Better Outcomes (better + outcome)

Distribution by Scientific Domains

Selected Abstracts

Sinonasal Undifferentiated Carcinoma: The Search for a Better Outcome,

Pierre Y. Musy MD
Abstract Objective To evaluate the clinical outcomes of a standardized treatment approach for sinonasal undifferentiated carcinoma (SNUC). Study Design Single-center, retrospective case series. Methods Fifteen patients with newly diagnosed SNUC were seen in the Department of Otolaryngology-Head and Neck Surgery at the University of Virginia from 1991 to 2000. Long-term follow-up on five additional patients diagnosed between 1986 and 1991 was also analyzed. Results Overall, 10 patients were treated with curative intent with neoadjuvant chemoradiotherapy followed by craniofacial resection (CFR). The majority of the remainder was treated with palliative radiotherapy or chemoradiotherapy alone. Four patients who underwent CFR are currently free of disease at 4, 36, 49, and 164 months postoperatively. The 2-year survival of all evaluable patients, regardless of treatment, was 47%. Two-year survival was 64% in the group treated by CFR and 25% in the group treated with chemo- and/or radiotherapy (P = .076). Conclusion For patients with good performance status and limited intracranial or intraorbital disease, we continue to advocate initial chemoradiotherapy followed by craniofacial resection. Patients who are deemed inoperable as a result of advanced disease may nevertheless experience significant palliation with chemoradiotherapy only. [source]

Geriatric Co-Management of Proximal Femur Fractures: Total Quality Management and Protocol-Driven Care Result in Better Outcomes for a Frail Patient Population

Susan M. Friedman MD
Hip fractures in older adults are a common event, leading to substantial morbidity and mortality. Hip fractures have been previously described as a "geriatric, rather than orthopedic disease." Patients with this condition have a high prevalence of comorbidity and a high risk of complications from surgery, and for this reason, geriatricians may be well suited to improve outcomes of care. Co-management of hip fracture patients by orthopedic surgeons and geriatricians has led to better outcomes in other countries but has rarely been described in the United States. This article describes a co-managed Geriatric Fracture Center program that has resulted in lower-than-predicted length of stay and readmission rates, with short time to surgery, low complication rates, and low mortality. This program is based on the principles of early evaluation of patients, ongoing co-management, protocol-driven geriatric-focused care, and early discharge planning. This is a potentially replicable model of care that uses the expertise of geriatricians to optimize the management of a common and serious condition. [source]

The role of the hospitalist in quality improvement: Systems for improving the care of patients with acute coronary syndrome,

Chad T. Whelan MD
Abstract Quality improvement (QI) initiatives for systems of care are vital to deliver quality care for patients with acute coronary syndrome (ACS) and hospitalists are instrumental to the QI process. Core hospitalist competencies include the development of protocols and outcomes measures that support quality of care measures established for ACS. The hospitalist may lead, coordinate, or participate in a multidisciplinary team that designs, implements, and assesses an institutional system of care to address rapid identification of patients with ACS, medication safety, safe discharge, and meeting core measures that are quality benchmarks for ACS. The use of metrics and tools such as process flow mapping and run charts can identify quality gaps and show progress toward goals. These tools may be used to assess whether critical timeframes are met, such as the time to fibrinolysis or percutaneous coronary intervention (PCI), or whether patients receive guideline-recommended medications and counseling. At the institutional level, Project BOOST (Better Outcomes for Older Adults Through Safe Transitions) is an initiative designed to improve outcomes in elderly patients who are at higher risk for adverse events during the transition from inpatient to outpatient care. BOOST offers resources related to project management and data collection, and tools for patients and physicians. Collection and analysis of objective data are essential for documenting quality gaps or achievement of quality benchmarks. Through QI initiatives, the hospitalist has an opportunity to contribute to an institution's success beyond direct patient care, particularly as required for public disclosure of institutional performance and financial incentives promoted by regulatory agencies. Journal of Hospital Medicine 2010;5:S1,S7. © 2010 Society of Hospital Medicine. [source]

Transitioning the patient with acute coronary syndrome from inpatient to primary care,

FACPE, Tomás Villanueva DO
Abstract Patients with acute coronary syndrome (ACS) undergo several transitions in care throughout the hospital stay, from prehospitalization to the postdischarge period when patients return to primary care. Hospitalist core competencies promote safe transitions in care for patients with ACS, including hospital discharge. These competencies also highlight the central role of the hospitalist in facilitating the continuity of care and as a key link between the patient and the primary care provider (PCP). Core competencies address key decision points and processes that occur during hospitalization for ACS including the initial evaluation and risk stratification, medication reconciliation, and discharge planning. Discharge is a crucial transition and one where hospitalists can both facilitate the transition to primary care and improve adherence to quality measures established for ACS. Poor communication during discharge reportedly results in postdischarge adverse events, most often related to medications and lack of follow-up related to pending test results. Standards for a safe discharge such as Project RED (Re-Engineered Discharge), initiatives to improve outcomes after discharge like Project BOOST (Better Outcomes for Older Adults Through Safe Transitions), and adaptive tools including the ACS Transitions Tool support timely and accurate communication of complex information between the hospitalist, the PCP, and the patient. While the role of hospitalists is evolving, it is clear that they have a central role in ensuring safe transitions in care for ACS. Journal of Hospital Medicine 2010;5:S8,S14. © 2010 Society of Hospital Medicine. [source]

Why Adjuvant Trastuzumab Led to Better Outcomes in Women with High-Risk HER-2-Positive Breast Cancer

Kadri Altundag MD
No abstract is available for this article. [source]