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Kenneth W Kizer

Publications and source records attributed to Kenneth W Kizer.

14 recordsLinked to original sources
PubMed2006

Serial murder by healthcare professionals.

The prosecution of Charles Cullen, a nurse who killed at least 40 patients over a 16-year period, highlights the need to better understand the phenomenon of serial murder by healthcare professionals. The authors conducted a LexisNexis search which yielded 90 criminal prosecutions of healthcare providers that met inclusion criteria for serial murder of patients. In addition we reviewed epidemiologic studies, toxicology evidence, and court transcripts, to provide data on healthcare professionals who have been prosecuted between 1970 and 2006. Fifty-four of the 90 have been convicted; 45 for serial murder, four for attempted murder, and five pled guilty to lesser charges. Twenty-four more have been indicted and are either awaiting trial or the outcome has not been published. The other 12 prosecutions had a variety of legal outcomes. Injection was the main method used by healthcare killers followed by suffocation, poisoning, and tampering with equipment. Prosecutions were reported from 20 countries with 40% taking place in the United States. Nursing personnel comprised 86% of the healthcare providers prosecuted; physicians 12%, and 2% were allied health professionals. The number of patient deaths that resulted in a murder conviction is 317 and the number of suspicious patient deaths attributed to the 54 convicted caregivers is 2113. These numbers are disturbing and demand that systemic changes in tracking adverse patient incidents associated with presence of a specific healthcare provider be implemented. Hiring practices must shift away from preventing wrongful discharge or denial of employment lawsuits to protecting patients from employees who kill.

Criminal Psychology↗
PubMed2003

Hospital use and survival among Veterans Affairs beneficiaries.

BACKGROUND: Initiatives to reduce hospital care were part of the reorganization of the Department of Veterans Affairs (VA) medical care system undertaken in the mid-1990s. We examined changes in the use of VA health services and survival from 1994 through 1998 among VA beneficiaries with serious chronic diseases. We postulated that if access to hospital care was reduced too much, or if decreased hospital use was not offset by improvements in ambulatory care, urgent care visits would increase or survival rates would fall. METHODS: We tracked changes in risk-adjusted VA bed-day rates, rates of medical visits, rates of visits for testing and consultation, and rates of urgent care visits per patient-year among VA beneficiaries in nine disease cohorts (a total of 342,300 beneficiaries). Trends in non-VA hospital use by VA beneficiaries 65 years of age or older who were enrolled in fee-for-service Medicare were also studied. VA and Medicare vital-status data were used to calculate one-year survival rates. RESULTS: From 1994 through 1998, VA bed-day rates fell by 50 percent, rates of medical-clinic visits and visits for testing and consultation increased moderately, and rates of urgent care visits fell by 35 percent. The sharp decline in the use of VA hospitals was not compensated for by increases in the use of Medicare-reimbursed non-VA hospital care by veterans eligible for both VA care and Medicare, and the use of non-VA hospitals actually declined in four cohorts. The survival rates were essentially unchanged over the study period. CONCLUSIONS: The marked decline in VA hospital use from 1994 through 1998 did not curtail access to needed services and was not associated with serious consequences for chronically ill VA beneficiaries.

Chronic Disease↗
PubMed2003

Effect of the transformation of the Veterans Affairs Health Care System on the quality of care.

BACKGROUND: In the mid-1990s, the Department of Veterans Affairs (VA) health care system initiated a systemwide reengineering to, among other things, improve its quality of care. We sought to determine the subsequent change in the quality of health care and to compare the quality with that of the Medicare fee-for-service program. METHODS: Using data from an ongoing performance-evaluation program in the VA, we evaluated the quality of preventive, acute, and chronic care. We assessed the change in quality-of-care indicators from 1994 (before reengineering) through 2000 and compared the quality of care with that afforded by the Medicare fee-for-service system, using the same indicators of quality. RESULTS: In fiscal year 2000, throughout the VA system, the percentage of patients receiving appropriate care was 90 percent or greater for 9 of 17 quality-of-care indicators and exceeded 70 percent for 13 of 17 indicators. There were statistically significant improvements in quality from 1994-1995 through 2000 for all nine indicators that were collected in all years. As compared with the Medicare fee-for-service program, the VA performed significantly better on all 11 similar quality indicators for the period from 1997 through 1999. In 2000, the VA outperformed Medicare on 12 of 13 indicators. CONCLUSIONS: The quality of care in the VA health care system substantially improved after the implementation of a systemwide reengineering and, during the period from 1997 through 2000, was significantly better than that in the Medicare fee-for-service program. These data suggest that the quality-improvement initiatives adopted by the VA in the mid-1990s were effective.

Fee-for-Service Plans↗
PubMed2003

Fractures in access to and assessment of trauma systems.

BACKGROUND: Trauma is a major public health problem and organized systems of trauma care have been shown to substantially reduce trauma-related mortality. Currently California and many other states have incompletely developed systems of trauma care delivery. This study was undertaken to determine how frequently patients incurring serious trauma in California receive treatment at a trauma center. STUDY DESIGN: Hospital discharge records for 360,743 acute trauma patients for 1995 to 1997 were analyzed. Abbreviated Injury Scale scores were calculated from discharge diagnosis codes. Severity of trauma and the need for trauma center treatment was defined by eight Abbreviated Injury Scale criteria combined with patient age and type of injury. RESULTS: According to study criteria, 67,718 patients needed trauma center care and 56% were treated at a trauma center. Among patients less than 55 years of age, 62% were treated at a trauma center compared with 40% of those aged 55 years or more (p < 0.0001). For patients less than 55 years old with brain injuries, 66% were treated at a trauma center compared with 44% for patients aged 55 years or more (p < 0.0001). Of the 29,849 patients who met Abbreviated Injury Scale criteria but were not treated at trauma centers, 59% were in counties with designated trauma centers and 41% were in counties without trauma centers. CONCLUSIONS: Only 56% of seriously injured patients in California were treated at trauma centers, despite most of the injuries occurring in the catchment areas of designated trauma care systems. Substantial undertriage of serious trauma patients to trauma centers appears to be occurring, especially in older persons and in persons with brain injuries. Efforts to understand why undertriage is occurring so frequently are hampered by fragmentation of the systems of care, inadequate data management systems, and lack of trauma care performance reporting by non-trauma center hospitals.

Abbreviated Injury Scale↗
PubMed2002

Knowledge for improvement: who will lead the learning?

If we wish to improve the results of a system, what is needed to help health professionals learn about the redesign of that system? To create learning experiences that will attract good health professionals, a special blend of practical insight and critical thinking is required. To enjoy good standing in the academy, these leaders must be able to design, conduct, and disseminate knowledge-building activities subject to peer review. This is the story of the development of the United States Veteran's Health Administration Quality Scholars Program from those who designed and formed it to prepare health professional teachers and academics.

Competency-Based Education↗
PubMed2002

The emerging imperative for health care quality improvement.

There are widespread and growing concerns about the variable and too often inadequate quality of health care in the United States. As a result, health care quality is being questioned and subjected to scrutiny as never before. Awareness of the quality deficits, combined with rising health care expenditures and changing attitudes of payers and consumers, has given rise to a nascent but growing quality improvement movement. Multiple barriers must be surmounted by this movement, but substantive work is under way on all fronts. Emergency medicine will definitely be affected by the quality improvement movement and should quickly move forward to define and establish performance measures for high-quality emergency care in an era when chronic disease dominates the agenda. Emergency medicine should also aggressively work to operationalize a culture of quality to minimize medical errors, to practice evidence-based medicine, to translate research results into clinical practice in a timely manner, and to establish accountability mechanisms for quality improvement and clinical excellence.

Emergency Medicine↗
PubMed2002

National Hepatitis C Surveillance Day in the Veterans Health Administration of the Department of Veterans Affairs.

Hepatitis C is a major public health and financial issue in health care. On March 17, 1999, a Veterans Health Administration (VHA) Hepatitis C Surveillance Day (HepCSD) was undertaken as an administrative tool to estimate the prevalence of hepatitis C antibody positivity in the population served by the VHA for purposes of resource needs allocation and cost projections. This was accomplished using blood from patients who were to have blood drawn for any other purpose. Data were gathered using a national electronic data-extraction system. Of 26,102 tests for hepatitis C virus antibody (HCVAb) performed that day, 1,724 were positive for HCVAb (6.6%). The mean age was 53.8 years, 58.7% were from the Vietnam era, 46% reported as white non-Hispanic, 29% reported as black non-Hispanic, and 97.4% were male. Compared with those who agreed to be tested and who were not seropositive for HCVAb and all persons having contact with the VHA on HepCSD, those who were HCVAb positive were more likely to be younger, black non-Hispanic, and to have served during the Vietnam era. The VHA has identified a target population for further screening and intervention efforts for hepatitis C.

Female↗
PubMedDate not supplied

Evaluating the performance and contribution of nurses to achieve an environment of safety.

Increasing evidence demonstrates that the quality and stability of nursing personnel substantially influence patient outcomes and healthcare costs. However, standardized performance measures to quantify this influence are limited by the gaps in the understanding of this connection and the underdeveloped state of measure development. Given the importance of nurses and the growing trend to make healthcare quality information available to consumers and purchasers, the paucity of standardized nursing-sensitive performance measures is a major void. To address these needs, the National Quality Forum (NQF) undertook a consensus project to endorse an initial set of performance measures for nursing-sensitive care and to define a research agenda that supports future refreshment and expansion of the national voluntary consensus standards in this area. This article describes the innovative approach taken by NQF to endorse a set of national voluntary consensus standards for nursing-sensitive care and the implications for use.

Benchmarking↗