Publications by authors named "David J Shulkin"

19 Publications

  • Page 1 of 1

Why the VA Needs More Competition.

N Engl J Med 2018 Jun;378(25):2356-2357

From the Department of Surgery, University of Michigan, Ann Arbor, and the Department of Veterans Affairs, Washington, DC (K.H.S.); and the Ninth Secretary U.S. Department of Veterans Affairs (D.J.S.).

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http://dx.doi.org/10.1056/NEJMp1803642DOI Listing
June 2018

Addressing the Opioid Epidemic in the United States: Lessons From the Department of Veterans Affairs.

JAMA Intern Med 2017 05;177(5):611-612

Office of the Under Secretary for Health, US Department of Veterans Affairs, Washington, DC.

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http://dx.doi.org/10.1001/jamainternmed.2017.0147DOI Listing
May 2017

A Framework for Disseminating Clinical Best Practices in the VA Health System.

JAMA 2017 01;317(3):255-256

US Department of Veterans Affairs, Washington, DC.

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http://dx.doi.org/10.1001/jama.2016.18764DOI Listing
January 2017

Transforming Evidence Generation to Support Health and Health Care Decisions.

N Engl J Med 2016 Dec;375(24):2395-2400

From the Office of the Commissioner (R.M.C., R.E.S.) and the Centers for Drug Evaluation and Research (M.A.R., J. Woodcock), Biologics Evaluation and Research (P.W.M.), and Devices and Radiological Health (J.S.), Food and Drug Administration, Silver Spring, the Office of the Director (A.B.B.) and the Center for Evidence and Practice Improvement (C.D.), Agency for Healthcare Research and Quality, Rockville, the National Center for Complementary and Integrative Health (J.P.B.), the Office of the Director (F.S.C.), and the National Center for Advancing Translational Sciences (P.K.) and Office of Extramural Research Activities (M.L.), National Institutes of Health, Bethesda, and the Centers for Medicare and Medicaid Services, Baltimore (P.H.C., A.M.S.) - all in Maryland; formerly the U.S. Army Office of the Surgeon General Pharmacovigilance Center, Falls Church, VA (T.S.C.); the Office of the Under Secretary for Health, Department of Veterans Affairs (D.J.S.), the Office of Health Policy, Office of the Assistant Secretary for Planning and Evaluation, (N.D.L., S.R.S.), the Office of the Assistant Secretary for Health (K.B.D.), and the Office of the National Coordinator for Health Information Technology (B.V.W., P.J.W.), Department of Health and Human Services, the National Academy of Medicine (V.J.D., J.M.M.), and the Patient-Centered Outcomes Research Institute (R.L.F., J.V.S.), Washington, DC; the Center for Medication Safety, Department of Veterans Affairs, Hines, IL (F.E.C.); the Department of Health Care Policy, Harvard University (R.G.F.), the Million Veteran Program, Veterans Affairs Boston Healthcare System-Division of Aging, Brigham and Women's Hospital and Harvard Medical School (J.M.G.), and the Department of Surgery, Boston University School of Medicine (J. Woodson), Boston; and the Office of Public Health Scientific Services, Centers for Disease Control and Prevention, Atlanta (C.R.).

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http://dx.doi.org/10.1056/NEJMsb1610128DOI Listing
December 2016

Why VA Health Care Is Different.

Authors:
David J Shulkin

Fed Pract 2016 May;33(5):9-11

is under secretary for health at the U.S. Department of Veterans Affairs in Washington, DC.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6369034PMC
May 2016

VA needs skilled healthcare leaders to speed system reforms.

Authors:
David J Shulkin

Mod Healthc 2016 Jan;46(1):25

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January 2016

Beyond the VA Crisis--Becoming a High-Performance Network.

Authors:
David J Shulkin

N Engl J Med 2016 Mar;374(11):1003-5

From the Department of Veterans Affairs, Washington, DC.

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http://dx.doi.org/10.1056/NEJMp1600307DOI Listing
March 2016

The role of allergists in accountable care organizations.

Authors:
David J Shulkin

Ann Allergy Asthma Immunol 2013 Dec 15;111(6):437-8. Epub 2013 Jul 15.

Morristown Medical Center and Mt Sinai School of Medicine, Morristown, New Jersey. Electronic address:

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http://dx.doi.org/10.1016/j.anai.2013.06.019DOI Listing
December 2013

A story of three generations in health care.

Virtual Mentor 2013 Jul 1;15(7):611-4. Epub 2013 Jul 1.

Robert F. Wagner Graduate School of Public Service of New York University, USA.

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http://dx.doi.org/10.1001/virtualmentor.2013.15.7.mnar1-1307DOI Listing
July 2013

Building an accountable care organization for all the wrong reasons.

Authors:
David J Shulkin

Mayo Clin Proc 2012 Aug;87(8):721-2

Morristown Medical Center and Atlantic Health System Accountable Care Organization, Morristown, NJ 07962, USA.

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http://dx.doi.org/10.1016/j.mayocp.2012.05.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3497997PMC
August 2012

PRIDE in accountable care.

Authors:
David J Shulkin

Popul Health Manag 2011 Oct;14(5):211-4

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http://dx.doi.org/10.1089/pop.2011.0038DOI Listing
October 2011

Impact of systems of care and blood pressure management on stroke outcomes.

Popul Health Manag 2011 Dec 20;14(6):267-75. Epub 2011 Apr 20.

Morristown Memorial Hospital, New Jersey, USA.

Stroke is the third leading cause of death in the United States and the leading cause of disability. Stroke patients' outcomes are strongly determined by how long they remain untreated ("time is brain"). The Joint Commission's adoption of stroke performance improvement measures combined with the Centers for Medicare and Medicaid's more recent adoption in October 2009 make a systems approach to improving stroke outcomes a higher priority. As hospitals establish local and regional stroke care systems to meet these performance measures, treatment of emergent high blood pressure (BP) is a major consideration to improve rapid triage and management of acute stroke patients. Intravenous thrombolysis with tissue plasminogen activator (tPA) is a critical quality of care component for acute ischemic stroke (AIS) treatment, but its administration is contingent on BP management. For patients with AIS who are potentially eligible for tPA and patients with intracerebral hemorrhage, timely, controlled BP may improve patient outcomes. Appropriate BP management, however, is still controversial given the heterogeneity of stroke subtypes, the varying attributes of candidate antihypertensive agents, and both local and central hemodynamics. Additionally, organizational delivery system factors may be suboptimal at some hospitals. Under current hospital stroke performance measures, payment mechanisms, and emergency department throughput measures, the impact of BP management may become transparent to patients and payers, and have important consequences for hospital-derived stroke outcomes.
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http://dx.doi.org/10.1089/pop.2010.0068DOI Listing
December 2011

Quality and financial outcomes from gainsharing for inpatient admissions: a three-year experience.

J Hosp Med 2010 Nov-Dec;5(9):501-7. Epub 2010 Aug 17.

Beth Israel Medical Center, Albert Einstein College of Medicine, New York, New York 10003, USA.

Background: Gainsharing is a way to provide incentives to physicians to decrease hospital costs without compromising quality.

Methods: A pay-for-performance program was instituted over a three-year period from July 2006 to June 2009. Baseline length of stay (LOS) and case costs were developed during the year prior to the inception of the program. Best practice norms (BPNs) were established at the top 25th percentile of physicians for each all patient refined (APR)-diagnosis related group (DRG). Hospital costs were analyzed in several areas, including operating room charge (OR), supplies and implants, nursing and per-diem room costs. Payments were based upon case level performance compared to BPN's and the physician's historic performance. Eligible cases included commercial insurance only for the first 2 years but Medicare cases were included after October 2008 resulting from a Centers for Medicare and Medicaid Services (CMS)-approved demonstration project. Payments to physicians required meeting quality thresholds, including chart completion, and compliance with core measures.

Results: A total of 184 (54%) physicians enrolled into the program. There was a $25.1 million reduction in hospital costs during the 3 years ($16 million from participating and $9.1 million from non-participating physicians, P < 0.01). Most cost reductions were attributed to reduced LOS and reductions in medical supply costs. Total physician payouts were over $2 million (average $1,866 per quarter). Delinquent medical records decreased from an average of 43% in the second quarter 2006 to 30% (P < 0.0001) in the second quarter 2009. Quality measures improved during the study period but not by a statistical significance.

Conclusions: Gainsharing provided an incentive for physicians to reduce hospital costs while maintaining hospital quality.
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http://dx.doi.org/10.1002/jhm.788DOI Listing
April 2011

Assessing hospital safety on nights and weekends: the SWAN tool.

Authors:
David J Shulkin

J Patient Saf 2009 Jun;5(2):75-8

Beth Israel Medical Center, Albert Einstein College of Medicine, New York, NY 10003, USA.

Patient safety in hospitals during nights and weekends has increasingly been recognized as a significant problem. The safety on weekends and nights tool was developed to assist health care leadership assess capabilities for care during off-hours and identify opportunities for improving outcomes. Eight categories of hospital-based services are detailed in the safety on weekends and nights tool that can assist clinical and administrative leaders in understanding services and processes of care that may eliminate differences in outcomes between day and night care. The implications of enhanced resources for off-hours care and future areas of study in this area of patient safety are discussed.
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http://dx.doi.org/10.1097/PTS.0b013e3181a5db10DOI Listing
June 2009

Like night and day--shedding light on off-hours care.

Authors:
David J Shulkin

N Engl J Med 2008 May;358(20):2091-3

Beth Israel Medical Center and Albert Einstein College of Medicine, New York, USA.

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http://dx.doi.org/10.1056/NEJMp0707144DOI Listing
May 2008

Establishing a rapid response team (RRT) in an academic hospital: one year's experience.

J Hosp Med 2006 Sep;1(5):296-305

Department of Internal Medicine, Section of Hospital Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania, USA.

Background: Rapid response teams and medical emergency teams have been utilized to rapidly manage seriously ill patients at risk of cardiopulmonary arrest and other high-risk conditions but have not been extensively described in the American medical literature.

Objectives: To describe a full year's experience of implementing a rapid response team (RRT) in an academic medical center.

Design: Retrospective analysis of our hospital's RRT database and description of the implementation process from July 2004 to July 2005.

Setting: Urban, academic medical center.

Results: The RRT system was activated for 307 potentially unstable patients. The most common reasons for an RRT activation were cardiac, respiratory, and neurological conditions. At least 37% of RRT calls were for off-unit inpatients and to outpatient/common areas frequented by outpatients and visitors, whereas at least 42% occurred in inpatient units. Most RRT calls, 82.9%, occurred during daytime hours. In the opinion of RRT leaders 98% of the evaluated calls were appropriate and 85% of the RRT responses resulted in the prevention of further clinical deterioration.

Conclusions: An RRT was introduced into an academic medical center, and the results suggested it is capable of preventing clinical deterioration in unstable patients and may have the potential to decrease the frequency of cardiac arrests. The RRT also may fill a gap in patient safety by enabling rapid triage and expedited treatment of off-unit inpatients, outpatients, and visitors. The keys to the early success of our implementation of an RRT were multidisciplinary input and improvements made in real time.
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http://dx.doi.org/10.1002/jhm.114DOI Listing
September 2006

Getting doctors to report medical errors: project DISCLOSE.

Jt Comm J Qual Patient Saf 2006 Jul;32(7):382-92

Department of Internal Medicine, Temple University Hospital, Temple University School of Medicine, Philadelphia, USA.

Background: Despite the number of patient safety incidents that occur in hospitals, physicians currently may not have the ideal incident reporting tools for easy disclosure. A study was undertaken to assess the effectiveness of a simplified paper incident reporting process for internal medicine physicians on uncovering patient safety incidents.

Design: Thirty-nine internal medicine attending physicians were instructed to incorporate the use of a simplified paper incident reporting tool (DISCLOSE) into daily patient rounds during a three-month period. All physicians were surveyed at the conclusion of the three months.

Results: Compared with physician reporting via the hospital's traditional incident reports from the same time period, a higher number (98 incidents versus 37; a 2.6-fold increase) of incidents were uncovered using the DISCLOSE reporting tool in a larger number of error categories (58 versus 14, a 4.1-fold increase). When reviewed and classified with a five-point harm scale, 41% of events were judged to have reached patients but not caused harm, 33% to have resulted in temporary harm, and 9% of reports, though not considered events, were to indicate a "risky situation." Surveyed physicians were more satisfied with the process of submitting incident reports using the new DISCLOSE tool.

Discussion: A simplified incident reporting process at the point of care generated a larger number and breadth of physician disclosed error categories, and increased physician satisfaction with the process.
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http://dx.doi.org/10.1016/s1553-7250(06)32050-8DOI Listing
July 2006

Healthcare Crisis.

Postgrad Med 1990 Nov;88(1):19-22

c Tucson.

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http://dx.doi.org/10.1080/00325481.1990.11716353DOI Listing
November 1990
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