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Site of Service Changes Have Resulted in Increased Opioid Prescriptions for Primary Total Hip and Knee Patients in Michigan, a Michigan Arthroplasty Registry Collaborative Quality Initiative Quality Study
No full textBACKGROUND: The Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI) successfully changed opioid prescribing patterns by instituting guidelines for total hip (THAs) and knee arthroplasties (TKAs). Given Medicare changes, cases are moving to ambulatory surgery centers (ASCs) and hospital outpatient departments (HOPDs). We aimed to assess whether these sites adopted the well-proven opioid recommendations.
METHODS: Using data from the Michigan Arthroplasty Registry Collaborative Quality Initiative, all opioid-naïve (no prescription within 30 days) patients undergoing primary total joint arthroplasty between July 1, 2021, and June 30, 2022, were identified. Of the 12,962 THAs: 11.0% (1425) were in ASCs, 5.2% (674) in HOPDs, and 84% (10,863) in hospitals. Of the 20,092 primary TKAs: 10.3% (2064) were in ASCs, 4.5% (906) in HOPDs, and 85.2% (17,122) in hospitals.
RESULTS: The cohorts were statistically different, with unhealthier patients within the hospital population. For THAs and TKAs, ASCs had the highest mean oral morphine equivalents at discharge, 239 (±109.9) and 307.4 (±151.9), compared to hospitals and HOPDs (P \u3c .05). Overall, HOPDs had the lowest oral morphine equivalent for THA (P \u3c .05), while HOPDs and Hospitals had similar levels for TKAs (P = .27). ASCs had the lowest compliance rate for both THA (56%) and TKA(69%) compared to HOPDs (89%, 80%) and hospitals (83%, 87%) (P \u3c .05), respectively.
CONCLUSIONS: ASC and HOPDs patients are selected for the ability to be discharged home. Yet opioid-naïve total joint arthroplasty patients at Michigan ASCs received more opioids at discharge compared to patients undergoing the same procedures at HOPDs and hospitals
Factors associated with all-cause 60-day readmission in patients with end-stage renal disease on hemodialysis discharged on outpatient parenteral antimicrobial therapy
No full textPURPOSE: Outpatient parenteral antimicrobial therapy (OPAT) is standard of care in patients who require intravenous antibiotics after hospitalization. There is a lack of data on OPAT in patients with end-stage renal disease on hemodialysis. This study characterized hemodialysis patients discharged on OPAT and identified factors associated with all-cause 60-day hospital readmission.
METHODS: This institutional review board-approved retrospective cohort study included hemodialysis patients 18 years of age or older who were discharged from January 2020 to August 2022 with at least 1 week of OPAT. Enrolled patients were divided into 2 groups depending on their 60-day readmission status (ie, readmitted and nonreadmitted) and compared to identify risk factors associated with readmission. Treatment success, adverse event (ADE) rates, and transition-of-care process measures were also assessed.
RESULTS: A total of 162 patients were included in the study, with 81 patients in each group. The most common indication for OPAT was bloodstream infection (n = 83, 51%). The median time to first readmission was 24 days (interquartile range, 11-45 days). After adjusting for confounders, nonreadmitted patients were more likely to have a pharmacist infection treatment plan note before discharge (adjusted odds ratio [aOR], 0.195; 95% confidence interval [CI], 0.039-0.977) and to have attended infectious disease (ID) follow-up appointments (aOR, 0.337; 95% CI, 0.161-0.705). Female sex was associated with increased risk of all-cause 60-day readmission (aOR, 3.352; 95% CI, 1.738-6.467; P \u3c 0.001). The rate of changes in OPAT after discharge, the number of reported ADEs, and the number of emergency department visits were all significantly higher in the readmitted group.
CONCLUSION: This study suggests that pharmacist-led education, attending follow-up ID appointments, and male sex are associated with reduced risk of all-cause 60-day readmission in hemodialysis patients
Clinical and Demographic Characteristics Associated With Diabetes Remission in Six Integrated Health Care Systems: A Retrospective Cohort Study
No full textOBJECTIVE: To assess the real-world frequency and characteristics associated with type 2 diabetes remission in a large and diverse cohort of U.S. adults.
RESEARCH DESIGN AND METHODS: This retrospective cohort study used 2014-2023 electronic health record data from six major U.S. health care delivery systems. The cohort included 556,758 adults (≥ 18 years) with type 2 diabetes who had one or more HbA1c measurement in 2 years before study entry and evidence of glucose-lowering medication use. Pregnant women or adults who underwent bariatric surgery before or during the study were excluded. Type 2 diabetes remission was defined as HbA1c \u3c 6.5% persisting for ≥ 3 months after cessation of glucose-lowering medications. Multivariate logistic regression was used to identify characteristics associated with type 2 diabetes remission.
RESULTS: Over a 3-year follow-up, 2.9% (16,016 adults) achieved type 2 diabetes remission, although 36.9% of those who experienced remission relapsed. The strongest characteristics associated with remission were not receiving glucose-lowering medications at baseline versus three or more medications (odds ratio [OR] 15.9, 95% CI 12.1-21.0), baseline HbA1c \u3c 7% vs. ≥ 11% (OR 3.1, 2.9-3.3) and diabetes duration \u3c 1 year versus ≥ 4 years (OR 2.6, 2.5-2.7).
CONCLUSIONS: Type 2 diabetes remission was low among adults without bariatric surgery. The strongest associated characteristics were fewer diabetes medications, lower baseline HbA1c, and shorter diabetes duration. These findings highlight actionable factors to identify patients who may benefit most from targeted interventions. Future research should evaluate the long-term durability and health impacts of remission
The Impact of Synergistic Therapy Between Colistin and Meropenem on Outcomes of Patients With Pneumonia or Bloodstream Infection Due to Carbapenem-Resistant Gram-Negative Pathogens
No full textBACKGROUND: Colistin, a last-line treatment for carbapenem-resistant Gram-negative bacilli (CRGNB), is frequently used in combination with meropenem because these agents often demonstrate in vitro synergy. Using data from the OVERCOME trial comparing colistin + meropenem to colistin + placebo for treatment of pneumonia or bloodstream infection due to CRGNB, we evaluated the impact of synergistic therapy on outcomes.
METHODS: In vitro synergy testing between colistin and meropenem was conducted using 24-hour time-kill analysis; synergy was defined as \u3e2-log reduction in colony-forming units/ml compared to the most active single agent. Patients receiving synergistic combination therapy were compared to patients receiving functional colistin monotherapy (colistin alone or combination therapy without synergy). Outcomes included mortality, clinical failure and microbiologic cure. Adjusted analyses controlled for variables on which randomization was stratified and confounders.
RESULTS: 146 subjects receiving synergistic combination therapy and 261 subjects receiving functional monotherapy were included. Most had pneumonia (70%), CR Acinetobacter baumannii infection (79%) and were in intensive care (69%). A. baumannii was more common in those receiving synergistic combination therapy than functional monotherapy (p\u3c 0.001). Mortality rates were similar (38.3%, 41.4%, respectively). In adjusted analyses, synergistic combination therapy was associated with significantly lower clinical failure rates (55.3%, 64.3%, adjusted odds ratio [aOR] 0.62, p=0.049), with consistent findings in pneumonia (62.6%, 71.8%, aOR 0.55, p=0.04) and A. baumannii subgroups (57.4%, 69.4%, aOR 0.60, p=0.06). Microbiologic cure rates were similar.
CONCLUSIONS: Colistin-based, synergistic combination treatment with meropenem (compared to non-synergistic colistin-based therapy), was associated with decreased clinical failure, particularly in patients with pneumonia and A. baumannii
Towards fair decentralized benchmarking of healthcare AI algorithms with the Federated Tumor Segmentation (FeTS) challenge
No full textComputational competitions are the standard for benchmarking medical image analysis algorithms, but they typically use small curated test datasets acquired at a few centers, leaving a gap to the reality of diverse multicentric patient data. To this end, the Federated Tumor Segmentation (FeTS) Challenge represents the paradigm for real-world algorithmic performance evaluation. The FeTS challenge is a competition to benchmark (i) federated learning aggregation algorithms and (ii) state-of-the-art segmentation algorithms, across multiple international sites. Weight aggregation and client selection techniques were compared using a multicentric brain tumor dataset in realistic federated learning simulations, yielding benefits for adaptive weight aggregation, and efficiency gains through client sampling. Quantitative performance evaluation of state-of-the-art segmentation algorithms on data distributed internationally across 32 institutions yielded good generalization on average, albeit the worst-case performance revealed data-specific modes of failure. Similar multi-site setups can help validate the real-world utility of healthcare AI algorithms in the future
Quality assessment of large language models\u27 output in maternal health
No full textOptimising healthcare is linked to broadening access to health literacy in Low- and Middle-Income Countries. The safe and responsible deployment of Large Language Models (LLMs) may provide accurate, reliable, and culturally relevant healthcare information. We aimed to assess the quality of outputs generated by LLMs addressing maternal health. We employed GPT-4, GPT-3.5, GPT-3.5 custom, Meditron-70b. Using mixed-methods, cross-sectional survey approach, specialists from Brazil, United States, and Pakistan assessed LLM-generated responses in their native languages to a set of three questions relating to maternal health. Evaluators assessed the answers in technical and non-technical scenarios. The LLMs\u27 responses were evaluated regarding information quality, clarity, readability and adequacy. Of the 47 respondents, 85% were female, mean age of 50 years old, with a mean of 19 years of experience (volume of 110 assisted pregnancies monthly). Scores attributed to answers by GPT-3.5 and GPT-4 were consistently higher [Overall, GPT-3.5, 3.9 (3.8-4.1); GPT-4.0, 3.9 (3.8-4.1); Custom GPT-3.5, 2.7 (2.5-2.8); Meditron-70b, 3.5 (3.3-3.6); p = 0.000]. The responses garnered high scores for clarity (Q&A-1 3.5, Q&A-2 3.7, Q&A-3 3.8) and for quality of content (Q&A-1 3.2, Q&A-2 3.2, Q&A-3 3.7); however, they differed by language. The commonest limitation to quality was incomplete content. Readability analysis indicated that responses may require high educational level for comprehension. Gender bias was detected, as models referred to healthcare professionals as males. Overall, GPT-4 and GPT-3.5 outperformed all other models. These findings highlight the potential of artificial intelligence in improving access to high-quality maternal health information. Given the complex process of generating high-quality non-English databases, it is desirable to incorporate more accurate translation tools and resourceful architectures for contextualization and customisation
Practical and ethical considerations in kidney paired donation and emerging liver paired exchange
No full textSince the first kidney paired donation (KPD) transplant in the United States in 1999, the volume and scope of KPD has expanded substantially, accounting for nearly 20% of living donor kidney transplants in 2021-2022. This review article discusses the practical and ethical issues specific to paired donor exchange that patients, transplant centers, and exchange programs commonly encounter. Access to paired donor exchange and education of candidates regarding the potential benefits, risks, and logistics of KPD are important considerations. Transplant centers and patients must consider practical issues including wait times, allocation and matching strategies, assessment of organ quality, complex donors, cold ischemia time, and risks of broken chains. Protections available to donors from current KPD programs, the potential psychosocial effects, and the ethical concerns related to variable access and the proprietary nature of private exchange programs are also discussed. More detailed, timely data collection at a national level, and ability to merge national data with individual donor exchange registries will enable the analysis of the impact and outcomes of future trends in paired donation. KPD experience and key concepts may inform liver paired exchange, which has been used internationally to expand living donor liver transplantation and is emerging in the United States
Differences in the Use and Quality of Active Surveillance for Prostate Cancer Among Men Insured by Medicaid
No full textProject #107: A quality improvement project to support birth person’s choice to exclusively breastfeed using Pasteurized Donor Human Milk (PDHM) at Henry Ford Wyandotte Hospital
No full texthttps://scholarlycommons.henryford.com/qualityexpo2025/1017/thumbnail.jp
Project #157: Improving Central Line Necessity Documentation: A Quality Improvement Project
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