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Article ; Online: The Challenges of Diabetes Medication Management at Hospital Discharge in Older Adults.

Vasilevskis, Eduard E

JAMA network open

2020 Volume 3, Issue 3, Page(s) e201500

MeSH term(s)	Aged ; Diabetes Mellitus ; Humans ; Medication Therapy Management ; Patient Discharge ; Prevalence ; Veterans Health
Language	English
Publishing date	2020-03-02
Publishing country	United States
Document type	Journal Article ; Comment
ISSN	2574-3805
ISSN (online)	2574-3805
DOI	10.1001/jamanetworkopen.2020.1500
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Article ; Online: Update in Hospital Medicine: Evidence Published in 2016.

Vasilevskis, Eduard E

Annals of internal medicine

2017 Volume 166, Issue 7, Page(s) W33–W39

Language	English
Publishing date	2017-03-30
Publishing country	United States
Document type	Journal Article
ZDB-ID	336-0
ISSN	1539-3704 ; 0003-4819
ISSN (online)	1539-3704
ISSN	0003-4819
DOI	10.7326/M17-0132
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Article ; Online: Using phenotypic data from the Electronic Health Record (EHR) to predict discharge.

Bhatia, Monisha C / Wanderer, Jonathan P / Li, Gen / Ehrenfeld, Jesse M / Vasilevskis, Eduard E

BMC geriatrics

2023 Volume 23, Issue 1, Page(s) 424

Abstract: Background: Timely discharge to post-acute care (PAC) settings, such as skilled nursing facilities, requires early identification of eligible patients. We sought to develop and internally validate a model which predicts a patient's likelihood of ... ...

Abstract	Background: Timely discharge to post-acute care (PAC) settings, such as skilled nursing facilities, requires early identification of eligible patients. We sought to develop and internally validate a model which predicts a patient's likelihood of requiring PAC based on information obtained in the first 24 h of hospitalization. Methods: This was a retrospective observational cohort study. We collected clinical data and commonly used nursing assessments from the electronic health record (EHR) for all adult inpatient admissions at our academic tertiary care center from September 1, 2017 to August 1, 2018. We performed a multivariable logistic regression to develop the model from the derivation cohort of the available records. We then evaluated the capability of the model to predict discharge destination on an internal validation cohort. Results: Age (adjusted odds ratio [AOR], 1.04 [per year]; 95% Confidence Interval [CI], 1.03 to 1.04), admission to the intensive care unit (AOR, 1.51; 95% CI, 1.27 to 1.79), admission from the emergency department (AOR, 1.53; 95% CI, 1.31 to 1.78), more home medication prescriptions (AOR, 1.06 [per medication count increase]; 95% CI 1.05 to 1.07), and higher Morse fall risk scores at admission (AOR, 1.03 [per unit increase]; 95% CI 1.02 to 1.03) were independently associated with higher likelihood of being discharged to PAC facility. The c-statistic of the model derived from the primary analysis was 0.875, and the model predicted the correct discharge destination in 81.2% of the validation cases. Conclusions: A model that utilizes baseline clinical factors and risk assessments has excellent model performance in predicting discharge to a PAC facility.
MeSH term(s)	Humans ; Patient Discharge ; Electronic Health Records ; Cohort Studies ; Hospitalization ; Drug Prescriptions
Language	English
Publishing date	2023-07-11
Publishing country	England
Document type	Observational Study ; Journal Article ; Research Support, U.S. Gov't, Non-P.H.S. ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	2059865-8
ISSN	1471-2318 ; 1471-2318
ISSN (online)	1471-2318
ISSN	1471-2318
DOI	10.1186/s12877-023-04147-y
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Article: Screening for the High-Need Population Using Single Institution Versus State-Wide Admissions Discharge Transfer Feed.

Balucan, Francis Salvador / French, Benjamin / Shi, Yaping / Kripalani, Sunil / Vasilevskis, Eduard E

Research square

2023

Abstract: Background: Access to programs for high-needs patients depending on single-institution electronic health record data (EHR) carries risks of biased sampling. We investigate a statewide admissions, discharge, transfer feed (ADT), in assessing equity in ... ...

Abstract	Background: Access to programs for high-needs patients depending on single-institution electronic health record data (EHR) carries risks of biased sampling. We investigate a statewide admissions, discharge, transfer feed (ADT), in assessing equity in access to these programs. Methods: This is a retrospective cross-sectional study. We included high-need patients at Vanderbilt University Medical Center (VUMC), who were 18 years or older, with minimum three emergency visits (ED) or hospitalizations in Tennessee from January 1 to June 30, 2021, including at least one at VUMC. We used the Tennessee ADT database to identify high-need patients with at least one VUMC ED/hospitalization, then compared this population with high-need patients identified using VUMC's Epic Results: We identified 2549 patients that had at least one ED/hospitalization and were assessed to be high-need based on the statewide ADT. Of those, 2100 had VUMC-only visits, and 449 had VUMC and non-VUMC visits. VUMC-only visit screening criteria showed high sensitivity (99.1%, 95% CI: 98.7% - 99.5%), indicating that the high-needs patients admitted to VUMC infrequently access alternative systems. Results demonstrated no meaningful difference in sensitivity when stratified by patient's race or insurance. Conclusions: ADT allows examination for potential selection bias when relying upon single-institution utilization. In VUMC's high-need patients, there's minimal selection bias when relying upon same-site utilization. Further research needs to understand how biases may vary by site, and durability over time.
Language	English
Publishing date	2023-03-16
Publishing country	United States
Document type	Preprint
DOI	10.21203/rs.3.rs-2565761/v1
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Article ; Online: Screening for the high-need population using single institution versus state-wide admissions discharge transfer feed.

Balucan, Francis Salvador / French, Benjamin / Shi, Yaping / Kripalani, Sunil / Vasilevskis, Eduard E

BMC health services research

2023 Volume 23, Issue 1, Page(s) 1111

Abstract: Background: Access to programs for high-needs patients depending on single-institution electronic health record data (EHR) carries risks of biased sampling. We investigate a statewide admission, discharge, and transfer feed (ADT) in assessing equity in ... ...

Abstract	Background: Access to programs for high-needs patients depending on single-institution electronic health record data (EHR) carries risks of biased sampling. We investigate a statewide admission, discharge, and transfer feed (ADT) in assessing equity in access to these programs. Methods: This is a retrospective cross-sectional study. We included high-need patients at Vanderbilt University Medical Center (VUMC) 18 years or older, with at least three emergency visits (ED) or hospitalizations in Tennessee from January 1 to June 30, 2021, including at least one at VUMC. We used the Tennessee ADT database to identify high-need patients with at least one VUMC ED/hospitalization. Then, we compared this population with high-need patients identified using VUMC's Epic® EHR database. The primary outcome was the sensitivity of VUMC-only criteria for identifying high-need patients compared to the statewide ADT reference standard. Results: We identified 2549 patients with at least one ED/hospitalization and assessed them as high-need based on the statewide ADT. Of those, 2100 had VUMC-only visits, and 449 had VUMC and non-VUMC visits. VUMC-only visit screening criteria showed high sensitivity (99.1%, 95% CI: 98.7 - 99.5%), showing that the high-needs patients admitted to VUMC infrequently access alternative systems. Results showed no meaningful difference in sensitivity when stratified by patient's race or insurance. Conclusions: ADT allows examination for potential selection bias when relying upon single-institution utilization. In VUMC's high-need patients, there's minimal selection bias when depending on same-site utilization. Further research must understand how biases vary by site and durability over time.
MeSH term(s)	Humans ; Patient Discharge ; Retrospective Studies ; Cross-Sectional Studies ; Hospitalization ; Tennessee ; Emergency Service, Hospital
Language	English
Publishing date	2023-10-17
Publishing country	England
Document type	Journal Article
ZDB-ID	2050434-2
ISSN	1472-6963 ; 1472-6963
ISSN (online)	1472-6963
ISSN	1472-6963
DOI	10.1186/s12913-023-10017-5
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Article ; Online: Why do older adults decline participation in research? Results from two deprescribing clinical trials.

Strayer, Thomas E / Hollingsworth, Emily K / Shah, Avantika S / Vasilevskis, Eduard E / Simmons, Sandra F / Mixon, Amanda S

Trials

2023 Volume 24, Issue 1, Page(s) 456

Abstract: Background: Heterogenous older adult populations are underrepresented in clinical trials, and their participation is necessary for interventions that directly target them. The purpose of this study was to evaluate reasons why hospitalized older adults ... ...

Abstract	Background: Heterogenous older adult populations are underrepresented in clinical trials, and their participation is necessary for interventions that directly target them. The purpose of this study was to evaluate reasons why hospitalized older adults declined participation in two deprescribing clinical trials. Methods: We report enrollment data from two deprescribing trials, Shed-MEDS (non-Veterans) and VA DROP (Veterans). For both trials, inclusion criteria required participants to be hospitalized, age 50 or older, English-speaking, and taking five or more home medications. Eligible patients were approached for enrollment while hospitalized. When an eligible patient or surrogate declined participation, the reason(s) were recorded and subsequently analyzed inductively to develop themes, and a chi-square test was used for comparison (of themes between Veterans and non-Veterans). Results: Across both trials, 1226 patients (545 non-Veterans and 681 Veterans) declined enrollment and provided reasons, which were condensed into three themes: (1) feeling overwhelmed by their current health status, (2) lack of interest or mistrust of research, and (3) hesitancy to participate in a deprescribing study. A greater proportion of Veterans expressed a lack of interest or mistrust in research (42% vs 26%, chi-square value = 36.72, p < .001), whereas a greater proportion of non-Veterans expressed feeling overwhelmed by their current health status (54% vs 35%, chi-square value = 42.8 p < 0.001). Across both trials, similar proportion of patients expressed hesitancy to participate in a deprescribing study, with no significant difference between Veterans and non-Veterans (23% and 21%). Conclusions: Understanding the reasons older adults decline participation can inform future strategies to engage this multimorbid population.
MeSH term(s)	Aged ; Humans ; Middle Aged ; Deprescriptions ; Polypharmacy
Language	English
Publishing date	2023-07-18
Publishing country	England
Document type	Clinical Trial ; Journal Article
ZDB-ID	2040523-6
ISSN	1745-6215 ; 1468-6694 ; 1745-6215
ISSN (online)	1745-6215
ISSN	1468-6694 ; 1745-6215
DOI	10.1186/s13063-023-07506-7
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Article ; Online: Effect of physical and occupational therapy on delirium duration in older emergency department patients who are hospitalized.

Jordano, James O / Vasilevskis, Eduard E / Duggan, Maria C / Welch, Sarah A / Schnelle, John F / Simmons, Sandra F / Ely, E Wesley / Han, Jin H

Journal of the American College of Emergency Physicians open

2023 Volume 4, Issue 1, Page(s) e12857

Abstract: Objective: Delirium in older emergency department (ED) adults is associated with poorer long-term physical function and cognition. We sought to evaluate if the time to and intensity of physical and/or occupational therapy (PT/OT) are associated with the ...

Abstract	Objective: Delirium in older emergency department (ED) adults is associated with poorer long-term physical function and cognition. We sought to evaluate if the time to and intensity of physical and/or occupational therapy (PT/OT) are associated with the duration of ED delirium into hospitalization (ED delirium duration). Methods: This is a secondary analysis of a prospective cohort study conducted from March 2012 to November 2014 at an urban, academic, tertiary care hospital. Patients aged ≥65 years presenting to the ED and who received PT/OT during their hospitalization were included. Days from enrollment to the first PT/OT session and PT/OT duration relative to hospital length of stay (PT/OT intensity) were abstracted from the medical record. ED delirium duration was defined as the duration of delirium detected in the ED using the Brief Confusion Assessment Method. Data were analyzed using a proportional odds logistic regression adjusted for multiple variables. Adjusted odds ratios (ORs) were calculated with 95% confidence intervals (95%CI). Results: The median log PT/OT intensity was 0.5% (interquartile range [IQR]: 0.3%, 0.9%) and was associated with shorter delirium duration (adjusted OR, 0.39; 95% CI, 0.21-0.73). The median time to the first PT/OT session was 2 days (IQR: 1, 3 days) and was not associated with delirium duration (adjusted OR, 1.02; 95% CI, 0.82-1.27). Conclusion: In older hospitalized adults, higher PT/OT intensity may be a useful intervention to shorten delirium duration. Time to first PT/OT session was not associated with delirium duration but was initiated a full 2 days after the ED presentation.
Language	English
Publishing date	2023-02-06
Publishing country	United States
Document type	Journal Article
ISSN	2688-1152
ISSN (online)	2688-1152
DOI	10.1002/emp2.12857
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Article ; Online: Clinicians' perceptions on implementation strategies used to facilitate ABCDEF bundle adoption: A multicenter survey.

Brockman, Audrey / Krupp, Anna / Bach, Christina / Mu, Jinjian / Vasilevskis, Eduard E / Tan, Alai / Mion, Lorraine C / Balas, Michele C

Heart & lung : the journal of critical care

2023 Volume 62, Page(s) 108–115

Abstract: ... bundle and how those strategies are perceived by end-users (i.e., ICU clinicians) related ... to clinicians (e.g., providing educational meetings or ongoing training), but less use of strategies ... that require changes to well-established organizational systems (e.g., alter incentive allowance structure ...

Abstract	Background: Intensive care unit (ICU) clinicians struggle to routinely implement the ICU Liberation bundle (ABCDEF bundle). As a result, critically ill patients experience increased risk of morbidity and mortality. Despite extensive research related to the barriers and facilitators of bundle use, little is known regarding which implementation strategies are used to facilitate its adoption and sustainability. Objectives: To identify implementation strategies used to increase adoption of the ABCDEF bundle and how those strategies are perceived by end-users (i.e., ICU clinicians) related to their helpfulness, acceptability, feasibility, and cost. Methods: We conducted a national, cross-sectional survey of ICU clinicians from the 68 ICU sites that previously participated in the Society of Critical Care Medicine's ICU Liberation Collaborative. The survey was structured using the 73 Expert Recommendations for Implementing Change (ERIC) implementation strategies. Surveys were delivered electronically to site contacts. Results: Nineteen ICUs (28%) returned completed surveys. Sites used 63 of the 73 ERIC implementation strategies, with frequent use of strategies that may be readily available to clinicians (e.g., providing educational meetings or ongoing training), but less use of strategies that require changes to well-established organizational systems (e.g., alter incentive allowance structure). Overall, sites described the ERIC strategies used in their implementation process to be moderately helpful (mean score >3<4 on a 5-point Likert scale), somewhat acceptable and feasible (mean score >2<3), and either not-at-all or somewhat costly (mean scores >1<3). Conclusions: Our results show a potential over-reliance on accessible strategies and the possible benefit of unused ERIC strategies related to changing infrastructure and utilizing financial strategies.
MeSH term(s)	Humans ; Cross-Sectional Studies ; Intensive Care Units ; Critical Care/methods ; Surveys and Questionnaires ; Patient Care Bundles/methods
Language	English
Publishing date	2023-07-01
Publishing country	United States
Document type	Multicenter Study ; Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, N.I.H., Extramural
ZDB-ID	193129-5
ISSN	1527-3288 ; 0147-9563
ISSN (online)	1527-3288
ISSN	0147-9563
DOI	10.1016/j.hrtlng.2023.06.006
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Article ; Online: An Exploration of Critical Care Professionals' Strategies to Enhance Daily Implementation of the Assess, Prevent, and Manage Pain; Both Spontaneous Awakening and Breathing Trials; Choice of Analgesia and Sedation; Delirium Assess, Prevent, and Manage; Early Mobility and Exercise; and Family Engagement and Empowerment: A Group Concept Mapping Study.

Mion, Lorraine C / Tan, Alai / Brockman, Audrey / Tate, Judith A / Vasilevskis, Eduard E / Pun, Brenda T / Rosas, Scott R / Balas, Michele C

Critical care explorations

2023 Volume 5, Issue 3, Page(s) e0872

Abstract: The goals of this exploratory study were to engage professionals from the Society for Critical Care Medicine ICU Liberation Collaborative ICUs to: 1) conceptualize strategies to enhance daily implementation of the Assess, prevent, and manage pain; Both ... ...

Abstract	The goals of this exploratory study were to engage professionals from the Society for Critical Care Medicine ICU Liberation Collaborative ICUs to: 1) conceptualize strategies to enhance daily implementation of the Assess, prevent, and manage pain; Both spontaneous awakening and breathing trials; Choice of analgesia and sedation; Delirium assess, prevent, and manage; Early mobility and exercise; and Family engagement and empowerment (ABCDEF) bundle from different perspectives and 2) identify strategies to prioritize for implementation. Design: Mixed-methods group concept mapping over 8 months using an online method. Participants provided strategies in response to a prompt about what was needed for successful daily ABCDEF bundle implementation. Responses were summarized into a set of unique statements and then rated on a 5-point scale on degree of necessity (essential) and degree to which currently used. Setting: Sixty-eight academic, community, and federal ICUs. Participants: A total of 121 ICU professionals consisting of frontline and leadership professionals. Interventions: None. Measurements and main results: A final set of 76 strategies (reduced from 188 responses) were suggested: education (16 strategies), collaboration (15 strategies), processes and protocols (13 strategies), feedback (10 strategies), sedation/pain practices (nine strategies), education (eight strategies), and family (five strategies). Nine strategies were rated as very essential but infrequently used: adequate staffing, adequate mobility equipment, attention to (patient's) sleep, open discussion and collaborative problem solving, nonsedation methods to address ventilator dyssynchrony, specific expectations for night and day shifts, education of whole team on interdependent nature of the bundle, and effective sleep protocol. Conclusions: In this concept mapping study, ICU professionals provided strategies that spanned a number of conceptual implementation clusters. Results can be used by ICU leaders for implementation planning to address context-specific interdisciplinary approaches to improve ABCDEF bundle implementation.
Language	English
Publishing date	2023-03-03
Publishing country	United States
Document type	Journal Article
ISSN	2639-8028
ISSN (online)	2639-8028
DOI	10.1097/CCE.0000000000000872
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Article ; Online: A Case of Catatonia Nearly Mistaken for Hepatic Encephalopathy.

Buell, Kevin G / Kiser, S B / Vasilevskis, Eduard E

The American journal of medicine

2019 Volume 132, Issue 6, Page(s) e587–e588

MeSH term(s)	Catatonia/diagnosis ; Catatonia/drug therapy ; Female ; GABA Modulators/therapeutic use ; Hepatic Encephalopathy/diagnosis ; Humans ; Lorazepam/therapeutic use ; Middle Aged
Chemical Substances	GABA Modulators ; Lorazepam (O26FZP769L)
Language	English
Publishing date	2019-03-02
Publishing country	United States
Document type	Case Reports ; Letter
ZDB-ID	80015-6
ISSN	1555-7162 ; 1873-2178 ; 0002-9343 ; 1548-2766
ISSN (online)	1555-7162 ; 1873-2178
ISSN	0002-9343 ; 1548-2766
DOI	10.1016/j.amjmed.2019.01.035
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