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23. Evaluation of an Enhanced Primary Care Team Model to Improve Diabetes Care

Author

Herges, Joseph R., Matulis, John C., III, Kessler, Maya E., Ruehmann, Lisa L., Mara, Kristin C., and McCoy, Rozalina G.

Subjects
Health care teams -- Practice, Diabetes therapy -- Methods, Primary nursing -- Methods, Family medicine, Health facilities -- Quality management, Health, Science and technology
Abstract

PURPOSE Primary care practices manage most patients with diabetes and face considerable operational, regulatory, and reimbursement pressures to improve the quality of this care. The Enhanced Primary Care Diabetes (EPCD) model was developed to leverage the expertise of care team nurses and pharmacists to improve diabetes care. METHODS Using a retrospective, interrupted-time series design, we evaluated the EPCD model's impact on D5, a publicly reported composite quality measure of diabetes care: glycemic control, blood pressure control, low-density lipoprotein control, tobacco abstinence, and aspirin use. We examined 32 primary care practices in an integrated health care system that cares for adults with diabetes; practices were categorized as staff clinician practices (having physicians and advanced practice providers) with access to EPCD (5,761 patients); resident physician practices with access to EPCD (1,887 patients); or staff clinician practices without access to EPCD (10,079 patients). The primary outcome was the percentage of patients meeting the D5 measure, compared between a 7-month preimplementation period and a 10-month postimplementation period. RESULTS After EPCD implementation, staff clinician practices had a significant improvement in the percentage of patients meeting the D5 composite quality indicator (change in incident rate ratio from 0.995 to 1.005; P=.01). Trends in D5 attainment did not change significantly among the resident physician practices with access to EPCD (P=.14) and worsened among the staff clinician practices without access to EPCD (change in incident rate ratio from 1.001 to 0.994; P=.05). CONCLUSIONS Implementation of the EPCD team model was associated with an improvement in diabetes care quality in the staff clinician group having access to this model. Further study of proactive, multidisciplinary chronic disease management led by care team nurses and integrating clinical pharmacists is warranted. https://doi.org/10.1370/afm.2884, INTRODUCTION In the United States, 37.3 million people or 11.3% of the population were reported to be living with diabetes in 2020. (1) With the continued increase in disease prevalence [...]

Published
2022
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40. Impact of Continuous Infusion Ketamine Compared to Continuous Infusion Benzodiazepines on Delirium in the Intensive Care Unit.

Author

Vollmer, Nicholas J., Wieruszewski, Erin D., Nei, Andrea M., Mara, Kristin C., Rabinstein, Alejandro A., and Brown, Caitlin S.

Subjects
INTENSIVE care units, BENZODIAZEPINES, ARTIFICIAL respiration, KETAMINE, MIDAZOLAM
Abstract

Purpose: The purpose of this study was to evaluate rates of delirium or coma-free days between continuous infusion sedative-dose ketamine and continuous infusion benzodiazepines in critically ill patients. Materials and Methods : In this single-center, retrospective cohort adult patients were screened for inclusion if they received continuous infusions of either sedative-dose ketamine or benzodiazepines (lorazepam or midazolam) for at least 24 h, were mechanically ventilated for at least 48 h and admitted to the intensive care unit of a large quaternary academic center between 5/5/2018 and 12/1/2021. Results: A total of 165 patients were included with 64 patients in the ketamine group and 101 patients in the benzodiazepine group (lorazepam n = 35, midazolam n = 78). The primary outcome of median (IQR) delirium or coma-free days within the first 28 days of hospitalization was 1.2 (0.0, 3.7) for ketamine and 1.8 (0.7, 4.6) for benzodiazepines (p = 0.13). Patients in the ketamine arm spent a significantly lower proportion of time with RASS −3 to +4, received significantly higher doses and longer durations of propofol and fentanyl infusions, and had a significantly longer intensive care unit length of stay. Conclusions: The use of sedative-dose ketamine had no difference in delirium or coma-free days compared to benzodiazepines. [ABSTRACT FROM AUTHOR]

Published
2024
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42. Progression of Intraductal Papillary Mucinous Neoplasms of the Pancreas After Liver Transplantation.

Author

Busebee, Bradley T., Chin, Jerry Yung‐Lun, Mara, Kristin, Johnson, Brad, Takahashi, Naoki, Majumder, Shounak, and Watt, Kymberly D.

Subjects
PROPORTIONAL hazards models, LIVER transplantation, KIDNEY transplantation, PANCREATIC cancer, TACROLIMUS
Abstract

Background: Intraductal papillary mucinous neoplasms (IPMNs) are the most commonly identified pancreatic cystic neoplasms. Incidentally detected IPMNs are common among liver transplant recipients. The risk of IPMN progression to pancreatic cancer in transplant recipients and the impact of immunosuppression on the risk of malignant transformation of IPMN are unclear. Methods: In this retrospective study of consecutive liver transplant recipients across Mayo Clinic over a 13‐year period, patients were assessed for possible IPMN by automated chart review. Pancreatic cystic lesions were characterized as suspected IPMNs based on imaging criteria. Cox proportional hazards models were used to determine the association between IPMN progression (the development of cancer or worrisome features) and clinical and immunosuppression regimen characteristics. Results: Of 146 patients with suspected IPMNs, progression occurred in 7 patients (2 cases of IPMN‐associated cancer and 5 cases of worrisome features) over an average follow‐up of 66.6 months. Immunosuppression type, medication number, and tacrolimus trough levels were not associated with IPMN progression (p > 0.05). Combined kidney and liver transplantation (p = 0.005) and pretransplant cholangiocarcinoma (p = 0.012) were associated with IPMN progression. Conclusion: IPMN progression is rare after liver transplantation even over an extended follow‐up period. The findings were notable for the absence of an association between IPMN progression and immunosuppression regimen. Larger studies are needed given the low incidence. [ABSTRACT FROM AUTHOR]

Published
2024
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