In 2005, the US Preventive Services Task Force issued recommendations for one-time abdominal aortic aneurysm (AAA) screening using abdominal ultrasonography in men aged 65 to 75 years with a history of smoking. However, despite a mortality rate of up to 80% for ruptured AAAs, providers order the screening for a minority of patients. We examined AAA screening rates among providers and investigated the role of visit duration and other factors in whether patients received screening. We also looked for potential interventions to improve compliance.Methods We retrospectively reviewed the records of patients who visited our clinic over a 4-month period and met the US Preventive Services Task Force criteria for AAA screening when our practice had a real-time decision support tool implemented to identify patients due for the screening. We also surveyed our clinic's providers about their knowledge and attitudes regarding AAA screening. Despite the use of physician reminders, providers ordered screening for only 12.9% of eligible patients. Screening was more likely to be ordered during longer visits versus shorter ones (24% vs. 6%). When surveyed, most providers (70.6%) indicated that a nurse-directed ordering system would improve compliance.Conclusions This study illustrates that physician reminders alone are not sufficient to improve care and that more time is needed for preventive services. This provides additional support for the use of a multidisciplinary approach to preventive screening, as in a patient-centred medical home. In a patient-centred medical home, a care team of physicians, nurses and office staff use technology such as clinical decision support to provide comprehensive, coordinated patient care.
The United States Preventive Services Task Force recommends a one-time screening for abdominal aortic aneurysm (AAA) with ultrasonography for men aged 65 to 75 years who have ever smoked. However, despite a mortality rate of up to 80% for ruptured AAAs, providers order the screening for a minorit...
Obesity constitutes an independent predictor for a nondiagnostic screening ultrasound (US) in suspected appendicitis. Furthermore, the imaging route consisting of the screening US with a second US if necessary has a significantly lower diagnostic accuracy in the obese children (83%) than their le...
Few studies link organizational variables and outcomes to quality indicators. This approach would expose operant mechanisms by which work environment characteristics and organizational outcomes affect clinical effectiveness, safety, and quality indicators.Question: What are the predominant psycho...
The objectives of this study were to establish the extent to which UK primary care has adopted recommended practices on supportive and palliative care of adults with cancer, and to relate this to participation in national initiatives. We conducted a cross-sectional postal questionnaire survey of ...
Pay-for-performance (P4P) is one of the primary tools used to support healthcare delivery reform. Substantial heterogeneity exists in the development and implementation of P4P in health care and its effects. This paper summarizes evidence, obtained from studies published between January 1990 and ...
submitted by corlahomilenck 1 year and 8 months ago
Prognostic assessment tools to identify subgroups of patients at risk of persistent low back pain who may benefit from targeted treatments have been developed and validated in primary care. The IMPaCT Back study is investigating the effects of introducing and supporting a subgrouping for targeted...
Underuse and overuse of diagnostic tests have important implications for health outcomes and costs. Decision support technology purports to optimize the use of diagnostic tests in clinical practice. The objective of this review was to assess whether computerized clinical decision support systems ...
Recent studies support the use of endovascular treatment for ruptured abdominal aortic aneurysms, but few studies have examined the use of thoracic endovascular aortic repair (TEVAR) for ruptured descending thoracic aortic aneurysm. We evaluated nationwide data regarding short-term outcomes of TE...
An individualised action plan (AP) is a potentially effective method of helping patients with chronic obstructive pulmonary disease (COPD) to recognise and anticipate early exacerbation symptoms. This multicentre randomised controlled trial evaluates the hypothesis that individualised APs reduce ...
To evaluate the effectiveness of a web-based, individually tailored decision aid (Patient Dialogue) on depression or acute low back pain for insurees of a German sickness fund.MethodsPatient Dialogue (PD) was compared to the non-tailored Static Patient Information (SPI) in an online randomized co...
