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Biomedical subjects

Rishi Sikka

Publications and source records attributed to Rishi Sikka.

7 recordsLinked to original sources
PubMed2006

Pay for performance in emergency medicine.

One of the latest market-based solutions to the rising costs and quality gaps in health care is pay for performance. Pay for performance is the use of financial incentives to promote the delivery of designated standards of care. Pay for performance represents a dramatic change in the reimbursement of providers, from fixed rates or fees, to variable compensation based on the quality of care. This article serves as an introduction to pay for performance. I discuss the goals and structure of pay for performance plans and their limitations and potential consequences in the health care arena. A particular focus is provided on pay-for-performance initiatives affecting the emergency department either directly by contracting at the group level or indirectly through hospital reward programs. I also provide a strategy to guide constructive engagement by emergency physicians in the pay-for-performance movement.

Emergency Medicine↗
PubMed2006

Resuscitation of the elderly.

The changing demographics of America's population over the past couple of decades have propelled geriatric medicine into the fore-front. Due to this, emergency medicine physicians will face numerous challenges managing an increasing number of critically ill elderly patients. This article will focus on success of resuscitation in this population, important pathophysiologic changes that occur with aging, as well as ethical considerations in end-of-life care.

Aged↗
PubMed2005

Bench to bedside: Pharmacogenomics, adverse drug interactions, and the cytochrome P450 system.

As physicians attempt to improve the quality of health care, one area of particular concern has been preventable medical errors from adverse drug interactions. The cytochrome P450 family of enzymes has been implicated in a large number of these preventable, adverse drug interactions. This report reviews the basic biochemistry and pharmacogenomics underlying the reactions catalyzed by the cytochrome P450 family of enzymes. An emphasis is placed on the phenotypic variations within a population and the resulting clinical effects. In addition, six members of the cytochrome P450 superfamily that are responsible for the metabolism of the majority of pharmaceutical agents are profiled in detail. These enzymes, CYP3A4, CYP2D6, CYP2C9, CYP2C19, CYP2E1, and CYP1A2, are reviewed with regard to their phenotypic variation in the population and the resulting clinical and therapeutic implications.

Adolescent↗
PubMed2005

Estimating medication persistency using administrative claims data.

OBJECTIVES: To review the definitions and methods for measuring medication persistency, and to propose a uniform definition of and calculation for persistency using pharmacy claims data. STUDY DESIGN: Literature review. METHODS: A MEDLINE search (1966 to present) was performed to identify articles detailing a definition or method of persistency measurement based on automated pharmacy data. Articles were screened for relevance by title and abstract. References from identified articles were used to expand the search results. RESULTS: The concept behind medication persistency measurement is to capture the amount of time that an individual remains on chronic drug therapy. The methods to calculate medication persistency can be classified into 1 of 3 categories: (1) Persistency as a function of the medication possession ratio; (2) persistency as a function of medication availability at a fixed point in time; and (3) persistency as a function of the gaps between refills. CONCLUSIONS: The common goal of all persistency measures should be to reflect the continuity of medication usage and to capture the timeliness and the frequency of refilling. The measurement of persistency as a function of the gaps between refills provides the best assessment of refill compliance across a variety of medication and disease states and lends itself to the well-established measurements of survival analysis.

Drug Prescriptions↗
PubMed2004

Unsuspected internal organ traumatic injuries.

Emergency medicine physicians can avoid missed traumatic intra-abdominal injury by adopting a paradigm for patient evaluation that recognizes the patterns of injury associated with pathology, the importance of positive and negative physical findings, and the limitations of diagnostic studies. The burden of avoiding missed traumatic injuries does not rest with emergency medicine physicians alone, however. A missed diagnosis may be the result of a medical error involving multiple systems and individuals.Ultimately, decreasing the incidence of missed traumatic injury is an opportunity for quality improvement for all practitioners involved in the care of patients with trauma.

Abdominal Injuries↗
PubMed2004

Analysis of occupational exposures associated with emergency department thoracotomy.

BACKGROUND: Although previous studies have examined the cost effectiveness of emergency department thoracotomy (EDT), provider risk has not been included in these analyses. This study examined the costs associated with provider exposure to human immunodeficiency virus (HIV) and hepatitis from percutaneous injury during EDT. METHODS: A decision tree describing the occupational risks and costs associated with EDT was created. Exposed providers undergo initial counseling, evaluation, and HIV postexposure prophylaxis and treatment as recommended by the Centers for Disease Control. Costs are reported from a health care system perspective in year-2000 dollars. The following prevalences were assumed: HIV (7.1%), hepatitis C (18%), and provider percutaneous injury rate (10%). Sensitivity analyses were performed by varying the prevalence of disease and the probability of seroconversion. RESULTS: According to the authors' model assumptions, the probability is 0.00004 for HIV and 0.0027 for chronic hepatitis C seroconversion. The total additional cost per thoracotomy associated with an exposure is dollars 1,377. CONCLUSIONS: Emergency department thoracotomy is associated with important provider medical risks. Future analyses of EDT should include these factors in reports on the value of this procedure.

Acquired Immunodeficiency Syndrome↗