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Results for “Minnesota Health Data Institute”

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PubMed1989

Population-based study of echocardiography. Time trends in utilization and diagnostic profile of an evolving technology, 1975-1987.

We evaluated trends in the use of echocardiography among residents of Olmsted County, Minnesota, from January 1, 1975, through June 30, 1987. Annual examinations per 100,000 population among Olmsted County residents increased 6-fold from 264 in 1975 to 1,644 in 1986. Given the pattern of echo use in Olmsted County, these population-based data project a potential annual utilization of 4 million echo exams in the United States. Marked increases over time in labeling of patients with regurgitant valvular heart disease were noted following the introduction of Doppler echocardiography. The diagnostic labeling associated with this evolving technology and the resultant apparent epidemic of valvular regurgitation present a significant clinical technology assessment dilemma.

Communication↗

PubMed1994

Decrease in the rate of ruptured ectopic pregnancies: a successful team approach.

Noting the increasing frequency of ectopic pregnancy and desiring to reduce both morbidity and mortality, OB/GYN physicians at a large midwestern HMO systematically monitored all ectopic pregnancies in their clinical practice as the first step in a quality improvement project. Data were collected on several components of care including access, risk assessment, diagnosis of ectopic pregnancy, and intervention. To ensure the system was able to coordinate new diagnostic and therapeutic modalities, several key initiatives were instituted to improve patient outcomes. These included application of comprehensive guidelines, increased ultrasound availability, and increased staff and patient awareness. Following the implementation of the initiatives, there was a decrease in rupture rates from 32% in 1988 to 5% in 1992. This paper discusses the development and integration of the initiatives into the staff model HMO.

Algorithms↗

PubMed2004

Assessment of mercury emissions inventories for the Great Lakes states.

Anthropogenic mercury (Hg) air emissions for the eight Great Lakes states in 1999-2000 were evaluated by analyzing three inventories. The US Environmental Protection Agency (EPA) National Emissions Inventory (NEI) had the most complete coverage for all states, and total Hg emissions ranged from 4226 lb in Minnesota to 15,828 lb in Pennsylvania. Coal-fired electric utilities accounted for 52.7% of the region's Hg emissions, varying from 20.2% of the total in New York to 67.5% in Ohio. Other important contributors to regional emissions included municipal waste combustion (5.6%), mercury-cell chlor-alkali plants and hazardous-waste incinerators (4% each), stationary internal combustion engines (ICEs) (3.5%), industrial, commercial, and institutional (ICI) boilers (3.3%), and lime manufacturing (3.0%). Although medical waste incineration accounted for just over 1% of regional emissions using the original classifications, the inclusion of health care facilities that may have been inappropriately identified with other sectors would increase the sector to 4.5% of regional emissions (and decrease the stationary ICE sector to 1.4% of the regional total). There were substantial differences for some sectors between the NEI and the Great Lakes Regional Air Toxics Emissions Inventory (GLEI), as well as unexplained differences within inventories between states (particularly for the cement, lime, and asphalt industries, and for lamp breakage). Toxics Release Inventory data for 2000 mainly covered electric utilities, and differences from the NEI were significant for several states. An independent assessment indicates the possibility of underestimated Hg emissions by about twofold for ICI boilers, although data for the sector (in particular concerning fuel oil emissions) are highly uncertain. Limited data indicate the likelihood of significant underestimates of electric arc furnace mercury emissions in the NEI and GLEI inventories. Several measures are here identified for improving the reliability of the inventories, both for modeling of atmospheric transport and deposition modeling and for tracking progress in Hg reduction initiatives.

Air Movements↗

PubMed2003

Surgical wound infection surveillance.

Measuring the frequency of a defined outcome flaw for a series of patients undergoing operative procedures generates information for performance evaluation. Such data influence decisions to improve care if used responsibly. Wound infection (WI), bacterial invasion of the incision, is the most common infectious complication of surgical care and WI prevention has value because the complication affects economic, patient satisfaction, and patient functional status outcomes. WI frequency, one kind of surgical outcome flaw rate, is traditionally used to judge one aspect of surgical care quality. At the author's institution, global WI surveillance was conducted without interruption for 20 years. Results for 85,260 consecutive inpatient operations performed during the period showed that secular changes in infection rates occurred but were not necessarily caused by surgical care quality decrements.

Antibiotic Prophylaxis↗

PubMed2004

Outcome of low-risk patients discharged home after a normal cardiac troponin I.

Patients with symptoms suggestive of, but at low risk for, acute coronary syndrome (ACS), who have a negative electrocardiogram (EKG) and a single normal troponin I at 6-9 h after symptom onset are frequently discharged from our Emergency Department (ED). We sought to determine their rate of adverse cardiac events at 30 days (ACE-30), defined as cardiac death or myocardial infarction (MI), by chart review, telephone interview, or county death records. Of 663 patients, data were available for 588 (89%). Mean age was 48 years; 59% were male. There were 390 patients (66%) who complained of chest pain. Previous coronary artery disease (CAD) was reported in 145 patients (25%). Two patients (0.34%) had ACE-30, both with non-ST elevation MI. There were no cases of cardiac death. None of the patients died in Hennepin County within 30 days. At our institution, low-risk patients with symptoms suggestive of ACS who are discharged home after a normal cTnI drawn 6-9 h after symptom onset have a very low incidence of cardiac events at 30 days.

Angina, Unstable↗

PubMed2005

Evaluating the performance of an institution using an intensive care unit benchmark.

OBJECTIVES: To describe the performances of selected intensive care units (ICUs) in a single institution using the Acute Physiology and Chronic Health Evaluation (APACHE) III benchmark and to propose interventions that may improve performance. PATIENTS AND METHODS: In this retrospective study, we analyzed APACHE III data from critically ill patients admitted to ICUs at the Mayo Clinic in Rochester, Minn, between October 1994 and December 2003. We retrieved ICU performance measures based on first ICU day APACHE III values. Standardized ratios were defined as ratios of measured to predicted values. The primary performance measure was the standardized mortality ratio, and secondary performance measures were length of stay (LOS) ratios, low-risk monitor ICU admission rates, and ICU readmission rates. We calculated 95% confidence intervals (CIs) for each performance, graded as good, average, or poor. RESULTS: Among 46,381 patients admitted during the study period, 57.5% were in surgical ICUs, 24.8% in a medical ICU, and 17.7% in a surgical-medical ICU. Low-risk monitoring accounted for 37.2% of admissions. Hospital standardized mortality ratios (95% CI) were 0.95 (0.90-0.99), 0.86 (0.81-0.91), and 0.70 (0.66-0.74) for medical, multispecialty, and surgical ICUs, respectively. Hospital LOS ratios (95% CI) were 0.83 (0.81-0.85), 0.91 (0.88-0.93), and 0.99 (0.97-1.00) for medical, multispecialty, and surgical ICUs, respectively. The ICU readmission rate for each ICU was higher than the 6.7% reported in the medical literature. Performances were good in mortality, average to good in LOS, average in low-risk admission, and poor in ICU readmission. CONCLUSIONS: A national benchmarking database can highlight the strengths and weaknesses of ICUs. The performances of ICUs in a single institution may differ; therefore, the performance of each unit should be evaluated individually.

APACHE↗

PubMed1990

A model for reducing the cost of care in VA medical centers that offer adult day health care.

One approach to providing cost-effective adult day health care (ADHC) services is to guide both the inputs to ADHC services and the provision of other services so that substitution for institutional services can realistically take place. This approach has been used in a randomized clinical trial to evaluate the medical efficacy and cost of ADHC in the Department of Veterans Affairs (DVA). This article describes the strategies that were used to improve the cost effectiveness of ADHC during the evaluation. Cost and use estimates were developed based on the best data available from the DVA and previous research on the cost for patients' use of ADHC, nursing home, hospital, and ambulatory care. A cost workshop was attended by the ADHC managers to develop plans for controlling costs. Plans were identified that increase the likelihood that ADHC can be shown to be less costly than customary care.

Adult↗

PubMed1993

Living will legislation, nursing home care, and the rejection of artificial nutrition and hydration: an analysis of bedside decision-making in three states.

Although state living will legislation establishing the boundaries of unwanted medical intervention has become almost universal, many states define artificial nutrition and hydration as a basic comfort measure rather than extraordinary intervention. In addition, several states have legislation prohibiting its withholding or withdrawal under any circumstances. Despite the recent growth in public awareness and controversy concerning artificial nutrition and hydration, there is little known about the actual influence of prohibitive legislation on bedside decisions involving its withdrawal. An analysis is undertaken of nursing home decision-making concerning the withdrawal of artificial nutrition and hydration in three states with typical variation in living will legislation specific to its legality. Data from interviews with 140 nursing home directors of nursing service responding to hypothetical case vignettes suggest that living will laws prohibiting the withdrawal of artificial nutrition and hydration have little influence over bedside decision-making in nursing homes. Factors found to be determinate of the likelihood of the withdrawal of artificial nutrition and hydration include the competency of the nursing home resident and form of nursing home ownership. State context exerts a significant influence over the likelihood of artificial nutrition and hydration withdrawal, but not in a direction consistent with language of living will legislation.

Decision Making, Organizational↗

PubMed2000

A practical approach to evidence grading.

BACKGROUND: The Institute for Clinical Systems Improvement (ICSI) is a collaboration of 17 Minnesota medical groups. Among other activities, ICSI develops health care guidelines and technology assessment reports. To maintain focus on the underlying evidence, ICSI has developed an evidence and conclusion grading system for use by the practicing clinicians who write the documents and use them in making decisions about patient care. THE EVIDENCE GRADING SYSTEM IN DETAIL: The centerpiece of the evidence grading system is the conclusion grading worksheet, which calls for statement of a conclusion, summarization of research reports that support or dispute the conclusion, assignment of classes and quality markers to the research reports, and assignment of a grade to the conclusion. EXPERIENCE AND RESULTS: The system has been used in the writing of more than 40 guidelines and numerous technology assessment reports. An example of a worksheet from the congestive heart failure guideline is presented. The system has helped the drafting groups to attend to the evidence. The methods have proven to be well accepted by practicing physicians and to be practical, although staff expertise in epidemiology is needed to support the system. Grading of conclusions appears to be reliable, although this characteristic of the system has not been rigorously tested. The outputs are valued by users of the documents. DISCUSSION: Although some residual problems remain to be solved, the system appears to be successful in overcoming the complexity of some published systems for grading evidence while still yielding a defensible classification of conclusions based on the strength of the underlying evidence.

Academies and Institutes↗

PubMed1994

Educational programs in US medical schools, 1993-1994.

From the data on faculty, students, and curriculum, is it possible to identify any responses to actual or anticipated health system changes? While one could foresee medical school downsizing in response to a potentially more competitive environment in which income from faculty practice would be reduced, what has occurred, on average, is steady growth in the number of faculty members across departments, with a large increase in the past year. However, expansion is not consistent across states. Between 1992-1993 and 1993-1994, the number of full-time faculty members decreased 1.5% in California medical schools, increased 3% in Minnesota medical schools, increased 6% in North Carolina medical schools, and increased 10% in New York and Pennsylvania medical schools. These differences may reflect the fiscal situation at the state level as well as differences in the practice environment in different areas. For example, managed care has not had a major effect in many markets. It will be important to monitor trends in faculty at both the national and regional levels to understand the full impact of health system changes. There is considerable diversity among US medical schools: in goals, in student profiles, and in curriculum structure. A number of schools have goals or objectives that contain a reference to the training of primary care physicians. The majority of these are public institutions, but a number of private schools have chosen to address the issue as well. Many schools, both public and private, are under external scrutiny related to the performance and specialty and practice location choices of their graduates.(ABSTRACT TRUNCATED AT 250 WORDS)

Accreditation↗

PubMed1998

Quality improvement in primary care clinics.

BACKGROUND: Case studies from Project IMPROVE, the first randomized controlled trial to evaluate the effectiveness of continuous quality improvement (CQI) in primary care, were subjected to a qualitative analysis. Three questions were addressed: How does change in the health care environment affect a quality improvement (QI) process? How does clinic organization influence a QI process? and What is the impact of a QI process on clinic organization? METHOD: Case studies were conducted in 6 clinics that had been randomly selected from the 22 clinics participating in the IMPROVE intervention. The case study data consisted of observations of CQI team meetings, open-ended interviews with 30 informants (team members plus others in the clinics), interviews with IMPROVE consultants, and documentation from the project. The data were analyzed to identify themes and generate concepts, assess and compare the informants' experiences, and develop a conceptual framework stimulated by research and theory literature. RESULTS: Change and uncertainty in the health care environment both complicated the QI process and motivated participation in improvement. The smaller clinics appeared to have more difficulty with the QI process because of limited resources and lack of compatibility between the QI approach and their clinic organization. Project IMPROVE had two qualitative effects on clinics: increased awareness of preventive services and application of the CQI method to other problems and issues. CONCLUSION: QI initiatives can help clinics adapt to a changing health care environment and create functioning teams or groups that can address a variety of organization problems and tasks. The process should be flexible to accommodate varying organization structures and cultures.

Ambulatory Care Facilities↗

PubMed2006

Evaluation and sustainability of the healthy learners asthma initiative.

The Healthy Learners Asthma Initiative (HLAI) involved collaboration between Minneapolis Public Schools (MPS), local health care providers/payors, parents, and other partners. The intervention included development of enhanced asthma care in school health offices and clinic performance improvement projects to foster adoption of National Institutes of Health asthma guidelines. Goals were to improve asthma management among school children and reduce asthma-related school absences, hospitalizations, and emergency department visits. The effectiveness evaluation utilized a randomized community trial design with 16 elementary and middle schools matched and randomly assigned to either an intervention or a control group. Outcomes investigated were (a) school health office impacts and (b) school attendance. Data sources included school health office records, district attendance, enrollment, and demographics files. Following implementation of the HLAI, asthma visits to health offices were significantly lower in intervention schools compared to control schools (91 vs 121 visits per 100 students with asthma per month), and intervention schools had greater availability of medication and asthma action plans and more peakflow measurements, asthma education, and parent communication. Clinics initiated significantly more asthma action plans and sent them to MPS. Attendance differences between groups were limited to students who received asthma care through the school health office. Monitoring of asthma management activities provided through school health offices from 2002 to 2005 indicates sustained implementation of enhanced asthma care in schools and increased asthma communication between school, parents, and health care providers.

Absenteeism↗

PubMed1994

The electronic medical record: perspective from Mayo Clinic.

On 1 January 1993, the Electronic Medical Record Task Force at Mayo Clinic published its report. Charged by the Mayo Foundation to define the Electronic Medical Record (EMR) for Mayo, the task force mapped the goals, strategies and time-lines for implementation of the EMR in that institution. The task force was composed predominantly of caregivers (physicians and nurses) with assistance from members of Mayo's information systems and administrative departments. The focus of the effort was care of the patient with the consensus belief that the EMR will improve that process and, if designed robustly, will serve the other information needs of claims, research, education and practice management. The recommendations of this report have been accepted by the Mayo Foundation leadership resulting in the generation of a master plan and the creation of the governance structure for implementation at Mayo. This paper abstracts key portions of the report.

Computer Systems↗

PubMed2006

Trends in prevalence and outcome of heart failure with preserved ejection fraction.

BACKGROUND: The prevalence of heart failure with preserved ejection fraction may be changing as a result of changes in population demographics and in the prevalence and treatment of risk factors for heart failure. Changes in the prevalence of heart failure with preserved ejection fraction may contribute to changes in the natural history of heart failure. We performed a study to define secular trends in the prevalence of heart failure with preserved ejection fraction among patients at a single institution over a 15-year period. METHODS: We studied all consecutive patients hospitalized with decompensated heart failure at Mayo Clinic Hospitals in Olmsted County, Minnesota, from 1987 through 2001. We classified patients as having either preserved or reduced ejection fraction. The patients were also classified as community patients (Olmsted County residents) or referral patients. Secular trends in the type of heart failure, associated cardiovascular disease, and survival were defined. RESULTS: A total of 6076 patients with heart failure were discharged over the 15-year period; data on ejection fraction were available for 4596 of these patients (76 percent). Of these, 53 percent had a reduced ejection fraction and 47 percent had a preserved ejection fraction. The proportion of patients with the diagnosis of heart failure with preserved ejection fraction increased over time and was significantly higher among community patients than among referral patients (55 percent vs. 45 percent). The prevalence rates of hypertension, atrial fibrillation, and diabetes among patients with heart failure increased significantly over time. Survival was slightly better among patients with preserved ejection fraction (adjusted hazard ratio for death, 0.96; P=0.01). Survival improved over time for those with reduced ejection fraction but not for those with preserved ejection fraction. CONCLUSIONS: The prevalence of heart failure with preserved ejection fraction increased over a 15-year period, while the rate of death from this disorder remained unchanged. These trends underscore the importance of this growing public health problem.

Aged↗

PubMed1996

Factors associated with safe use of agricultural pesticides in Minnesota.

How farmers protect themselves against pesticide exposure has important public health consequences. To obtain insights into pesticide self-protection, this study obtained data on chemically resistant glove and other protective equipment use as they relate to the type of farming practice, demographic characteristics of farmers and their farming operations, farmers' preventive health beliefs and behaviors, and factors related to their health care. Data were obtained by telephone interviews conducted in six rural Minnesota counties. Survey respondents totaled 1, 327 (87% response rate), with 502 reporting pesticide use. Ninety-five percent of the latter respondents believed in the effectiveness of protective equipment and 88 percent believed that pesticide exposures are harmful. Fifty-six percent of the subjects wore chemically resistant gloves and 22 percent wore other protective clothing 75 percent of the time or more when using pesticides. Glove use and certification to use restricted pesticides was less frequent for women. The use of protective equipment in this group of Minnesota farmers was weakly related to being certified to apply restricted pesticides, believing in the effectiveness of protective clothing, believing that smoking causes serious health problems, using crop insecticides, and distance to a health care facility.

Agriculture↗

PubMed1998

Reducing adverse drug events and medication errors using rapid cycle improvement.

The article describes Fairview Health System's participation in the Institute for Healthcare Improvement Breakthrough Series on adverse drug events and medication errors. Fairview commissioned an interdisciplinary team to design, plan, and lead activities focused on reducing adverse drug events and medication errors. This team managed, facilitated, or led 15 separate projects, each focusing on a specific aspect of the medications process. Specific systems improvements were identified, leading to reductions in errors or adverse events. As a result of this effort, Fairview has committed to a long-term plan to reduce the risk of adverse drug events and medication errors to the lowest possible rate.

Anticoagulants↗

PubMedDate not supplied

Ambulatory care quality measures for the 6 aims from administrative data.

Pressure is building for performance measures that can be collected inexpensively and repeatedly for internal and external accountability and quality improvement. The objective of this study was to develop and test measures obtainable from administrative data covering each of the Institute of Medicine's (IOM) 6 aims. Measure definitions were developed for 3 common chronic conditions and were revised after testing the feasibility of collecting them from claims data. The setting was a large, multispecialty medical group in the Midwest and included all adult patients with diabetes, coronary heart disease, or depression. Problems identified in the original 99 measures led to refinements or elimination. The resulting 46 measures ready for use include 11 measures for 5 aims applicable to most common chronic conditions, plus 10 to 14 effectiveness measures for each condition. They have been successfully used to describe care quality changes for these patients over time. This starter set for the 6 IOM aims should be tested and expanded by others.

Ambulatory Care↗

PubMed2006

A comparison of intensive care unit physician staffing costs at the 3 Mayo Clinic sites.

OBJECTIVES: To determine the provider cost of administering intensive care unit (ICU) services, comparing 3 different staffing models for ICU coverage, and to compare the costs of using house staff vs nonphysician providers (NPPs). METHODS: Data were collected on total staff composition and number of beds In ICUs from January 1, 2004, through December 31, 2004, at the 3 Mayo Clinic sites: Rochester, Minn; Jacksonville, Fla; and Scottsdale, Ariz. Institutional or national average staff salaries were used to determine total staffing costs per ICU bed per year at each site. Medicare medical education reimbursements were also taken into account. RESULTS: Costs per ICU bed for physician staffing were $18,630 in Rochester, $37,515 in Jacksonville, and $38,010 in Scottsdale. When NPPs were substituted for house staff, the costs per bed were $72,466 in Rochester, $61,291 in Jacksonville, and $49,909 in Scottsdale. Incremental costs per ICU bed using NPPs were $53,836 in Rochester, $23,776 in Jacksonville, and $11,899 in Scottsdale. CONCLUSION: Use of residents and fellows in ICU staffing at a major tertiary health center is more cost-efficient than use of NPPs. This finding could have Implications for the cost of physician services in nonteaching community hospitals and the methods by which care is provided.

Arizona↗