scholarly journals Telehealth Use by Age and Race at a Single Academic Medical Center During the COVID-19 Pandemic: Retrospective Cohort Study (Preprint)

2020 ◽  
Author(s):  
Jennifer P Stevens ◽  
Oren Mechanic ◽  
Lawrence Markson ◽  
Ashley O'Donoghue ◽  
Alexa B Kimball
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Health Care Disparities ◽  
Medical Center ◽  
Cohort Analysis ◽  
Academic Medical Center ◽  
Race And Gender ◽  
Asian Patients ◽  
Academic Medical

BACKGROUND During the COVID-19 pandemic, many ambulatory clinics transitioned to telehealth, but it remains unknown how this may have exacerbated inequitable access to care. OBJECTIVE Given the potential barriers faced by different populations, we investigated whether telehealth use is consistent and equitable across age, race, and gender. METHODS Our retrospective cohort study of outpatient visits was conducted between March 2 and June 10, 2020, compared with the same time period in 2019, at a single academic health center in Boston, Massachusetts. Visits were divided into in-person visits and telehealth visits and then compared by racial designation, gender, and age. RESULTS At our academic medical center, using a retrospective cohort analysis of ambulatory care delivered between March 2 and June 10, 2020, we found that over half (57.6%) of all visits were telehealth visits, and both Black and White patients accessed telehealth more than Asian patients. CONCLUSIONS Our findings indicate that the rapid implementation of telehealth does not follow prior patterns of health care disparities.

Impact of Telemedicine Use on Blood Pressure Control During the Covid-19 Pandemic: A Cohort Study (Preprint)

2021 ◽  
Author(s):  
Siqin Ye ◽  
D. Edmund Anstey ◽  
Anne Grauer ◽  
Gil Metser ◽  
Nathalie Moise ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cohort Study ◽  
Retrospective Cohort ◽  
Primary Outcome ◽  
Medical Center ◽  
Academic Medical Center ◽  
Pressure Control ◽  
Care Quality ◽  
Academic Medical ◽  
Cardiovascular Care

BACKGROUND Telemedicine use vastly expanded during the Covid-19 pandemic, with uncertain impact on cardiovascular care quality. OBJECTIVE We sought to examine the association between telemedicine use and blood pressure (BP) control. METHODS This is a retrospective cohort study of 32,727 adult patients with hypertension (HTN) seen in primary care and cardiology clinics at an urban, academic medical center from February to December, 2020. The primary outcome was poor BP control, defined as having no BP recorded OR if the last recorded BP was ≥140/90 mmHg. Multivariable logistic regression was used to assess the association between telemedicine use during the study period (none, 1 telemedicine visit, 2+ telemedicine visits) and poor BP control, adjusting for demographic and clinical characteristics. RESULTS During the study period, no BP was recorded for 486/20,745 (2.3%) patients with in-person visits only, for 1,863/6,878 (27.1%) patients with 1 telemedicine visit, and for 1,277/5,104 (25.0%) patients with 2+ telemedicine visits. After adjustment, telemedicine use was associated with poor BP control (odds ratio [OR], 2.06, 95% confidence interval [CI] 1.94 to 2.18, p<.001 for 1 telemedicine visit, and OR 2.49, 95% CI 2.31 to 2.68, p<.001 for 2+ telemedicine visits; reference, in-person visit only). This effect disappears when analysis was restricted to patients with at least one recorded BP (OR 0.89, 95% CI 0.83 to 0.95, p=.001 for 1 telemedicine visit, and OR 0.91, 95% CI 0.83 to 0.99, p=.03 for 2+ telemedicine visits). CONCLUSIONS BP is less likely to be recorded during telemedicine visits, but telemedicine use does not negatively impact BP control when BP is recorded. CLINICALTRIAL NA

Does Attending Surgeon Presence at the Preinduction Briefing Improve Operating Room Efficiency?

2019 ◽  
Vol 161 (5) ◽  
pp. 787-795 ◽  
Author(s):  
Rajeev C. Saxena ◽  
Mark E. Whipple ◽  
Moni B. Neradilek ◽  
Stuart Solomon ◽  
Christine T. Fong ◽  
...  
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Medical Center ◽  
Academic Medical Center ◽  
Minor Effect ◽  
Efficiency Gain ◽  
Linear Regression Models ◽  
Surgical Equipment ◽  
Mean Time

Objective To examine if attending surgeon presence at the preinduction briefing is associated with a shorter time to incision. Study Design Retrospective cohort study and survey. Setting Tertiary academic medical center. Subjects and Methods A retrospective cohort study was conducted of 22,857 operations by 141 attending surgeons across 12 specialties between August 3, 2016, and June 21, 2018. The independent variable was attending surgeon presence at the preinduction briefing. Linear regression models compared time from room entry to incision overall, by service line, and by surgeon. We hypothesized a shorter time to incision when the attending surgeon was present and a larger effect for cases with complex surgical equipment or positioning. A survey was administered to evaluate attending surgeons’ perceptions of the briefing, with a response rate of 68% (64 of 94 attending surgeons). Results Cases for which the attending surgeon was present at the preinduction briefing had a statistically significant yet operationally minor reduction in mean time to incision when compared with cases when the attending surgeon was absent. After covariate adjustment, the mean time to incision was associated with an efficiency gain of 1.8 ± 0.5 minutes (mean ± SD; P < .001). There were no statistically significant differences in the subgroups of complex surgical equipment and complex positioning or in secondary analysis comparing service lines. The surgeon was the strongest confounding variable. Survey results demonstrated mild support: 55% of attending surgeons highly prioritized attending the preinduction briefing. Conclusion Attending surgeon presence at the preinduction briefing has only a minor effect on efficiency as measured by time to incision.

A Retrospective Comparison of the Effectiveness and Safety of Intravenous Olanzapine Versus Intravenous Haloperidol for Agitation in Adult Intensive Care Unit Patients

2021 ◽  
pp. 088506662098445
Author(s):  
Michelle Wang ◽  
Tuyen T. Yankama ◽  
George T. Abdallah ◽  
Ijeoma Julie Eche ◽  
Kristen N. Knoph ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cohort Study ◽  
Intensive Care ◽  
Length Of Stay ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Medical Center ◽  
Academic Medical Center ◽  
Icu Length Of Stay ◽  
Haloperidol Group

Objective: Intravenous (IV) olanzapine could be an alternative to first-generation antipsychotics for the management of agitation in intensive care unit (ICU) patients. We compared the effectiveness and safety of IV olanzapine to IV haloperidol for agitation management in adult patients in the ICU at a tertiary academic medical center. Methods: A retrospective cohort study was conducted. The primary outcome was the proportion of patients who achieved a Richmond Agitation Sedation Scale (RASS) score of < +1 within 4 hours of IV olanzapine or IV haloperidol administration. Secondary outcomes included the proportion of patients who required rescue medications for agitation within 4 hours of initial IV olanzapine or IV haloperidol administration, incidence of adverse events and ICU length of stay. Results: In the 192 patient analytic cohort, there was no difference in the proportion of patients who achieved a RASS score of < +1 within 4 hours of receiving IV olanzapine or IV haloperidol (49% vs. 42%, p = 0.31). Patients in the IV haloperidol group were more likely to receive rescue medications (28% vs 55%, p < 0.01). There was no difference in the incidence of respiratory events or hypotension between IV olanzapine and IV haloperidol. Patients in the IV olanzapine group experienced more bradycardia (11% vs. 3%, p = 0.04) and somnolence (9% vs. 1%, p = 0.02) compared to the IV haloperidol group. Patients in the IV olanzapine group had a longer median ICU length of stay (7.5 days vs. 5 days, p = 0.04). Conclusion: In this retrospective cohort study, there was no difference in the effectiveness of IV olanzapine compared to IV haloperidol for the management of agitation. IV olanzapine was associated with an increased incidence of bradycardia and somnolence.

scholarly journals Retrospective Cohort Study: Ledipasvir-Sofosbuvir With/Without Ribavirin for Chronic Hepatitis C Post–Liver Transplant in a Real-World Population

2018 ◽  
Vol 34 (5) ◽  
pp. 199-203
Author(s):  
Kelsey L. Hawkins ◽  
Ives Hot
Keyword(s):  
Cohort Study ◽  
Hepatitis C ◽  
Liver Transplant ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Medical Center ◽  
Academic Medical Center ◽  
The United States ◽  
World Population ◽  
Transplant Patients

Background: Liver damage caused by hepatitis C virus (HCV) is the number one indication for liver transplantation in the United States and Europe. Patients with a detectable HCV level at time of transplant will universally develop a recurrent infection, which can lead to increased morbidity and mortality. Objective: To assess the sustained virologic response rate post end-of-treatment (SVR) in HCV-infected, post–liver transplant patients at the University of Washington Medical Center (UWMC) treated with ledipasvir-sofosbuvir (LDV/SOF). Methods: This retrospective, cohort study of HCV-positive, genotype 1 or 4 infected, post–liver transplant patients treated with LDV/SOF was conducted at a large academic medical center affiliated clinic. Patients treated with 12 weeks of LDV/SOF with or without ribavirin were included in the 12-week group, and patients treated with 24 weeks of LDV/SOF without ribavirin were included in the 24-week group. Results: Twenty-nine patients with recurrent HCV post–liver transplant receiving 12 weeks of LDV/SOF with or without ribavirin and 32 patients receiving 24 weeks of LDV/SOF alone were assessed. SVR was achieved by 100% (29/29) of patients in the 12-week group and 100% (32/32) of patients in the 24-week group. Conclusion: Post–liver transplant patients at UWMC treated with LDV/SOF for recurrent HCV achieved high rates of SVR.

Impact of Intensive Care Unit Discharge Delays on Patient Outcomes: A Retrospective Cohort Study

2018 ◽  
Vol 34 (11-12) ◽  
pp. 924-929 ◽  
Author(s):  
Somnath Bose ◽  
Alistair E. W. Johnson ◽  
Ari Moskowitz ◽  
Leo Anthony Celi ◽  
Jesse D. Raffa
Keyword(s):  
Cohort Study ◽  
Intensive Care ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Discharge Planning ◽  
Medical Center ◽  
Intensive Care Unit Discharge ◽  
Academic Medical Center ◽  
Icu Discharge ◽  
The Impact

Objective:Patients often overstay in intensive care units (ICU) after they are deemed discharge ready. The objective of this study was to examine the impact of such discharge delays (DD) on subsequent in-hospital morbidity and mortality.Design:Retrospective cohort study.Setting:Single tertiary academic medical center.Patients:Adult patients admitted to the medical ICU between 2005 and 2011.Interventions:For all patients, DD (ie, time between request for a ward bed and time of ICU discharge) was calculated. Discharge delays was dichotomized as long (≥24 hours) or short (<24 hours). Multivariable linear and logistic regressions were used to assess the association between dichotomized DD and post-ICU clinical outcomes.Results:Overall, 9673 discharges were included of which 10.4% patients had long DDs. In the fully adjusted model, a long delay was not associated with increased odds of death (adjusted odds ratio [aOR]: 0.99, 95% confidence interval [CI]: 0.74-1.31, P = .95) but was associated with a shorter log plus one of post-ICU discharge length of stay (LOS; regression coefficient: −0.13, 95% CI: −0.17 to −0.08, P < .001). Longer DD was not associated with more hospital-free days (HFD: a composite of post-ICU LOS and in-hospital mortality). Shorter DDs were associated with shorter LOS when LOS was measured from the time of ward bed request as opposed to the time of ICU discharge.Conclusions:In this study, long DD was associated with a slight decrease in post-ICU LOS but longer LOS when measured from the point of ward bed request, suggesting a potential role for more aggressive discharge planning in the ICU for patients with long DDs. There was no association between long DD and subsequent mortality or HFD.

Effects From Continuous Infusions of Dexmedetomidine and Propofol on Hemodynamic Stability in Critically Ill Adult Patients With Septic Shock

2018 ◽  
Vol 35 (9) ◽  
pp. 875-880 ◽  
Author(s):  
Kristen M. Nelson ◽  
Gourang P. Patel ◽  
Drayton A. Hammond
Keyword(s):  
Intensive Care Unit ◽  
Septic Shock ◽  
Cohort Study ◽  
Retrospective Cohort ◽  
Medical Center ◽  
Academic Medical Center ◽  
Hemodynamic Stability ◽  
Lengths Of Stay ◽  
Academic Medical ◽  
Clinically Significant

Purpose: To compare the development of clinically significant hemodynamic event (ie, hypotension or bradycardia) in adults with septic shock receiving either propofol or dexmedetomidine. Materials and Methods: A retrospective cohort study of adults with septic shock admitted to an intensive care unit (ICU) at an academic medical center between July 2013 and July 2017. Results: Patients in the propofol (n = 35) and dexmedetomidine (n = 37) groups developed a clinically significant hemodynamic event at similar frequencies (31.4 vs 29.7%, P = .99). All patients with an event experienced hypotension, whereas 2 (5.4%) patients in the dexmedetomidine group also experienced bradycardia. Most patients in both groups (70% vs 90%) received an escalating sedative dose, and almost half (42.9%) in the dexmedetomidine group had the sedative dosage increased more frequently than every 30 minutes. Patients in both groups had similar ICU (24.1 vs 24.3 days, P = .98) and hospital (37.9 vs 29.7 days, P = .29) lengths of stay. There was no difference in median time to hemodynamic event between the groups (propofol 1 hour [interquartile range, IQR: 0.5-9.9] vs dexmedetomidine 2 hours [IQR: 1.5-11.1 hours], P = .85). Conclusion: Patients with septic shock receiving propofol or dexmedetomidine experienced similar rates of clinically significant hemodynamic events. Most patients did not experience an event and those who did most frequently did so in the first couple of hours of therapy.

scholarly journals LDL-cholesterol change and goal attainment following statin intensity titration among Asians in primary care: a retrospective cohort study

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Hao Sen Andrew Fang ◽  
Qiao Gao ◽  
Mong Li Lee ◽  
Wynne Hsu ◽  
Ngiap Chuan Tan
Keyword(s):  
Primary Care ◽  
Clinical Trials ◽  
Cohort Study ◽  
Real World ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Goal Attainment ◽  
Real World Data ◽  
World Data ◽  
Asian Patients

Abstract Background Clinical trials have demonstrated that either initiating or up-titrating a statin dose substantially reduce Low-Density Lipoprotein-Cholesterol (LDL-C) levels. However, statin adherence in actual practice tends to be suboptimal, leading to diminished effectiveness. This study aims to use real-world data to determine the effect on LDL-C levels and LDL-C goal attainment rates, when selected statins are titrated in Asian patients. Methods A retrospective cohort study over a 5-year period, from April 2014 to March 2019 was conducted on a cohort of multi-ethnic adult Asian patients with clinical diagnosis of Dyslipidaemia in a primary care clinic in Singapore. The statins were classified into low-intensity (LI), moderate-intensity (MI) and high-intensity (HI) groups according to the 2018 American College of Cardiology and American Heart Association (ACC/AHA) Blood Cholesterol Guidelines. Patients were grouped into “No statin”, “Non-titrators” and “Titrators” cohorts based on prescribing patterns. For the “Titrators” cohort, the mean percentage change in LDL-C and absolute change in LDL-C goal attainment rates were computed for each permutation of statin intensity titration. Results Among the cohort of 11,499 patients, with a total of 266,762 visits, there were 1962 pairs of LDL-C values associated with a statin titration. Initiation of LI, MI and HI statin resulted in a lowering of LDL-C by 21.6% (95%CI = 18.9–24.3%), 28.9% (95%CI = 25.0–32.7%) and 25.2% (95%CI = 12.8–37.7%) respectively. These were comparatively lower than results from clinical trials (30 to 63%). The change of LDL-C levels due to up-titration, down-titration, and discontinuation were − 12.4% to − 28.9%, + 13.2% to + 24.6%, and + 18.1% to + 32.1% respectively. The improvement in LDL-C goal attainment ranged from 26.5% to 47.1% when statin intensity was up-titrated. Conclusion In this study based on real-world data of Asian patients in primary care, it was shown that although statin titration substantially affected LDL-C levels and LDL-C goal attainment rates, the magnitude was lower than results reported from clinical trials. These results should be taken into consideration and provide further insight to clinicians when making statin adjustment recommendations in order to achieve LDL-C targets in clinical practice, particularly for Asian populations.

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