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Although many suffering from congenital heart defects (CHDs) have seen their conditions become chronic in Denmark today, the risk of complications, deteriorations, and further surgical interventions often lurk in the future. Building on fieldwork in outpatient clinics in Denmark and the homes of families living with CHDs, I explore the role outpatient encounters play in families’ efforts to understand and navigate the prognoses of CHDs by examining how they become routine punctuations and images of uncertainty, and how they play into families’ efforts to prepare for futures where CHDs might develop negatively while also trying to keep such scenarios at bay. I argue that these encounters exemplify, generate, and tentatively curb the particular uncertainties of living with CHDs. Hence, I suggest that they can be thought of as prognostic calibrations—a conceptual oxymoron that encapsulates the anxiety and uncertainty that I show persist around CHD prognoses despite many efforts by families and healthcare staff to establish routine, a sense of security, and certainty.

Inaccessible home environments that create barriers to the enjoyment and the approachability of the living space impact some U.S. Veterans. Injuries acquired while serving in the military or developed through the aging process complicate matters for Veterans with disabilities. Home modifications (HM) afforded by the Home Improvements and Structural Alterations (HISA) program can increase accessibility. We examine the difference between urban and rural Veterans in their health service utilization (hospitalization versus outpatient encounters) 12 months before and 12 months after their HISA use. All the study patients were Veterans with disabilities who use the HISA program. There is a significant decrease in hospitalization post-HM as compared with pre-HM provision for all HM users. There is a significant increase in outpatient encounters post-HM as compared with pre-HM provision for all users. Rural vs. urban status was only significant in outpatient encounters 12 months pre-provision of HM. Provision of HM is associated with favorable clinical outcomes such as decreased hospitalization and increased preventative outpatient care visits. Our findings suggest some subset of hospitalizations could be prevented or delayed if timely and appropriate outpatient care is accessible to patients along with HM. Increasing the provision of HM services such as HISA can free up hospital beds, reduce cost to both individuals and institutions, decrease the risk of hospital acquired morbidity, and promote community integration. [ABSTRACT FROM AUTHOR]

Background: Several challenges are associated with collecting clinically meaningful post-operative outcomes. The widespread implementation of electronic medical records (EMR) offers a new opportunity to evaluate surgical outcomes using routinely collected data in these systems. This study evaluated whether surgical outcomes can be ascertained from EMR's hospital and outpatient encounters. Specifically, we evaluated anterior cruciate ligament reconstructions (ACLR) outcomes.Methods: A retrospective cohort study of 6985 ACLRs performed between 2/2005-9/2012 was conducted. Patient encounters during days 1-90 and days 91-180 after ACLR surgery were the exposures of interest. Nine hospital and eight outpatient encounter types were evaluated. The main endpoint of the study was revision surgery six months after ACLR.Results: The cohort was 66.7% male, the mean age was 28 (standard deviation=11) years-old, and the incidence of revision was 1.5% (n=105). After adjustments, in days 1-90 post-ACLR, compared to patients with 0-4 orthopedic office visits, patients with 5-9 (hazard ratio (HR)=9.9, 95% confidence interval(CI), 4.3-23.2) and those with 10 or more (HR=13.8, 95%CI, 5.6-33.8) visits had a higher risk of revision. In days 91-180, patients with any outpatient hospital encounters (HR=2.5, 95%CI 1.4-4.5) had a higher risk of revision than patients without visits. Additionally, patients with 4-5 regular office visits (HR=3.8 times, 95%CI, 2.0-7.0) had a higher risk of revision surgery than those with 0-1 visits.Discussion: The number of post-operative outpatient visits was associated with ACLR revision surgery. Using EMR encounters to assess surgical outcomes is a viable option for monitoring ACLR patients. The simple assessment of visit types and number of encounters alone can provide valuable information regarding the normal course of rehabilitation of a surgical patient and possible deviation from this normal course. In large cohorts of patients, this type of patient surveillance can assist surgeons with monitoring their patients. [ABSTRACT FROM AUTHOR]