Regenstrief Institute

About: Regenstrief Institute is a nonprofit organization based out in Indianapolis, Indiana, United States. It is known for research contribution in the topics: Health care & Population. The organization has 742 authors who have published 2042 publications receiving 96966 citations.

Malpractice claims involving pediatricians: epidemiology and etiology.

Abstract: OBJECTIVE. Our goals were to examine malpractice claims data that are specific to the specialty of pediatrics and to provide a better understanding of the effect that malpractice has on this specialty. METHODS. The Physician Insurers Association of America is a trade association of medical malpractice insurance companies. The data contained in its data-sharing project represent ∼25% of the medical malpractice claims in the United States at a given time. Although this database is not universally comprehensive, it does contain information not available in the National Practitioner Data Bank, such as information on claims that are not ultimately paid and specialty of the defendant. We asked the Physician Insurers Association of America to perform a query of its data-sharing project database to find malpractice claims reported between January 1, 1985, and December 31, 2005, in which the defendant9s medical specialty was coded as pediatrics. Comparison data were collected for 27 other specialties recorded in the database. RESULTS. During a 20-year period (1985–2005), there were 214226 closed claims reported to the Physician Insurers Association of America data-sharing project. Pediatricians account for 2.97% of these claims, making it 10th among the 28 specialties in terms of the number of closed claims. Pediatrics ranks 16th in terms of indemnity payment rate (28.13%), with dentistry ranked highest at 43.35%, followed by obstetrics and gynecology at 35.50%. Indemnity payment refers to settlements or awards made directly to plaintiffs as a result of claim-resolution process. Data are presented on changes over time, claim-adjudication status, expenses on claims, the causes of claims, and injuries sustained. CONCLUSIONS. Malpractice is a serious issue. Some will read the results of this analysis and draw comfort; others will view the same data with alarm and surprise. Regardless of how one interprets these findings, they are important in truly informing the debate with generalizable facts.

Pregnancy and Mental Health Among Women Veterans Returning from Iraq and Afghanistan

Abstract: Background: Veterans of Operations Enduring Freedom and Iraqi Freedom (OEF/OIF) may experience significant stress during military service that can have lingering effects. Little is known about mental health problems or treatment among pregnant OEF/OIF women veterans. The aim of this study was to determine the prevalence of mental health problems among veterans who received pregnancy-related care in the Veterans Health Administration (VHA) system. Methods: Data from the Defense Manpower Data Center (DMDC) deployment roster of military discharges from October 1, 2001, through April 30, 2008, were used to assemble an administrative cohort of female OEF/OIF veterans enrolled in care at the VHA (n = 43,078). Pregnancy and mental health conditions were quantified according to ICD-9-CM codes and specifications. Mental healthcare use and prenatal care were assessed by analyzing VHA stop codes. Results: During the study period, 2966 (7%) women received at least one episode of pregnancy-related care, and 3...

Emergency Department Use Among Older Adults With Dementia

Abstract: Although persons with dementia are frequently hospitalized, relatively little is known about the health profile, patterns of health care use, and mortality rates for patients with dementia who access care in the emergency department (ED). We linked data from our hospital system with Medicare and Medicaid claims, Minimum Data Set, and Outcome and Assessment Information Set data to evaluate 175,652 ED visits made by 10,354 individuals with dementia and 15,020 individuals without dementia over 11 years. Survival rates after ED visits and associated charges were examined. Patients with dementia visited the ED more frequently, were hospitalized more often than patients without dementia, and had an increased odds of returning to the ED within 30 days of an index ED visit compared with persons who never had a dementia diagnosis (odds ratio, 2.29; P<0.001). Survival rates differed significantly between patients by dementia status (P<0.001). Mean Medicare payments for ED services were significantly higher among patients with dementia. These results show that older adults with dementia are frequent ED visitors who have greater comorbidity, incur higher charges, are admitted to hospitals at higher rates, return to EDs at higher rates, and have higher mortality after an ED visit than patients without dementia.

Decision-making for percutaneous endoscopic gastrostomy among older adults in a community setting.

Abstract: Objective To describe clinical decision-making for percutaneous endoscopic gastrostomy from the perspective of patients, caregivers, and physicians. Design A prospective cohort study. Setting and patients All patients aged 60 and older receiving percutaneous endoscopic gastrostomies in a defined community over a 16-month period. Main outcomes measures Either patients or their surrogate decision-makers completed a semistructured face-to-face interview to map out the information gathering process, expectations, and discussants involved in the decision to proceed with gastrostomy feeding. Physicians completed a written questionnaire to determine their likelihood of recommending percutaneous endoscopic gastrostomy, their involvement in the decision-making and recommendation process, and sources of perceived pressure in the decision-making. Results We identified 100 patients who received percutaneous endoscopic gastrostomy during the study window and 82 primary care physicians who provided care in the defined community. The most common reasons for the procedure were stroke, neurologic disease, and cancer. Patients or their surrogate decision-makers reported multiple discussants, incomplete information, and considerable distress in arriving at the decision to proceed with artificial feeding. This distress was usually in the context of an acute and debilitating illness that often overshadowed the decision about artificial feeding. The decision for gastrostomy often appeared to be a "non-decision" in the sense that decision-makers perceived few alternatives. Physicians also reported considerable distress in arriving at recommendations to proceed with percutaneous endoscopic gastrostomy, including perceived pressures from families or other healthcare professionals. Physicians have clear patterns of triage for percutaneous endoscopic gastrostomy, but the assumptions underlying these patterns are not well supported by the medical literature. Conclusions Patients, caregivers, and physicians are often compelled to make decisions about long-term enteral feeding under tragic circumstances and with incomplete information. Decision-makers typically do not perceive any acceptable alternatives. Because data on these patients' long-term functional outcomes are lacking, decision-makers appear to focus primarily on the short-term safety of the procedure and the potential for improved nutrition.