Double Coverage Research Articles

Evolution, Achievements, and Challenges for New Cooperative Medical Schemes in Rural China

Objectives: To describe the development of NCMS in the past decade including three sections and to bring up relevant policy implications. Methods: Based on secondary data and literature review, the evolution and achievement of NCMS in the past decade and the expected future challenges were analyzed. Results: Impressive advances have been seen in establishing the largest medical insurance system, New Cooperative Medical Scheme (NCMS), covered more than 800 million farmers in rural China during the past decade. Remarkable achievements during the development of NCMS include universal health coverage among rural residents, rapid increasing premium, balanced pooling fund, improved service, cost and coverage of farmers, and a strengthened primary health care system. In the meantime, the NCMS also confronted certain challenges: Institutionalization and legalization lagged behind the development of NCMS; payment reform failed to control the rapid growth of medical expenditure and financial protection for enrollees was insufficient; solidarity and equity between NCMS and other medical insurance systems is still an issue that needs to be solved; sustainable financing mechanism was not established successfully and moreover, it was also not compatible with the aging population and epidemiological transition of rural China; double coverage for rural residents turned up as portability was not achieved.

Application of SiO2 nanoparticles with double layer coverage consist of citric acid and l(+)-ascorbic acid for the production of poly(vinyl chloride)/SiO2 nanocomposite films with enhanced optical and thermal properties

Incorporation of SiO2 nanoparticles (NPs) into poly(vinyl chloride) (PVC) matrix to prepare PVC/SiO2 nanocomposites (NCs) can enhance its properties. To achieve improved properties for the NCs, NPs should be dispersed properly and be compatible within the polymer matrix. Therefore, to prevent SiO2 NPs from aggregation, surface modification of NPs was performed by citric acid (CA) and l(+)-ascorbic acid (AA) as biological and environmental friendly coating layers for the first time. This process was carried out under ultrasonic irradiation condition, which is an economical and eco-friendly tool. After that three different amounts of modified SiO2 (SiO2–CA–AA) were inserted into PVC matrix and PVC/SiO2–CA–AA NCs were prepared using solution casting method. The structures and morphology of the prepared NC films were verified by several techniques including Fourier transfer infrared, X-ray diffraction, field emission scanning electron microscopy, transmission electron microscopy, thermogravimetric analysis, ultraviolet–visible (UV–Vis) spectroscopy and tensile testing. Thermogravimetric analysis confirmed the presence of about 13 wt% modifiers on the surface of SiO2. Microscopic observations showed good dispersity of SiO2–CA–AA NPs in the polymer matrix. Resulting NC films showed more flexibility than pure PVC.

Severe pneumonia requiring ICU admission: Revisited

Abstract Objectives To describe the aetiology, outcome and management approach for patients with community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP) who required ICU admission and to determine the predictors of mortality. Methods A prospective observational study of 119 consecutive patients who were admitted to the ICU with diagnoses of CAP (n = 89) or HAP (n = 30) from May 2011 until December 2012. Results The overall ICU and hospital mortality rates for CAP and HAP were 24.4% and 30.3%, respectively. There were no significant differences between the patients with CAP and HAP in terms of ICU mortality or the average length of hospital stay. The most commonly isolated pathogens were H1N1 (23%) and Streptococcus pneumonia (17%) in the patients with CAP and Acinetobacter baumannii (37%) in the patients with HAP. Multidrug resistant (MDR) organisms were detected in 32 (38.6%) isolates. The median time for receiving antibiotics was 2 h. Most of the patients (82%) received double antibiotic coverage. Multiple regression analysis identified septic shock (beta = 0.43, p Conclusion The outcomes of patients with severe pneumonia who were admitted to the ICU were better than those of previous reports. Early administration of combination antibiotics was practiced with vigilance. MDR organisms and respiratory viruses were the commonly isolated pathogens. The presence of septic shock, ARDS and high PSI were independent predictors of mortality.

First EURONEAR NEA discoveries from La Palma using the INT★

Since 2006, the European Near Earth Asteroids Research (EURONEAR) project has been contributing to the research of near-Earth asteroids (NEAs) within a European network. One of the main aims is the amelioration of the orbits of NEAs, and starting in 2014 February we focus on the recovery of one-opposition NEAs using the Isaac Newton Telescope (INT) in La Palma in override mode. Part of this NEA recovery project, since 2014 June EURONEAR serendipitously started to discover and secure thefirst NEAs from La Palma and using the INT, thanks to the teamwork including amateurs and students who promptly reduce the data, report discoveries and secure new objects recovered with the INT and few other telescopes from the EURONEAR network. Five NEAs were discovered with the INT, including 2014 LU14, 2014 NL52 (one very fast rotator), 2014 OL339 (the fourth known Earth quasi-satellite), 2014 SG143 (a quite large NEA), and 2014 VP. Another very fast moving NEA was discovered but was unfortunately lost due to lack of follow-up time. Additionally, another 14 NEA candidates were identified based on two models, all being rapidly followed-up using the INT and another 11 telescopes within the EURONEAR network. They include one object discovered by Pan-STARRS, two Mars crossers, two Hungarias, one Jupiter trojan, and other few inner main belt asteroids (MBAs). Using the INT and Sierra Nevada 1.5 m for photometry, then the Gran Telescopio de Canarias for spectroscopy, we derived the very rapid rotation of 2014 NL52, then its albedo, magnitude, size, and its spectral class. Based on the total sky coverage in dark conditions, we evaluate the actual survey discovery rate using 2-m class telescopes. One NEA is possible to be discovered randomly within minimum 2.8 deg 2 and maximum 5.5 deg 2 . These findings update our past statistics, being based on double sky coverage and taking into account the recent increase in discovery.

Cost-effective analyses for emergency medical services deployment: A case study in Shanghai

The response speed of emergency medical services (EMS) is extremely critical for pre-hospital lifesaving. Each second plays a vital role in emergent cases. Therefore, the EMS network should be carefully designed to provide timely and reliable services. This paper focuses on improving the classical ambulance deployment method to optimize the distribution of first-aid resources. We refine the double coverage model with a new objective function that minimizes the expected cost for delayed emergencies plus the operational cost for EMS. EMS operators can use this refined model to analyze the cost-effectiveness of the emergency network, as demonstrated in a real-world EMS deployment case study. To solve this large-scale integer-programming problem, we compared several heuristic algorithms and finally chose ant colony optimization algorithm. Several modifications are made to adapt the traditional ant colony algorithm to solve our problem. The paper concludes with an optimized and cost-effective plan for ambulance deployment in the downtown area of Shanghai. After optimization, the objective cost is lowered by about 11% each year and 10% less emergency calls are missed or delayed. In addition, we use our modified model to test scenarios with relaxed limit of resources. Potential improvement of future EMS network is discovered. It turns out that increasing the number of first-aid stations from 35 (current number of stations) to 50 and adding 10 vehicles will achieve a surprising 49% cost saving while maintaining a satisfactory service level.

Impact of an Antimicrobial Stewardship Program on Unnecessary Double Anaerobic Coverage Prescription.

BackgroundCo-administration of two or more antimicrobials with anti-anaerobic activity is not recommended except in certain circumstances. We therefore conducted an intervention to reduce unnecessary double anaerobic coverage (DAC) prescription.Materials and MethodsThe intervention consisted of education using an institutional intranet and prospective audits and feedback provided through collaboration between a pharmacist and an infectious diseases physician in Seoul National University Bundang Hospital, a tertiary hospital in Seongnam, Republic of Korea, in 2013. The study period was 1 year which contained 6 months of pre-intervention period and 6 months of intervention period. To estimate the overall effect of the intervention, we compared the monthly number of patients receiving unnecessary DAC for more than 3 days and the proportion of patients receiving unnecessary DAC for more than 3 days among all patients receiving DAC.ResultsThe average monthly number of patients receiving unnecessary DAC for more than 3 days after screening decreased by 73.9% in the intervention period from 26.8 to 7.0. Wilcoxon rank sum test revealed there was a significant statistical difference in the monthly number of patients receiving unnecessary DAC for more than 3 days (P = 0.005). The proportion of patients receiving unnecessary DAC for more than 3 days after screening among all patients identified as receiving necessary or unnecessary DAC also decreased by 67.8% in the intervention period from 42.3% to 13.6% (P < 0.001).ConclusionThe multidisciplinary antimicrobial stewardship program with combined methods reduced unnecessary DAC prescription successfully.

Experiences with primary care associated to health, socio-demographics and use of services in children and adolescents

This study aimed to evaluate user experiences with primary care for children and adolescents according to health, socio-demographic characteristics, and use of healthcare services. The 2006 Catalan Health Interview Survey studied a representative sample of the population aged 0 to 14 (n = 2,200). Parents reported their experiences with primary care through 17 items from the Primary Care Assessment Tool. Multivariate models were fitted to estimate prevalence ratios (PR) of scoring low on experiences with primary care by health, use of services, and socio-demographic variables. A low first contact-accessibility score was associated with declared chronic conditions. Immigrant parents declared a poor experience with several primary care functions. A low score on first contact-accessibility, continuity of care, and cultural competence was less likely when children had double healthcare coverage and more likely when they had visited emergency services. Improvement of some aspects of primary care services may reduce both use of emergency services and inequity in this area.

A Critical Evaluation of Healthcare-Associated Pneumonia and the Need for Anti-pseudomonal Therapy, Including Double Coverage

In 2005, healthcare-associated pneumonia (HCAP) was described as a distinct entity, reflecting the concern that patients with HCAP have mortality rates and microbiologic culprits more akin to patients with hospital-acquired pneumonia (HAP) and, thus, warrant treatment similar to HAP, including empiric broad spectrum antibiotics. Increasing evidence suggests that the HCAP definition and criteria are insufficient predictors of which patients are at highest risk of being infected with a multi-drug resistant organism (MDRO); this lack of accuracy leads to overuse of broad spectrum antibiotics. New risk stratification schemes have been proposed that may supplant our current reliance on HCAP criteria for identifying patients who may be infected with an MDRO. Regardless of the risk stratification method used, antibiotic decisions must account for local MDRO prevalence rates. In settings where P. aeruginosa resistance to anti-pseudomonal therapies is high or in patients who are critically ill, empiric combination therapy for P. aeruginosa may be considered. However, therapy should be narrowed to a single agent once an effective agent has been identified from culture susceptibility data.

Antimicrobial stewardship in a community hospital: attacking the more difficult problems.

Antibiotic stewardship has been proposed as an important way to reduce or prevent antibiotic resistance. In 2001, a community hospital implemented an antimicrobial management program. It was successful in reducing antimicrobial utilization and expenditure. In 2011, with the implementation of a data-mining tool, the program was expanded and its focus transitioned from control of antimicrobial use to guiding judicious antimicrobial prescribing. To test the hypothesis that adding a data-mining tool to an existing antimicrobial stewardship program will further increase appropriate use of antimicrobials. Interventional study with historical comparison. Rules and alerts were built into the data-mining tool to aid in identifying inappropriate antibiotic utilization. Decentralized pharmacists acted on alerts for intravenous (IV) to oral conversion, perioperative antibiotic duration, and restricted antimicrobials. An Infectious Diseases (ID) Pharmacist and ID Physician/Hospital Epidemiologist focused on all other identified alert types such as antibiotic de-escalation, bug-drug mismatch, and double coverage. Electronic chart notes and phone calls to physicians were utilized to make recommendations. During 2012, 2,003 antimicrobial interventions were made with a 90% acceptance rate. Targeted broad-spectrum antimicrobial use decreased by 15% in 2012 compared to 2010, which represented cost savings of $1,621,730. There were no statistically significant changes in antimicrobial resistance, and no adverse patient outcomes were noted. The addition of a data-mining tool to an antimicrobial stewardship program can further decrease inappropriate use of antimicrobials, provide a greater reduction in overall antimicrobial use, and provide increased cost savings without negatively affecting patient outcomes.

Heuristic Approach for Optimizing Emergency Medical Services in Road Safety within Large Urban Networks

Emergency medical service (EMS) providers participating in vehicle crash-induced incident management aim to offer as wide and efficient coverage as possible to meet the demand for incident responses effectively; however, the design and provision of efficient and cost-effective services are tough issues faced by emergency management authorities. This paper introduces a double standard model (DSM), along with a genetic algorithm (GA) for assigning EMS fleet from vehicle locations to intersection vehicle crash sites such that crash demand sites can be covered in accordance with two service coverage standards. Specifically, all demand sites are required to receive single coverage according to the secondary coverage standard and at least a portion (α) of demand sites need to maintain single coverage as per the primary coverage standard. The proposed model is applied for top 200 intersections in the City of Chicago selected using intersection crash records for 2004–2010 according to crash frequency-based and severity-based scenarios. The top 200 intersections are split into high and low severity sites for model application. Using the EMS vehicle fleet size currently maintained by the Chicago Fire Department as 15 basic life support (BLS) and 60 advanced life support (ALS) ambulances, almost 100% of double vehicle coverage can be achieved. Extended model application is conducted by keeping 15 BLS ambulances unchanged and reducing the 60 ALS ambulances by 50% to 30. Results show that nearly 90% of double coverage according to the primary standard can still be reached.

A Comparison of Performance Measures for Online Algorithms

This paper provides a systematic study of several proposed measures for online algorithms in the context of a specific problem, namely, the two server problem on three colinear points. Even though the problem is simple, it encapsulates a core challenge in online algorithms which is to balance greediness and adaptability. We examine Competitive Analysis, the Max/Max Ratio, the Random Order Ratio, Bijective Analysis and Relative Worst Order Analysis, and determine how these measures compare the Greedy Algorithm, Double Coverage, and Lazy Double Coverage, commonly studied algorithms in the context of server problems. We find that by the Max/Max Ratio and Bijective Analysis, Greedy is the best of the three algorithms. Under the other measures, Double Coverage and Lazy Double Coverage are better, though Relative Worst Order Analysis indicates that Greedy is sometimes better. Only Bijective Analysis and Relative Worst Order Analysis indicate that Lazy Double Coverage is better than Double Coverage. Our results also provide the first proof of optimality of an algorithm under Relative Worst Order Analysis.

Time-dependent ambulance allocation considering data-driven empirically required coverage

Empirical studies considering the location and relocation of emergency medical service (EMS) vehicles in an urban region provide important insight into dynamic changes during the day. Within a 24-hour cycle, the demand, travel time, speed of ambulances and areas of coverage change. Nevertheless, most existing approaches in literature ignore these variations and require a (temporally and spatially) fixed (double) coverage of the planning area. Neglecting these variations and fixation of the coverage could lead to an inaccurate estimation of the time-dependent fleet size and individual positioning of ambulances. Through extensive data collection, now it is possible to precisely determine the required coverage of demand areas. Based on data-driven optimization, a new approach is presented, maximizing the flexible, empirically determined required coverage, which has been adjusted for variations due to day-time and site. This coverage prevents the EMS system from unavailability of ambulances due to parallel operations to ensure an improved coverage of the planning area closer to realistic demand. An integer linear programming model is formulated in order to locate and relocate ambulances. The use of such a programming model is supported by a comprehensive case study, which strongly suggests that through such a model, these objectives can be achieved and lead to greater cost-effectiveness and quality of emergency care.

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Introduction: Critical illness is a known risk factor for nephrotoxicity as is exposure to aminoglycosides. The rate of nephrotoxicity comparing aminoglycosides to a control group is unknown using a standardized criterion such as RIFLE. Methods: A retrospective, cohort study of patients who received tobramycin or ciprofloxacin as part of empiric double gram-negative coverage in the SICU or MICU at a large academic medical center was performed. The choice of ciprofloxacin versus tobramycin was determined by hospital protocol which changed halfway through the study period. The primary outcome was the incidence of nephrotoxicity as defined by the RIFLE criteria within seven days of antibiotics. Secondary outcomes were length of hospital and ICU stay, hospital and ICU mortality, length of mechanical ventilation, incidence of Clostridium difficile, and initiation of renal replacement therapy. Categorical variables were compared using Chi-Square and continuous variables were compared by the Two-Sample t-Test or the Wilcoxon Rank-Sum Test depending on the distribution of the continuous variable. Results: A total of 263 patients received ciprofloxacin and 148 patients received tobramycin with similar baseline characteristics. The incidence of nephrotoxicity was 29.7% with ciprofloxacin and 33.1% with tobramycin (p=0.467). There was a significant difference in the number of patients requiring initiation of renal replacement therapy with 3.8% in the ciprofloxacin group and 8.8% in the tobramycin group (p=0.035). No other secondary outcomes were significantly different. In patients who received 4 to 5 concomitant nephrotoxic agents, there was a trend toward increased nephrotoxicity (p=0.076). A multivariable logistic regression was performed and no differences between the groups were found. Conclusions: No difference was found in the incidence of nephrotoxicity between tobramycin and ciprofloxacin in critically ill patients based on the RIFLE criteria. Tobramycin should be used cautiously in patients with multiple risk factors for nephrotoxicity as more patients who received tobramycin required renal replacement therapy. A prospective study is required to further characterize the risk of aminoglycoside nephrotoxicity in the critically ill.

Technique de couverture des traumatismes balistiques transfixiants de la main : intérêt du lambeau scapulaire bifolié libre. À propos d’un cas

Balistic transfixing hand traumas require a complex reconstruction management. Stabilization and reconstruction of the injuried tissues need a double skin-paddle coverage. We present an original case report of a double skin-paddle scapular/parascapular free flap used to cover a through and through gunshot injury of the right hand. A 14-years-old patient presents a severe and extensive wound with full-thickness palmar and dorsal skin defects, dislocation of the carpal bones, median nerve and flexor tendons losses. Distal vascularization is maintained by the deep palmar arch system supplied by the ulnar artery. The radial artery is severed at the level of the first dorsal interosseous space. The measured defect of the dorsal skin was 12×7cm and the palmar one was 6×3cm. After skeletal stabilization, tendinous and nerve preparation, the hand coverage was performed using a double skin-paddle scapular/parascapular free flap. The vascular anastomoses include an end-to-side arterial suture between the circumflex scapular and the radial arteries, and an end-to-end venous suture between the circumflex scapular and the dorsal radial veins. The scapular/parascapular double skin-paddle free flap is a safe and reliable technique to achieve a dorsal and palmar hand coverage in lack of local flaps alternatives. It can be used as a good option prior to bone graft, tendinous and nervous reconstruction.

Time-Dependent Ambulance Allocation Considering Data Driven Empirically Required Coverage

Empirical studies considering the location and relocation of emergency medical services (EMS) vehicles in an urban region provide important insight into dynamic changes during the day. Within a time period of one day the demand, travel time/speed of ambulances and covered areas change cyclically. Nevertheless, most existing approaches in literature ignore these variations and require a (temporally and spatially) fixed (double) coverage of the planning area. Neglecting these variations and fixation of the coverage could lead to a false estimation of the time dependent fleet size and individual positioning of ambulances. Through extensive data collection, nowadays it is possible to precisely determine the required coverage of demand areas. Based on data driven optimization a new approach is presented, maximizing the flexible, empirically determined required coverage, which has been adjusted for variations due to day-time and site. This coverage prevents the EMS system from unavailability of ambulances due to parallel operations to ensure an improved coverage of the planning area closer to realistic demand. An integer linear programming model is formulated in order to locate and relocate ambulances. Based on a comprehensive case study it is shown, that the approach achieves these objectives and leads to cost savings and improvement in the quality of emergency care.

Marathon Day at Massachusetts General

An emergency medicine physician discusses how being prepared helped him and his colleagues save lives after the Boston Marathon bombing.

In Vitro Comparison of Combination and Monotherapy for the Empiric and Optimal Coverage of Bacterial Keratitis Based on Incidence of Infection

Cefazolin/tobramycin, cefuroxime/gentamicin, and moxifloxacin were compared using bacterial keratitis isolates to determine whether empiric therapy constituted optimal antibacterial treatment. Based on percent incidence of corneal infection, 27 Staphylococcus aureus, 16 Pseudomonas aeruginosa, 10 Serratia marcescens, 4 Moraxella lacunata, 3 Haemophilus influenzae, 9 coagulase-negative staphylococci, 7 Streptococcus viridans, 6 Streptococcus pneumoniae, 7 assorted Gram-positive isolates, and 11 assorted Gram-negative isolates were tested for minimum inhibitory concentrations to cefazolin, tobramycin, cefuroxime, gentamicin, and moxifloxacin using E-tests to determine susceptibility and potency. The in vitro coverage (susceptible to at least one antibiotic) of cefuroxime/gentamicin (97%) was statistically equal to cefazolin/tobramycin (93%) and moxifloxacin (92%) (P = 0.29). Double coverage (susceptible to both antibiotics) was equivalent (P = 0.77) for cefuroxime/gentamicin (42%) and cefazolin/tobramycin (40%). The susceptibilities of individual coverage were moxifloxacin (92%), gentamicin (89%), tobramycin (74%), cefazolin (58%), and cefuroxime (52%). Methicillin-resistant S. aureus was best covered by gentamicin 100% (9 of 9). Tobramycin was more potent (P = 0.00001) than gentamicin for P. aeruginosa, whereas cefazolin was more potent (P = 0.0004) than cefuroxime for S. aureus. Although there seems to be no in vitro empiric coverage advantage between cefazolin/tobramycin, cefuroxime/gentamicin, and moxifloxacin monotherapy, potency differences may occur and optimal treatment can best be determined with laboratory studies.

Epitaxial Silicon Dots Self-Assembled on Aluminum Nitride/Si (111)

Si nanoscale dots are synthesized on AlN/Si(111) by molecular beam epitaxy. A dot density of 2.2 × 10(11) cm(-2) with a mean radius of 5.6 ± 2.8 nm is obtained in Volmer-Weber growth mode. A double Si coverage leads to a decrease in dot density and increase in dot size. The dot orientations are [11[overline]0](Si) (or [1[overline]10](Si))//[112[overline]0](AlN) and (111)(Si)//(0001)(AlN), which are similar (or identical) to the orientation of AlN relative to the Si substrate.

Effect of Double Layer Dartos Flap in Reduction of Fistula Rate Post Hypospadias Repair = استخدام طبقة مزدوجة من السديلة السلخية يقلل من حدوث الناسور الإحليلي بعد إجراء عمليات إصلاح المبال التحتي

Objective: To assess the impact of double layer dartos flap on urethro-cutaneous fistula rate reduction and to compare it with single layer dartos flap in Tubularized Incised Plate Urethroplasty (TIPU) for hypospadias in children. Methods: Between January 2008 and month 2011 retrospective charts review for 120 patients who had hypospadias repair by the author. 26 patients were excluded from the study because they were not suitable for TIPU procedure. Therefore, our study sample involved 94 children. Results: Mean age at time of surgery was 16 months (10-96 months), with a mean follow up of 18.2 months (10–36 months). All patients had hypospadias repair by utilizing TIPU. Patients were divided into two groups: Group one involved 50 patients had double layer dartos flap. Group two involved 44 patients had single-layer dartos flap. All patients had stent insertion at the time of repair. 6/44 patients [13.6%] developed fistula in group two and 2/50 patients [4%] in group one had fistula. Conclusions: Dartos coverage appears to have significant effect in reducing urethro-cutaneous fistula in TIPU repair. With double layer dartos coverage further reduction can be achieved.

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Introduction: National practice guidelines suggest that patients with healthcare-associated pneumonia (HCAP) receive empiric antibiotics that include double-coverage (DC) for P. aeruginosa (PsA). After implementation of an HCAP CPOE orderset that included DC with ciprofloxacin, we noted decreased susceptibility among PsA isolates. Hypothesis: We hypothesized that the susceptibility patterns of PsA would improve after elimination of automatic DC from an HCAP CPOE orderset. Methods: A retrospective chart review was conducted on adult patients admitted to the University of California, San Diego Health System (UCSDHS) with a diagnosis of HCAP from July 2007 to December 2011. Patients were identified if their admitting physician used the HCAP orderset. In March 2011, the orderset was modified; DC to include ciprofloxacin was eliminated and single-coverage (SC) with piperacillin-tazobactam or aztreonam alone was substituted. Patients were included in the DC group if they received HCAP antibiotics before March 2011; otherwise, they were included in the SC group. PsA susceptibility data was collected from UCSDHS antibiograms. Results: 122 patients were included in the DC group and 61 patients in the SC group. Baseline characteristics were similar for both groups; however, frequency of lung disease, recent use of antibiotics, and recent use of home infusion services were significantly higher in the SC group (p<0.05). PsA sensitivity to ciprofloxacin increased significantly after orderset modification (71% vs. 62%; p<0.001). No significant differences in in-hospital mortality or length of hospital stay were observed. 30-day hospital readmission was higher for SC patients (31% vs. 12%; p=0.004). Antibiotic costs ($202 vs. $349; p=0.004) and hospital costs ($13,683 vs. $37,148; p<0.001) were significantly lower for SC patients. Conclusions: Elimination of double-coverage from an HCAP CPOE orderset contributed to improved PsA sensitivity to ciprofloxacin and decreased antibiotic and hospital costs, but was associated with increased 30-day hospital readmission. Reasons for excess readmissions were not clear, but we hypothesize that the increase frequency of comorbidities in this group may have contributed.