By UlricheDmond on September 2nd, 2010
Is physician engagement with Web-based CME associated with patients’ baseline hemoglobin A1c levels? The Rural Diabetes Online Care study.
Acad Med. 2010 Sep;85(9):1511-7
Authors: Crenshaw K, Curry W, Salanitro AH, Safford MM, Houston TK, Allison JJ, Estrada CA
PURPOSE: To investigate the association between physician participants’ levels of engagement in a Web-based educational intervention and their patients’ baseline diabetes measures. METHOD: The authors conducted a randomized trial of online CME activities designed to improve diabetes care provided by family, general, and internal medicine physicians in rural areas of 11 southeastern states between September 2006 and July 2008. Using incidence rate ratios derived from negative binomial models, the relationship between physicians’ engagement with the study Web site and baseline proportion of their patients having controlled diabetes (hemoglobin A1c < or = 7%) was explored. RESULTS: One hundred thirty-three participants (intervention = 64; control = 69) provided information for 1,637 patients with diabetes. In the intervention group, physicians in practices in the worst quartiles of A1c control were least engaged with the study Web site in nearly all dimensions. Total number of pages viewed decreased as quartile of A1c control worsened (137, 73, 68, 57; P = .007); similarly, for a given 10% increase in proportion of patients with controlled A1c, participants viewed 1.13 times more pages (95% CI: 1.02-1.26, P = .02). In the control group, engagement was neither correlated with A1c control nor different across quartiles of A1c control. CONCLUSIONS: Engagement in Web-based interventions is measurable and has important implications for research and education. Because physicians of patients with the greatest need for improvement in A1c control may not use online educational resources as intensely as others, other strategies may be necessary to engage these physicians in professional development activities.
20736679
– Is physician engagement with Web-based CME associated with patients’ baseline hemoglobin A1c levels? The Rural Diabetes Online Care study.
By blog1wgyxj on September 2nd, 2010
Is physician engagement with Web-based CME associated with patients’ baseline hemoglobin A1c levels? The Rural Diabetes Online Care study.
Acad Med. 2010 Sep;85(9):1511-7
Authors: Crenshaw K, Curry W, Salanitro AH, Safford MM, Houston TK, Allison JJ, Estrada CA
PURPOSE: To investigate the association between physician participants’ levels of engagement in a Web-based educational intervention and their patients’ baseline diabetes measures. METHOD: The authors conducted a randomized trial of online CME activities designed to improve diabetes care provided by family, general, and internal medicine physicians in rural areas of 11 southeastern states between September 2006 and July 2008. Using incidence rate ratios derived from negative binomial models, the relationship between physicians’ engagement with the study Web site and baseline proportion of their patients having controlled diabetes (hemoglobin A1c < or = 7%) was explored. RESULTS: One hundred thirty-three participants (intervention = 64; control = 69) provided information for 1,637 patients with diabetes. In the intervention group, physicians in practices in the worst quartiles of A1c control were least engaged with the study Web site in nearly all dimensions. Total number of pages viewed decreased as quartile of A1c control worsened (137, 73, 68, 57; P = .007); similarly, for a given 10% increase in proportion of patients with controlled A1c, participants viewed 1.13 times more pages (95% CI: 1.02-1.26, P = .02). In the control group, engagement was neither correlated with A1c control nor different across quartiles of A1c control. CONCLUSIONS: Engagement in Web-based interventions is measurable and has important implications for research and education. Because physicians of patients with the greatest need for improvement in A1c control may not use online educational resources as intensely as others, other strategies may be necessary to engage these physicians in professional development activities.
20736679
– Is physician engagement with Web-based CME associated with patients’ baseline hemoglobin A1c levels? The Rural Diabetes Online Care study.
By dr_vinieet on August 11th, 2010
Communication discrepancies between physicians and hospitalized patients.
Arch Intern Med. 2010 Aug 9;170(15):1302-7
Authors: Olson DP, Windish DM
BACKGROUND: Hospital surveys indicate lack of patient awareness of diagnoses and treatments, yet physicians report they effectively communicate with patients. Gaps in understanding and communication could result in decreased quality of care. We sought to assess patient knowledge and perspectives of inpatient care and determine differences from physician assessments. METHODS: Two validated questionnaires assessed the experiences of inpatients treated by house staff from October 10, 2008, through June 23, 2009. We surveyed corresponding internal medicine resident and attending physicians, asking them to report on their care of hospitalized patients and their understanding of their patients’ perspectives on the care received. RESULTS: Eighty-nine patients and 43 physicians participated. Although 73% of patients thought there was 1 main physician, 18% correctly named that physician, compared with 67% of physicians who thought patients knew their names (P < .001). Most physicians (77%) believed patients knew their diagnosis; however, 57% of patients did (P < .001). A total of 58% of patients thought that physicians always explained things in a comprehensible way, compared with 21% of physicians who stated they always provided explanations of some kind (P < .001). Two-thirds of patients reported receiving a new medication in the hospital, yet 90% noted never being told of any adverse effects of these medications. Nearly all physicians (98%) stated that they at least sometimes discussed their patients' fears and anxieties, compared with 54% of patients who said their physicians never did this (P = .001). CONCLUSIONS: Significant differences exist between patients' and physicians' impressions about patient knowledge and inpatient care received. Steps to improve patient-physician communication should be identified and implemented.
20696951
– Communication discrepancies between physicians and hospitalized patients.
By nightwal7 on August 11th, 2010
Outcomes and processes of care related to preoperative medical consultation.
Arch Intern Med. 2010 Aug 9;170(15):1365-74
Authors: Wijeysundera DN, Austin PC, Beattie WS, Hux JE, Laupacis A
BACKGROUND: Preoperative consultations by internal medicine physicians facilitate documentation of comorbid disease, optimization of medical conditions, risk stratification, and initiation of interventions intended to reduce risk. Nonetheless, the impact of these consultations, which may be performed by general internists or specialists, on outcomes is unclear. METHODS: We used population-based administrative databases to conduct a cohort study of patients 40 years or older who underwent major elective noncardiac surgery in Ontario, Canada, between 1994 and 2004. Propensity scores were used to assemble a matched-pairs cohort that reduced differences between patients who did and did not undergo preoperative consultation by general internists or specialists. The association of consultation with mortality and hospital stay was determined within this matched cohort. As a sensitivity analysis, we evaluated the association of consultation with an outcome for which no difference would be expected: postoperative wound infection. RESULTS: Of 269 866 patients in the cohort, 38.8% (n = 104 695) underwent consultation. Within the matched cohort (n = 191 852), consultation was associated with increased 30-day mortality (relative risk [RR], 1.16; 95% confidence interval [CI], 1.07-1.25; number needed to harm, 516), 1-year mortality (1.08; 1.04-1.12; number needed to harm, 227), mean hospital stay (difference, 0.67 days; 0.59-0.76), preoperative testing, and preoperative pharmacologic interventions. Notably, consultation was not associated with any difference in postoperative wound infections (RR, 0.98; 95% CI, 0.95-1.02). These findings were stable across subgroups as well as sensitivity analyses that tested for unmeasured confounding. CONCLUSIONS: Medical consultation before major elective noncardiac surgery is associated with increased mortality and hospital stay, as well as increases in preoperative pharmacologic interventions and testing. These findings highlight the need to better understand mechanisms by which consultation influences outcomes and to identify efficacious interventions to decrease perioperative risk.
20696963
– Outcomes and processes of care related to preoperative medical consultation.
