MEDICA@MUSC (Medical University of South Carolina)
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Admissions for CHF or ED Visits for COPD: Are there cost savings?
Get PDFObjective: The primary objective of the current study is to evaluate the existing healthcare costs that healthcare emergency departments (EDs) and hospitals incur as a result of ED visits from chronic obstructive pulmonary disease (COPD) exacerbations and hospital admissions for congestive heart failure (CHF) within the medium size hospitals in the state of Florida in 2018. These data insights can determine better where telehealth might be used to save hospitals more money. Methods: The study design chosen was a retrospective cohort study analysis of HCUP archival billing data that examines specific databases- SID and SEDD- for CHF admissions and COPD ER visits for all adult individuals age 18 years and older in the calendar year 2018. Results: For CHF admissions, the total number of hospitals included totaled 182 facilities. The the total median charges for CHF admissions was 11,000. In terms of COPD ER visits, the total number of hospitals included totaled 163 hospitals. The total median charges was 3.6M. The total median cost was 599. Conclusion: CHF admissions cost more money than the COPD ER visit (822M, respectively). Telehealth services offer annual significant cost savings for both conditions (274M, respectively)
A Program Evaluation of Direct Primary Care: Assessment of In-Person Visits, Phone and Text Message Utilization by Age, Gender, Family Status, and Risk Stratification
Get PDFDirect Primary Care (DPC) is one of the fastest growing models of care innovation in the United States. Despite such dramatic growth and national policy support, there is little to no research available to help understand this model. The purpose of this program evaluation is to better understand the emerging model of DPC as it is being delivered across 8 participating DPC organizations. A retrospective, longitudinal analysis has been performed utilizing electronic health record, telehealth, and membership data from full-years 2018 and 2019 to identify utilization patterns across stratified DPC patient populations. Patient records will be stratified by gender, age, risk, and family status to assess physical and virtual utilization patterns and statistically significant differences between each population segment. This evaluation was conducted to help direct primary care clinics better understand the staffing and technological resources required to best manage and care for their patient panels, better anticipate resource constraints when onboarding new patients, and better identify appropriate patient panel sizes
Targeting Galectin-1 as a Potential Therapeutic for Glioblastoma
Get PDFGlioblastoma (GB) is classified by the World Health Organization (WHO) as a Grade IV astrocytoma characterized by a poor prognosis with a median survival time ranging from 15-16 months. The standard of care for GB is surgery followed by radiation and chemotherapy treatment with Temozolomide, but even with the aggressive treatment, GB recurrence occurs in approximately 90 % of the patient population. New treatment options have been FDA approved which include Novocure’s Optune Device and Genentech’s Avastin, but neither of these options drastically change survival time or quality of life. Galectin-1 (Gal-1), a protein with a high affinity to bind β-galactosides, has been implicated in other cancers such as renal cancer, liver cancer, and urothelial cancer and plays a role ranging from angiogenesis to altering the tumor microenvironment for immune suppression. Little research has been conducted investigating Gal-1’s role in GB so the aim of our in vitro and in vivo studies was to gain a better understanding of Gal-1’s potential mechanisms in GB and see the feasibility of Gal-1 inhibition as a potential treatment option. The data collected illustrated roles of Gal-1 in angiogenesis, in apoptosis, and in facilitation of a hypoxic environment. Inhibition of Gal-1 shows signs of being a plausible treatment option especially if given coadjuvant to an Anti-VEGF therapy
Exploration of Supportive Care in Advanced Disease Prostate Cancer Survivors
Get PDFAccording to the National Cancer Institute, in 2019, there were approximately 17 million cancer survivors in the United States, of whom 3.7 million were prostate cancer (PC) survivors. Due to an increase in life expectancy, extensive screening, and novel therapies, this number is expected to continue rising in the coming years. PC survivors in advanced stages (III, IV, or recurrent) are particularly prone to experience a wide range of harmful effects that stem from cancer and the many treatments they undergo during this cancer’s long trajectory. Past research has highlighted the importance of implementing supportive care as a standard for cancer survivors due to its multiple benefits, such as reducing morbidity and improving both quality of life (QOL) and health outcomes. However, little is known about supportive care needs and implementation among this subset of survivors. This information is vital to inform future patient-centered, holistic supportive care strategies that aim to optimize this population’s QOL and rehabilitation. This dissertation work found robust guidance from the Supportive Care Framework for Cancer Care due to its comprehensive taxonomy and holistic view of the cancer continuum. The first manuscript explored the supportive care interventions available to men with advanced prostate cancer. Next, a holistic needs assessment in American advanced disease PC survivors was conducted using a mixed-methods approach in order to provide a more comprehensive picture of their perceived supportive care needs. Finally, an exploration of the existing barriers and facilitators to supportive care implementation was performed before taking the next step in this line of research. The results of the three manuscripts included in this dissertation reported that advanced disease PC survivors suffer from unmet needs that affect every dimension of the individual. Existing supportive care interventions were promising but limited, focusing primarily on specific domains of needs. Implementing supportive care can only become a standard of care if researchers and clinicians find ways to minimize identified barriers while they maximize facilitators
Pediatric Rates of Psychiatric Emergency Department Visits and Potential Savings via Tele-Mental Health
Get PDFResearch suggests that visits to the Emergency Department (ED) for psychiatric purposes among youth are rising and has been identified as a public health crisis. One in five school aged children struggle with mental illness with 70% of those diagnosed going untreated which promotes academic failure, behavior challenges, dropout, and unproductivity that leads into adulthood (Bains, Cusson, White-Frese & Walsh, 2017; Grady, Lever, Cunnigham, & Stephen, 2011). Schools have been identified as an ideal place for children to receive mental health services. School based tele-mental health is noted as a beneficial treatment that if delivered on site at schools could assist with closing the gap to accessing pediatric mental health needs saving money through transportation, time missed from school or work, and lower insurance cost (Hoover, Bernstein, Lever, & Edwards, 2016). This study will evaluate the cost effectiveness of receiving school based mental health treatment instead of visiting the emergency department for care (School-Based Tele-Mental Health Services, 2015; CEDAR, 2018)
Optimal AP Maxillary Incisor Position Displayed in a Smiling Profile in Caucasian Males
Get PDFIntroduction: This study investigated an optimal anteroposterior (AP) position of maxillary incisors displayed in a smiling profile in Caucasian males relative to Glabella Vertical (GV). The study also assessed any difference in preferred AP incisor position between orthodontists and laypersons, among orthodontists in various years of practice, among laypersons in various age groups, and between genders of orthodontists and laypersons. Methods: Existing smiling profile photographs of 40 Caucasian males, ages 15 to 60, were retrospectively collected from the Medical University of South Carolina (MUSC) Department of Orthodontics database. Photographs were numerically randomized and uploaded into a Research Electronic Data Capture (REDCAP) survey. Seventy-one orthodontists and forty-six laypersons age 18 and older responded to the survey having assessed the AP incisor position in each profile photograph as: 1) too far forward, 2) too far back, or 3) just about right, which were considered Group F, Group B, Group 0, respectively. Orthodontists were divided into five groups based on years in practice. Laypersons were divided into three groups based on age. Results: An optimal group (Group 0) was constructed based on incisor AP position rated just about right from 70% of all judges. Group O yielded a mean maxillary incisor to GV of -1.5mm. Mean maxillary incisor to GV measurement for orthodontists was -1.1 mm, while the measurement for laypersons was -2.4mm. The too far back group (Group B) was similarly developed with the same 70% threshold. Mean maxillary incisor to GV was -5.8mm for orthodontists and -6.lmm for laypersons. There was insufficient agreement (below 70%) for the too far forward group (Group F) to conduct a similar analysis. Results indicate the mean GV for \u27just about right, too far forward, and too far back groups are statistically different for both orthodontists (p\u3c0.05) and laypersons (p\u3c0.05). There were no differences in ratings by orthodontists based on years in practice, by laypersons based on age groups, or between genders of orthodontists and laypersons. Conclusions: Among orthodontists and laypersons combined, the optimal AP maxillary incisor position in Caucasian males was found to be 1.5mm behind GV. Orthodontists rated the optimal AP maxillary incisor position as 1.1mm behind GV, while laypersons rated the optimal AP maxillary incisor position as 2.4mm behind GV. While statistically significant, the difference was only 1.3mm. There were no differences in AP ratings among orthodontists based on years in practice, among laypersons based on age group, or between genders of orthodontists and laypersons. GV may be a useful landmark for assessing the AP position of the maxillary incisor in Caucasian males
Optimal Anteroposterior Position of Maxillary Incisors in Caucasian Females
Get PDFIntroduction: This study investigated an ideal anteroposterior position of maxillary incisors viewed from a facial profile perspective in Caucasian females. Methods: Smiling profile photographs were collected from pre-treatment records of 40 Caucasian female patients within the Department of Orthodontics at the Medical University of South Carolina. The 40 patient photographs were randomly compiled in a REDCAP survey. The survey was distributed to 82 orthodontists and 31 laypersons who were asked to determine whether the maxillary incisor in the photographs were too far forward, too far back or just about right within the face. An optimal group (Group O) was established from the photographs of patients whose incisors were rated as “just about right” by 75% of the raters. The same method was applied to find a “too far back” group (Group B) and “too far forward” group (Group F). A mean incisor to glabella vertical distance and the standard deviation was determined for both groups. Results: Within the optimal group, the average incisor to GV measurement rated by all judges as “just about right” was -1.17 mm. Within Group F, the average incisor to GV measurement rated by all judges was 2.67 mm. Within Group B, the average incisor to GV measurement rated by all judges was -2.75 mm. There was a statistically significant difference between the overall way orthodontists and laypeople rated the upper incisor position (p-value\u3c0.0001). There was no correlation between forehead inclination and incisor position relative to GV within the optimal group (p-value = 0.2658, Spearman correlation = 0.34). Conclusions: The optimal AP position of maxillary incisors in Caucasian females is -1 mm to 0 mm relative to Glabella Vertical. Glabella Vertical may be a useful landmark to determine the optimal position of maxillary incisors in Caucasian females
The IMPAiR (Identifying Comorbid Subgroups of Patients with Acute Respiratory Failure) Study: Risk Stratification of Physical Disability Post-Intensive Care
No full textOf the 2 million adults who require mechanical ventilation (MV) in intensive care units (ICUs) in the United States every year, up to 65% develop physical disability post-intensive care (PD PIC). PD PIC is characterized by muscle weakness, reduced mobility, activity impairments, and difficulty returning to pre-critical illness roles, all of which negatively influence quality of life and produce financial hardship due to loss of employment. While early mobilization (EM) in the ICU may reduce or prevent PD PIC, numerous environmental and patient-level facilitators and barriers influence its delivery. Additionally, it is unknown which subgroups of patients are at greatest risk for PD PIC or may benefit most from EM in the ICU. This dissertation is a compendium of three manuscripts, each utilizing the World Health Organization International Classification of Functioning, Disability, and Health to illustrate the complex relationship between critical illness, environmental and patient-level factors, and PD PIC. First, a two-part integrative review was conducted to synthesize the environmental and patient-level facilitators and barriers to EM in the ICU and the subsequent relationship between these contextual factors and PD PIC. The third manuscript describes two parts of an original research study: 1) a latent class analysis of a sample of medical ICU patients to identify comorbid subgroups of patients with acute respiratory failure who required MV and 2) an analysis of differences in PD PIC at hospital discharge among these subgroups. The information presented in this dissertation work creates a foundation for future study of PD PIC in comorbid subgroups to reduce disability and improve quality of life in survivors of critical illness
Immediate On-Demand Emergent Administrative Training Program for First-Time Respiratory Therapy Supervisors with Little or No Prior Supervisory Experience
Get PDFFirst-time frontline clinical supervisors, such as Respiratory Therapy (RT) supervisors are management officials that are often hired with little or no prior supervisory experience, and the administrative duties required of an RT supervisor are not taught as part of a clinical RT college program. This project is designed to provide an overview and an immediate on-demand emergent administrative training program for the administrative responsibilities required of a first-time RT supervisor with little or no prior supervisory experience, that are required to supervise respiratory therapists that provide critical patient care, and ensure that these respiratory therapists do not harm patients. It can take several years supervising a respiratory therapy department to learn and become proficient with the required administrative responsibilities, in conjunction with the completion of professional development courses to learn how to supervise an RT department in the most effective manner. This dissertation project will help them deal with issues when supervising an RT department for the first time, and transition into RT management as smoothly as possible
Effects of Medicaid Expansion on Diabetes Related Hospital Utilization in Appalachia
Get PDFThe problem that we face as a nation is the increasing cases of opiate overdoses (CDC, 2019). Regulations vary across state lines regarding patient needs and prescribing regulations. The current study addresses closing the gaps in opioid use disorder. The overarching research question for this study is—How are Narcan policies related to the drug’s utilization? Other questions in this study will be explored through analysis of national claims data. The study population consist of beneficiaries who have received a prescription for Narcan in 2016. The data includes Narcan prescriptions across state lines as well as the Narcan access law. Using the MarketScan Commercial Database we look at patient claims from states that do not have a Narcan access law and states with a Narcan access law. The study included a total of 3,756,833 prescriptions for naloxone and opioids (14,210, 0.38%), naloxone only (1660, 0.04%), and opioids only (3,740,963, 99.6%) provided to privately insured individuals in 2016. In total, 7448 Naloxone prescriptions by State Policy Status were dispensed in 2016. The odds of receiving a Naloxone prescription in access law states presented 40% greater than the states without the access law in 2016. This study will add to the literature concerning the misuse of prescription and illicit opioids