Predictors of asthma-related health care utilization and quality of life among inner-city patients with asthma.

Background: Asthma morbidity and mortality are highest among minority inner-city populations.

Objective: To identify factors associated with acute health care resource utilization and asthma-related quality of life among high-risk, minority patients with asthma.

Methods: We interviewed a prospective cohort of 198 adults hospitalized for asthma in an inner city hospital over a period of 1 year.

Allergen sensitization evaluation and allergen avoidance education in an inner-city adult cohort with persistent asthma.

Background: Asthma morbidity, mortality, and health services utilization are highest among inner-city populations. The National Asthma Education and Prevention Program Expert Panel recommends that all patients with moderate and severe persistent asthma be evaluated for sensitization to environmental allergens.

Objective: This study examined whether a cohort of inner-city adults hospitalized with asthma had been evaluated for allergen sensitization, received avoidance counseling, and followed through on these recommendations.

Ethnic disparities in the treatment of stage I non-small cell lung cancer.

Rationale: Important variations exist in the treatment of non-small cell lung cancer. Because resection is the most effective treatment for patients with early disease, disparities in surgical rates can generate considerable differences in outcomes.

Objective: We analyzed data from a national population-based registry to evaluate disparities in the treatment of Hispanic and white patients with stage I lung cancer and to assess the extent to which these inequalities explain survival differences.

Patient relocation in the 6 months after hip fracture: risk factors for fragmented care.

Objectives: To describe the incidence and patterns of patient relocation after hip fracture, identify factors associated with relocation, and examine effect of relocation on outcomes.

Design: Prospective cohort study.

Setting: Four hospitals in the New York metropolitan area.

Limited impact of a multicenter intervention to improve the quality and efficiency of pneumonia care.

Study Objectives: To evaluate the impact of a multifactorial intervention to improve the quality, efficiency, and patient understanding of care for community-acquired pneumonia.

Design: Times series cohort study.

Setting: Four academic health centers in the New York City metropolitan area.

The effect of perioperative anemia on clinical and functional outcomes in patients with hip fracture.

Objectives: To describe the epidemiology of perioperative anemia in patients with hip fracture and assess the relationship between the hemoglobin measurements and clinical outcomes.

Design: Prospective observational cohort study.

Setting: Four university and community teaching hospitals.

Physical therapy and mobility 2 and 6 months after hip fracture.

Objectives: To examine the relationship between early physical therapy (PT), later therapy, and mobility 2 and 6 months after hip fracture.

Design: Prospective, multisite observational study.

Setting: Four hospitals in the New York City area.

Guidelines for community-acquired pneumonia: are they reflected in practice?

Community-acquired pneumonia (CAP) is common, costly, and clinically serious. Several national and international practice guidelines have been developed to promote more appropriate, cost-effective care for patients with CAP. This article compares and contrasts eight international practice guidelines for the management of CAP, describes the extent to which recommendations are reflected in practice, and proposes explanations for non-adherence to guidelines.

Association of timing of surgery for hip fracture and patient outcomes.

Context: Previous studies of surgical timing in patients with hip fracture have yielded conflicting findings on mortality and have not focused on functional outcomes.

Objective: To examine the association of timing of surgical repair of hip fracture with function and other outcomes.

Design: Prospective cohort study including analyses matching cases of early (< or =24 hours) and late (>24 hours) surgery with propensity scores and excluding patients who might not be candidates for early surgery.

An evidence-based domestic violence education program for internal medicine residents.

Background: Domestic violence (DV) is prevalent but often unrecognized, and it is a challenge to teach. This article presents an evidence-based DV education program for medical residents and incorporates it into a women's medicine curriculum.

Description: An initial 3-hr seminar included video and case discussion, literature review, and role play.

Physician awareness and self-reported use of local and national guidelines for community-acquired pneumonia.

Objectives: To assess physician awareness and reported use of medical guidelines for community-acquired pneumonia (CAP), and to identify factors associated with variations in awareness and use of these guidelines.

Design: A questionnaire was administered during the preintervention phase of a randomized clinical trial of a pneumonia guideline implementation strategy.

Participants: Three hundred and fifty-two physicians who managed CAP patients at 7 Pittsburgh, PA hospitals completed the questionnaire.

Effects of blood transfusion on clinical and functional outcomes in patients with hip fracture.

Background: Anemia and transfusion are common among elderly patients requiring surgery. The effects of transfusion on morbidity and mortality are controversial. The influence of transfusion on risk-adjusted mortality, readmissions, and functional mobility was examined.

Revisiting the appropriateness of carotid endarterectomy.

Background And Purpose: In the 1980s, carotid endarterectomy was controversial because proof of efficacy was lacking, complication rates were high, and one third of cases were reported to be inappropriate. Since publication of several randomized controlled trials (RCTs), rates of carotid endarterectomy have doubled nationwide. This study assesses the appropriateness and use of carotid endarterectomy since publication of the RCTs.

Hospital readmissions after hospital discharge for hip fracture: surgical and nonsurgical causes and effect on outcomes.

Objectives: To examine the causes of hospital readmission after hip fracture and the relationships between hospital readmission and 6-month physical function and mortality.

Design: Prospective, multisite, observational cohort study.

Setting: Four hospitals in the New York City metropolitan area.

Improving physicians' knowledge of the costs of common medications and willingness to consider costs when prescribing.

Objectives: To determine the effectiveness of an educational intervention designed to improve physicians' knowledge of drug costs and foster willingness to consider costs when prescribing.

Design: Pre- and post-intervention evaluation, using physicians as their own controls.

Setting: Four teaching hospitals, affiliated with 2 residency programs, in New York City and northern New Jersey.

Frequency and impact of active clinical issues and new impairments on hospital discharge in patients with hip fracture.

Background: Hip fracture is associated with significant mortality and disability. Patients who are discharged from the hospital with active clinical problems may have worse outcomes than those patients without active clinical problems.

Objective: To assess the frequency and impact of clinical problems at discharge on clinical and functional hip fracture outcomes.

[Influence of thermoplastic masks on the absorbed skin dose for head and neck tumor radiotherapy].

The influence of thermoplastic masks used in clinical routine for patient immobilization in head and neck radiotherapy treatment on the absorbed skin dose has been investigated at Gustave-Roussy Institute. The measurements were performed in 60Co gamma-rays, 4 and 6MV X-rays and in 8 and 10MeV electron beams. Initially, the measurements were performed with thermoluminescent dosimeters (LiF) and a NACP chamber on a polystyrene phantom in order to study the influence of physical parameters (distance, field size, energy.

Is volume related to outcome in health care? A systematic review and methodologic critique of the literature.

Purpose: To systematically review the methodologic rigor of the research on volume and outcomes and to summarize the magnitude and significance of the association between them.

Data Sources: The authors searched MEDLINE from January 1980 to December 2000 for English-language, population-based studies examining the independent relationship between hospital or physician volume and clinical outcomes. Bibliographies were reviewed to identify other articles of interest, and experts were contacted about missing or unpublished studies.

Instability on hospital discharge and the risk of adverse outcomes in patients with pneumonia.

Background: Investigating claims that patients are being sent home from the hospital "quicker and sicker" requires a way of objectively measuring appropriateness of hospital discharge.

Objective: To define and validate a simple, usable measure of clinical stability on discharge for patients with community-acquired pneumonia.

Methods: Information on daily vital signs and clinical status was collected in a prospective, multicenter, observational cohort study.

Association of surgical specialty and processes of care with patient outcomes for carotid endarterectomy.

Background And Purpose: Because there is considerable variation in practice patterns and outcomes for carotid endarterectomy (CE), there is a need to study the processes of care that are associated with adverse outcomes. The purpose of this study was to examine the impact of processes of care and surgical specialty on adverse outcomes for CE.

Methods: A retrospective cohort study based on a voluntary CE registry containing 3644 patients undergoing CE between April 1, 1997, and March 31, 1999, in New York hospitals was used in the study.

What factors influence physicians' decisions to switch from intravenous to oral antibiotics for community-acquired pneumonia?

Objective: One of the major factors influencing length of stay for patients with community-acquired pneumonia is the timing of conversion from intravenous to oral antibiotics. We measured physician attitudes and beliefs about the antibiotic switch decision and assessed physician characteristics associated with practice beliefs.

Design: Written survey assessing attitudes about the antibiotic conversion decision.

What are Medicare managed care plans doing to measure and improve quality of care?

To explore managed care plans' efforts to assess and improve quality of care for Medicare beneficiaries, the authors surveyed managed care plans with risk contracts for Medicare beneficiaries in 20 large metropolitan areas in January 1998. The survey inquired about: (1) the health plans' efforts to assess and improve quality of care for specific underuse, overuse, and misuse problems; (2) how the health plans assessed functional status of enrollees, and (3) the quality improvement program they believed had the greatest impact on the health of enrollees. The managed care plans reported a heterogeneous mix of quality improvement activities ranging from poorly developed to very sophisticated.