAFacts, from May 2020 to February 2021, linked to a 2018 national NH survey.
Background COVID-19 stressed hospitals and may have disproportionately affected the stroke outcomes and treatment of Black and Hispanic individuals. Methods and Results This retrospective study used 100% Medicare Provider Analysis and Review file data from between 2016 and 2020. We used interrupted time series analyses to examine whether the COVID-19 pandemic exacerbated disparities in stroke outcomes and reperfusion therapy.
View Article and Find Full Text PDFImportance: The COVID-19 pandemic disrupted usual care for emergent conditions, such as acute myocardial infarction (AMI). Understanding whether Black and Hispanic individuals experiencing AMI had greater increases in poor outcomes compared with White individuals during the pandemic has important equity implications.
Objective: To investigate whether the COVID-19 pandemic was associated with increased disparities in treatment and outcomes among Medicare patients hospitalized with AMI.
Objectives: The aim was to characterize hospitalization costs, charges, and lengths of hospital stay for COVID-19 patients treated with venovenous (VV) extracorporeal membrane oxygenation (ECMO) in the United States during 2020. Secondarily, differences in hospitalization costs, charges, and lengths of hospital stay were explored based on hospital-level factors.
Design: Retrospective cohort study.
Importance: Whether people from racial and ethnic minority groups experience disparities in access to minimally invasive mitral valve surgery (MIMVS) is not known.
Objective: To investigate racial and ethnic disparities in the utilization of MIMVS.
Design, Setting, And Participants: This cross-sectional study used data from the Society of Thoracic Surgeons Database for patients who underwent mitral valve surgery between 2014 and 2019.
Article Synopsis
- The study investigates the link between low preoperative serum creatinine levels and negative postoperative outcomes in patients undergoing nonemergent surgery.
- Out of over 1.8 million patients analyzed, those with very low creatinine levels showed significantly increased odds for both 30-day mortality and major complications compared to those with normal levels.
- The findings suggest that low preoperative creatinine is prevalent and may indicate higher surgical risk, highlighting the need for additional patient evaluation and potential optimization before surgery.
Background: Coronary artery bypass grafting (CABG) is the most common cardiac surgical procedure in the world and up to one-third of patients are transfused red blood cells (RBCs). RBC transfusion may increase the risk for health care-associated infection (HAI) after CABG, but previous studies have shown conflicting results and many did not establish exposure temporality. Our objective was to explore whether intraoperative RBC transfusion is associated with increased odds of postoperative HAI.
View Article and Find Full Text PDFArticle Synopsis
- - The study investigates how the Comprehensive Care for Joint Replacement (CJR) model impacts the number of joint replacements for Medicare beneficiaries who have Alzheimer's disease and related dementias (ADRD), as they are at higher risk for arthritis.
- - Utilizing national Medicare data from 2013 to 2017, the research involves about 24.6 million beneficiary-year observations and examines whether beneficiaries underwent hip or knee replacements before and after the implementation of the CJR model in 2016.
- - Results show that there is a significant focus on how hospitals might be avoiding elective joint replacements for ADRD patients due to the lack of risk adjustment in the CJR model, suggesting potential disparities in care for this vulnerable group.
Article Synopsis
- The COVID-19 pandemic significantly disrupted surgical care, raising concerns about its impact on economically disadvantaged patients, particularly those with Medicaid or without insurance compared to those with commercial insurance.
- This study analyzed data from nearly 3 million adults who underwent major surgery across 677 U.S. hospitals from 2018 to 2020, focusing on the relationship between the extent of COVID-19 cases in hospitals and patient mortality.
- Results showed that patients undergoing surgery during high and very high COVID-19 burdens faced increased mortality risks, with those on Medicaid having a 29% higher likelihood of death compared to those with commercial insurance.
Importance: Perioperative strokes are a major cause of death and disability. There is limited information on which to base decisions for how long to delay elective nonneurologic, noncardiac surgery in patients with a history of stroke.
Objective: To examine whether an association exists between the time elapsed since an ischemic stroke and the risk of recurrent stroke in older patients undergoing elective nonneurologic, noncardiac surgery.
Importance: Racial minority groups account for 70% of excess deaths not related to COVID-19. Understanding the association of the Centers for Medicare & Medicaid Services' (CMS's) moratorium delaying nonessential operations with racial disparities will help shape future pandemic responses.
Objective: To evaluate the association of the CMS's moratorium on elective operations during the first wave of the COVID-19 pandemic among Black individuals, Asian individuals, and individuals of other races compared with White individuals.