Evaluation of individual and ensemble probabilistic forecasts of COVID-19 mortality in the United States.

Short-term probabilistic forecasts of the trajectory of the COVID-19 pandemic in the United States have served as a visible and important communication channel between the scientific modeling community and both the general public and decision-makers. Forecasting models provide specific, quantitative, and evaluable predictions that inform short-term decisions such as healthcare staffing needs, school closures, and allocation of medical supplies. Starting in April 2020, the US COVID-19 Forecast Hub (https://covid19forecasthub.

A Case Report: Cornerstone Health Care Reduced the Total Cost of Care Through Population Segmentation and Care Model Redesign.

Over the course of a single year, Cornerstone Health Care, a multispecialty group practice in North Carolina, redesigned the underlying care models for 5 of its highest-risk populations-late-stage congestive heart failure, oncology, Medicare-Medicaid dual eligibles, those with 5 or more chronic conditions, and the most complex patients with multiple late-stage chronic conditions. At the 1-year mark, the results of the program were analyzed. Overall costs for the patients studied were reduced by 12.

Protecting patients from harm: design and implementation of an institutional bloodborne pathogen protocol.

Background: Patients are sometimes exposed to the blood of health care workers (HCWs) while receiving medical care. No national guidelines exist that authoritatively articulate the responsibility of HCWs infected with a potentially transmissible bloodborne pathogen (BBP). Geisinger Health System crafted and implemented a policy delineating the responsibilities of an HCW in the event of accidental blood exposure of a patient, specifically addressing HCWs known to be infected with a BBP.

Value and the medical home: effects of transformed primary care.

Background: The primary care medical home has been promoted to integrate and improve patient care while reducing healthcare spending, but with little formal study of the model or evidence of its efficacy. ProvenHealth Navigator (PHN), an intensive multidimensional medical home model that addresses care delivery and financing, was introduced into 11 different primary care practices. The goals were to improve the quality, efficiency, and patient experience of care.

"ProvenCareSM": a provider-driven pay-for-performance program for acute episodic cardiac surgical care.

Objective: To test whether an integrated delivery system could successfully implement an evidence-based pay-for-performance program for coronary artery bypass graft (CABG) surgery.

Methods: The program consisted of 3 components: (1) establishing implementable best practices; (2) developing risk-based pricing; (3) establishing a mechanism for patient engagement. Surgeons reviewed all class I and IIa "2004 American Heart Association/American College of Cardiology Guidelines for CABG Surgery" and translated them into 40 verifiable behaviors.

A hub-and-spoke model of care: providing specialty care in patients' own communities.

The authors describe how they used lessons learned in increasing office efficiency to improve primary care providers' ability to arrange for many specialty consultations and care within a reasonable driving distance for patients.

The public release of hospital and physician mortality data in Pennsylvania. A case study.

Objectives: Using the public reports of the Pennsylvania Health Care Cost Containment Council on coronary artery bypass graft surgery for 1990 to 1992 as a case study, the authors assess the sensitivity of results to the choice of data and statistical methodology.

Methods: Using the Council's public-release data, surgical mortality and utilization were reanalyzed by standard linear models, empirical Bayes methods, Monte Carlo simulations, and hierarchical statistical models.

Results: Statistical power calculations demonstrate that the annual volume of bypass surgery for many hospitals and for most surgeons is too small for meaningful mortality comparisons.

Efficacy of the Steri-Shield filtered exhaust helmet in limiting bacterial counts in the operating room during total joint arthroplasty.

Filtered exhaust helmets (space suits) have been reported as efficacious in decreasing wound infections following joint arthroplasty procedures; however, strict experimental control of the many variables related to the incidence of clinical infection has been lacking in these studies, making support of such conclusions difficult. Any potential benefit of filtered exhaust helmets in the control of infection rates can be logically assigned to the reduction of airborne bacterial counts within the operating room. A study was done using the Steri-Shield helmet (Bio-Medical Devices, Irvine, CA) to define its efficacy in limiting airborne bacterial contaminates during total joint arthroplasty.

Data initiatives: building a managed care network utilizing clinical performance data.

Responding to the rising health care costs of its traditional indemnity health care plan, Hershey Foods Corporation developed its own managed care plan as part of the company strategy to better control its health care costs. In developing a provider network for its managed care plan, Hershey Foods utilized data from the Pennsylvania Health Care Cost Containment Council and the expertise of many different groups, health care data consultants (Healthcare Research Affiliates), the insurance provider (Capital Blue Cross/Pennsylvania Blue Shield), health care providers, as well as the employees and their union representatives. Selection of providers for the network necessitated a data initiative that analyzed indicators of quality and cost efficiency.

Comparison of three typing methods for clinical and environmental isolates of Aspergillus fumigatus.

To evaluate procedures used for epidemiologic analysis of outbreaks of aspergillosis, we analyzed a collection of 35 Aspergillus fumigatus isolates using three typing methods: isoenzyme analysis (IEA), random amplified polymorphic DNA (RAPD) analysis, and restriction endonuclease analysis (REA). Twenty-one isolates were from a single hospital, with four isolates coming from different patients. Three clinical isolates came from a different hospital, and 11 clinical or environmental isolates were derived from a culture collection.

Comparing hospital mortality in adult patients with pneumonia. A case study of statistical methods in a managed care program.

Objective: To compare and contrast a managed care program's analysis of differences in hospital mortality with results obtained by accepted statistical methods.

Design: A re-analysis of computerized discharge data using the same method used by a managed care program, and using conventional methods of categorical data analysis. One thousand computer simulations of a method for comparing hospitals by severity-adjusted mortality were done to determine the probability of falsely identifying hospitals as high-mortality outliers.

Randomized, prospective comparison of first- and second-generation cephalosporins as infection prophylaxis for cardiac surgery.

Surgical wound infections after cardiovascular surgery may be life threatening and are resource intensive. Second-generation cephalosporins are purported to have a broader antimicrobial spectrum than first-generation cephalosporins and, therefore, may be more efficacious for infection prophylaxis. We have conducted a randomized prospective study of 702 patients undergoing open heart surgery to test the hypothesis that the second-generation cephalosporin, cefuroxime, will be more efficacious for infection prophylaxis than the first-generation cephalosporin, cefazolin.

A predictive risk index for nosocomial pneumonia in the intensive care unit.

Purpose: To develop a scoring system for stratifying patients in intensive care units (ICUs) by risk of developing nosocomial pneumonia (NP) and to identify the time period associated with the highest risk.

Patients And Methods: Two hundred and three patients 18 years of age or older and residing in the ICU for 72 hours or more were followed until development of NP or death or for 48 hours after discharge from the ICU. After the identification of independent risk factors for NP, a scoring system was developed to arrive at a predictive risk index for NP.

Self-reported HIV and AIDS experience, practices, and knowledge of Pennsylvania family physicians.

Background: Patients with disease caused by the human immunodeficiency virus (HIV), while still more commonly treated in urban settings, are being seen in nonurban areas in numbers rapidly outstripping the local availability of specialists with expertise in HIV or acquired immunodeficiency syndrome (AIDS).

Methods: A questionnaire designed to measure self-assessed experience, practices, and knowledge regarding basic aspects of HIV was mailed in 1989 to the 2177 members of the Pennsylvania Academy of Family Physicians.

Results: The response rate was 72 percent.

The occurrence and distribution of burnout among infectious diseases physicians.

The occurrence and distribution of the three dimensions of the burnout syndrome (emotional exhaustion, depersonalization, and lowered feelings of personal accomplishment) were studied among infectious diseases physicians. A written survey was mailed to the entire identified US population of infectious diseases physicians (n = 4328); a 46.3% response rate provided 1840 usable surveys.

Infectious disease manpower in the United States--1986. 2. Changes in practice patterns over time and training needs. Manpower and Training Committee, Infectious Diseases Society of America.

Infectious disease-trained internal medicine physicians responding to a questionnaire survey (n = 1802) reported minor differences in time spent in patient care versus laboratory-based research whether they subsequently became practitioners or academicians. Both practitioners and academicians ranked hospital epidemiology first, followed by knowledge of hospital antibiotic policies in order of importance for new trainees to be taught. Internists with greater than 12 months of training in infectious diseases were divided into private practice versus academically based groups, and their distribution of time spent in various professional activities was analyzed by 5-year intervals for each cohort.

Infectious disease manpower in the United States--1986. 1. Description of infectious disease physicians. Manpower and Training Committee, Infectious Diseases Society of America.

A survey designed to assess the number, type, and current practice patterns of all infectious disease (ID) physicians active in the United States in 1986 was carried out in early 1987. Of 4328 mailed questionnaires, 48.3% were returned.

Drug-resistant Nocardia asteroides infection in a patient with acquired immunodeficiency syndrome.

We have reported what we believe to be the first case of disseminated infection due to a multiply drug resistant strain of Nocardia asteroides in a patient with the acquired immunodeficiency syndrome and concomitant disseminated histoplasmosis. This strain of the organism fits a pattern of susceptibility that is rare among N asteroides isolates in general and has been called the type 5 pattern, described as a resistance to broad spectrum cephalosporins, ciprofloxacin, and all aminoglycosides except amikacin. The recognition of disease due to this group of organisms is especially important in patients with AIDS because sulfonamides, considered the drugs of choice for treatment of N asteroides infection, are associated with a high incidence of adverse effects in these patients.

Endophthalmitis caused by non-albicans species of Candida.

While endophthalmitis due to Candida albicans is commonly seen in clinical practice, non-albicans species of Candida (NAC) are rarely reported to cause this condition. The English-language literature from 1965 through 1989 was reviewed for cases of endophthalmitis due to NAC. Clinical details of six well-documented cases and one unpublished case are presented here.

Control of epidemic methicillin-resistant Staphylococcus aureus.

We controlled the spread of epidemic methicillin-resistant Staphylococcus aureus (MRSA) infection in an 884-bed veterans' facility by cohorting known active MRSA carriers and MRSA-infected patients on one nursing unit. Simultaneously, all previously-institutionalized transfers into the veterans' facility were screened with swab cultures for MRSA at the time of admission. All MRSA patients were maintained on contact (gown and glove) or strict isolation and treated aggressively with topical and enteral antibiotics with the assistance of the infectious disease consultant.

Dermatoses among floral shop workers.

Concern about the increasing incidence of hand dermatitis in floral shop workers in the United States and its possible association to the plant Alstroemeria, a flower that has become popular since its introduction in 1981, prompted investigation of the prevalence and cause of hand dermatitis in a sample of floral workers. Fifty-seven floral workers were surveyed, and 15 (26%) reported hand dermatitis within the previous 12 months. Sixteen floral workers (eight with dermatitis) volunteered to be patch tested to the North American Contact Dermatitis Group Standard and Perfume Trays, a series of eight pesticides and 20 plant allergens.