Biomedical subjects

R Portelli

Publications and source records attributed to R Portelli.

6 recordsLinked to original sources

PubMed2005

Institutionalization after stroke.

BACKGROUND AND PURPOSE: There are widespread regional variations in the institutionalization rate after stroke. This study sought to identify the factors that predict institutionalization after a primary diagnosis of stroke and determine whether institutionalization rate could be used to assess the quality of hospital care. METHODS: A retrospective case note audit of 2778 consecutive admissions with stroke, between 1 September and 31 October 2000 from a randomly selected sample of 79 hospitals in England, Wales and Northern Ireland. Data were collected on demographics, case-mix, clinical outcome, organization of discharge, and place of residence at discharge and at three and six months. The figures from this audit were validated using data from the 1998 National Sentinel Audit of Stroke. RESULTS: Overall 14% of patients previously living at home were discharged to nursing or residential homes. Using logistic regression, Barthel Index score at discharge accounted for 40% of variation. Two-thirds of patients with a discharge Barthel score of < 5 were institutionalized. Age alone explained 14% and when taken together with discharge Barthel and length of stay it accounted for 54% of variation. On admission 22% of the variation in institutionalization rate could be accounted for by total Glasgow Coma Score (15, < 15), age and ability to walk unaided. Regional variations in institutionalization rates are evident and may in part be explained by differences in ease of access to the institutions. CONCLUSIONS: Discharge disability and older age were the dominant factors determining admission to nursing and residential homes. It is not possible to predict sufficiently reliably for an individual patient the likelihood of institutionalization at admission or at 72 h after admission, to justify early resource allocation decisions.

Age Distribution↗

PubMed1999

Addressing adverse events through clinical indicators.

In an attempt to improve the reporting rate of adverse drug reactions the Adverse Drug Reaction Advisory Committee approached the Australian Council on Healthcare Standards Care Evaluation Program to develop a set of indicators to improve healthcare standards by heightening awareness amongst clinical staff of the morbidity, mortality and financial implications of adverse drug reactions. Ten clinical indicators addressing: (i) reporting of adverse drug reactions; (ii) adherence to treatment protocols for anaphylaxis; (iii) monitoring of warfarin; and (iv) monitoring of streptokinase, were field tested in ten Australian health-care organizations, to determine that the data were available, that the indicators were relevant to clinical practice and that the measures were achievable. Based on the results of this field test, six adverse drug reaction clinical indicators will be introduced into the Australian Council on Healthcare Standards Evaluation and Quality Improvement Program from January 1999.

Adverse Drug Reaction Reporting Systems↗

PubMed1999

Measuring the quality of hospital in the home care: a clinical indicator approach.

BACKGROUND: Hospital in the home (HIH) refers to the delivery of acute hospital care to patients at home. This includes the delivery of intravenous therapy, low molecular weight heparin, and complex wound care that would necessitate hospital admission. The development of quality assessment and improvement in HIH has been hampered by several factors. OBJECTIVE: To (i) develop clinical indicators for HIH care from an analysis of the current literature and test their suitability for implementation by HIH programmes; and (ii) make a preliminary assessment of the quality of HIH care delivered in several HIH units in Victoria, through an examination of clinical indicator data. DESIGN: Prospective descriptive study in 3 consecutive months of HIH admissions. PARTICIPANTS: Nine HIH units in Victoria, Australia. MAIN OUTCOME MEASURES/INTERVENTIONS: Five clinical indicators for HIH care: unexpected patient telephone calls; unplanned staff call-outs; unplanned return to hospital; medication administration errors; and patient refusal to consent to HIH care. RESULTS: Seven hundred and fifty-nine patient admissions over a 3-month period were included. On average, 10% of patients made an unexpected telephone call, 2.4% of patient admissions required an unplanned staff call-out, and 7.3% of admissions resulted in an unplanned return to hospital. Only one medication administration error was reported. Patient refusal of HIH was very uncommon. CONCLUSIONS: Clinical indicators relating to unexpected patient telephone calls, unplanned staff call-outs and returns to hospital are recommended for inclusion in Australia's hospital accreditation programme. On the basis of this study, it appears that HIH is a safe and acceptable form of care. However, the findings also suggest a minimum level of service provision, particularly in the area of after-hours support, for the safe management of acute hospital care at home.

Acute Disease↗

PubMed1998

The late-expressed region of the temperate coliphage 186 genome.

The late-lytic region of the genome of bacteriophage 186 encodes the phage proteins that synthesize the complex viral particle and lyse the bacterial host. We report the completion of the DNA sequence of the late region and the assignment of 18 previously identified genes to open reading frames in the sequence. The 186 late region is similar to the late region of phage P2, sharing 26 genes of known function: the single gene for activation of late gene transcription, 6 genes for construction of DNA-containing heads, 16 for tail morphogenesis, and 3 for cell lysis. We identified two 186 late genes with unknown function; one is homologous to previously unrecognised genes in P2, HP1, and phiCTX, and the other may modulate DNA packaging. The 186 late region, like the rest of the genome, lacks the lysogenic conversion genes that are carried by P2, allowing the 186 late region to be transcribed from only three late promoters rather than four. The relative absence of lysogenic conversion genes in 186 suggests that the two phages have evolved to use the lytic and lysogenic reproductive modes to different extents.

Amino Acid Sequence↗

PubMed1997

Using clinical indicators to change clinical practice.

A study of the qualitative information received by the Australian Council on Healthcare Standards (ACHS) Care Evaluation Program (CEP) in 1993 showed that the monitoring of clinical indicators had the potential to stimulate a variety of quality activities within health-care organizations. To determine whether the potential for improved patient outcomes has continued, the ACHS CEP conducted a survey of those organizations which submitted clinical indicator data as part of their accreditation survey in 1995. Analysis of the qualitative data received showed that change was reported on 505 occasions by organizations monitoring the hospital-wide medical and obstetrics and gynaecology clinical indicator sets. Details of 251 reported changes were received through a follow-up survey. These details provide evidence that clinical indicators are being used to implement changes in clinical practice to improve the quality of patient care.

Australia↗

PubMedDate not supplied

Matching ICD-9-CM codes to clinical indicators--is it the way to go?

In early 1997, the Australian Council on Healthcare Standards (ACHS) Care Evaluation Program (CEP) collaborated with the National Centre for Classification in Health (NCCH) to determine the feasibility of matching ICD-9-CM codes with a selected number of clinical indicators developed by CEP. While the results of this activity were encouraging, CEP is hesitant in advocating the use of ICD-9-CM as the complete answer to the data collection 'burden' experienced by health care organisations collecting clinical indicator data. CEP is concerned that obtaining clinical indicator data through ICD-9-CM coding alone may limit clinician participation in quality activities, narrow the focus of performance monitoring to one department, potentially compromise the intent of the indicators, and encourage a culture of 'near enough is good enough'. This paper examines the limitations of ICD-9-CM coding as the sole means of extracting clinical indicator data.

Abstracting and Indexing↗