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5. Multimorbidity and Social Participation Is Moderated by Purpose in Life and Life Satisfaction

Author

Luster, Jamie E, Ratz, David, and Wei, Melissa Y

Subjects
Behavioral and Social Science, Aging, Basic Behavioral and Social Science, Clinical Research, Aged, Humans, Linear Models, Multimorbidity, Personal Satisfaction, Quality of Life, Social Participation, health-related quality of life, epidemiology, successful aging, leisure, Clinical Sciences, Gerontology
Abstract

ObjectivesWe examined the association between multimorbidity and social participation and whether purpose in life and life satisfaction moderate this relationship.MethodsParticipants were 12,825 Health and Retirement Study adults. We used multiple linear regression to examine the association between a cumulative-updated multimorbidity-weighted index (MWI) and social participation.ResultsAmong adults with average purpose in life or life satisfaction, MWI was associated with lower social participation. For those with above average purpose in life, each 1-point increase in MWI was associated with a 0.11-point (95% confidence interval [CI]: [0.07, 0.14]) better social participation score. Participants with above average life satisfaction experienced a 0.04-point (95% CI: [0.02, 0.07]) better social participation score with each 1-point increase in MWI.DiscussionMultimorbidity was associated with worse social participation, but this was reversed by above average purpose in life and life satisfaction. Interventions that improve well-being should be assessed to enhance social participation among older adults with any degree of multimorbidity.

Published
2022

13. Bacteremia From a Presumed Urinary Source in Hospitalized Adults With Asymptomatic Bacteriuria

Author

Advani, Sonali D., primary, Ratz, David, additional, Horowitz, Jennifer K., additional, Petty, Lindsay A., additional, Fakih, Mohamad G., additional, Schmader, Kenneth, additional, Mody, Lona, additional, Czilok, Tawny, additional, Malani, Anurag N., additional, Flanders, Scott A., additional, Gandhi, Tejal N., additional, and Vaughn, Valerie M., additional

Published
2024
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16. Development of Patient Safety Measures to Identify Inappropriate Diagnosis of Common Infections.

Author

White, Andrea T, Vaughn, Valerie M, Petty, Lindsay A, Gandhi, Tejal N, Horowitz, Jennifer K, Flanders, Scott A, Bernstein, Steven J, Hofer, Timothy P, Ratz, David, McLaughlin, Elizabeth S, Nielsen, Daniel, Czilok, Tawny, Minock, Jennifer, and Gupta, Ashwin

Subjects
ANTIBIOTICS, URINARY tract infections, HUMAN services programs, PATIENT safety, FOCUS groups, RESEARCH funding, HOSPITAL care, RESEARCH evaluation, DIAGNOSTIC errors, HOSPITALS, PATIENT care, SURVEYS, TEST validity, COMMUNITY-acquired infections, QUALITY assurance, USER-centered system design
Abstract

Background Inappropriate diagnosis of infections results in antibiotic overuse and may delay diagnosis of underlying conditions. Here we describe the development and characteristics of 2 safety measures of inappropriate diagnosis of urinary tract infection (UTI) and community-acquired pneumonia (CAP), the most common inpatient infections on general medicine services. Methods Measures were developed from guidelines and literature and adapted based on data from patients hospitalized with UTI and CAP in 49 Michigan hospitals and feedback from end-users, a technical expert panel (TEP), and a patient focus group. Each measure was assessed for reliability, validity, feasibility, and usability. Results Two measures, now endorsed by the National Quality Forum (NQF), were developed. Measure reliability (derived from 24 483 patients) was excellent (0.90 for UTI; 0.91 for CAP). Both measures had strong validity demonstrated through (a) face validity by hospital users, the TEPs, and patient focus group, (b) implicit case review (ĸ 0.72 for UTI; ĸ 0.72 for CAP), and (c) rare case misclassification (4% for UTI; 0% for CAP) due to data errors (<2% for UTI; 6.3% for CAP). Measure implementation through hospital peer comparison in Michigan hospitals (2017 to 2020) demonstrated significant decreases in inappropriate diagnosis of UTI and CAP (37% and 32%, respectively, P <.001), supporting usability. Conclusions We developed highly reliable, valid, and usable measures of inappropriate diagnosis of UTI and CAP for hospitalized patients. Hospitals seeking to improve diagnostic safety, antibiotic use, and patient care should consider using these measures to reduce inappropriate diagnosis of CAP and UTI. [ABSTRACT FROM AUTHOR]

Published
2024
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21. 2724. Community-acquired Pneumonia in Immunocompromised Patients: Predictors and Outcomes Associated with Empiric Broad-spectrum Antibiotic Treatment

Author

Saravolatz, Louis, primary, Gandhi, Tejal N, additional, Vaughn, Valerie, additional, Ratz, David, additional, Horowitz, Jennifer K, additional, Gupta, Ashwin, additional, McLaughlin, Elizabeth, additional, Weinmann, Allison J, additional, Paje, David, additional, Malani, Anurag, additional, Dumkow, Lisa E, additional, Flanders, Scott A, additional, and Petty, Lindsay A, additional

Published
2023
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25. A Statewide Quality Initiative to Reduce Unnecessary Antibiotic Treatment of Asymptomatic Bacteriuria

Author

Vaughn, Valerie M., primary, Gupta, Ashwin, additional, Petty, Lindsay A., additional, Malani, Anurag N., additional, Osterholzer, Danielle, additional, Patel, Payal K., additional, Younas, Mariam, additional, Bernstein, Steven J., additional, Burdick, Stephanie, additional, Ratz, David, additional, Szymczak, Julia E., additional, McLaughlin, Elizabeth, additional, Czilok, Tawny, additional, Basu, Tanima, additional, Horowitz, Jennifer K., additional, Flanders, Scott A., additional, and Gandhi, Tejal N., additional

Published
2023
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31. Risk Factors and outcomes associated with inappropriate empiric broad-spectrum antibiotic use in hospitalized patients with community-acquired pneumonia

Author

Gandhi, Tejal, primary, Petty, Lindsay, additional, Vaughn, Valerie, additional, Malani, Anurag, additional, Ratz, David, additional, Czilok, Tawny, additional, Horowitz, Jennifer, additional, McLaughlin, Elizabeth, additional, Dumkow, Lisa, additional, Burdick, Stephanie, additional, Osterholzer, Danielle, additional, Younas, Mariam, additional, Bernstein, Steven, additional, and Flanders, Scott, additional

Published
2023
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36. The influence of hospital leadership support on burnout, psychological safety, and safety climate for US infection preventionists during the coronavirus disease 2019 (COVID-19) pandemic

Author

Gilmartin, Heather M., Saint, Sanjay, Ratz, David, Chrouser, Kristin, Fowler, Karen E., and Greene, M. Todd

Abstract

AbstractObjective:To explore infection preventionists’ perceptions of hospital leadership support for infection prevention and control programs during the coronavirus disease 2019 (COVID-19) pandemic and relationships with individual perceptions of burnout, psychological safety, and safety climate.Design:Cross-sectional survey, administered April through December 2021.Setting:Random sample of non-federal acute-care hospitals in the United States.Participants:Lead infection preventionists.Results:We received responses from 415 of 881 infection preventionists, representing a response rate of 47%. Among respondents, 64% reported very good to excellent hospital leadership support for their infection prevention and control program. However, 49% reported feeling burned out from their work. Also, ∼30% responded positively for all 7 psychological safety questions and were deemed to have “high psychological safety,” and 76% responded positively to the 2 safety climate questions and were deemed to have a “high safety climate.” Our results indicate an association between strong hospital leadership support and lower burnout (IRR, 0.61; 95% CI, 0.50–0.74), higher perceptions of psychological safety (IRR, 3.20; 95% CI, 2.00–5.10), and a corresponding 1.2 increase in safety climate on an ascending Likert scale from 1 to 10 (β, 1.21; 95% CI, 0.93–1.49).Conclusions:Our national survey provides evidence that hospital leadership support may have helped infection preventionists avoid burnout and increase perceptions of psychological safety and safety climate during the COVID-19 pandemic. These findings aid in identifying factors that promote the well-being of infection preventionists and enhance the quality and safety of patient care.

Published
2024
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40. Guard Duty for the Garries: Soldiers, Internees and the History of POW Camp R.

Author

RATZ, DAVID K. and BEAULIEU, MICHEL S.

Subjects
WORLD War II, PRISONERS of war, VETERANS, NAZIS, NATIONAL socialism
Abstract

With the outbreak of the Second World War, Winnipeg's Fort Garry Horse (or Garries as they call themselves), like many units across Canada, found themselves mobilising and preparing to go overseas. However, when the order to embark on a train to Quebec was received in June 1940, it was not what many had hoped or expected. Instead of boarding a ship bound for England, they were instead sent to meet the first German prisoners of war sent to Canada to escort them to a newly established camp in northwestern Ontario at Red Rock. Using a series of interviews with veterans done in the 1970s as part of a larger oral history project by the Fort Garry Horse Museum, this article explores the Garries' first encounter with the prisoners and how they navigated the expectation of "dangerous Nazis" with the reality of the diverse group of civilians who came down the gangplank at Quebec. [ABSTRACT FROM AUTHOR]

Published
2024
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41. Enhancing Resident Education by Embedding Improvement Specialists Into a Quality and Safety Curriculum

Author

Levy, Kathryn L., Grzyb, Katie, Heidemann, Lauren A., Paliani, Debra Burke, Grondin, Christopher, Solomon, Gabriel, Spranger, Elizabeth, Ellies, Tammy, Ratz, David, and Houchens, Nathan

Subjects
Original Research
Abstract

BACKGROUND: Quality improvement and patient safety (QIPS) curricula are critical in graduate medical education, yet barriers limit the educational experience and project outcomes. OBJECTIVE: To explore the impact of QIPS curricular enhancements and integration of continuous improvement specialists (CIS) by examining the A3 document, the primary project product and surrogate for project quality. METHODS: Since 2009, University of Michigan internal medicine and medicine-pediatric residents participate in a QIPS curriculum, which includes a 4-week group project. In 2016, residency leaders collaborated with CIS staff, non-clinical experts in QIPS with backgrounds in engineering and business, to improve the curriculum. Informed by a needs assessment, the intervention was implemented in 2017 and consisted of a set of enhancements including integration of CIS staff into groups as co-facilitators. In this retrospective cohort study, a blinded reviewer evaluated all available A3 documents before and after the intervention using a quantitative analysis tool. RESULTS: All residents participated in the curriculum during the pre-intervention (July 2009 to June 2016, n=351) and post-intervention (July 2017 to June 2020, n=148) periods. A total of 23 of 84 (27%) pre-intervention and 31 of 34 (91%) post-intervention A3 documents were available for review. Scores improved significantly for 17 of 23 (74%) A3 items and for 7 of 8 (88%) sections. Mean A3 total scores increased from 29.0 to 47.0 (95% CI 12.6-23.4; P

Published
2023

44. Afterword

Author

Beaulieu, Michel S., primary, K. Ratz, David, additional, and Harpelle, Ronald N., additional

Published
2017
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46. 1592. SHEA Featured Oral Abstract: Reducing Unnecessary Antibiotic Treatment for Asymptomatic Bacteriuria: A Statewide Collaborative Quality Initiative

Author

Vaughn, Valerie, primary, Gupta, Ashwin, additional, Petty, Lindsay A, additional, Malani, Anurag N, additional, Osterholzer, Danielle, additional, Patel, Payal K, additional, Younas, Mariam, additional, Bernstein, Steven, additional, Ratz, David, additional, McLaughlin, Elizabeth, additional, Czilok, Tawny, additional, Horowitz, Jennifer, additional, Flanders, Scott A, additional, and Gandhi, Tejal N, additional

Published
2022
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47. 1800. Impact of Updated ATS/IDSA CAP Guidelines on Duration of Antibiotics

Author

Petty, Lindsay A, primary, Vaughn, Valerie, additional, Malani, Anurag N, additional, Younas, Mariam, additional, Osterholzer, Danielle, additional, Bernstein, Steven, additional, Ratz, David, additional, McLaughlin, Elizabeth, additional, Czilok, Tawny, additional, Horowitz, Jennifer, additional, Flanders, Scott A, additional, and Gandhi, Tejal N, additional

Published
2022
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