Further efforts to translate the Choosing Wisely recommendations into practice should promote data-driven benchmarking and learning collaboratives to achieve sustained practice improvement. There was no significant change in imaging UR for Atraumatic Back Pain for XR (36.0% vs 33.3% 95% CI: -5.9%, -0 5%), CT (20.1% vs 17.7% 95% CI: -5.1%, -0.4%) or MRI (0.8% vs 0.7%, 95% CI: -0.4%, -0.3%).ConclusionsEarly data from the E-QUAL Avoidable Imaging Initiative suggests QI interventions could potentially improve imaging stewardship and reduce low-value care.
ED sites with sustained participation showed significant decreases in CT UR in 2017 compared to 2018 for Syncope (56.4% vs 48.0% 95% CI: -12.7%, -4.1%) and Minor Head Injury (76.3% vs 72.1% 95% CI: -7.3%, -1.1%). The mean CT UR for Minor Head Injury was 72.6% (IQR 65.6%-81.7%). Participating EDs reported imaging utilization rates (UR) and common QI practices for three Choosing Wisely targets: Atraumatic Low Back Pain, Syncope, or Minor Head Injury.Results305 ED sites participated in the initiative. Demographic characteristic at study visit of patients with and without HZįigure 1.PurposeTo characterize performance among ED sites participating in the Emergency Quality Network (E-QUAL) Avoidable Imaging Initiative for clinical targets on the American College of Emergency Physicians Choosing Wisely list.MethodsThis was an observational study of quality improvement (QI) data collected from hospital-based ED sites in 2017-2018. HZ can be an early comorbidity in SLE, with 43.1% of cases occurring within 5 years of SLE diagnosis and 57% after 10 years of SLE diagnosis. The HZ prevalence of 30.8% was higher than previously published data in SLE. Seventy-two patients (56.7%) were on immunosuppressant (Azathioprine 31.5%, Mycophenolate mofetil 14.17%, Methotrexate 6.3% and cyclophosphamide 4.72%). Of those, 32 patients reported a mean prednisone dose of 23.3 mg/day (range, 3–60 mg). 1).Įighty patients (62.9%) reported taking prednisone at the time of HZ. The majority of the patients reported pain (95.9%) and 74.0% scored between 7-10 (Fig. HZ pain, itching or tingling in the rash area was reported in 96.7% of patients. 97.6% of HZ was confirmed by physician and 78% received anti-viral therapy. Most (78.8%) of those who developed HZ were not vaccinated prior to HZ. Mean SLE duration at first HZ was 9.6 ± 9.8 years. HZ occurred in the first 5 years post SLE diagnosis in 43.1% of patients, 18.1% reported HZ from 6-10 years and 38.2% reported HZ occurrence ≥10 years post SLE diagnosis. The demographic features of SLE patients with and without HZ are presented in Table 1. Of these 127 patients, 32 (25.2%) patients experienced recurrent HZ event, occurring within 12.2 ± 12.1 years from the 1 st HZ event. The prevalence of HZ was 127 (30.8%) at a mean age of 47.4 ± 13.7 years. Of 912 patients who visited the clinic within that period, 412 patients completed the survey. Analysis included descriptive statistics. All patients were evaluated according to a standard protocol which includes assessment of disease activity (SLE Disease Activity Index 2000 ). The survey was distributed to consecutive SLE patients attending the Lupus Clinic from January 2016 to April 2018.
It includes different questions on patient’ demographics, the onset of HZ in relation the SLE onset, pain related to HZ, history of varicella zoster vaccine, anti-viral therapy for HZ, and several estimated risk factors for HZ. The objective of this study is to determine the prevalence and describe the characteristics of HZ in an SLE cohort.Ī patient questionnaire was developed to examine HZ in SLE patients. The higher prevalence of HZ in Systemic Lupus Erythematosus (SLE) patients is aggravated by the concomitant use of immunosuppressant and glucocorticoids (GCs). The prevalence of HZ is 3.6-19.9% in previously reported data. Herpes zoster (HZ) commonly observed in the elderly and in immune-compromised patients.
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