Developing a Toolkit to Reduce Infections Following Durable LVAD Implantation in the United States Using a Multistage Mixed Methods Design.

Rationale: Pulmonary rehabilitation (PR) after hospitalization for chronic obstructive pulmonary disease (COPD) is recommended by guidelines; however, few patients participate, and rates vary between hospitals. Objectives: To identify contextual factors and strategies that may promote participation in PR after hospitalization for COPD. Methods: Using a positive-deviance approach, we calculated hospital-specific rates of PR after hospitalization for COPD among a cohort of Medicare beneficiaries. At a purposive sample of high-performing and innovative hospitals in the United States, we conducted in-depth interviews with key stakeholders. We defined high-performing hospitals as having a PR rate above the 95th percentile, at least 6.58%. To learn from hospitals that demonstrated a commitment to improving rates of PR, regardless of PR rates after discharge, we identified innovative hospitals on the basis of a review of American Thoracic Society conference research presentations from prior years. Interviews were audio-recorded and transcribed verbatim. Using a directed content analysis approach, transcripts were coded iteratively to identify themes. Results: Interviews were conducted with 38 stakeholders at nine hospitals (seven high-performers and two innovators). Hospitals were diverse regarding size, teaching status, PR program characteristics, and geographic location. Participants included PR medical directors, PR managers, respiratory therapists, inpatient and outpatient providers, and others. We found that high-performing hospitals were broadly focused on improving care for patients with COPD, and several had recently implemented new initiatives to reduce rehospitalizations after admission for COPD in response to the Centers for Medicare and Medicaid Services/Medicare's Hospital Readmission Reduction Program. Innovative and high-performing hospitals had systems in place to identify patients with COPD that enabled them to provide patient education and targeted discharge planning. Strategies took several forms, including the use of a COPD navigator or educator. In addition, we found that high-performing hospitals reported effective interprofessional and patient communication, had clinical champions or external change agents, and received support from hospital leadership. Specific strategies to promote PR included education of referring providers, education of patients to increase awareness of PR and its benefits, and direct assistance in overcoming barriers. Conclusions: Our findings suggest that successful efforts to increase participation in PR may be most effective when part of a larger strategy to improve outcomes for patients with COPD. Further research is necessary to test the generalizability of our findings.

Of the approximately four million women who give birth each year in the United States, nearly 13percent experience one or more major complications. But the extent to which the rates of major obstetrical complications vary across hospitals in the United States is unknown. We used multivariable logistic regression models to examine the variation in obstetrical complication outcomes across US hospitals among a large, nationally representative sample of more than 750,000 obstetrical deliveries in 2010. We found that 22.55percent of patients delivering vaginally at low-performing hospitals experienced major complications, compared to 10.42percent of similar patients delivering vaginally at high-performing hospitals. Hospitals were classified as having low, average, or high performance based on a calculation of the relative risk that a patient would experience a major complication. Patients undergoing a cesarean delivery at low-performing hospitals had nearly five times the rate of major complications that patients undergoing a cesarean delivery at high-performing hospitals had (20.93percent compared to 4.37percent). Our finding that the rate of major obstetrical complications varies markedly across US hospitals should prompt clinicians and policy makers to develop comprehensive quality metrics for obstetrical care and focus on improving obstetrical outcomes.

4th Decennial International Conference on Nosocomial and Healthcare-Associated Infections: A challenge for change

Hospitals across the United States are pursuing strategies to reduce avoidable readmissions but the evidence on how best to accomplish this goal is mixed, with no specific clinical practice shown to reduce readmissions consistently. Changes to hospital organizational practices, a key component of context, also may be critical to improving performance on readmissions, but this has not been studied. The aim of this study was to understand how high-performing hospitals improved risk-stratified readmission rates, and whether their changes to clinical practices and organizational practices differed from low-performing hospitals. This was a qualitative study of 10 hospitals in which readmission rates had decreased (n=7) or increased (n=3). A total of 82 hospital staff drawn from hospitals that had participated in the State Action on Avoidable Readmissions quality improvement initiative. High-performing hospitals were distinguished by several organizational practices that facilitated readmissions reduction, that is, collective habits of action or interpretation shared by organization members. First, high-performing hospitals reported focused efforts to improve collaboration across hospital departments. Second, they helped postacute providers improve care by sharing the hospital's clinical and quality improvement expertise and data. Third, high performers enthusiastically engaged in trial and error learning to reduce readmissions. Fourth, they emphasized that readmissions represented bad outcomes for patients, de-emphasizing the role of financial penalties. Both high-performing and low-performing hospitals had implemented most clinical practice changes commonly recommended to reduce readmissions. Our findings highlight several organizational practices that hospitals may be able to use to enhance the effectiveness of their readmissions reduction efforts.

Firearm Injury and Mortality Prevention in Pediatric Health-care Settings.

The American Heart Association/American Stroke Association (AHA/ASA) is a trusted source of scientific information in cardiovascular medicine. The AHA/ASA has a longstanding commitment to support state-of-the-art scientific research in cardiovascular disease and stroke. The AHA/ASA has also developed a leadership role in translating cardiovascular science into internationally respected guidelines. In 2000, however, the AHA/ASA concluded that, to provide maximal benefit for patients with cardiovascular disease and those at risk, it needed to develop a rigorous approach to translating its guidelines into clinical practice. The result was a comprehensive suite of programs collectively called Get With The Guidelines (GWTG). Modeled in part on the University of California, Los Angeles Cardiovascular Hospitalization Atherosclerosis Management Program (CHAMP),1,2 GWTG was successfully piloted by the AHA in Massachusetts.3 Based on the success of the Massachusetts pilot, the AHA committed significant human and financial resources to extend the program across the United States. This commitment included the development of a national steering committee composed of AHA/ASA volunteers, and the addition of multiple modules including hospital-based management of coronary artery disease, heart failure, stroke, and resuscitation after in-hospital cardiac arrest. The scientific foundation of the program is the best evidence from the latest American College of Cardiology/AHA/ASA guidelines. GWTG staff work with participating hospitals to implement these guidelines by using AHA/ASA quality improvement professional consultation, workshops, and Webinars. In addition, the AHA developed sophisticated clinical databases (registries) through which hospitals and physicians collect information in real time for the assessment of quality, regional, and national benchmarking, national recognition, and the generation of new science. The AHA underwrites a portion of the costs associated with the technology platform and data collection tools to reduce the financial burden on participating sites. From the 4 GWTG disease-specific registries, >200 articles have been published in peer-reviewed journals. …

ERP variation may be negatively correlated with P300 speller performance

Peritoneal Dialysis Access Associated Infections.

Perceived knowledge among patients cared for by nephrologists about chronic kidney disease and end-stage renal disease therapies

Value of Registries in ST-Segment-Elevation Myocardial Infarction Care in Both the Pre-Coronavirus Disease 2019 and the Coronavirus Disease 2019 Eras.

Variation in Waitlisting Rates at the Dialysis Facility Level in the Context of Goals for Improving Kidney Health in the United States

Growing a peritoneal dialysis program: A single‐center experience

Bloodstream Infection Prevention in ESRD: Forging a Pathway for Success

Is perioperative home the future of surgical patient care?

Transcript Auto scroll search expand close Search Transcript Search Up Search Down Close Search Tools Tools icon close Download PDFopens in new window Cite Cite icon close Format APA APA Chicago Harvard MLA AMA Joseph, A. (Academic). (2023). Researching acculturation processes & psychological functioning of asian indian women in the united states using a mixed methods approach [Video]. Sage Research Methods. https://doi.org/10.4135/9781529630060 Joseph, Anitha. "Researching Acculturation Processes & Psychological Functioning of Asian Indian Women in the United States Using a Mixed Methods Approach." In Sage Video. : SAGE Publications, Ltd., 2023. Video, 00:15:16. https://doi.org/10.4135/9781529630060. Joseph, A., 2023. Researching Acculturation Processes & Psychological Functioning of Asian Indian Women in the United States Using a Mixed Methods Approach, Sage Video. [Streaming Video] London: Sage Publications Ltd. Available at: <https://doi.org/10.4135/9781529630060 & gt; [Accessed 17 Mar 2023]. Joseph, Anitha. Researching Acculturation Processes & Psychological Functioning of Asian Indian Women in the United States Using a Mixed Methods Approach. Online video clip. SAGE Video. London: SAGE Publications, Ltd., 12 Dec 2022. doi: https://doi.org/10.4135/9781529630060. 17 Mar 2023. Researching Acculturation Processes & Psychological Functioning of Asian Indian Women in the United States Using a Mixed Methods Approach [Streaming video]. 2023. doi:10.4135/9781529630060. Accessed 03/17/2023 copy to clipboard or Export to your reference manager Endnote Endnote Reference Manager ProCite RefWorks BibTeX Zotero Medlars Mendeley Word Export Cancel Share Share icon close Share via Email Please log in from an authenticated institution or log into your member profile to access the email feature. Sign in/register Embed Embed icon close Embed this Content Add this content to your learning management system or webpage by copying the code below into the HTML editor on the page. Look for the words HTML or </>. Learn More about Embedding Video icon link (opens in new window) Clip - https://methods.sagepub.com/video/researching-acculturation-and-psychological-functioning-of-asian-indian-women Embed code: Copy to clipboard Select a length: Entire video Entire video Select a size: 420x236 640x360 853x480 Sample View: (opens in new window) Cancel Get link Get link icon close Select a length: Entire video Entire video Link to this page directly with a permalink: https://methods.sagepub.com/video/researching-acculturation-and-psychological-functioning-of-asian-indian-women Copy to clipboard Cancel