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The release-of-information (ROI) process is time-consuming, paper-intensive, and highly regulated. Most healthcare provider organizations outsource the process. Many have chosen HealthPort. Innovative ROI technology combined with quality services and trusted expertise yields a proven solution for hospitals, clinics, and physician practices. Over 7,600 healthcare organizations use HealthPort Release-of-Information (HealthPort ROI) technology, services, or both. You can outsource the entire function or just a few tasks., delicious.com

Medical Education, Vol. 40, No. 6. (June 2006), pp. 568-575.Deleng, A Bas, Dolmans, JM Dianah, Muijtjens, M Arnom, Van Dervleuten, M Ceesp, citeulike.org

Crit Care Med, Vol. 26, No. 6. (June 1998), pp. 1020-1024.OBJECTIVE: To determine if early interventions for septic shock were associated with reduced mortality. DESIGN: Retrospective cohort study. SETTING: University hospital intensive care unit (ICU) and general wards. PATIENTS: Forty-one consecutive patients prospectively identified with positive blood cultures and septic shock. Although all patients were eventually treated in an ICU, ten (24%) patients were on a general ward at the onset of septic shock, and 31 (76%) were in an ICU setting. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Over a period of 9 mos, a cohort of 41 patients who had positive blood cultures and septic shock was prospectively identified. The 28-day crude mortality was 46% (19 deaths). We compared the management of septic shock and outcome for patients on a general ward vs. those patients in an ICU setting. Of the ten patients on the ward at time of shock onset (median age 55.5 yrs; median Acute Physiology and Chronic Health Evaluation II score of 18.5), seven (70%) died. In contrast, the 31 patients receiving intensive care when shock developed were older and more ill (median age 66 yrs; median APACHE II 24), yet had a mortality of 39% (12 deaths). The odds ratio (OR) for death for ward patients compared with ICU patients was 3.57 (p=.17). In a multivariate logistic regression analysis, two risk factors for mortality were important: APACHE II score (p=.015) and ward status (p=.08). Candida species in the bloodstream is known to have a high attributable mortality. When type of bloodstream pathogen (Candida species vs. bacteria) was added to the model, APACHE II (OR 2.64 for 10-unit increase) remained significant (p=.014), but ward status (OR 3.97) became statistically nonsignificant (p=.222). The patients who were on a general ward when their shock developed had a median delay of 67 mins before transfer to an ICU setting. Ward patients received an intravenous fluid bolus after a median delay of 27 mins, whereas those in the ICU who received a fluid bolus did so after a median of 15 mins (p=.48). Ward patients also had a median delay of 310 mins to receive inotropic support compared with a median 22.5 mins (p=.037) for the patients in an ICU setting when shock started. CONCLUSIONS: The data suggest that for patients with septic shock on wards, there were clinically important delays in transfer of patients to the ICU, receipt of intravenous fluid boluses, and receipt of inotropic agents. However, the most powerful predictors of mortality were APACHE II scores and bloodstream infection with Candida species.JS Lundberg, TM Perl, T Wiblin, MD Costigan, J Dawson, MD Nettleman, RP Wenzel, citeulike.org

Dr. Sanjay Gupta is a shill for big pharma - vote No to Gupta on Change.gov, delicious.com

A list of Doctors, Medical Students and Medicine related tweets, delicious.com

must register to view article, delicious.com

Ann Fam Med, Vol. 3, No. 6. (1 November 2005), pp. 545-552.Society invests billions of dollars in the development of new drugs and technologies but comparatively little in the fidelity of health care, that is, improving systems to ensure the delivery of care to all patients in need. Using mathematical arguments and a nomogram, we demonstrate that technological advances must yield dramatic, often unrealistic increases in efficacy to do more good than could be accomplished by improving fidelity. In 2 examples (the development of anti-platelet agents and statins), we show that enhanced efficacy failed to achieve the health gains that would have occurred by delivering older agents to all eligible patients. Society's huge investment in technological innovations that only modestly improve efficacy, by consuming resources needed for improved delivery of care, may cost more lives than it saves. The misalignment of priorities is driven partly by the commercial interests of industry and by the public's appetite for technological breakthroughs, but health outcomes ultimately suffer. Health, economic, and moral arguments make the case for spending less on technological advances and more on improving systems for delivering care. 10.1370/afm.406Steven Woolf, Robert Johnson, citeulike.org

Circulation (6 October 2008), CIRCULATIONAHA.108.190500.Abstract--The assessment of medical practice is evolving rapidly in the United States. An initial focus on structure and process performance measures assessing the quality of medical care is now being supplemented with efficiency measures to quantify the "value" of healthcare delivery. This statement, building on prior work that articulated standards for publicly reported outcomes measures, identifies preferred attributes for measures used to assess efficiency in the allocation of healthcare resources. The attributes identified in this document combined with the previously published standards are intended to serve as criteria for assessing the suitability of efficiency measures for public reporting. This statement identifies the following attributes to be considered for publicly reported efficiency measures: integration of the quality and cost; valid cost measurement and analysis; minimal incentive to provide poor quality care; and proper attribution of the measure. The attributes described in this statement are relevant to a wide range of efforts to profile the efficiency of various healthcare providers, including hospitals, healthcare systems, managed-care organizations, physicians, group practices, and others that deliver coordinated care. 10.1161/CIRCULATIONAHA.108.190500Harlan Krumholz, Patricia Keenan, John Brush, Vincent Bufalino, Michael Chernew, Andrew Epstein, Paul Heidenreich, Vivian Ho, Frederick Masoudi, David Matchar, Sharon-Lise Normand, John Rumsfeld, Jeremiah Schuur, Sidney Smith, John Spertus, Mary Walsh, citeulike.org