Chronic disease management: a residency-led intervention to improve outcomes in diabetic patients.

BACKGROUND: When quality improvement processes are integrated into resident education, many opportunities are created for improved outcomes in patient care. For Bethesda Family Medicine (BFM), integrating quality improvement into resident education is paramount in fulfilling the Accreditation Council for Graduate Medical Education Practice-Based Learning and Improvement core competency requirements. METHODS: A resident-developed diabetes management treatment protocol that targeted 11 evidence-based measures recommended for successful diabetes management was implemented within the BFM residency and all physician practices under its parent healthcare system. This study compares diabetes management at BFM and at 2 other family medicine practices at timepoints before and after protocol implementation. We measured hemoglobin A1c (HbA1c), low-density lipoprotein (LDL) cholesterol, and systolic blood pressure (SBP) in adult diabetics and compared patient outcomes for these measures for the first and third quarters of 2009 and 2010. RESULTS: In BFM patients, HbA1c, LDL, and SBP levels decreased, but only HbA1c improvement persisted long term. For the comparison groups, in general levels were lower than those of BFM patients but not significantly so after the first measurement period. CONCLUSIONS: A resident-led treatment protocol can improve HbA1c outcomes among residents' diabetic patients. Periodic educational interventions can enhance residents' focus on diabetes management. Residents in graduate medical education can initiate treatment protocols to improve patient care in a large healthcare system.

Do electronic medical record (EMR) demonstrations change attitudes, knowledge, skills or needs?

INTRODUCTION: Electronic medical records (EMRs) are the future of primary care. Transition to electronic records can have a significant impact on physicians, office staff, nursing staff and patients. There are no published EMR studies combining these four populations or studies that have evaluated the impact of EMR demonstrations. To better understand the impact of EMRs, an online survey was administered before and after EMR demonstrations. METHODS: A longitudinal cohort survey design was used to assess primary outcomes (attitudes, knowledge, skills and needs) related to EMRs in four populations that were divided into two groups--one of physicians and the other of nursing staff, office staff and patients. A total of 39 participants (19 physicians and 20 staff/patients) completed a pretest survey four weeks prior to and post-test surveys at four and ten weeks after EMR demonstrations. Mean composite scores for each primary outcome were calculated for each group and mean differences were calculated and compared within and between groups--from baseline to four weeks and four to ten weeks using paired t-tests and Student's t-tests, respectively. RESULTS: Groups differed in several areas: physicians were younger, had more education and had fewer years of experience in a primary care office. There were no significant differences in gender or computer experience between groups. Staff/patients reported significant improvements in attitudes, knowledge and needs from baseline to four weeks (P<0.05, P<0.01 and P<0.05). Physician attitudes, knowledge and needs significantly increased at week four (P<0.05, P<0.01 and P<0.05). Attitudes, knowledge and needs were sustained in both groups from week four through to week ten. CONCLUSION: EMR demonstrations improved attitudes, knowledge and needs of staff/patients and physicians. EMR demonstrations may be effective in favorably influencing healthcare personnel towards EMRs.

Young adults admitted for asthma: does gender influence outcomes?

OBJECTIVE: To assess any outcome differences between young men and women who are admitted for asthma. METHODS: We conducted a retrospective cohort study based on hospitalizations. An inclusion criterion was admission for asthma between January 1, 1998 and July 1, 2001. Exclusion criteria included age >45, chronic obstructive pulmonary disease (COPD), and emphysema. Data were collected on 10 potential confounding variables. Four outcome variables were assessed, including length of stay, intensive care unit (ICU) length of stay, mortality, and respiratory failure. RESULTS: Patients admitted for asthma were significantly more likely to be female (374 females vs. 106 males, p <0.05). There was no difference between the genders comparing month of admission. The women were significantly older, with more Medicaid insured, and more anxiety/depression (p <0.05). There was no difference between the genders for obesity, race, tobacco history, gastroesophageal reflux disease (GERD), hypertension, diabetes, and pneumonia. There was no reported mortality. Using regression analysis, there was no difference between the genders for length of stay (odds ratio [OR] = 1.06, 95% confidence interval [CI] 0.97-1.17) and respiratory failure (OR = 1.58, 95% CI 0.53-4.76). Men stayed significantly longer in the ICU (OR = 1.18, 95% CI 1.01-1.38). CONCLUSIONS: Patients admitted with asthma are significantly more likely to be female. Males stay significantly longer in the ICU. There is no difference between the genders for length of stay and respiratory failure. There was no reported mortality for either gender.