Evaluation of the relationship between a chronic disease care management program and California pay-for-performance diabetes care cholesterol measures in one medical group.

No abstract

IntroductionMany prior studies have compared the acuity of Emergency Department (ED) patients who have Left Without Being Seen (LWBS) against non-LWBS patients. A weakness in these studies is that patients may walk out prior to the assignment of a triage score, biasing comparisons. We report an operational change whereby acuity was assessed immediately upon patient arrival. We hypothesized more patients would receive acuity scores with EQAS. We also sought to compare LWBS and non-LWBS patient characteristics with reduced bias.MethodsSetting: urban, academic medical center. Retrospective cohort study, electronic chart review, collecting data on all ED patients presenting between 4/1/2010 and 10/31/2011 (“Traditional Acuity Score” period, TAS) and from 11/1/2011 to 3/31/2012 (“Early Quick Acuity Score” period, EQAS). We recorded disposition (LWBS versus non-LWBS), acuity and demographics. For each subject during the EQAS period, we calculated how many prior ED visits and how many prior walkouts the subject had had during the TAS period.ResultsAcuity was recorded in 92,275 of 94,526 patients (97.6%) for TAS period, and 25,577 of 25,760 patients (99.3%) for EQAS period, a difference of 1.7% (1.5%, 1.8%). LWBS patients had acuity scores recorded in 5,180 of 7,040 cases (73.6%) during TAS period, compared with 897 of 1,010 cases (88.8%) during the EQAS period, a difference of 15.2% (14.8%, 15.7%). LWBS were more likely than non-LWBS to be male, were younger and had lower acuity scores. LWBS averaged 5.3 prior ED visits compared with 2.8 by non-LWBS, a difference of 2.5 (1.5, 3.5). LWBS averaged 1.3 prior ED walkouts compared with 0.2 among non-LWBS, a difference of 1.1 (0.8, 1.3).ConclusionsEQAS resulted in a higher proportion of patients receiving acuity scores, particularly among LWBS. This offers more complete data when comparing LWBS and non-LWBS patient characteristics. The comparison reinforced findings from prior studies.

This provocative title poses a critical question regarding a possible role for patients and is a testament to the movement within medicine to become more patient centered. The editor, Patrice L. Spath, has compiled 9 chapters written by 13 different authors, all demonstrating a need for change in the way the medical community cares for patients. The authors claim that medicine, as practiced today, is not safe because of preventable medical errors and that providers do little to ensure the well-being of patients. As stated in the foreword, "[T]hat is why this book will be such a useful resource for patients, families, advocates, providers, and others working to prevent harm from medical errors."Each of 9 chapters individually establishes the need for reform in preventing medical errors. The authors use stories, anecdotes, and research studies to establish major causes. These include lack of proper oversight, lack of communication and dialogue, lack of patient involvement (through asking and answering questions), and the presence of physician "paternalism," which prohibits patient collaboration. The authors not only plea for a change to include patients in medical care but also prove that it is a necessity to prevent error.A key concept of chapter 5 that explains the lack of dialogue is that many patients are not "health literate." They neither understand nor are able to make sound decisions from medical jargon and health information. The authors stress the necessity for physicians to openly communicate with patients using language they will understand. This