Cost-Effectiveness of Primary HPV Testing, Cytology and Co-testing as Cervical Cancer Screening for Women Above Age 30 Years.

Background: Cervical cancer screening guidelines for women aged ≥30 years allow for co-testing or primary cytology testing. Our objective was to determine the test characteristics and costs associated with Cytology, HPV and Co-testing screening strategies.

Main Methods: Retrospective cohort study of women undergoing cervical cancer screening with both cytology and HPV (Hybrid Capture 2) testing from 2004 to 2010 in an integrated health system.

Determining the Optimal Vaccination Schedule for Herpes Zoster: a Cost-Effectiveness Analysis.

Background: The Advisory Committee on Immunization Practices recommends a single dose of herpes zoster (HZ) vaccine in persons aged 60 years or older, but the efficacy decreases to zero after approximately 10 years. A booster dose administered after 10 years might extend protection, but the cost-effectiveness of a booster strategy has not been examined.

Objective: We aimed to determine the optimal schedule for HZ vaccine DESIGN: We built a Markov model to follow patients over their lifetime.

Development of an Ambulatory Clinical Pharmacy Prioritization Prediction Model for Patients With Diabetes.

Background: Health care reform and the projected shortage of primary care physicians necessitate more efficient use of multidisciplinary collaboration. No studies, to date, have evaluated factors associated with treatment success among patients referred to a clinical pharmacist.

Objective: To develop a prediction model using patient factors to assist in selecting patients with diabetes most likely to benefit from pharmacy interventions.

Prospective Correlation between Likelihood of Favorable Pathology on the 17-Gene Genomic Prostate Score and Actual Pathological Outcomes at Radical Prostatectomy.

Introduction: We evaluate the Genomic Prostate Score in a prospective clinical setting and determine the cutoff point for likelihood of favorable pathology, below which definitive treatment should be advised.

Methods: Pathological data were recorded for men who had the Genomic Prostate Score performed and who ultimately underwent radical prostatectomy. Inclusion criteria were newly diagnosed prostate cancer, and NCCN classification as very low, low and low volume intermediate risk.

Hospital Volume and Outcomes of Noninvasive Ventilation in Patients Hospitalized With an Acute Exacerbation of Chronic Obstructive Pulmonary Disease.

Objective: To determine the relationship between hospital noninvasive ventilation caseload and outcomes among patients with an acute chronic obstructive pulmonary disease exacerbation.

Design: Cross-sectional study of 13,893 patients with chronic obstructive pulmonary disease treated with noninvasive ventilation.

Setting: A total of 243 U.

High-Cost Patients: Hot-Spotters Don't Explain the Half of It.

Background: Understanding resource utilization patterns among high-cost patients may inform cost reduction strategies.

Objective: To identify patterns of high-cost healthcare utilization and associated clinical diagnoses and to quantify the significance of hot-spotters among high-cost users.

Design: Retrospective analysis of high-cost patients in 2012 using data from electronic medical records, internal cost accounting, and the Centers for Medicare and Medicaid Services.

Validation of the HOSPITAL Score for 30-Day All-Cause Readmissions of Patients Discharged to Skilled Nursing Facilities.

Objectives: To validate the HOSPITAL score for predicting 30-day all-cause readmission rates in a cohort of medical patients discharged to skilled nursing facilities (SNFs).

Design: Retrospective cohort.

Setting: Cleveland Clinic Main Campus.

Characteristics and Outcomes of Patients Presenting With Hypertensive Urgency in the Office Setting.

Importance: The prevalence and short-term outcomes of hypertensive urgency (systolic blood pressure ≥180 mm Hg and/or diastolic blood pressure ≥110 mm Hg) are unknown. Guidelines recommend achieving blood pressure control within 24 to 48 hours. However, some patients are referred to the emergency department (ED) or directly admitted to the hospital, and whether hospital management is associated with better outcomes is unknown.

The use of pre-existing CT imaging in screening for abdominal aortic aneurysms.

Ultrasound screening for abdominal aortic aneurysm (AAA) is recommended for male smokers >65 years of age, but screening rates remain low. If computed tomography (CT) performed for other indications could be considered adequate for screening, one-third of ultrasounds would potentially be unnecessary, and overall screening rates would be substantially higher. The objective of this study was to evaluate the sensitivity of CT imaging of the abdomen for the detection of AAA when performed for other clinical indications.

Medical scribes: How do their notes stack up?

Their outpatient notes stack up well, according to this small, retrospective review. Scribes' notes were rated slightly higher in overall quality than physicians' notes-- at least for certain patient encounters.

Physician, Scribe, and Patient Perspectives on Clinical Scribes in Primary Care.

Background: Extending medical assistants and nursing roles to include in-visit documentation is a recent innovation in the age of electronic health records. Despite the use of these clinical scribes, little is known regarding interactions among and perspectives of the involved parties: physicians, clinical scribes, and patients.

Objective: The purpose of this project is to describe perspectives of physicians, clinical scribes, and patients regarding clinical scribes in primary care.

How well do patients and providers agree on the severity of dyspnea?

Background: Understanding the severity of patients' dyspnea is critical to avoid under- or overtreatment of patients with acute cardiopulmonary conditions.

Objective: To evaluate the agreement between dyspnea assessment by patients and healthcare providers and to explore which factors contribute to discordance in assessment.

Design, Settings And Participants: Prospective study of patients hospitalized for acute cardiopulmonary diseases at an urban teaching hospital.

Antipsychotic medication utilization in nonpsychiatric hospitalizations.

Background: Although antipsychotics are used for treatment of delirium/agitation in hospitalized patients, their scope of use has not been investigated in a large, multicenter cohort.

Objective: To determine rates of use and hospital variation in use of antipsychotics in nonpsychiatric admissions.

Design, Setting, Patients: Cohort study of adult, nonpsychiatric admissions to 300 US hospitals contributing data to the Premier database, from July 1, 2009 to June 30, 2010.

Financial Incentives and Diabetes Disease Control in Employees: A Retrospective Cohort Analysis.

Background: Many employers offer worksite wellness programs, including financial incentives to achieve goals. Evidence supporting such programs is sparse.

Objective: To assess whether diabetes and cardiovascular risk factor control in employees improved with financial incentives for participation in disease management and for attaining goals.

Association Between Initial Route of Fluoroquinolone Administration and Outcomes in Patients Hospitalized for Community-acquired Pneumonia.

Background: Fluoroquinolones have equivalent oral and intravenous bioavailability, but hospitalized patients with community-acquired pneumonia (CAP) generally are treated intravenously. Our objectives were to compare outcomes of hospitalized CAP patients initially receiving intravenous vs oral respiratory fluoroquinolones.

Methods: This was a retrospective cohort study utilizing data from 340 hospitals involving CAP patients admitted to a non-intensive care unit (ICU) setting from 2007 to 2010, who received intravenous or oral levofloxacin or moxifloxacin.

Communication Skills Training for Physicians Improves Patient Satisfaction.

Background: Skilled physician communication is a key component of patient experience. Large-scale studies of exposure to communication skills training and its impact on patient satisfaction have not been conducted.

Objective: We aimed to examine the impact of experiential relationship-centered physician communication skills training on patient satisfaction and physician experience.

Preventable Admissions on a General Medicine Service: Prevalence, Causes and Comparison with AHRQ Prevention Quality Indicators-A Cross-Sectional Analysis.

Background: Rates of preventable admissions will soon be publicly reported and used in calculating performance-based payments. The current method of assessing preventable admissions, the Agency of Healthcare Research and Quality (AHRQ) Preventable Quality Indicators (PQI) rate, is drawn from claims data and was originally designed to assess population-level access to care.

Objective: To identify the prevalence and causes of preventable admissions by attending physician review and to compare its performance with the PQI tool in identifying preventable admissions.

Antipsychotic Use in Hospitalized Adults: Rates, Indications, and Predictors.

Objectives: To investigate patterns and predictors of use of antipsychotics in hospitalized adults.

Design: Retrospective cohort study.

Setting: Academic medical center.

Predictors of Medical Management in Patients Undergoing Elective Cardiac Catheterization for Chronic Ischemic Heart Disease.

Background: Compared with medical therapy, percutaneous coronary intervention (PCI) does not reduce mortality or myocardial infarction in patients with stable angina. Therefore, PCI should be guided by refractory anginal symptoms and not just lesion characteristics.

Hypothesis: We hypothesized that angiographic lesion characteristics and stress test results would have a greater role in the decision to proceed with PCI than would symptom severity.

Ambulatory Morning Report: A Case-Based Method of Teaching EBM Through Experiential Learning.

Objectives: Evidence-based medicine (EBM) skills are important to daily practice, but residents generally feel unskilled incorporating EBM into practice. The Kolb experiential learning theory, as applied to curricular planning, offers a unique methodology to help learners build an EBM skill set based on clinical experiences. We sought to blend the learner-centered, case-based merits of the morning report with an experientially based EBM curriculum.

Impact of Video Education on Influenza Vaccination in Pregnancy.

Objective: Despite influenza vaccination being an integral part of prenatal care, vaccination rates remain low. To evaluate the impact of pre-visit video education on patients' vaccination health beliefs and vaccination rate.

Study Design: From November 2013-January 2014 unvaccinated patients seen for routine prenatal carewere randomized into 2 study groups: pre-visit vaccination video education or control.