ABSTRACT
BACKGROUND: An estimated 200,000 Americans suffer central line-associated bloodstream infections (CLABs) each year, with 15%-20% mortality. Two intensive care units (ICUs) redefined the processes of care through system redesign to deliver reliable outcomes free of the variations that created the breeding ground for infection. METHODS: The ICUs, comprising 28 beds at Allegheny General Hospital, employed the principles of the Toyota Production System adapted to health care--Perfecting Patient Care--and applied them to central line placement and maintenance. Intensive observations, which revealed multiple variances from established practices, and root cause analyses of all CLABs empowered the workers to implement countermeasures designed to eliminate the defects in the processes of central line placement and maintenance. RESULTS: New processes were implemented within 90 days. Within a year CLABs decreased from 49 to 6 (10.5 to 1.2 infections/1,000 line-days), and mortalities from 19 to 1 (51% to 16%), despite an increase in the use of central lines and number of line-days. These results were sustained during a 34-month period. DISCUSSION: CLABs are not an inevitable product of complex ICU care but the result of highly variable and therefore unreliable care delivery that predisposes to infection.
Subject(s)
Bacteremia/prevention & control , Catheters, Indwelling/microbiology , Cross Infection/prevention & control , Problem Solving , Total Quality Management/methods , Academic Medical Centers , Bacteremia/etiology , Catheterization, Central Venous/adverse effects , Catheters, Indwelling/adverse effects , Drug Resistance, Multiple, Bacterial , Hospital Bed Capacity, 500 and over , Humans , Inservice Training , Intensive Care Units , Pennsylvania , Sentinel SurveillanceABSTRACT
INTRODUCTION: Population-based health surveys seldom assess sexual orientation, which results in the absence of a reliable measure of smoking among lesbians, gays, and bisexuals (LGB), a population perceived to have higher risks of tobacco-related diseases. This is the first study to compare the cigarette smoking rate of LGB with that of heterosexual individuals using a population-based sample with both male and female adults, and to identify which sub segments of LGB population are particularly burdened by tobacco use. METHODS: California Health Interview Survey (CHIS), a population-based telephone survey was used to assess smoking prevalence and its correlates among respondents. Of 44,606 respondents, 343 self-identified as lesbian; 593 self-identified as gay; and 793 identified themselves as bisexual (511 female and 282 male). Statistical analysis was performed using SAS and SUDAAN. RESULTS: Lesbians' smoking rate (25.3%), was about 70% higher than that of heterosexual women (14.9%) Gay men had a smoking prevalence of 33.2%, comparing to heterosexual men (21.3%). After controlling for demographic variables, logistic regression analysis showed that lesbians and bisexual women were significantly more likely to smoke compared with heterosexual women (OR = 1.95 and OR = 2.08, respectively). Gay men were also significantly more likely to smoke than heterosexual men (OR = 2.13; 95% CI = 1.66-2.73). Being 35-44-years-old, non-Hispanic White, and having low-education attainment and low-household income were common demographic predictors of cigarette smoking among LGB. CONCLUSION: Our study provides the strongest evidence to date that lesbians, bisexual females, and gay men had significantly higher cigarette smoking prevalence rates than their heterosexual counterparts.
Subject(s)
Bisexuality/statistics & numerical data , Homosexuality, Female/statistics & numerical data , Homosexuality, Male/statistics & numerical data , Smoking/epidemiology , Adolescent , Adult , Age Factors , California/epidemiology , Female , Health Surveys , Humans , Income , Male , Middle Aged , PrevalenceABSTRACT
The Pittsburgh Regional Healthcare Initiative (PRHI) is an innovative model for health system change based on regionwide shared learning. By linking patient outcomes data with processes of care and sharing that information widely, PRHI supports measurable improvements in regionwide clinical practice and patient safety. In addition, through the redesign of problem solving at the front lines of care, PRHI helps health care organizations to evolve toward becoming sustainable systems of perfect patient care. This paper describes PRHI's design for change, reviews the progress and limitations of the shared learning model, and offers a set of broader policy considerations.
Subject(s)
Information Dissemination , Interinstitutional Relations , Learning , Models, Organizational , Outcome and Process Assessment, Health Care , Regional Medical Programs/organization & administration , Staff Development , Humans , Leadership , Organizational Case Studies , Organizational Innovation , Pennsylvania , Safety Management , Total Quality ManagementABSTRACT
OBJECTIVES: We examined patron responses to a California smoke-free bar law. METHODS: Three telephone surveys measured attitudes and behavior changes after implementation of the law. RESULTS: Approval of the law rose from 59.8% to 73.2% (odds ratio [OR] = 1.95; 95% confidence interval [CI] = 1.58, 2.40). Self-reported noncompliance decreased from 24.6% to 14.0% (OR = 0.50; 95% CI = 0.30, 0.85). Likelihood of visiting a bar or of not changing bar patronage after the law was implemented increased from 86% to 91% (OR = 1.76; 95% CI = 1.29, 2.40). CONCLUSIONS: California bar patrons increasingly support and comply with the smoke-free bar law.
