Showing papers by "Kevin J. O'Leary published in 2021"
Harvard University1, Brigham and Women's Hospital2, University of Michigan3, Leonard Davis Institute of Health Economics4, University of Pennsylvania5, Beth Israel Deaconess Medical Center6, Vanderbilt University7, Northwestern University8, University of Kentucky9, University of California, San Francisco10
14 citations
TL;DR: In this article, the authors developed and tested a consolidated model that shows how mobile health care communication technology acceptance and utilization are influenced by the moderating effects of social context on perceptions about the technology.
14 citations
TL;DR: The Complex High Admission Management Program (CHAMP) as discussed by the authors was established as a multidisciplinary program to improve continuity of care and reduce readmissions for frequently hospitalized patients by using comprehensive care planning and inpatient, outpatient and community visits to address both medical and social needs.
Abstract: A small number of patients are disproportionally readmitted to hospitals. The Complex High Admission Management Program (CHAMP) was established as a multidisciplinary program to improve continuity of care and reduce readmissions for frequently hospitalized patients. To compare hospital utilization metrics among patients enrolled in CHAMP and usual care. Pragmatic randomized controlled trial. Inclusion criteria were as follows: 3 or more, 30-day inpatient readmissions in the previous year; or 2 inpatient readmissions plus either a referral or 3 observation admissions in previous 6 months. Patients randomized to CHAMP were managed by an interdisciplinary team including social work, physicians, and pharmacists. The CHAMP team used comprehensive care planning and inpatient, outpatient, and community visits to address both medical and social needs. Control patients were randomized to usual care and contacted 18 months after initial identification if still eligible. Primary outcome was number of 30-day inpatient readmissions 180 days following enrollment. Secondary outcomes were number of hospital admissions, total hospital days, emergency department visits, and outpatient clinic visits 180 days after enrollment. There were 75 patients enrolled in CHAMP, 76 in control. Groups were similar in demographic characteristics and baseline readmissions. At 180 days following enrollment, CHAMP patients had more inpatient 30-day readmissions [CHAMP incidence rate 1.3 (95% CI 0.9–1.8) vs. control 0.8 (95% CI 0.5–1.1), p=0.04], though both groups had fewer readmissions compared to 180 days prior to enrollment. We found no differences in secondary outcomes. Frequently hospitalized patients experienced reductions in utilization over time. Though most outcomes showed no difference, CHAMP was associated with higher readmissions compared to a control group, possibly due to consolidation of care at a single hospital. Future research should seek to identify subsets of patients with persistently high utilization for whom tailored interventions may be beneficial. ClinicalTrials.gov identifier: NCT03097640; https://clinicaltrials.gov/ct2/show/NCT03097640
3 citations
TL;DR: In this paper, the authors describe how hospital medicine groups vary staffing models to match available workforce with expected patient volumes and acuity, and how large groups often assign a single hospitalist to triage pager duty which can b...
Abstract: Hospital medicine groups vary staffing models to match available workforce with expected patient volumes and acuity. Larger groups often assign a single hospitalist to triage pager duty which can b...
2 citations
TL;DR: The objective of this work was to measure and improve the absolute and experienced workload of the admitting hospitalists, and to analyze admitting capacity relative to expected volume.
Abstract: Staffing models vary across hospital groups for many reasons, one of which is to balance workforce with anticipated workload. Excessive workload may contribute to errors and adverse events. Sustained periods of excessive workload may contribute to increased cognitive stress, frustration, and subsequently burnout. Hospital admissions follow a diurnal pattern, increasing in the late afternoon. Many practices, including ours, employ afternoon swing shifts to address the admissions increase. In preparation for expanded bed coverage, our hospitalist group analyzed admitting capacity relative to expected volume. We desired to measure and improve the absolute and experienced workload of the admitting hospitalists.
2 citations
TL;DR: The Northwestern Medicine Academy for Quality and Safety Improvement (NM AQSI) as discussed by the authors was developed to prepare individuals across the Northwestern health system to lead QI. The 7-month program consists of classwork and team-based project work.
1 citations
TL;DR: In this paper, the authors examined trends in health care avoidance documents that CVD hospitalizations decreased in Chicago before significant burden of COVID-19 cases or deaths and normalized during the first surge of the pandemic.
1 citations
TL;DR: In this article, the authors evaluated the efficacy of a program to limit the use of the IV push route for opioids on the experience of pain by inpatients and on associated safety events.
Abstract: Objective To determine the efficacy of a program to limit the use of the IV push route for opioids on the experience of pain by inpatients and on associated safety events. Design Retrospective cohort study. Setting Two inpatient general medicine floor units at an urban tertiary care academic medical center. Subjects 4752 inpatient opioid recipients. Methods Patients on one unit were exposed to a multidisciplinary intervention to limit prescription of opioids via the IV push route, with the other unit used as a control unit. The primary study outcome was mean numeric pain score per patient during the hospital stay. Secondary measures included hospital length of stay and post-discharge patient satisfaction. Fidelity measures included percentage of patient population exposed to each opioid administration route and amount of opioid administered per route. Safety measures included patient disposition, transfer to intensive care, and incidence of naloxone administration. Results The intervention was successful in decreasing both percentage of patients exposed to IV push opioids and amount of opioid administered via the IV push route, but no associated changes in other study outcomes were identified. Conclusions For treatment of acute pain in medical inpatients, no evidence of benefit or harm was identified in relation to increase or decrease in use of the IV push opioid route.