No description available.

No description available.

Class of 2010 Abstract / OBJECTIVES: The objective of this study was to evaluate whether implementation of new anticoagulation policy at a community hospital resulted in better monitoring of warfarin, increased warfarin patient education prior to discharge, and less bleeding complications due to warfarin. METHODS: This study was a pre-­‐ post-­‐retrospective chart review quality improvement study. A retrospective chart review was conducted of all patients who were inpatients and received warfarin in the time period of April 1, 2008 to July 31, 2008 (historical control group before implementation of the new anticoagulation program) and the time period of April 1, 2009 to July 31, 2009 (after implementation of the new anticoagulation policies). To compare appropriateness of laboratory monitoring, the frequency of warfarin-­‐related laboratory orders that included a baseline international normalized ratio (INR), daily INR, baseline complete blood count (CBC), and CBC every 3 days were assessed before and after program implementation. The analysis was repeated for the frequency of patient education that included documentation by pharmacy, nursing, and dietary services. Finally, data was collected to determine frequencies of bleeding complications associated with warfarin. RESULTS: There were 112 patients in the pre-­‐policy group and 115 patients in the post-­‐policy group. After implementation of the inpatient warfarin policy, obtaining baseline INRs increased from 74% to 90% (p=0.001). In addition, prescriber orders for baseline CBCs increased from 85% to 94% (p=0.026). Obtaining CBCs every 3 days increased from 54% to 74%, (p<0.001). However, there was not a significant increase in orders for daily INR levels (p=0.055). Education by nursing increased from 54% to 80%, (p<0.001). Education by pharmacy increased from 8% to 76%, (p<0.001). Education by dietary increased from 11% to 79%, (p<0.001). Moreover, documentation by all three disciplines in each patient increased significantly from 3.6% to 59%, (p<0.001). There were significantly fewer patients receiving vitamin K and/ or fresh frozen plasma for supratherapeutic INRs with bleeding complications after the policy was initiated compared to baseline (p=0.009). CONCLUSIONS: The implementation of an inpatient warfarin policy led to better monitoring of patients receiving warfarin, and increased patient education. Studies have demonstrated that increased monitoring of warfarin translates to improved patient outcomes. However, a larger and longer assessment is necessary to determine if these changes are maintained and how these changes affect clinical outcomes.

Class of 2007 Abstract / Objectives: To explore the economic burden of illness and outcomes associated with in-patient related cases of asthma. Methods: This retrospective database study used Healthcare Cost and Utilization Project’s National Inpatient Survey to investigate the total number of discharges, length of stay and health care costs of patients with a primary diagnosis of asthma based on gender, payer and level of income. Data was analyzed using a non-parametric z-test to determine if results were significant. Results: A total of 418,789 patients (164,045 male, 251,264 female, 3,479 missing) were admitted with the category diagnosis of asthma in 2004. Females had a longer mean length of stay, higher mean charges and higher aggregate charges than males. These apparent differences were found to be significant. Medicaid had a larger number of total discharged and higher aggregate charges. Both these outcomes were found to be significant when compared to all other payers, expect there was no significance between Medicaid and Medicare in regards to aggregate charges. Medicare had a longer mean length of stay and higher mean charges which were found to be significant when compared to all other payers. Not low median income had more discharges, longer mean length of stay and higher mean and aggregate charges compared to low median income. These apparent differences were found to be significant. Conclusions: Being of female gender, or part of a government funded program (Medicaid or Medicare) or having an income of $36,000+ would result in higher discharge rates, longer mean length of stay and higher mean and aggregate charges in respect to asthma hospitalizations.

Class of 2007 Abstract / Objectives: The purpose of this study is to determine if an antibiotic formulary is beneficial in an inpatient ICU setting. The main goal, of course, is to ensure patients receive the most appropriate antimicrobial therapy resulting in the least amount of resistance, by using an antibiotic formulary and ICU antibiotic intervention. Methods: This project will use a retrospective design in which one-year post-intervention antibiotic resistant trends will be compared with pre-intervention trends at Yuma Regional Medical Center (YRMC). As is common at YRMC, patients started on antibiotic therapy had susceptibility testing performed to determine the best treatment for the patient. This susceptibility data will be the data used for comparison. Comparison of patient charges and hospital costs associated with these patients will also be performed. YRMC employed an ICU antibiotic intervention documentation form that was used to monitor and extrapolate intervention data. Hospital lab percent susceptibility data will be looked at to determine isolate susceptibility data to determine if any trends are present in antibiotic resistance between the time period when the antibiotic formulary was implemented and the previous corresponding period of time before the formulary. This data will also be compared with the hospital trends in resistant isolates as a whole. The data is desensitized, as individual patient data is not being reviewed. In looking at patient charges and hospital costs, charts will be reviewed. These charts will be de-identified to the investigators of this study. Of further note, YRMC placed the intervention in action in February 2006 and began collecting post-intervention data at that time. This study will be using post intervention data collected from February 2006 thru February 2007. Results: Conclusions:

Since National Health Insurance (NHI) was practiced in 1995,its public satisfaction was nearly 70% in the first year while the financial status got worse and worse years by years (15.3 billion of deficit in 1999,27.8 B deficits in Y2000, and around 37.7 B in Y2001). Therefore, Bureau of National Health Insurance (BNHI) had to not only care about cost saving, social fairness but also maintain medical care quality. In order to balance the worse finance, BNHI enforced many strategies, such as case payment (1997), outpatient and inpatient co-payment, high rejection rate of requested medical cases, global budget (Dental clinic in 1998, Chinese ambulatory in 2000, primary-cared clinics in 2001/07, hospital in 2002/07), drug price reduction from November of 1996 to December of 2002 to save about 14.65 billion, rationalization of OPD service, increase insurer fee (2002/09)¡K.etc. Those implemented strategies incurred the impacts on patients, medical provider, pharmaceutical industry, and government. Therefore, the aims of this study is to explore balancing strategic variables for finding out optimal solutions among heavy financial loading from insurers, profit loss and arguments of so-called ¡§Drug price Black-Hole¡¨ from pharmaceutical industry, and quality of medical care from hospitals. This study was through the ways of two-phase interview. The first one phase is to have in-depth interview with legislators, MNHI ministers, hospital administratives, scholars who are specialized at public health, and managers of consumer society; this phase was aimed at validity for all variables that were identified from the study. Until the second phase, we would focus on validated variables from phase one to design questionnaires for telephone interviewing with all stakeholders such as common people, phsicians from hospitals, managers from pharmaceutical industry, officials from BNHI. The study will try to reveal the strategic variables from different dimensions to find out concrete balancing strategies and suggestions to stakeholders in order for coping with the inevitable impacts under system thinkings in the future.

Myocardial infarction patients (MI, or heart attack) are vulnerable patients that require special care. The purpose of this study was to develop a teaching guide to be used by nursing staff with MI patients in the hospital setting, and to investigate the impact of this Individualized Patient Teaching Guide (IPTG). This research met its specific purposes through a three phase structure: development of the teaching guide, implementation, and assessment of participant impact. In phase one, development of the teaching guide, two focus groups were conducted: one with previous MI patients and the other with nursing staff. The IPTG was developed using topics identified as important by these two groups. Twenty patients participated in the implementation phase. The intention was for these patients to have patient teaching guided by the options they chose on their IPTGs. Seventy per cent of the patients provided feedback concerning the impact of the guide. All of these patients (n=14) indicated that Risk Factors was very important or important for them to learn about while in the hospital, and 13 of them received instruction on Risk Factors from health care practitioners. Psychological concerns was the topic most neglected: only one of the patients that had identified this as important received instruction on this topic. While the majority of patients (n=10) indicated that the IPTG provided them with an opportunity to identify their learning needs, only four of the patients surveyed felt that their learning needs were completely met in the hospital setting. The other six patients indicated that the information provided to them was insufficient. It seems that some of the topics identified as important were addressed in the clinical setting. Furthermore, the tool did allow patients an opportunity to identify learning needs. However, given that the majority of patients indicated dissatisfaction with the amount of education they received in the hospital setting, it may be concluded that the IPTG did not accomplish the goal of improving the in-patient learning experience. Reasons for this are discussed. / Thesis (Master, Education) -- Queen's University, 2008-07-25 11:33:49.114

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Class of 2012 Abstract / Specific Aims: This study was aimed to evaluate inpatient clinical treatment characteristics associated with the use of intracranial implantation of chemotherapeutic wafers for malignant brain neoplasms within United States, and assess inpatient mortality and total charges regarding treatment with wafer versus without. Methods: A retrospective cohort investigation was conducted utilizing inpatient discharge records from the Agency for Healthcare Research and Quality (AHRQ) Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample from 2005 to 2009. From this nationally- representative sample, 9,455 adults aged 18 years or older were identified with malignant neoplasms of the brain treated with implantable chemotherapeutic wafers. Outcomes of inpatient mortality and charges were assessed via multivariate regression analysis, controlling for patient characteristics, hospital structure, comorbidities, and clinical complications. Main Results: The average age of patients with brain neoplasms was 56.6 (±16.5) years, and of those patients, 42.9% were female. The odds ratio for inpatient mortality of patients treated with implantable chemotherapeutic wafers was OR=0.380 (P<0.001), and patients that received wafer treatment had increased charges exp(b)=2.147 (P<0.001). Conclusions: Multiple factors were associated with inpatient mortality and charges among the 247,829 patients that were diagnosed with malignant brain neoplasms from 2005-2009. With regards to these patients, implantable chemotherapeutic wafers were associated with increased inpatient survival and increased charges.

Class of 2010 Abstract / OBJECTIVES: To assess disease-related and resource consumption characteristics of esophageal cancer mortality within hospital inpatient settings in the United States from 2002 to 2006. METHODS: This retrospective investigation of adults aged 18 years or older with diagnoses of malignant neoplasms of the esophagus (ICD-9: 150.x) utilized nationally-representative hospital discharge records from the Agency for Healthcare Research and Quality (AHRQ) Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample. Cases resulting in inpatient death were analyzed with respect to patient demographics, payer, hospital characteristics, number of procedures and diagnoses, Deyo-Charlson disease-based case-mix risk adjustor, and predominant comorbidities. RESULTS: Overall, 168,450 inpatient admissions for esophageal cancer were observed between 2002 and 2006, averaging 66.3 + or - 11.9 years, length of stay of 10.3 + or - 15.2 days, and charge of $51,600 + or _ 92,377. Predominant comorbidities within these persons included: secondary malignant neoplasms; disorders of fluid, electrolyte, and acid-base balance; pneumonia; respiratory failure/collapse or insufficiency; sepsis; anemia; hypertension; cardiac arrhythmias; obstructive pulmonary disease; acute or chronic renal disease; and heart failure. Significant predictors of increased charges included longer lengths of stay, higher numbers of diagnoses and procedures, median annual family income over $45k, urban hospital location, and presence of heart failure, chronic pulmonary disease, fluid and electrolyte disorders, or metastatic cancers (P< or = 0.05). Longer lengths of stay were associated with higher total charges, female sex, larger number of diagnoses and procedures, Medicaid, black race, increased case-mix severities, and fluid and electolyte disorders (P< or = 0.05). CONCLUSIONS: Patient mortality occurs in over one-tenth of esophageal cancer hospital admission cases. Further research is warranted to understand the impact of various comorbidities or treatment approaches and to assess potential disparities in lengths of stay.