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Introduction of Innovative Medical Practices in Mayo Clinic: Effect of the Interventions on Patient Outcomes
Başlık:
Introduction of Innovative Medical Practices in Mayo Clinic: Effect of the Interventions on Patient Outcomes
Yazar:
Aljabri, Duaa I., author.
ISBN:
9780438111516
Yazar Ek Girişi:
Fiziksel Tanımlama:
1 electronic resource (147 pages)
Genel Not:
Source: Dissertation Abstracts International, Volume: 79-11(E), Section: B.
Advisors: Mahmud Khan Committee members: Ronnie Horner; James Naessens; Sudha Xirasagar.
Özet:
Purpose: Assessment of health technologies in medical practice is an ongoing process to provide clinicians and policymakers with information on the value of those applications. This dissertation aims to add to the existing body of literature and fill the gaps in prior studies by assessing two health technologies in Mayo Clinic Florida (MCF). The first paper provides an assessment of patient portal adoption and activity during hospitalization among cancer patients, and determines whether a portal application is associated with selected indices of patient safety, utilization and satisfaction. The second paper provides an assessment of a new approach in pain management after total knee arthroplasty (TKA), a periarticular anesthetic injection (PAI), and compares patient outcomes postoperatively among those who had this new pain management approach versus the traditionally used approach using peripheral nerve blocks in consecutive earlier period. Methods: The first paper retrospectively reviewed all cancer inpatients admitted in MCF between 2012-2014 (N = 4,594), compared portal adopters (i.e., who registered for a portal account) versus non-adopters, and compared inpatient portal activity among active versus inactive users. The second paper retrospectively reviewed consecutive patients who underwent primary unilateral TKA between March 1, 2013, and August 31, 2014 (N = 511) and received FNB with SNB versus those who underwent TKA between October 1, 2014 and March 31, 2016 (N = 479) and received PAI. In addition to descriptive statistics, postoperative outcomes, including pain scores, time to first ambulation, cumulative distance walked, in-hospital falls, length of stay, discharge disposition, satisfaction with pain control, emergency visits within 14 days, readmissions within 30 days, revisions within 90 days, and total cost of hospitalization and 90-day follow-up period, were compared using univariate statistics: Pearson chi-square analysis for categorical variables and Wilcoxon for continuous non-parametric variables. SAS Version 9.4 (SAS Institute Inc., Cary, NC, USA) was used for all analyses. Results: We found that 2352 (51.1%) were portal adopters, and of them, 632 (26.8%) were active inpatient users. Adoption was influenced by predisposing and enabling factors, such as age, sex, race, marital status, employment status, income, and type of health insurance. Active inpatient use was similarly influenced by predisposing and enabling factors, such as age, race, and marital status, in addition to factors related to need, such as being sicker, nonlocal and admitted for medical treatment (P < 0.05). In the second paper, we found that PAI had better analgesic effect during the first 24 hours after surgery compared to FNB, but no differences at 48 hours. Patients who received PAI had earlier ambulation, longer walking distance, shorter hospital stay, more discharges to home, better patient satisfaction with pain control, and lower hospitalization cost. On average, each patient who had their pain managed using PAI saved $3,539 on their TKA hospitalization cost. Conclusion: Based on early evidence, cancer patients reached modest levels of portal adoption, with increased adoption associated with predisposing and enabling determinants, and increased inpatient use associated with need. In pain management after TKA, we found that PAI is superior in providing early postoperative pain relief, improved functional recovery, better patient satisfaction with pain, and lower hospitalization cost compared to FNB with single-shot SNB following TKA. Findings may provide insight for clinicians and policymakers who are interested in health technology assessment and directing future research efforts on the value of care.
Notlar:
School code: 0202
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Yer Numarası | Demirbaş Numarası | Shelf Location | Lokasyon / Statüsü / İade Tarihi |
---|---|---|---|
XX(688211.1) | 688211-1001 | Proquest E-Tez Koleksiyonu | Arıyor... |
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