Becker's Clinical Quality & Infection Control

32 QUALITY IMPROVEMENT & MEASUREMENT Cleveland Clinic develops tool to determine diabetes patients' complication risks By Mackenzie Garrity P hysicians at Cleveland Clinic have released a calculator for patients with type 2 diabetes to determine their risk of developing major health complications over a 10-year period depending on their treatment path. "e calculator can be a useful tool for physicians and patients with type 2 diabetes and obesity. It shows a patient's risk of heart disease, stroke, heart failure, diabetic kidney disease and death over the next 10 years with usual care. It also shows how a patients' risk of those adverse events could change aer metabolic surgery," said Ali Aminian, MD, a bariatric surgeon at Cleveland Clinic. It took two years to develop the calculator, known as the 10-year Individualized Diabetes Complications Risk Score. During two phases, researchers observed nearly 2,300 patients who underwent metabolic surgery and 11,500 matched patients with similar characteris- tics who received usual care. Phase one results showed patients with type 2 diabe- tes and obesity had a 40 percent lower risk of death and major adverse cardiovascular events if they underwent weight-loss surgery. Surgical patients also lost more weight, had better diabetes control and used fewer medications. During the second phase, researches used the same group of patients to identify predictors for different health outcomes. ey used evidence-based models to build the risk calculator, which estimates the likelihood a patient develops chronic conditions. "Based on the advice of subject matter experts, our team was able to explore 26 risk factors for the different outcomes, including risk of dying, in that large group of patients," said Michael Kattan, PhD, chairman of the department of quantitative health sciences at Cleveland Clinic's Lerner Research Institute. "We then compared machine learning and traditional statistical techniques to identify the most accurate predication models for each outcome and built those into the calculator. n Flu shot cuts severe outcomes for hospitalized patients, study finds By Anuja Vaidya V accination can reduce the likelihood of severe outcomes, including death, in adults hospitalized with influenza by up to 36 percent, according to a study presented at IDWeek 2019, which took place Oct. 2-6, in Washington, D.C. Researchers identified adults hospitalized with laboratory-con- firmed flu during seasons 2013-14 through 2017-18 to the U.S. Influenza Hospitalization Surveillance Network. They gathered the vaccination status of the patients using medical records, vaccine registries and interviews. Of 67,452 adults hospitalized with influenza, 43,608 were included in the study. Forty-seven percent were between the ages of 18 to 64 and 53 percent were older than 65. Thirty-eight percent of the 18- to 64-year-olds and 65 percent of those older than 65 were vaccinated. Researchers found vaccination was linked to decreased odds of ad- mission to the intensive care unit and mechanical ventilation in both age groups among patients with influenza A(H1N1)pdm09. Additionally, vaccination was associated with lower likelihood of pneumonia and death as well as shortened ICU length of stay among the 18 to 64 age group. It was also associated with short- ened hospital length of stay among the 65-plus age group. n Hospitals' fall prevention efforts cause 'epidemic of immobility,' expert says By Mackenzie Bean H ospitals' extreme focus on preventing falls has caused an "epidemic of immobility" among elderly patients, one health expert told The Washington Post and Kaiser Health News. CMS introduced penalties for patient falls in 2008. This policy creates "a climate of fear of falling" in which nurses worry they'll be blamed if a patient falls during their shift, according to Kenneth Covinsky, MD, a geriatrician and researcher at the University of Cali- fornia at San Francisco. These fears have driven many hospitals to drastically limit elderly patients' mobility, including those who may benefit from the physical activity. Dr. Covinsky said patients who are bedbound during their hospital stay often leave weaker than when they were admitted, thereby putting them more at risk of falls. To address this issue, many organizations nationwide are rolling out initiatives to promote mobil- ity in elderly hospital patients. CMS declined to provide a direct answer as to whether its readmis- sion program has hindered patient mobility, according to The Post and KHN. n

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