Successful implementation of a comprehensive computer-based patient record system in Kaiser Permanente Northwest: strategy and experience.
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Kaiser Permanente Northwest (KPNW) has implemented a computer-based patient record (CPR) system for outpatients. Clinicians at KPNW use this comprehensive CPR to electronically document patient encounters; code diagnoses and procedures; maintain problem lists; order laboratory tests, radiology tests, and prescriptions; and send patient-specific messages and referrals to other medical providers. More than 700 clinicians, representing more than 20 medical and surgical specialties, and 2600 support staff in 31 geographically separate sites use this system as the information foundation of delivery and documentation of health care for KPNW's membership of 430,000. As of May 1998, more than four million visits and two million telephone calls had been processed and documented into the system. More than 5000 outpatient visits are processed and documented each weekday. From an integrated clinical workstation, clinicians also access e-mail, an extensive results-reporting system, and sites on both the internet and KPNW's intranet. This article describes a strategy for and experience with the implementation of a large-scale, comprehensive CPR in an integrated HMO. This information may be useful for persons attempting to implement CPRs in their own institutions. (+info)
Risk of ventricular arrhythmias associated with nonsedating antihistamine drugs.
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AIMS: To quantify and compare the incidence of ventricular arrhythniias associated with the use of five nonsedating antihistamines: acrivastine, astemizole, cetirizine, loratadine and terfenadine. The effects of age, sex, dose, duration of treatment, and the interaction with P450 inhibitor drugs were also examined. METHODS: We carried out a cohort study with a nested case-control analysis using the UK-based General Practice Research database (GPRD). The study cohort included persons aged less than 80 years old who received their first prescription for any of the five study drugs between January 1, 1992 and September 30, 1996. We estimated relative risks and 95% confidence intervals of idiopathic ventricular arrhythmias with current use of antihistamines as compared with non use. RESULTS: The study cohort included 197425 persons who received 513012 prescriptions. Over the study period 18 valid cases of idiopathic ventricular arrhythmias were detected. Nine occurred during the current use of any antihistamine, resulting in a crude incidence of 1.9 per 10000 person-years (95%CI: 1.0-3.6) and a relative risk of 4.2 (95%CI: 1.5-11.8) as compared with non use. Astemizole presented the highest relative risk (RR= 19.0; 95%CI: 4.8-76.0) of all study drugs, while terfenadine (RR=2.1; 95%CI:0.5-8.5) was in the range of other nonsedating antihistamines. Older age was associated with a greater risk of ventricular arrhythmias (RR=7.4; 95%CI: 2.6-21.4) and seemed to increase the effect of antihistamines (RR=6.4; 95%CI: 1.7-24.8). The proportions of high dose terfenadine and the concomitant use with P450 inhibitors among current users of terfenadine were 2.7% and 3.4%, respectively over the study period with no single case of ventricular arrhythmias occurring in the presence of these two risk factors. CONCLUSIONS: The use of nonsedating antihistamines increases the risk of ventricular arrhythmias by a factor of four in the general population. Yet, the absolute effect is quite low requiring 57000 prescriptions, or 5300 person-years of use for one case to occur. The risk associated with terfenadine was no different from that with other nonsedating antihistamines. (+info)
Geographic information systems and the environmental risk of schistosomiasis in Bahia, Brazil.
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A geographic information system was constructed using maps of regional environmental features, Schistosoma mansoni prevalence in 30 representative municipalities, and snail distribution in Bahia, Brazil to study the spatial and temporal dynamics of infection and to identify environmental factors that influence the distribution of schistosomiasis. Results indicate that population density and the duration of annual dry period are the most important determinants of prevalence of schistosomiasis in the areas selected for study. Maximum rainfall, total precipitation during three consecutive months, annual maximum or minimum temperatures, and diurnal temperature difference were not shown to be significant factors influencing S. mansoni prevalence in local populations or distribution of snail hosts. Prevalence of the disease was highest in the coastal areas of the state. Higher prevalence tended to occur in areas with latossolo soil type and transitional vegetation. (+info)
Temporal and geographical distributions of reported cases of Escherichia coli O157:H7 infection in Ontario.
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The distribution of 3001 cases of verocytotoxigenic Escherichia coli (VTEC) reported in the Province of Ontario, Canada, were examined to describe the magnitude of this condition geographically and to evaluate the spatial relationship between livestock density and human VTEC incidence using a Geographical Information System. Incidence of VTEC cases had a marked seasonal pattern with peaks in July. Areas with a relatively high incidence of VTEC cases were situated predominantly in areas of mixed agriculture. Spatial models indicated that cattle density had a positive and significant association with VTEC incidence of reported cases (P = 0.000). An elevated risk of VTEC infection in a rural population could be associated with living in areas with high cattle density. Results of this study suggested that the importance of contact with cattle and the consumption of contaminated well water or locally produced food products may have been previously underestimated as risk factors for this condition. (+info)
An experience of utilization review in Europe: sequel to a BIOMED project.
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OBJECTIVE: To develop and test a utilization review screening tool for use in European hospitals. SETTING: In 1993 a group of researchers financed by a European Union grant reviewed the use of utilization review in Europe. They quickly noticed a lack of specifically designed instruments able to take into account the health care and cultural differences across Europe, and available for use in different health care systems. Hence, they embarked upon the task of developing and testing a utilization review screening tool for use in European hospitals. RESULTS: The European Union-Appropriateness Evaluation Protocol's list of reasons was developed and assessed. This is a common taxonomy that classifies days identified as unnecessary and provides a list of levels of care to identify patients' needs. This new protocol not only substitutes for the multiple previous local versions of the Appropriateness Evaluation Protocol, but will also facilitate comparisons of the varying experiences in European countries. MAIN FINDINGS: Development of utilization review in Europe has been carried out mostly on a voluntary basis and the main objective was not control. The experience varies widely: from France, where utilization review is still developing and research has been implemented by local teams, to Portugal, where utilization review programmes have been initiated by government authorities. At this point different initiatives in quality improvement, and more specifically in utilization review, are being developed within the European context. (+info)
Statistical method to evaluate management strategies to decrease variability in operating room utilization: application of linear statistical modeling and Monte Carlo simulation to operating room management.
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BACKGROUND: Operating room (OR) managers seeking to maximize labor productivity in their OR suite may attempt to reduce day-today variability in hours of OR time for which there are staff but for which there are no cases ("underutilized time"). The authors developed a method to analyze data from surgical services information systems to evaluate which management interventions can most effectively decrease variability in underutilized time. METHODS: The method uses seven summary statistics of daily workload in a surgical suite: daily allocated hours of OR time, estimated hours of elective cases, actual hours of elective cases, estimated hours of add-on cases, actual hours of add-on cases, hours of turnover time, and hours of underutilized time. Simultaneous linear statistical equations (a structural equation model) specify the relationship among these variables. Estimated coefficients are used in Monte Carlo simulations. RESULTS: The authors applied the analysis they developed to two OR suites: a tertiary care hospital's suite and an ambulatory surgery center. At both suites, the most effective strategy to decrease variability in underutilized OR time was to choose optimally the day on which to do each elective case so as to best fill the allocated hours. Eliminating all (1) errors in predicting how long elective or add-on cases would last, (2) variability in turnover or delays between cases, or (3) day-to-day variation in hours of add-on cases would have a small effect. CONCLUSIONS: This method can be used for decision support to determine how to decrease variability in underutilized OR time. (+info)
Making sense of the electronic resource marketplace: trends in health-related electronic resources.
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Changes in the practice of medicine and technological developments offer librarians unprecedented opportunities to select and organize electronic resources, use the Web to deliver content throughout the organization, and improve knowledge at the point of need. The confusing array of available products, access routes, and pricing plans makes it difficult to anticipate the needs of users, identify the top resources, budget effectively, make sound collection management decisions, and organize the resources effectively and seamlessly. The electronic resource marketplace requires much vigilance, considerable patience, and continuous evaluation. There are several strategies that librarians can employ to stay ahead of the electronic resource curve, including taking advantage of free trials from publishers; marketing free trials and involving users in evaluating new products; watching and testing products marketed to the clientele; agreeing to beta test new products and services; working with aggregators or republishers; joining vendor advisory boards; benchmarking institutional resources against five to eight competitors; and forming or joining a consortium for group negotiating and purchasing. This article provides a brief snapshot of leading biomedical resources; showcases several libraries that have excelled in identifying, acquiring, and organizing electronic resources; and discusses strategies and trends of potential interest to biomedical librarians, especially those working in hospital settings. (+info)
Ethnic groups and our healthier nation: whither the information base?
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The Government has made the health of minority ethnic groups a central part of its programme to reduce social exclusion and inequalities in health provision. It has also given a commitment in its 'contract for health' to provide the information that is needed to address inequalities, stating that it will be able to draw on a range of data sources, including mortality statistics, cancer registrations, hospital episode data, and general practitioner data. In reality, only one of these is a potential source of comprehensive information on minority ethnic groups and the information base needed to support Government policies is essentially unavailable. Priorities for further action are identified. (+info)