Publications by authors named "Karen Ream"
Background: Leaders in Informatics, Quality, and Systems (LInQS) is a non-ACGME (Accreditation Council for Graduate Medical Education)-accredited 2-year training program developed to enhance training in the fields of health care delivery, quality improvement (QI), clinical informatics, and leadership.
Methods: This single-institution 2-year longitudinal training program grounded in QI and informed by leadership and clinical informatics includes didactics, coaching, and mentorship, all centered around individualized QI projects. The program has been available to sub-specialty fellows, advanced practice providers, and physicians.
Background: Females have historically lower rates of cardiovascular testing when compared to males. Clinical decision pathways (CDP) that utilize standardized risk-stratification methods may balance this disparity. We sought to determine whether clinical decision pathways could minimize sex-based differences in the non-invasive workup of chest pain in the emergency department (ED).
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- The study aimed to create an easy-to-use scoring system to assess the risk of needing a permanent pacemaker (PPM) after transcatheter aortic valve replacement (TAVR).
- Atrial block, a common issue related to TAVR, prompted the need for a more clinically applicable risk prediction model, as existing models weren't suitable for pre-procedure planning.
- The resulting PRIME score was developed using five key pre-procedure variables and demonstrated high accuracy in predicting PPM needs in both training and validation groups.
Background: Serum troponin levels correlate with the extent of myocyte necrosis in acute myocardial infarction (AMI) and predict adverse outcomes. However, thresholds of cardiac troponin elevation that could portend to poor outcomes have not been established.
Methods: In this cohort study, we characterized all cardiac troponin elevations > 0.
Article Synopsis
- - The study analyzes two Medicare payment programs for treating acute myocardial infarction (AMI) using different classification methods: the Hospital Readmissions Reduction Program (using ) codes) and the Bundled Payments for Care Improvement Advanced (using diagnosis-related groups, or DRGs).
- - Among 2,176 patients, only 19.3% were common to both cohorts, with DRG patients being older, more often female, and having higher rates of heart and kidney diseases; they also experienced higher mortality and readmission rates compared to the AMI cohort.
- - The findings indicate that the choice of classification method significantly impacts patient demographics and outcomes, highlighting the need for careful consideration in quality assessment initiatives.
Article Synopsis
- - The report discusses the importance of advanced practice registered nurses (APRNs) in improving healthcare quality and cost-effectiveness through initiatives linked to the Choosing Wisely® campaign.
- - A national collaborative has engaged 16 APRN teams from 14 states to develop initiatives aimed at reducing unnecessary medical tests and treatments, promoting proper antibiotic use, and encouraging better practices for hospitalized elderly patients.
- - The findings indicate that the collaborative approach is effective in fostering teamwork among APRNs and advancing high-value, evidence-based clinical practices.
Article Synopsis
- Delayed high-grade atrioventricular block (DH-AVB) is a potential complication after transcatheter aortic valve replacement (TAVR) that hasn't been thoroughly explored in outpatients, particularly with recent TAVR technologies.
- A study at the University of Colorado investigated the use of ambulatory event monitoring (AEM) to detect DH-AVB, finding that 10% of monitored patients developed this condition within 30 days of discharge and identified hypertension and right bundle branch block (RBBB) as associated risk factors.
- The research highlights the importance of AEM for early identification of DH-AVB post-TAVR, suggesting that while RBBB is a risk factor, it may not be