Last data update: May 06, 2024. (Total: 46732 publications since 2009)
Records 1-3 (of 3 Records) |
Query Trace: Cincotta S[original query] |
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Regional impact of multidrug-resistant organism prevention bundles implemented by facility type: A modeling study
Cincotta SE . Infect Control Hosp Epidemiol 2024 1-8 BACKGROUND: Emerging multidrug-resistant organisms (MDROs), such as carbapenem-resistant Enterobacterales (CRE), can spread rapidly in a region. Facilities that care for high-acuity patients with longer stays may have a disproportionate impact on this spread. OBJECTIVE: We assessed the impact of implementing preventive interventions, directed at a subset of facilities, on regional prevalence. METHODS: We developed a deterministic compartmental model, parametrized using CRE and patient transfer data. The model included the community and healthcare facilities within a US state. Individuals may be either susceptible or infectious with CRE. Individuals determined to be infectious through admission screening, periodic prevalence surveys (PPSs), or interfacility communication were placed in a state of lower transmissibility if enhanced infection prevention and control (IPC) practices were in place at a facility. RESULTS: Intervention bundles that included PPS and enhanced IPC practices at ventilator-capable skilled nursing facilities (vSNFs) and long-term acute-care hospitals (LTACHs) had the greatest impact on regional prevalence. The benefits of including targeted admission screening in acute-care hospitals, LTACHs, and vSNFs, and improved interfacility communication were more modest. Daily transmissions in each facility type were reduced following the implementation of interventions primarily focused at LTACHs and vSNFs. CONCLUSIONS: Our model suggests that interventions that include screening to limit unrecognized MDRO introduction to, or dispersal from, LTACHs and vSNFs slow regional spread. Interventions that pair detection and enhanced IPC practices within LTACHs and vSNFs may substantially reduce the regional burden. |
Impact of state stroke systems of care laws on stroke outcomes
Fulmer EB , Keener Mast D , Godoy Garraza L , Gilchrist S , Rasool A , Xu Y , Brown A , Omeaku N , Ye Z , Donald B , Shantharam S , Coleman King S , Popoola A , Cincotta K . Healthcare (Basel) 2023 11 (21) Since 2003, 38 US states and Washington, DC have adopted legislation and/or regulations to strengthen stroke systems of care (SSOCs). This study estimated the impact of SSOC laws on stroke outcomes. We used a coded legal dataset of 50 states and DC SSOC laws (years 2003-2018), national stroke accreditation information (years 1997-2018), data from the Healthcare Cost and Utilization Project (years 2012-2018), and National Vital Statistics System (years 1979-2019). We applied a natural experimental design paired with longitudinal modeling to estimate the impact of having one or more SSOC policies in effect on outcomes. On average, states with one or more SSOC policies in effect achieved better access to primary stroke centers (PSCs) than expected without SSOC policies (ranging from 2.7 to 8.0 percentage points (PP) higher), lower inpatient hospital costs (USD 610-1724 less per hospital stay), lower age-adjusted stroke mortality (1.0-1.6 fewer annual deaths per 100,000), a higher proportion of stroke patients with brain imaging results within 45 min of emergency department arrival (3.6-5.0 PP higher), and, in some states, lower in-hospital stroke mortality (5 fewer deaths per 1000). Findings were mixed for some outcomes and there was limited evidence of model fit for others. No effect was observed in racial and/or rural disparities in stroke mortality. |
Evaluation of antifungal use in long-term care facilities using pharmacy dispensing data in the USA, 2019
Dickinson DT , Gouin KA , Neuhauser MM , Benedict K , Cincotta S , Kabbani S . J Antimicrob Chemother 2022 78 (1) 309-311 Antimicrobials are one of the most commonly prescribed medications in long-term care (LTC) settings.1–3 Cross-sectional surveys have estimated that antifungals account for 0.1%–5% of antimicrobials administered to LTC residents.2,3 However, these prevalence surveys did not capture use over time or characterize the prescribing of specific agents. Dispensing data from LTC pharmacies can be leveraged to track and report LTC antimicrobial use.4 Due to the risk of adverse events and drug interactions among older adults, characterizing antifungal use and describing variability in antifungal prescribing can inform antimicrobial stewardship efforts to ensure resident safety.5–7 |
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