Derivation and validation of a risk assessment model for drug-resistant pathogens in hospitalized patients with community-acquired pneumonia.

Objective: To derive and validate a model for risk of resistance to first-line community-acquired pneumonia (CAP) therapy.

Design: We developed a logistic regression prediction model from a large multihospital discharge database and validated it versus the Drug Resistance in Pneumonia (DRIP) score in a holdout sample and another hospital system outside that database. Resistance to first-line CAP therapy (quinolone or third generation cephalosporin plus macrolide) was based on blood or respiratory cultures.

Benchmarking Inpatient Mortality Using Electronic Medical Record Data: A Retrospective, Multicenter Analytical Observational Study.

Objectives: To develop a model to benchmark mortality in hospitalized patients using accessible electronic medical record data.

Design: Univariate analysis and multivariable logistic regression were used to identify variables collected during the first 24 hours following admission to test for risk factors associated with the end point of hospital mortality. Models were built using specific diagnosis (International Classification of Diseases, 9th Edition or International Classification of Diseases, 10th Edition) captured at discharge, rather than admission diagnosis, which may be discordant.

COVID-19: A Personal and Professional Perspective.

The COVID-19 pandemic has affected millions of Americans, including health care staff. This article traces the experience of 1 nurse leader as she falls ill, only to learn that she has, indeed, been infected with the virus. She describes her 4-week quarantine, including the impact on her family and her attempts to continue to support her staff.

Assessment of the Accuracy of Using ICD-9 Diagnosis Codes to Identify Pneumonia Etiology in Patients Hospitalized With Pneumonia.

Importance: Administrative databases may offer efficient clinical data collection for studying epidemiology, outcomes, and temporal trends in health care delivery. However, such data have seldom been validated against microbiological laboratory results.

Objective: To assess the validity of International Classification of Diseases, Ninth Revision (ICD-9) organism-specific administrative codes for pneumonia using microbiological data (test results for blood or respiratory culture, urinary antigen, or polymerase chain reaction) as the criterion standard.

Association Between Alcohol Use Disorders and Outcomes of Patients Hospitalized With Community-Acquired Pneumonia.

Importance: Patients with alcohol use disorder (AUD) are at elevated risk of developing pneumonia, but few studies have assessed the outcomes of pneumonia in patients with AUD.

Objectives: To compare the causes, treatment, and outcomes of pneumonia in patients with and without AUD and to understand the associations of comorbid illnesses, alcohol withdrawal, and any residual effects due to alcohol itself with patient outcomes.

Design, Setting, And Participants: A retrospective cohort study was conducted of 137 496 patients 18 years or older with pneumonia who were admitted to 177 US hospitals participating in the Premier Healthcare Database from July 1, 2010, to June 30, 2015.

Pressure Injuries at Intensive Care Unit Admission as a Prognostic Indicator of Patient Outcomes.

Background: Pressure injuries, also known as pressure ulcers, are a serious complication of immobility. Patients should be thoroughly examined for pressure injuries when admitted to the intensive care unit to optimize treatment. Whether community-acquired pressure injuries correlate with poor hospital outcomes among critically ill patients is understudied.

Population Health Management: Coming of Age.

Purpose: Population health is finally catching up with itself. Before it was known as disease management, it began at New England Medical Center in Boston, MA (now Tufts Medical Center), more than 30 years ago.

Implications For Case Management Practice: Take-away ideas: (1) population health management is about segmenting and targeting specific patient populations for interventions that are evidence based; (2) there are currently many examples of population health management; (3) population health management will not work without social workers and nurse navigators/care coordinators working side by side.

The CNO and Leading Innovation: Competencies for the Future.

Although innovation is critical to success in today's tumultuous environment, health care is slow to embrace it, and there is significant variability in strategic adoption of innovation across organizations. Nurse leaders do not need to be innovators themselves but must engage in, and have the ability to create, an organizational culture of innovation. Twenty-six leadership behaviors specific to innovation leadership were identified through a Delphi study to develop competencies as well as the knowledge, skills, and attitudes that support nurse leaders in acquiring or expanding the capability of nurse leaders to create a culture of innovation.

A 30-Year Retrospective: Degrees of Difficulty in Decreasing LOS.

Purpose: In an attempt to avoid future revisionist history, the author offers a 30-year retrospective (1986-2016) on the evolution of strategies to reduce length of stay (LOS). She and her colleagues have been involved from the onset by developing tools such as critical paths, roles such as clinical case management, and operational systems for managing measureable outcome-driven care from the bedside to the boardroom.

Primary Practice Setting: Acute care hospitals.

Nursing Leadership and Care Coordination: Creating Excellence in Coordinating Care Across the Continuum.

Continuum Care is different today from in the past. It requires care coordination with an emphasis on relationships and new roles. Nurses and nurse leaders must be located at the epicenter of developing strategies to align resources with patients and family along all points of the continuum.

Doubts About the National Agenda of "Self-Managing" Chronic Conditions.

What comes to mind when I hear the name Karen Zander: case manager pioneer, brilliant and compassionate nurse leader, articulate teacher, mentor, and friend. Karen has a unique perspective on health care today as a consumer and provider. While she manages through physical limitations, it has never diminished her passion, commitment or can-do spirit.

Psychiatric Case Management in the Emergency Department.

Purpose: The care of the mentally ill has reached a real crisis in the United States. There were more than 6.4 million visits to emergency departments (EDs) in 2010, or about 5% of total visits, involved patients whose primary diagnosis was a mental health condition or substance abuse ().

Case management accountability for safe, smooth, and sustained transitions: a plea for building "wrap-around" case management services now.

Purpose: The purpose is to encourage hospital administrations to address readmissions immediately and to restructure and significantly enhance case management services once and for all so that they can provide a "wraparound" service for the full clinical course from admission to transition for all patients and families. If 10 basic interventions cannot be provided because of staffing limitations or processes, case management will continue to operate in a crisis mode and hospitals will suffer potentially large financial, quality, and satisfaction losses. If further customization cannot be provided to patients and their families, hospitals will be at risk to fail both their margin and their mission.

Converting case managers from MD/service to unit-based assignments: a before and after comparison.

An ongoing dilemma in acute care case management is whether to assign case managers to a unit or MD/Service-based assignment. There are strong logical arguments to be made on both sides of the decision. There are also strong political reasons why organizations opt for one or the other.