Impact of Clinical Decision Support with Mandatory versus Voluntary Venous Thromboembolism Risk Assessment in Hospitalized Patients.

 Venous thromboembolism (VTE) causes significant preventable morbidity and mortality in hospitalized patients. Assessing VTE risk is essential to initiating appropriate prophylaxis and reducing VTE outcomes. Studies show that computerized clinical decision support (CDS) can improve VTE risk assessment (RA), prophylaxis, and outcomes but few examined the effectiveness of specific design features.

The relationship between diabetes mellitus and 30-day readmission rates.

Background: It is estimated that 9.3% of the population in the United States have diabetes mellitus (DM), 28% of which are undiagnosed. The high prevalence of DM makes it a common comorbid condition in hospitalized patients.

Validation of the Caprini Venous Thromboembolism Risk Assessment Model in Critically Ill Surgical Patients.

Importance: Appropriate risk stratification for venous thromboembolism (VTE) is essential to providing appropriate thromboprophylaxis and avoiding morbidity and mortality.

Objective: To validate the Caprini VTE risk assessment model in a previously unstudied high-risk cohort: critically ill surgical patients.

Design, Setting, And Participants: We performed a retrospective cohort study of 4844 adults (≥18 years old) admitted to a 20-bed surgical intensive care unit in a large tertiary care academic hospital during a 5-year period (July 1, 2007, through June 30, 2012).

Chemoprophylaxis for venous thromboembolism in otolaryngology.

Importance: Venous thromboembolism (VTE) causes significant morbidity and mortality in surgical patients. Despite strong evidence that thromboprophylaxis reduces the incidence VTE, guidelines for prophylaxis in otolaryngology are not well established. Key to the development of VTE prophylaxis recommendations are effective VTE risk stratification and evaluation of the benefits and harms of prophylaxis.

Inadequate venous thromboembolism risk stratification predicts venous thromboembolic events in surgical intensive care unit patients.

Background: Surgical intensive care unit (SICU) patients are known to be at high risk for venous thromboembolism (VTE). The 2005 Caprini Risk Assessment Model (RAM) predicts VTE risk in surgical patients. However, a physician's ability to accurately complete this RAM and the effect that inaccurate RAM completion might have on VTE risk remain unknown.

Implementation of a small bowel obstruction guideline improves hospital efficiency.

Background: We performed an internal review of triage decisions and outcomes for all patients admitted for small bowel obstruction (SBO). Concern for potential delays in operation led to formalization of an institution-wide SBO management guideline. We hypothesized that use of the guideline would improve initial triage and patient outcomes.

Identifying patients at high risk for venous thromboembolism requiring treatment after outpatient surgery.

Objective: To identify independent predictors of 30-day venous thromboembolism (VTE) events requiring treatment after outpatient surgery.

Background: An increasing proportion of surgical procedures are performed in the outpatient setting. The incidence of VTE requiring treatment after outpatient surgery is unknown.

Stratifying the risk of venous thromboembolism in otolaryngology.

Objective: The consequences of perioperative venous thromboembolism (VTE) are devastating; identifying patients at risk is an essential step in reducing morbidity and mortality. The utility of perioperative VTE risk assessment in otolaryngology is unknown. This study was designed to risk-stratify a diverse population of otolaryngology patients for VTE events.

PA-driven VTE risk assessment improves compliance with recommended prophylaxis.

Objective: Venous thromboembolism (VTE) is a major cause of morbidity and mortality in hospitalized patients, particularly surgical patients. We hypothesize that PAs are well-positioned to assist health systems with implementation of efforts to reduce the rates of this in-hospital complication and increase adherence to published standards for VTE prophylaxis.

Methods: We conducted a retrospective cohort study of general surgical patients who underwent an operation at the University of Michigan between July 2005 and June 2007.

A validation study of a retrospective venous thromboembolism risk scoring method.

Objectives: Validate a retrospective venous thromboembolism (VTE) risk scoring method, which was developed at the University of Michigan Health System and based on the Caprini risk assessment model, and assess the confounding effects of VTE prophylaxis.

Background: Assessing patients for risk of VTE is essential to initiating appropriate prophylaxis and reducing the mortality and morbidity associated with deep vein thrombosis and pulmonary embolism.

Methods: VTE risk factors were identified for 8216 inpatients from the National Surgical Quality Improvement Program using the retrospective scoring method.

Improved outcomes in patients with head and neck cancer using a standardized care protocol for postoperative alcohol withdrawal.

Objective: To show clinical benefit in the main outcome measures by the use of a standardized protocol for identification, characterization, and treatment of alcohol withdrawal syndrome (AWS) in postoperative patients with head and neck cancer.

Design: Prospective cohort study with a retrospective cohort control.

Setting: Tertiary care university.

Exploratory analyses of the "failure to rescue" measure: evaluation through medical record review.

Clinicians and hospital leaders are interested in assessing the degree to which the failure-to-rescue indicator identifies true problems in processes of care at the individual or system level. Failure-to-rescue complications are flagged through administrative data, and the clinical course of events is evaluated. The review suggests that many factors influence whether a case is included in the measure, such as existing health problems, the presence of complex comorbidities, and variation in clinical documentation and coding practices.

Do the AHRQ patient safety indicators flag conditions that are present at the time of hospital admission?

Objective: The Agency for Healthcare Research and Quality (AHRQ) developed 20 patient safety indicators (PSIs) to identify potentially preventable complications of acute inpatient care based on administrative data. The objective of this patient safety performance study was to assess the impact of cases flagged by each PSI for diagnoses that were actually present on admission on unadjusted PSI rates.

Methods: The latest AHRQ PSI software, which allows users to produce 14 of the 20 PSIs for adult inpatients both without and with a "present on admission" (PoA) variable, was applied to administrative data for adult patients discharged from the University of Michigan Health System (UMHS) in 2006.

Developing dashboards to measure and manage inpatient pharmacy costs.

Purpose: A pharmacy dashboard was developed and implemented to identify trends in drug use; normalize data for patient volumes; allow the user to determine whether changes were due to cost increases, actual use changes, or both; permit evaluation of drug use within key diagnoses for individual services; and allow multiple formats and layers of analysis.

Summary: At the University of Michigan, a drug cost and drug-use database had been developed, and an enterprise data warehouse had been implemented. The data warehouse served as the core data source for the pharmacy dashboard effort.

Population-based medical and disease management: an evaluation of cost and quality.

Reports by the Institute of Medicine and the Health Care Financing Administration have emphasized that the integration of medical care delivery, evidence-based medicine, and chronic care disease management may play a significant role in improving the quality of care and reducing medical care costs. The specific aim of this project is to assess the impact of an integrated set of care coordination tools and chronic disease management interventions on utilization, cost, and quality of care for a population of beneficiaries who have complementary health coverage through a plan designed to apply proactive medical and disease management processes. The utilization of health care services by the study population was compared to another population from the same geographic service area and covered by a traditional fee-for-service indemnity insurance plan that provided few medical or disease management services.

Linear programming to optimize performance in a department of surgery.

Background: Linear programming is an analytic method that can be used to develop models for health care that optimize distribution of resources through mathematical means.

Study Design: The linear programming model contained objective, decision, and constraint elements. The objective was to optimize financial outcomes for both the hospital and physicians in the Department of Surgery.

Relevance of the Agency for Healthcare Research and Quality Patient Safety Indicators for children's hospitals.

Objectives: Patient safety indicators (PSIs) were developed by the Agency for Healthcare Research and Quality. Our objectives were (1) to apply these algorithms to the National Association of Children's Hospitals and Related Institutions (NACHRI) Aggregate Case Mix Comparative Database for 1999-2002, (2) to establish mean rates for each of the PSI events in children's hospitals, (3) to investigate the inadequacies of PSIs in relation to pediatric diagnoses, and (4) to express the data in such a way that children's hospitals could use the PSIs determined to be appropriate for pediatric use for comparison with their own data. In addition, we wanted to use the data to set priorities for ongoing clinical investigations and to propose interventions if the indicators demonstrated preventable errors.

Clinical redesign using all patient refined diagnosis related groups.

Objective: Clinical redesign of processes in hospitals that care for children has been limited by a paucity of severity-adjusted indicators that are sensitive enough to identify areas of concern. This is especially true of hospitals that analyze pediatric patient care using standard Centers for Medicare and Medicaid Services (CMS) diagnosis-related groups (DRGs). The objectives of this study were to determine whether 1) utilization of all-patient refined (APR)-DRG severity-adjusted indicators (length of stay, cost per case, readmission rate) from the National Association of Children's Hospitals and Related Institutions (NACHRI) database could identify areas for improvement at University of Michigan Mott Children's Hospital (UMMCH) and 2) hospital staff could use the information to implement successful clinical redesign.

Reducing costs and improving outcomes of percutaneous coronary interventions.

Objective: To describe cost reduction and quality improvement efforts in our percutaneous coronary intervention (PCI) program and how risk adjustment was used to assess the effects of these changes.

Study Design: Single center registry analysis.

Patients And Methods: Data were collected on 2158 PCIs performed between July 1, 1994, and June 30, 1997.