Impact of a transitional care program for heart failure patients at Baylor Scott & White Health: a pilot study.

Heart failure is a chronic health condition characterized by complex symptom management and costly hospitalizations. Hospitalization for the treatment of heart failure symptoms is common; however, many hospitalizations are thought to be preventable with effective self-management. This study describes the small, pilot implementation of a new, interventional, self-management heart failure program, "Engagement in Heart Failure Care" (EHFC), developed to assist heart failure patients with the management of disease symptoms following discharge from an inpatient hospital stay.

The impact of informal leader nurses on patient satisfaction.

Background: The relationship between informal leaders, i.e., highly competent individuals who have influence over peers without holding formal leadership positions, and organisational outcomes has not been adequately assessed in health care.

Barriers and Benefits to the Use of Patient-Reported Outcome Measures in Routine Clinical Care: A Qualitative Study.

Patient-reported outcomes (PROs) provide information on how health care affects patient health and well-being and represent a patient-centered approach. Despite this potential, PROs are not widely used in clinical settings. Semi-structured focus groups were conducted with 3 stakeholder groups (patients, providers, and health care administrators) to determine the top 5 perceived barriers and benefits of PRO implementation.

Factors Associated With Rehabilitation Outcomes After Traumatic Brain Injury: Comparing Functional Outcomes Between TBIMS Centers Using Hierarchical Linear Modeling.

Objective: To examine differences in patient outcomes across Traumatic Brain Injury Model Systems (TBIMS) rehabilitation centers and factors that influence these differences using hierarchical linear modeling (HLM).

Setting: Sixteen TBIMS centers.

Participants: A total of 2056 individuals 16 years or older with moderate to severe traumatic brain injury (TBI) who received inpatient rehabilitation.

Variations in Inpatient Rehabilitation Functional Outcomes Across Centers in the Traumatic Brain Injury Model Systems Study and the Influence of Demographics and Injury Severity on Patient Outcomes.

Objective: To compare patient functional outcomes across Traumatic Brain Injury Model Systems (TBIMS) rehabilitation centers using an enhanced statistical model and to determine factors that influence those outcomes.

Design: Multicenter observational cohort study.

Setting: TBIMS centers.

Development and testing of Baylor Scott & White Health's "Attitudes and Practices of Patient Safety Survey".

Improving the quality of patient care requires a culture attuned to safety. We describe the development, implementation, and psychometric evaluation of the Attitudes and Practices of Patient Safety Survey (APPSS) within the Baylor Scott & White Health system. The APPSS was designed to enable safety culture data to be collected and aggregated at the unit level to identify high-priority needs.

Improving diabetes care and outcomes with community health workers.

Background: Type II diabetes continues to be a major health problem in USA, particularly in minority populations. The Diabetes Equity Project (DEP), a clinic-based diabetes self-management and education program led by community health workers (CHWs), was designed to reduce observed disparities in diabetes care and outcomes in medically underserved, predominantly Hispanic communities.

Objective: The purpose of this study was to evaluate the impact of the DEP on patients' clinical outcomes, diabetes knowledge, self-management skills, and quality of life.

The impact of preexisting illness and substance use on functional and neuropsychological outcomes following traumatic brain injury.

Traumatic brain injury (TBI) is a significant public health problem in the US. Specific preexisting medical illnesses delay recovery after TBI and increase mortality or risk of repeat TBI. This study examined the impact of preexisting illness and substance use on patient rehabilitation outcomes following TBI.

Characteristics of ACS-verified Level I and Level II trauma centers: A study linking trauma center verification review data and the National Trauma Data Bank of the American College of Surgeons Committee on Trauma.

Background: The Trauma Quality Improvement Project of the American College of Surgeons (ACS) has demonstrated variations in trauma center outcomes despite similar verification status. The purpose of this study was to identify structural characteristics of trauma centers that affect patient outcomes.

Methods: Trauma registry data on 361,187 patients treated at 222 ACS-verified Level I and Level II trauma centers were obtained from the National Trauma Data Bank of ACS.

Development of a tool to measure user experience following electronic health record implementation.

Objective: The aim of this study was to develop a survey tool to assess electronic health record (EHR) implementation to guide improvement initiatives.

Background: Survey tools are needed for ongoing improvement and have not been developed for aspects of EHR implementation.

Methods: The Baylor EHR User Experience (UX) survey was developed to capture 5 concept domains: training and competency, usability, infrastructure, usefulness, and end-user support.

Compliance with recommended care at trauma centers: association with patient outcomes.

Background: State health departments and the American College of Surgeons focus on the availability of optimal resources to designate hospitals as trauma centers, with little emphasis on actual delivery of care. There is no systematic information on clinical practices at designated trauma centers. The objective of this study was to measure compliance with 22 commonly recommended clinical practices at trauma centers and its association with in-hospital mortality.

From bedside to graveside: increased stress among healthcare chaplains.

The authors conducted a survey of Baylor Health Care System chaplains in an attempt to understand the stress they experience when leading funeral services of staff, staff family members, and patients. The intensity of stress experienced by these chaplains appears to be related to the cause of death, the deceased's age, and the relationship the deceased had with the chaplain. Further research is needed to corroborate these findings as well as to investigate how chaplains manage their own grief when they are involved in the grief experiences of patients and families.

Validation of Rules of Two™ as a paradigm for assessing asthma control.

Assessing asthma control at each patient encounter is an essential task to determine pharmacologic requirements. Rules of Two (Ro2) was created from the original 1991 National Asthma Education Program guidelines to determine the need for controller therapy. This study determined the degree of agreement between Ro2 and the Expert Panel Report (EPR-3) definition of "in control" asthma and compared that value with the Asthma Control Test (ACT) in a group of asthmatics for the purpose of validating this tool.

Suboptimal compliance with evidence-based guidelines in patients with traumatic brain injuries.

Object: Evidence-based management (EBM) guidelines for severe traumatic brain injuries (TBIs) were promulgated decades ago. However, the extent of their adoption into bedside clinical practices is not known. The purpose of this study was to measure compliance with EBM guidelines for management of severe TBI and its impact on patient outcome.

Advance care planning knowledge and documentation in a hospitalized cancer population.

To have a better understanding of our patients' knowledge of advance directive planning and execution, as well as communication with their oncologists regarding their wishes, we conducted a survey on our inpatient hematology-oncology services. A total of 68 unique hospitalized patients with a diagnosis of cancer completed surveys. Surveys were given to all oncology patients regardless of their reason for admission.

Comparative effectiveness of traumatic brain injury rehabilitation: differential outcomes across TBI model systems centers.

Objective: To measure patient functional outcomes across rehabilitation centers.

Setting: Traumatic Brain Injury Model System (TBIMS) centers.

Participants: Patients with traumatic brain injury (TBI) admitted to 21 TBIMS rehabilitation centers (N = 6975, during 1999-2008).

The intensity and frequency of moral distress among different healthcare disciplines.

Introduction: The objectives of this study are to assess and compare differences in the intensity, frequency, and overall severity of moral distress among a diverse group of healthcare professionals.

Methods: Participants from within Baylor Health Care System completed an online seven-point Likert scale (range, 0 to 6) moral distress survey containing nine core clinical scenarios and additional scenarios specific to each participant's discipline. Higher scores reflected greater intensity and/or frequency of moral distress.

Frequency of adoption of practice management guidelines at trauma centers.

Evidence-based management guidelines have been shown to improve patient outcomes, yet their utilization by trauma centers remains unknown. This study measured adoption of practice management guidelines or protocols by trauma centers. A survey of 228 trauma centers was conducted over 1 year; 55 completed the survey.

Insuring the uninsured: potential impact of Health Care Reform Act of 2010 on trauma centers.

Background: Viability of trauma centers is threatened by cost of care provided to patients without health insurance. The health care reform of 2010 is likely to benefit trauma centers by mandating universal health insurance by 2014. However, the financial benefit of this mandate will depend on the reimbursement provided.

Totally Thoracoscopic Surgical Ablation or Catheter Ablation of Atrial Fibrillation: A Systematic Review and Preliminary Meta-Analysis.

This article provides results of a preliminary meta-analysis of the stand-alone atrial fibrillation (AF) surgical publications from 2009 to 2011. In 6 studies with postoperative freedom from AF as primary end point, the meta-analysis indicated an overall success rate of 84% (95% confidence interval [CI], 80.0-88.

Chronic consequences of acute injuries: worse survival after discharge.

Background: The Trauma Quality Improvement Program uses inhospital mortality to measure quality of care, which assumes patients who survive injury are not likely to suffer higher mortality after discharge. We hypothesized that survival rates in trauma patients who survive to discharge remain stable afterward.

Methods: Patients treated at an urban Level I trauma center (2006-2008) were linked with the Social Security Administration Death Master File.

Moving from "optimal resources" to "optimal care" at trauma centers.

Background: The Trauma Quality Improvement Program has shown that risk-adjusted mortality rates at some centers are nearly 50% higher than at others. This "quality gap" may be due to different clinical practices or processes of care. We have previously shown that adoption of processes called core measures by the Joint Commission and Centers for Medicare and Medicaid Services does not improve outcomes of trauma patients.

Barriers to compliance with evidence-based care in trauma.

Background: We have preciously demonstrated that trauma patients receive less than two-thirds of the care recommended by evidence-based medicine. The purpose of this study was to identify patients least likely to receive optimal care.

Methods: Records of a random sample of 774 patients admitted to a Level I trauma center (2006-2008) with moderate to severe injuries (Abbreviated Injury Scale score ≥3) were reviewed for compliance with 25 trauma-specific processes of care (T-POC) endorsed by Advanced Trauma Life Support, Eastern Association for the Surgery of Trauma, the Brain Trauma Foundation, Surgical Care Improvement Project, and the Glue Grant Consortium based on evidence or consensus.

Health care reform at trauma centers--mortality, complications, and length of stay.

Objective: The Trauma Quality Improvement Program has demonstrated existence of significant variations in risk-adjusted mortality across trauma centers. However, it is unknown whether centers with lower mortality rates also have reduced length of stay (LOS), with associated cost savings. We hypothesized that LOS is not primarily determined by unmodifiable factors, such as age and injury severity, but is primarily dependent on the development of potentially preventable complications.

The risk of subsequent joint arthroplasty after primary unilateral total knee arthroplasty, a 10-year study.

The purposes of this study were to determine the probabilities of subsequent lower extremity arthroplasty after index knee arthroplasty for osteoarthritis and to evaluate the demographic as well as radiographic factors that may predict progression to arthroplasty in the contralateral knee. Between 1984 and 1994, 646 patients, aged 40 to 75 years, with a primary cruciate-retaining knee were identified. The 10-year probability of having a contralateral knee after index knee was 36%.