Health Services Research Commons^™

Trends And Outcomes Associated With Angiotensin-Converting Enzyme Inhibitors, Chyke Doubeni, Carol Bigelow, Darleen Lessard, Frederick Spencer, Jorge Yarzebski, Joel Gore, Jerry Gurwitz, Robert Goldberg

Jorge L. Yarzebski

BACKGROUND: Limited recent data are available describing the patterns of use of angiotensin converting enzyme inhibitor (ACEI) therapy in patients with acute myocardial infarction (AMI), particularly from the more generalizable population-based setting. The purpose of this study was to examine trends in the receipt of ACEIs and associated short-term outcomes in patients hospitalized with AMI in a large Northeastern community.

METHODS: We conducted a community-wide study of 7991 patients hospitalized with AMI in all metropolitan Worcester, Massachusetts, medical centers during 8 annual periods between 1990 and 2003.

RESULTS: Among all patients, 44% received ACEI therapy during their acute hospitalization. There …

Age-Specific Differences In The Use Of Thrombolytic Therapy And Hospital Outcomes In Patients With Acute Myocardial Infarction: A Community-Wide Perspective, Omar Ali, Immad Sadiq, Robert Goldberg, Jorge Yarzebski, Darleen Lessard, Jerry Gurwitz, Joel Gore

Jorge L. Yarzebski

BACKGROUND: Relatively limited information is available about recent, and trends over time, use of thrombolytic therapy in patients of different ages hospitalized with acute myocardial infarction and the association between use of thrombolytic therapy and hospital outcomes. METHODS: We conducted an observational study of 5601 residents of the Worcester, Massachusetts, metropolitan area (1990 census = 437,000) with confirmed acute myocardial infarction in all local hospitals during 6 one-year periods between 1990 and 1999. RESULTS: Despite relatively stable use of thrombolytic therapy between 1990 and 1995, decreases in the use of thrombolytic therapy in all patients with acute myocardial infarction were …

Recent Trends In The Incidence Rates Of And Death Rates From Atrial Fibrillation Complicating Initial Acute Myocardial Infarction: A Community-Wide Perspective, Robert Goldberg, Jorge Yarzebski, Darleen Lessard, Jacqueline Wu, Joel Gore

Jorge L. Yarzebski

BACKGROUND: Limited information is available about recent trends in the incidence and death rates from atrial fibrillation (AF) complicating acute myocardial infarction (AMI). The purpose of this study was to examine the impact and trends over time of AF complicating initial AMI. METHODS: We conducted a longitudinal study of 2596 residents of the Worcester, Massachusetts, metropolitan area with initial AMI and without previous AF who were hospitalized at all area hospitals in 5 annual periods between 1990 and 1997. RESULTS: A total of 13% of hospitalized patients developed AF. There was a marked decrease in the proportion of patients who …

Use Of Do-Not-Resuscitate Orders In Patients With Kidney Disease Hospitalized With Acute Myocardial Infarction, Joline Chen, Jonathan Sosnov, Darleen Lessard, Jorge Yarzebski, Joel Gore, Robert Goldberg

Jorge L. Yarzebski

BACKGROUND: Patients with kidney disease are at increased risk for adverse health outcomes in comparison to patients without kidney disease. Therefore, patients with kidney disease may have greater use of do-not-resuscitate (DNR) orders than patients without kidney disease in the setting of an acute illness. We examined the association between advanced kidney disease and use of DNR orders in patients admitted with an acute myocardial infarction (AMI) to all greater Worcester, MA, hospitals as part of an epidemiological study.

METHODS: Use of DNR orders in 4,033 Worcester residents hospitalized with AMI at 11 greater Worcester medical centers during 1997, 1999, …

Bleeding Complications In Patients With Anemia And Acute Myocardial Infarction, Harold Dauerman, Darleen Lessard, Jorge Yarzebski, Joel Gore, Robert Goldberg

Jorge L. Yarzebski

Anemia has recently been associated with increased mortality in patients who undergo percutaneous coronary intervention. The mechanisms associated with increased mortality among patients who have anemia have not been defined. We sought to determine whether patients who had anemia and acute myocardial infarction (AMI) might be at higher risk for bleeding or cardiogenic shock during acute hospitalization compared with patients who did not have anemia. This population-based study included 5,378 residents of the Worcester metropolitan area who were hospitalized with a diagnosis of AMI in five 1-year periods from 1995 to 2003. Patients were analyzed according to the presence or …

Thirty-Year Trends (1975-2005) In The Magnitude And Hospital Death Rates Associated With Complete Heart Block In Patients With Acute Myocardial Infarction: A Population-Based Perspective, Hoa Nguyen, Darleen Lessard, Frederick Spencer, Jorge Yarzebski, Juan Zevallos, Joel Gore, Robert Goldberg

Jorge L. Yarzebski

BACKGROUND: The contemporary magnitude and prognostic implications of complete heart block (CHB) in patients with acute myocardial infarction (AMI) are unknown. As part of a community-based study of patients hospitalized with AMI in the Worcester, MA, metropolitan area, changes over time in the incidence rates of CHB complicating AMI and the prognostic impact of CHB on short-term survival were examined.

METHODS: The study population consisted of 13,663 residents of the Worcester metropolitan area who were hospitalized with AMI at all greater Worcester medical centers during 15 annual periods between 1975 and 2005.

RESULTS: The average age of the hospitalized study …

Treatment Practices And Outcomes Of Patients With Established Peripheral Arterial Disease Hospitalized With Acute Myocardial Infarction In A Community Setting, Frederick Spencer, Darleen Lessard, Chyke Doubeni, Jorge Yarzebski, Joel Gore, Robert Goldberg

Jorge L. Yarzebski

BACKGROUND: There are little contemporary data available describing the hospital and long-term outcomes of patients with peripheral arterial disease (PAD) who are hospitalized with acute myocardial infarction (AMI). The objectives of our population-based study were to examine the hospital and long-term outcomes, as well as the use of different treatment practices, among patients with established PAD who were hospitalized with AMI. METHODS: The study sample consisted of 4480 patients hospitalized with AMI at all Worcester, Mass, medical centers in 4 alternate years between 1997 and 2003. RESULTS: Among the metropolitan Worcester residents hospitalized with AMI, 13.5% had a history of …

Changing Trends (1986-2003) In The Use Of Lipid Lowering Medication In Patients Hospitalized With Acute Myocardial Infarction: A Community-Based Perspective., Jorge Yarzebski, Edgard Granillo, Frederick Spencer, Darleen Lessard, Jerry Gurwitz, Joel Gore, Robert Goldberg

Jorge L. Yarzebski

OBJECTIVES: The objectives of this community-wide observational study were to describe nearly two decade long (1986-2003) trends in the use of lipid lowering therapy in patients hospitalized with acute myocardial infarction (AMI) and clinical and demographic factors associated with underutilization of this treatment regimen. METHODS: A total of 9429 greater Worcester (MA) residents hospitalized with confirmed AMI at all metropolitan Worcester medical centers in 10 annual periods between 1986 and 2003 comprised the study population. Hospital medical records were reviewed to ascertain the prescribing of lipid lowering agents during hospitalization for AMI. RESULTS: The mean age of the study sample …

Excess Body Weight, Clinical Profile, Management Practices, And Hospital Prognosis In Men And Women After Acute Myocardial Infarction, Robert Goldberg, Jiang Cui, Barbara Olendzki, Frederick Spencer, Jorge Yarzebski, Darleen Lessard, Joel Gore

Jorge L. Yarzebski

BACKGROUND: Excess body weight is increasingly being recognized as a major health problem in American men and women. It is unclear, however, whether body weight is associated with the demographic and clinical profile, treatment of, and hospital prognosis after acute myocardial infarction (AMI).

METHODS: Nonconcurrent prospective epidemiologic investigation of Worcester (Massachusetts) metropolitan residents hospitalized at all 11 greater Worcester medical centers with validated AMI in 1997, 1999, 2001, and 2003.

RESULTS: A total of 2008 men and 1505 women were hospitalized with confirmed AMI during the 4 study periods. Approximately 41% of men and 29% of women were classified as …

T2 And T3 Sympathetic Ganglia In The Adult Human: A Cadaver And Clinical-Radiographic Study And Its Clinical Application, Jorge Yarzebski, H. Wilkinson

Jorge L. Yarzebski

The technique of percutaneous radiofrequency (RF) upper thoracic sympathectomy mandates an exact knowledge of the anatomical location of the sympathetic ganglia. Because conflicting descriptions are given in anatomy texts, we examined the T2 and T3 sympathetic ganglia in 48 sympathetic chains in adult cadavers to measure the exact location of the ganglia. Measurements were made relative to their distances (a) dorsal to the ventral surface of the vertebral body and (b) rostral or caudal to the midpoint of the vertebral body. Median locations of T2 and T3 ganglia were 17 to 20 mm dorsal to the ventral surface of the …

Trends (1986 To 1999) In The Incidence And Outcomes Of In-Hospital Stroke Complicating Acute Myocardial Infarction (The Worcester Heart Attack Study), Frederick Spencer, Joel Gore, Jorge Yarzebski, Darleen Lessard, Elizabeth Jackson, Robert Goldberg

Jorge L. Yarzebski

Although stroke is an infrequent hospital complication of acute myocardial infarction (AMI), limited contemporary data are available about the incidence and death rates associated with this serious complication. The objective of this population-based study was to examine temporal trends (1986 to 1999) in the risk of stroke and associated hospital outcomes in patients hospitalized with AMI. This was an observational study of 6,325 metropolitan Worcester, Massachusetts, residents hospitalized with validated AMI and without prior stroke at all greater Worcester hospitals during 8 one-year periods between 1986 and 1999. Overall, 1.5% of patients (n = 92) with confirmed AMI developed an …

Tapping The Potential Of The Health Care Workforce: Scope-Of-Practice And Payment Policies For Advanced Practice Nurses And Physician Assistants, Robert Cunningham

National Health Policy Forum

Expanding coverage and increasing delivery of team-based care are likely to entail a growing role in the
health system for advanced practice nurses (APNs), physician assistants (PAs), and other nonphysician clinicians. These professions have already grown rapidly and have increased access to primary and specialty care, especially in rural and other underserved areas. This background paper provides an overview of the role of APNs and PAs. It reviews the primary features of the training and credentialing of these health professions, including the impact of public policies and market forces on their growth and deployment. It describes variations in state scope-of-practice …

Perfil Dos Atendimentos Ambulatoriais Realizados Em Uma Clínica De Cirurgia Plástica No Sul Do Brasil / Outpatient Service Profile In A Plastic Surgery Clinic In Southern Brazil, Everton Fernando Alves

Everton Fernando Alves

Objetivo: Descrever o perfil dos atendimentos ambulatoriais realizados em uma clínica de cirurgia plástica no sul do Brasil. Materiais e Métodos: Foi realizado um estudo descritivo, exploratório e de caráter quantitativo com o intuito de analisar a totalidade de atendimentos ambulatoriais (consultas e cirurgias) realizadas em uma clínica privada de cirurgia plástica no período de 01 de janeiro a 31 de dezembro de 2010. Resultados: Observou-se que, das 671 (60,5%) consultas novas, apenas 205 (18,5%) cirurgias foram realizadas. Março foi o mês com mais consultas (10%) e cirurgias (11,7%). Do total de consultas novas, as reparadoras foram predominantes em 55,6% …

Clinical And Economic Impact Of Infusion Reactions In Patients With Colorectal Cancer Treated With Cetuximab., K A Foley, P F Wang, B L Barber, S R Long, J E Bagalman, V Wagner, X Song, Z Zhao

College of Population Health Faculty Papers

BACKGROUND: Systemic agents in cancer treatment were often associated with possible infusion reactions (IRs). This study estimated the incidence of IRs requiring medical intervention and assessed the clinical and economic impacts of IRs in patients with colorectal cancer (CRC) treated with cetuximab.

PATIENTS AND METHODS: Details on patients with CRC receiving cetuximab in 2004-2006 were extracted from a large USA administrative claims database. IRs were identified based on the occurrence of outpatient treatment, emergency room (ER) visit, and/or hospitalization for hypersensitivity and allergic reactions. Multivariate regressions were used to examine potential risk factors and quantify the economic impact of IRs. …

An Exploration Of Faculty Perspectives On The In-Training Evaluation Of Residents, Christopher Watling, Cynthia Kenyon, Valerie Schulz, Mark Goldszmidt, Elaine Zibrowski, Lorelei Lingard

Lorelei Lingard

PURPOSE: The in-training evaluation report (ITER) is the most widely used approach to the evaluation of residents' clinical performance. Participants' attitudes toward the process may influence how they approach the task of resident evaluation. Whereas residents find ITERs most valuable when they perceive their supervisors to be engaged in the process, faculty attitudes have not yet been explored. The authors studied faculty supervisors' experiences and perceptions of the ITER process to gain insight into the factors that influence faculty engagement.

METHOD: Using a grounded theory approach, semistructured interviews were completed in 2008 with a purposive sample of 17 faculty involved …

Keeping Health Insurance After A Job Loss: Cobra Continuation Coverage And Subsidies, Kathryn Linehan

National Health Policy Forum

Many Americans under 65 have health insurance through an employer. Beginning in 1985, a federal law known as COBRA required that eligible workers and their dependents have the option to continue employer-based group health coverage when employment is terminated. Because premiums for COBRA coverage can be very expensive, the 111th Congress included provisions in the American Recovery and Reinvestment Act of 2009 (and subsequent legislation) to temporarily subsidize premiums for those who have lost their jobs since September 2008. This issue brief outlines the eligibility rules for COBRA as well as the current COBRA subsidies. It also discusses the possible …

Forced Migration And The Survival Needs Of The Nigerian Child, Ngozi Diwunma Obidike

Journal of Global Initiatives: Policy, Pedagogy, Perspective

This article identifies the survival needs of the forced migrant Nigerian child as well as the extent to which the identified needs are satisfied. The population consisted of 600 forced migrant children and 10 emergency workers who were chosen based on their experiences being forced migrants. A questionnaire was used for the study. The result showed) among other things, that although the need for food, clean water, education, peace, and shelter were identified as the five most essential needs, other needs were also identified as necessary for the children's survival. Based on the results, recommendations were made.

Health Care Shortage Designations: Hpsa, Mua, And Tbd, Eileen Salinsky

National Health Policy Forum

A wide variety of federal programs designed to improve access to health care services rely on specific criteria to designate areas and populations eligible for funding and other types of aid. Two related yet distinct designations, the Health Professional Shortage Area (HPSA) and the Medically Underserved Area (MUA), are most commonly used to identify underserved people or places. This background paper reviews the methodologies currently utilized in these designations, identifies the federal programs that use these designations to allocate resources, describes proposals that have been advanced to consolidate and improve these designations, and discusses key issues and challenges for future …

Heath Care Spending: Why Is Miami An Outlier?, Laura A. Dummit, Mary Ellen Stahlman

National Health Policy Forum

The National Health Policy Forum’s site visit to Miami focused on the complex factors that drive health care spending and is the latest in a series on the dynamics of health care markets. Miami has long been recognized as having among the highest Medicare per capita spending in the country, along with high rates of uninsured, strong managed care presence, and a history of health care fraud. This colorful health care market brings into stark relief many of the reasons for high and growing health care spending across the country. It also highlights several issues involved in building and maintaining …

Practice Notes: Strategies In Health Education, Lisa D. Lieberman

Department of Public Health Scholarship and Creative Works

Objective: To monitor the progress in the promotion of walkable community initiatives.