Browsing by Author "Gupta, Nupur"

Now showing 1 - 6 of 6
  • Thumbnail Image
    Item
    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.
  • Thumbnail Image
    Item
    Is It Time for Precision Dialysis?
    (American Society of Nephrology, 2021) Gupta, Nupur; Wish, Jay B.; Medicine, School of Medicine
  • Thumbnail Image
    Item
    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.
  • Thumbnail Image
    Item
    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.
  • Thumbnail Image
    Item
    Program Director and Nephrology Fellow's Perceptions of Home Hemodialysis Education in the United States
    (Wolters Kluwer, 2025) Gupta, Nupur; Howard, Andrew J.; Yuan, Christina M.; Medicine, School of Medicine
    Key Points: Our survey reports the existence of home hemodialysis (HHD) curricula, including didactic, outside HHD courses, shared decision-making training, and continuity clinics. Fellows attending outpatient clinics were more likely to be confident in their ability and prepared to manage HHD patients. The critical barrier to HHD education identified by program directors and fellows was insufficient patients. Background: Public policy focuses on increasing the prevalence of home dialysis. Home hemodialysis (HHD) education and comfort with the procedure are significant barriers to increasing prevalence. This study examines nephrology fellowship didactic curriculum, training program infrastructure, and barriers identified by both program directors and trainees. Methods: An anonymous, online survey was developed to assess HHD curriculum in US nephrology fellowship programs. During academic year 2023–2024, all US nephrology program directors (n=150) were surveyed and asked to forward survey link to their fellows and to indicate the number to whom they forwarded the link. Results: Fifty-five (55/150; 37%) US nephrology program directors responded to the survey; 80% completed it. Thirty-seven (37/55, 67%) forwarded the link to their fellows. Fellow response rate was 53/237 (22%); 50/53 completed it (94%). Seventy-five percent of the program directors reported either having an HHD curriculum or were developing one. Program directors reported that didactic lectures (87%) were the most frequently available curriculum component, whereas fellows report education on counseling (72%) was most frequent. Sixty percent of fellows and 86% of program directors reported fellow attendance at HHD longitudinal/continuity clinic (routinely or as part of a block rotation). Both peritoneal dialyses and fellows identified insufficient patients as a key barrier to implementing HHD curriculum. Fellows who attended outpatient HHD clinic felt more confident and prepared in HHD-related competencies. Conclusions: The HHD curriculum exists as didactic lectures, attendance at outside HHD courses, and ESKD-shared decision-making at training programs. Most programs also have continuity clinics. Our findings highlight the presence of curriculum although inconsistent. Fellows who worked in clinic were more likely to be confident and more prepared to manage HHD patients. In addition, fellows with longitudinal clinic felt better prepared than those attending block rotations. Training programs should consider incorporating HHD longitudinal clinical rotations, although this may require creativity to achieve.
  • Thumbnail Image
    Item
    Training Nephrology Fellows in Home Dialysis in the United States
    (Wolters Kluwer, 2021) Gupta, Nupur; Miller, Brent W.; Medicine, School of Medicine