Patient Visits Research Articles

What's the harm? Results of an active surveillance adverse event reporting system for chiropractors and physiotherapists.

This prospective, community-based, active surveillance study aimed to report the incidence of moderate, severe, and serious adverse events (AEs) after chiropractic (n = 100) / physiotherapist (n = 50) visit in offices throughout North America between October-2015 and December-2017. Three content-validated questionnaires were used to collect AE information: two completed by the patient (pre-treatment [T0] and 2-7 days post-treatment [T2]) and one completed by the provider immediately post-treatment [T1]. Any new or worsened symptom was considered an AE and further classified as mild, moderate, severe or serious. From the 42 participating providers (31 chiropractors; 11 physiotherapists), 3819 patient visits had complete T0 and T1 assessments. The patients were on average 50±18 years of age and 62.5% females. Neck/back pain was the most common presenting condition (70.0%) with 24.3% of patients reporting no condition/preventative care. From the patients visits with a complete T2 assessment (n = 2136 patient visits, 55.9%), 21.3% reported an AE, of which: 7.9% were mild, 6.2% moderate, 3.7% severe, 1.5% serious, and 2.0% had missing severity rating. The most common symptoms reported with moderate or higher severity were discomfort/pain, stiffness, difficulty walking and headache. This study provides valuable information for patients and providers regarding incidence and severity of AEs following patient visits in multiple community-based professions. These findings can be used to inform patients of what AEs may occur and future research opportunities can focus on mitigating common AEs.

A human centered design approach to define and measure documentation quality using an EHR virtual simulation.

Electronic health record (EHR) documentation serves multiple functions, including recording patient health status, enabling interprofessional communication, supporting billing, and providing data to support the quality infrastructure of a Learning Healthcare System. There is no definition and standardized method to assess documentation quality in EHRs. Using a human-centered design (HCD) approach, we define and describe a method to measure documentation quality. Documentation quality was defined as timely, accurate, user-centered, and efficient. Measurement of quality used a virtual simulated standardized patient visit via an EHR vendor platform. By observing and recording documentation efforts, nurse practitioners (NPs) (N = 12) documented the delivery of an Age-Friendly Health System (AFHS) 4Ms (what Matters, Medication, Mentation, and Mobility) clinic visit using a standardized case. Results for timely documentation indicated considerable variability in completion times of documenting the 4Ms. Accuracy varied, as there were many types of episodes of erroneous documentation and extra time in seconds in documenting the 4Ms. The type and frequency of erroneous documentation efforts were related to navigation burden when navigating to different documentation tabs. The evaluated system demonstrated poor usability, with most participants scoring between 60 and 70 on the System Usability Scale (SUS). Efficiency, measured as click burden (the number of clicks used to navigate through a software system), revealed significant variability in the number of clicks required, with the NPs averaging approximately 13 clicks above the minimum requirement. The HCD methodology used in this study to assess the documentation quality proved feasible and provided valuable information on the quality of documentation. By assessing the quality of documentation, the gathered data can be leveraged to enhance documentation, optimize user experience, and elevate the quality of data within a Learning Healthcare System.

The Effect of Virtual Patient Visits in the Intensive Care Unit on Postpartum Depression.

Maternal postpartum depression negatively affects the baby's emotional, behavioral, and cognitive development and attachment pattern. We aimed to examine the effect of virtual patient visits in neonatal intensive care unit on postpartum depression in mothers. Research data were obtained from mothers whose preterm infants were hospitalized in the neonatal intensive care unit between April and December 2022. A total of 100 mothers of preterm infants (50 in the virtual patient visit and 50 in the control group) treated in the neonatal intensive care unit of a hospital constituted the sample of the study. Using the Zoom application, virtual patient visits were made for 5 minutes, seven days a week, between mother and the preterm infants, with no nursing intervention implemented for at least 30 minutes. Mothers in the control group saw their babies face to face two days a week. In standard hospital procedure, mothers saw their babies twice a week. Edinburgh postpartum depression scale (EPDS) was administered online to the all mothers before and after the study. The research resulted with statistically significant decreased EPDS scores of the mothers in virtual patient visit group with the pre-study scores. A statistically significant decrease was found compared to the control group (P<0.001). Virtual patient visits between preterm infants in neonatal intensive care unit and their mothers could be effective in preventing or reducing postpartum depression of the mother.

Changes in Substance Use Diagnoses in the Great Plains during the COVID-19 Pandemic.

As drug overdose mortality rises in the United States, healthcare visits present critical opportunities to mitigate this trend. This study examines changes in healthcare visits for substance use disorders (SUDs) and remission prior to and during the COVID-19 pandemic in the Great Plains, with a focus on identifying the characteristics of those served. Data were analyzed from 109,671 patient visits (mode = one visit per patient), encompassing diverse demographics, including sex, age, race, ethnicity, and geographic location. Visits analyzed included those for Alcohol Use Disorder (AUD), Opioid Use Disorder (OUD), or Stimulant Use Disorder (StUD) and those in remission of these disorders between March 2019 and March 2021. Patient demographic information and geographic factors, like rurality and Medicaid expansion status, were considered, and logistic regression was utilized. Visits were primarily by White (70.83%) and Native American (21.39%) patients, non-Hispanic (91.70%) patients, and males (54.16%). Various demographic, geographic, and temporal trends were observed. Findings indicated that males were more likely to receive an AUD diagnosis, while females were more likely to receive an OUD or StUD diagnosis. Metropolitan-residing patients were more likely to receive an AUD diagnosis, while non-metropolitan patients were more likely to receive an OUD diagnosis. Remission odds increased for StUD during the pandemic but decreased for AUD and OUD. These findings illuminate the demographic and geographic patterns of SUD-related healthcare visits, suggesting critical touchpoints for intervention. The results emphasize the urgent need for targeted healthcare strategies, especially in rural and underserved areas, to address persistent health disparities.

Predicting pediatric asthma severe outcomes using machine learning methods for EHR data with repeated clinic visits

Asthma is the most common multifactorial chronic disease among children. Identifying children at high risk of severe asthma outcomes, such as emergency department (ED) visits and hospitalizations due to asthma exacerbation, is essential in asthma care and clinical management. Existing studies have employed different machine learning methods to predict pediatric asthma occurrence or progression using electronic health records (EHR) data. However, these studies often neglected the correlated nature of EHR data (e.g., repeated clinic visits of the same patients). To address this issue, this research applied and evaluated two types of machine learning-based methods for longitudinal or clustered data, including random forests with mixed effects and generalized neural networks with mixed effects. We applied these methods to the real-world large asthma EHR data obtained from the Children’s Hospital of Pittsburgh in a four-year period expanded from pre to post-COVID-19 pandemic, focusing on predicting the chance of having ED visits due to asthma exacerbation and the length of stay (LOS) when hospitalized. Moreover, we characterized the importance of predictors using the kernel SHAP metric and identified vulnerable patient groups that are more likely to experience asthma exacerbation or have a longer LOS. Our findings provide valuable guidance to improve pediatric asthma care by prioritizing the protection of these vulnerable patients, especially when a disruptive health crisis occurs. Journal of Statistical Research 2024, Vol. 58, No. 1, pp. 131-149.

SOCIALIZATION OF THE ACCURACY REGARDING THE CALCULATION OF RECAPITULATION FOR INPATIENTS BASED ON AGE, DISEASE AND GENDER AT CHARIS MEDIKA HOSPITAL

A hospital is one of the subsystems of health services that organizes two types of services for the community, namely health services and administrative services. Health services include medical services, medical rehabilitation and care services. Every health service or hospital should be proud if every patient who visits continues to increase, the increase in patients can be seen from the changes in the existing graph of the number of patient visits. The number of patient visits that continues to increase greatly affects the smooth running of each health service, because patients who often visit have high trust in the health service they visit. The number of visits for inpatients for postpartum care based on age, disease, and gender is 115 visits, the number of visits for care patients based on age, disease, and gender is 37 visits. It can be concluded that medical records officers should write down inpatient data completely and clearly in the register book, good communication between medical records officers and doctors treating patients should be good so that the diagnosis written by the doctor in the patient's medical record is easy to read.

Telehealth visit type and patient-reported outcomes among patients with cancer

BackgroundRelaxed licensing restrictions on telehealth use during the COVID-19 pandemic allowed broad use irrespective of visit type. As these telehealth waivers expire, optimal uses of telehealth must be assessed to inform policy and clinical care. We evaluated patient experience associated with telehealth and in-person new or established visits. MethodsPatients seen in-person and via telehealth for urologic cancer care from August 2019 to June 2022 received a survey on satisfaction with care, perceptions of communication during their visit, travel time, travel costs, and days of work missed. We assessed survey responses with descriptive statistics. ResultsSurveys were completed for 1,031 patient visits (N = 494 new visits, N = 537 established visits). Satisfaction rates were high for all visit modalities among new and established patients (mean score range 59.9–60.7 [maximum 63], P > 0.05). Patient-rated quality of the encounter did not differ by visit type and modality (P > 0.05, for nearly all comparisons). New in-person patient visits were associated with significantly higher travel costs (mean $496.10, SD $1021) compared with new telehealth visits (mean $26.60, SD $141; P < 0.001); 27% of new in-person patients required plane travel and 41% required a hotel stay (P < 0.001 vs. 0.8% and 3.2% of new telehealth patients, respectively). ConclusionsSatisfaction outcomes among patients with urologic cancer receiving new patient telehealth care equaled those of new patients cared for in-person while costs were significantly lower. Offering telehealth exemption beyond COVID-19 licensing waivers to include new patient visits would allow for ongoing delivery of high-quality urologic cancer care irrespective of geographic location.

Ultrasound-Guided Polypectomy: Evaluation of a Novel Technique to Remove Endometrial Polyps in the Office.

To present a novel technique for office resection of pedunculated endometrial polyps under ultrasound guidance. A prospective trial was conducted at an academic center where women with abnormal uterine bleeding (AUB) who were diagnosed an endometrial polyp following saline infusion sonogram (SIS), were offered polyp removal under ultrasound guidance using a universal grasping forceps (2.5 mm × 25 cm). The primary outcome was to evaluate the feasibility of this technique for complete removal of the polyp. The secondary outcomes were to evaluate the patients' pain score, satisfaction score using visual analogue score (VAS), and efficacy of the technique in alleviating symptoms in patients with AUB due to polyps. Thirty patients participated, with a mean age of 54.8 ± 11 years. Average polyp volume was 1.87 cm3 and mean duration for polypectomy was 11 minutes 31 seconds. The median pain score immediately post-procedure was 5 (0-9). We were unable to complete the procedure in two patients due to patient discomfort and poor visualization. Complete removal of polyp was ensured by checking for a thin endometrial echo at the end of the procedure and by performing SIS at 3-months post-procedure. Of the 22 patients who returned for follow-up, 19 (86.36%) showed no evidence of polyp on SIS and all reported resolution of AUB symptoms. The median satisfaction score at the follow-up was 10/10. Adequate pathology samples were obtained from all cases, diagnosing malignancy in one and endometrial hyperplasia in one patient. This technique offers safe and effective removal of pedunculated endometrial polyps in an office setting, avoiding the need for general anesthesia. It can be offered as a therapeutic option at the initial point of contact, providing symptom relief and tissue diagnosis while reducing costs and patient visits.

The effect of antibiotic premedication on postoperative complications following dental extractions.

We aimed to evaluate the association between antibiotic prophylaxis and adverse outcomes following tooth extraction within the Veterans Affairs Healthcare System. We conducted a retrospective cohort study of patients undergoing dental extractions in 2015-2019. The primary exposure was antibiotic prophylaxis. The primary outcome was post-extraction complication within 7 days (e.g., alveolar osteitis and surgical site infection); the secondary outcome was subsequent medical care relating to a post-extraction oral complication within 7 days. Multivariable logistic regression models assessed the independent effect of antibiotic prophylaxis on each outcome. Of 385,880 visits with a dental extraction, 122,810 (31.8%) received antibiotic prophylaxis. Overall, 3387 (0.9%) experienced a post-extraction complication and 350 (0.09%) received medical care relating to a post-extraction oral complication within 7 days. In multivariable regression, diabetes was a statistically significant (p = 0.01) effect modifier of the association between antibiotic prophylaxis and post-extraction complication. Among visits for patients without diabetes, antibiotic prophylaxis was significantly associated with an increased odds of post-extraction complication (odds ratio [OR] = 1.25, 95% confidence interval [CI]: 1.13-1.38), but among visits for patients with diabetes no significant effect was observed (OR = 1.03, 95% CI: 0.92-1.15). Antibiotic prophylaxis was not significantly associated with post-extraction medical care (OR = 1.04; 95% CI: 0.83-1.30). In this large retrospective cohort, we observed no significant protective effect of antibiotic prophylaxis on post-extraction complications or subsequent medical care utilization in a setting with low complication rates. These data suggest that use of antibiotic prophylaxis in similar settings may need to be re-evaluated to minimize unnecessary antibiotic use.

Utilization of Hip or Knee MRI in Patients 50 Years and Older With Atraumatic Pain: An Analysis of the National Ambulatory Medical Care Survey

PurposeThe aim of this study was to use the National Ambulatory Medical Care Survey database to assess MRI utilization in patients 50 years and older with atraumatic hip or knee pain. MethodsNational Ambulatory Medical Care Survey weighted survey data (2007-2019) were obtained for ambulatory visits in patients 50 years and older with atraumatic hip or knee pain. The outcome variable was MRI ordering status, and analyzed characteristics included patient age, race/ethnicity, payer, physician specialty, metropolitan statistical area, and a coexistent radiography order. Multivariable logistic regressions were conducted to assess the association between MRI ordering status and the analyzed patient characteristics. All tests were two sided, and P values ≤.05 were considered to indicate statistical significance. ResultsIn total, 88,978,804 knee pain and 28,675,725 hip pain patient visits (survey weighted) were analyzed, with 4,690,943 (5.3%) and 2,023,226 (7.1%) having knee or hip MRI orders, respectively. Overall, 2,454,433 knee pain visits (2.8%) and 575,155 hip pain visits (2.0%) had orders for both MRI and radiographs. Black patients (P = .03) and patients 80 years and older (P = .04) were less likely to have knee MRI ordered, whereas uninsured patients were less likely to have hip MRI ordered (P = .01). Patients with hip pain were more likely to have hip MRI ordered if seen by a surgical subspecialist (P = .01). ConclusionsA low proportion of MRI examinations were ordered for visits in patients 50 years and older with atraumatic hip or knee pain. Groups with lower health care access were less likely to have an MRI order, highlighting known disparities in health care equity.

Effect of Inpatient Pharmacist-Led Medication Reconciliations on Medication-Related Interventions in Intensive Care Unit Recovery Centers.

Background: Critical care pharmacists complete comprehensive medication reviews in Post Intensive Care Syndrome (PICS) patients at Intensive Care Unit Recovery Centers (ICU-RCs) to optimize medication therapies after hospital discharge. Inpatient pharmacists often complete medication reconciliations prior to hospital discharge, which could affect interventions at an ICU-RC. However, this association remains ill-described. Objective: The purpose of this study was to, in patients with PICS, describe the effect of an inpatient, pharmacist-led medication reconciliation on the number of clinical pharmacist interventions at the first ICU-RC visit. Methods: This was a post-hoc subgroup analysis of an international, multicenter cohort study of adults who had a pharmacist-led comprehensive medication reconciliation conducted in 12 ICU-RCs. Only patients' first ICU-RC visit was eligible for inclusion. The primary outcome was the number of medication interventions made at initial ICU-RC visit in PICS patients who had an inpatient, pharmacist-led medication reconciliation compared to those who did not. Results: Of 323 patients included, 83 received inpatient medication reconciliations and 240 did not. No difference was observed in the median number of medication interventions between groups (2 vs 2, p = .06). However, a higher incidence of any intervention (86.3% vs 78.3%, p = .09) and dose adjustment (20.4% vs 9.6%; p = .03) was observed in the no medication reconciliation group. Only ICU Sequential Organ Failure Assessment score was associated with an increased odds of medication intervention at ICU-RC visit (aOR 1.15, 95% CI 1.05-1.25, p < .01). Conclusion and Relevance: No difference in the total number of medication interventions made by ICU-RC clinical pharmacists was observed in patients who received an inpatient, pharmacist-led medication reconciliation before hospital discharge compared to those who did not. Still, clinical observations within this study highlight the continued importance and study of clinical pharmacist involvement during transitions of care, including ICU-RC visits.

Application of principles learned in a prevention-focused pediatric dental residency curriculum to professional practice.

This study examined whether pediatric dentists who participated in a pediatric dental residency program focusing on disease prevention and management training and screening for social determinants of health (SDOH) were applying these principles to their professional practice upon graduation. Using a cross-sectional study design, a one-time-only online survey was disseminated to 75 pediatric dentists who graduated from the University of California, Los Angeles's training program between 2012 and 2022. The 21-item survey included questions on demographics, patient population characteristics, and application of preventive dentistry and SDOH to their professional practice. Descriptive statistics and bivariate analyses were used to assess survey items. The survey response rate was 64%. Over two-thirds (67%) of alumni reported accepting Medicaid, 34% saw patients in a medically underserved area and all reported seeing children with special needs in their practice. Strategies used to address SDOH in their practice included providing anticipatory guidance (98%) and educating families on oral disease prevention and screening for SDOH (96%). Alumni accepting patients with Medicaid/public health insurance were more likely to address SDOH in their practice, such as assisting patients with filling out Medicaid paperwork (p<0.05), conducting outreach to underserved communities (p<0.05), and using interpreters in their practice (p<0.01) in comparison with alumni not accepting patients with Medicaid/public health insurance. This study demonstrated that a pediatric dental residency program may be successful in training residents to educate children, families, and special needs patients on disease prevention and management in an ethical and culturally sensitive manner and screen for SDOH during patient visits.

Potentially Avoidable Emergency Department Transfers for Acute Pediatric Respiratory Illness

BackgroundAcute pediatric respiratory illness is one of the most common reasons for emergency department (ED) transfer; however, few studies have examined predictors of potentially avoidable ED transfer (PAT) in this subpopulation. This study aimed to characterize patterns and predictors of PATs in children with acute respiratory illness. MethodsCross-sectional analysis of 8,402,577 visits for patients ≤17 years from 2018 to 2019 Health Care Utilization Project State ED and Inpatient Datasets from New York, Maryland, Wisconsin, and Florida. ED transfers matched to a visit at a receiving facility with a primary diagnosis of pneumonia, croup/other URI, bronchiolitis, or asthma were included. PAT was defined as discharge from receiving ED or within 24 hours of inpatient admission without specialized procedures, as previously described. PATs were compared with necessary transfers using a 3-level generalized linear mixed model with adjustment for patient and hospital covariates. ResultsAmong 4409 matched respiratory transfers, 25.5% were potentially avoidable. Most PATs originated from EDs within the third highest quartile of annual pediatric ED visits (n = 472, 42.0%). In the multivariable model, the likelihood of PAT was higher for patients with croup/other URI (OR 2.72 (2.09–3.5) and if referring ED was in the highest quartile of annual pediatric ED volumes (OR 0.48 95% CI 0.26–0.88). ConclusionsPediatric respiratory transfers with a diagnosis of croup/other URI were the most likely to be potentially avoidable. Future implementation efforts to reduce PATs should consider focusing on croup management in EDs in the lower 3 quartiles of pediatric volume.

Decreasing Patient Visit Length at a Student-Run Free Clinic via a Continuous Quality Improvement Project.

The University of Florida Equal Access Clinic Network (EACN) is the largest student-run free clinic(SRFC) network in Florida. This student-driven, continuous quality improvement (CQI) project is intended to decrease total patient visit length at Eastside clinic, one of EACN's primary care sites. The original median visit length of 126.25 minutes represented a significant time burden for patients, especially those with limited transportation or inflexible schedules. Over six months, four Plan-Do-Study-Act (PDSA) cycles were implemented. PDSA cycle 1 increased personnel and space for taking vitals. PDSA cycle 2 reduced redundancy in the intake process. PDSA cycle 3 triaged patients to match patient complexity with student experience level. PDSA cycle 4 introduced "nudge" interventions to reinforce clinic flow. Total patient visit length and time spent at each step of clinic flow were recorded anonymously for each patient visit. The median visit length per week was tracked on a run chart. From PDSA cycle 1 through PDSA cycle 4, the median visit length decreased from 126 minutes to 114 minutes. This shift was primarily driven by a decrease in the length of patient intake from a median of 19 minutes to 9 minutes. The run chart did not show clear trends until PDSA cycle 4, which demonstrated a strong downward trend. This study demonstrated the ability of a student-driven CQI model to decrease patient visit length in an SRFC setting. Similar models could be used to address this and other contributors to patient experience across SRFCs nationwide.

Electronic Health Record–Based Screening for Intimate Partner Violence

Intimate partner violence (IPV) is a significant public health issue, with a 25% lifetime prevalence. Screening for IPV in primary care is a recommended practice whose effectiveness is debated. To assess the effect of an electronic health record (EHR)-based multifactorial intervention screening on the detection of IPV risk in primary care practice. This cluster randomized clinical trial used a stepped-wedge design to assign 15 family medicine primary care clinics in the Medical University of South Carolina Health System in the Charleston region to 3 matched blocks from October 6, 2020, to March 31, 2023. All women aged 18 to 49 years who were seen in these clinics participated in this study. A noninterruptive EHR alert combined with confidential screening by computer questionnaire using the EHR platform followed by risk assessment and a decision support template. The main outcomes were the rate at which patients were screened for IPV across the clinics and the rate at which patients at risk for IPV were detected by screening procedures. The study clinics cared for 8895 unique patients (mean [SD] age, 34.6 [8.7] years; 1270 [14.3%] with Medicaid or Medicare and 7625 [85.7%] with private, military, or other insurance) over the study period eligible for the screening intervention. The intervention had significant effects on the overall rate of screening for IPV, increasing the rate of screening from 45.2% (10 268 of 22 730 patient visits) to 65.3% (22 303 of 34 157 patient visits) when the noninterruptive alert was active (relative risk, 1.46 [95% CI, 1.44-1.49]; P < .001). The confidential screening process was more effective than baseline nurse-led oral screening at identifying patients reporting past-year IPV (130 of 8895 patients [1.5%] vs 9 of 17 433 patients [0.1%]). The intervention was largely effective in increasing screening adherence and the positive detection rate of IPV in primary care. A highly private approach to screening for IPV in primary care may be necessary to achieve adequate detection rates while addressing potential safety issues of patients experiencing IPV. ClinicalTrials.gov Identifier: NCT06284148.

Diabetes detection from non-diabetic retinopathy fundus images using deep learning methodology

Diabetes is one of the leading causes of morbidity and mortality in the United States and worldwide. Traditionally, diabetes detection from retinal images has been performed only using relevant retinopathy indications. This research aimed to develop an artificial intelligence (AI) machine learning model which can detect the presence of diabetes from fundus imagery of eyes without any diabetic eye disease. A machine learning algorithm was trained on the EyePACS dataset, consisting of 47,076 images. Patients were also divided into cohorts based on disease duration, each cohort consisting of patients diagnosed within the timeframe in question (e.g., 15 years) and healthy participants. The algorithm achieved 0.86 area under receiver operating curve (AUC) in detecting diabetes per patient visit when averaged across camera models, and AUC 0.83 on the task of detecting diabetes per image. The results suggest that diabetes may be diagnosed non-invasively using fundus imagery alone. This may enable diabetes diagnosis at point of care, as well as other, accessible venues, facilitating the diagnosis of many undiagnosed people with diabetes.

Disparity in Guideline-Based Antidiabetic Drugs Prescribing for Type 2 Diabetes Patients in Primary Healthcare Facilities Across China, 2017-2019.

The purpose of this study is to evaluate the pattern, appropriateness, and cost of antidiabetic drugs prescribed for patients with Type 2 diabetes at primary healthcare facilities (PHFs) in China. We collected outpatient-visit prescriptions from 363 PHFs in 31 cities covering eastern, central, and western regions of China. The visits of adult patients with Type 2 diabetes diagnosis were collected and classified the antidiabetic medication pattern of each patient use as recommended or non-recommended according to Chinese guidelines. We then calculated the proportion of guideline-recommended patterns and the average monthly cost for each pattern, overall and by region. Of 33 519 prescriptions for Type 2 diabetes, most (73.9%) were for guideline-recommended antidiabetic treatments. The proportion of guideline-recommended prescriptions varied by region (eastern [75.9%], central [87.5%], and western [59.7%]). Metformin monotherapy was the most common guideline-recommended treatment in all three regions (eastern [20.1%], central [28.0%], and western [24.6%]). The most common non-guideline-recommended treatments were monotherapy of insulin (eastern [16.5%], central [5.1%], and western [25.7%]) and traditional Chinese antidiabetic medicines (eastern [5.6%], central [5.7%], and western [11.1%]). The average monthly costs were lower for guideline-recommended treatments compared to non-recommended treatments in all regions (eastern [13.6 ± 15.4 USD vs. 28.1 ± 22.0 USD], central [9.8 ± 10.9 USD vs. 28.7 ± 19.4 USD], and western [17.9 ± 21.4 USD vs. 30.3 ± 23.6 USD]). The majority of patients with Type 2 diabetes received guideline-recommended antidiabetic medications at PHFs in China, with only half of the prescriptions containing guideline-recommended metformin. Utilization of guideline-recommended therapies differed across regions. Tailored interventions to promote evidence-based antidiabetic prescribing are urgently needed, especially in the undeveloped western region.

Quality of Blood Pressure Monitoring During Telehealth Visits for Pregnant Patients at Risk of Preeclampsia.

Introduction: Preeclampsia is a significant cause of morbidity and mortality. The United States Preventative Services Task Force released 2023 recommendations encouraging more research on telehealth's role in facilitating blood pressure monitoring for patients with hypertensive disorders of pregnancy, including preeclampsia. This study evaluates the integration of self-measured blood pressure (SMBP) into telehealth obstetric visits during the COVID-19 pandemic for pregnant patients at risk of preeclampsia. Methods: A retrospective chart review was conducted of patients with one or more preeclampsia risk factors who delivered at a tertiary hospital from January to March 2021. Information pertaining to patients' number of antepartum, postpartum, and telehealth visits, blood pressure cuff access, and documentation of SMBP readings was recorded. Analyses were conducted in RStudio version 2022.12.0 + 353 (R Foundation for Statistical Computing). Results: Of 721 eligible patients, 244 (33.8%) had 2 or more ante- or postpartum telehealth visits. Of these 244 patients, 142 (58.2%) had chart documentation of owning a home blood pressure cuff. Only 106 (43.4%) had 1 or more SMBP documented in their telehealth visit notes, and they were more likely to have received care at federally qualified health centers than maternal fetal medicine clinics (p = 0.018) or private clinics (p < 0.001). Charts revealed no explanation for lack of blood pressure documentation during telehealth visits for most cases (n = 129, 93.5%). Conclusions: Opportunities exist to standardize blood pressure recording and documentation during telehealth visits, especially for patients with risk factors for preeclampsia, and to advocate for greater access to home blood pressure cuffs for all pregnant patients.

Improving Colorectal Cancer Screening via Mailed Fecal Immunochemical Testing in a Veterans Affairs Health System.

Colorectal cancer screening rates at the Veterans Affairs Connecticut Healthcare System (VACHS) decreased during the COVID-19 pandemic. Fecal immunochemical testing is recognized as a tier 1 preferred screening method by the US Multi-Society Task Force on Colorectal Cancer. The VACHS implemented a program that mailed fecal immunochemical testing kits to patients to improve colorectal cancer screening rates. This article describes the components of the VACHS patient aligned care team-based mailed fecal immunochemical testing program. Fecal immunochemical testing utilization, completion, and colorectal cancer screening rates at VACHS substantially increased after the implementation of this project. Through a proactive, population-based colorectal cancer screening program centered on mailed fecal immunochemical testing kits outside of a traditional patient visit, VACHS substantially increased the utilization of fecal immunochemical testing kits as well as colorectal cancer screening rates.

Outcomes associated with prehospital epinephrine in adult and pediatric patients with anaphylaxis

BackgroundPrompt epinephrine administration is important to improve outcomes in anaphylaxis. ObjectiveTo assess the impact of prehospital epinephrine on clinical outcomes of hospital admission, biphasic reactions, and emergency department (ED) length of stay (LOS) in a cohort of ED patients who had anaphylaxis including both children and adults. MethodsWe conducted a single-center prospective and retrospective cohort study of patients who had anaphylaxis from April 2008 to December 2022. Associations between prehospital epinephrine administration with biphasic reactions and ED LOS were assessed with univariable models and the association with ED disposition was assessed with both univariable and multivariable logistic regression. ResultsA total of 1107 patient visits were included for analysis. The median patient age was 29 (IQR: 14-50), 593 (53.6%) patients were of female sex, and 366 (33.1%) were younger than 18 years of age. Patients in the prehospital epinephrine group were also less likely to experience a biphasic reaction (5.4% vs 9.3%; odds ratio [OR] 0.56, 95% CI: 0.34-0.92) and had a decreased ED LOS (median 4.0 hours vs 4.7 hours). There was no difference in hospital admission between patients with and without prehospital epinephrine in both the univariable (19.5% vs 15.7%; OR 1.30, 95% CI: 0.94-1.79) and multivariable (adjusted OR 1.08, 95% CI: 0.71-1.64) models. ConclusionPrehospital epinephrine administration reduced the odds of a biphasic reaction and decreased ED LOS but did not reduce hospitalization in this cohort of ED patients who had anaphylaxis. Our findings suggest that timely administration of prehospital epinephrine is associated with improved patient outcomes.