Use of the neonatal EOS calculator may dramatically reduce the number of infants who require antibiotics at birth, leading to reduced need for laboratory monitoring and improved antimicrobial stewardship. More safety data is needed.

Introduction: Investigators from Kaiser Permanente developed a risk-assessment calculator as a tool for evaluation of early-onset sepsis (EOS) to narrow antibiotic use for the treatment of EOS. The integration of the EOS risk calculator into an electronic health record will minimize manual calculations and data entry and improve compliance and accuracy through automation. Methods: We performed a retrospective chart review for neonates ≥34 weeks and 0 days gestational age. We collected data pre-integration and post-integration of the EOS risk calculator. The primary outcome measure is the accuracy of user input into the calculator. Secondary outcomes include compliance with using the EOS risk calculator, impact on clinical recommendation when incorrectly calculated, assessment of antibiotic utilization rate (AUR), and comparison of EOS risk calculator recommendations with Centers for Disease Control and American Academy of Pediatrics recommendations. Results: Miscalculations occurred in 52% of instances pre-integration and 19% of instances post-integration; P < 0.001. Compliance was 93% pre-integration and 98% post-integration; P = 0.138. Clinical recommendations were changed for 21% (13/62) of miscalculations pre-integration and 4% (1/23) of miscalculations post-integration; P = 0.099. The AUR for combined NICU and nursery patients was 47 pre-integration and 47 post-integration; P > 0.999. Six cases of culture-positive sepsis were identified, and all recommendations generated by the EOS risk calculator were in alignment with current Centers for Disease Control/American Academy of Pediatrics treatment guidelines. Conclusions: Integration of the EOS risk calculator into the electronic health record significantly increased calculator accuracy, although it did not show statistically significant differences with regards to compliance, clinical recommendations, or AUR.

To study the trend of asthma exacerbation readmission rates over the last several years. METHODS: We evaluated the readmission rates for asthma over the last several years to observe the trend of asthma readmissions to the hospital within 30 days of discharge. We present the trends during the time period 2009 to 2013 using data from Healthcare Cost and Utilization Project Nationwide Readmissions Database. A cohort of 1,220,047 asthma hospitalizations of patients older than 18 years was identified in this time period and the 30-day readmission rates were analyzed by comparing rates in consecutive years and the beginning and end of the time period listed using Z-test for proportions.

PURPOSE: To identify and define the population of patients diagnosed with COPD, Emphysema and Chronic Bronchitis in a primary care practice. METHODS: We performed a retrospective chart review of patients with a new diagnosis of COPD, Emphysema or Chronic Bronchitis (ICD-9 491.2, 491.9, 492.8) seen in the primary care practice of Tufts Medical Center from 2001 through 2016. Diagnostic accuracy was determined using clinic notes, pulmonary function testing and chest imaging. Patients were divided into two groups using Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria: COPD and Indeterminate. The COPD group included patients with one or more of the following: an obstructive ventilatory defect on spirometry, radiographic evidence of emphysema, a clinical history consistent with chronic bronchitis. Patients lacking these criteria were Indeterminate. Clinical and diagnostic covariates including age, gender, BMI, comorbidities, smoking history, frequency of pulmonary function testing (PFTs) and pulmonary consultation were compared between the two groups. Data were summarized using means (standard deviations) and n (%) where appropriate. Chi-square and T-test were used for between group comparisons. RESULTS: During the 15 year period, 290 patients seen in the Tufts primary care practice were given a new diagnosis of COPD, Emphysema or Chronic bronchitis. Eighty percent of these patients were correctly diagnosed with COPD (n¼53), Emphysema (n¼152) or Chronic Bronchitis (n¼27). Patients that were Indeterminate (n¼58) had a higher BMI (31.3 AE 7.6 vs. 27.4 AE 6.6, p < 0.0001) and a higher prevalence of a prior Asthma diagnosis (25.9% vs. 8.2%, p < 0.0001). There was no significant difference in age, sex, or primary language between the groups. Pulmonary function testing (45% vs. 74%, p < 0.0001) and pulmonary consultation (41% vs. 65%, p < 0.0009) were significantly less likely to have been performed in the Indeterminate group. CONCLUSIONS: In this academic primary care practice 20% of patients given a new diagnosis of COPD, Emphysema or Chronic Bronchitis were mis-or underdiagnosed as they had not undergone sufficient testing to support the diagnosis. These patients with an Indeterminate diagnosis were more overweight or to have a prior diagnosis of asthma than the COPD patients, implying that alternative diagnoses for their symptoms should be considered. Use of PFTs or pulmonary consultation was interestingly less frequent in this Indeterminate group. These data demonstrate that a significant proportion of patients given the diagnosis of COPD in primary care practices may be mis-identified. This has important implications for provider education, patient outcomes and health services utilization. CLINICAL IMPLICATIONS: Establishing a correct diagnosis of COPD has important implications for individual patients as appropriate clinical interventions can be associated with improved symptoms, functional capacity and quality and duration of life. Proper identification of COPD is also becoming more critical to ...

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