Showing papers by "Michael T. McDermott published in 2010"
TL;DR: Implementation of a hospitalist comanagement service had little effect on patient outcomes or satisfaction but appeared to reduce hospital costs and improve health care professionals' perceptions of care quality.
Abstract: Background Shared management of surgical patients between surgeons and hospitalists (comanagement) is increasingly common, yet few studies have described its effects. Methods Retrospective, interrupted time-series analysis of data collected from adults admitted to a neurosurgery service at our university-based teaching hospital between June 1, 2005, and December 31, 2008. Data regarding length of stay, costs, inpatient mortality rate, and 30-day readmission rate were collected from administrative sources; patient and caregiver satisfaction was assessed through surveys. We used multivariable models to estimate the effect of comanagement on key outcomes after adjusting for secular trends and patient-specific risk factors. Results During the study period, 7596 patients were admitted to the neurosurgery service: 4203 (55.3%) before July 1, 2007, and 3393 (44.7%) after comanagement began. Of those admitted during the postimplementation period, 988 (29.1%) were comanaged. After implementation of comanagement, no differences were found in patient mortality rate, readmission, or length of stay. No consistent improvements were seen in patient satisfaction, but strong perceived improvements occurred in care quality reported by nurses and nonnurse health care professionals. In addition, we observed a reduction in hospital costs of $1439 per admission. Conclusions Implementation of a hospitalist comanagement service had little effect on patient outcomes or satisfaction but appeared to reduce hospital costs and improve health care professionals' perceptions of care quality. As comanagement models are adopted, more emphasis should be placed on developing systems that improve patient outcomes.
94 citations
11 May 2010
TL;DR: Osteoporosis is the most common cause but other conditions may contribute to or be the sole cause of low bone mass and fragility fractures and an assessment for other bone disorders and secondary bone loss should be undertaken.
Abstract: Osteoporosis is defined as impaired bone strength that predisposes to the development of fragility fractures (1-4). Fragility fractures are bone fractures that occur with low trauma (a fall from a standing height or less). Figures 1 and 2 illustrate a vertebral fracture as imaged by a lateral chest X-ray and MRI, respectively. Bone mineral density (BMD) measurement is best used to identify osteoporosis in patients who have not yet had a fragility fracture. Osteoporosis is diagnosed by bone densitometry criteria when the lowest T-score (number of standard deviations the patient is below the average BMD for young normal adults) is -1.0. Figure 3 shows a typical bone densitometry report. Osteoporosis is the most common cause but other conditions may contribute to or be the sole cause of low bone mass and fragility fractures (Table 1). Once osteoporosis is diagnosed, an assessment for other bone disorders and secondary bone loss (5, 6) should be undertaken by a cost effective evaluation such as that outlined in Table 2.