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PubMed1992

Use of generic quality improvement chart review to recognize nosocomial infection.

BACKGROUND: Generic medical quality improvement concurrent chart review for adverse patient occurrences was introduced into our hospital. To determine whether this program could be used to augment the surveillance activities of the infection control program, an evaluation of this review was carried out and it was compared with existing surveillance methods. METHODS: Analysts were provided with Centers for Disease Control definitions of site infections and were trained in identification. During a 6-month period (period 1) infections in this manner documented were reviewed by infection control program to confirm nosocomial infection as a measure of specificity. Data were also compared with infection control surveillance data when the two programs overlapped (nosocomial bloodstream infections and surgical wound infections) as a check on the sensitivity of the data generated in the medical quality improvement process. A second 6-month review of data (period 2), starting 3 months after completion of period 1, was carried out; this review was limited to areas of overlap and designed to determine whether changes in data occurred with experience. RESULTS: In period 1, 72% (109/152) of infections detected by chart review were confirmed by infection control methods, and 51% (26/51) of infections detected by the infection control program were also detected by chart review. During period 2 the values were 73% (52/71) for confirmed infections and 61% (43/70) for detected infections. There was no statistical difference between periods 1 and 2. In the two periods 25 bacteremic infections went undetected by chart surveyors. CONCLUSION: We conclude that this chart surveillance has only moderate sensitivity and specificity compared with our infection control surveillance methods. Improvements were not demonstrated with experience.

Alberta↗
PubMed1995

The behavioral economics of concurrent drug reinforcers: a review and reanalysis of drug self-administration research.

In economics, goods can function as substitutes, complements, or be independent of one another. These concepts refer to increases, decreases, or no change in the consumption of one item as the price of a second item increases. This review examined whether these economic terms can be used to describe relationships between concurrently available reinforcers in drug self-administration research. Sixteen drug self-administration studies that examined the effects of concurrent reinforcers were identified through a MEDLINE search. Across these studies, the following substances were employed: caffeinated coffee, cocaine, etonitazene, ethanol, heroin, food, methadone, morphine, nicotine cigarettes, pentobarbital, phencyclidine, sucrose and water. These studies were reanalyzed and the results were shown to be consistent with these economic notions. These analyses also showed that relationships among the concurrently available reinforcers were reliable within and across studies, that concurrently available reinforcers can affect each other asymmetrically, and that the relative price may determine the magnitude of effect for substitutes. These findings suggest that these economic concepts may be useful in characterizing the type and magnitude of interactions between concurrently available reinforcers and may suggest potential mechanisms that determine these relationships.

Alcohol Drinking↗
PubMed1992

Impact of a pharmacist/physician cooperative target drug monitoring program on prophylactic antibiotic prescribing in obstetrics and gynecology.

The pharmacist's role in promoting rational, cost-effective use of drugs has been described in the literature. In a target drug monitoring program (TDMP), a single agent or group of agents becomes targeted for review. Antibiotics have been the primary focus of TDMP because of their therapeutic impact and cost considerations. The objectives of this project were to assess the prophylactic antibiotic prescribing habits of OB/GYN physicians and to evaluate the impact of a pharmacist/physician cooperative TDMP on prophylactic antibiotic prescribing and cost. The study was conducted in three phases: 1) a retrospective chart review of 150 patients, 2) an in-service education session, and 3) a concurrent chart review of 107 patients. Patient selection, timing of preoperative dose, and use of single dose prophylaxis were according to criteria in greater than 90% of patients both before and after the in-service training. Compliance with recommended regimens increased from 45 to 73% after the in-service training. A cost savings was not realized because the physicians wished to use a regimen with anti-anaerobic coverage (i.e., cefotetan) rather than a less expensive agent. However, the cost of selection of resistant organisms must be considered when discouraging the use of multiple broad spectrum agents. Active involvement of the medical staff in a pharmacy-based TDMP produces a cooperative atmosphere in which to educate clinicians and promote rational prescribing habits.

Anti-Bacterial Agents↗
PubMed1980

A trial of two strategies to modify the test-ordering behavior of medical residents.

We studied two methods to reduce the ordering of laboratory and radiologic tests by medical residents in their first postgraduate year. Dividing the residents into three groups, we compared the effect of concurrent chart review and discussion in one group with the effect of a moderate financial incentive for limited ordering of tests in a second group. The third group of residents served as a concurrent control, and data on the testing patterns of residents at the same hospital during the year before the study provided a retrospective control.

Boston↗
PubMed1991

From retrospective to concurrent monitoring in a university student health center: a report on the transition.

From 1984, when the quality assurance (QA) program at the Student Health Center of the New Mexico State University, Las Cruces, was initiated, to 1990, QA activities moved from purely retrospective chart reviews to concurrent monitoring. The QA plan divides center services into six units (physician medical, certified nurse practitioner [CNP] medical, nursing, clerical, laboratory, and pharmacy), for which indicators are selected by the QA committee to be evaluated each semester. Concurrent monitoring has led to improvement in areas such as laboratory specimen labeling, patient chart documentation, and patient satisfaction.

Adult↗
PubMed2000

The bill drops here. Concurrent coding reduces billing delays, improves accuracy and saves time and money.

PROBLEM: Salinas Valley wanted to improve its reporting procedures to payors for reimbursement. Delays in reporting referred outpatients and inpatients can significantly impact receipt of reimbursements from payors. SOLUTION: Salinas Valley developed a program of concurrent coding in which every procedure is assigned a reimbursement code that is automatically registered in the patient's B/AR record when the procedure is logged into any of the clinical applications in the healthcare information system. RESULTS: Quicker turnaround on receiving payments from payors, as well as an increased return on investment as the ratio of reimbursement to cost-of-time-spent increases. KEYS TO SUCCESS: Integral to the success of the concurrent coding review program was the openness of the operating system at Salinas Valley.

Abstracting and Indexing↗
PubMed1998

A yearly summary of quality assessment and improvement in the optometric pediatric clinics of the SUNY College of Optometry.

BACKGROUND: Each clinic within the University Optometric Center (UOC) of the State University of New York (SUNY) College of Optometry develops a Quality Management (QM) Plan for each calendar year. The vehicle for implementation is a Quality Assessment and Improvement (QA&I) committee. The clinical adherence to the objectives are reviewed each year. The following article is a review of the QA&I reports of the Pediatric Vision Clinics within the College for the year 1996. METHODS: Clinical records were concurrently and retrospectively reviewed for completeness and appropriateness of care. One hundred percent of the records were concurrently reviewed, and 10% of each doctors' total records were retrospectively reviewed. In addition, records with specific diagnoses--chosen as clinical indicators--were reviewed for a specified period of time. RESULTS: Patient satisfaction exceeded predetermined threshold values. On general review, the clinical faculty performed at a 95% efficiency level. The pediatric population yielded only minimal major pathologies. In our strabismic sample, patients with esotropia exceeded those with exotropia (61% vs. 39%). Strabismic amblyopes were more prevalent than refractive amblyopes (80% vs. 20%). Preschool vision therapy appeared to be successful in most cases. CONCLUSION: Quality assessment and improvement is an ongoing process that can provide an overview of case management and type. The process serves to monitor quality of care, provide a modality for improvement, enhance outcomes, and guide future QM plans.

Academic Medical Centers↗
PubMed1988

Complications of concurrent lithium and electroconvulsive therapy: a review of clinical material and theoretical considerations.

Several anecdotal reports and two retrospective chart reviews have examined complications of concurrent lithium and electroconvulsive treatment. Discussions have generally been contradictory or confusing. This article reviews the literature and particularly emphasizes theoretical considerations and mechanisms, concluding (A) that lithium may act synergistically with neuromuscular blockers, but the effect is not clinically significant, and (B) that repeated electroconvulsive seizures may cause a toxic delirium in patients concurrently taking lithium.

Combined Modality Therapy↗
PubMed2003

Denials of reimbursement for hospital care.

Much of the negative perception of managed care focuses on fear of denials of certification for reimbursement. This study examined more than 50,000 concurrent utilization reviews completed over a four-year period (1998-2001) at a large teaching hospital. The results showed a denial rate of less than 1.5% of all patients reviewed, higher denial rates among certain clinical services, higher rates of reviews among certain services only partially explained by volume of admissions, and a lack of patient criteria to receive care in the inpatient setting as the most frequent reason given for denial.

Concurrent Review↗
PubMed1995

Measuring and improving physician compliance with clinical practice guidelines. A controlled interventional trial.

OBJECTIVE: To determine factors that may lead physicians not to comply with clinical practice guidelines. DESIGN: Retrospective analysis of patients whose physicians were not compliant with discharge recommendations from a prospective, controlled interventional trial of a guideline to reduce hospital length of stay for patients admitted for chest pain. SETTING: A large community teaching hospital. PARTICIPANTS: Patients admitted with chest pain who were not discharged according to a practice guideline. RESULTS: 79 (34%) of 230 patients with chest pain classified as being at low risk by concurrent or retrospective review were not discharged by day 3 (the guideline recommendation). Of these 79 patients, 33 (42%) were misclassified at concurrent review (10 were falsely classified as being at high risk and 23 were falsely classified as being at low risk). Of 46 correctly classified patients, 11 (14%) were classified as having noncompliant physicians because of health care system inefficiencies. The status of 7 (9%) patients was changed to high risk between initial classification and potential discharge. For 15 patients (19%), no obvious reason for delayed discharge was found, but they had a higher severity of illness than did low-risk patients discharged according to the guideline as measured by mean time-insensitive predictive instrument scores (41.3% +/- [SD] 14.1% compared with 31.5% +/- 14.3%; P = 0.017). In 13 patients (16%), physicians refused to follow the guideline recommendations. CONCLUSIONS: In measuring and attempting to improve physician compliance with a length-of-stay guideline, physician refusal accounts for a small percentage (16%) of noncompliance. Implementation issues, health care system inefficiency, and severity of illness were the predominant reasons why physicians did not comply with guidelines. Our study further supports the principle that clinical practice guidelines should complement rather than be a substitute for physician judgment.

Chest Pain↗
PubMed1989

Multidisciplinary program for detecting and evaluating adverse drug reactions.

An adverse drug reaction (ADR)-reporting program involving detection of charted ADRs by quality assurance nurses and data collection and causality assessment by staff pharmacists is described. The voluntary ADR-reporting mechanism used in a 900-bed, university-based hospital complex produced less than one ADR report per month. The newly implemented system depends on nurses to detect and report documented ADRs through concurrent chart review. Staff pharmacists are then responsible for follow-up chart review, data collection, and causality assignment based on two published algorithms. An inservice education program designed to increase the awareness and understanding of ADRs was provided to the department of pharmacy and the quality assurance nurses. The clinical staff provides quality assurance through weekly ADR committee meetings. Drug information center personnel complete the causality algorithms by using the data collected by the staff pharmacists. The ADR committee then compares the algorithm results of the two assessors. Discrepancies in scoring are evaluated to determine whether a change in the system is necessary. An FDA report is generated if the staff pharmacist assessor and the drug information center assessor obtain results of "probable" for both algorithms. An ADR-reporting program that relies on quality assurance nurses to detect charted ADRs and on staff pharmacists to evaluate reported ADRs increased the average number of ADRs reported from 0.4 to 20 per month.

Concurrent Review↗