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Item Ambulatory Computerized Provider Order Entry and PDA-Based Clinical Decision Support Systems: An Investigation of their Patient Safety Effectiveness via an Integrative and Systematic ReviewTaffel, Jared Ross; Jones, Josette F.Substantial research has been done on inpatient provider order entry systems with varying degrees of clinical decision support. Such studies have examined how these technologies impact patient safety as well as the quality and cost of care. However, given that most medical care and prescriptions are administered in an ambulatory setting, the dearth of research on ACPOE systems is quite astonishing. This knowledge gap demonstrates the need for an integrative and systematic literature review that attempts to assess the research done on computerized patient safety interventions in ambulatory care. This review’s findings provided adequate evidence that ACPOE systems are effective interventions for reducing medication errors. Other evidence further indicated that, in terms of functional capabilities, commercial ACPOE and e-prescribing systems may be catching up with their homegrown counterparts. PDA-based CDSSs were depicted as useful tools for raising adherence to guidelines and inducing safer prescribing. These findings suggest that ACPOE And PDA-based CDS systems show promise for improving safety and healthcare quality in ambulatory settings. ACPOE specifically, tended to have more advanced CDS attributes but, nonetheless, showed more negative results compared to the e-prescribing systems. Close scrutiny should therefore be given to the elements of decision support that ambulatory physicians find most useful.Item Ambulatory PCNL may be cost-effective compared to Standard PCNL(Mary Ann Liebert, 2021) Lee, Matthew S.; Assmus, Mark A.; Agarwal, Deepak; Rivera, Marcelino E.; Large, Tim; Krambeck, Amy; Urology, School of MedicineAbstract Background COVID-19 changed the practice of medicine in America. During the March 2020 lockdown, elective cases were cancelled to conserve hospital beds/resources resulting in financial losses for health systems and delayed surgical care. Ambulatory percutaneous nephrolithotomy (aPCNL) has been shown to be safe and could be a strategy to: ensure patients receive care that has been delayed, conserve hospital resources, and maximize cost-effectiveness. We aimed to compare the safety and cost-effectiveness of patients undergoing ambulatory percutaneous nephrolithotomy (aPCNL) against standard PCNL (sPCNL). Materials and Methods 98 patients underwent PCNL at Indiana University Methodist hospital, a tertiary referral center, by three expert surgeons from January 2020 to September 2020. The primary outcome of the study was to compare the 30-day rates of ED-visits, readmissions, and complications between sPCNL and aPCNL. Secondary outcomes included: cost analysis and stone free rates (SFRs). Prospensity-score matching was performed to ensure the groups were balanced. Statistical analyses were performed using SAS 9.4 using independent t-tests for continuous variables and chi-square analyses for categorical variables. Results 98 patients underwent PCNL during the study period (sPCNL=75 and aPCNL=23). After propensity-score matching, 42 patients were available for comparison (sPCNL=19 and aPCNL=23). We found no difference in 30-day ED-visits, readmissions, or complications between the two groups. aPCNL resulted in cost savings of $5327±442 per case. Stone free rates were higher for aPCNL compared to sPCNL. Conclusions aPCNL appears safe to perform and does not have a higher rate of ED-visits or readmissions compare to sPCNL. aPCNL may also be cost-effective compared to sPCNL.Item Effectiveness of Covid-19 Vaccines in Ambulatory and Inpatient Care Settings(Massachusetts Medical Society, 2021-10-07) Thompson, Mark G.; Stenehjem, Edward; Grannis, Shaun; Ball, Sarah W.; Naleway, Allison L.; Ong, Toan C.; DeSilva, Malini B.; Natarajan, Karthik; Bozio, Catherine H.; Lewis, Ned; Dascomb, Kristin; Dixon, Brian E.; Birch, Rebecca J.; Irving, Stephanie A.; Rao, Suchitra; Kharbanda, Elyse; Han, Jungmi; Reynolds, Sue; Goddard, Kristin; Grisel, Nancy; Fadel, William F.; Levy, Matthew E.; Ferdinands, Jill; Fireman, Bruce; Arndorfer, Julie; Valvi, Nimish R.; Rowley, Elizabeth A.; Patel, Palak; Zerbo, Ousseny; Griggs, Eric P.; Porter, Rachael M.; Demarco, Maria; Blanton, Lenee; Steffens, Andrea; Zhuang, Yan; Olson, Natalie; Barron, Michelle; Shifflett, Patricia; Schrag, Stephanie J.; Verani, Jennifer R.; Fry, Alicia; Gaglani, Manjusha; Azziz-Baumgartner, Eduardo; Klein, Nicola P.; Family Medicine, School of MedicineBACKGROUND There are limited data on the effectiveness of the vaccines against symptomatic coronavirus disease 2019 (Covid-19) currently authorized in the United States with respect to hospitalization, admission to an intensive care unit (ICU), or ambulatory care in an emergency department or urgent care clinic. METHODS We conducted a study involving adults (≥50 years of age) with Covid-19–like illness who underwent molecular testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We assessed 41,552 admissions to 187 hospitals and 21,522 visits to 221 emergency departments or urgent care clinics during the period from January 1 through June 22, 2021, in multiple states. The patients’ vaccination status was documented in electronic health records and immunization registries. We used a test-negative design to estimate vaccine effectiveness by comparing the odds of a positive test for SARS-CoV-2 infection among vaccinated patients with those among unvaccinated patients. Vaccine effectiveness was adjusted with weights based on propensity-for-vaccination scores and according to age, geographic region, calendar time (days from January 1, 2021, to the index date for each medical visit), and local virus circulation. RESULTS The effectiveness of full messenger RNA (mRNA) vaccination (≥14 days after the second dose) was 89% (95% confidence interval [CI], 87 to 91) against laboratory-confirmed SARS-CoV-2 infection leading to hospitalization, 90% (95% CI, 86 to 93) against infection leading to an ICU admission, and 91% (95% CI, 89 to 93) against infection leading to an emergency department or urgent care clinic visit. The effectiveness of full vaccination with respect to a Covid-19–associated hospitalization or emergency department or urgent care clinic visit was similar with the BNT162b2 and mRNA-1273 vaccines and ranged from 81% to 95% among adults 85 years of age or older, persons with chronic medical conditions, and Black or Hispanic adults. The effectiveness of the Ad26.COV2.S vaccine was 68% (95% CI, 50 to 79) against laboratory-confirmed SARS-CoV-2 infection leading to hospitalization and 73% (95% CI, 59 to 82) against infection leading to an emergency department or urgent care clinic visit. CONCLUSIONS Covid-19 vaccines in the United States were highly effective against SARS-CoV-2 infection requiring hospitalization, ICU admission, or an emergency department or urgent care clinic visit. This vaccine effectiveness extended to populations that are disproportionately affected by SARS-CoV-2 infection. Methods: We conducted a study involving adults (≥50 years of age) with Covid-19-like illness who underwent molecular testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We assessed 41,552 admissions to 187 hospitals and 21,522 visits to 221 emergency departments or urgent care clinics during the period from January 1 through June 22, 2021, in multiple states. The patients' vaccination status was documented in electronic health records and immunization registries. We used a test-negative design to estimate vaccine effectiveness by comparing the odds of a positive test for SARS-CoV-2 infection among vaccinated patients with those among unvaccinated patients. Vaccine effectiveness was adjusted with weights based on propensity-for-vaccination scores and according to age, geographic region, calendar time (days from January 1, 2021, to the index date for each medical visit), and local virus circulation. Results: The effectiveness of full messenger RNA (mRNA) vaccination (≥14 days after the second dose) was 89% (95% confidence interval [CI], 87 to 91) against laboratory-confirmed SARS-CoV-2 infection leading to hospitalization, 90% (95% CI, 86 to 93) against infection leading to an ICU admission, and 91% (95% CI, 89 to 93) against infection leading to an emergency department or urgent care clinic visit. The effectiveness of full vaccination with respect to a Covid-19-associated hospitalization or emergency department or urgent care clinic visit was similar with the BNT162b2 and mRNA-1273 vaccines and ranged from 81% to 95% among adults 85 years of age or older, persons with chronic medical conditions, and Black or Hispanic adults. The effectiveness of the Ad26.COV2.S vaccine was 68% (95% CI, 50 to 79) against laboratory-confirmed SARS-CoV-2 infection leading to hospitalization and 73% (95% CI, 59 to 82) against infection leading to an emergency department or urgent care clinic visit. Conclusions: Covid-19 vaccines in the United States were highly effective against SARS-CoV-2 infection requiring hospitalization, ICU admission, or an emergency department or urgent care clinic visit. This vaccine effectiveness extended to populations that are disproportionately affected by SARS-CoV-2 infection. (Funded by the Centers for Disease Control and Prevention.).