The Geographic Distribution of Vascular Surgeons and Trainees by State in 2023.

Background: Approximately 1.4 vascular surgeons/100,000 persons are estimated to fulfill current patient needs in the United States (US), but an ongoing shortage exists. The aims of this study are to provide an updated nationwide state-by-state workforce analysis and compare the distribution of practicing vascular surgeons and training opportunities.

Analysis of Oklahoma amputation trends and identification of risk factors to target areas for limb preservation interventions.

Objective: Annual trends of lower extremity amputation due to end-stage chronic disease are on the rise in the United States. These amputations are leading to massive expenses for patients and the medical system. In Oklahoma, we have a high-risk population because access to care is low, the number of uninsured is high, cardiovascular health is poor, and our overall health care performance is ranked 50th in the country.

Vascular Surgery Training Positions and Applicant 10-Year Trends with Consideration for Further Expansion.

Background: There is a significant shortage of vascular surgeons in the United States and projections for these practicing surgical specialists continue to worsen. Annual appraisal of our workforce recruitment and growth is imperative.

Materials And Methods: Retrospective data were analyzed using the National Resident Matching Program from 2012-2022 applicant appointment years (specialty code for vascular surgery 450).

Incident Infection in a High School Population.

Prospective cohort studies of sexually transmitted infections (STIs) are logistically impractical owing to time and expenses. In schools, students are readily available for school-related follow-ups and monitoring. Capitalizing on the logistics that society already commits to ensure regular attendance of adolescents in school, a school-based STI screening in New Orleans made it possible to naturally observe the occurrence of chlamydia and to determine its incidence among 14-19-year-old adolescents.

Quality and equity of care in U.S. hospitals.

Background: Nearly every U.S. hospital publicly reports its performance on quality measures for patients who are hospitalized for acute myocardial infarction, heart failure, or pneumonia.

Quality of care for elderly patients hospitalized for pneumonia in the United States, 2006 to 2010.

Importance: Nearly every US acute care hospital reports publicly on adherence to recommended processes of care for patients hospitalized with pneumonia. However, it remains uncertain how much performance of these process measures has improved over time or whether performance is associated with superior patient outcomes.

Objectives: To describe trends in processes of care, mortality, and readmission for elderly patients hospitalized for pneumonia and to assess the independent associations between processes and outcomes of care.

Hospital performance measures and 30-day readmission rates.

Background: Lowering hospital readmission rates has become a primary target for the Centers for Medicare & Medicaid Services, but studies of the relationship between adherence to the recommended hospital care processes and readmission rates have provided inconsistent and inconclusive results.

Objective: To examine the association between hospital performance on Medicare's Hospital Compare process quality measures and 30-day readmission rates for patients with acute myocardial infarction (AMI), heart failure and pneumonia, and for those undergoing major surgery.

Design, Setting And Participants: We assessed hospital performance on process measures using the 2007 Hospital Inpatient Quality Reporting Program.

Predictors of in-hospital vs postdischarge mortality in pneumonia.

Background: Many patients who die within 30 days of admission to the hospital for pneumonia die after discharge. Recently, 30-day mortality for patients with pneumonia became a publicly reported performance measure, meaning that hospitals are, in part, being measured based on how the patient fares after discharge from the hospital. This study was undertaken to determine which factors predict in-hospital vs postdischarge mortality in patients with pneumonia.

National performance on door-in to door-out time among patients transferred for primary percutaneous coronary intervention.

Background: Delays in treatment time are commonplace for patients with ST-segment elevation acute myocardial infarction who must be transferred to another hospital for percutaneous coronary intervention. Experts have recommended that door-in to door-out (DIDO) time (ie, time from arrival at the first hospital to transfer from that hospital to the percutaneous coronary intervention hospital) should not exceed 30 minutes. We sought to describe national performance in DIDO time using a new measure developed by the Centers for Medicare & Medicaid Services.

Improvements in door-to-balloon time in the United States, 2005 to 2010.

Background: Registry studies have suggested improvements in door-to-balloon times, but a national assessment of the trends in door-to-balloon times is lacking. Moreover, we do not know whether improvements in door-to-balloon times were shared equally among patient and hospital groups.

Methods And Results: This analysis includes all patients reported by hospitals to the Centers for Medicare & Medicaid Services for inclusion in the time to percutaneous coronary intervention (acute myocardial infarction-8) inpatient measure from January 1, 2005, through September 30, 2010.

Use of Medicare claims to rank hospitals by surgical site infection risk following coronary artery bypass graft surgery.

Objective: To evaluate whether longitudinal insurer claims data allow reliable identification of elevated hospital surgical site infection (SSI) rates.

Design: We conducted a retrospective cohort study of Medicare beneficiaries who underwent coronary artery bypass grafting (CABG) in US hospitals performing at least 80 procedures in 2005. Hospitals were assigned to deciles by using case mix-adjusted probabilities of having an SSI-related inpatient or outpatient claim code within 60 days of surgery.

Racial and ethnic disparities in pneumonia treatment and mortality.

Background: The extent to which racial/ethnic disparities in pneumonia care occur within or between hospitals is unclear.

Objective: Examine within and between-hospital racial/ethnic disparities in quality indicators and mortality for patients hospitalized for pneumonia.

Research Design: Retrospective cohort study.

Factors associated with antimicrobial use in nursing homes: a multilevel model.

Objectives: To describe antimicrobial prescribing patterns in nursing homes.

Design: Retrospective, observational study.

Setting: Total of 73 nursing homes in four U.

Initial antibiotic selection and patient outcomes: observations from the National Pneumonia Project.

Background: Guidelines for empirical treatment of hospitalized patients with pneumonia provide specific recommendations for antibiotic selection that are primarily based on findings from observational studies.

Methods: We conducted a retrospective study of 27,330 community-dwelling, immunocompetent Medicare patients (age, >65 years) with pneumonia who were hospitalized in 1998-1999 and 2000-2001. Associations between initial antimicrobial regimens and risk-adjusted mortality were assessed, accounting for differences in patient characteristics, comorbidities, illness severity, geographic location, and processes of care.

Performance measures for pneumonia: are they valuable, and are process measures adequate?

Purpose Of Review: Pneumonia has been the target of large national initiatives to measure and report quality of care. Measures of pneumonia care are now being used for public reporting and pay-for-performance in an effort to increase provider accountability for healthcare quality in the USA. Increasingly, concerns have been raised about the potential for unintended consequences of performance measurement and reporting that might lead to patient harm.

Antibiotic timing and diagnostic uncertainty in Medicare patients with pneumonia: is it reasonable to expect all patients to receive antibiotics within 4 hours?

Background: Many organizations, including the Centers for Medicare & Medicaid Services, measure the percentage of patients hospitalized with pneumonia who receive antibiotics within 4 h of presentation. Because the diagnosis of pneumonia can be delayed in patients with an atypical presentation, there are concerns that attempts to achieve a performance target of 100% may encourage inappropriate antibiotic usage and the diversion of limited resources from seriously ill patients. This study was performed to determine how frequently Medicare patients with a hospital discharge diagnosis of pneumonia present in a manner that could potentially lead to diagnostic uncertainty and a resulting appropriate delay in antibiotic administration.

Volume, quality of care, and outcome in pneumonia.

Background: The establishment of minimum volume thresholds has been proposed as a means of improving outcomes for patients with various medical and surgical conditions.

Objective: To determine whether volume is associated with either quality of care or outcome in the treatment of pneumonia.

Design: Retrospective cohort study.

Timing of antibiotic administration and outcomes for Medicare patients hospitalized with community-acquired pneumonia.

Background: Pneumonia accounts for more than 600 000 Medicare hospitalizations yearly. Guidelines have recommended antibiotic treatment within 8 hours of arrival at the hospital.

Methods: We performed a retrospective study using medical records from a national random sample of 18 209 Medicare patients older than 65 years who were hospitalized with community-acquired pneumonia from July 1998 through March 1999.

Effects of previous influenza vaccination on subsequent readmission and mortality in elderly patients hospitalized with pneumonia.

Purpose: To determine the effect of influenza vaccination on mortality and hospital readmission rates following discharge of elderly patients admitted with pneumonia.

Methods: We reviewed the medical records of 12,566 randomly selected Medicare beneficiaries hospitalized for pneumonia from October 1 through December 31, 1998, to assess mortality and hospital readmission rates from the date of discharge through the influenza season, May 1, 1999. Patients were grouped based on vaccination status: before hospitalization, during hospitalization, or unknown (no evidence of vaccination).

Failure to vaccinate Medicare inpatients: a missed opportunity.

Background: Hospitalized elderly patients are at risk for subsequent influenza and pneumococcal disease. Despite this risk, they are often not vaccinated in this setting.

Methods: We reviewed the medical records of a national sample of 107 311 fee-for-service Medicare patients, 65 years or older, discharged from April 1, 1998, through March 31, 1999, with a principal diagnosis of acute myocardial infarction, heart failure, pneumonia, or stroke.