Antihypertensive Medication Adherence,Ambulatory Visits,and Risk of Stroke and Death

BACKGROUND  

This study seeks to determine whether antihypertensive medication refill adherence, ambulatory visits, and type of antihypertensive medication exposures are associated with decreased stroke and death for community-dwelling hypertensive patients.     

Changes in Disparities Following the Implementation of a Health Information Technology-Supported Quality Improvement Initiative

BACKGROUND  

Health information technology (HIT)-supported quality improvement initiatives have been shown to increase ambulatory care quality for several chronic conditions and preventive services, but it is not known whether these types of initiatives reduce disparities.     

Dependence on Emergency Care among Young Adults in the United States

BACKGROUND  

Young adults have a high prevalence of many preventable diseases and frequently lack a usual source of ambulatory care, yet little is known about their use of the emergency department.     

Medication-related problem type and appearance rate in ambulatory hemodialysis patients

Background  

Hemodialysis (HD) patients are at risk for medication-related problems (MRP). The MRP number, type, and appearance rate over time in ambulatory HD patients has not been investigated.     

Blood cultures in ambulatory outpatients

Background  

Blood cultures are a gold standard specific test for diagnosing many infections. However, the low yield may limit their usefulness, particularly in low-risk populations. This study was conducted to assess the utility of blood cultures drawn from ambulatory outpatients.     

Code Status Documentation in the Outpatient Electronic Medical Records of Patients with Metastatic Cancer

BACKGROUND  

Advanced care planning (ACP) is considered an essential component of medical care in the United States, especially in patients with incurable diseases. However, little is known about clinical practices in outpatient oncology settings related to discussing end-of-life care and documenting code status preferences in ambulatory medical records.     

Relationship of 24-hour ambulatory blood pressure and heart rate with markers of hepatic function in cirrhotic patients

Background  

There is evidence that in cirrhotic patients, certain hemodynamic parameters, such as blood pressure and heart rate, are related to the severity of liver disease. This study investigated whether non-invasive 24-hour ambulatory blood pressure and heart rate are more closely associated with markers of liver disease severity than conventional office measurements.     

Validation of a new physical activity questionnaire for a sedentary population

Background  

Many available physical activity questionnaires (PAQs) are limited due to either focus on recreational activities or burdensome length.     

Catheter-related bacteremia due to Kocuria rosea in a patient undergoing peripheral blood stem cell transplantation

Background  

Micrococcus species may cause intracranial abscesses, meningitis, pneumonia, and septic arthritis in immunosuppressed or immunocompetent hosts. In addition, strains identified as Micrococcus spp. have been reported recently in infections associated with indwelling intravenous lines, continuous ambulatory peritoneal dialysis fluids, ventricular shunts and prosthetic valves.     

U.S. Trends in Hospitalization and Generalist Physician Workforce and the Emergence of Hospitalists

Background  

General internists and other generalist physicians have traditionally cared for their patients during both ambulatory visits and hospitalizations. It has been suggested that the expansion of hospitalists since the mid-1990s has “crowded out” generalists from inpatient care. However, it is also possible that declining hospital utilization relative to the size of the generalist workforce reduced the incentives for generalists to continue providing hospital care.     

Pancreatic hyperamylasemia during acute gastroenteritis: incidence and clinical relevance

Background  

Many case reports of acute pancreatitis have been reported but, up to now, pancreatic abnormalities during acute gastroenteritis have not been studied prospectively.     

Effect of Verification Bias on the Sensitivity of Fecal Occult Blood Testing: a Meta-Analysis

OBJECTIVES  

There is controversy regarding the sensitivity of fecal occult blood tests (FOBT) for detecting colorectal cancer. Many of the published studies failed to correct for verification bias which may have increased the sensitivity.     

Inflammatory Bowel Disease Characteristics and Treatment in Hispanics and Caucasians

Background  

Many inflammatory bowel disease (IBD) studies have focused on Caucasian patients and little data exist on IBD in Hispanics living in the United States.     

Moving Forward in GME Reform: A 4 + 1 Model of Resident Ambulatory Training

BACKGROUND

Traditional ambulatory training models have limitations in important domains, including opportunities for residents to learn, fragmentation of care delivery experience, and satisfaction with ambulatory experiences. New models of ambulatory training are needed.

AIM

To compare the impact of a traditional ambulatory training model with a templated 4 + 1 model.

SETTING

A large university-based internal medicine residency using three different training sites: a patient-centered medical home, a hospital-based ambulatory clinic, and community private practices.

PARTICIPANTS

Residents, faculty, and administrative staff.

PROGRAM DESCRIPTION

Development of a templated 4 + 1 model of residency where trainees do not attend to inpatient and outpatient responsibilities simultaneously.

PROGRAM EVALUATION

A mixed-methods analysis of survey and nominal group data measuring three primary outcomes: 1) Perception of learning opportunities and quality of faculty teaching; 2) Reported fragmentation of care delivery experience; 3) Satisfaction with ambulatory experiences. Self-reported empanelment was a secondary outcome. Residents’ learning opportunities increased (p = 0.007) but quality of faculty teaching was unchanged. Participants reported less fragmentation in the care residents provide patients in the inpatient and outpatient setting (p < 0.0001). Satisfaction with ambulatory training improved (p < 0.0001). Self-reported empanelment also increased (p < 0.0001). Results held true for residents, faculty, and staff at all three ambulatory training sites (p < 0.0001).

DISCUSSION

A 4 + 1 model increased resident time in ambulatory continuity clinic, enhanced learning opportunities, reduced fragmentation of care residents provide, and improved satisfaction with ambulatory experiences. More studies of similar models are needed to evaluate effects on additional trainee and patient outcomes.

Electronic supplementary material

The online version of this article (doi:10.1007/s11606-013-2387-3) contains supplementary material, which is available to authorized users.KEY WORDS: ambulatory training, 4 + 1 model     

Patient-Provider Concordance in the Prioritization of Health Conditions Among Hypertensive Diabetes Patients

BACKGROUND  

Many patients with diabetes have multiple other chronic conditions, but little is known about whether these patients and their primary care providers agree on the relative importance that they assign these comorbidities.     

Magnitude and characteristics of arthritis and other rheumatic conditions on ambulatory medical care visits,United States, 1997

Objective

To describe ambulatory medical care utilization, defined to exclude injury‐related visits, for persons with arthritis and other rheumatic conditions.

Methods

National estimates, rates, and other characteristics of ambulatory care visits were calculated from a national sample of patient visits to physician offices and acute care hospital outpatient and emergency departments.

Results

An estimated 36.5 million ambulatory care visits were related to arthritis and other rheumatic conditions. Visit rates increased with age and, overall, were twice as high among women as men. Rates of visits by race varied by ambulatory care setting. Soft tissue disorders (9.3 million), osteoarthritis (7.1 million), nonspecific joint pain/effusion (7.0 million), and rheumatoid arthritis (3.9 million) were the most common diagnoses.

Conclusions

Arthritis and other rheumatic conditions account for about as many ambulatory care visits as cardiovascular disease or essential hypertension. These visits serve as excellent opportunities to counsel patients regarding prevention messages for arthritis.

     

Inadequate Health Literacy Among Paid Caregivers of Seniors

Background  

Many seniors rely on paid non-familial caregivers to maintain their independence at home. Caregivers often assist with medication reminding and activities of daily living. No prior studies have examined the health literacy levels among paid non-familial caregivers.     

Comparison of morning versus afternoon cecal intubation rates

Background  

Many factors impacting cecal intubation rates have been examined in detail; however, little information exists regarding the effect of the timing of the procedure. We sought to examine any difference in cecal intubation rates between morning and afternoon colonoscopies and identify factors contributing to a discrepancy.