Objective To develop expeditiously a pragmatic, modular, and extensible software framework for understanding and improving healthcare value (costs relative to outcomes).Materials and methods In 2012, a multidisciplinary team was assembled by the leadership of the University of Utah Health Sciences Center and charged with rapidly developing a pragmatic and actionable analytics framework for understanding and enhancing healthcare value. Based on an analysis of relevant prior work, a value analytics framework known as Value Driven Outcomes (VDO) was developed using an agile methodology. Evaluation consisted of measurement against project objectives, including implementation timeliness, system performance, completeness, accuracy, extensibility, adoption, satisfaction, and the ability to support value improvement.Results A modular, extensible framework was developed to allocate clinical care costs to individual patient encounters. For example, labor costs in a hospital unit are allocated to patients based on the hours they spent in the unit; actual medication acquisition costs are allocated to patients based on utilization; and radiology costs are allocated based on the minutes required for study performance. Relevant process and outcome measures are also available. A visualization layer facilitates the identification of value improvement opportunities, such as high-volume, high-cost case types with high variability in costs across providers. Initial implementation was completed within 6 months, and all project objectives were fulfilled. The framework has been improved iteratively and is now a foundational tool for delivering high-value care.Conclusions The framework described can be expeditiously implemented to provide a pragmatic, modular, and extensible approach to understanding and improving healthcare value.

No abstract

a unique case study for examining the specific considerations for mass violence events in senior living facilities. A variety of factors, including reduced sensory perception, reduced mobility, and cognitive decline, may increase the vulnerability of the populations of senior living facilities during mass violence events. Management of response aspects such as evacuation, relocation, and reunification also require special consideration in the context of mass violence at senior living facilities. Better awareness of these vulnerabilities and response considerations can assist facility administrators and emergency managers when preparing for potential mass violence events at senior living facilities. (Disaster Med Public Health Preparedness. 2017;11:150-152)

A significant decrease in patient volume was seen at the AL1TC with the initiation of the PL2TC in close proximity. Orthopaedic patient volume did not recuperate after the removal of the PL2TC status.

Missed injuries in trauma patients are a significant source of preventable morbidity. The tertiary survey is a head-to-toe physical exam performed within 24 hours of admission to identify any injuries which may have been missed during initial assessment and resuscitation. The Physician Assist Trauma Software (PATS) is an electronic program designed to guide users through a thorough tertiary survey and document the results. This thesis project was designed to study the impact of implementing this novel mobile device based electronic tertiary survey program on missed injuries. The first phase of this study involved quantifying and characterizing the missed injury rate at two distinct pilot sites. The second phase compared missed injury rates before and after implementation of the PATS program. Completion rates before and after implementation were also compared as a measure of feasibility. The implementation of the PATS program significantly decreased missed injury rates and improved documentation compliance at both sites. The third phase focused on user-level feasibility by surveying the pre-and post-PATS practitioners responsible for completing the tertiary survey. Overall, users found the PATS program useful, time-saving, and effective. The PATS program appears to be an effective and feasible way to reduce missed injuries and improve documentation in trauma.

Background: Bacterial translocation (BT) from the gut can develop and persist after short periods of hemorrhagic shock secondary to traumatic injuries. Erythroopoietin (EPO) exerts hemodynamic and anti-inflammatory effects in addition to its erythropoietic effect. We tested the hypothesis that EPO given at the time of acute resuscitation with normal saline (NS), Ringer's lactate (RL) or 7.5% hypertonic saline (7.5%HTS) will limit shock-induced mucosal injury and BT. Methods: Rats were hemorrhaged 30 mL/kg over 10 minutes via arterial catheter for 50 minutes, then randomized to 1 of 6 resuscitation groups (n = 5/group): NS, NS+EPO, RL, RL+EPO, 7.5%HTS and 7.5%HTS+EPO. Intravenous EPO (1000 U/kg) was given at the start of NS or RL (3 times the volume of shed blood) and 4 mL/kg of 7.5%HTS+1 volume of RL resuscitation. Postresuscitation gut function was evaluated using agar cultures of mesenteric lymph nodes and portal vein plasma lipopolysaccharide, IL-6 and TNF-α levels. Three of 5 rats per group underwent light microscopic examination using semi-thin plastic sections of the distal ileum and fluorescein isothiocyanate dextran 4000 used to assess the distal ileum mucosal permeability to macromolecules. Results: Two hours postshock and resuscitation, BT to mesenteric lymph nodes decreased in the NS+EPO versus the NS group (299 ± 104 v. 1050 ± 105 CFU/gm, p < 0.05); the addition of EPO to the RL or 7.5%HTS had no effect. Comparing different solutions, there was a significant increase in BT in the NS group versus the RL+EPO, 7.5%HTS+EPO and 7.5%HTS groups (1050 ± 105 v. 357 ± 134, 462 ± 129, 428 ± 106 CFU/gm, respectively; p < 0.05). There were no significant differences in terminal ileum permeability between groups, but there was a noticeable trend in decreasing terminal ileum permeability in the EPO-treated groups: NS versus NS+EPO (18.0 ± 9.5 v. 12.9 ± 6.3 µg/mL, p = 0.84), RL versus RL+EPO (17.7 ± 5.9 v. 8.4 ± 2.7 µg/mL, p = 0.22) and 7.5%HTS versus 7.5%HTS+EPO (11.4 ± 6.4 v. 6.5 ± 2.9 µg/mL, p = 0.69). There was no significant morphological evidence of mucosal injuries and no cytokine differences between groups and within groups. Conclusion: Preliminary data from an uncontrolled mean arterial pressure hemorrhagic shock rat model revealed that BT is an early event occurring within 2 hours of injury and resuscitation before any evidence of histological injury. Erythroopoietin with NS significantly decreased BT to the portal vein as compared with NS alone, but not with RL and 7.5%HTS.Analgesia in the management of pediatric trauma in the resuscitative phase: the role of the trauma centre.

AimTo assess the relationship between risk perception and reported traffic collisions (TC) and traffic injuries (TI) the year before.MethodsDesign: Cohorts.SettingPrimary Care (PC). Urban area. Barcelona (Spain).Population1938 subjects possessing driving license, who attended a participating practice from March to November/2009.MeasurementsOutcome: TC, TI the year before.Main exposuresPerception of risk for TCs (self-perception (SPR) and as assessed by a health professional (HPPR)), scored 0–10.CovariatesAge, gender, seatbelt use, adherence to speed limits, long-term conditions (LTC) and drugs which increase risk for TC (LTD), psychoactive substance (PS).Data collectionInterview with a health professional during the recruitment visit. Checked with medical records.StatisticsWilcoxon-test to assess differences in risk perception between categories. Logistic regression to assess relationship between risk perception scores, covariates and TC, TI.ResultsPatients that take LTD scored SPR lower (mean difference (MD) -0.561(−0.938 to −0.183);p=0.019); those with LTC, and PS users dont score higher (p=0.09, p=0.35 respectively). Health professionals score higher those with LTC (MD 0.879(0.634 to 1.123); p<0.001), LTD (MD 0.967 (0.722 to 1.212); p<0.001) and PS users (MD 0.857 (0.497 to 1.216); p<0.001). HPPR is independently associated with TCs (p=0.026), and TIs (p=0.025). SPR is not related with TCs, nor it is with TIs (both p>0.5).DiscussionPC patients are not aware of the increased risk associated with their LTD, nor with the LTC they are prescribed; PS users arent either. By contrast, HPPRs know about the excess of risk associated with these. Their advice could be an effective intervention.