Background: The geriatric syndrome of frailty is one the greatest challenges facing U.S. aging population. Frailty in older adults associated with higher adverse outcomes, such as mortality and hospitalization. Identifying precise early indicators pre-frailty measures specific components are key importance to enable targeted interventions remediation. We hypothesize that sensor-derived parameters, measured by a pendant accelerometer device home setting, sensitive identifying pre-frailty....

Objectives We examined the role of discharge instructions in postoperative recovery for patients undergoing colorectal surgery and report themes related to patient perceptions postdischarge experience. Design Semistructured interviews were conducted as part a formative evaluation Project Re-Engineered Discharge intervention adapted surgical patients. Setting Michael E. DeBakey VA Medical Center, tertiary referral centre Houston, Texas. Participants Twelve elective surgery. Interviews at...

Physical frailty together with cognitive impairment (Cog), known as frailty, is emerging a strong and independent predictor of decline over time. We examined whether remote physical activity (PA) monitoring could be used to identify those frailty. A validated algorithm was quantify PA behaviors, patterns, nocturnal sleep using accelerometer data collected by chest-worn sensor for 48-h. Participants (N = 163, 75 ± 10 years, 79% female) were classified into four groups based on presence or...

Abstract Challenges to recruitment of family caregivers exist and are amplified when consent must occur in the context chaotic healthcare circumstances, such as transition from hospital home. The onset COVID-19 pandemic during our randomized controlled trial provided an opportunity for a natural experiment exploring examining different processes caregiver recruitment. purpose this publication is describe (in-person versus virtual) compare diversity rates care recipient’s hospitalization. We...

To evaluate the effect of E-consults on wait times and resource utilization for positive antinuclear antibody (ANA) referrals in outpatient rheumatology.We conducted a pre-post study E-consult implementation ANA referrals. We retrospectively reviewed "positive ANA" from 1/2015-3/2017. A statistical process control chart was created to display monthly average in-person clinic visits identify special cause variation. Final diagnoses, were recorded compared between referrals.There 139 with 126...

Introduction: This short report introduces an application of curriculum mapping in a postgraduate health professions continuing education setting. Our focus is on the Health Professions Education Evaluation and Research (HPEER) Advanced Fellowship Program, national interprofessional 2-year program offered through Department Veterans Affairs. Methods: We designed Excel-based tool to align HPEER domains competencies with curricular elements. An team conducted independent review curricula,...

Frailty is a syndrome associated with increased vulnerability and diminished physiological reserves. Three-quarters (78%) of heart failure (HF) patients are frail. Traditional frailty indices (FIs) assess cross-sectional deficits, while trajectories (FTs) measure changes over time. This study aims to examine the interaction between FI FT enhance risk stratification in hospitalized adults HF. retrospective cohort utilized data from Veterans Health Administration, including 143,687 veterans...

Overuse of urine testing is a driver inappropriate antimicrobial use. Limiting wasteful important for patient safety. We examined the national prevalence and patterns during adult inpatient admission in United States.We performed retrospective cohort study using dataset admissions from 263 hospitals States 2009 to 2014. included all admissions, excluding those related pregnancy, urology procedures, with lengths stay >30 days. A facility-level fixed-effects quasi-Poisson regression model was...

Abstract We sought to understand the current state of research in adult Hospital Medicine by repeating a 2018 survey leaders with changes improve response rate surveyed programs. also analyzed public sources federal funding and MEDLINE‐indexed publications from 2010 through 2019 among members Society (SHM). Of 102 contacted groups across country, 49 responded, for total 48%. Among 3397 faculty represented responding programs, 72 (2%) were identified as conducting more than 50% their time....

Adverse events leading to patient harm are rarely the result of an individual error but instead due a series errors resulting from system breakdowns. Thus, Accreditation Council for Graduate Medical Education requires all residents participate in quality improvement and safety programs. However, major reported obstacle sustainable curricula, as well meaningful practice improvement, is small number faculty with expertise or training these topics.This workshop provides simple framework...

Abstract Background and Objectives This study aims to identify patterns of caregiving intensity assess associations between multidimensional physical health indicators behaviors among spousal caregivers persons with Alzheimer’s disease related dementia. Research Design Methods Using data from 152 aged 65 older, the their experience was measured as number frequency health- medical-related helping activities for care recipient. Multidimensional included self-reported fatigue, sleep...

Background: Individuals with heart failure (HF) have a high burden of health care utilization, cost, and morbidity in the year following hospitalization for an acute HF exacerbation.Frailty, described as increased vulnerability to adverse events, is common among those increases age1.Health systems worldwide are integrating automated tools within electronic records (EHR) measure frailty.However, consideration longitudinal data frailty better predict outcomes lacking2-5. Objective:We sought...

To assess the impact of adding Prognostic Nutritional Index (PNI) to U.S. Veterans Health Administration frailty index (VA-FI) for prediction time-to-death and other clinical outcomes in hospitalized with Heart Failure.

OBJECTIVE To examine the impact on infection rates and hospital rank for catheter-associated urinary tract (CAUTI), central line-associated bloodstream (CLABSI), ventilator-associated pneumonia (VAP) using device days bed as denominator DESIGN Retrospective survey from October 2010 to July 2013 SETTING Veterans Health Administration medical centers providing acute surgical care PATIENTS Patients admitted 120 reporting healthcare-associated infections METHODS We examined importance of between...

Readmission following colorectal surgery, typically due to surgery-related complications, is common. Patient-centered discharge warnings may guide recognition of early complication signs after surgery.User-centered design a tool consisted iterative health literacy review and heuristic evaluation with human factors clinical experts as well patient end users establish content validity usability.Literacy the prototype suggested >12th-grade reading level. Subsequent revisions reduced level 8th...

OBJECTIVE To examine the impact of urine culture testing on day 1 admission inpatient antibiotic use and hospital length stay (LOS). DESIGN We performed a retrospective cohort study using national dataset from 2009 to 2014. SETTING The used data 230 hospitals in United States. PARTICIPANTS Admissions for adults 18 years older were included this study. Hospitalizations matched with coarsened exact matching by facility, patient age, gender, Medicare severity-diagnosis related group (MS-DRG), 3...

To describe the development, implementation, and preliminary evaluation of Opioid Overdose Response Protocol using intranasal (IN) naloxone in a homeless shelter.Opioid training curriculum were developed Massachusetts Department Public Health Education Naloxone Distribution (OEND) flow chart, American Heart Association (AHA) simplified adult basic life support algorithm, resources through Harms Reduction Coalition.Intranasal offers safe effective method for opioid reversal. combat rising...

ABSTRACT Introduction: Adapting Project Re-Engineered Discharge (Project RED), an intervention for reducing internal medicine hospital readmissions, is a promising option colorectal surgery readmissions. Methods: We conducted pilot study the adaptation and implementation of RED with patients admitted colectomy at regional VA tertiary care center between July 2014 January 2015. Implementation was evaluated using adherence to components results from Survey Healthcare Experiences Patients. The...

Despite the need for leaders in health care improvement across professions, there are no standards knowledge and skills that should be achieved through advanced interprofessional training. Existing training competencies focus on foundational expected of all trainees or specific career pathways. Health fill multiple roles within organizations promote practice. The diverse skill set required modern necessitates development specifically fellowships applied improvement. authors describe revised...

Fear of the kind engendered by disciplinary approach poisons improvement in quality, since it inevitably leads to dissatisfaction, distortion information, and loss chance learn. —Donald Berwick1 Quality has a culture problem. In its inception, quality movement adopted model continuous improvement, which purpose performance measurement was offer providers an opportunity for continual learning.1 Starting mid-1990s, healthcare systems explored role measures monitoring on national scale...

Abstract Health professions educators need knowledge, skills, and attitudes to provide high-quality education within dynamic clinical learning environments. Although postgraduate training opportunities in health (HPE) have increased significantly, no shared competencies exist across the field. This article describes systematic development of HPE for Professions Education, Evaluation, Research (HPEER) Advanced Fellowship, a 2-year, interprofessional, post–master’s degree postdoctoral program...

ObjectiveIn 2011, our institution developed a venous thromboembolism (VTE) prophylaxis order set to monitor management through physician-generated risk assessment orders. Prophylaxis rates obtained using the orders were falsely low compared with chart review. Our goal was redesign increase percentage of VTE assessments ordered, both improve care and better reflect performance.