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PubMed1986

Effective use and control of forms in the medical group practice.

At the heart of the medical group practice administrative system is the form. Forms are important information management tools. They have the potential for achieving administrative efficiency and lowering operating costs or, on the other hand, the potential for creating significant paperwork problems. In this thorough presentation, guidelines for implementation and management of an ongoing forms control and management system are provided.

Forms and Records Control↗
PubMed1999

Forms management for the health care supervisor.

The creation of necessary, efficient forms at the lowest possible cost is possible. However, it requires a willingness to diligently perform forms analysis, design, and control. Untrained forms designers may know what items they need on a form, but they do not necessarily know how to arrange items on a form or how to select the physical properties of the form. This article addresses the salient points of forms analysis, design, and control.

Communication↗
PubMed2003

Application of a method to evaluate the quality of work histories and document the exposure assessment process.

BACKGROUND: Review of work history records by industrial hygienists is an important component of many occupational epidemiologic studies. A number of factors may influence the hygienist, such as the quality of the data and his or her previous experience. As part of a case-control study of mesothelioma, a system was developed to capture data on several factors that can be considered in a review of work history information. METHODS: The overall quality of the work history record was described by noting the completeness and the consistency of the information; for any potential exposures, the reviewer experience on which the decision was based and the relative quality of the information were categorized. Because of the potential for mesothelioma cases and their next-of-kin to have undergone rigorous questioning about previous asbestos exposure an evaluation of the knowledge of the respondent was included. The frequency and intensity of exposure were also evaluated. RESULTS: Evaluation of 3,444 work records is described. The importance of data completeness in the overall evaluation of quality is shown; follow-up questions regarding specific work tasks provide information not elicited in the standard interview process. The use of the literature was an important resource to the reviewer. Asbestos was reported by the respondent as an exposure on 149 work records; of these, 111 (74%) were judged to represent an unusual level of knowledge for a next-of-kin respondent. CONCLUSIONS: The approach presented allows capture of information about data quality and experience of the reviewer in an epidemiologic analysis. The ratings of frequency and intensity of exposure allow exploration of differences in exposure-response analyses using various exposure metrics.

Case-Control Studies↗
PubMed1991

National nosocomial infections surveillance system (NNIS): description of surveillance methods.

The National Nosocomial Infections Surveillance System (NNIS) is an ongoing collaborative surveillance system sponsored by the Centers for Disease Control (CDC) to obtain national data on nosocomial infections. The CDC uses the data that are reported voluntarily by participating hospitals to estimate the magnitude of the nosocomial infection problem in the United States and to monitor trends in infections and risk factors. Hospitals collect data by prospectively monitoring specific groups of patients for infections with the use of protocols called surveillance components. The surveillance components used by the NNIS are hospitalwide, intensive care unit, high-risk nursery, and surgical patient. Detailed information including demographic characteristics, infections and related risk factors, pathogens and their antimicrobial susceptibilities, and outcome, is collected on each infected patient. Data on risk factors in the population of patients being monitored are also collected; these permit the calculation of risk-specific rates. An infection risk index, which includes the traditional wound class, is being evaluated as a predictor of the likelihood that an infection will develop after an operation. A major goal of the NNIS is to use surveillance data to develop and evaluate strategies to prevent and control nosocomial infections. The data collected with the use of the surveillance components permit the calculation of risk-specific infection rates, which can be used by individual hospitals as well as national health-care planners to set priorities for their infection control programs and to evaluate the effectiveness of their efforts. The NNIS will continue to evolve in finding more effective and efficient ways to assess the influence of patient risk and changes in the financing of health care on the infection rate.

Centers for Disease Control and Prevention, U.S.↗
PubMed2002

Reducing failed extubations in the intensive care unit.

BACKGROUND: Failed extubation is associated with substantially increased morbidity, mortality, and costs for patients receiving mechanical ventilation. A study was designed in 1998 to identify risk factors for failed extubation and use a quality improvement model to reduce failed extubation rates in a surgical intensive care unit (SICU) in an academic hospital. METHODS: Study design involved a prospective cohort SICU with a concurrent control SICU. The primary outcome was rate of failed extubations per 1,000 ventilator days. Information on risk factors for failed extubations was also collected. Performance improvement staff identified failed extubation patients, and respiratory therapy provided information on ventilator days. The quality improvement model implemented three phases between October 1998 and June 2000: (1) identifying factors associated with failed extubation, (2) developing a guideline to reduce failed extubation, and (3) implementing the guideline. RESULTS: Significant factors associated with failed extubation included suctioning more frequently than every 4 hours versus the current model of "every 4 hours or greater" (odds ratio [OR] 11.3; 95% confidence interval [CI] 1.5-88.3), being agitated or sedated versus being alert (OR 4.5, CI: 1.2-14.7), and oxygen saturation < or = 95% versus > or = 95% (OR 4.0; CI: 1.2-13). Failed extubation rate in the SICU decreased from 8/1,000 in October 1998 to 1.5/1,000 in June 2000, and control SICU rates remained unchanged (8/1,000). DISCUSSION: The intervention significantly reduced the rate of failed extubation in the SICU. By employing a quality improvement model and identifying risk factors for failed extubation, providers should be able to decrease risk of failed extubation for SICU patients.

Academic Medical Centers↗
PubMed1994

Developing an effective infection control program for home care.

Home care agencies can develop comprehensive, effective infection control and prevention programs by including six critical elements: surveillance for infections, infection control education, consultation, epidemiological investigation, quality improvement activities, and policy and procedure development.

Centers for Disease Control and Prevention, U.S.↗
PubMed2000

APCs challenge hospital EDs and outpatient clinics.

As the uneasily awaited Medicare outpatient prospective payment system becomes reality July 1, hospital emergency department and outpatient clinics face an even greater need for accurate coding models and systems, as well as vigorous cost-reduction strategies. By the nature of the services they provide, such facilities will find securing adequate payment for appropriate, quality care to be a complex and challenging task. Those organizations that have prepared effectively, however, may benefit under the prospective payment system.

Aged↗
PubMed2002

New classification for deaths and injuries involving terrorism.

Classification of the deaths and injuries that occurred as the result of the events of September 11, 2001, presented CDC's National Center for Health Statistics (NCHS) with a dilemma. Under the current classification systems for mortality and morbidity, the World Health Organization's International Classification of Diseases, Tenth Revision (ICD-10) and the United States' International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), deaths and injuries associated with acts of terrorism could not be identified uniquely.

Cause of Death↗
PubMed1994

Critical pathways: an integrated documentation tool.

A multipurpose six-page, three-fold flow sheet improves patient outcomes, meets JCAHO standards and facilitates easy tracking of a patient's progress. The flow sheet is divided into nursing process, expected patient outcomes, critical pathway and variance report. Outcomes management is an effective process to control costs and improve patient outcomes.

Documentation↗
PubMed1999

Cone receptor sensitivity is altered in form deprivation myopia in the chicken.

PURPOSE: The effect of form deprivation myopia (FDM) on cone photoreceptor function was investigated. METHODS: Photopic electroretinogram (ERG) a-waves were recorded from control and form-deprived eyes of chickens. Cone-generated P3 responses were derived from the leading edge of ERG a-waves using an analytical expression derived from a quantitative model of phototransduction. The parameters obtained were the maximum cone P3 response (RmaxP3), sensitivity (S), and delay (t(d)). RESULTS: P3 response sensitivity is significantly higher in form-deprived eyes, at lower retinal irradiances. At higher flash intensities, in form-deprived eyes, P3 response sensitivity declines at a significantly greater rate, per unit increase in retinal irradiance, than in control eyes. Visual deprivation does not significantly affect RmaxP3 or t(d). CONCLUSIONS: Hypotheses to explain the altered cone photoreceptor sensitivity in form-deprived eyes are proposed. Changes in the biochemistry of phototransduction, or intrinsic geometric and physical attributes of photoreceptors or their waveguide modal properties, could account for the findings.

Animals↗