Deep Blue at the University of Michigan
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The incomplete infrastructure for interhospital patient transfer - Iwashyna, Theodore J
Interhospital transfer of critically ill patients is a common part of their care. This article sought to review the data on the current patterns of use of interhospital transfer and identify systematic barriers to optimal integration of transfer as a mechanism for improving patient outcomes and value of care.
Narrative review of medical and organizational literature.
Interhospital transfer of patients is common, but not optimized to improve patient outcomes. Although there is a wide variability in quality among hospitals of nominally the same capability, patients are not consistently transferred to the highest quality nearby hospital. Instead, transfer destinations are selected by...
The Burdens of Survivorship: An Approach to Thinking about Long-Term Outcomes after Critical Illness. - Iwashyna, Theodore J.; Netzer, Giora
Internationally accepted approaches to the study of functioning and disability can inform critical care practitioners and scholars in their study of functional limitations, disability, and quality of life after critical illness and intensive care. Therefore this article provides an introduction to the World Health Organization's International Classification of Functioning, Disability and Health (ICF). The Institute of Medicine has also recommended this approach for the study of disability. This conceptual framework divides potential problems as follows: problems in body structure and tissue, limitations in activity (i.e., functional limitations as assessed in standardized environments), and restrictions in participation (i.e., the inability to...
Despite variation in volume, Veterans Affairs hospitals show consistent outcomes among patients with non-postoperative mechanical ventilation - Cooke, Colin R; Kennedy, Edward H; Wiitala, Wyndy L; Almenoff, Peter L; Sales, Anne E; Iwashyna, Theodore J
To assess the relationship between volume of nonoperative mechanically ventilated patients receiving care in a specific Veterans Health Administration hospital and their mortality.
Retrospective cohort study.
One-hundred nineteen Veterans Health Administration medical centers.
We identified 5,131 hospitalizations involving mechanically ventilated patients in an intensive care unit during 2009, who did not receive surgery.
MEASUREMENTS AND MAIN RESULTS:
We extracted demographic and clinical data from the VA Inpatient Evaluation Center. For each hospital, we defined volume as the total number of nonsurgical admissions receiving mechanical ventilation in an intensive care unit during 2009. We examined the hospital contribution to 30-day mortality using multilevel logistic regression models...
Depressive symptoms in spouses of older patients with severe sepsis - Davydow, Dimitry S; Hough, Catherine L; Langa, Kenneth M; Iwashyna, Theodore J.
To examine whether spouses of patients with severe sepsis are at increased risk for depression independent of the spouse's presepsis history, whether this risk differs by sex, and is associated with a sepsis patient's disability after hospitalization.
Prospective longitudinal cohort study.
Population-based cohort of U.S. adults over 50 yrs old interviewed as part of the Health and Retirement Study (1993-2008).
Nine hundred twenty-nine patient-spouse dyads comprising 1,212 hospitalizations for severe sepsis.
MEASUREMENTS AND MAIN RESULTS:
Severe sepsis was identified using a validated algorithm in Medicare claims. Depression was assessed with a modified version of the Center for Epidemiologic Studies Depression Scale. All analyses were stratified...
Chemotherapy was not associated with cognitive decline in older adults with breast and colorectal cancer: findings from a prospective cohort study - Shaffer, VA; Merkle, EC; Fagerlin, A; Griggs, Jennifer J; Langa, Kenneth M; Iwashyna, Theodore J
: This study tested 2 hypotheses: (1) chemotherapy increases the rate of cognitive decline in breast and colorectal cancer patients beyond what is typical of normal aging and (2) chemotherapy results in systematic cognitive declines when compared with breast and colorectal cancer patients who did not receive chemotherapy.
: Data came from personal interviews with a prospective cohort of patients with breast (n=141) or colorectal cancer (n=224) with incident disease drawn from the nationally representative Health and Retirement Study (1998-2006) with linked Medicare claims.
: The 27-point modified Telephone Interview for Cognitive Status was used to assess cognitive functioning, focusing on memory...
Population burden of long-term survivorship after severe sepsis in older Americans - Iwashyna, Theodore J.; Cooke, Colin R.; Wunsch, Hannah; Kahn, Jeremy M
To ascertain the absolute number of Medicare beneficiaries surviving at least 3 years after severe sepsis and to estimate their burden of cognitive dysfunction and disability.
Retrospective cohort analysis of Medicare data.
All short-stay inpatient hospitals in the United States, 1996 to 2008.
Individuals aged 65 and older.
Severe sepsis was detected using a standard administrative definition. Case-fatality, prevalence, and incidence rates were calculated.
Six hundred thirty-seven thousand eight hundred sixty-seven Medicare beneficiaries were alive at the end of 2008 who had survived severe sepsis 3 or more years earlier. An estimated 476,862 (95% confidence interval (CI) = 455,026-498,698) had functional disability, with 106,311 (95%...