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Physician Response (physician + response)
Selected AbstractsPhysician Responses to the Malpractice Crisis: From Defense to OffenseTHE JOURNAL OF LAW, MEDICINE & ETHICS, Issue 3 2005Allen Kachalia First page of article [source] A Multifaceted Intervention to Implement Guidelines Improved Treatment of Nursing Home,Acquired Pneumonia in a State Veterans HomeJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 11 2006Evelyn Hutt MD OBJECTIVES: To assess the feasibility of a multifaceted strategy to translate evidence-based guidelines for treating nursing home,acquired pneumonia (NHAP) into practice using a small intervention trial. DESIGN: Pre-posttest with untreated control group. SETTING: Two Colorado State Veterans Homes (SVHs) during two influenza seasons. PARTICIPANTS: Eighty-six residents with two or more signs of lower respiratory tract infection. INTERVENTION: Multifaceted, including a formative phase to modify the intervention, institutional-level change emphasizing immunization, and availability of appropriate antibiotics; interactive educational sessions for nurses; and academic detailing. MEASUREMENTS: Subjects' SVH medical records were reviewed for guideline compliance retrospectively for the influenza season before the intervention and prospectively during the intervention. Bivariate comparisons-of-care processes between the intervention and control facility before and after the intervention were made using the Fischer exact test. RESULTS: At the intervention facility, compliance with five of the guidelines improved: influenza vaccination, timely physician response to illness onset, x-ray for patients not being hospitalized, use of appropriate antibiotics, and timely antibiotic initiation for unstable patients. Chest x-ray and appropriate and timely antibiotics were significantly better at the intervention than at the control facility during the intervention year but not during the control year. CONCLUSION: Multifaceted, evidence-based, NHAP guideline implementation improved care processes in a SVH. Guideline implementation should be studied in a national sample of nursing homes to determine whether it improves quality of life and functional outcomes of this debilitating illness for long-term care residents. [source] Physician compliance with advanced electronic alerts for preventing venous thromboembolism among hospitalized medical patientsJOURNAL OF THROMBOSIS AND HAEMOSTASIS, Issue 8 2009N. KUCHER Summary.,Background: Worldwide, more than half of the hospitalized medical patients at high risk do not receive venous thromboembolism (VTE) prophylaxis. Although VTE among hospitalized patients at risk is reduced with electronic alerts (eAlerts), the majority of eAlerts are being ignored by the responsible physician. Methods: We investigated physician compliance with an advanced eAlert system in 1027 (age 59 ± 17 years) hospitalized medical patients. A continuously flashing non-interruptive eAlert, visible to all healthcare professionals, was issued in the electronic patient chart 6 h after admission if the physician did not order prophylaxis. Results: The rate of appropriate prophylaxis increased from 44% before to 76% after the implementation of the eAlert system. Although the patients whose physicians cared for , 20 patients during the study period had a more frequent physician response to the eAlert than patients whose physicians cared for fewer patients (69% vs. 40%, P < 0.001), they received appropriate prophylaxis less often (72% vs. 81%, P = 0.016). After adjustment for significant patient predictors of appropriate prophylaxis, including cancer, age, duration of hospital stay, and thrombocytopenia, patients whose physicians cared for , 20 patients during the study period were less likely to receive appropriate prophylaxis (odds ratio 0.65, 95% confidence interval 0.44,0.96; P = 0.032) than patients whose physicians cared for fewer patients. Conclusions: The introduction of an advanced eAlert system accompanied by continuing medical education for the prevention of VTE resulted in a substantial increase in the rate of appropriate prophylaxis among hospitalized medical patients. However, many eAlerts may cause decreased physician compliance owing to ,alert fatigue'. [source] 19 A Novel Approach to Residency Education in EMS: The MD-PM AmbulanceACADEMIC EMERGENCY MEDICINE, Issue 2008Angela Fiege Challenge:, Indiana University EM residents have actively provided prehospital care as crew members on a hospital-based air ambulance service. This service functions as a secondary responder for high acuity patients who have already had first tier evaluation and care. First response, ground EMS experiences have been observational only as residents have ridden along with a two-paramedic team on an urban ambulance service for 24 hours during their residency careers. Resident understanding of first response care and challenges faced by initial EMS providers has been limited to that gleaned during their observational period. Solution:, Most EM residencies do not provide opportunities for residents to function as first response providers. Therefore, we developed a Physician-Paramedic team to provide first response care within a busy metropolitan area. This two-member team operates within a "geozone" that includes a diverse patient population with both medical and trauma complaints. Unlike other residency ground EMS programs, the MD-PM truck responds primarily to all ambulance requests within their designated geozone and assists outside their designated geozone for multi-patient casualties in which a physician response would benefit patient care (fires, motor vehicle accidents, multiple gunshot victims). Residents on the MD-PM truck not only provide care equivalent to that expected of a nationally certified paramedic (IVs, drug administration, splinting, packaging), but also perform advanced skills such as RSI which is outside the scope of a traditional two-paramedic team. Immersion into the first response ground EMS system will provide valuable insight into the challenges of providing care outside of the hospital. [source] Is there a discrepancy between patient and physician quality of life assessment?,NEUROUROLOGY AND URODYNAMICS, Issue 3 2009Sushma Srikrishna Abstract Aims Quality of Life (QoL) assessment remains integral in the investigation of women with lower urinary tract dysfunction. Previous work suggests that physicians tend to underestimate patients' symptoms and the bother that they cause. The aim of this study was to assess the relationship between physician and patient assessed QoL using the Kings Health Questionnaire (KHQ). Methods Patients complaining of troublesome lower urinary tract symptoms (LUTS) were recruited from a tertiary referral urodynamic clinic. Prior to their clinic appointment they were sent a KHQ, which was completed before attending. After taking a detailed urogynecological history, a second KHQ was filled in by the physician, blinded to the patient responses, on the basis of their impression of the symptoms elicited during the interview. These data were analyzed by an independent statistician. Concordance between patient and physician assessment for individual questions was assessed using weighted kappa analysis. QoL scores were compared using Wilcoxons signed rank test. Results Seventy-five patients were recruited over a period of 5 months. Overall, the weighted kappa showed relatively poor concordance between the patient and physician responses; mean kappa: 0.33 (range 0.18,0.57). The physician underestimated QoL score in 4/9 domains by a mean of 5.5% and overestimated QoL score in 5/9 domains by a mean of 6.9%. In particular, physicians underestimated the impact of LUTS on social limitations and emotions (P,<,0.05). Conclusion This study confirms that physicians often differ from patients in the assessment of QoL. This is most likely due to a difference in patient,physician perception of "significant" LUTS and clearly demonstrates the importance of patient evaluated QoL in routine clinical assessment. Neurourol. Urodynam. 28:179,182, 2009. © 2008 Wiley-Liss, Inc. [source] Paper Versus Electronic Medical Records: The Effects of Access on Physicians' Decisions to Use Complex Information Technologies,DECISION SCIENCES, Issue 2 2009Virginia Ilie ABSTRACT This study examines physicians' responses to complex information technologies (IT) in the health care supply chain. We extend individual-level IT adoption models by incorporating a new construct: system accessibility. The main premise of the study is, when faced with a decision between alternate IT systems, individual users tend to select and make use of the technology or system that is most readily accessible. We discuss both physical and logical dimensions of accessibility as they relate to adoption of electronic medical records (EMR). Physical accessibility refers to the availability of computers that can be used to access EMR, while logical accessibility refers to the ease or difficulty of logging into the system. Using data from a survey of 199 physicians practicing in a large U.S. hospital, we show that, when deciding between the paper chart and EMR, accessibility is an important consideration in a physician's decision to use the system. Both dimensions of accessibility act as barriers to EMR use intentions through their indirect effect on physicians' perceptions of EMR usefulness and ease of use. Logical access also has a direct effect on EMR use intentions. We conclude that accessibility is an important factor that limits acceptance of complex IT such as EMR. [source] | ||||||||||