Effectiveness of demonstration on practice regarding pulmonary rehabilitation techniques among patients with chronic obstructive pulmonary disease in selected hospital at Udaipur city, Rajasthan.

Practice related to demonstration on pulmonary rehabilitation techniques are posing a great threat globally in COPD patient's mortality and morbidity, COPD is an increasing health problem globally and India is not an exemption. The patients have poor practice related to pulmonary rehabilitation techniques. Present study is aimed to assess the effectiveness of demonstration on practice regarding pulmonary rehabilitation techniques among patients with chronic obstructive pulmonary disease in selected hospital at Udaipur city, Rajasthan. 60 samples was selected using Non probability purposive sampling techniques. The findings revealed that In pre test 88.33% respondents were found with poor level of practice whereas with post test 21.67% of the respondents had poor practice level, 11.67% respondents had average practice level in the pre test whereas in post test it was 75.00%, there were no respondents found with good practice level in pre test whereas in post test good respondents level improved to 3.33%. The study concluded that there was significant improvement in the level of practice of patient with COPD regarding pulmonary rehabilitation techniques. Which indicated that the demonstration was effective. The study also revealed that there is a significant association between pre test practice scores with selected socio demographic variables. Hence this kind of practice should be conducted from time to time for patients so that their practice can be improved by pulmonary rehabilitation techniques and reduce the breathing complications in COPD patients.

The Relationship Between Electronic Health Record System and Performance on Quality Measures in the American College of Rheumatology’s Rheumatology Informatics System for Effectiveness (RISE) Registry: Observational Study

Background Routine collection of disease activity (DA) and patient-reported outcomes (PROs) in rheumatoid arthritis (RA) are nationally endorsed quality measures and critical components of a treat-to-target approach. However, little is known about the role electronic health record (EHR) systems play in facilitating performance on these measures. Objective Using the American College Rheumatology’s (ACR’s) RISE registry, we analyzed the relationship between EHR system and performance on DA and functional status (FS) quality measures. Methods We analyzed data collected in 2018 from practices enrolled in RISE. We assessed practice-level performance on quality measures that require DA and FS documentation. Multivariable linear regression and zero-inflated negative binomial models were used to examine the independent effect of EHR system on practice-level quality measure performance, adjusting for practice characteristics and patient case-mix. Results In total, 220 included practices cared for 314,793 patients with RA. NextGen was the most commonly used EHR system (34.1%). We found wide variation in performance on DA and FS quality measures by EHR system (median 30.1, IQR 0-74.8, and median 9.0, IQR 0-74.2), respectively). Even after adjustment, NextGen practices performed significantly better than Allscripts on the DA measure (51.4% vs 5.0%; P<.05) and significantly better than eClinicalWorks and eMDs on the FS measure (49.3% vs 29.0% and 10.9%; P<.05). Conclusions Performance on national RA quality measures was associated with the EHR system, even after adjusting for practice and patient characteristics. These findings suggest that future efforts to improve quality of care in RA should focus not only on provider performance reporting but also on developing and implementing rheumatology-specific standards across EHRs.

Association of patient engagement strategies with utilisation and spending for musculoskeletal problems in the USA: a cross-sectional analysis of Medicare patients and physician practices

ObjectiveMusculoskeletal problems like hip and knee osteoarthritis and low-back pain are preference sensitive conditions. Patient engagement strategies (PES), such as shared decision-making and motivational interviewing, can help align patients’ preferences with treatment options and potentially reduce spending. We assess the association of physician practice-level adoption of PES with utilisation and spending.DesignCross-sectional study in which patients were matched across low, moderate and high levels of PES via coarsened exact matching.SettingPrimary and secondary care in 2190 physician practices.Participants39 336 hip, 48 362 knee and 67 940 low-back patients who were Medicare beneficiaries were matched to the 2017–2018 National Survey of Healthcare Organizations and Systems.Primary and secondary outcome measuresTotal hip replacement (THR), total knee replacement (TKR), 1–2 level posterior lumbar fusion (LF), total annual spending, components of total annual spending.ResultsTotal annual spending for patients with musculoskeletal problems did not differ for practices with low versus moderate PES, low versus high PES or moderate versus high PES, but spending was significantly lower in some categories for practices with relatively higher PES adoption. For hospital-owned and health system-owned practices, the ORs of receiving LF were 0.632 (95% CI 0.396 to 1.009) for patients attributed to practices with high PES compared with patients attributed to practices with moderate PES. For independent practices, the odds of receiving THR were 1.403 (95% CI 1.035 to 1.902) for patients attributed to practices with moderate PES compared with patients attributed to practices with low PES.ConclusionsPractice-level adoption of PES for patients with musculoskeletal problems was generally not associated with total spending. PES, however, may steer patients toward evidence-based treatments. Opportunities for overall spending reduction exist as indicated by the variation in the subcomponents of total spending by PES adoption.

The relationship between mothers' knowledge and practice level of cough etiquette and their children's practice level in South Korea

Purpose: This study investigated the relationships between mothers' knowledge and practice level of cough etiquette and their children's practice level of cough etiquette as perceived by their mothers.Methods: This study was a descriptive correlational study. The data were collected from 160 mothers with preschoolers attending daycare centers and kindergartens in Gwangju, South Korea using self-reported questionnaires.Results: The correct answer rate for cough etiquette knowledge in mothers was 86.0%, mothers' average practice score was 33.65±4.14, and their children's average practice score was 28.39±4.85 out of 48. The correlation between mothers' cough etiquette knowledge and practice level was not statistically significant. However, mothers' cough etiquette practice was positively correlated with children's cough etiquette level as perceived by mothers (r=.35, p<.001).Conclusion: The development of a systematic cough etiquette education program and measurements for both mothers and children according to their developmental stages is important to effectively prevent respiratory infections.

National benchmarks and practice level variation on eight cross cutting quality measures.

255 Background: While there is increased attention on the importance of quality measurement in oncology, especially with the rise of value-based payment, limited data exist on national averages and practice level variation for proposed quality measures to establish benchmarks and targets for quality improvement initiatives or value-based contracts. Methods: UnitedHealthcare (UHC) developed peer comparison reports for eight cross cutting quality measures for practices with an active contract for at least one of its commercial, Medicare or Medicaid health plans and ≥1 provider from the following specialties: gynecologic oncology, hematology/oncology, pediatric hematology/oncology, radiation oncology, or surgical oncology. Adherence to the quality measures below was calculated using a mix of claims data, clinical data from a prior authorization for cancer therapy, and CMS MIPS data. Patients were attributed through an algorithm that selected the most probable physician responsible for the patient’s care - responsible prior authorization provider, servicing provider or most recent visited provider prior to the treatment, varying by each measure. Dates of service differ by measure, ranging from 1/1/2019 through 12/31/2020. Results: We identified 5,828 unique tax identification numbers (TINs) with UHC members with cancer attributed to them during 2019-20. The number of practices included in the measurement cohort per measure varied significantly from 301 to 4,120 (tobacco screening and performance status, respectively). 2,422 TINs met the minimum patient count for at least one measure (≥10 patients or events). Overall performance ranged from 13.5% to 77.3% (hospice admission and PS documented) for measures where higher adherence reflects better quality of care. For measures where lower scores represent higher quality of care the range was 11.4% to 22.6% (hospice < 3 days and ED admission, respectively). Observed adherence was statistically better than expected for 0.5%-5.8% and statistically less than expected for 0.9%-5.6% of TINs in UHC’s network; however, more than half of the practices had insufficient sample size to make a determination. Conclusions: We observed substantial variation in quality across a national cohort of oncology practices. However, even for a large national payer, small sample sizes limited the assessment of a substantial number of practices.[Table: see text]

Differences by race in systemic oncologic end-of-life (EOL) care among patients with cancer.

137 Background: Prior studies indicate that Black patients with cancer are more likely to receive aggressive EOL care, including chemotherapy within 14 days (d) prior to death. However, most studies are limited to specific subgroups, and it is unclear if disparities remain in the immunotherapy era. In this study, we evaluated racial differences in systemic oncologic EOL treatment among a national all-payer cohort of patients treated in routine practice. Methods: We conducted a retrospective cohort study utilizing data from the nationwide Flatiron Health electronic health record (EHR)-derived de-identified database. Patients with confirmed cancer diagnosis, with documented treatment on or after 1/1/2011 and who died between 2015 and 2019, were included. Patients with documented race of White or Black or African American were included. We defined our outcome measures as receipt of any systemic oncologic treatment within 30d or 14d prior to death, and also stratified by mono-chemotherapy (Chemo) and immunotherapy ± targeted therapy (ICI). We used mixed-level logistic regression models to assess the likelihood of receiving each treatment, compared to patients without any EOL treatment, between Black and White patients, adjusted for patient- and practice-level characteristics as fixed effects and a practice-specific random intercept. Race-specific adjusted rates were estimated using stratified analysis. Results: A total of 40,675 White and 5,150 Black patients were included in the analysis. Compared to White patients, Black patients were younger at diagnosis, were more likely to be female and have Medicaid coverage. Black patients were more likely to be treated at practices with higher patient-to-physician ratio (25.8% in highest quintile vs. 18.7%) and with a high proportion (> 10%) of patients with Medicaid (38.1% vs. 31.6%). Compared to White patients within the same practice, Black patients were less likely to receive any EOL treatment within 30d (adjusted odds ratio [aOR]: 0.87; 95% CI: 0.81-0.93) or 14d (aOR: 0.87; 95% CI: 0.80-0.96). Adjusted rates of any EOL treatment within 30d prior to death were 33.8% and 37.6% among Black and White patients, respectively. When stratified by treatment types, Black patients were less likely to receive ICI within 30d prior to death, compared to White patients (aOR: 0.87; 95% CI: 0.76-1.00). Conclusions: Our findings differ from prior studies of oncologic EOL care and suggest that in contemporary practice Black patients are less likely to receive anti-cancer therapy near EOL, largely driven by lower rates of ICI use. Future research should investigate the complex causal pathway underlying observed racial differences among patient and practice-level factors.

Variation in referrals from primary care to scheduled paediatric services in North and East Scotland -a cross-sectional study

Background Factors contributing to decisions to refer children for scheduled appointments at medical paediatric outpatient clinics are not well understood. Our aim was to describe practice-level characteristics associated with referrals to general paediatric clinics. Methods In this cross-sectional study the setting was general practices in three health boards in Scotland, NHS Grampian, NHS Highland and NHS Tayside The outcome was average annual number of referrals per 1000 children between 2011 and 2017. Univariate and multivariate analyses related the outcome to practice characteristics. For each practice the following characteristics were determined: distance from hospital; area deprivation; number of children registered; presence of ≥ 1 general practitioner with a child health interest and practice ownership. Results There were 62 practices in NHS Grampian, 63 in NHS Highland, and 65 in NHS Tayside; representative annual number of referrals to paediatric clinics per capita were 22, 34, and 35/1000 respectively. In the multivariate model, the number of referrals was inversely related to number of children in the practice (0.8 % fall per 1000 children [95 % confidence interval, CI, 0.5, 1.1]) and was higher from practices in the more deprived areas by a mean 55 % [95 % CI 9, 121] compared to less deprived areas. The number of referrals from a practice rose by 0.91 % [95 % CI 0.86, 0.97] for each additional partner in the practice. Conclusion Some practice-level characteristics were related to the standardised number of referrals, and associations differed between regions.