RESUMEN
Health information technology (HIT) holds potential to transform Home Health Care (HHC), yet, little is known about its adoption in this setting. In the context of infection prevention and control, we aimed to: (1) describe challenges associated with the adoption of HIT, for example, electronic health records (EHR) and telehealth and (2) examine HHC agency characteristics associated with HIT adoption. We conducted in-depth interviews with 41 staff from 13 U.S. HHC agencies (May-October 2018), then surveyed a stratified random sample of 1506 agencies (November 2018-December 2019), of which 35.6% participated (N = 536 HHC agencies). We applied analytic weights, generating nationally-representative estimates, and computed descriptive statistics, bivariate and multivariable analyses. Four themes were identified: (1) Reflections on providing HHC without EHR;(2) Benefits of EHR;(3) Benefits of other HIT;(4) Challenges with HIT and EHR. Overall, 10% of the agencies did not have an EHR;an additional 2% were in the process of acquiring one. Sixteen percent offered telehealth, and another 4% were in the process of acquiring telehealth services. In multivariable analysis, EHR use varied significantly by geographic location and ownership, and telehealth use varied by geographic location, ownership, and size. Although HIT use has increased, our results indicate that many HHC agencies still lack the HIT needed to implement technological solutions to improve workflow and quality of care. Future research should examine the impact of HIT on patient outcomes and the impact of the COVID-19 pandemic on HIT use in HHC.
RESUMEN
The coronavirus disease 2019 (COVID-19) crisis ought to serve as a reminder about the costs of failure to consider another long-term risk, climate change. For this reason, it is imperative to consider the merits of policies that may help to limit climate damages. This essay rebuts three common objections to carbon taxes: (1) that they do not change behaviour, (2) that they generate unfair burdens and increase inequality, and (3) that fundamental, systemic change is needed instead of carbon taxes. The responses are (1) that there is both theoretical and empirical reason to think that carbon taxes do change behaviour, with larger taxes changing it to a greater extent;(2) that undistributed carbon taxes are regressive but distributing the tax receipts can alleviate that regressivity (and, in many cases, make the overall effect progressive);and (3) that while small changes for increasing democratic decision-making may be helpful, (fundamental) change takes time and the climate crisis requires urgent action.
RESUMEN
Allergen specific immunotherapy is now recognized as an allergic disease modifying treatment. Studies have shown that allergen specific immunotherapy (AIT) can prevent new allergic sensitization, reduce medication use in allergic respiratory disease and prevent the development of asthma in patients suffering from allergic rhinitis. The benefits from AIT also translates into lower health care costs. Many society and national guidelines on allergic rhinitis and asthma now endorses the use of AIT in the treatment of patients with allergic sensitization with relevant trigger for their allergic respiratory disease. Patients on AIT are found to mount immunological changes during therapy, there is production of specific IgG4 and induction of regulatory Tcells. The regulatory T-cells are thought to be the key player in modulating the allergic inflammation through the production of IL-10 and TGF-B and is responsible for the prolonged persistent clinical benefits that we see in patients who have completed their AIT treatment. Acarizax is a sublingual immunotherapy product that is FDA approved for the treatment of allergic respiratory disease triggered by house dust mites. This product is a unique fast dissolving sublingual tablet formulation of standardized amounts of the major Group 1 and Group 2 allergens found in house dust mites Dermatophagoides farinae and D.pteronyssinus. There are 3 major well-designed double blinded placebo trials that were conducted on Acarizax in subjects with house dust mite sensitization that demonstrated clinical benefits and the effective dose. One trial, P003 showed that the SQ12 dose reduced allergic rhinitis symptoms in an environmental chamber challenge with onset of effect as early as 8 weeks and demonstrated persistent benefits 1 year after treatment was discontinued. The MERIT trial demonstrated that Acarizax can decrease symptoms scores, medication use with improvement in the Rhinitis Quality of Life Scores. The MITRA trial was conducted in subjects with allergic asthma and demonstrated the ability to reduce medication use in asthma and reduce risk of exacerbations of asthma when inhaled corticosteroids were stopped. In the current Covid-19 pandemic, Acarizax provides an option for patients to safely receive AIT through the sublingual route by self-administration at home. This can help reduce medical visits compared to injection AIT which requires multiple clinic visits for administration along with a 30 minutes observation post injection in a medical setting. Allergen specific immunotherapy is now recognized as an allergic disease modifying treatment. Studies have shown that allergen specific immunotherapy (AIT) can prevent new allergic sensitization, reduce medication use in allergic respiratory disease and prevent the development of asthma in patients suffering from allergic rhinitis. The benefits from AIT also translates into lower health care costs. Many society and national guidelines on allergic rhinitis and asthma now endorses the use of AIT in the treatment of patients with allergic sensitization with relevant trigger for their allergic respiratory disease.
RESUMEN
INTRODUCTION: Sepsis affects nearly 2 million adults each year in the United States. While still a leading cause of mortality, sepsis care has improved with increased awareness, recognition and treatment promoted by the Surviving Sepsis Campaign (SSC). Multiple studies have shown that lower mortality is correlated with increased bundle compliance. Yet, overall compliance remains low reported as 21.5% in one study over 7.5 years and reported as 45% in NY State in 2019. Sepsis care in our institution has been an ongoing focus resulting in achievement of 77% bundle compliance in 2019. In the aftermath of COVID-19, we have renewed our focus on enhancing sepsis care in our emergency department (ED). A multidisciplinary quality improvement (QI) team aimed to optimize a tool, launched September 2019 in our high-volume ED, within our EHR to guide and improve sepsis bundled care compliance. METHODS: A retrospective cohort study to assess sepsis bundle compliance was completed. Adherence to each component (1st and 2nd lactate, timely appropriate antibiotics, blood cultures before antibiotics, fluid resuscitation, hemodynamic reassessment and vasopressor initiation) was compared with and without the use of the EHR tool using descriptive statistics. Simultaneously, an ongoing prospective evaluation of the rate of utilization of the EHR tool was monitored over 3 months. Through QI initiatives, the aim was to increase utilization to > 50% of sepsis cases in the ED. RESULTS: A total of 114 cases were identified. 36% used the EHR tool which led to a higher overall bundle compliance (56% versus 19%), as well as for each individual component. The largest differences were noted in fluid resuscitation (73.2% vs 29.6%), hemodynamic reassessment (61.0% vs 26.8%), and 2nd lactate (96.9% vs. 64.5%). After QI initiatives, including multi-disciplinary education and individualized case feedback, the usage of the EHR tool increased from an average of 23.2% to 76.7%. CONCLUSIONS: An EHR tool, when introduced with education and work flow integration, can assist with bundled care compliance to improve sepsis care. Next steps include obtaining qualitative feedback on the EHR tool's effectiveness and usability to further enhance utilization.