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Mangia G, Angelucci M, Golia C. Preoperative Evaluation Outpatient Clinic Management by Using Digital Health and Telemedicine Tools: The Virtual Preassessment. Anesth Analg 2024; 138:e48-e50. [PMID: 38771615 PMCID: PMC11081483 DOI: 10.1213/ane.0000000000007011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Affiliation(s)
- Giovanni Mangia
- Orbetello Hospital (GR), ASL South East Tuscany, Orbetello, Italy,
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Payne T, Kevric J, Stelmach W, To H. The Use of Electronic Consultations in Outpatient Surgery Clinics: Synthesized Narrative Review. JMIR Perioper Med 2022; 5:e34661. [PMID: 35436223 PMCID: PMC9052035 DOI: 10.2196/34661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 01/20/2022] [Accepted: 03/18/2022] [Indexed: 11/28/2022] Open
Abstract
Background Electronic consultations (eConsults) are an increasingly used form of telemedicine that allows a nonspecialist clinician to seek specialist advice remotely without direct patient-specialist communication. Surgical clinics may see benefits from such forms of communication but face challenges with the need for intervention planning. Objective We aimed to use the Quadruple Aim Framework to integrate published knowledge of surgical outpatient eConsults with regard to efficacy, safety, limitations, and evolving use in the era of COVID-19. Methods We systematically searched for relevant studies across four databases (Ovid MEDLINE, Embase, Scopus, and Web of Science) on November 4, 2021, with the following inclusion criteria: English language, published in the past 10 years, and data on the outcomes of outpatient surgical eConsults. Results A total of 363 studies were screened for eligibility, of which 33 (9.1%) were included. Most of the included studies were from the United States (23/33, 70%) and Canada (7/33, 21%), with a predominant multidisciplinary focus (9/33, 27%). Most were retrospective audits (16/33, 48%), with 15% (5/33) of the studies having a prospective component. Conclusions The surgical eConsult studies indicated a possible benefit for population health, promising safety results, enhanced patient and clinician experience, and cost savings compared with the traditional face-to-face surgical referral pathway. Their use appeared to be more favorable in some surgical subspecialties, and the overall efficacy was similar to that of medical subspecialties. Limited data on their long-term safety and use during the COVID-19 pandemic were identified, and this should be the focus of future research.
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Affiliation(s)
- Thomas Payne
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
- Department of Surgery, The Northern Hospital, Melbourne, Australia
| | - Jasmina Kevric
- Department of Surgery, The Northern Hospital, Melbourne, Australia
| | - Wanda Stelmach
- Department of Surgery, The Northern Hospital, Melbourne, Australia
| | - Henry To
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
- Department of Surgery, The Northern Hospital, Melbourne, Australia
- Department of Surgery, Werribee Mercy Hospital, Melbourne, Australia
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Connelly Y, Lotan R, Brzezinski Sinai Y, Rolls D, Beker A, Abensour E, Neudorfer O, Stocki D. Implementation of a Personalized Digital Application for Pediatric Pre-Anesthesia Evaluation and Education: An Ongoing Usability Analysis and Dynamic Improvement Scheme. JMIR Form Res 2022; 6:e34129. [PMID: 35416171 PMCID: PMC9121218 DOI: 10.2196/34129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 02/23/2022] [Accepted: 04/08/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Pre-anesthesia evaluation session is a basic practice preceding any surgical procedure, aimed at tailoring individualized anesthetic plan per patient, improving safety, and providing patients with educational knowledge and tools in preparation for the surgery day. In the last two decades, electronic health (eHealth) and mobile health (mHealth) settings gradually replaced part of the face-to-face encounters as the platform for pre-anesthesia communication between doctor and patient, yielding a range of benefits as demonstrated in recent publications. Yet, there is a lack of studies examining the effectiveness of surgical mHealth applications focusing on the pediatric preanesthetic setting and addressing their usability among families. OBJECTIVE This study describes a dynamic approach for the development process of GistMD's pre-anesthesia mHealth system, a mobile-based educational and management system designed for the pediatric setting. METHODS The study was conducted in four departments in a 1500-beds quaternary, academic medical center in Tel Aviv, Israel. During the study period, pre-anesthesia system was sent via text message to families whose children were about to undergo surgery. The system included pre-anesthesia questionnaires, educational videos, downloadable instructions, and consent forms. Ongoing collection and examination of usability data were conducted during the implementation term including responsiveness, effectiveness, and satisfaction indicators. The information collected in each stage was used to draw conclusions regarding potential usability gaps of the system and to plan product adjustments for the following period. RESULTS In a period of 141 days of implementation, GistMD pre-anesthesia management system was sent to 769 families. Three product fit actions were applied during this term: (1) Change of text message scheduling, aimed at addressing learnability and accessibility, resulted in a significant increase of 27% (χ2 [1] = 12.65, P<.001) in view rates and 27.4% (χ2 [1] = 30.01, P<.001) in satisfaction rates; (2) Reduce the number of screens, aimed at increasing efficiency and operability, resulted in a significant decrease of 8.6% of cases in which users did not perform any activity on the system after logging in (χ2 [1] = 6.18, P=.02); (3) Patient-focused campaign in two departments aimed at addressing memorability, resulted in significant increases in eight of twelve usability indicators. CONCLUSIONS Our results indicate that mHealth product-fit decisions derived from theory-based approach and ongoing usability data analysis allow tailoring of most appropriate responses for usability gaps, as reflected in increasing use rates and satisfaction. In the case of the pre-anesthesia management system in the pediatric setting, increased usability conveyed important benefits for patients and families. This work suggests a framework and study methods that may also be applicable in other mHealth settings and domains. CLINICALTRIAL
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Affiliation(s)
- Yaron Connelly
- GistMD, Stricker, 163, Tel Aviv, IL.,ICET - The Israeli Center for Emerging Technologies in Healthcare, Samir Medical Center, Zerifin, IL
| | | | - Yitzhak Brzezinski Sinai
- Department of Anesthesiology and Intensive Care, Tel Aviv Medical Center, Tel Aviv, IL.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, IL
| | | | | | | | - Orit Neudorfer
- GistMD, Stricker, 163, Tel Aviv, IL.,Dizengoff Pediatric Community Center, Clalit Health Services, Tel Aviv, IL
| | - Daniel Stocki
- Department of Anesthesiology and Intensive Care, Tel Aviv Medical Center, Tel Aviv, IL.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, IL
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Zhang K, Rashid-Kolvear M, Waseem R, Englesakis M, Chung F. Virtual preoperative assessment in surgical patients: A systematic review and meta-analysis. J Clin Anesth 2021; 75:110540. [PMID: 34649158 DOI: 10.1016/j.jclinane.2021.110540] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/26/2021] [Accepted: 10/02/2021] [Indexed: 12/19/2022]
Abstract
STUDY OBJECTIVE Preoperative assessment is a standard evaluation, traditionally done in-person in a preanesthesia clinic, for patients who will be undergoing a procedure involving anesthesia. Given the increased adoption of virtual care during the coronavirus disease 2019 (COVID-19) pandemic, the purpose of this systematic review and meta-analysis is to review the effectiveness of virtual preoperative assessment for the evaluation of surgical patients. DESIGN Systematic review and meta-analysis. SETTING MEDLINE (Ovid), MEDLINE InProcess/ePubs, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and ClinicalTrials.gov were searched from the initial coverage of the respective database to May 2021. A manual citation search of Google Scholar and PubMed was conducted to identify missed articles. Continued literature surveillance was done through July 2021. PATIENTS Patients aged 18 years and older undergoing virtual preoperative anesthesia assessment. INTERVENTIONS Virtual preoperative assessment. MEASUREMENTS Surgery cancellation rates, patient experience, resources saved, staff experience, success in using the data collected to diagnose and manage patients. MAIN RESULTS Fifteen studies (n = 31,496 patients) were included in this review. The average age of patients was 58 ± 15 years, and 47% were male. Virtual preoperative assessment resulted in similar surgery cancellation rates compared to in-person evaluation, with a pooled cancellation rate of 2% (95% confidence interval [CI]: 1-3%). Most studies reported a positive patient experience, with a pooled estimate of 90% (95% CI, 81-95%). There was a high success rate in using the information collected with virtual care, in the range of 92-100%, to diagnose and manage patients resulting in time and cost savings in the range of 24-137 min and $60-67 per patient. CONCLUSIONS This systematic review and meta-analysis demonstrates the utility of virtual care for preoperative assessment of surgical patients. Virtual preanesthesia evaluation had similar surgery cancellation rates, high patient satisfaction, and reduced costs compared to in-person evaluation.
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Affiliation(s)
- Kevin Zhang
- Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; Department of Anesthesia and Pain Management, University Health Network, University of Toronto, Toronto, ON M5T 2S8, Canada
| | - Matin Rashid-Kolvear
- Department of Anesthesia and Pain Management, University Health Network, University of Toronto, Toronto, ON M5T 2S8, Canada; School of Medicine, University College Dublin, Dublin, Leinster D04 C7X2, Ireland
| | - Rida Waseem
- Department of Anesthesia and Pain Management, University Health Network, University of Toronto, Toronto, ON M5T 2S8, Canada
| | - Marina Englesakis
- Library and Information Services, University Health Network, Toronto, ON M5G 2C4, Canada
| | - Frances Chung
- Department of Anesthesia and Pain Management, University Health Network, University of Toronto, Toronto, ON M5T 2S8, Canada.
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Gaye M, Mehrotra A, Byrnes-Enoch H, Chokshi D, Wallach A, Rodriguez L, Barnett ML. Association of eConsult Implementation With Access to Specialist Care in a Large Urban Safety-Net System. JAMA HEALTH FORUM 2021; 2:e210456. [PMID: 35977310 PMCID: PMC8796905 DOI: 10.1001/jamahealthforum.2021.0456] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 03/17/2021] [Indexed: 12/16/2022] Open
Abstract
Question What was the association of implementation of an eConsult program with access to specialty care in a large safety-net hospital system in the US? Findings In this study, 13% of submitted specialty referral requests were resolved electronically and, among requests requiring an in-person visit, appointment scheduling rates increased and wait times to an appointment decreased following eConsult implementation, while visit rates were unchanged. These improvements were mitigated during a hospital-level electronic health record transition. Meaning Wide-scale implementation of an eConsult program was associated with reduced wait times for patients in an urban safety-net health system with specialty care needs. Importance Accessing specialty care continues to be a persistent problem for patients who use safety-net health systems. To address this access barrier, hospital systems have begun to implement electronic referral systems using eConsults, which allow clinicians to submit referral requests to specialty clinics electronically and enable specialty reviewers to resolve referrals, if appropriate, through electronic dialogue without an in-person visit. Objective Measure the effect of implementing an eConsult program on access to specialty care. Design, Setting, and Participants Using an interrupted time series design with data from 2016 to 2020, this study analyzed 50 260 referral requests submitted during the year before and the year after eConsult implementation at 19 New York City Health + Hospitals (NYC H+H) specialty clinics that spanned 7 NYC H+H hospital facilities and 6 unique specialties. Exposures Referral request was submitted to a specialty clinic in the year following eConsult implementation. Main Outcomes and Measures Main outcomes included the fraction of referral requests resolved without an in-person visit following eConsult implementation; and, among requests triaged to have an in-person visit, the fraction of referrals with a successfully scheduled appointment, mean wait time to a specialty appointment, and the fraction of referral requests with a completed specialty visit. Changes associated with eConsult implementation were estimated using multivariate linear regression adjusting for patient age, gender, and specialty clinic fixed effects. Results Across 19 NYC H+H specialty clinics, 26 731 referral requests were submitted in the year before and 23 529 referrals were submitted in the year after eConsult implementation. Following eConsult implementation, 13% of all requests were resolved electronically. Among requests requiring a follow-up visit, the fraction with an appointment successfully scheduled increased by 15.8%, from 66.5% to 82.3% (P < .001). The mean time to an appointment decreased from 61.0 days pre-eConsult to 54.1 days post-eConsult, an adjusted 8.2-day shorter wait time (or 13.3% reduction) following eConsult adoption (P < .001). The percentage of referrals with a completed follow-up visit with a specialist within 90 days of the request did not change (38.4% vs 37.9%, P = .07). Changes in outcomes were mitigated during months when most clinics underwent an electronic health record transition after implementing eConsult. Conclusions and Relevance In this quality improvement study, implementation of eConsults at a large multi-specialty safety-net system was associated with improvements in appointment scheduling rates and wait times. Despite an additional electronic health record transition, eConsults are a promising health care delivery tool for increasing access to specialty care.
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Affiliation(s)
- Marema Gaye
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Ateev Mehrotra
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | | | - Dave Chokshi
- New York City Department of Health and Mental Hygiene, New York, New York
- Department of Population Health, New York University Grossman School of Medicine, New York, New York
- Department of Medicine, New York University Grossman School of Medicine, New York, New York
| | - Andrew Wallach
- Department of Medicine, New York University Grossman School of Medicine, New York, New York
- Office of Ambulatory Care, New York City Health + Hospitals, New York, New York
| | - Laura Rodriguez
- Office of Ambulatory Care, New York City Health + Hospitals, New York, New York
| | - Michael L. Barnett
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
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Qi M, Cui J, Li X, Han Y. Perceived Factors Influencing the Public Intention to Use E-Consultation: Analysis of Web-Based Survey Data. J Med Internet Res 2021; 23:e21834. [PMID: 33470934 PMCID: PMC7857952 DOI: 10.2196/21834] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 09/24/2020] [Accepted: 12/17/2020] [Indexed: 12/18/2022] Open
Abstract
Background Unbalanced distribution of medical resources is becoming a major challenge, particularly in the selection of doctors. e-Consultation could provide patients with more choices of doctors and break the constraints of time and space. However, the acceptance of e-consultation is still poor and the mechanism of adoption is unclear. Objective The aim of this study was to identify the factors influencing the public intention to use e-consultation and explore the effect path of the factors and behavior intention. Methods The hypotheses of our research model were developed based on the technology acceptance model and perceived risk theory. A web-based survey was conducted by an electronic questionnaire collection platform; this survey that consisted of a 29-item questionnaire with 5-point Likert scales was completed by 934 respondents. Structural equation modeling was used to analyze the data. Item evaluation and reliability, validity, path loading, goodness of fit, and multiple group analysis were used to check the moderation effects. Results The standardized factor loadings of the items were between 0.551 and 0.873. The composite reliability of 9 constructs ranged from 0.706 to 0.840. The average variance extracted ranged from 0.387 to 0.640. The fitness indices showed that the collected data fitted well with the research model. Perceived usefulness was the strongest positive factor effecting behavior intention (β=.399, P<.001). Perceived ease of use had a positive effect on behavior intention but it was not statistically significant (β=.117, P=.07) and it had a positive effect on perceived usefulness (β=.537, P<.001). Perceived risk could be well explained by financial risk (β=.972, P<.001), privacy risk (β=.774, P<.001), social risk (β=.871, P<.001), time risk (β=.894, P<0.001), and psychological risk (β=.774, P<.001). Perceived risk had negative effects on perceived usefulness (β=–.375, P<.001) and behavior intention (β=–.297, P<.001). Personal innovativeness had a positive influence on perceived ease of use (β=.241, P<.001) and a slight effect on behavior intention (β=.124, P=.001). Age (χ258=133.5, P<.001) and usage experience (χ258=82.5, P=.02) had a slight moderation effect on the paths. Conclusions Perceived usefulness and perceived risk have significant effects on public intention to use e-consultation. Therefore, platform and manufacturer must improve the function of e-consultation, which will promote the public intention to use e-consultation fundamentally. In order to control the perceived risk of public, government should play an important role in enforcing management of e-consultation markets and approving corresponding medical insurance policies. Besides, personal innovativeness had an effect on behavior intention. Moreover, the paths of factors had some heterogeneity among people with different characteristics. Therefore, it is necessary to adjust the strategies to fit more groups better.
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Affiliation(s)
- Miaojie Qi
- School of Public Health, Capital Medical University, Beijing, China
| | - Jiyu Cui
- School of Public Health, Capital Medical University, Beijing, China
| | - Xing Li
- School of Public Health, Capital Medical University, Beijing, China
| | - Youli Han
- School of Public Health, Capital Medical University, Beijing, China
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Vimalananda VG, Orlander JD, Afable MK, Fincke BG, Solch AK, Rinne ST, Kim EJ, Cutrona SL, Thomas DD, Strymish JL, Simon SR. Electronic consultations (E-consults) and their outcomes: a systematic review. J Am Med Inform Assoc 2021; 27:471-479. [PMID: 31621847 DOI: 10.1093/jamia/ocz185] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 08/06/2019] [Accepted: 09/30/2019] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Electronic consultations (e-consults) are clinician-to-clinician communications that may obviate face-to-face specialist visits. E-consult programs have spread within the US and internationally despite limited data on outcomes. We conducted a systematic review of the recent peer-reviewed literature on the effect of e-consults on access, cost, quality, and patient and clinician experience and identified the gaps in existing research on these outcomes. MATERIALS AND METHODS We searched 4 databases for empirical studies published between 1/1/2015 and 2/28/2019 that reported on one or more outcomes of interest. Two investigators reviewed titles and abstracts. One investigator abstracted information from each relevant article, and another confirmed the abstraction. We applied the GRADE criteria for the strength of evidence for each outcome. RESULTS We found only modest empirical evidence for effectiveness of e-consults on important outcomes. Most studies are observational and within a single health care system, and comprehensive assessments are lacking. For those outcomes that have been reported, findings are generally positive, with mixed results for clinician experience. These findings reassure but also raise concern for publication bias. CONCLUSION Despite stakeholder enthusiasm and encouraging results in the literature to date, more rigorous study designs applied across all outcomes are needed. Policy makers need to know what benefits may be expected in what contexts, so they can define appropriate measures of success and determine how to achieve them.
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Affiliation(s)
- Varsha G Vimalananda
- Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, Bedford, Massachusetts, USA.,Section of Endocrinology, Diabetes, and Metabolism, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Jay D Orlander
- Department of General Medicine, VA Boston Healthcare System, Boston, Massachusetts, USA.,Evans Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Melissa K Afable
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Quality, Safety and Value, Partners Healthcare System, Boston, Massachusetts, USA
| | - B Graeme Fincke
- Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, Bedford, Massachusetts, USA.,Section of Health Law, Policy & Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Amanda K Solch
- Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, Bedford, Massachusetts, USA
| | - Seppo T Rinne
- Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, Bedford, Massachusetts, USA.,Section of Pulmonary, Allergy, Sleep, and Critical Care Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Eun Ji Kim
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, USA.,Division of General Internal Medicine, Zucker School of Medicine, Hofstra Northwell, Manhasset, New York, USA
| | - Sarah L Cutrona
- Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, Bedford, Massachusetts, USA.,Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Dylan D Thomas
- Center for Healthcare Organization and Implementation Research, Bedford VA Medical Center, Bedford, Massachusetts, USA.,Section of Endocrinology, Diabetes, and Metabolism, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Judith L Strymish
- Department of Medicine, Harvard Medical School, Cambridge, Massachusetts, USA.,Department of Medicine and Infectious Diseases, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Steven R Simon
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Medicine, Harvard Medical School, Cambridge, Massachusetts, USA.,Geriatrics and Extended Care Service, VA Boston Healthcare System, Boston, Massachusetts, USA
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Shahait AD, Alghanem L, Cmorej P, Tracy W, Hasnain MR, Baldawi M, Girten K, Weaver D, Saleh KJ, Gruber SA, Mostafa G. Postoperative outcomes of ventral hernia repair in veterans. Surgery 2020; 169:603-609. [PMID: 33077198 DOI: 10.1016/j.surg.2020.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 08/30/2020] [Accepted: 09/01/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Ventral hernia repair is a common procedure with reported 15% to 37% morbidity and 0.3% to 1.4% mortality rates. This study examines the 30-day morbidity and mortality of open and laparoscopic ventral hernia repair in veterans, along with the impact of body mass index on these outcomes. METHODS The Veterans Affairs Surgical Quality Improvement Program was queried for all ventral hernia repairs during the period 2008 to 2015. In this retrospective analysis, we compared outcomes of open ventral hernia repair versus laparoscopic ventral hernia repair and among different body mass index classes. RESULTS A total of 19,883 patients were identified (92.6% male, mean age 59.7, 53.1% obese, and 71.6% with American Society of Anesthesiologists class ≥III). There were 95 (0.5%) mortalities, and complications occurred in 1,289 (6.5%) patients. Open ventral hernia repair was performed in 60.2%; 14.5% were recurrent, and 3.3% were performed as an emergency operation. When compared with open ventral hernia repair, the laparoscopic ventral hernia repair group had higher mean body mass index, less patients with American Society of Anesthesiologists class ≥III, fewer emergency operations, longer operative time, less complications, decreased mortality, and shorter duration of stay. Body mass index 35.00 to 49.99 was predictive of overall complications in the open ventral hernia repair group. CONCLUSION Ventral hernia repair can be performed in the veteran population with outcomes comparable to those in the private sector. Morbid obesity has a negative impact on ventral hernia repair outcomes that is most prominent following open surgery. Laparoscopic ventral hernia repair may offer superior outcomes when compared to open ventral hernia repair and may be considered.
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Affiliation(s)
- Awni D Shahait
- Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine/Detroit Medical Center, Detroit, MI; Department of Surgery, John D. Dingell VA Medical Center, Detroit, MI
| | - Lana Alghanem
- The Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI
| | - Peter Cmorej
- Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine/Detroit Medical Center, Detroit, MI; Department of Surgery, John D. Dingell VA Medical Center, Detroit, MI
| | - William Tracy
- Department of Surgery, John D. Dingell VA Medical Center, Detroit, MI
| | | | - Mohanad Baldawi
- Department of Surgery, John D. Dingell VA Medical Center, Detroit, MI
| | - Kara Girten
- Department of Surgery, John D. Dingell VA Medical Center, Detroit, MI
| | - Donald Weaver
- Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine/Detroit Medical Center, Detroit, MI
| | - Khaled J Saleh
- Department of Surgery, John D. Dingell VA Medical Center, Detroit, MI
| | - Scott A Gruber
- Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine/Detroit Medical Center, Detroit, MI; Department of Surgery, John D. Dingell VA Medical Center, Detroit, MI
| | - Gamal Mostafa
- Michael and Marian Ilitch Department of Surgery, Wayne State University School of Medicine/Detroit Medical Center, Detroit, MI; Department of Surgery, John D. Dingell VA Medical Center, Detroit, MI.
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The prevalence of preoperative medical testing and consultation in cataract surgery patients at a teaching hospital. J Cataract Refract Surg 2020; 46:827-830. [PMID: 32347690 DOI: 10.1097/j.jcrs.0000000000000153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the prevalence of preoperative cataract surgery testing and consultation at a single United States teaching hospital. SETTING Academic-affiliated Veterans Affairs Medical Center. DESIGN Retrospective chart review. METHODS This study included patients who received cataract surgery from 2014 to 2018. For patients with bilateral cataracts, the second surgery was excluded to ensure independent selection. Charlson Comorbidity Index (CCI) scores and heart disease status were recorded. The outcomes of interest were preoperative testing, such as complete blood count, chemistry panel, and echocardiography, and consultation (office visits to non-ophthalmologists) during the period between the date the decision was made to proceed with surgery and the cataract surgery date. RESULTS For this study 1320 charts were reviewed; 1257 (95.2%) patients met the study criteria. The mean CCI score was 1.7; 42.0% (528/1257) had heart disease. The prevalence of preoperative testing was 0.08% (1/1257). The prevalence of preoperative consultation was 4.2% (53/1257); 86.8% (46/53) of patients received cardiology consultation; 17.0% (9/53) pulmonology; and 15.1% (8/53) primary care. Of the patients who received cardiac consultation, 63.0% (29/46) had heart disease; the remaining had an electrocardiogram abnormality. CONCLUSIONS There was a low prevalence of preoperative testing and consultation for cataract surgery at this teaching hospital. Further studies using medical record data are needed to assess the current rates and the role of preoperative testing and consultation for cataract surgery patients.
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Abstract
Patients with gynecologic cancers experience better outcomes when treated by specialists and institutions with experience in their diseases. Unfortunately, high-volume centers tend to be located in densely populated regions, leaving many women with geographic barriers to care. Remote management through telemedicine offers the possibility of decreasing these disparities by extending the reach of specialty expertise and minimizing travel burdens. Telemedicine can assist in diagnosis, treatment planning, preoperative and postoperative follow-up, administration of chemotherapy, provision of palliative care, and surveillance. Telemedical infrastructure requires careful consideration of the needs of relevant stakeholders including patients, caregivers, referring clinicians, specialists, and health system administrators.
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Cyr ME, Etchin AG, Guthrie BJ, Benneyan JC. Access to specialty healthcare in urban versus rural US populations: a systematic literature review. BMC Health Serv Res 2019; 19:974. [PMID: 31852493 PMCID: PMC6921587 DOI: 10.1186/s12913-019-4815-5] [Citation(s) in RCA: 105] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 12/05/2019] [Indexed: 11/25/2022] Open
Abstract
Background Access to healthcare is a poorly defined construct, with insufficient understanding of differences in facilitators and barriers between US urban versus rural specialty care. We summarize recent literature and expand upon a prior conceptual access framework, adapted here specifically to urban and rural specialty care. Methods A systematic review was conducted of literature within the CINAHL, Medline, PubMed, PsycInfo, and ProQuest Social Sciences databases published between January 2013 and August 2018. Search terms targeted peer-reviewed academic publications pertinent to access to US urban or rural specialty healthcare. Exclusion criteria produced 67 articles. Findings were organized into an existing ten-dimension care access conceptual framework where possible, with additional topics grouped thematically into supplemental dimensions. Results Despite geographic and demographic differences, many access facilitators and barriers were common to both populations; only three dimensions did not contain literature addressing both urban and rural populations. The most commonly represented dimensions were availability and accommodation, appropriateness, and ability to perceive. Four new identified dimensions were: government and insurance policy, health organization and operations influence, stigma, and primary care and specialist influence. Conclusions While findings generally align with a preexisting framework, they also suggest several additional themes important to urban versus rural specialty care access.
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Affiliation(s)
- Melissa E Cyr
- School of Nursing, Northeastern University, 360 Huntington Avenue, Boston, MA, 02115, USA
| | - Anna G Etchin
- VA Boston Healthcare System, 150 South Huntington Avenue, Jamaica Plain, MA, 02130, USA
| | - Barbara J Guthrie
- Bouvé College of Health Sciences, Northeastern University, 360 Huntington Avenue, Boston, MA, 02115, USA
| | - James C Benneyan
- Healthcare Systems Engineering Institute, Northeastern University, 360 Huntington Avenue, Boston, MA, 02115, USA.
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