Judy Mikhail - Profile on Academia.edu (original) (raw)
Papers by Judy Mikhail
Survey Research: A Reporting Guideline for the Journal of Trauma Nursing
Journal of trauma nursing : the official journal of the Society of Trauma Nurses, 2021
Building Your Scholarship Portfolio: One Brick at a Time
Journal of Trauma Nursing, 2021
Pull back the curtain: External data validation is an essential element of quality improvement benchmark reporting
Journal of Trauma and Acute Care Surgery, 2020
Supplemental digital content is available in the text. BACKGROUND Accurate and reliable data are ... more Supplemental digital content is available in the text. BACKGROUND Accurate and reliable data are pivotal to credible risk-adjusted modeling and hospital benchmarking. Evidence assessing the reliability and accuracy of data elements considered as variables in risk-adjustment modeling and measurement of outcomes is lacking. This deficiency holds the potential to compromise benchmarking integrity. We detail the findings of a longitudinal program to evaluate the impact of external data validation on data validity and reliability for variables utilized in benchmarking of trauma centers. METHODS A collaborative quality initiative-based study was conducted of 29 trauma centers from March 2010 through December 2018. Case selection criteria were applied to identify high-yield cases that were likely to challenge data abstractors. There were 127,238 total variables validated (i.e., reabstracted, compared, and reported to trauma centers). Study endpoints included data accuracy (agreement between registry data and contemporaneous documentation) and reliability (consistency of accuracy within and between hospitals). Data accuracy was assessed by mean error rate and type (under capture, inaccurate capture, or over capture). Cohen's kappa estimates were calculated to evaluate reliability. RESULTS There were 185,120 patients that met the collaborative inclusion criteria. There were 1,243 submissions reabstracted. The initial validation visit demonstrated the highest mean error rate at 6.2% ± 4.7%, and subsequent validation visits demonstrated a statistically significant decrease in error rate compared with the first visit (p < 0.05). The mean hospital error rate within the collaborative steadily improved over time (2010, 8.0%; 2018, 3.2%) compared with the first year (p < 0.05). Reliability of substantial or higher (kappa ≥0.61) was demonstrated in 90% of the 20 comorbid conditions considered in the benchmark risk-adjustment modeling, 39% of these variables exhibited a statistically significant (p < 0.05) interval decrease in error rate from the initial visit. CONCLUSION Implementation of an external data validation program is correlated with increased data accuracy and reliability. Improved data reliability both within and between trauma centers improved risk-adjustment model validity and quality improvement program feedback.
Journal of Trauma Nursing, 2020
Transitions
Journal of Trauma Nursing, 2019
The Social Determinants of Trauma: A Trauma Disparities Scoping Review and Framework
Journal of Trauma Nursing, 2018
The drivers of trauma disparities are multiple and complex; yet, understanding the causes will di... more The drivers of trauma disparities are multiple and complex; yet, understanding the causes will direct needed interventions. The aims of this article are to (1) explore how the injured patient, his or her social environment, and the health care system interact to contribute to trauma disparities and examine the evidence in support of interventions and (2) develop a conceptual framework that captures the socioecological context of trauma disparities. Using a scoping review methodology, articles were identified through PubMed and CINAHL between 2000 and 2015. Data were extracted on the patient population, social determinants of health, and interventions targeting trauma disparities and violence. Based on the scoping review of 663 relevant articles, we inductively developed a conceptual model, The Social Determinants of Trauma: A Trauma Disparities Framework, based on the categorization of articles by: institutional power (n = 9), social context—place (n = 117), discrimination experiences (n = 59), behaviors and comorbidities (n = 57), disparities research (n = 18), and trauma outcomes (n = 85). Intervention groupings included social services investment (n = 54), patient factors (n = 88), hospital factors (n = 27), workforce factors (n = 31), and performance improvement (n = 118). This scoping review produced a needed taxonomy scheme of the drivers of trauma disparities and known interventions that in turn informed the development of The Social Determinants of Trauma: A Trauma Disparities Framework. This study adds to the trauma disparities literature by establishing social context as a key contributor to disparities in trauma outcomes and provides a road map for future trauma disparities research.
JAMA Surgery, 2018
Program (ACS TQIP) provides feedback to hospitals on risk-adjusted outcomes. The Michigan Trauma ... more Program (ACS TQIP) provides feedback to hospitals on risk-adjusted outcomes. The Michigan Trauma Quality Improvement Program (MTQIP) goes beyond the provision of feedback alone, focusing on collaborative quality improvement. It is unknown whether the addition of a collaborative approach to benchmark reporting improves outcomes. OBJECTIVE To evaluate the association of hospital participation in the ACS TQIP (benchmark reporting) or the MTQIP (benchmark reporting and collaborative quality improvement) with outcomes compared with control hospitals that did not participate in either program. DESIGN, SETTING, AND PARTICIPANTS In this cohort study, data from the National Trauma Data Bank from 2009 to 2015 were used. A total of 2 373 130 trauma patients 16 years or older with an Injury Severity Score of 5 or more were identified from 98 ACS TQIP hospitals, 23 MTQIP hospitals, and 429 nonparticipating hospitals, based on program participation status in 2011. A difference-indifferences analytic approach was used to evaluate whether hospital participation in the ACS TQIP or the MTQIP was associated with improved outcomes compared with nonparticipation in a quality improvement program. EXPOSURES Hospital participation in MTQIP, a quality improvement collaborative, compared with ACS TQIP participation and nonparticipating hospitals. MAIN OUTCOMES AND MEASURES In-hospital mortality, mortality or hospice, major complications, and venous thromboembolism events were assessed. RESULTS Of the 2 373 130 included trauma patients, 64.2% were men and 73.0% were white, and the mean (SD) age was 50.7 (21.9) years. After accounting for patient factors and preexisting time trends toward improved outcomes, there was a statistically significant improvement in major complications after (vs before) hospital enrollment in the MTQIP collaborative compared with nonparticipating hospitals (odds ratio [OR], 0.89; 95% CI, 0.83-0.95) or ACS TQIP hospitals (OR, 0.88; 95% CI, 0.82-0.94). A similar result was observed for venous thromboembolism (MTQIP vs nonparticipating: OR, 0.78; 95% CI, 0.69-0.88; MTQIP vs ACS TQIP: OR, 0.84; 95% CI, 0.74-0.95), for which MTQIP targeted specific performance improvement efforts. Hospital participation in both ACS TQIP and MTQIP was associated with improvement in mortality or hospice (ACS TQIP vs nonparticipating: OR, 0.90; 95% CI, 0.87-0.93; MTQIP vs nonparticipating: OR, 0.88; 95% CI, 0.81-0.96). Hospitals participating in MTQIP achieved the lowest overall risk-adjusted mortality in the postenrollment period (4.2%; 95% CI, 4.1-4.3). CONCLUSIONS AND RELEVANCE This study demonstrates that hospital participation in a regional collaborative quality improvement program is associated with improved patient outcomes beyond benchmark reporting alone while promoting compliance with processes of care.
The journal of trauma and acute care surgery, Jan 21, 2018
The appropriate triage of acutely injured patients within a trauma system is associated with impr... more The appropriate triage of acutely injured patients within a trauma system is associated with improved rates of mortality and optimal resource utilization. The American College of Surgeons Committee on Trauma (ACS-COT) put forward six minimum criteria (ACS-6) for full trauma team activation (TTA). We hypothesized that ACS-COT-verified trauma center compliance with these criteria is associated with low undertriage rates and improved overall mortality. Data from a state-wide collaborative quality initiative was used. We used data collected from 2014 through 2016 at 29 ACS verified Level I and II trauma centers. Inclusion criteria are: adult patients (≥16 years) and Injury Severity Score of 5 or less. Quantitative data existed to analyze four of the ACS-6 criteria (emergency department systolic blood pressure ≤ 90 mm Hg, respiratory compromise/intubation, central gunshot wound, and Glasgow Coma Scale score < 9). Patients were considered to be undertriaged if they had major trauma (In...
The Michigan Trauma Quality Improvement Program: Results from a collaborative quality initiative
The journal of trauma and acute care surgery, 2017
American College of Surgeons verified trauma centers and a third-party payer within the state of ... more American College of Surgeons verified trauma centers and a third-party payer within the state of Michigan built a regional collaborative quality initiative (CQI). The Michigan Trauma Quality Improvement Program began as a pilot in 2008 and expanded to a formal program in 2011. Here, we examine the performance of the collaborative over time with regard to patient outcomes, resource utilization, and process measures. Data from the initial 23 hospitals that joined the CQI in 2011 were analyzed. Performance trends from 2011 to 2015 were evaluated for outcomes, resource utilization, and process measures using univariate analysis. Risk-adjustment was performed to confirm results observed in the unadjusted data. To calculate the potential number of patients impacted by the CQI program, the maximum absolute change was multiplied by the number of trauma patients treated in the 23 hospitals during 2015. Membership in a CQI program significantly reduced serious complications (8.5 vs. 7.3%, p =...
Journal of trauma nursing : the official journal of the Society of Trauma Nurses
Although race, socioeconomic status, and insurance individually are associated with trauma mortal... more Although race, socioeconomic status, and insurance individually are associated with trauma mortality, their complex interactions remain ill defined. This retrospective cross-sectional study from a single Level I center in a racially diverse community was linked by socioeconomic status, insurance, and race from 2000 to 2009 for trauma patients aged 18-64 years with an injury severity score more than 9. The outcome measure was inpatient mortality. Multiple logistic regression analyses were performed to investigate confounding variables known to predict trauma mortality. A total of 4,007 patients met inclusion criteria. Individually, race, socioeconomic status, and insurance were associated with increased mortality rate; however, in multivariate analysis, only insurance remained statistically significant and varied by insurance type with age. Odds of death were higher for Medicare (odds ratio [OR] = 3.63, p = .006) and other insurance (OR = 3.02, p = .007) than for Private Insurance. H...
Regional data validation methodology decreases data discrepancy rates
Massive transfusion in trauma: process and outcomes
Journal of trauma nursing : the official journal of the Society of Trauma Nurses
Massive transfusion in trauma presents a unique challenge to trauma center effectiveness. It requ... more Massive transfusion in trauma presents a unique challenge to trauma center effectiveness. It requires the highest level of collaboration between multiple departments working together in a timed event and as such serves as a barometer of trauma program maturity and success. The development of a massive transfusion protocol is necessary to manage this limited resource in trauma centers. The protocol should be revised frequently to reflect cutting edge research and continual improvements in blood banking. This article will review the status of massive transfusion in trauma, use of massive transfusion protocols and suggest quality improvement initiatives for blood use in trauma centers.
Acute burn care: an update
Journal of emergency nursing: JEN : official publication of the Emergency Department Nurses Association
Journal of Trauma Nursing, 2001
Purposeful Paranoia
Journal of Trauma Nursing, 2005
Journal of Trauma Nursing, 2005
В работе получен аналог теоремы Прочези-Размыслова для алгебры полуинвариантов представлений прои... more В работе получен аналог теоремы Прочези-Размыслова для алгебры полуинвариантов представлений произвольного колчана с вектором размерности (2, 2,. .. , 2). Библиография: 7 названий.
The Media and the Trauma Service Part I — Friend or Foe?
Journal of Trauma Nursing, 2001
International Journal of Trauma Nursing, 1995
Resuscitation Endpoints in Trauma
AACN Clinical Issues: Advanced Practice in Acute and Critical Care, 1999
Shock is defined as inadequate perfusion of tissues with oxygen and nutrients to support cellular... more Shock is defined as inadequate perfusion of tissues with oxygen and nutrients to support cellular function. Resuscitation from shock can therefore only be complete when all evidence of oxygen debt, anaerobic metabolism, and tissue acidosis has been eliminated. All of the diagnostic and therapeutic maneuvers performed by trauma nurses today, whether basic or advanced, whether performed in the field, emergency department, operating room, or intensive care unit, can be traced directly or indirectly to this goal. Resuscitation in trauma is now viewed across the continuum of physiologic insult and response that occurs after hemorrhage or tissue injury. Resuscitation endpoints (i.e., variables or parameters) must be viewed across the continuum of shock because the effectiveness of endpoints varies with the phase of resuscitation. The optimal resuscitation endpoint in trauma is controversial, remains elusive, and is one of the most published topics in modern medical literature. This article presents the current understanding of the resuscitation endpoints in trauma.
AACN Clinical Issues: Advanced Practice in Acute and Critical Care, 1999
Survey Research: A Reporting Guideline for the Journal of Trauma Nursing
Journal of trauma nursing : the official journal of the Society of Trauma Nurses, 2021
Building Your Scholarship Portfolio: One Brick at a Time
Journal of Trauma Nursing, 2021
Pull back the curtain: External data validation is an essential element of quality improvement benchmark reporting
Journal of Trauma and Acute Care Surgery, 2020
Supplemental digital content is available in the text. BACKGROUND Accurate and reliable data are ... more Supplemental digital content is available in the text. BACKGROUND Accurate and reliable data are pivotal to credible risk-adjusted modeling and hospital benchmarking. Evidence assessing the reliability and accuracy of data elements considered as variables in risk-adjustment modeling and measurement of outcomes is lacking. This deficiency holds the potential to compromise benchmarking integrity. We detail the findings of a longitudinal program to evaluate the impact of external data validation on data validity and reliability for variables utilized in benchmarking of trauma centers. METHODS A collaborative quality initiative-based study was conducted of 29 trauma centers from March 2010 through December 2018. Case selection criteria were applied to identify high-yield cases that were likely to challenge data abstractors. There were 127,238 total variables validated (i.e., reabstracted, compared, and reported to trauma centers). Study endpoints included data accuracy (agreement between registry data and contemporaneous documentation) and reliability (consistency of accuracy within and between hospitals). Data accuracy was assessed by mean error rate and type (under capture, inaccurate capture, or over capture). Cohen's kappa estimates were calculated to evaluate reliability. RESULTS There were 185,120 patients that met the collaborative inclusion criteria. There were 1,243 submissions reabstracted. The initial validation visit demonstrated the highest mean error rate at 6.2% ± 4.7%, and subsequent validation visits demonstrated a statistically significant decrease in error rate compared with the first visit (p < 0.05). The mean hospital error rate within the collaborative steadily improved over time (2010, 8.0%; 2018, 3.2%) compared with the first year (p < 0.05). Reliability of substantial or higher (kappa ≥0.61) was demonstrated in 90% of the 20 comorbid conditions considered in the benchmark risk-adjustment modeling, 39% of these variables exhibited a statistically significant (p < 0.05) interval decrease in error rate from the initial visit. CONCLUSION Implementation of an external data validation program is correlated with increased data accuracy and reliability. Improved data reliability both within and between trauma centers improved risk-adjustment model validity and quality improvement program feedback.
Journal of Trauma Nursing, 2020
Transitions
Journal of Trauma Nursing, 2019
The Social Determinants of Trauma: A Trauma Disparities Scoping Review and Framework
Journal of Trauma Nursing, 2018
The drivers of trauma disparities are multiple and complex; yet, understanding the causes will di... more The drivers of trauma disparities are multiple and complex; yet, understanding the causes will direct needed interventions. The aims of this article are to (1) explore how the injured patient, his or her social environment, and the health care system interact to contribute to trauma disparities and examine the evidence in support of interventions and (2) develop a conceptual framework that captures the socioecological context of trauma disparities. Using a scoping review methodology, articles were identified through PubMed and CINAHL between 2000 and 2015. Data were extracted on the patient population, social determinants of health, and interventions targeting trauma disparities and violence. Based on the scoping review of 663 relevant articles, we inductively developed a conceptual model, The Social Determinants of Trauma: A Trauma Disparities Framework, based on the categorization of articles by: institutional power (n = 9), social context—place (n = 117), discrimination experiences (n = 59), behaviors and comorbidities (n = 57), disparities research (n = 18), and trauma outcomes (n = 85). Intervention groupings included social services investment (n = 54), patient factors (n = 88), hospital factors (n = 27), workforce factors (n = 31), and performance improvement (n = 118). This scoping review produced a needed taxonomy scheme of the drivers of trauma disparities and known interventions that in turn informed the development of The Social Determinants of Trauma: A Trauma Disparities Framework. This study adds to the trauma disparities literature by establishing social context as a key contributor to disparities in trauma outcomes and provides a road map for future trauma disparities research.
JAMA Surgery, 2018
Program (ACS TQIP) provides feedback to hospitals on risk-adjusted outcomes. The Michigan Trauma ... more Program (ACS TQIP) provides feedback to hospitals on risk-adjusted outcomes. The Michigan Trauma Quality Improvement Program (MTQIP) goes beyond the provision of feedback alone, focusing on collaborative quality improvement. It is unknown whether the addition of a collaborative approach to benchmark reporting improves outcomes. OBJECTIVE To evaluate the association of hospital participation in the ACS TQIP (benchmark reporting) or the MTQIP (benchmark reporting and collaborative quality improvement) with outcomes compared with control hospitals that did not participate in either program. DESIGN, SETTING, AND PARTICIPANTS In this cohort study, data from the National Trauma Data Bank from 2009 to 2015 were used. A total of 2 373 130 trauma patients 16 years or older with an Injury Severity Score of 5 or more were identified from 98 ACS TQIP hospitals, 23 MTQIP hospitals, and 429 nonparticipating hospitals, based on program participation status in 2011. A difference-indifferences analytic approach was used to evaluate whether hospital participation in the ACS TQIP or the MTQIP was associated with improved outcomes compared with nonparticipation in a quality improvement program. EXPOSURES Hospital participation in MTQIP, a quality improvement collaborative, compared with ACS TQIP participation and nonparticipating hospitals. MAIN OUTCOMES AND MEASURES In-hospital mortality, mortality or hospice, major complications, and venous thromboembolism events were assessed. RESULTS Of the 2 373 130 included trauma patients, 64.2% were men and 73.0% were white, and the mean (SD) age was 50.7 (21.9) years. After accounting for patient factors and preexisting time trends toward improved outcomes, there was a statistically significant improvement in major complications after (vs before) hospital enrollment in the MTQIP collaborative compared with nonparticipating hospitals (odds ratio [OR], 0.89; 95% CI, 0.83-0.95) or ACS TQIP hospitals (OR, 0.88; 95% CI, 0.82-0.94). A similar result was observed for venous thromboembolism (MTQIP vs nonparticipating: OR, 0.78; 95% CI, 0.69-0.88; MTQIP vs ACS TQIP: OR, 0.84; 95% CI, 0.74-0.95), for which MTQIP targeted specific performance improvement efforts. Hospital participation in both ACS TQIP and MTQIP was associated with improvement in mortality or hospice (ACS TQIP vs nonparticipating: OR, 0.90; 95% CI, 0.87-0.93; MTQIP vs nonparticipating: OR, 0.88; 95% CI, 0.81-0.96). Hospitals participating in MTQIP achieved the lowest overall risk-adjusted mortality in the postenrollment period (4.2%; 95% CI, 4.1-4.3). CONCLUSIONS AND RELEVANCE This study demonstrates that hospital participation in a regional collaborative quality improvement program is associated with improved patient outcomes beyond benchmark reporting alone while promoting compliance with processes of care.
The journal of trauma and acute care surgery, Jan 21, 2018
The appropriate triage of acutely injured patients within a trauma system is associated with impr... more The appropriate triage of acutely injured patients within a trauma system is associated with improved rates of mortality and optimal resource utilization. The American College of Surgeons Committee on Trauma (ACS-COT) put forward six minimum criteria (ACS-6) for full trauma team activation (TTA). We hypothesized that ACS-COT-verified trauma center compliance with these criteria is associated with low undertriage rates and improved overall mortality. Data from a state-wide collaborative quality initiative was used. We used data collected from 2014 through 2016 at 29 ACS verified Level I and II trauma centers. Inclusion criteria are: adult patients (≥16 years) and Injury Severity Score of 5 or less. Quantitative data existed to analyze four of the ACS-6 criteria (emergency department systolic blood pressure ≤ 90 mm Hg, respiratory compromise/intubation, central gunshot wound, and Glasgow Coma Scale score < 9). Patients were considered to be undertriaged if they had major trauma (In...
The Michigan Trauma Quality Improvement Program: Results from a collaborative quality initiative
The journal of trauma and acute care surgery, 2017
American College of Surgeons verified trauma centers and a third-party payer within the state of ... more American College of Surgeons verified trauma centers and a third-party payer within the state of Michigan built a regional collaborative quality initiative (CQI). The Michigan Trauma Quality Improvement Program began as a pilot in 2008 and expanded to a formal program in 2011. Here, we examine the performance of the collaborative over time with regard to patient outcomes, resource utilization, and process measures. Data from the initial 23 hospitals that joined the CQI in 2011 were analyzed. Performance trends from 2011 to 2015 were evaluated for outcomes, resource utilization, and process measures using univariate analysis. Risk-adjustment was performed to confirm results observed in the unadjusted data. To calculate the potential number of patients impacted by the CQI program, the maximum absolute change was multiplied by the number of trauma patients treated in the 23 hospitals during 2015. Membership in a CQI program significantly reduced serious complications (8.5 vs. 7.3%, p =...
Journal of trauma nursing : the official journal of the Society of Trauma Nurses
Although race, socioeconomic status, and insurance individually are associated with trauma mortal... more Although race, socioeconomic status, and insurance individually are associated with trauma mortality, their complex interactions remain ill defined. This retrospective cross-sectional study from a single Level I center in a racially diverse community was linked by socioeconomic status, insurance, and race from 2000 to 2009 for trauma patients aged 18-64 years with an injury severity score more than 9. The outcome measure was inpatient mortality. Multiple logistic regression analyses were performed to investigate confounding variables known to predict trauma mortality. A total of 4,007 patients met inclusion criteria. Individually, race, socioeconomic status, and insurance were associated with increased mortality rate; however, in multivariate analysis, only insurance remained statistically significant and varied by insurance type with age. Odds of death were higher for Medicare (odds ratio [OR] = 3.63, p = .006) and other insurance (OR = 3.02, p = .007) than for Private Insurance. H...
Regional data validation methodology decreases data discrepancy rates
Massive transfusion in trauma: process and outcomes
Journal of trauma nursing : the official journal of the Society of Trauma Nurses
Massive transfusion in trauma presents a unique challenge to trauma center effectiveness. It requ... more Massive transfusion in trauma presents a unique challenge to trauma center effectiveness. It requires the highest level of collaboration between multiple departments working together in a timed event and as such serves as a barometer of trauma program maturity and success. The development of a massive transfusion protocol is necessary to manage this limited resource in trauma centers. The protocol should be revised frequently to reflect cutting edge research and continual improvements in blood banking. This article will review the status of massive transfusion in trauma, use of massive transfusion protocols and suggest quality improvement initiatives for blood use in trauma centers.
Acute burn care: an update
Journal of emergency nursing: JEN : official publication of the Emergency Department Nurses Association
Journal of Trauma Nursing, 2001
Purposeful Paranoia
Journal of Trauma Nursing, 2005
Journal of Trauma Nursing, 2005
В работе получен аналог теоремы Прочези-Размыслова для алгебры полуинвариантов представлений прои... more В работе получен аналог теоремы Прочези-Размыслова для алгебры полуинвариантов представлений произвольного колчана с вектором размерности (2, 2,. .. , 2). Библиография: 7 названий.
The Media and the Trauma Service Part I — Friend or Foe?
Journal of Trauma Nursing, 2001
International Journal of Trauma Nursing, 1995
Resuscitation Endpoints in Trauma
AACN Clinical Issues: Advanced Practice in Acute and Critical Care, 1999
Shock is defined as inadequate perfusion of tissues with oxygen and nutrients to support cellular... more Shock is defined as inadequate perfusion of tissues with oxygen and nutrients to support cellular function. Resuscitation from shock can therefore only be complete when all evidence of oxygen debt, anaerobic metabolism, and tissue acidosis has been eliminated. All of the diagnostic and therapeutic maneuvers performed by trauma nurses today, whether basic or advanced, whether performed in the field, emergency department, operating room, or intensive care unit, can be traced directly or indirectly to this goal. Resuscitation in trauma is now viewed across the continuum of physiologic insult and response that occurs after hemorrhage or tissue injury. Resuscitation endpoints (i.e., variables or parameters) must be viewed across the continuum of shock because the effectiveness of endpoints varies with the phase of resuscitation. The optimal resuscitation endpoint in trauma is controversial, remains elusive, and is one of the most published topics in modern medical literature. This article presents the current understanding of the resuscitation endpoints in trauma.
AACN Clinical Issues: Advanced Practice in Acute and Critical Care, 1999