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Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

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At least 595 records · Page 33Linked to original sources
PubMed1999

Implementing a congestive heart failure disease management program to decrease length of stay and cost.

Congestive heart failure (CHF) is the most common reason for a hospital admission in the Medicare age group and is nearly double the rate of pneumonia, the next highest volume diagnosis. The economic burden of this debilitating, chronic disease demands a mechanism to improve quality of care while preventing unnecessary hospitalizations. Beginning in 1995, Evanston Northwestern Healthcare (ENH) created a disease management program involving a multidisciplinary team designed to decrease length of stay (national average = 6.2 days; ENH = 4 days), reduce costs, prevent readmissions (national 30-day readmission rate = 23%; ENH CHF Program = 2.3%), and improve compliance with the treatment regimen. Compliance monitoring through an automated telemanagement program reinforces education, identifies early warning signs and reduces the likelihood of hospitalization. After 18 months, telemanagement participants' compliance rate averages 89.5%. CHF hospitalization rates are 0.6/patient/year compared with the national benchmark of 1.7/patient/year. A disease management program consists of inpatient consultation, education, outpatient CHF clinic, cardiac home care, and compliance monitoring. Throughout this continuum, education must be communicated consistently by all team members. A CHF Assessment Guide assists the multidisciplinary team to thoroughly complete all education and address unique solutions to patients' needs.

Ambulatory Care↗
PubMed1996

Reducing variation in patient care. Nursing responds to capitation.

As managed care and capitation methods of payment become more common to hospitals, a strategy to improve quality and reduce costs is introduced in response to these new pressures. Nursing leaders must take the initiative and respond to these changes by reducing the variations in patient care. The author describes seven initiatives undertaken by the nursing leaders of The St. Joseph Healthcare System in Albuquerque. New Mexico during a 3-year period. The success of these initiatives and their universal application is discussed.

Capitation Fee↗
PubMed1996

Primary care diagnosis and pharmacologic treatment of depression in adults.

Depression is a common clinical problem seen in primary care. Despite a high prevalence of depression in patients of all ages, it is underdiagnosed and undertreated by primary care and other nonpsychiatric health care providers-the practitioners most likely to see the patient initially, greater than 50% of the time. Differentiating depression and physical illness is difficult and often comorbidity confounds the problem. Diagnostic criteria for depression are presented along with tips for assessment of suicide risk. Laboratory screening should be done as part of the diagnostic process to document certain changes in physiological parameters related to depression. The choice of treatment for depression includes psychotherapy, medication, ECT, or combined treatment with medication and psychotherapy. The result of managed care is that primary providers are more often responsible for medication management of depression than they were in the past. An overview of antidepressant pharmacotherapeutics for primary care is presented.

Adult↗
PubMed2000

New directions in heart failure management.

Approximately 4.8 million Americans are afflicted with heart failure; this accounts for 800,000 to 900,000 hospital admissions annually. Astute management in the primary care setting is essential for decreasing mortality and minimizing the risk for hospitalization. Although heart failure was initially viewed as a hemodynamic disorder, current evidence overwhelmingly supports that neurohormones, such as angiotensin II and aldosterone, contribute significantly to disease progression. The benefits of angiotensin-converting enzyme inhibitors and other drugs that block these substances are well established. This article discusses current management options that retard left ventricular remodeling to improve systolic function over time.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed2001

Genital herpes in pregnant and nonpregnant women.

The incidence of genital herpes is increasing. Proper diagnosis and management is crucial in pregnant women because transmission to neonates can be deadly. The diagnosis and management of potential genital herpes obstetric complications can decrease transmission rates to neonates. Standards of care have recently changed regarding the clinical presentation of genital herpes: Many cases of genital herpes are asymptomatic. This article discusses management and treatment options in pregnant and nonpregnant women.

Centers for Disease Control and Prevention, U.S.↗
PubMed2000

New rules impact sedation and anesthesia care, Part 1.

Learn why the Joint Commission has revised its anesthesia care standards. The new standards incorporate four sedation levels: minimum sedation, moderate sedation/analgesia, deep sedation/analgesia, and anesthesia.

Anesthesia↗
PubMedDate not supplied

How to start a nurse-managed foot care clinic.

The goals of a nurse-managed clinic are to prevent illness and encourage an active participation in health maintenance by increasing patient knowledge. A nurse-managed clinic that focuses on foot care presents an excellent opportunity to provide quality care to patients who are at risk by monitoring for debilitating foot conditions while teaching proper foot care techniques. It is well documented that foot care can prevent serious complications, such as amputation, making it essential for patients to be educated and receive professional foot care. This article addresses the development of a foot care clinic managed and staffed by nurses.

Documentation↗