In a hybrid lecture- and PBL-based curriculum, student performance on objective examinations covering PBL materials is unaffected by the status of the facilitator (student vs. faculty). However, in peer-facilitated groups, students sometimes took short cuts in the PBL process that may undermine some of the intended goals of PBL.

No abstract

No abstract

No abstract

Background: The importance of preventive services has been well established, yet rates of preventive service delivery continue to lag behind national goals. While numerous studies have identified barriers to preventive service delivery and implemented interventions to improve delivery, research into this important area is lacking in the setting of student-run clinics.  Methods: In this study a multifaceted intervention consisting of patient and provider education, provider check list, pre-clinic chart review, and financial assistance for preventive services was implemented for 14 months in a student-run clinic.Results: Rates of delivery of United States Preventive Services Task Force (USPSTF) Grade A and B recommended preventive services were evaluated before and after implementation of the intervention with 16 of 26 services improving during the intervention but only tetanus immunization reaching significance. In addition, rates of delivery of preventive services were compared to reported national averages and targets set by Healthy People 2020 with 16 of 20 services being offered at or above reported national averages and 10 of 16 services meeting the targets laid out in Healthy People 2020.Conclusions: The rate of preventive services can be improved in student-run clinics through the implementation of multi-faceted interventions to a level that meets national averages and targets.

Background Inappropriate antimicrobial therapy of Staphylococcus aureus bacteremia (SAB) is associated with worsened outcomes. The impact of insurance coverage on appropriate selection of antibiotics at discharge is poorly understood. Methods We used a retrospective cohort design to evaluate whether patients with SAB at a large academic medical center over 2 years were more likely to receive inappropriate discharge antibiotics, depending on their category of insurance. Insurance was classified as Medicare, Medicaid, commercial, and none. Logistic regression was used to determine the odds of being prescribed inappropriate discharge therapy. Results A total of 273 SAB patients met inclusion criteria, with 14.3% receiving inappropriate discharge therapy. In the unadjusted model, there was 2-fold increased odds of being prescribed inappropriate therapy for Medicare, Medicaid, and no insurance, compared with commercial insurance, respectively (odds ratio [OR], 2.08; 95% CI, 1.39–3.13). After controlling for discharge with nursing assistance and infectious diseases (ID) consult, there were 1.6-fold increased odds (OR, 1.57; 95% CI, 0.998–2.53; P = .064) of being prescribed inappropriate therapy for Medicare, Medicaid, and no insurance, compared with commercial insurance, respectively. We found that being discharged home without nursing assistance resulted in 4-fold increased odds of being prescribed inappropriate therapy (OR, 4.16; 95% CI, 1.77–9.77; P < .01), and failing to consult an ID team resulted in 59-fold increased odds of being prescribed inappropriate therapy (OR, 59.2; 95% CI, 11.4–306.9; P < .001). Conclusions We found strong evidence that noncommercial insurance, discharging without nursing assistance, and failure to consult ID are risk factors for being prescribed inappropriate antimicrobial therapy for SAB upon hospital discharge.

BackgroundInappropriate or inadequate antimicrobial therapy of Staphylococcus aureus bacteremia (SAB) is associated with worsened outcomes. The impact of insurance coverage on appropriate selection of antibiotics is poorly understood. In patients diagnosed with SAB, we assessed the impact of insurance coverage on appropriate selection and duration of antibiotics at discharge.MethodsWe analyzed 273 patients who were diagnosed with SAB during their hospitalization at Nebraska Medicine and were discharged on antibiotics in 2015 and 2016. Antimicrobial therapy was deemed inappropriate if (i) total treatment duration was less than 14 days, (ii) oral delivery route was used, (iii) vancomycin was used to treat methicillin sensitive S. aureus in non-β-lactam allergic patients, or (iv) any penicillin or cephalosporin was used to treat methicillin-resistant S. aureus. Insurance was categorized broadly into (i) no insurance, (ii) Medicaid, (iii) Medicare, and (iv) Commercial. We collected data on a suite of additional variables that included: type of infectious disease (ID) inpatient consult and location of discharge. Logistic regression was used to determine the odds of being prescribed inappropriate therapy in univariate and multivariate analyses and likelihood ratio tests (LRT) were used to evaluate the strength of evidence.ResultsIn unadjusted models, not having insurance was associated with inappropriate antimicrobial therapy (Reference Group: Any insurance; OR No insurance 4.71; LRT P = 0.027). Two additional risk factors for inappropriate therapy were identified in unadjusted models: discharge location (Refrence Group: Nursing assistance; OR Home without assistance 3.37; 95% CI 1.34–8.46; LRT P = 0.008) and lack of an ID consult (Reference Group: Academic team; OR Not consulted 26.8, 95% CI 7.66–93.8; LRT P < 0.001).ConclusionWe found strong evidence that not having insurance, being discharged to home without assistance, and not having an inpatient ID consult are risk factors for being prescribed inappropriate antimicrobial therapy for SAB upon hospital discharge; however, the sparsity of outcomes prevents us from drawing causal inferences. This study adds to the extensive body of evidence that has shown that uninsured patients tend to have suboptimal therapeutic choices.Disclosures All authors: No reported disclosures.

No abstract