Dataset Information

Quality of hepatitis C care at an urban tertiary care medical center.

ABSTRACT:

Background

More effective treatment for hepatitis C virus (HCV) creates an opportunity to improve health outcomes.

Objective

To use Centers for Medicare and Medicaid Services (CMS)-defined HCV quality indicators (QI) as a framework to assess the quality of care at an urban safety net hospital.

Design

Retrospective cohort.

Participants

Patients engaged in care (at least two outpatient visits, and minimum six-month follow-up time) between 2005 and 2011. Outcomes measures. 1) HCV ribonucleic acid (RNA); 2) genotyping; 3) treatment; and 4) Hepatitis A and B vaccination. Study time was divided into three periods: 1) 2005-2006, 2) 2007-2008, 3) 2009-2011. Key results. Number who met inclusion criteria: 3,018; 13% were human immunodeficiency virus co-infected. Only 1% completed the care recommended in the CMS quality indicators that were evaluated. Later time periods were independently associated with greater rates (aHR for HCV testing, 1.15; 95% CI, 1.04-1.28).

Conclusions

Quality of care is improving, but it remains suboptimal. Initiatives are needed to increase QI completion.

SUBMITTER: Assoumou SA

PROVIDER: S-EPMC4541792 | biostudies-literature | 2014 May

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Quality of hepatitis C care at an urban tertiary care medical center.

Assoumou Sabrina A SA Huang Wei W Horsburgh C Robert CR Mus Linas Benjamin P BP

Journal of health care for the poor and underserved 20140501 2

<h4>Background</h4>More effective treatment for hepatitis C virus (HCV) creates an opportunity to improve health outcomes.<h4>Objective</h4>To use Centers for Medicare and Medicaid Services (CMS)-defined HCV quality indicators (QI) as a framework to assess the quality of care at an urban safety net hospital.<h4>Design</h4>Retrospective cohort.<h4>Participants</h4>Patients engaged in care (at least two outpatient visits, and minimum six-month follow-up time) between 2005 and 2011. Outcomes measur ...[more]

PMID: 24858880

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Project description:INTRODUCTION:Smoking remains a major public health issue and a leading cause of death and disability in the United States. The objective of this study was to determine the effect of a simple intervention on smoking guidance, based on the electronic medical record (EMR), including providing discharge instructions and/or cessation counseling to emergency department (ED) patients who smoke. METHODS:This was an interventional before-and-after study in an ED with 70000 visits per year. A pre-intervention and post-intervention chart review was performed on a random sample of ED visits occurring in 2014 and 2016, identifying smokers and the frequency with which smokers received discharge instructions and/or cessation counseling. In the fall of 2015, our EMR was programmed to deploy smoking cessation discharge instructions automatically. RESULTS:In all, 28.7% (172/600; 95% CI: 25.2-32.4%) reported current smoking in the pre-intervention ED population and 27.6% (166/600; 95% CI: 24.2-31.4%) reported smoking in the post-intervention population. Smoking cessation guidance was provided to a total of 3.5% of self-reported smokers in the pre-intervention group (6/172; 95% CI: 1.4-7.6%); 1.2% (2/172; 95% CI: 0.3-4.1%) were informed of smoking cessation resources as part of their printed ED discharge instructions and 2.3% (4/172; 95% CI: 0.9-5.8%) received smoking cessation counseling by the ED provider. There was a statistically significant increase in the proportion of patients receiving any smoking cessation guidance after the intervention. All patients (166/166; 95% CI: 97-100% in this period received ED discharge instructions and a list of smoking cessation resources and 3.6% of smokers (6/166; 95% CI: 1.7-7.7%) received smoking cessation counseling by the ED provider. CONCLUSIONS:Automated deployment of smoking cessation discharge instructions in the EMR improves smoking cessation discharge instructions, and also has a positive impact on improving rates of in-person counseling by ED providers.

Project description:BackgroundThe US faces a maternal health crisis and struggles to deliver recommended postpartum care. In some populations, less than half of mothers attend a postpartum visit.ObjectiveTo determine if a two-generation (Two-Gen) model of interdisciplinary, postpartum primary care was associated with increased visit attendance for postpartum care, primary care, and behavioral health.DesignRetrospective study of care delivered at a single, urban, academic, safety-net medical center between 2020 and 2023.ParticipantsMothers who received postpartum care in Two-Gen and a comparison group who received usual postpartum care.Main measuresAdjusted logistic regression to estimate the effect of Two-Gen participation on the odds of attending an early (birth-to-3 weeks) postpartum visit, later (4-to-12 weeks) postpartum visit, OB/GYN visit, and primary care visit.Key resultsA total of 247 mothers (98 Two-Gen and 149 usual care) were included for analysis. Most identified as Non-Hispanic Black (55%) or Hispanic (34%) and had Medicaid insurance (74%). On average, Two-Gen mothers were younger and more likely to be primiparous. Compared to usual care, Two-Gen mothers had similar rates of early postpartum visits (79% vs 64%; adjusted odds ratio (aOR) 1.70; 95% confidence interval (CI) 0.92-3.14) and were significantly more likely to have a later postpartum visit (92% vs 79%; aOR 2.46; 95%CI 1.06-5.74) in adjusted analyses. Almost all Two-Gen mothers (97%) had a visit with a primary care doctor in the first postpartum year, compared to 19% of mothers receiving usual care (aOR 12.95; 95%CI 6.80-24.68). Of those with behavioral health diagnoses, Two-Gen mothers had higher rates of psychiatrist visits than usual care mothers (49% vs 13%; p = 0.001).ConclusionsTwo-Gen clinic participation was associated with high rates of timely postpartum care in a group of predominantly young, publicly insured, racial, and ethnic minority mothers and compared favorably to usual care across multiple metrics, notably utilization of primary and behavioral health care.

Dataset Information

Quality of hepatitis C care at an urban tertiary care medical center.

Background

Objective

Design

Participants

Conclusions

Publications

Quality of hepatitis C care at an urban tertiary care medical center.

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