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Biomedical subjects

E C Nelson

Publications and source records attributed to E C Nelson.

151 records · Page 9Linked to original sources
PubMedDate not supplied

Increasing the value of cardiac care: the Dartmouth approach.

UNLABELLED: A cardiac services team at Dartmouth-Hitchcock Medical Center (DHMC) launched multiple efforts to improve the quality and value of their services. The team developed a critical path for coronary artery bypass grafting (CABG) and tracked important clinical outcomes, such as mortality rates and wound complications. The team also studied the patient's view of the process. Staff used focus groups and surveys to distill the "voice of the customer" into six quality characteristics and developed methods to better involve patients in clinical decision making and evaluation of treatment efficacy. RESULTS: CABG mortality declined from 5.7 percent in 1992 to 2.7 percent in 1994, 16 months after the critical path was developed. Mean total intubation time for patients following open-heart surgery was reduced from 22 hours to 14 hours. Median postoperative length of stay decreased from seven days to six for elective CABG patients. The number of patients discharged in five days or less increased from 20 percent to 40 percent. Readmission to the hospital following discharge remained stable, despite the shorter length of stay.

Cardiology Service, Hospital↗
PubMedDate not supplied

A randomized trial of the use of patient self-assessment data to improve community practices.

OBJECTIVE: Because of time constraints in the office environment, problems of concern to elderly patients may not be raised during clinic visits. To facilitate communication about geriatric health problems, we examined the impact of a strategy that used patient self-assessment data to improve community practices. DESIGN: Twenty-two primary care practices were randomized to participate in the intervention strategy (intervention practices) or to provide usual care (usual care practices). SETTING: Primary care practices in 16 towns in New Hampshire (total, 45 physicians). PATIENTS: 1651 patients 70 years of age or older. INTERVENTION: All patients received a mailed survey that asked about their health problems and about how well these problems were being addressed by their physicians. In the intervention practices, these data were used to generate a customized letter that directed the patient to specific sections in an 80-page modified version of the National Institute on Aging's Age Pages and were summarized and communicated to the patient's physician. MAIN OUTCOME MEASURE: Change from baseline in patients' overall assessment of health care. RESULTS: In 8 of 11 intervention practices, patients felt that their care had improved over the 2-year study period. This improvement occurred in only 1 of 11 usual care practices (P = 0.003). Patients in intervention practices reported receiving significantly more help with physical function, fall prevention, and assistance for memory problems. Self-assessed health status did not differ in the two groups. CONCLUSION: A standard, easy-to-implement strategy to improve the quality of provider--patient interactions can improve the satisfaction of older patients cared for in community practices.

Aged↗
PubMedDate not supplied

Effectiveness of physician antismoking advice.

The Dartmouth Primary Care Cooperative Information (COOP) Project conducted a controlled trial on the impact of antismoking advice from office-based physicians. Eighteen primary care medical practices were randomly assigned to be intervention or customary care practices. Medical personnel assigned to the intervention practices were to systematically identify cigarette smokers (among patients aged 35 to 59 years making an office visit), advise them to quit smoking, and provide educational materials. A random sample of 258 smokers was identified and followed-up four months later. Intervention-group smokers were more likely to report being advised to quit smoking (77 percent versus 47 percent) and to attempt quitting (39 percent versus 31 percent), but had success rates similar to those of the other group (6 percent versus 7 percent). We conclude that the medical office is an excellent place to identify large numbers of smokers and initiate attempts at quitting, but find that simple antismoking information and advice are not enough to improve cessation rates.

Adult↗