Center For Outcomes Research Research Articles

Increasing pneumococcal vaccination rates among adults with cystic fibrosis.

DAVID C. YOUNG, PHARM.D., is Clinical Pharmacist, Intermountain Cystic Fibrosis Adult Center (ICFAC), Salt Lake City, UT, and Assistant Professor, Department of Pharmacy Practice, College of Pharmacy, University of Utah (UU), Salt Lake City. KRISTIN BLEYL, R.N., is Clinical Coordinator and TERESA CLARK, R.R.T., is Respiratory Therapist, ICFAC. GARY ODERDA, PHARM.D., M.P.H., is Director, Pharmacotherapy Outcomes Research Center, and Professor, Department of Pharmacy Practice, College of Pharmacy, UU. THEODORE G. LIOU, M.D., is Director, ICFAC; Assistant Professor Increasing pneumococcal vaccination rates among adults with cystic fibrosis

Is bigger better? Re-exploring the relationship between hospital volume and surgical outcomes

Is bigger better? Re-exploring the relationship between hospital volume and surgical outcomes

Documenting outcomes of occupational therapy: the center for outcomes research and education.

This article presents two themes related to the development and implementation of sound outcomes research that emerged from a 3-year dialogue among fellows of the University of Illinois Center for Outcomes Research and Education (CORE). These themes are: that outcomes research needs to be an interrelated multi-method system of investigation, and it should be developed in collaboration with its key stakeholders (consumers and practitioners). Examples from the literature and from a cluster of papers published in this focus issue are used to exemplify the themes.

Revascularization Versus Implantable Cardioverter-Defibrillators to Prevent Sudden Death in Patients With Severe Left Ventricular Dysfunction

Sudden death remains a dreaded consequence of coronary artery disease, and efforts to predict its incidence and to prevent its occurrence remain a major concern. A number of the challenges in management are highlighted in the article by Veenhuyzen et al1 in the present issue of Circulation . In their study, mortality and modes of death were assessed in 5410 patients with ischemic left ventricular function who were enrolled in the Studies of Left Ventricular Dysfunction (SOLVD) study.2 There were 1870 patients who had had prior coronary artery bypass grafting (CABG) and 3540 who had not had prior CABG. The SOLVD trial database is a good source for these data, both because it is large and because the cause of death (ie, whether cardiac and whether sudden or not) was established. See p 1489 The key findings of Veenhuyzen et al1 are that CABG was associated with a 25% reduction in the risk of death (from 24.3% to 18.4%) and a 46% reduction in the risk of sudden death (from 7.5% to 4.1%). These findings are independent of ejection fraction, severity of heart failure symptoms, age, and other clinical variables. In a stratified analysis by severity of left ventricular dysfunction, there was some evidence for interaction, but similar results were noted overall. Prior CABG was not associated with an alteration in the risk of death from progressive heart failure. The results were applied to a group of patients with left ventricular dysfunction from the Coronary Artery Surgery Study Registry who had not undergone surgery, offering a predicted annual rate of death of 8.2% and sudden death …

Best practices: our quest for excellence in behavioral health care.

Best practices: our quest for excellence in behavioral health care.

Performance of the '100 top hospitals': what does the report card report?

We examine whether Medicare patients with acute myocardial infarction (AMI) admitted to one of HCIA-Mercer's "100 top hospitals" received better care or had better outcomes than patients treated in other hospitals. Among four hospital peer groups, the top 100 hospitals had similar thirty-day mortality and use of aspirin, beta-blockers, and reperfusion compared with their peers, but lower lengths-of-stay and in-hospital costs, with similar or lower readmission rates. Our findings suggest that the 100 Top Hospitals study may be better suited for identifying hospitals with higher performance on financial and operating measures than superior clinical performance in treating elderly AMI patients. However, there was no evidence that quality was sacrificed for increased financial efficiency among the top 100 hospitals.

Practicing neurology: a delicate balance.

As we near this end of the Decade of the Brain, we can all feel proud of the enormous neuroscientific advances and improved treatments for our patients that we, collectively, have developed. Yet isn’t it remarkable that we are increasingly preoccupied by the consequences of rising health care costs? The Academy, historically known for our outstanding scientific presentations and comprehensive educational offerings, has recognized that irony and that we must respond to these new demands. Several years ago, Academy President Kenneth Viste launched a strategic planning initiative to identify ways to assist our members in responding successfully to today’s fiscal imperative.1 I’m happy to report that we are well into meeting our strategic goals. Our Center for Outcomes Research is implementing a performance improvement plan that will help us demonstrate to the public the quality and accountability of the neurologic services we provide, and our Center for Health Policy has developed important coalitions to move our agenda forward in the political arena. We are also reexamining the training needs for neurologists, developing methods to expand the scope of neurologic practice, and creating a host of tools, some of which you can already find on our Web site (http://www.aan.com), to assist neurologists in practice. These initiatives must not allow us to become complacent, because we have a long way to go. We all face an enormous challenge to learn how to balance three key components of our professional lives: scientific advances, humanistic care, and financial constraints. When all is said and done, our success will be judged by the quality of life our patients with neurologic disorders can experience. That is why I’d like to begin by briefly telling you about two of my dearest patients who had neuromuscular diseases I’ve studied my entire academic career. Both died just before …

Impact of sumatriptan on lost labour costs and QOL in migraine

There has been a drive towards providing care in the ambulatory setting in the US as a result of increasing healthcare costs. In this setting, conditions such as migraine headache can have significant effects on the clinical, economic and humanistic outcomes for patients. SC sumatriptan has been shown to improve all 3 types of outcomes in the management of migraine headache. Dr John Mackowiak, president for the Center for Outcomes Research in North Carolina, US, presented recent studies on the impact of sumatriptan use on lost labour costs and quality of life (QOL) at a Glaxo Wellcome-sponsored symposium held during the annual meeting of the American Society of Health-System Pharmacists [Baltimore, US; June 1998]. These study findings reinforce the need for health insurers to reimburse this product for their enrollees.

ALS care: a resource for measuring and improving ALS outcomes.

The Amyotrophic Lateral Sclerosis Clinical Assessment, Research, and Education Project (ALS CARE) will conduct outcomes research and develop educational programs that benefit ALS patients and neurologists. An advisory board of neurologists, who are experts in ALS, will establish the policies governing this project and control the dissemination of aggregate data on ALS practices and outcomes. As a first step toward improving the care of ALS patients, a data coordinating center has been established in the Center for Outcomes Research at the University of Massachusetts Medical Center, which will manage a North American Database of ALS Outcomes. This voluntary database is designed to (1) guide the development of educational programs to improve the care of ALS patients and (2) provide a mechanism for neurologists to evaluate the impact of their diagnostic and therapeutic decisions in a manner that is timely, confidential, and objective.

Clinical practice evaluation at Providence Health System.

Over the past seven years, Providence Health System (PHS) in Portland, Oregon, has used an outcomes research paradigm to study treatment of back pain, coronary artery disease, total joint replacement, and cancer. In presenting case studies of each of these areas, the authors chronicle the evolution of clinical practice evaluation at PHS, beginning with early studies in the 1960s, to the establishment of the Center for Outcomes Research and Education (CORE), to the formation of a new systemwide strategy that is responsive to the evolving health care marketplace.

Evaluating a Patient Satisfaction Survey for Maximum Benefit

Patient satisfaction surveys are now in use in some form at most hospitals and health care systems. Yet, it is unclear how well information collected meets the needs of all groups who might benefit from patient feedback. An evaluation was conducted at the Center for Outcomes Research, Sisters of Providence Health System (Portland, Ore), to determine the extent to which the survey, then almost three years in use, was satisfying its internal consumers and to guide redesign of the entire survey process. The evaluation of the survey process was designed to address several questions: who uses the results (consumers); what are their objectives (goals); what results are useful (product); and what is done with the results (intervention utility). Techniques such as interviews, literature reviews, and supplemental data collection, were used to explore the needs of each consumer group. The evaluation has led to a number of changes in the patient satisfaction survey process. Large-scale patient satisfaction surveys result in large-scale costs and therefore must be beneficial to multiple users in multiple ways.