A Comparison of Urgent Care Center Access for TRICARE Prime Enrollees Before and After Implementation of a Re-Engineering Initiative

1999 ◽  
Author(s):  
Bradley S. Rustan
Keyword(s):  
Care Center ◽  
Urgent Care ◽  
Urgent Care Center ◽  
Before And After

Performing complex cancer surgery in the ambulatory setting.

2017 ◽  
Vol 35 (8_suppl) ◽  
pp. 106-106
Author(s):  
Vincent Paul Laudone ◽  
Robert Durany ◽  
Behfar Ehdaie ◽  
Mario M. Leitao ◽  
Marcia Levine ◽  
...  
Keyword(s):  
Care Center ◽  
Urgent Care ◽  
Ambulatory Setting ◽  
Immediate Reconstruction ◽  
Urgent Care Center ◽  
Overnight Stay ◽  
Before And After ◽  
Surgical Complexity ◽  
Hospital Stays ◽  
The Difference

106 Background: The drive to move complex surgeries into the ambulatory setting will impact the cancer population. In anticipation, we developed an “ambulatory extended recovery” (AXR) program for pathway-based management of patients undergoing procedures with traditional 1-4 day hospital stays. Then in 2016 we opened the Josie Robertson Surgery Center (JR), a freestanding ambulatory surgical facility designed for complex cancer surgeries with one overnight stay. Methods: Using hospital databases we identified AXR cases eligible to be performed at JR and examined pathway completion (discharge home on POD 1), and 30-day institutional urgent care center (UCC) visits and readmissions. We compared AXR program results before and after opening JR in January 2016. Results: The most frequent AXR procedures were mastectomy ± immediate reconstruction, thyroidectomy, and minimally invasive prostatectomy, nephrectomy, and hysterectomy. 3307 and 2359 AXR procedures were done in 2015 and Jan-Sep 2016. In 2016 74% of AXR cases were performed at JR with the remainder at Memorial Hospital (MH), primarily for scheduling considerations or patient or surgical complexity. Pathway completion was 92% in 2015 and 95% in 2016 (p < 0.001). 30-day UCC visits/readmission rates were 8.8%/3.7% in 2015 and 8.6%/3.1% in 2016 (ns). Comparing cases at JR vs MH in 2016, pathway completion rates were 98.3% at JR vs 86.4% at MH (p < 0.001). Patient satisfaction was high for care provided at both facilities. Conclusions: Many complex cancer surgeries may be safely completed with a single overnight stay at a freestanding ambulatory facility. UCC visits and readmissions were not different between years, suggesting that quality of care was maintained in the ambulatory setting. The difference in pathway completion in 2016 at JR compared to MH may reflect successful triage of more medically complex patients and/or surgically complex procedures to MH.

scholarly journals Increase in Urgent Care Center Visits for Sexually Transmitted Infections, United States, 2010–2014

2017 ◽  
Vol 23 (2) ◽  
pp. 367-369 ◽  
Author(s):  
William S. Pearson ◽  
Guoyu Tao ◽  
Karen Kroeger ◽  
Thomas A. Peterman
Keyword(s):  
United States ◽  
Sexually Transmitted Infections ◽  
Care Center ◽  
Urgent Care ◽  
Urgent Care Center ◽  
Sexually Transmitted

Capacity Rationing in Primary Care: Provider Availability Shocks and Channel Diversion

2021 ◽  
Author(s):  
Hessam Bavafa ◽  
Anne Canamucio ◽  
Steven C. Marcus ◽  
Christian Terwiesch ◽  
Rachel M. Werner
Keyword(s):  
Operations Management ◽  
Care Center ◽  
Urgent Care ◽  
Veterans Health ◽  
Health Administration ◽  
Urgent Care Center ◽  
Standard Deviations ◽  
Using Data ◽  
Capacity Constrained

We study capacity rationing by servers facing differentiated customer classes using data from the Veterans Health Administration, which is the largest integrated healthcare system in the U.S. Using more than 11 million health encounters over two years in which the system was capacity constrained, our study provides a comprehensive analysis of the impacts of provider availability shocks on care channel diversion and delays. The outcomes studied include emergency room (ER) visits broken down by type, urgent care center visits, office and phone visits with one’s own versus another provider, post-ER follow-up visits, and ER readmissions. Availability shocks in our analysis are a residualized measure characterizing weeks in which the provider has fewer (or more) office appointments than expected based on typical patterns. The main finding is that moving from two standard deviations above to two standard deviations below in availability shocks increases ER visits by 2.4%, or about 20,000 yearly ER visits. Interestingly, the increase in ER visits is only present for the non-emergent category, indicating differentiated service to emergent and non-emergent care requests; capacity-constrained providers still tend to the patients in most need. Another finding is that provider availability shocks delay and divert post-ER follow-up care. Yet there is no effect on ER readmissions, a severe outcome of delayed or foregone follow-up, indicating that providers ration by priority these follow-up appointments. This paper was accepted by Vishal Gaur, operations management.

scholarly journals Comparison of Quidel Sofia SARS FIA Test to Hologic Aptima SARS-CoV-2 TMA Test for Diagnosis of COVID-19 in Symptomatic Outpatients

2020 ◽  
Author(s):  
Eric T. Beck ◽  
Wendy Paar ◽  
Lara Fojut ◽  
Jordan Serwe ◽  
Renee R. Jahnke
Keyword(s):  
Symptom Onset ◽  
Care Center ◽  
Urgent Care ◽  
Molecular Diagnostic ◽  
Nasopharyngeal Swab ◽  
Urgent Care Center ◽  
Ct Value ◽  
High Prevalence ◽  
Nasal Swabs ◽  
Molecular Diagnostic Test

The Quidel Sofia SARS FIA test (SOFIA) is a rapid antigen immunoassay for detection of SARS-CoV-2 viral proteins from nasal or nasopharyngeal swab specimens. The purpose of this study was to compare the results of the SOFIA test to the Hologic Aptima SARS-CoV-2 TMA test (APTIMA TMA), a high-throughput molecular diagnostic test that uses transcription mediated amplification for detection of SARS-CoV-2 nucleic acid from upper respiratory specimens. Three hundred and 40-seven symptomatic patients, from an urgent care center in an area with a high prevalence of SARS-CoV-2 infections, were tested in parallel using nasal swabs on the SOFIA test and nasopharyngeal swabs on the APTIMA TMA test. The SOFIA test demonstrated an 82.0% positive percent agreement (PPA) compared to the APTIMA TMA test for symptomatic patients tested ≤ 5 days from symptom onset and a 54.5% PPA for symptomatic patients > 5 days from symptom onset. The Cepheid Xpert Xpress SARS-CoV-2 RT-PCR test was used to determine the cycle threshold (Ct) value from any specimens that were discrepant between the SOFIA and APTIMA TMA tests. Using a Ct value of ≤ 35 as a surrogate for SARS-CoV-2 culture positivity, we estimate that the SOFIA test detected 87.2% of symptomatic patients tested ≤ 5 days from symptom onset that were likely to be culture positive.

scholarly journals 2060. Evaluation of a Pharmacist’s Impact on Antimicrobial Prescribing in an Urgent Care Center

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S694-S694
Author(s):  
Amy Fabian ◽  
Sara Linnertz ◽  
Lisa Avery
Keyword(s):  
Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Viral Infections ◽  
Care Center ◽  
Urgent Care ◽  
Antibiotic Prescribing ◽  
Composite Outcome ◽  
Post Intervention ◽  
Urgent Care Center ◽  
Tract Infections

Abstract Background The urgent care center (UC) setting is an opportunity for pharmacists to promote antimicrobial stewardship (AS). The primary objective is to determine compliance with antibiotic prescribing recommendations for the treatment of urinary tract infections (UTIs), skin and soft-tissue infections (SSTIs), upper respiratory tract infections (URIs), and lower respiratory tract infections (LRTIs) before, during, and after the presence of an AS pharmacist in an UC. Methods Single-center, retrospective, observational, pre (December 10, 2018–January 6, 2019), intervention (January 7–February 3, 2019), and post-intervention (February 4–March 3, 2019) study. All non-pregnant, adult patients with a chief complaint consistent with UTI, SSTI, URI, or LRTI were included. Patients transferred to another facility, presented for a follow-up visit, with multiple sites of infection, or treated for a bite, wound, or surgical site infection were excluded. Noncompliance (NC) was a composite endpoint of non-guideline adherent antibiotic prescribing for viral infections, inappropriate empiric selection, duration, and/or dosage. Secondary outcomes include composite outcome components and subgroup analysis of disease states. Results A total of 1,930 patients were screened with 439,440, and 430 patients included in the pre, intervention, and post-intervention group. Demographics were similar between groups, except for age (P = 0.001) and influenza diagnoses (P < 0.001). NC decreased from 43.3% to 31.1% (P = 0.0002) pre-intervention to intervention and from 31.1% to 26.5% (P = 0.14) post-intervention. Pre-intervention to intervention resulted in a change in composite outcome components of non-compliant prescribing (18.9% to 13%, P = 0.02), empiric selection (8.7% to 5.9%, P = 0.12), duration (4.1% to 5.9%, P = 0.28), dosage (3.4% to 0.5%, P = 0.001), and multiple components for NC (8.2% to 6.4%, P = 0.3). Reductions in NC were seen for UTI (83.3% to 69.2%, P = 0.26), SSTI (45.7% to 42.9%, P = 1.0), URI (23.5% to 23.2%, P = 1.0), and LRTI (82.1% to 51.6%, P = 0.0004). Conclusion An AS pharmacist’s presence in a UC significantly reduced NC to antibiotic prescribing recommendations. The largest impact was in reducing antibiotic treatment of viral infections and optimizing antibiotic dosing. Disclosures All authors: No reported disclosures.

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