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Search results for "Specialization of Care"
Journal Article > Study
Adverse events and patient outcomes among hospitalized children cared for by general pediatricians vs hospitalists.
Atkinson MK, Schuster MA, Feng JY, Akinola T, Clark KL, Sommers BD. JAMA Netw Open. 2018;1:e185658.
The number of hospitalists—physicians practicing exclusively in acute care settings—continues to grow. However, whether patient outcomes differ between hospitalists and general physicians remains unclear. This study examined medical record data from a single urban academic children's hospital to compare patient outcomes between general pediatricians and hospitalists. After adjustment for patient characteristics (e.g., age and number of chronic conditions) and for physician characteristics (e.g., number of years in practice), the investigators did not find differences in readmission rates, total costs, or lengths of stay. The hospitalists' patients had a greater risk for device-related adverse events, which was explained by differences in physician experience. The authors conclude that the safety of care delivered by general versus hospitalist pediatricians is similar. A related editorial predicts that the hospitalist model of pediatric acute care will continue to grow.
Journal Article > Study
Saint S, Greene MT, Krein SL, et al. N Engl J Med. 2016;374:2111-2119.
The landmark Keystone ICU study, which achieved remarkable sustained reductions in central line–associated bloodstream infections in intensive care unit (ICU) patients, stands as one of the most prominent successes of the patient safety field. Although the use of a checklist gathered the most publicity, the study's key insight was that preventing health care–associated infections (HAIs) required extensive attention to improving safety culture by addressing the socioadaptive factors within hospitals that contributed to HAIs. In this new AHRQ funded national study, the Comprehensive Unit-based Safety Program was implemented at 603 hospitals in 32 states, with the goal of preventing catheter-associated urinary tract infections in ICU and ward patients. The effort involved socioadaptive interventions (various approaches shown to improve safety culture) and technical interventions (targeted training to reduce usage of indwelling urinary catheters and providing regular data feedback to participating units). Catheter usage and infection rates significantly decreased in ward patients, although no change was found in ICU patients. This study thus represents one of the few safety interventions that has achieved a sustainable improvement in a clinical outcome. An earlier article described the implementation of the program, which involved collaboration between state and national agencies and academic centers. In a 2008 PSNet interview, the study's lead author discussed his work on preventing HAIs.
Journal Article > Review
Hwang RW, Herndon JH. Clin Orthop Relat Res. 2007;457:21-34.
The authors discuss the financial incentives of improving patient outcomes as the business case for patient safety.