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Mark Callahan

Publications and source records attributed to Mark Callahan.

6 recordsLinked to original sources
PubMed2006

Lack of adherence with preoperative B-blocker recommendations in a multicenter study.

BACKGROUND: Clinical guidelines support the use of preoperative B-blocker in select patients. Patient safety groups have sought to measure the level of adherence to these recommendations. OBJECTIVE: This study was performed to compare the utilization of preoperative B-blocker with current guidelines across multiple diverse institutions. DESIGN: Retrospective chart review was performed of inpatients undergoing noncardiac surgery across 5 hospital centers during 2003 to 2004. The primary outcome of interest was the administration of preoperative B-blocker. PARTICIPANTS: The study sample included 1,304 randomly selected patients meeting the guideline criteria for preoperative B-blockade. MEASUREMENTS AND MAIN RESULTS: Among patients meeting recommendations for preoperative B-blocker, only 44% (430/983) received B-blocker before surgery. Patients who had not previously received B-blocker were given B-blocker before surgery in only 14% (85/600) of cases. Target heart rates goals for perioperative B-blockade were achieved in 26% (113/430) of cases. Predictors for initiating preoperative B-blocker included nonelective surgery or a history of hypertension or diabetes. Individual hospitals were independently predictive of preoperative B-blocker administration in multivariable models. CONCLUSIONS: Preoperative B-blocker was significantly underutilized when compared with the current guideline recommendations. Target heart rate goals were not achieved in clinical practice, and few hospitalized patients had preoperative B-blockade initiated. The lack of adherence to preoperative B-blocker recommendations in practice may be impacted by ongoing clinical questions regarding the appropriate selection of candidates for this therapy. Further efforts toward achieving guideline recommendations for preoperative B-blocker use should be focused on the subset of patients that are uniformly agreed upon to be at high risk for cardiac events.

Adrenergic beta-Antagonists↗
PubMed2006

Improving the transition to home healthcare by rethinking the purpose and structure of the CMS 485: first steps.

Transition points are the weak links in communication between providers. As an example, the discharge home often is a hurried "handoff" from inpatient physician to home care agency, whose visiting nurse admits the patient for a period of observation, medication management, rehabilitation, and teaching. The primary means of communication between physician and home health agency is the CMS 485, a form that contains the orders and that physicians frequently sign well after patients begin receiving services. This paper describes the first phase of a project that restructured and automated the CMS 485 using an existing electronic health record. The principles guiding the restructuring are described along with early reaction to and revision of the form to address operational issues. The paper also discusses evaluation plans and a web-based system of communication that will be developed in the second phase of the project.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed2002

Rapid antibiotic delivery and appropriate antibiotic selection reduce length of hospital stay of patients with community-acquired pneumonia: link between quality of care and resource utilization.

OBJECTIVES: To measure quality-of-care variables relevant to the treatment of community-acquired pneumonia and to determine their relative contribution to variation in length of hospital stay (LOS). METHODS: One hundred cases of pneumonia requiring hospitalization from each of 7 institutions (2 community and 5 university teaching hospitals) were randomly selected (total sample, 700 cases). Demographic and clinical variables were abstracted using a standardized data instrument. Three quality-of-care measures were analyzed: (1) site of initial antibiotic treatment (emergency department vs floor), (2) door-to-needle time, and (3) appropriateness of antibiotic selection. Appropriate antibiotic selection was defined by the 1998 Infectious Disease Society of America guidelines for the treatment of hospitalized pneumonia cases. Regression modeling was used to determine associations between LOS and our quality-of-care (process) variables. RESULTS: The mean +/- SD LOS for this sample was 7.0 +/- 4.1 days. Prolonged LOS, defined as greater than or equal to the 75th percentile of the LOS distribution, was the dependent variable in our regression analysis and was greater than or equal to 9.0 days. After clinical and demographic variables were adjusted for, logistic regression modeling revealed that all 3 quality-of-care measures were associated with prolonged LOS: (1) initial antibiotic treatment in the emergency department (odds ratio [OR], 0.31; 95% confidence interval [CI], 0.19-0.48); (2) appropriate antibiotic selection (OR, 0.55; 95% CI, 0.35-0.88); and (3) door-to-needle time (OR, 1.75 per 8 hours; 95% CI, 1.34-2.29). In a secondary analysis, we examined the clinical and demographic characteristics of the patients who were treated more rapidly in the emergency department compared with those who were treated on the inpatient floor. No clinically meaningful differences were observed between these groups. CONCLUSIONS: Unlike clinical and demographic variables, process-of-care variables are modifiable and amenable to quality improvement. We observed that rapid antibiotic initiation and appropriate antibiotic selection in the emergency department have a statistically significant association with shorter LOS. These findings suggest quality improvement targeted at these processes of care may improve resource utilization and reduce LOS for patients with community-acquired pneumonia.

Aged↗
PubMed2002

A practice-profiling system for residents.

Providers are increasingly evaluated and measured as part of quality, credentialling, and reimbursement programs, an approach often used by managed care organizations. However, these evaluations are rarely used in residency training, meaning that physicians entering practice have little experience or understanding of these measures. To address this issue, in 1998 the authors successfully developed a three-part practice-profiling system for internal medicine residents at their institution that includes measures of patient satisfaction, disease-management profiles for diabetes and hypertension, and an Internet-based faculty-evaluation program. The patient-satisfaction profile utilizes a ten-question patient survey that emphasizes physician-patient communication issues. The diabetes and hypertension disease-management profiles use the resident's own patients to profile process and outcome measures for common chronic ambulatory conditions. The faculty-evaluation profile is conducted over the Internet, and allows the resident to compare faculty evaluations with those of his or her peer group. Residents receive the profiles as a packet in a scheduled session with a faculty supervisor twice each year. A total of 120 residents are profiled annually for the above measures. Residents rated the program very highly, and found the profiling program to be instructive and effective feedback. As payers and regulators increasingly use physician profiling, residents will benefit from learning the strengths and weaknesses of profiling systems early in their training.

Clinical Competence↗
PubMedDate not supplied

Economic consequences of renal dysfunction among cardiopulmonary bypass surgery patients: a hospital-based perspective.

BACKGROUND: Renal dysfunction is common after cardiopulmonary bypass procedures and is associated with higher mortality rates and longer lengths of stay. However, less is known about the actual cost of care for these patients. We sought to quantify the hospital costs attributed to renal dysfunction in cardiopulmonary bypass patients at a large academic referral center. METHODS: All patients undergoing cardiopulmonary bypass procedures were identified through administrative databases for a 3-year study period. Renal failure was defined using laboratory values from the hospitalization. Total direct costs and costs by hospital department were determined using the hospital cost-accounting system. A multivariate linear model was developed to determine total direct hospital costs after cardiopulmonary bypass procedures after adjusting for relevant clinical and demographic variables. RESULTS: Nine percent of the study population developed new-onset renal dysfunction, and 18% of patients overall undergoing cardiopulmonary bypass experienced renal dysfunction during the hospitalization. Direct costs were 42% higher for patients with renal dysfunction, an average of 5807 US dollars per case. Higher costs were noted in intensive care unit use and pharmacy, laboratory, and radiology services. CONCLUSIONS: Renal dysfunction increases the direct hospital costs of care, even after adjustment for age, sex, race, and comorbidities. Nationwide, we estimate that renal dysfunction may add up to 643 million US dollars in hospital costs for caring for cardiopulmonary bypass patients. Interventions designed to reduce the incidence and severity of renal dysfunction may significantly reduce hospital costs for these patients.

Aged↗