Eileen M. Stock

A successful multifaceted strategy to improve hand hygiene compliance rates

Health care-acquired infections are a major contributor of mortality; therefore, prevention of these infections is a priority. Hand hygiene compliance among health care workers is low. We report the process at our institution to increase the hand hygiene compliance rate (HHCR).We implemented interventions over 6xa0months. The periods were divided into preintervention, intervention, and postintervention, and the monthly HHCR was calculated. The primary objective was to measure the HHCR after the intervention period and ensure sustainability. There were 25,372 observations, with 22,501 compliant events, for an overall HHCR of 88.7%. The HHCR improved over time (preintervention, 72.7%; invention, 79.7%; postintervention, 93.2%), with significance between pre-and postintervention periods (Pxa0<xa0.002). The HHCR stabilized after all interventions and was sustained over 22xa0months. Our study highlights a multifaceted intervention, including administrative leadership, that led to an increase in the HHCR. Institutions should individualize their multimodal approach to include administrative leadership to achieve a high, sustained HHCR.

Racial/Ethnic disparities in monitoring metabolic parameters for patients with schizophrenia receiving antipsychotic medications.

OBJECTIVEnPatients with schizophrenia experience risks for metabolic dysregulation from medications and lifestyle behaviors. Although most patients with schizophrenia in the Veterans Health Administration (VA) receive antipsychotics, variation in monitoring metabolic dysregulation by race/ethnicity has not been assessed. This study analyzed differential monitoring of metabolic parameters by minority status.nnnMETHODSnThis retrospective study approximated the five components of metabolic syndrome (fasting glucose, high-density-lipoprotein cholesterol, triglycerides, blood pressure, and large waistline) using archival data, substituting body mass index for waistline. VA patients with schizophrenia age 50 or older were followed from October 1, 2001 through September 2009 (N = 30,258). Covariates included age, gender, race (white, black), Hispanic ethnicity, region, marital status, VA priority status, comorbidity, and antipsychotic type. Repeated-measures analysis assessed the association of race/ethnicity with metabolic monitoring.nnnRESULTSnAverage patients age was 59 years (standard deviation: 9; range: 50-101), 97% were men, 70% white, 30% black, and 8% Hispanic. At baseline, 6% were monitored on all five metabolic components; this increased to 29% by 2005. In adjusted models, blacks were less likely to be monitored on all parameters, whereas Hispanics were less likely to have glucose and high-density-lipoprotein cholesterol monitored but more likely to have triglycerides tested. By 2009, lab assays were similar across race and ethnicity.nnnCONCLUSIONnGuideline-concordant monitoring metabolic parameters appear to be equitable but low and somewhat at odds with racial/ethnic risk among older patients with schizophrenia. Physicians should discuss lipids, weight, and glucose with patients at risk for developing heart disease, diabetes, and other sequelae of the metabolic syndrome.

Prognostication of Survival Outcomes in Patients Diagnosed with Glioblastoma

OBJECTIVEnGlioblastoma multiforme (GBM) is an aggressive primary brain tumor with dismal survival. This study aims to examine the prognostic value of primary tumor sites and race on survival outcomes.nnnMETHODSnPatient data obtained from the Scott and White Hospital Brain Tumor Registry (1976-2013) were stratified according to sex, age, race, primary tumor site, vital status, and survival.nnnRESULTSnOf the 645 patients, 580 (89.9%) were diagnosed with GBM not otherwise specified (GBM NOS), 57 (8.8%) with GBM, and 8 (1.2%) with giant-cell GBM. Most were male (53.5%), aged 50 years or older (78.7%). The white population had the highest GBM prevalence (87.1%) and the lowest overall survival versus all other race groups (6.6% vs. 30.1%; P < 0.01). The black population had a relatively low prevalence of GBM (5.9%) and the greatest overall survival versus all others (47.4% vs. 7.3%; P < 0.01). Primary tumor sites located in the temporal (25.8% vs. 20.2%; Pxa0= 0.03), occipital (8.1% vs. 2.9%; Pxa0= 0.05), and parietal lobes (24.2% vs. 20.8%; Pxa0= 0.05) had a greater occurrence in surviving individuals. The overall survival for men versus women was (62.9% vs. 37.1%; Pxa0= 0.12).nnnCONCLUSIONSnBlack racial background and temporal, occipital, or parietal primary tumor sites are suggestive of positive survival outcomes. Conversely, white racial background with primary tumor sites in the brain overlapping and NOS areas seem to be associated with negative outcomes and decreased survival. Thus, racial background and primary tumor site may be useful prognostic factors in patients with GBM.

Mental health treatment after major surgery among Vietnam-era Veterans with posttraumatic stress disorder

The purpose of this study was to examine mental health treatment use among Vietnam Veterans with posttraumatic stress disorder and determine whether undergoing major surgery interrupted mental health treatment or increased the risk of psychiatric hospitalization. Using retrospective data from Veterans Health Administration’s electronic medical record system, a total of 3320 Vietnam-era surgery patients with preoperative posttraumatic stress disorder were identified and matched 1:4 with non-surgical patients with posttraumatic stress disorder. The receipt of surgery was associated with a decline in overall mental health treatment and posttraumatic stress disorder–specific treatment 1u2009month following surgery but not during any subsequent month thereafter. Additionally, surgery was not associated with psychiatric admission.

Payer types associated with antipsychotic polypharmacy in an ambulatory care setting

Objectivesu2002 Antipsychotic polypharmacy is increasingly prescribed despite little documented evidence of a therapeutic benefit. There is also a limited understanding of the role that health insurance plays on the prevalence of antipsychotic polypharmacy. This study was undertaken to investigate the relationship between antipsychotic polypharmacy and individuals intended source of payment in a US national sample of ambulatory care patients.

Bayesian Interval Estimation for the Difference in TPRs and FPRs of Two Diagnostic Tests with Unverified Negatives

We derive Bayesian interval estimators for the differences in the true positive rates and false positive rates of two dichotomous diagnostic tests applied to the members of two distinct populations. The populations have varying disease prevalences with unverified negatives. We compare the performance of the Bayesian credible interval to the Wald interval using Monte Carlo simulation for a spectrum of different TPRs, FPRs, and sample sizes. For the case of a low TPR and low FPR, we found that a Bayesian credible interval with relatively noninformative priors performed well. We obtain similar interval comparison results for the cases of a high TPR and high FPR, a high TPR and low FPR, and of a high TPR and mixed FPR after incorporating mildly informative priors.

PS1-37: Comparison of Antipsychotic Polypharmacy Trends among Schizophrenia Patients across Multiple Healthcare Systems

Background/Aims Although a number of international guidelines recommend antipsychotic monotherapy in patients with schizophrenia, frequently the complex pharmacological treatment for these individuals involves multiple medications. To investigate prescribing patterns for patients with schizophrenia, this study examined antipsychotic polypharmacy across multiple outpatient healthcare settings (including two HMORN sites) and their association with hospital admission. Methods This multi-system study utilized data on patients diagnosed with schizophrenia, including 119,662 Veterans in the Department of Veterans Affairs (VA) healthcare system, 553 and 4,887 patients in two private, integrated health systems (HMORN), and outpatients (17,596,617 visits in 1-week look-back) from a nationally representative sample of U.S. residents seeking care outside federal systems (National Ambulatory Medical Care Survey, NAMCS). Antipsychotic polypharmacy was defined as use of more than one antipsychotic drug (first or second generation) during the covered period (week, year). The prevalence and trend of antipsychotic polypharmacy was assessed in each system (2002–2009 or 2005–2009) and their association with one-year hospital admission using multivariable logistic regression. Results Annual antipsychotic treatment in the VA ranged between 74–78% each year, with the lowest rates observed in the HMORN systems (49–67% site 1, 22–41% site 2) per pharmacy fill data; NAMCS ranged between 69–84% per clinician-reported prescriptions. Polypharmacy rates depended on the defined covered period. The VA had lower polypharmacy when data were restricted to the one-week covered period used in non-federal systems (20–22% vs. 19–31% NAMCS). In each system, polypharmacy was associated with increased odds of admission (odds ratio ranging 1.4–2.4). Conclusions The unadjusted longitudinal trends suggest tremendous system variations in antipsychotic use in patients with schizophrenia. Cross-system comparisons are inherently subject to uncertainty due to variation in the amount and type of data collected (e.g., look-back period, pharmacy records versus clinician chart review), yet represent a significant effort to understand organizational differences and context. Given current debates over healthcare access and treatment costs, electronic systems to signal polypharmacy could assist in identifying patients requiring more complex clinical and pharmacy management, individuals at substantially higher risk for adverse events. Such enhanced sentinel detection and follow-up care could ultimately lead to improved clinical practice and fiscal well-being.