Search PubMed⌕ Search

Biomedical subjects

Barbara Jones

Publications and source records attributed to Barbara Jones.

9 recordsLinked to original sources
PubMed2007

Enhancement of claims data to improve risk adjustment of hospital mortality.

CONTEXT: Comparisons of risk-adjusted hospital performance often are important components of public reports, pay-for-performance programs, and quality improvement initiatives. Risk-adjustment equations used in these analyses must contain sufficient clinical detail to ensure accurate measurements of hospital quality. OBJECTIVE: To assess the effect on risk-adjusted hospital mortality rates of adding present on admission codes and numerical laboratory data to administrative claims data. DESIGN, SETTING, AND PATIENTS: Comparison of risk-adjustment equations for inpatient mortality from July 2000 through June 2003 derived by sequentially adding increasingly difficult-to-obtain clinical data to an administrative database of 188 Pennsylvania hospitals. Patients were hospitalized for acute myocardial infarction, congestive heart failure, cerebrovascular accident, gastrointestinal tract hemorrhage, or pneumonia or underwent an abdominal aortic aneurysm repair, coronary artery bypass graft surgery, or craniotomy. MAIN OUTCOME MEASURES: C statistics as a measure of the discriminatory power of alternative risk-adjustment models (administrative, present on admission, laboratory, and clinical for each of the 5 conditions and 3 procedures). RESULTS: The mean (SD) c statistic for the administrative model was 0.79 (0.02). Adding present on admission codes and numerical laboratory data collected at the time of admission resulted in substantially improved risk-adjustment equations (mean [SD] c statistic of 0.84 [0.01] and 0.86 [0.01], respectively). Modest additional improvements were obtained by adding more complex and expensive to collect clinical data such as vital signs, blood culture results, key clinical findings, and composite scores abstracted from patients' medical records (mean [SD] c statistic of 0.88 [0.01]). CONCLUSIONS: This study supports the value of adding present on admission codes and numerical laboratory values to administrative databases. Secondary abstraction of difficult-to-obtain key clinical findings adds little to the predictive power of risk-adjustment equations.

Clinical Laboratory Information Systems↗
PubMed2006

From cure to palliation: managing the transition.

When a child is diagnosed with a life-threatening or life-limiting condition, their physical and affective world is immediately changed, regardless of the outcome of treatment. Pediatric care providers are in a unique position to offer hope to children and families even when cure is not possible. This hope focuses not only on cure, but incorporates the understanding that quality of life is not commensurate with length of life and that compassionate care can be provided in all stages of treatment.

Attitude to Death↗
PubMed2006

Functional analyses of RNA structures shared between the internal ribosome entry sites of hepatitis C virus and the picornavirus porcine teschovirus 1 Talfan.

The internal ribosome entry site (IRES) of porcine teschovirus 1 (PTV-1), a member of the Picornaviridae family, is quite distinct from other well-characterized picornavirus IRES elements, but it displays functional similarities to the IRES from hepatitis C virus (HCV), a member of the Flaviviridae family. In particular, a dominant negative mutant form of eIF4A does not inhibit the activity of the PTV-1 IRES. Furthermore, there is a high level (ca. 50%) of identity between the PTV-1 and HCV IRES sequences. A secondary-structure model of the whole PTV-1 IRES has been derived which includes a pseudoknot. Validation of specific features within the model has been achieved by mutagenesis and functional assays. The differences and similarities between the PTV-1 and HCV IRES elements should assist in defining the critical features of this type of IRES.

Animals↗
PubMed2006

The hazards of using administrative data to measure surgical quality.

Administrative claims data have been used to measure risk-adjusted clinical outcomes of hospitalized patients. These data have been criticized because they cannot differentiate risk factors present at the time of admission from complications that occur during hospitalization. This paper illustrates how valid risk-adjustment can be achieved by enhancing administrative data with a present-on-admission code, admission laboratory data, and admission vital signs. Examples are presented for inpatient mortality rates following craniotomy and rates of postoperative sepsis after elective surgical procedures. Administrative claims data alone yielded a risk-adjustment model with 10 variables and a C-statistic of 0.891 for mortality after craniotomy, and a model with 18 variables and a C-statistic of 0.827 for postoperative sepsis. In contrast, the combination of administrative data and clinical data abstracted from medical records increased the number of variables in the craniotomy model to 21 with a C-statistic of 0.923, and the number of variables in the postoperative sepsis model to 29 with a C-statistic of 0.858. Use of only administrative data resulted in unacceptable amounts of systematic bias in 24 per cent of hospitals for craniotomy and 19 per cent of hospitals for postoperative sepsis. Addition of a present-on-admission code, laboratory data, and vital signs reduced the percentage of hospitals with unacceptable bias to two percent both for craniotomy and for postoperative sepsis. These illustrations demonstrate suboptimal risk stratification with administrative claims data only, but show that present-on-admission coding combined with readily available laboratory data and vital signs can support accurate risk-adjustment for the assessment of surgical outcomes.

Adult↗
PubMed2005

Female gender is an independent predictor of operative mortality after coronary artery bypass graft surgery: contemporary analysis of 31 Midwestern hospitals.

BACKGROUND: Women have a higher operative mortality (OM) after coronary artery bypass graft (CABG) surgery than men. Suggested contributing factors have included women's increased age, advanced disease, comorbidities, and smaller body surface area (BSA). It is unclear whether women's increased risk factors fully account for this difference or whether female gender within itself is associated with increased OM. We attempted to determine whether, all other factors being equal, there is a significant difference in OM between men and women undergoing CABG. METHODS AND RESULTS: We retrospectively reviewed a clinical database of 15,440 patients who underwent CABG at 31 Midwestern hospitals in 1999-2000. Each patient record consisted of >400 data elements. Risk-adjusted mortality rates were computed using a predictive equation derived by stepwise logistic regression. Overall, women were older, had a higher incidence of diabetes and valvular disease, and were more likely to be presenting in shock. The OM for the entire population was 2.88% (women 4.24% versus men 2.23%, P<0.0001). Lower BSA was found to be an independent predictor of increased mortality, and a direct inverse relationship between BSA and OM was noted. After adjusting for all comorbidities including BSA, female gender remained an independent predictor of increased mortality (risk-adjusted OM was 3.81% for women and 2.43% for men). Thus, whereas risk adjustment reduced women's OM from 90% higher than men's to 22% higher, a significant difference remained. CONCLUSIONS: In this contemporary data set from 31 Midwestern hospitals, female gender was an independent predictor of perioperative mortality, even after accounting for all comorbidities, including low BSA.

Adult↗
PubMed2005

[Norwegian and Australian physicians' attitudes to adverse events].

BACKGROUND: As "second victims", doctors may find it difficult to meet patients and relatives with an open and regretting mind after adverse incidents. MATERIAL AND METHODS: In a series of six workshops 103 doctors, 46 from Australia and 57 from Norway, were included. Initially the participants completed a questionnaire about possible reactions after serious adverse events, experiences with formal complaints and legal charges, and an option to describe a personally experienced adverse event. This was followed by an interactive educational session, where prevention and management of adverse events were discussed. A descriptive analysis based on a combination of questionnaire data and notes from the discussions has been performed. RESULT AND INTERPRETATION: The questionnaire responses showed that Australian and Norwegian doctors mainly did agree about the most appropriate ways of responding after a serious adverse event. Subsequent discussions showed that certain issues were recurrently and similarly discussed among the participants through all the workshops. Although the majority principally did agree on an open approach, an underlying sceptical attitude emerged, partially connected to experiences of being thoughtlessly blamed by colleagues in the wisdom of hindsight. The study outlines a strategy to raise doctors' understanding of the importance of openness in order to reinforce trust in relation to all involved parties--patient, relatives, colleagues and self--after adverse events.

Attitude of Health Personnel↗
PubMed2002

Screening for chlamydia in general practice.

OBJECTIVE: To determine the prevalence of genital Chlamydia trachomatis infection in young patients presenting to general practitioners and to evaluate selective screening, based on risk factors, including gender. METHODS: A cross sectional survey of 508 consecutive patients aged 18-24, presenting to six general practices and one youth clinic in Mackay, North Queensland. We screened urine for chlamydia using Ligase chain reaction. RESULTS: Of 508 samples, 25 were positive (5%). The only factors with increased risks of infection were attendance at a youth clinic and recent change in sexual partner. It was as high in men as in women. CONCLUSION: Prevalence of chlamydia infection may be high enough to support screening of all patients aged 18-24, depending on cost effectiveness studies.

Adolescent↗