RESUMEN
PURPOSE OF STUDY: Racial and ethnic minorities with socioeconomic disadvantages are vulnerable to 30-day hospital readmissions. A 16-week quality improvement (QI) project aimed to decrease readmissions of the vulnerable patient populations through tailored discharge planning. The project evaluated the effectiveness of using a 25-item checklist to increase patients' and caregivers' health knowledge, skills, and willingness for self-care and decrease readmissions. PRIMARY PRACTICE SETTING: The project took place in an inner-city teaching hospital in the Mid-Atlantic region. METHODOLOGY AND PARTICIPANTS: A casual comparative design compared readmissions of the before-intervention group (May 1-July 31, 2021) and the after-intervention group (August 1-October 31, 2021). A pre- and postintervention design evaluated the effectiveness of a 25-item checklist by analyzing the differences of Patient Activation Measure (PAM) pre- and postintervention survey scores and levels in the after-intervention group. Participants were General Medicine Unit patients 18 years or older who had Medicare Fee-for-Service, resided in 10 zip codes near the hospital, and were discharged home. RESULTS: Of 30 patients who received the intervention, one patient was readmitted compared with 11 readmissions from 58 patients who did not receive the intervention. The readmission rate was decreased from 19% to 4% during the 16-week project: 11 (19%) versus 1 (4%), p = .038. After receiving the intervention, patients' PAM scores were increased by 8.55, t(22) = 2.67, p < .014. Three patients had a lower postintervention survey level, whereas 12 patients obtained a higher postintervention survey level (p = .01). The increase in scores and levels supported that the intervention effectively improved patients' self-management knowledge, skill, and willingness for self-care. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: The QI project showed that the hospital could partner with patients at high risk for readmission and their caregivers. Accurate evaluation of patients' health knowledge, skills, and willingness for self-care was essential for sufficient discharge planning. Tailored use of the checklist improved patients' self-activation and functionally facilitated patients' and caregivers' care needs and capabilities. The checklist was statistically and clinically effective in decreasing 30-day hospital readmissions of vulnerable patient populations.
Asunto(s)
Alta del Paciente , Readmisión del Paciente , Anciano , Humanos , Estados Unidos , Cuidadores , Medicare , AutocuidadoAsunto(s)
Ginecología , Obstetricia , Humanos , Internado y Residencia , Aplicaciones Móviles , MédicosAsunto(s)
Hospitales de Enseñanza , Internado y Residencia , Humanos , Atención al Paciente , MédicosAsunto(s)
Internado y Residencia , Rondas de Enseñanza , Niño , Humanos , Medicina Interna/educación , Pediatría , PercepciónRESUMEN
OBJECTIVES: To clarify the relationship between age and pathologic Gleason score and their effect on prostate-specific antigen recurrence (PSAR). METHODS: The data from a cohort of 2911 men who had undergone radical prostatectomy from 1988 to 2006 were retrieved from the Duke Prostate Center database. Patient age was divided into 3 groups: <60, 60-64, and >or=65 years. The pathologic Gleason score was divided into 5 groups:
Asunto(s)
Recurrencia Local de Neoplasia/sangre , Antígeno Prostático Específico/sangre , Prostatectomía , Neoplasias de la Próstata/sangre , Neoplasias de la Próstata/patología , Factores de Edad , Anciano , Supervivencia sin Enfermedad , Humanos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/epidemiología , Estadificación de Neoplasias , Valor Predictivo de las Pruebas , Prostatectomía/métodos , Neoplasias de la Próstata/cirugíaRESUMEN
INTRODUCTION: Allergic eosinophilic esophagitis (AEE) is thought to be an allergic reaction that is characterized by inflammation caused by predominant accumulation of eosinophils in esophageal mucosa (> or =15 eosinophils per high power field). AIMS: To examine the seasonal distribution of newly diagnosed AEE children. METHODS: Retrospective analysis of all patients diagnosed with AEE at our institution over a nearly 6-year period (December 1998 to October 2004). RESULTS: Two hundred thirty-four children (mean age 7.3 y, median age 7.0 y, age range 0.2 to 19.5 y) were diagnosed with AEE during the study period. Significantly fewer patients were diagnosed with AEE in Winter as compared with Spring, Summer, and Fall. Although all the patients had severe eosinophilic esophagitis, the intensity of esophageal eosinophilia was less in Winter than in Summer or Fall, but not Spring, seasons. CONCLUSIONS: A seasonal variation was noted with Winter, a season of low outdoor allergens, having the fewest number of newly diagnosed AEE patients.