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Scott Kaatz

Publications and source records attributed to Scott Kaatz.

11 recordsLinked to original sources
PubMed2006

Instruments for evaluating education in evidence-based practice: a systematic review.

CONTEXT: Evidence-based practice (EBP) is the integration of the best research evidence with patients' values and clinical circumstances in clinical decision making. Teaching of EBP should be evaluated and guided by evidence of its own effectiveness. OBJECTIVE: To appraise, summarize, and describe currently available EBP teaching evaluation instruments. DATA SOURCES AND STUDY SELECTION: We searched the MEDLINE, EMBASE, CINAHL, HAPI, and ERIC databases; reference lists of retrieved articles; EBP Internet sites; and 8 education journals from 1980 through April 2006. For inclusion, studies had to report an instrument evaluating EBP, contain sufficient description to permit analysis, and present quantitative results of administering the instrument. DATA EXTRACTION: Two raters independently abstracted information on the development, format, learner levels, evaluation domains, feasibility, reliability, and validity of the EBP evaluation instruments from each article. We defined 3 levels of instruments based on the type, extent, methods, and results of psychometric testing and suitability for different evaluation purposes. DATA SYNTHESIS: Of 347 articles identified, 115 were included, representing 104 unique instruments. The instruments were most commonly administered to medical students and postgraduate trainees and evaluated EBP skills. Among EBP skills, acquiring evidence and appraising evidence were most commonly evaluated, but newer instruments evaluated asking answerable questions and applying evidence to individual patients. Most behavior instruments measured the performance of EBP steps in practice but newer instruments documented the performance of evidence-based clinical maneuvers or patient-level outcomes. At least 1 type of validity evidence was demonstrated for 53% of instruments, but 3 or more types of validity evidence were established for only 10%. High-quality instruments were identified for evaluating the EBP competence of individual trainees, determining the effectiveness of EBP curricula, and assessing EBP behaviors with objective outcome measures. CONCLUSIONS: Instruments with reasonable validity are available for evaluating some domains of EBP and may be targeted to different evaluation needs. Further development and testing is required to evaluate EBP attitudes, behaviors, and more recently articulated EBP skills.

Educational Measurement↗
PubMed2006

Potential drug-drug interactions in the outpatient setting.

BACKGROUND: Although medication safety research has tended to focus on inpatients, the safety of drug use among outpatients is also a concern. OBJECTIVE: We estimate the frequency of potentially interacting concomitant medication dispensing among outpatients. RESEARCH DESIGN: We report the number and percent of patients annually dispensed an object drug of interest (ie, warfarin, digoxin, cyclosporine, or lovastatin/simvastatin) with a potentially interacting drug among a random sample of insured adults receiving care from 10 integrated delivery systems. We use 2 definitions of concomitant dispensing: medications dispensed: 1) during the time period for which the patient had the other medication available ('days supply') and 2) on the same day. We also estimate the number of insured U.S. population codispensed these medication pairs. RESULTS: Among patients dispensed a drug of interest, between 17.8% (95% confidence interval [CI]=17.1-18.6%) and 28.0% (95% CI=24.0-32.1%) were concomitantly dispensed a potentially interacting drug using the "days supply" definition, and between 7.1% (95% CI=6.6-7.7%) and 17.7% (95% CI=14.4-21.1%) using the "same day" definition. Extrapolating to the insured U.S. population, between 1.29 (95% CI=1.25-1.33; same day) and 2.67 (95% CI=2.62-2.72; days supply) million insured adults are dispensed 1 of these 4 potentially interacting pairs. CONCLUSIONS: We found evidence of potentially interacting concomitant medication dispensing among outpatients. An opportunity exists to better understand how such dispensing translates into adverse events and ultimately to improved medication safety.

Aged↗
PubMed2005

Quality of anticoagulation control and costs of monitoring warfarin therapy among patients with atrial fibrillation in clinic settings: a multi-site managed-care study.

BACKGROUND: Warfarin is recommended for prevention of stroke in patients with atrial fibrillation who are at moderate or high risk, but requires intensive management to achieve safe and optimal anticoagulation control. Anticoagulation clinics are often used to administer warfarin therapy more effectively. OBJECTIVE: To collect data from multiple sites and assess the quality and costs associated with anticoagulation clinic services. METHODS: A random sample of 600 adults with chronic nonvalvular atrial fibrillation (CNVAF) receiving warfarin was selected from anticoagulation clinics affiliated with 3 health plans. Patients were identified between 1996 and 1998 and followed for up to one year. We assessed the proportion of time that international normalized ratio (INR) values were within the recommended range (2.0-3.0) and the costs of anticoagulation clinic care. RESULTS: Patients had an average of 18 clinic contacts over a mean duration of follow-up of 10.5 months. On average, patients were within the recommended INR range 62% of this time, with 25% of days below range and 13% above range. The mean per-patient cost of warfarin monitoring over the follow-up period averaged $261 at site A, $305 at site B, and $205 at site C (in 2003 US$). Mean costs for patients treated for one full year were $288, $339, and $216, respectively. CONCLUSIONS: In 3 geographically diverse health plans, anticoagulation clinics provided a generally higher quality of control than previously reported in other observational studies. This study highlights the costs of obtaining this level of control.

Adult↗
PubMed2003

Anticoagulation of pregnant women with mechanical heart valves.

The management of pregnant women with mechanical heart valves is challenging. Recently, based on small numbers of patients and poor-quality data, correspondence from Aventis Pharmaceuticals Inc has described treatment "failures" and concerns about teratogenicity with the use of the low-molecular-weight heparin (LMWH) enoxaparin. The company issued a "Warning" that enoxaparin should not be used in patients with prosthetic heart valves and a "Precaution" about potential teratogenicity. This has created a huge problem for physicians managing pregnant women with prosthetic heart valves because the alternatives, unfractionated heparin and warfarin, are problematic. There have been case reports of failures (including death from thrombosed valves) with unfractionated heparin, whereas the package insert for warfarin states that the drug is contraindicated during pregnancy because of potential teratogenicity. Initially, LMWHs appeared suitable for pregnant patients with prosthetic heart valves. Unfortunately, the company correspondence, presumably supported by the Food and Drug Administration (FDA), raises medicolegal concerns with use of any LMWH. We believe that pharmaceutical companies and the FDA should not endorse scientifically unsupported claims that eliminate acceptable therapeutic options. This correspondence has created considerable confusion among patients and treating physicians and is likely to lead to frivolous lawsuits and preclude the performance of properly designed trials in pregnant women. We believe a consensus conference among experts in the field to identify key unresolved issues and a commitment by the FDA and industry to perform appropriate studies are now critical.

Adult↗
PubMed2003

Opportunities for improvement in the diagnosis and treatment of heart failure.

BACKGROUND: Improved treatment of congestive heart failure (CHF) can slow disease progression, promote clinical stability, and prolong survival. HYPOTHESIS: Patterns in diagnostic test utilization and pharmacotherapy among patients with newly diagnosed heart failure may affect outcomes. METHODS: Claims data were analyzed from all diagnostic procedures and prescriptions from 1995 to 1998 in 3,353 patients with heart failure diagnosed within 1 year. Rates of diagnostic testing and categories of drugs prescribed were the main outcome measures. Demographic variables and type of provider were analyzed within a setting whose access to care was controlled. RESULTS: Rates of diagnostic testing with respect to basic, metabolic/endocrine, alternative diagnoses, underlying ischemia, and left ventricular function varied as a function of gender, age, race, and primary versus specialty care provider. Only 4.7% of patients underwent all diagnostics and treatments recommended in current guidelines. However, those patients (27.5%) who underwent an evaluation for ischemic heart disease and were prescribed vasodilators or beta blockers enjoyed the lowest crude mortality. CONCLUSIONS: There are multiple opportunities apparent to improve the initial diagnostic and therapeutic care of patients with heart failure. There appears to be an early survival benefit with respect to use of vasodilators and beta blockers within the first year of treatment.

Adrenergic beta-Antagonists↗
PubMed2003

Should patients on warfarin for 3 months for idiopathic proximal deep venous thrombosis receive bridging therapy precolonoscopy (with expected biopsy)?

A 63-year-old woman presents to discuss periprocedure anticoagulation management. She has been on oral warfarin with an international normalized ratio between 2 and 3 for the past 3 months because of an idiopathic left popliteal vein thrombosis. A colonic polyp was identified during her purely diagnostic colonoscopy performed as part of her age- and gender-appropriate cancer screening. Immediate repeat colonoscopy with polypectomy is recommended. The clinician is asked to provide periprocedural anticoagulation recommendations.

Anticoagulants↗
PubMed2003

Angiotensin converting enzyme inhibitors and beta-blockers in African Americans with heart failure.

Previous analyses have implied diminished efficacy of angiotensin converting enzyme inhibitors (ACEI), and equivalent or enhanced efficacy of beta-blockers (BB), in African Americans (AA) with congestive heart failure (CHF), when compared to placebo. These results may have been influenced by lead-time bias, in that AA may not have been entered into the older ACEI trials until late in their CHF course. Our goal was to use a prospective cohort study of 29,686 CHF patients within a single health system to examine the impact on AA mortality of administering ACEI and BB within the first year of CHF diagnosis. Pharmacy claims from 1995-1998 were available for 3353 newly diagnosed CHF patients (39.2% AA; N=1317) within the health maintenance organization. Rates of ACEI and BB use were 46.4% and 54.0%; 43.4% and 28.9%; and 40.7% and 18.6%, for Whites, AA, and other races, respectively. The relative risk reductions (RRR) for ACEI were 68.7%, P<.0001; 52.1%, P<.0001; and -36.3%, P=.56, for Whites, AA, and other races, respectively. The RRR for BB were 59.0%, P<.0001; 34.6%, P=.009; and 74.3%, P=.17, for Whites, AA, and other races, respectively. Age- and gender-adjusted survival rates for AA were significantly enhanced in those taking ACEI, BB, or a combination of the two: P<.001, P=.001, and P=.003, respectively. Although we could not control for selection bias, these data suggest that AA benefit from both ACEI and BB when treatment is initiated within the first year of CHF diagnosis. Future, similar analyses other databases should control for the duration of illness to avoid lead-time bias in AA with CHF.

Adrenergic beta-Antagonists↗
PubMed2002

Confirmation of a heart failure epidemic: findings from the Resource Utilization Among Congestive Heart Failure (REACH) study.

OBJECTIVES: The purpose of this study was to create an automated surveillance tool for reporting the incidence, prevalence and processes of care for patients with heart failure. BACKGROUND: Previous epidemiologic studies suggest that the increasing prevalence of heart failure is a consequence of improved survival coupled with minimal changes in disease prevention. Developing new, efficient methods of assessing the incidence and prevalence of heart failure could allow continued surveillance of these rates during an era of rapidly changing treatments and health care delivery patterns. METHODS: Using administrative data sets, we created a definition of heart failure using diagnosis codes. After adjustment for patients leaving our health system or death, we derived the incidence, prevalence and mortality of the population with heart failure from 1989 to 1999. RESULTS: A total of 29,686 patients of all ages, 52.6% women and 47.4% men, met the definition of heart failure. Mean ages were 71.1 +/- 14.5 for women and 67.7 +/- 14.4 for men, p < 0.0001. Race proportions were 50.5% white, 44.6% African American and 4.9% other race. Incidence rates were higher in men and African Americans across all age groups. There was an annual increase in prevalence of 1/1,000 for women and 0.9/1,000 for men, p = 0.001 for both trends. CONCLUSIONS: Through the feasible and valid use of automated data, we have confirmed a chronic disease epidemic of heart failure manifested primarily by an increase in prevalence over the past decade. Our surveillance system mirrors the results of epidemiologic studies and may be a valid method for monitoring the impact of prevention and treatment programs.

Black or African American↗
PubMed2002

Congestive heart failure and QRS duration: establishing prognosis study.

STUDY OBJECTIVES: There is a lack of epidemiologic information about duration of QRS complex in the general heart failure population. We sought to describe age, sex, and clinical subset specific prevalence of QRS prolongation in this population. METHODS: Data were abstracted from the Resource Utilization Among Congestive Heart Failure Study, which identified 29,686 patients with heart failure from a large, mixed-model managed-care organization during 1989 to 1999. A target population of 3,471 had echocardiographic data and ECG data obtained from automated sources during the first year of diagnosis. Systolic dysfunction was defined as heart failure plus a left ventricular ejection fraction < 45%. MEASUREMENTS AND RESULTS: Among the heart failure population, 20.8% of the subjects had a QRS duration > or = 120 ms. A total of 425 men (24.7%) and 296 women (16.9%) had a prolonged QRS duration (p < 0.01). There was a linear relationship between increased QRS duration and decreased ejection fraction (p < 0.01). A prolonged QRS duration of 120 to 149 ms demonstrated increased mortality at 60 months (p = 0.001), when adjusted for age, sex, and race (p = 0.001). Systolic dysfunction was associated with graded increases in mortality across ascending levels of QRS prolongation. CONCLUSIONS: Approximately 20% of a generalized heart failure population can be expected to have a prolonged QRS duration within the first year of diagnosis, suggesting that as many as 20% of patients with heart failure may be candidates for biventricular pacing.

Aged↗
PubMedDate not supplied

Outcomes and prognostic factors of systolic as compared with diastolic heart failure in urban America.

We sought to describe a large heart failure (HF) population with respect to systolic and diastolic abnormalities in terms of demographics, echocardiographic parameters, and survival. Using data abstracted from the Resource Utilization Among Congestive Heart Failure (REACH) study, a targeted subpopulation of 3471 patients had electrocardiographic, echocardiographic, and clinical data taken from automated sources during the first year of diagnosis. Among the HF population, 1811 (52.2%) had diastolic HF. Prevalence of diastolic HF trended with age, from 46.4% in those less than 45 years to 58.7% in those 85 years or older (p=0.001 for trend). Patients with diastolic HF had a higher mean ejection fraction (55.7% vs. 28.0%), lower left ventricular end-systolic diameter (3.11 vs. 4.74 cm), and lower left atrium:aortic outlet ratio (1.28 vs. 1.38) (p=0.001 for each comparison). Annualized age, sex, and race-adjusted mortality were 11.2% and 13.0% for those with diastolic and systolic HF, respectively (p=0.001). In a large, racially mixed, urban HF population, those with diastolic HF predominate and enjoy better-adjusted survival than counterparts with systolic HF.

Aged↗