Copyright (c) 2009 All rights reserved. http://works.bepress.com/franklinp Recent documents in Patricia D. Franklin en-us Tue, 13 Oct 2009 07:30:59 PDT 3600 http://works.bepress.com/franklinp/14 http://works.bepress.com/franklinp/14 Thu, 27 Mar 2008 17:35:40 PDT Purpose of program/study/research: To accelerate the advancement of women professionals at an academic medical center through creative collaboration. Methodology (including study design, analysis, and evaluation): The UMass Medical School Women's Faculty Committee (WFC) initiated a partnership with the medical library to compete successfully to host the traveling exhibition "Changing the Face of Medicine: Celebrating America's Women Physicians." Concurrent with the 6-week exhibition, fifteen events brought local and nationally prominent women together for mentoring activities, an original dramatic production, and an awards luncheon for women faculty. Women featured in the exhibit as well as its Visiting Curator spoke at UMMS about their research and career challenges, read from their published works, and were featured at graduation and a regional medical society event. Results: Application-writing and event planning sessions forged robust working relationships among top-ranking administrators, senior and junior faculty, and staff. The exhibition increased opportunities for administration, faculty, and students to understand the impact of women in medicine, their leadership potential, and historical contributions. It also generated new mentor/mentee relationships and grant-writing collaborations. The exhibition's national recognition helped draw a larger, more diverse and gender-balanced audience (575+ people) to the events enhancing the visibility of the WFC, as evidenced by institutional funding for women faculty to attend the AAMC WIM professional development workshops and ELAM for the first time. Conclusion(s): Creative partnerships, motivated by the opportunity to host "Changing the Face of Medicine," produced greater than expected gains for women faculty, generating new awareness and understanding of women's accomplishments and leadership potential. This partnership allowed for a wide range of multi-disciplinary efforts, strengthening networking across silos, and advancing the goals of women in an academic medical center. Presented October 29, 2006 at AAMC 2006 Annaul Meeting, Seattle, WA. Patricia D. Franklin Physicians, Women Academic Medical Centers Mentors Education, Medical Libraries, Medical http://works.bepress.com/franklinp/13 http://works.bepress.com/franklinp/13 Thu, 27 Mar 2008 17:35:38 PDT Improving patient outcomes while controlling the costs of care requires a partnership between clinical researchers and hospital management. To this end, Strong Memorial Hospital in Rochester, New York, dedicated hospital operating funds to a program of small grants designed to align the patient care and academic interests of clinicians with the goals of efficient hospital management. The grants gave clinicians an opportunity to test the efficacy of specific patient care maneuvers. These studies resulted in improved guidelines for the use of diagnostic and therapeutic modalities, new technology, and length of hospitalization. Annual marginal cost savings from implementing the first-year study results are projected to be $587,255, an 8 to 1 return on the first year's expenses. The authors conclude that a hospital-funded applied research program encourages those delivering patient care to identify inefficiencies and introduce change while ensuring quality patient care. This joint faculty-management effort can augment the hospital's quality-assurance, utilization management, and technology assessment programs while advancing the scholarship of faculty members. Patricia D. Franklin Cost-Benefit Analysis Diffusion of Innovation Economics, Hospital Hospital Bed Capacity, 500 and over *Hospitals, Teaching Humans Institutional Practice Length of Stay Patient Care Planning *Research Support Technology Assessment, Biomedical http://works.bepress.com/franklinp/12 http://works.bepress.com/franklinp/12 Thu, 27 Mar 2008 17:35:35 PDT Despite widespread acceptance of total knee replacement surgery's clinical effectiveness, variation persists in long-term functional outcome. Our aim was to quantify the relative contributions of physical and emotional coexisting conditions to the variation in improvement in 12-month post-total knee replacement physical function. Data from 165 patients who had primary total knee replacement (62% women; mean age 68 years) were evaluated. Eighty-four percent had at least one comorbid illness, with cardiovascular conditions the most prevalent (61%). Mean improvement in 12-month general function (Short Form-36 Physical Component Score) and knee-specific function (Western Ontario and McMaster Universities Osteoarthritis Index) was similar for patients with and without comorbid medical diagnoses. Adding coexisting conditions to age, gender, and baseline physical function did not improve the model's ability to explain variation in 12-month physical function as measured by either Short Form-36 Physical Component Score or Western Ontario and McMaster Universities Osteoarthritis Index. Although coexisting medical conditions did not predict the degree of 12 month post-total knee replacement functional improvement, poorer pre-total knee replacement emotional health (Short Form-36 Mental Component Score) was associated with smaller improvements in Short Form-36 Physical Component Score and Western Ontario and McMaster Universities Osteoarthritis Index. The lack of a relationship between the presence of coexisting medical diagnoses and 12-month physical function in this study is important for patients and orthopedic surgeons. David C Ayers Aged *Arthroplasty, Replacement, Knee Cardiovascular Diseases Comorbidity Female Health Status Humans Male Mental Disorders Multivariate Analysis Osteoarthritis, Knee Recovery of Function Treatment Outcome http://works.bepress.com/franklinp/10 http://works.bepress.com/franklinp/10 Thu, 27 Mar 2008 17:35:31 PDT This article describes the importance and the development of data concerning hospital readmissions as an outcomes indicator. It emphasizes the need for consistent definition of readmissions according to time intervals and diagnostic categories. It describes the development of readmission information using computer abstract databases to ensure consistency of indicators. It also provides examples of data developed through this approach. Patricia D. Franklin Data Interpretation, Statistical Humans New York Nursing Service, Hospital Outcome Assessment (Health Care) Patient Readmission *Quality Indicators, Health Care United States http://works.bepress.com/franklinp/9 http://works.bepress.com/franklinp/9 Thu, 27 Mar 2008 17:35:29 PDT Variation in patients' independent exercise and activity after total knee arthroplasty (TKA) surgery may contribute to variable functional gains but have never been quantified. We pilot tested daily exercise logs and step activity monitors to quantify exercise and general home activity post-TKA. Patients successfully maintained logs and wore activity monitors. Logs documented significant variation in quantity of daily exercises. Women with poor emotional health recorded fewer repetitions and greater variation. More daily exercise repetitions correlated with larger 6-month functional improvement. Activity peaks on step monitors correlated with logged exercise sessions. However, most step activity was in addition to exercise sessions. Further research is needed to validate these findings and to clarify the relationship among post-TKA exercise, activity, and functional gain. Patricia D. Franklin Aged Arthroplasty, Replacement, Knee Documentation Exercise Therapy Female Humans Male Monitoring, Ambulatory Motor Activity *Patient Compliance Pilot Projects *Recovery of Function Self Disclosure Treatment Outcome Walking http://works.bepress.com/franklinp/7 http://works.bepress.com/franklinp/7 Thu, 27 Mar 2008 17:35:24 PDT Magnetic resonance imaging effectively defines and characterizes musculoskeletal pathologic lesions, particularly meniscal tears. Most studies comparing the efficacy of magnetic resonance imaging and arthroscopic evaluation have been performed on high-field (1.5-T) systems. The effectiveness of a low-field (0.2-T), dedicated, extremity magnetic resonance imaging device in diagnosing meniscal tears was studied prospectively on 35 patients with knee symptoms who subsequently had arthroscopic evaluation. Magnetic resonance imaging examinations were performed before surgery and were read by an experienced radiologist who was blinded to the results of the arthroscopic evaluations. Specificity was 100% for both the medial and lateral menisci. Sensitivity was 86% for the medial menisci, 89% for the lateral menisci, and 87% for both. Accuracy was 91% for the medial menisci, 97% for the lateral menisci, and 94% overall. The positive predictive values were 100% for the medial menisci, 100% for the lateral menisci, and 100% for both. The negative predictive values were 81% for the medial menisci, 96% for the lateral menisci, and 91% for both. The low-field magnetic resonance imaging system provided specificity and sensitivity that were equal to or better than previous reports with high-field systems. In particular, this low-field system eliminated the problem of false-positive results that has been found in some studies using high-field systems. Patricia D. Franklin Adolescent Adult Aged Ambulatory Care Arthroscopy Female Humans Knee Injuries Knee Joint Magnetic Resonance Imaging Male Menisci, Tibial Middle Aged Prospective Studies Sensitivity and Specificity http://works.bepress.com/franklinp/6 http://works.bepress.com/franklinp/6 Thu, 27 Mar 2008 17:35:22 PDT OBJECTIVE: Decreasing reimbursement provided by third-party payors necessitates reduction of costs for providing critical care services. If academic medical centers are to remain viable, methods must be instituted that allow cost reduction through practice change. METHODS: We used short cycle improvement methodology to rapidly achieve these goals. Short cycle improvement methodology involves identifying the areas for improvement, defining a mechanism to evaluate outcome, initiating an improvement plan on a small number of patients, and repeating the cycle with new adjustments based on outcome. Baseline data on areas for improvement was prospectively collected, and protocols to initiate change were developed and tested by short improvement cycles. Outcomes were evaluated, protocols were modified, and another cycle was performed. This methodology was continued until the desired goals had been achieved. To adjust outcomes for severity of illness, Acute Physiology and Chronic Health Evaluation II methodology was used. Using this methodology, we focused on three areas for improvement. Standing orders for laboratory studies, electrocardiograms, and chest x-ray films were eliminated. Protocols were developed for the appropriate use of sedation, analgesics, and neuromuscular blocking agents. Finally, a protocol for weaning from mechanical ventilation was developed to allow respiratory therapists to proceed through the weaning process, which was ordered by a physician. RESULTS: Laboratory tests were reduced by 65% (from 510 to 180 tests per day) with an annual cost savings of $21,593. Chest x-ray reduction of 56% resulted in an annual savings of $3,941. There was a 75% reduction in cost of neuromuscular blocking agents. The use of neuromuscular blocking agents resulted in a 75% reduction in drug costs. Ventilator hours were reduced by 35% from 140 to 90 hours. The average length of overall intensive care unit stay was reduced by 1.5 days (5.0 to 3.5 days). The cost per patient day decreased with an annualized cost savings of 4% per patient day. Unexpected outcomes included a reduction in intensive care unit days from 54 days at baseline to 7 days at the 6-month interval. The infection rates for blood stream infections, urinary tract infections, and nosocomial pneumonia were reduced. Using national nosocomial infection data, these rates represented a reduction from the fiftieth percentile to the twenty-fifth percentile for all measured indicators. Acute Physiology and Chronic Health Evaluation II scores were 19.54 at baseline and increased to 21.2 (p = 0.001) at the 6-month interval. Mortality rates were 16.7% at baseline and were 17.6% (p = 0.89) at the 6-month interval. CONCLUSION: We concluded that utilization of short cycle improvement methodology provided an ongoing method for reducing costs of critical care services in our patient population with no change in mortality. W H Marx APACHE Adolescent Adult Aged Aged, 80 and over Child Cost Savings Critical Care Fees, Pharmaceutical Female Guidelines *Hospital Costs Humans Intensive Care Units Length of Stay Male Middle Aged New York Quality Assurance, Health Care Respiration, Artificial Treatment Outcome http://works.bepress.com/franklinp/5 http://works.bepress.com/franklinp/5 Thu, 27 Mar 2008 17:35:19 PDT The clinical outcome of duodenal ulcer treated with proton pump inhibitor (PPI)-based, anti-Helicobacter pylori (H.p.) regimens varies according to cytochrome P450 2C19 (CYP2C19) genotype. CYP2C19 genotypes differ markedly in peoples of Pacific Rim descent compared with another ethnicity. The authors sought to determine the specific impact that these factors have on the cost-effectiveness of duodenal ulcer management. Their model consisted of two patient cohorts with Helicobacter pylori and duodenal ulcer, trichotomized into CYP2C19 homozygous extensive metabolizers (EMs), heterozygous EMs, and poor metabolizers (PMs), altering the anti-H.p. regimen in the genotyped cohort only. The authors took the perspective of a third-party payer, and the denominator was ulcer episode prevented. In the reference case, the use of CYP2C19 genotyping prior to initiating anti-H.p. therapy was dominant (costs were saved with each ulcer episode prevented) in all geographic regions of the United States. The subsequent break-even analysis showed a range of 89.20 dollars to 118.96 dollars--from Hawaii to the Midwest, respectively--required to eliminate the cost-savings from each genotype test performed. Using probabilities most unfavorable to genotyping, the variation of peoples with Pacific Rim origins from 0% to 100% altered the cost-effectiveness from 495 dollars to 2125 dollars per ulcer event prevented, respectively. The results suggest that treatment decisions for H.p. infection that are based on a patient's CYP2C19 genotype decreases expenses for health plans implementing testing. This analysis provides an economic basis to support recent calls to expand this technology into routine clinical care to prevent toxicity of narrow therapeutic index drugs. David F Lehmann Aryl Hydrocarbon Hydroxylases Continental Population Groups Cost-Benefit Analysis Decision Support Techniques Duodenal Ulcer Genotype Helicobacter Infections *Helicobacter pylori Humans Mixed Function Oxygenases Models, Economic *Pharmacogenetics Polymorphism, Genetic Probability Proton Pumps http://works.bepress.com/franklinp/4 http://works.bepress.com/franklinp/4 Thu, 27 Mar 2008 17:35:17 PDT This article evaluates the use of hospital inpatient mortality as an indicator of health care outcomes and describes the development of related data. It demonstrates both the strengths and limitations of mortality as a measure of outcomes. It provides guidance concerning the development of raw and severity adjusted mortality data. It also provides information concerning data related to unexpected mortality and complications. Patricia D. Franklin Benchmarking Data Collection *Hospital Mortality Humans New York Nursing Service, Hospital Outcome Assessment (Health Care) *Quality Indicators, Health Care Severity of Illness Index United States http://works.bepress.com/franklinp/3 http://works.bepress.com/franklinp/3 Thu, 27 Mar 2008 17:35:15 PDT BACKGROUND: US adults report suboptimal physical activity and fruit and vegetable intake. Innovative strategies to promote healthy behaviors are needed. Employee health promotion programs have been associated with reductions in health risks but are labor-intensive and costly to implement. E-mail and Web-based worksite programs have the potential to reach a broad adult population and to provide a cost-effective approach to employee wellness programming. OBJECTIVE: To assess the feasibility of using sequential e-mail messages to promote physical activity and increase fruit and vegetable intake among employed adults. METHODS: Employees at one worksite of a large insurance company in New York State were invited to participate. Interested workers provided written consent. After completing a baseline survey, participants received daily e-mails, Monday through Friday, for 26 weeks. The e-mails provided (a) succinct strategies to encourage physical activity or increase fruit and vegetable intake and (b) links to detailed Web-based information and tools. Program reach was assessed by the number of e-mails opened, measures of sustained participation over 6 months, and the number of health-related Web-links clicked. RESULTS: Of 960 employees, 388 (40%) consented to participate; of these, 345 (89%) completed the baseline health survey. After 6 months, 70% of the 345 participants had opened 50% or more of the daily e-mails. In addition, 75% of participants continued to open at least one e-mail a week through week 26 of the study. E-mail opening rates did not vary by gender, age, income, education, ethnicity, or baseline health behavior. CONCLUSIONS: The rate of enrollment and sustained participation document the feasibility, broad reach, employee acceptance, and potential value of using electronic communications for health promotion in the workplace. Patricia D. Franklin Adult Aged *Electronic Mail Feasibility Studies Female Food Habits Fruit *Health Behavior Health Promotion Health Surveys Humans Male Middle Aged Motor Activity *Occupational Health Vegetables