PubMed Health⌕ Search

Biomedical subjects

J G Demakis

Publications and source records attributed to J G Demakis.

12 recordsLinked to original sources
PubMed2000

Improving residents' compliance with standards of ambulatory care: results from the VA Cooperative Study on Computerized Reminders.

CONTEXT: Computerized systems to remind physicians to provide appropriate care have not been widely evaluated in large numbers of patients in multiple clinical settings. OBJECTIVE: To examine whether a computerized reminder system operating in multiple Veterans Affairs (VA) ambulatory care clinics improves resident physician compliance with standards of ambulatory care. DESIGN, SETTING, AND PARTICIPANTS: A total of 275 resident physicians at 12 VA medical centers were randomly assigned in firms or half-day clinic blocks to either a reminder group (n = 132) or a control group (n = 143). During a 17-month study period (January 31, 1995-June 30, 1996), the residents cared for 12,989 unique patients for whom at least 1 of the studied standards of care (SOC) was applicable. MAIN OUTCOME MEASURES: Compliance with 13 SOC, tracked using hospital databases and encounter forms completed by residents, compared between residents in the reminder group vs those in the control group. RESULTS: Measuring compliance as the proportion of patients in compliance with all applicable SOC by their last visit during the study period, the reminder group had statistically significantly higher rates of compliance than the control group for all standards combined (58.8% vs 53.5%; odds ratio [OR], 1.24; 95% confidence interval [CI], 1.08-1.42; P =.002) and for 5 of the 13 standards examined individually. Measuring compliance as the proportion of all visits for which care was indicated in which residents provided proper care, the reminder group also had statistically significantly higher rates of compliance than the control group for all standards combined (17.9% vs 12.2%; OR, 1.57; 95% CI, 1.45-1.71; P<.001) and for 9 of the 13 standards examined individually. The benefit of reminders, however, declined throughout the course of the study, even though the reminders remained active. CONCLUSIONS: Our data indicate that reminder systems installed at multiple sites can improve residents' compliance to multiple SOC. The benefits of such systems, however, appear to deteriorate over time. Future research needs to explore methods to better sustain the benefits of reminders. JAMA. 2000;284:1411-1416.

Adult↗
PubMed2000

Reinventing VA health care: systematizing quality improvement and quality innovation.

The Veterans Health Administration (VHA) in the US Department of Veterans Affairs (VA) manages the largest fully integrated health care system in the United States. In 1995, the VHA initiated a reinvention effort that included the most radical redesign of VA health care to occur since the veterans health care system was formally established in 1946. The 2 paramount goals of this reinvention effort were to ensure the predictable and consistent provision of high-quality care everywhere in the system and to optimize the value of VA health care. Although still a work in progress, dramatic results have been achieved toward these ends during the past 5 years. This article provides an overview of the veterans health care system, and it highlights selected aspects of the system's reengineering. It also describes various steps that have been taken to better manage performance and to systematize quality improvement and quality innovation. This information provides a global context that should facilitate understanding of the genesis and purposes of the Quality Enhancement Research Initiative that is described in other articles in this issue of Medical Care.

Community Health Planning↗
PubMed2000

Quality Enhancement Research Initiative (QUERI): A collaboration between research and clinical practice.

This article provides an overview of the Quality Enhancement Research Initiative (QUERI), an ambitious attempt to develop a data-driven national quality-improvement program for the Veterans Health Administration (VHA) that is fully integrated within VHA's Strategic Framework for Quality Management, as discussed elsewhere in this supplement. QUERI is designed to ensure the systematic translation of findings and products (quality tools that promote use of research findings) to promote optimal patient outcomes and system-wide improvements. In developing QUERI, a framework was created to integrate structural elements (organizational characteristics) and process considerations (those actions and action sequences associated with positive change) with outcomes (both at the patient level and at the systems level). In developing this framework, a process for translation of evidence into action was born. The QUERI process depends on having or discovering accurate information about what services are needed, who needs them, how they should be provided, and relevant outcomes and costs. This article describes the 6-step QUERI process and presents an overview of relevant programmatic details, including QUERI's rigorous review process, and VHA's unique qualifications for establishing a national model for quality improvement.

Benchmarking↗
PubMed1998

Prevalence of subacute patients in acute care: results of a study of VA hospitals.

Subacute care is a transitional level of care for medically stable patients who no longer require daily diagnostic/invasive care but require more intensive care than is typical in a skilled care facility. A Congressionally mandated study was undertaken to determine the number of VA patients with subacute needs being cared for in acute care. InterQual, Inc. subacute care criteria were retrospectively applied to 858 medical and surgical admissions from 43 VA hospitals. Over one-third contained at least one subacute day; with an average length of stay (LOS) of 12.7 days (SD = 12.4); of which 6.8 days were subacute. Patients with these admissions had significantly longer LOSs, were older, and were more likely to die or to be discharged to a nursing home. Diagnoses with subacute days included COPD, pneumonia, joint replacement, and cellulitis. Future studies should develop clinical pathways to prospectively manage admissions with subacute needs and then evaluate their effectiveness.

Age Factors↗
PubMed1995

Weekly and yearly rhythms in plasma fibrinogen in hospitalized male military veterans.

The variation in plasma fibrinogen level demonstrating prominent circaseptan and circannual cycles is clinically relevant. There is a correlation between increasing level of fibrinogen and other hemostatic factors and risk of myocardial infarction and sudden death. The circaseptan and circannual cycles in fibrinogen concentration described in this study may help to explain further the variation in frequency of coronary events. Furthermore, the recent demonstration of a circadian pattern in the efficacy of tissue plasminogen activator, with peak efficacy occurring at 2000 hours--10 hours after the peak incidence of myocardial infarction--implies that further patterns to coronary artery syndromes may be predicted and the treatment efficacy may rely on demonstrated circaseptan and circannual cycles of these events.

Adult↗
PubMed1990

The whole is greater than the sum of its parts: the anatomy of the Department of Veterans Affairs Medical District 17 Health Services Research and Development Field Program.

The Medical District 17 Health Services Research and Development (HSR&D) Field Program was funded by the Veterans Administration (now the Department of Veterans Affairs--VA) in January 1983. This article describes the organization, progress, and accomplishments of this field program, and it provides a review of the breadth of health services research that is being conducted in Medical District 17. Overall, the field program has conducted research that addresses significant problems in the delivery of health care within the VA system. Resource utilization, cost effectiveness, and the care of geriatric patients have been some of the areas in which the Medical District 17 HSR&D Field Program has provided important research findings for VA. The field program plans to continue its response to the needs of VA. Moreover, HSR&D investigators will be collaborating with researchers of other services to conduct research that is both enlightening and highly relevant to the delivery of health care to the nation's veterans. The proposal for an HSR&D field program was developed by the Edward A. Hines Jr. VA Hospital in collaboration with the Center for Health Services and Policy Research (CHSPR) of Northwestern University. The program was funded in January 1983, as the result of a national competition to establish an HSR&D field program in each of the VA regions. The goals of the Medical District 17 Field Program are to improve the health care of veterans by conducting relevant research on the processes and outcomes of patient care; to provide comprehensive technical research assistance; and to educate VA managers, planners, and clinicians, as well as the general medical community, about advances in health care delivery. The field program's commitment to excellence is strengthened by its multidisciplinary approach, which enables physicians, nurses, social workers, psychologists, sociologists, economists, statisticians, administrators, and individuals in various related disciplines to cooperate in efforts to address a wide range of topical issues. These collaborations are a major strength of the field program. Primary research priorities of the field program are cost effectiveness of VA services (e.g., patient care technologies, delivery systems), long-term care, and rehabilitation. Investigators, however, are not limited to these topics and explore many other health services research issues of particular interest to them.

Forecasting↗