| Current Projects
Implementation of a Bladder Bundle to Prevent
Catheter-Associated Urinary Tract Infection
Catheter-related urinary tract infection – the most frequent
healthcare-associated infection in the United States – is a costly
and potentially lethal condition. The state of Michigan is
initiating an ambitious patient safety project to ameliorate the
burden of disease associated with indwelling catheterization. The
overarching objective of this research is to identify and develop
strategies to optimize the implementation of key practices in the
field of patient safety and healthcare-associated infection
prevention. This study has three specific aims: 1) To describe the
adoption and implementation of a Catheter-Associated Urinary Tract
Infection Prevention Bundle (“Bladder Bundle”) as part of a Michigan
state-wide patient safety initiative aimed at reducing unnecessary
catheter utilization and infection rates; 2) To identify and compare
the barriers to and facilitators of implementing the Bladder Bundle
across a diverse group of hospitals; and 3) To develop and evaluate
strategies to facilitate implementation of the Bladder Bundle and
assess patient outcomes including catheter utilization,
discontinuation, re-insertion, and infection rates.
A Cluster-Randomized Cross-Over Trial Comparing the Effects of
Three Skin Antiseptic Agents on Peripheral Blood Culture
Contamination Rates
The goals of this project are: 1) To determine the relative rates of
blood culture contamination for three different skin antisepsis
preparations (povidone iodine, iodine tincture, and chlorhexidine
gluconate-isopropyl alcohol solution) when used by dedicated
phlebotomy teams to obtain blood cultures by peripheral venipuncture
in non-ICU medical and surgical patients; and 2) To estimate cost
savings associated with decreased rates of blood culture
contamination.
Predictors of Hospital-Acquired Urinary Tract-Related
Bloodstream Infection
Preventive efforts to reduce urinary tract-related bloodstream
infection are hampered by the scarcity of analytic studies that
identify etiologic factors, particularly those specific to the
time-dependent elements that may impact prognosis during
hospitalization. Therefore, the ability of clinicians to
intercede in a meaningful way has been restricted. The
objective of this study is to delineate both host- and
time-dependent factors that contribute to urinary tract-related
bloodstream infection in hospitalized patients. This study is
unique in that it will ascertain potential causal mechanisms of
bloodstream infection taking into account the time course of a
hospitalized patient’s stay and the multiple procedures and
treatments that occur during this stay. Specific Aim #1
addresses the relation between obesity, diabetes, and urosepsis.
Specific Aim #2 is directed to time-related procedural and
treatment factors that impact the incidence of infection. Of
particular interest are the use of catheterization, ultrasound
detection of urinary retention, antibiotics, immunosuppressant
therapies, statin use, and allogeneic blood transfusions.
We anticipate that the information obtained from the proposed
study – which evaluates novel risk factors and is responsive to
program announcement PA-06-151 by utilizing secondary data –
will enhance tools for clinical decision making and provide a
framework for preventive trials.
Specialist Hospitalist Allied Research Program (SHARP):
Partners Specialists with Hospitalists to Perform Hospital Based
Clinical Research
SHARP has several objectives: (1) to develop a clinical
research infrastructure within the University of Michigan Hospital
Medicine Program that would facilitate patient participation; (2) to
foster increased specialist-hospitalist collaboration in addressing
common inpatient problems; (3) to facilitate pilot projects
and preliminary data collection that enhance the ability to obtain
subsequent extramural funding for collaborative research projects;
(4) to facilitate multi-center investigation led by the University
of Michigan by allowing the SHARP investigators to utilize an
existing hospitalist consortium to expand the scope of research
projects; and (5) ultimately, to develop the ability to perform
multi-center intervention-based clinical trials.
Reducing Infection and
Mortality after Coronary Artery Bypass Graft (CABG) Surgery in
Michigan
The goal of this study is to assess
variability in the risk of infection and mortality by use of
allogeneic blood transfusion in Michigan Medicare beneficiaries
who underwent CABG surgery from 2003-2006.
Does the University of
Michigan's Claims Management Model Reduce Malpractice Costs?
The aim of this
project, funded by Blue Cross Blue Shield of Michigan Foundation, is
to assess whether the University of Michigan's claims management
model reduces three outcomes: (1) provider costs, (2) the time
between the report of a medical event to settlement, and (3) the
number of claims that enter the court system (as indicated by a
notice of intent to sue).
Translating
Infection Prevention Evidence into Practice (TRIP)
The goal of this project is to identify
facilitators and impediments to translating proven nosocomial
infection preventive methods into practice.
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Addressing Barriers to Translation for
Treatment of Hypertension
(1) Identify important clinician, organizational and
patient factors that contribute to inadequate treatment of elevated
blood pressure among patients with diabetes; and (2) understand the
relative contributions of these factors in the failure to initiate
appropriate treatment among patients with uncontrolled hypertension.
Infection Risk of
Urinary Collection Strategies
(1) To describe urinary collection device use over time in a
cohort of residents in long-term care facilities and determine the
antecedent and subsequent effects of such use. We will also describe
the extent of regional variation in the United States in the use of
urinary collection devices. (2) To assess the risks, both incident and
recurrent, of urinary tract infection and septicemia by bladder
management strategy (indwelling catheter, condom catheter,
intermittent catheter, or other) in incontinent residents of long-term
care facilities. Hospitalization rates due to urinary tract infection
and septicemia will also be determined. Effect modification by
cognitive skill level of the patient and presence of diabetes mellitus
will be evaluated.
Toward a Safety
Culture: Reducing Nosocomial Infections
The major goal of this project is to implement and evaluate
evidence-based methods for preventing nosocomial infection in the
intensive care units.
Enhancing Patient Safety by Preventing Catheter-Related Infection
Long-term directions for research are to (1) determine the types of problems commonly undermining the safety of patients in hospitals and long-term care facilities; (2) identify evidence-based, cost-effective methods for preventing these problems; and (3) understand and overcome the barriers to implementing the use of appropriate and cost-effective preventive methods.
Supporting Medical Residents: A Study of Medical Mishaps
Develop a model of how personal, professional, and systems factors interact in the production of medical errors.
Translating Infection Prevention Evidence Into Practice The primary aims of this study are: (1) to describe and compare the adoption and diffusion of evidence-based infection prevention practices across different health care systems, including VA and non-VA hospitals; (2) to identify and compare factors that facilitate or impede the adoption and implementation of evidence-based infection prevention practices in VA and non-VA hospitals; and (3) to develop and disseminate portable, deployable, and flexible interventions to facilitation adoption and implementation of proven infection prevention practices in both VA and non-VA hospitals. A secondary aim of this study is to examine the correlation between the adoption/implementation of several selected infection prevention practices and nosocomial infection rates for those facilities that are using a comparable surveillance system.
Recent Projects
Hospitalists as Emerging Leaders in
Patient Safety (HELPS) Consortium of Southeastern Michigan: Targeting
Few to Affect Many
(1) To identify best practices to prevent important adverse
events and errors in hospitalized patients. (2) To share these best
practices with Consortium members, including an explicit discussion of
both benefits and drawbacks. (3) To facilitate local implementation of
these best practices at each member institution. (4) To determine what
facilitates and what impedes best practice implementation. (5) To
evaluate successes and failures in each hospital’s attempt to
implement selected best practices. (6) To disseminate each
institution’s experience to others both within and outside the
Consortium through the peer-reviewed literature and via local,
regional, and national conferences.
Coronary artery bypass graft surgery (CABG)
mortality in men and women and the influence of hospital factors
To examine the association between gender and CABG hospital mortality
using adjustment for hospital volume, clustering within hospitals, and proxies
for socioeconomic status (SES) and geographic proximity.
Targeting Interventions to Reduce Errors
Form a Development Center for Evaluation and Research in Patient Safety (DCERPS) that will (1) identify creative interventions that enhance patient safety by fostering new interdisciplinary collaboration; and (2) improve patient care by targeting interventions.
Enhancing Patient
Safety by Reducing Urinary Catheterization
This project will (1) determine if a catheter stop-order is
effective in reducing the incidence of inappropriate indwelling
urethral catheterization in hospitalized patients; and (2) assess
the clinical and economic consequences of using the catheter
stop-order hospital-wide, if the stop-order is effective.
Which antiseptic solution should we use for vascular catheter site care? This project will determine if vascular catheter site disinfection with chlorhexidine rather than povidone-iodine provides clinical and economic benefits by decreasing infection and increasing patient safety in hospitalized patients.
Collaborative Center for Research
and Education in the Care of Older Adults
(1) Establish Education Advisory Committee. Meet
quarterly, two informal gatherings per year. (2) Deliver 20-hour
geriatrics clinical and teaching skills seminars to 12-16 General
Medicine faculty over two years. (3) Establish ongoing
collaborative relationships between four Lead Geriatrics Educators
(selected from seminar participants) and geriatrics faculty to
develop, integrate, and evaluate designed geriatrics curricula
into the teaching of the Lead Geriatrics Educators. (4) Develop a
method for Geriatrics Lead Educators to keep up with recent
geriatric literature and updating their curricula. (5) Integrate
core topics in geriatrics into the weekly clinical conferences for
General Medicine faculty.
Variation in ICU Outcomes
Examines the human team and organizational factors
important in risk-adjusted outcome (hospital mortality and length of
stay-LOS) for ICU patients.
Long-term Care Requirements of Elderly
Patients Undergoing Coronary Artery Bypass Grafting Surgery in
Michigan
(1) Establish Education
Advisory Committee. Meet quarterly, two informal gatherings per year.
(2) Deliver 20-hour geriatrics clinical and teaching skills seminars
to 12-16 General Medicine faculty over two years. (3) Establish
ongoing collaborative relationships between four Lead Geriatrics
Educators (selected from seminar participants) and geriatrics faculty
to develop, integrate, and evaluate designed geriatrics curricula into
the teaching of the Lead Geriatrics Educators. (4) Develop a method
for Geriatrics Lead Educators to keep up with recent geriatric
literature and updating their curricula. (5) Integrate core topics in
geriatrics into the weekly clinical conferences for General Medicine
faculty.
Improving Patient Safety in Hospitals:
Implementing Change at Ground Zero
Develop a half-day conference and conference-based support
materials on ways to achieve a culture of safety in hospitals by
implementing (1) evidence-based best practices; (2) interdisciplinary
practice approaches; (3) root-cause analysis of medical errors; and
(4) changes in health care norms relevant to patient safety.
Long-term Care Requirements of Elderly
Patients Undergoing Coronary Artery Bypass Grafting Surgery
(1) To determine the association between age and discharge location
(home or long-term care facility) following CABG; and (2) to determine
the rates and predictors of extended (greater than 4 weeks) long-term
care stays among patients undergoing CABG.
Predicting Safe
Hospital Discharge for Children with Acute Bronchiolitis
The overarching goal of this project is to optimize the care provided
to children who are hospitalized with bronchiolitis at the University
of Michigan Health System (UMHS).
Supporting
Medical Residents: A Study of Medical Mishaps
Develop a model of how personal, professional, and systems
factors interact in the production of medical errors.
Translation failure research: Assessment
of specificity in quality indicators
This pilot project attempts to examine one specific
translation failure, namely the inability to control LDL levels in
diabetic patients and attempts to delineate the specific errors that
cause this failure to achieve goals shown in clinical trials to reduce
mortality. This project will serve as a pilot for a large
multi-center grant examining six translation failures.
Improving Patient Safety in Hospitals: Turning Ideas into Action
A half-day conference and conference-based support materials have been developed on ways to achieve a culture of safety in hospitals by implementing (1) evidence-based best practices; (2) interdisciplinary practice approaches; (3) root-cause analysis of medical errors; and (4) changes in health care norms relevant to patient safety. The conference occurred on November 22, 2002.
Long-Term Care Requirements of Elderly Patients Undergoing Coronary Artery Bypass Grafting Surgery
This study has two specific aims: (1) to determine the association between age and discharge location (home or long-term care facility) following CABG; and (2) to determine the rates and predictors of extended (greater than 4 weeks) long-term care stays among patients undergoing CABG. To achieve these aims, we will combine data from the inpatient Medicare files and MDS using unique patient identifiers.
Linking these databases will allow us to assess important processes and outcomes of health care in elderly individuals as they transition from hospital to long-term care facilities following CABG in the state of Michigan. This information will allow a better accounting of the risks and benefits associated with CABG in elderly individuals and identify potential patient characteristics that are associated with increased risk of post-operative institutionalization.
Translation failure research: Assessment of specificity in quality indicators
This pilot project attempts to examine one specific translation failure, namely the inability to control LDL levels in diabetic patients and attempts to delineate the specific errors that cause this failure to achieve goals shown in clinical trials to reduce mortality. This project will serve as a pilot for a large multi-center grant examining six translation failures.
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