Care Management Strategies Research Articles

Nursing Care Management Strategies in Isolation Wards during the COVID-19 Outbreak

Coronavirus disease 2019 (COVID-19) is highly infectious and has spread worldwide. Medical staff may be exposed to the infection under circumstances of medical supply shortages and improper protection. How to better protect medical staff has become the focus of all walks of life. Therefore, during the COVID-19 outbreak, timely adjustments and optimization of nursing management strategies in isolation wards are important for improving care quality and reducing the infection of medical staff. Based on a literature review and clinical nursing management practices, this article summarizes the nursing management strategies in isolation wards during the COVID-19 outbreak, aiming to provide references for clinical nursing managers.

Stakeholder impact on the implementation of integrated care: Opportunities to consider for patient-centered outcomes research

Nearly half of Americans live with chronic disease. Many have multiple chronic conditions that often present as a combination of physical and mental health conditions. Aligning stakeholder-driven, patient-centered outcomes research with population health strategies such as innovative ways to deliver care management can reduce the burden of multiple chronic conditions. In addition, successfully creating meaningful, inclusive research requires actively engaging stakeholders throughout the lifecycle of a study. This study integrates stakeholder engagement, using a large health plan in western Pennsylvania, to conduct a randomized controlled trial. Three care management strategies, High-Touch, High-Tech, and Usual Care, are compared for effectiveness among members with multiple chronic conditions.Care strategies are delivered via the Community Team, a multidisciplinary community-based team, offering in-person (High-Touch) and digital (High-Tech) care management in 14 counties across Pennsylvania. Participants are followed for 12months, with repeated measurements of self-reported health status and activation in care, while tracking administrative measurements of primary and specialty health service utilization. Quality of life, care satisfaction, engagement in care, and service utilization will be compared using generalized mixed models. Additionally, semi-structured interviews are conducted for both participants and care managers over the course of the study to evaluate feasibility. This manuscript presents implementation strategies, while noting that the implementation of patient-centered outcomes research in a real-world setting requires rapid evaluation, redesign of workflow, and tailored approaches for success.

“I just glove up and do what has to be done”: A mixed‐methods exploration of dementia care challenges and care management strategies

AbstractBackgroundMost family caregivers for persons living with dementia (PLwD) don’t receive training for their role and therefore adopt a variety of care management strategies, some of which may be harmful. The current study utilizes a mixed‐methods design to integrate family caregiver’s qualitative and quantitative descriptions of recent care challenges (e.g. cognitive, functional, and behavioral symptoms of dementia), and the strategies utilized to manage these symptoms.MethodParticipants included 100 primary family caregivers for PLwD who were 74% female, 18% non‐White, and on average 64 years old. Participants were interviewed qualitatively about their management of a recent care challenge and with the Caregiver Assessment of Function and Upset, Neuropsychiatric Symptom Inventory, Dementia Severity Rating Scale, and Dementia Management Strategies Scale (subscales: criticism, active management, encouragement). Care challenges and care management strategies are compared across qualitative analysis and T‐tests.ResultThe most common type of qualitatively reported care challenge was BPSD (45%) followed by symptoms of cognitive decline (18%). Quantitatively caregivers reported the most stressful ADL to be toileting and BPSD as aggression. Caregivers providing ADL/IADL care (r=.34, p<.01) and with PLwDs with more severe cognitive symptoms (r=.30, p<.01) had significantly higher use of active management care strategies, relative to caregivers not assisting with those tasks. In contrast, caregivers providing care for PLwDs with greater BPSD burden (r=.34, p<.001) and particularly challenging symptoms of aggression (t=‐.4.0, p<.001), agitation (t=‐3.4, p<.001), irritability (t=‐.2.4, p<.05) and hallucinations (t=‐2.3, p<.05) reported more use of criticism as a management strategy.ConclusionMixed‐methods assessment of care challenges provides a more nuanced understanding of how caregivers manage care stressors. Active management or other straightforward assistive approaches may be required when the severity of dementia increases, yet critical strategies seem to emerge with greater severity of BPSD. Encouragement strategies, on the other hand, were independent of any care challenges and may be used to support the PLwD, not address an underlying symptom. As criticism tends to be associated with more negative care outcomes (burden, potentially harmful behavior), intervention approaches may help caregivers identify more adaptive responses to prepare for stressful challenges such as BPSD.

Prospective or retrospective ACO attribution matters for seriously ill patients.

Since 2019, the Medicare Shared Savings Program (MSSP) has allowed accountable care organizations (ACOs) to choose either retrospectively or prospectively attributed ACO populations. To understand how ACOs' choice of attribution method affects incentives for care among seriously ill Medicare beneficiaries, this study compares beneficiary characteristics and Medicare per capita expenditures between prospective and retrospective ACO populations. This retrospective, cross-sectional analysis describes survival, patient characteristics, and Medicare spending for Medicare fee-for-service beneficiaries identified with serious illness (n = 1,600,629) using 100% Medicare Master Beneficiary Summary and MSSP beneficiary files (2014-2016). We used generalized linear models with ACO and year fixed effects to estimate the average within-ACO difference between potential retrospective and prospective ACO populations. Dying in the first 90 days of the performance year was associated with reduced odds of retrospective ACO attribution (odds ratio [OR], 0.24; 95% CI, 0.24-0.25) relative to beneficiaries surviving 270 days or longer. Similarly, hospice use was associated with reduced odds of retrospective assignment (OR, 0.80; 95% CI, 0.79-0.80). Among ACOs that did not achieve shared savings, average per capita Medicare expenditures (after truncation) were $2459 (95% CI, $2192-$2725) higher for prospective vs retrospective ACO populations. The difference was $834 (95% CI, $402-$1266) greater per capita among ACOs that achieved shared savings. The difference in survival and spending for ACO populations captured by prospective vs retrospective attribution methods means that ACOs may need to employ different care management strategies to improve performance depending on their attribution method.

Challenges of nurses and care management of depressed older adults: a narrative literature review.

The number of older adults with depression has increased in recent years. In relation to this, conducting a narrative review helps provide a better understanding of the adaptive functioning of depressed older adults and the significance of interventions in reducing depression. This narrative review investigates the nurses' management of depressed older adult patients. It also presents a detailed investigation of the barriers preventing nurses from successfully implementing nursing care for older adults. A narrative literature review was performed on four electronic databases, namely, (i) Cumulative Index of Nursing and Allied Health Literature, (ii) Pubmed, (iii) PsycINFO and (iv) Taylor and Francis. English language and peer-reviewed journal articles were included. A total of 19 articles were selected for the review, and four main themes were generated: (i) the challenges in implementing depression care management, (ii) the role of social support in depression treatment, (iii) the pharmacological management approach and (iv) the health care management process. Nurses experience several challenges in implementing depression care management. The role of social support in the treatment of depression, pharmacological management and different types of health care management strategies all provide solutions for depressed older adults. The review findings provide insights for improving health care nursing services for depressed older adults and reducing the negative health outcomes in this population.

Estrategias de gestión y política sanitaria para el desarrollo del Patient Blood Management en los sistemas de salud en España

Patient Blood Management (PBM) programs have proven to be successful in reducing overuse and improving patient safety, clinical outcomes and efficiency. Despite its benefits, PBM is still scarcely used in real clinical practice with a high variability among hospitals in Spain. Recent guidelines from the European Union on how to implement PBM, as well as recommendations from experts in the field, suggest that further development in PBM implementation requires not only the participation of healthcare professionals but also the commitment and support of Health Authorities and senior hospital management. This article provides some thoughts on health care management and policy strategies to help implement PBM throughout the Spanish autonomous healthcare systems.

Discharge Communication of Dementia-Related Neuropsychiatric Symptoms and Care Management Strategies During Hospital to Skilled Nursing Facility Transitions.

Provided the complexity of managing dementia-related neuropsychiatric symptoms (NPS), accurate communication about these symptoms at hospital discharge is critical to facilitating safe and effective transitions, particularly transitions from hospitals to skilled nursing facilities (SNF), which are often poorly managed. Skilled nursing facilities providers have cited undercommunication regarding NPS as a major challenge that contributes to poor outcomes including rehospitalization. This multisite retrospective cohort study identified omission rates for NPS and associated management strategies in discharge communication as compared to medical record documentation in the 72 hours preceding discharge among hospitalized patients with dementia. High rates of omission were found across NPS and management strategies: anxiety (94%), agitation/aggression (77%), hallucinations (85%), 1:1 supervision (90%), high fall risk (89%), use of restraints (91%). Omission rate for new or modified antipsychotic medication was 12.9%. Findings underscore the need for additional research on cross-setting communication regarding care needs of patients with dementia-who often cannot communicate these needs on their own-in facilitating high-quality transitions.

A pragmatic perspective on mental disorders by psychiatrists of Karachi, Pakistan: A qualitative study

Introduction: There is an alarming rise in mental health problems in Pakistan, due to various reasons including genetic vulnerability. There is a paucity of reliable and updated data on mental illnesses in Pakistan.
 Objective: The main objective of our study was to explore the perspective of psychiatrists on frequency of mental disorders, their related factors and expected recovery from mental illnesses in a Psychiatric Care and Rehabilitation center of Karachi, Pakistan.
 Methodology: This qualitative study was conducted at the Karwan-e-Hayat Psychiatric Care and Rehabilitation center, Karachi, Pakistan from Dec 2019 to April 2020. Seventeen study participants were recruited through purposive sampling and data was collected through in-depth interviews. Qualitative thematic analysis of content was done though generation of a coding scheme.
 Results: Analysis of the interview transcripts revealed two main themes related to psychiatrists’ views about mental disorders in Pakistan; (1) Contributing and consequential correlates of mental disorders (2) Effective therapeutic strategies and recovery rate from mental disorders.
 Conclusion: Our study concluded that mental disorders are increasing with high proportion of psychosis and schizophrenia cases in Pakistan. The productive young age group and male gender are most commonly affected. The factors associated with mental disorders include lower socio-economic status, Low-literacy, divorce, exposure to traumatic events like violence and political turmoil, and sleep disturbances. The recovery rate from mental disorders is promising with integrative approach including pharmacological, psychosocial and care management strategies.

Narrative as a strategy for understanding the experience of chronic illness: a literature review

This article aims to explore, in available literature, the use of narrative in studies of chronic illness. It is hoped that this study in addition to knowing how to have been the use of narrative in studies, contribute to the care of people with chronic illness. Methodologically, the study consists of a literature review of qualitative nature, focusing on articles with the Virtual Health Library descriptors (VHL). In terms of results, three stand out meanings attributed to the use of narrative by the authors: technique to get testimonies, research method and specific type of testimony; and in terms of the main results attributed by the authors with the use of narrative, are evident two themes: the experience of chronic illness in the subject ill perspective, highlighting the search for meaning, reframing the chronicity and coping strategies; and the possibility of understanding chronic illness, by professionals from the experience of the subject ill. It is verified, in the analyzed studies, that the use of the narrative itself or the narration process can make possible the resignification of the process of illness by the subjects and point out strategies for care management in chronic illness.

Looking through the eyes of the multidisciplinary team: the design and clinical evaluation of a decision support system for lung cancer care.

BackgroundDecision-making in lung cancer is complex due to a rapidly increasing amount of diagnostic data and treatment options. The need for timely and accurate diagnosis and delivery of care demands high-quality multidisciplinary team (MDT) collaboration and coordination. Clinical decision support systems (CDSSs) can potentially support MDTs in constructing a shared mental model of a patient case. This enables the team to assess the strength and completeness of collected diagnostic data, stratification for the right personalized therapy driven by clinical stage and other treatment-influencing factors, and adapt care management strategies when needed. Current CDSSs often have a suboptimal fit into the decision-making workflow, which hampers their impact in clinical practice.MethodsA CDSS for multidisciplinary decision-making in lung cancer was designed to support the abovementioned goals through presentation of relevant clinical data in line with existing mental model structures of the MDT members. The CDSS was tested in a simulated multidisciplinary tumor board meeting for primary diagnosis and treatment selection, based on de-identified primary lung cancer cases (n=8). Decision course analysis, eye-tracking data and questionnaires were used to assess the impact of the CDSS on constructing shared mental models to improve the decision-making process and outcome.ResultsThe CDSS supported the team in their self-correcting capacity for accurate diagnosis and TNM classification. It enabled cross-validation of diagnostic findings, surfaced discordance between diagnostic tests and facilitated cancer staging according the diagnostic evidence, as well as spotting contra-indications for personalized treatment selection.ConclusionsThis study shows the potential of CDSS on clinical decision making, when these systems are properly designed in line with clinical thinking. The presented setup enables assessment of the impact of CDSS design on clinical decision making and optimization of CDSSs to maximize their effect on decision quality and confidence.

Alternative management for gynecological cancer care during the COVID-2019 pandemic: A Latin American survey.

ObjectiveTo determine the acceptance rate of treatment alternatives for women with either preinvasive conditions or gynecologic cancers during the COVID‐19 pandemic among Latin American gynecological cancer specialists.MethodsTwelve experts in gynecological cancer designed an electronic survey, according to recommendations from international societies, using an online platform. The survey included 22 questions on five topics: consultation care, preinvasive cervical pathology, and cervical, ovarian, and endometrial cancer. The questionnaire was distributed to 1052 specialists in 14 Latin American countries. A descriptive analysis was carried out using statistical software.ResultsA total of 610 responses were received, for an overall response rate of 58.0%. Respondents favored offering teleconsultation as triage for post‐cancer treatment follow‐up (94.6%), neoadjuvant chemotherapy in advanced stage epithelial ovarian cancer (95.6%), and total hysterectomy with bilateral salpingo‐oophorectomy and defining adjuvant treatment with histopathological features in early stage endometrial cancer (85.4%). Other questions showed agreement rates of over 64%, except for review of pathology results in person and use of upfront concurrent chemoradiation for early stage cervical cancer (disagreement 56.4% and 58.9%, respectively).ConclusionLatin American specialists accepted some alternative management strategies for gynecological cancer care during the COVID‐19 pandemic, which may reflect the region’s particularities.The COVID‐19 pandemic led Latin American specialists to accept alternative management strategies for gynecological cancer care, especially regarding surgical decisions.

The Neurocritical Care Society of India (NCSI) and the Indian Society of Neuroanaesthesiology and Critical Care (ISNACC) Joint Position Statement and Advisory on the Practice of Neurocritical Care during the COVID-19 Pandemic

AbstractThe COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus (SARS-CoV-2) has rapidly spread across the world including India. Management of patients complicated with neurological illness requiring neurocritical care is challenging during this time. Patients with neurological disease may develop COVID-19 infection or there could be independent neurological manifestations of COVID-19. Critically ill neurological patients are more vulnerable to contracting SARS-CoV-2 infection. Also, neurological patients with comorbidities and multisystem involvement are at increased risk of adverse outcomes. Though SARS-CoV-2 predominantly affects the pulmonary system, it can complicate the assessment and management of neurological patients. With increasing COVID-19 numbers, the hospitalizations of both non-COVID and COVID-19 neurological patients will bring significant strain on the hospital and neurocritical care facilities. Streamlining work pattern, understanding the pathophysiology of COVID-19 and its impact on neurological function, establishing general and specific neurocritical care management strategies, ensuring protection and well-being of health care providers, and implementing effective infection control policies are key elements of efficient neurocritical care management during this pandemic. This joint position statement and advisory on the practice of neurocritical care during the COVID-19 pandemic by the Neurocritical Care Society of India and the Indian Society of Neuroanaesthesiology and Critical Care has been developed to guide clinicians providing care to the critically ill neurological patients in the neurocritical care unit during the current pandemic. As the situation from this novel disease is rapidly evolving, readers must constantly update themselves with newly emerging evidence to provide the best possible care to the critically ill neurological patients.

Early Initiation of Pediatric Palliative Care.

Pediatric palliative care (PPC) literature was utilized to identify barriers for early initiation of palliative care at diagnosis among children with life-threatening diseases. Early integration of PPC enhances quality of life and reduces suffering in these children, but many clinicians fail to initiate advanced care planning, establish goals of care, and refer to specialists. Barriers to early PPC initiation include clinician misperceptions, emotional toll on clinicians, and prognostic uncertainty about treatment options and care management strategies. Pediatric nurse practitioners can increase awareness, educate, and support other clinicians to promote early initiation of PPC in children with life-threatening diseases.

Guidance for Rebooting Electrophysiology Through the COVID-19 Pandemic From the Heart Rhythm Society and the American Heart Association Electrocardiography and Arrhythmias Committee of the Council on Clinical Cardiology.

Coronavirus disease 2019 (COVID-19) has presented substantial challenges to patient care and impacted healthcare delivery, including cardiac electrophysiology practice throughout the globe. Based upon the undetermined course and regional variability of the pandemic, there is uncertainty as to how and when to resume and deliver electrophysiology services for patients with arrhythmia. This joint document from representatives of the Heart Rhythm Society, American Heart Association, and American College of Cardiology seeks to provide guidance for clinicians and institutions reestablishing safe electrophysiological care. To achieve this aim, we address regional and local COVID-19 disease status, the role of viral screening and serological testing, return-to-work considerations for exposed or infected health care workers, risk stratification and management strategies based on COVID-19 disease burden, institutional preparedness for resumption of elective procedures, patient preparation and communication, prioritization of procedures, and development of outpatient and periprocedural care pathways.

Strategies for implementing best practices in independent physician associations.

Scholars have highlighted the importance of preventing hospital admissions and readmissions for individuals with costly chronic conditions. Providing effective care management strategies can help reduce inpatient admissions, thereby reducing rising health care costs. However, implementing effective care management strategies may be more difficult for independent physician associations (IPAs) that contract with multiple organizations that have competing interests and agendas. This study aims to identify and investigate strategies that facilitate the implementation of evidence-based best practices among IPAs. The research synthesized peer-reviewed literature to identify best practices in chronic disease management for Medicare beneficiaries. Subsequently, 20key informant interviews were conducted to explore barriers and facilitators in adapting these best practices in IPA settings. Informant interviews were conducted with 3 key groups: executives, medical directors, and care managers. Key informant interviews were conducted to explore barriers and facilitators in implementing best care management practices. Key informants provided unique insights regarding the challenges of implementing best care management practices among IPAs. These challenges included implementing and sustaining the operations of evidence-based care management programs while maintaining contractual obligations to health plans, engaging physicians in large and diverse networks, and building high-touch programs in large geographic areas using risk-stratifying algorithms. IPA managed care organizations require unique considerations in regard to selected strategies used to manage chronic disease in Medicare populations. These considerations are critical for optimal management of the population, particularly in a risk-based or pay-for-performance environment.

Impact of medication review via tele-expertise on unplanned hospitalizations at 3\u2009months of nursing homes patients (TEM-EHPAD): study protocol for a randomized controlled trial

BackgroundInappropriate drug prescribing causes preventable drug-related adverse events that result in increased morbidity and mortality, additional costs and diminished quality of life. Numerous initiatives have been launched to improve the quality of drug prescribing and safeguard the security of drug administration processes in nursing homes. Against the backdrop of implementation of telemedicine services, the focus of the present work is to evaluate the impact of a telemedication review carried out by a hospital physician and pharmacist as part of the telemedicine offer.MethodsThe present study is a randomized controlled clinical trial. A total of 364 patients will be randomized into two groups: (1) an experimental group (182 patients) benefiting from a telemedication review using tele-expertise and (2) a control group (182 patients) receiving standard care. The primary endpoint will be rate of all-cause unplanned hospital admissions occurring within 3 months of randomization. The secondary endpoints will be rate of unplanned admissions at 6 months, patient quality of life, incidence of behavioral disturbances, number of falls, number of residents prescribed at least one inappropriate medication, nursing staff satisfaction, proposed medication reviews and their acceptability rate, characteristics of patients whose general practitioners have taken account of tele-expertise, efficacy of tele-expertise as compared to standard prescription and acceptability and satisfaction surveys of participating caregivers.DiscussionIn the literature, various studies have investigated the utility of structured medication review processes, but outcome measures are heterogeneous, and results vary widely. Medication review can detect medication-related problems in many patients, but evidence of clinical impact is scant. Incremental cost-effectiveness ratios will be used to compare the cost and effectiveness of the experimental strategy and that of standard care. Our approach, involving the combination of an acceptability survey and a mixed-method (qualitative and quantitative) satisfaction survey, is particularly innovative. The results of this randomized trial are expected to confirm that medication review using tele-expertise has potential as a worthwhile care management strategy for nursing home residents.Trial registrationClinicaltrials.gov NCT03640845; registered August 21, 2018 (Clinicaltrials.gov NCT03640845).

Improving Family Navigation for Children With Autism: A Comparison of Two Pilot Randomized Controlled Trials.

Family navigation (FN), a care management strategy, helps families overcome systems and person-level barriers to care. We previously demonstrated FN's feasibility, acceptability, and potential efficacy for increasing access and reducing time to autism-related diagnostic services among low-income, minority children. In this paper, we describe modifications to FN in response to concerns raised in our first pilot randomized controlled trial (RCT), and then assess these modifications in a second pilot RCT. An advisory group recommended modifications to recruitment procedures and study conditions. Forty parent-child dyad participants with autism-related concerns were randomized to receive modified usual care (UC) or modified FN. We compared whether the first and second pilot RCTs differed in: participant enrollment, satisfaction with clinical care, and timely completion of the diagnostic assessment. Recruitment improved under the modified protocol with significantly fewer potentially eligible families refusing (19.5% vs 4.8%, P < .05) or being excluded from study enrollment (43.6% vs 0%, P < .01). Comparing the first and second pilot RCTs, regardless of study arm, families in the second pilot were more likely to complete diagnostic assessment (UC: hazard ratio [HR] 3.41, 95% confidence intervals [CI 1.20, 9.68]; FN: HR 2.64, 95% CI [1.31, 5.30]) and report greater satisfaction with clinical care. In the second pilot, compared to UC, FN continued increase the likelihood of completing the diagnostic assessment (HR: 2.57; 95% CI [1.22, 5.40]). Easy-to-implement system-level enhancements improved study recruitment, satisfaction with care, and completion of a diagnostic assessment. With enhancement, FN continued to confer benefits to families.

Hygiene Conditions and Animal-Environment Relations in Farm Animals Barns

In all type farms, animal health and the environment represents a major component, besides feeding, genetics and management quality. A healthy animal can only be grown in health and hygienic conditions. Health and environmental hygiene should not be ignored feature of the all types of farm production process quality. Animal health and care can be solved by prevention applications, vaccination strategies, disease reduction precautions and risk management approaches. Animal health - care management strategies and risk applications, several animal hygiene issues, have not been widely adopted and it is not known to most businesses yet. Appropriate animal health-care takes into consideration not only the zootechnical and veterinary affairs, but also the disease aspects and environmental hygiene conditions, economic relevances and furthermore product-production process quality related features. Enterprise-level hygiene covering all farm units is an important indicator of welfare for farm animals and is mostly dependent on facilities, management strategies of enterprise owners, climate conditions, and the behavior of the animals. According to the information given above, the objective of this study is to determine the associations between farm animal (cattle, sheep and chicken) behaviors, barn hygiene, animal hygiene, environmental conditions and the qualities of experiencing in Turkey.

No. 397 – Conservative Care of Urinary Incontinence in Women

To outline the evidence for conservative care, including both assessment and management options, for urinary incontinence in women. Relevant primary care providers and medical specialists including but not limited to physicians, nurses, midwives, and pelvic health physiotherapists. Women (>18 years of age) with urinary incontinence. Assessment options include gathering of a detailed history, physical examination, laboratory analysis, urodynamic evaluation, and cystoscopy. Conservative management options include lifestyle management, pelvic floor muscle training, behavioural management, and mechanical devices. To provide an evaluation-based summary of current available evidence concerning efficacy of conservative care (assessment and management) strategies for urinary incontinence in women. The Cochrane Library and Medline (2013-2018) were searched to find articles related to conservative care of urinary incontinence in women (>18 years). Articles were appraised, and the collective evidence was graded. The evidence obtained was reviewed and evaluated by the Society of Obstetricians and Gynaecologists of Canada (SOGC) Urogynecology Committee under the leadership of the principal authors. The quality of evidence was rated using the criteria described in the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology framework. Evidence for the efficacy of conservative care (assessment and management) options for women with urinary incontinence is strong. Furthermore, these options carry minimal or no harm and confer an established cost benefit. This SOGC Clinical Practice Guideline will be automatically reviewed 5 years after publication. RECOMMENDATIONS.

Prognostic Value of Late Gadolinium Enhancement for the Prediction of Cardiovascular Outcomes in Dilated Cardiomyopathy: An International, Multi-Institutional Study of the MINICOR Group.

Dilated cardiomyopathy is associated with increased risk of major cardiovascular events. Late gadolinium enhancement (LGE) cardiac magnetic resonance imaging is a unique tissue-based marker that, in single-center studies, suggests strong prognostic value. We retrospectively studied associations between LGE presence and adverse cardiovascular events in patients with dilated cardiomyopathy in a multicenter setting as part of an emerging global consortium (MINICOR [Multi-Modal International Cardiovascular Outcomes Registry]). Consecutive patients with dilated cardiomyopathy referred for cardiac magnetic resonance (2000-2017) at 12 institutions in 4 countries were studied. Using multivariable Cox proportional hazard and semiparametric Fine and Gray models, we evaluated the association between LGE and the composite primary end point of all-cause mortality, heart transplantation, or left ventricular assist device implant and a secondary arrhythmic end point of sudden cardiac death or appropriate implantable cardioverter-defibrillator shock. We studied 1672 patients, mean age 56±14 years (29% female), left ventricular ejection fraction 33±11%, and 25% having New York Heart Association class III to IV; 650 patients (39%) had LGE. During 2.3 years (interquartile range, 1.0-4.3) follow-up, 160 patients experienced the primary end point, and 88 experienced the arrhythmic end point. In multivariable analyses, LGE was associated with 1.5-fold (hazard ratio, 1.45 [95% CI, 1.03-2.04]) risk of the primary end point and 1.8-fold (hazard ratio, 1.82 [95% CI, 1.20-3.06]) risk of the arrhythmic end point. Primary end point risk was increased in patients with multiple LGE patterns, although arrhythmic risk was higher among patients receiving primary prevention implantable cardioverter-defibrillator and widening QRS. In this large multinational study of patients with dilated cardiomyopathy, the presence of LGE showed strong prognostic value for identification of high-risk patients. Randomized controlled trials evaluating LGE-based care management strategies are warranted.