Sondra Vazirani
University of California, Los Angeles
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Publication
Featured researches published by Sondra Vazirani.
Medical Decision Making | 2006
Susan L. Ettner; Jenny Kotlerman; Abdelmonem A. Afifi; Sondra Vazirani; Ron D. Hays; Martin F. Shapiro; Marie J. Cowan
Objective. Hospitals adapt to changing market conditions by exploring new care models that allow them to maintain high quality while containing costs. The authors examined the net cost savings associated with care management by teams of physicians and nurse practitioners, along with daily multidisciplinary rounds and postdischarge patient follow-up. Methods. One thousand two hundred and seven general medicine inpatients in an academic medical center were randomized to the intervention versus usual care. Intervention costs were compared to the difference in nonintervention costs, estimated by comparing changes between preadmission and postadmission in regression-adjusted costs for intervention versus usual care patients. Intervention costs were calculated by assigning hourly costs to the time spent by different providers on the intervention. Patient costs during the index hospital stay were estimated from administrative records and during the 4-month follow-up by weighting selfreported utilization by unit costs. Results. Intervention costs were
Journal of Hospital Medicine | 2012
Sondra Vazirani; Azadeh Lankarani‐Fard; Li-Jung Liang; Matthias Stelzner; Steven M. Asch
1187 per patient and associated with a significant
American Journal of Roentgenology | 2011
Guy W. Soo Hoo; Carol C. Wu; Sondra Vazirani; Zhaoping Li; Bruce M. Barack
3331 reduction in nonintervention costs. About
Journal of Hospital Medicine | 2010
Neil M. Paige; Sondra Vazirani; Christopher J. Graber
1947 of the savings were realized during the initial hospital stay, with the remainder attributable to reductions in postdischarge service use. After adjustment for possible attrition bias, a reasonable estimate of the cost offset was
Journal of The American College of Radiology | 2018
Guy W. Soo Hoo; Emily B. Tsai; Sondra Vazirani; Zhaoping Li; Bruce M. Barack; Carol C. Wu
2165, for a net cost savings of
Journal of Nutritional Therapeutics | 2014
Shannon Wongvibulsin; Sondra Vazirani; Zhaoping Li; David Heber
978 per patient. Because health outcomes were comparable for the 2 groups, the intervention was cost-effective. Conclusions. Wider adoption of multidisciplinary interventions in similar settings might be considered. The savings previously reported with hospitalist models may also be achievable with other models that focus on efficient inpatient care and appropriate postdischarge care.
Medical Teacher | 2009
Anne M. Walling; Ron D. Hays; Jason Fish; Anish P. Mahajan; Sondra Vazirani; Jodi Friedman; Neil S. Wenger
BACKGROUND A structured, medical preoperative evaluation may positively impact the perioperative course of medically complex patients. Hospitalists are in a unique position to assist in preoperative evaluations, given their expertise with inpatient medicine and postoperative surgical consultation. OBJECTIVE To evaluate specific outcomes after addition of a Hospitalist-run, medical Preoperative clinic to the standard Anesthesia preoperative evaluation. DESIGN, SETTING, PATIENTS A pre/post retrospective, comparative review of outcomes of 5223 noncardiac surgical patients at a tertiary care Veterans Administration (VA) medical center. RESULTS Length of stay was reduced for inpatients with an American Society of Anesthesia (ASA) score of 3 or higher (P < 0.0001). There was a trend towards a reduction in same-day, medically avoidable surgical cancellations (8.5% vs 4.9%, P = 0.065). More perioperative beta blockers were used (P < 0.0001) and more stress tests were ordered (P = 0.012). Inpatient mortality rates were reduced (1.27% vs 0.36%, P = 0.0158). CONCLUSION A structured medical preoperative evaluation may benefit medically complex patients and improve perioperative processes and outcomes.
American Journal of Critical Care | 2005
Sondra Vazirani; Ron D. Hays; Martin F. Shapiro; Marie J. Cowan
OBJECTIVE The objective of our study was to evaluate the impact of incorporating a mandatory clinical decision rule and selective d-dimer use on the yield of pulmonary CT angiography (CTA). MATERIALS AND METHODS Guidelines incorporating a clinical decision rule (Wells score: range, 0-12.5) and a highly sensitive d-dimer assay as decision points were placed into a computerized order entry menu. From December 2006 through November 2008, 261 pulmonary CTA examinations of 238 men and 14 women (mean age ± SD, 65 ± 12 years; range, 31-92 years) were performed. Eight patients underwent more than one pulmonary CTA examination. Charts were reviewed. The results of pulmonary CTA, the clinical decision rule, and d-dimer level (if obtained) were analyzed with the Student t test, chi-square test, or other comparisons using statistical software (MedCalc, version 11.0). RESULTS Of the pulmonary CTA examinations, 16.5% (43/261) were positive for pulmonary embolism (PE) compared with 3.1% (6/196) during the previous 2 years. The mean clinical decision rule score and mean d-dimer level were 5.5 ± 2.4 (SD) and 4956 ± 2892 ng/mL, respectively, for those with PE compared with 4.5 ± 2.1 and 2398 ± 2100 ng/mL for those without PE (both, p < 0.01). The negative predictive value of a clinical decision rule score of 4 or less and d-dimer level of less than 1000 ng/mL was 1.0. A clinical decision rule of greater than 4 and a higher d-dimer level were better predictors for PE, especially a d-dimer level of greater than 3000 ng/mL (odds ratio = 6.69; 95% CI = 2.72-16.43). CONCLUSION Guidelines combining a clinical decision rule with d-dimer level significantly improved the utilization of pulmonary CTA and positive yield for PE.
Journal of Nursing Administration | 2006
Marie J. Cowan; Martin F. Shapiro; Ron D. Hays; Abdelmonem A. Afifi; Sondra Vazirani; Cathy Rodgers Ward; Susan L. Ettner
Infectious diseases are commonly encountered by hospitalists in their day-to-day care of patients. Challenges involved in caring for patients with infectious diseases include choosing the correct antibiotic, treating patients with a penicillin allergy, interpreting blood cultures, and caring for patients with human immunodeficiency virus (HIV). The evidence-based pearls in this article will help hospitalists avoid common pitfalls in the recognition and treatment of such disorders and guide their decision about when to consult an infectious diseases specialist.
The American Journal of Medicine | 2016
Mark D. Duncan; Sondra Vazirani
PURPOSE This study evaluated the long-term effectiveness of mandatory assignment of both a clinical decision rule (CDR) and highly sensitive d-dimer in the evaluation of patients with suspected pulmonary embolism (PE). MATERIALS AND METHODS Institutional guidelines with a CDR and highly sensitive d-dimer were embedded in an order entry menu with mandatory assignment of key components before ordering a CT pulmonary angiogram (CTPA). Data were retrospectively extracted from the electronic health record. RESULTS This was a retrospective review of 1,003 CTPA studies (905 patients, 845 male and 60 female patients, age 63.7 ± 13.5 years). CTPAs were positive for PE in 170 studies (17%), representing an average yield of 15% (year [average]; 2007 [15%], 2008 [18%], 2009 [15%], 2010 [15%], 2011 [17%], 2012 [15%], 2013 [23%]). The increased yield represented efforts of mandatory order entry assignments, educational sessions, and clinical champions. Different d-dimer thresholds with or without age adjustments in combination with the CDR identified about 10% of patients who may have been managed without CTPA. CONCLUSION Mandatory assignment of a CDR and highly sensitive d-dimer clinical decision pathway can be successfully incorporated into an order entry menu and produce a sustained increase in CTPA yield of patients with suspected PE.