Browsing by Author "Gupta, Nupur"

Now showing 1 - 5 of 5
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    Impact of Geographical Cohorting in the ICU: An Academic Tertiary Care Center Experience
    (Wolters Kluwer, 2020-09-25) Kapoor, Rajat; Gupta, Nupur; Roberts, Scott D.; Naum, Chris; Perkins, Anthony J.; Khan, Babar A.; Medicine, School of Medicine
    ICU is a multifaceted organization where multiple teams care for critically ill patients. In the current era, collaboration between teams and efficient workflows form the backbone of value-based care. Geographical cohorting is a widespread model for hospitalist rounding, but its role in ICUs is unclear. This study evaluates the outcomes of geographical cohorting in a large ICU of an Academic Health Center. Design: This is a retrospective analysis of quality metrics collected 12 months pre- and post-implementation of geographical cohorting. Setting: A total of 130 bedded ICU at tertiary academic health center in Midwest. Patients: All patients admitted to the ICU. Interventions: Our institution piloted the geographical cohorting model for critical care physician rounding on September 1, 2018. Measurements: The quality metrics were categorized as ICU harm events and ICU hospital metrics. Team of critical care providers were surveyed 12 months after implementation. Main results: The critical care utilization in the pre- and post-implementation numbers were similar for patient days (pre = 34,839, post = 35,155), central-line days (pre = 17,648, post = 19,224), and Foley catheter days (pre = 18,292, post = 17,364). The ICU length of stay was similar (4.9 d) in both pre- and post-intervention periods. Significant reduction in the incidence of Clostridium difficile infection (relative risk, -0.50; 95% CI, 0.25-0.96; p = 0.039), hospital-acquired pressure injury (relative risk, -0.60; 95% CI, 0.39-0.92; p = 0.020), central line-associated bloodstream infection incidence (relative risk, -0.19; 95% CI, 0.05-0.52; p = 0.008), and catheter-associated urinary tract infection (relative risk, -0.52; 95% CI, 0.29-0.93; p = 0.027). Healthcare providers perceived optimal utilization of their time, reduced interruptions, and improved coordination of care with geographical rounding. Conclusions: Geographical cohorting improves coordination of care, physician workflow, and critical care quality metrics in very large ICUs.
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    Is It Time for Precision Dialysis?
    (American Society of Nephrology, 2021) Gupta, Nupur; Wish, Jay B.; Medicine, School of Medicine
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    Maintaining Blood Glucose Levels in Range (70–150 mg/dL) is Difficult in COVID-19 Compared to Non-COVID-19 ICU Patients—A Retrospective Analysis
    (MDPI (Multidisciplinary Digital Publishing Institute), 2020-11-12) Kapoor, Rajat; Timsina, Lava R.; Gupta, Nupur; Kaur, Harleen; Vidger, Arianna J.; Pollander, Abby M.; Jacobi, Judith; Khare, Swapnil; Rahman, Omar; Medicine, School of Medicine
    Beta cell dysfunction is suggested in patients with COVID-19 infections. Poor glycemic control in ICU is associated with poor patient outcomes. This is a single center, retrospective analysis of 562 patients in an intensive care unit from 1 March to 30 April 2020. We review the time in range (70–150 mg/dL) spent by critically ill COVID-19 patients and non-COVID-19 patients, along with the daily insulin use. Ninety-three in the COVID-19 cohort and 469 in the non-COVID-19 cohort were compared for percentage of blood glucose TIR (70–150 mg/dL) and average daily insulin use. The COVID-19 cohort spent significantly less TIR (70–150 mg/dL) compared to the non-COVID-19 cohort (44.4% vs. 68.5%). Daily average insulin use in the COVID-19 cohort was higher (8.37 units versus 6.17 units). ICU COVID-19 patients spent less time in range (70–150 mg/dL) and required higher daily insulin dose. A higher requirement for ventilator and days on ventilator was associated with a lower TIR. Mortality was lower for COVID-19 patients who achieved a higher TIR.
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    Optimal Care for Kidney Health: Development of a Merit-based Incentive Payment System (MIPS) Value Pathway
    (Wolters Kluwer, 2023) Tummalapalli, Sri Lekha; Struthers, Sarah A.; White, David L.; Beckrich, Amy; Brahmbhatt, Yasmin; Erickson, Kevin F.; Garimella, Pranav S.; Gould, Edward R.; Gupta, Nupur; Lentine, Krista L.; Lew, Susie Q.; Liu, Frank; Mohan, Sumit; Somers, Michael; Weiner, Daniel E.; Bieber, Scott D.; Mendu, Mallika L.; Medicine, School of Medicine
    The Merit-based Incentive Payment System (MIPS) is a mandatory pay-for-performance program through the Centers for Medicare & Medicaid Services (CMS) that aims to incentivize high-quality care, promote continuous improvement, facilitate electronic exchange of information, and lower health care costs. Previous research has highlighted several limitations of the MIPS program in assessing nephrology care delivery, including administrative complexity, limited relevance to nephrology care, and inability to compare performance across nephrology practices, emphasizing the need for a more valid and meaningful quality assessment program. This article details the iterative consensus-building process used by the American Society of Nephrology Quality Committee from May 2020 to July 2022 to develop the Optimal Care for Kidney Health MIPS Value Pathway (MVP). Two rounds of ranked-choice voting among Quality Committee members were used to select among nine quality metrics, 43 improvement activities, and three cost measures considered for inclusion in the MVP. Measure selection was iteratively refined in collaboration with the CMS MVP Development Team, and new MIPS measures were submitted through CMS's Measures Under Consideration process. The Optimal Care for Kidney Health MVP was published in the 2023 Medicare Physician Fee Schedule Final Rule and includes measures related to angiotensin-converting enzyme inhibitor and angiotensin receptor blocker use, hypertension control, readmissions, acute kidney injury requiring dialysis, and advance care planning. The nephrology MVP aims to streamline measure selection in MIPS and serves as a case study of collaborative policymaking between a subspecialty professional organization and national regulatory agencies.
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    Training Nephrology Fellows in Home Dialysis in the United States
    (Wolters Kluwer, 2021) Gupta, Nupur; Miller, Brent W.; Medicine, School of Medicine