Determining barriers to submitting antimicrobial-resistant isolates among hospitals in Texas Public Health Region 8.

Background: The Antimicrobial Resistance Laboratory Network (AR Lab Network) was developed by the CDC to detect emerging antimicrobial-resistant (AR) threats and prevent outbreaks. However, low submission rates of AR isolates limit the potential of the AR Lab Network to address antimicrobial resistance (AMR). Aim: The aim of this study was to investigate barriers to submission of AR isolates in acute care hospitals (ACHs) and critical access hospitals (CAHs) within Texas Public Health Region 8 (PHR8) counties. Methods: A survey was designed and emailed to laboratory professionals to identify barriers to AR isolate submission. Responses were analyzed using 2-sided Fisher's exact tests to identify associations between responses and respondent characteristics. Results: Of the 33 hospitals within PHR8 invited to participate in the survey, responses were received from 21, a response rate of 63.6%. Lack of awareness of the AR Lab Network was the most frequently cited barrier to submission (65.4% of respondents). Other reported barriers to submission included lack of laboratory staff time (57.7%), lack of training with the submission process (34.6%), lack of personnel certified to ship infectious substances (23.1%), and lack of laboratory/shipping supplies (23.1%). Discussion: Regardless of the respondent's role, time in that role, or type of hospital in which they worked, the most common barrier to isolate submission was lack of awareness of the AR Lab Network. In the future, we will address the identified barriers by implementing educational outreach programs about AMR and the AR Lab Network for hospitals and other healthcare facilities within PHR8.

Telehealth Uptake Among Hispanic People During COVID-19: Retrospective Observational Study.

Background: The Hispanic community represents a sizeable community that experiences inequities in the US health care system. As the system has moved toward digital health platforms, evaluating the potential impact on Hispanic communities is critical. Objective: The study aimed to investigate demographic, socioeconomic, and behavioral factors contributing to low telehealth use in Hispanic communities. Methods: We used a retrospective observation study design to examine the study objectives. The COVID-19 Research Database Consortium provided the Analytics IQ PeopleCore consumer data and Office Alley claims data. The study period was from March 2020 to April 2021. Multiple logistic regression was used to determine the odds of using telehealth services. Results: We examined 3,478,287 unique Hispanic patients, 16.6% (577,396) of whom used telehealth. Results suggested that patients aged between 18 and 44 years were more likely to use telehealth (odds ratio [OR] 1.07, 95% CI 1.05-1.1; P<.001) than patients aged older than 65 years. Across all age groups, patients with high incomes were at least 20% more likely to use telehealth than patients with lower incomes (P<.001); patients who had a primary care physician (P=.01), exhibited high medical usage (P<.001), or were interested in exercise (P=.03) were more likely to use telehealth; patients who had unhealthy behaviors such as smoking and alcohol consumption were less likely to use telehealth (P<.001). Male patients were less likely than female patients to use telehealth among patients aged 65 years and older (OR 0.94, 95% CI 0.93-0.95; P<.001), while male patients aged between 18 and 44 years were more likely to use telehealth (OR 1.05, 95% CI 1.03-1.07; P<.001). Among patients younger than 65 years, full-time employment was positively associated with telehealth use (P<.001). Patients aged between 18 and 44 years with high school or less education were 2% less likely to use telehealth (OR 0.98, 95% CI 0.97-0.99; P=.005). Results also revealed a positive association with using WebMD (WebMD LLC) among patients aged older than 44 years (P<.001), while there was a negative association with electronic prescriptions among those who were aged between 18 and 44 years (P=.009) and aged between 45 and 64 years (P=.004). Conclusions: This study demonstrates that telehealth use among Hispanic communities is dependent upon factors such as age, gender, education, socioeconomic status, current health care engagement, and health behaviors. To address these challenges, we advocate for interdisciplinary approaches that involve medical professionals, insurance providers, and community-based services actively engaging with Hispanic communities and promoting telehealth use. We propose the following recommendations: enhance access to health insurance, improve access to primary care providers, and allocate fiscal and educational resources to support telehealth use. As telehealth increasingly shapes health care delivery, it is vital for professionals to facilitate the use of all available avenues for accessing care.

Individual- and Community-Level Predictors of Hospital-at-Home Outcomes.

Advanced Care at Home is a Mayo Clinic hospital-at-home (HaH) program that provides hospital-level care for patients. The study examines patient- and community-level factors that influence health outcomes. The authors performed a retrospective study using patient data from July 2020 to December 2022. The study includes 3 Mayo Clinic centers and community-level data from the Agency for Healthcare Research and Quality. The authors conducted binary logistic regression analyses to examine the relationship among the independent variables (patient- and community-level characteristics) and dependent variables (30-day readmission, mortality, and escalation of care back to the brick-and-mortar hospital). The study examined 1433 patients; 53% were men, 90.58% were White, and 68.2% were married. The mortality rate was 2.8%, 30-day readmission was 11.4%, and escalation back to brick-and-mortar hospitals was 8.7%. At the patient level, older age and male gender were significant predictors of 30-day mortality (P-value <0.05), older age was a significant predictor of 30-day readmission (P-value <0.05), and severity of illness was a significant predictor for readmission, mortality, and escalation back to the brick-and-mortar hospital (P-value <0.01). Patients with COVID-19 were less likely to experience readmission, mortality, or escalations (P-value <0.05). At the community level, the Gini Index and internet access were significant predictors of mortality (P-value <0.05). Race and ethnicity did not significantly predict adverse outcomes (P-value >0.05). This study showed promise in equitable treatment of diverse patient populations. The authors discuss and address health equity issues to approximate the vision of inclusive HaH delivery.

Telehealth for Chronic Disease Management Among Vulnerable Populations.

Chronic diseases disproportionately affect patients in low-income minority groups who traditionally use in-person healthcare services. COVID-19 disrupted their routines and limited options for people to receive care; this could exacerbate health inequities. The study examined telehealth chronic disease management among low-income minority groups. We used Florida Medicaid claims data from March to December 2020 and the American Consumer Survey to examine the study objectives. Data were analyzed using Linear and Logistic Regression. We retrieved claim records of 52,904 unique patients; 31,999 were female and 49% of the sample had at least one telehealth visit. Medicaid patients were 8% less likely to use telehealth and 21% more likely to have audio visits when compared to Medicare patients. The analyses suggest that Non-Hispanic Black patients and individuals with a lack of education experience significant health inequities. People with chronic obstructive pulmonary disease (5%) and heart failure (14%) were less likely to use telehealth than patients with diabetes. Telehealth will continue to be a health delivery option; thus we recommend that strategies are enacted to educate, and resources are provided to promote equity among Non-Hispanic Black patients. Without priority attention to people among low-income minority populations, health inequities will continue to plague this community.

The Greenhouse Model of Nursing Home Care: A Scoping Review.

The study aimed to comprehensively review and assess evidence-based outcomes of the Greenhouse model. We systematically reviewed, assessed, and reported on relevant literature using the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines for the scoping review. We identified qualitative or quantitative studies that met our inclusion criteria from PubMed, Medline, CINAHL, and EBSCOhost. The review yielded 41,515 articles published between January 2015 and December 2022; eleven articles met the inclusion criteria and were included in the analysis. The emerging themes were organizational culture, clinical outcomes, and business effects. The Greenhouse model offers a favorable organizational culture with opportunities to enhance clinical and business outcomes. The scoping review was registered in Prospero: CRD42023389048.

Digital communication use before and during COVID among residential older adults.

Many older adults living in residential care facilities do not use digital communication technologies. The study was a retrospective pre-post study testing the impact of a digital communication program instituted at two Continuing Care Retirement Communities. We distributed a survey between March 2021 and April 2021 to examine study objectives. Data analyses were performed using JMP Pro 16.1 and SAS 9.4. One hundred twenty-six people started the survey, with 120 completing the survey and included in the analysis. The mean age was 84 years, 67.5% were female, 95.8% were White, 64.2% were widowed, and 35.3% reported at least a bachelor's degree level of education. There were minimal increases in digital communication behavior and communication frequency. Older adults most notably reported privacy concerns and have mixed responses about the utility of digital communication for social engagement. We apply the results to the Stage of Change model and provide recommendations to promote behavior change.

Telehealth Usage Among Low-Income Racial and Ethnic Minority Populations During the COVID-19 Pandemic: Retrospective Observational Study.

BACKGROUND: Despite considerable efforts to encourage telehealth use during the COVID-19 pandemic, we witnessed a potential widening of health inequities that may continue to plague the US health care system unless we mitigate modifiable risk factors. OBJECTIVE: This study aimed to examine the hypothesis that there are systemic differences in telehealth usage among people who live at or below 200% of the federal poverty level. Factors that we consider are age, gender, race, ethnicity, education, employment status, household size, and income. METHODS: A retrospective observational study was performed using the COVID-19 Research Database to analyze factors contributing to telehealth inequities. The study period ranged from March 2020 to April 2021. The Office Ally database provided US claims data from 100 million unique patients and 3.4 billion claims. The Analytics IQ PeopleCore Consumer database is nationally representative of 242.5 million US adults aged 19 years and older. We analyzed medical claims to investigate the influence of demographic and socioeconomic factors on telehealth usage among the low-income racial and ethnic minority populations. We conducted a multiple logistic regression analysis to determine the odds of patients in diverse groups using telehealth during the study period. RESULTS: Among 2,850,831 unique patients, nearly 60% of them were female, 75% of them had a high school education or less, 49% of them were unemployed, and 62% of them identified as non-Hispanic White. Our results suggest that 9.84% of the patients had ≥1 telehealth claims during the study period. Asian (odds ratio [OR] 1.569, 95% CI 1.528-1.611, P<.001) and Hispanic (OR 1.612, 95% CI 1.596-1.628, P<.001) patients were more likely to use telehealth than non-Hispanic White and -Black patients. Patients who were employed full-time were 15% (OR 1.148, 95% CI 1.133-1.164, P<.001) more likely to use telehealth than unemployed patients. Patients who identified as male were 12% (OR 0.875, 95% CI 0.867-0.883, P<.001) less likely to use telehealth than those who identified as female. Patients with high school education or less were 5% (OR 0.953, 95% CI 0.944-0.962, P<.001) less likely to use telehealth than those with a bachelor's degree or higher. Patients in the 18-44-year age group were 32% (OR 1.324, 95% CI 1.304-1.345, P<.001) more likely to use telehealth than those in the ≥65-year age group. CONCLUSIONS: Factors that impact telehealth usage include age, gender, race, education, employment status, and income. While low-income racial and ethnic minority communities are at greater risk for health inequities among this group, Hispanic communities are more likely to use telehealth, and non-Hispanic Black patients continue to demonstrate telehealth inequity. Gender, age, and household income contribute to health inequities across gradients of poverty. Strategies to improve health use should consider characteristics of subgroups, as people do not experience poverty equally.

Unique trans-kingdom microbiome structural and functional signatures predict cognitive decline in older adults.

The prevalence of age-related cognitive disorders/dementia is increasing, and effective prevention and treatment interventions are lacking due to an incomplete understanding of aging neuropathophysiology. Emerging evidence suggests that abnormalities in gut microbiome are linked with age-related cognitive decline and getting acceptance as one of the pillars of the Geroscience hypothesis. However, the potential clinical importance of gut microbiome abnormalities in predicting the risk of cognitive decline in older adults is unclear. Till now the majority of clinical studies were done using 16S rRNA sequencing which only accounts for analyzing bacterial abundance, while lacking an understanding of other crucial microbial kingdoms, such as viruses, fungi, archaea, and the functional profiling of the microbiome community. Utilizing data and samples of older adults with mild cognitive impairment (MCI; n = 23) and cognitively healthy controls (n = 25). Our whole-genome metagenomic sequencing revealed that the gut of older adults with MCI harbors a less diverse microbiome with a specific increase in total viruses and a decrease in bacterial abundance compared with controls. The virome, bacteriome, and microbial metabolic signatures were significantly distinct in subjects with MCI versus controls. Selected bacteriome signatures show high predictive potential of cognitive dysfunction than virome signatures while combining virome and metabolic signatures with bacteriome boosts the prediction power. Altogether, the results from our pilot study indicate that trans-kingdom microbiome signatures are significantly distinct in MCI gut compared with controls and may have utility for predicting the risk of developing cognitive decline and dementia- debilitating public health problems in older adults.

Use of Telehealth Among Racial and Ethnic Minority Groups in the United States Before and During the COVID-19 Pandemic.

OBJECTIVES: The COVID-19 pandemic has propelled the use of technology for health care services delivery. Because of inequities in health care and technology access, we investigated the use of telehealth services among racial and ethnic minority groups before and during the COVID-19 pandemic. METHODS: For this retrospective study, we examined the electronic health records of privately insured patients in the Healthjump database, provided by the COVID-19 Research Database Consortium. We examined 17.98 million unique visit records of 2.93 million patients from March through December 2019 and 22.17 million records of 3.55 million patients from March through December 2020. We conducted a descriptive analysis and used multiple logistic regression to examine differences in the use of telehealth services among 3 racial and ethnic groups: non-Hispanic White, non-Hispanic Black, and Hispanic people. RESULTS: Telehealth visits before and during COVID-19 accounted for 8.3% and 10.9% of total visits, respectively, with a peak of 15.5% in April 2020. Pre-COVID-19, Hispanic patients had a significantly lower monthly utilization rate (5.3%) than non-Hispanic White patients (8.4%, P < .001) and non-Hispanic Black patients (10.4%, P = .001). During the pandemic study period, Hispanic patients were 41% less likely than non-Hispanic White patients to have a telehealth visit, controlling for age and sex. CONCLUSIONS: The likelihood of using telehealth was lower among Hispanic patients than among non-Hispanic White and non-Hispanic Black patients during the pandemic. Culturally sensitive measures are needed to support telehealth use among the Hispanic population.

Assessing COVID-19 testing strategies in K-12 schools in underserved populations: study protocol for a cluster-randomized trial.

BACKGROUND: Since March 2020, COVID-19 has disproportionately impacted communities of color within the United States. As schools have shifted from virtual to in-person learning, continual guidance is necessary to understand appropriate interventions to prevent SARS-CoV-2 transmission. Weekly testing of students and staff for SARS-CoV-2 within K-12 school setting could provide an additional barrier to school-based transmission, especially within schools unable to implement additional mitigation strategies and/or are in areas of high transmission. This study seeks to understand the role that weekly SARS-CoV-2 testing could play in K-12 schools. In addition, through qualitative interviews and listening sessions, this research hopes to understand community concerns and barriers regarding COVID-19 testing, COVID-19 vaccine, and return to school during the COVID-19 pandemic. METHODS/DESIGN: Sixteen middle and high schools from five school districts have been randomized into one of the following categories: (1) Weekly screening + symptomatic testing or (2) Symptomatic testing only. The primary outcome for this study will be the average of the secondary attack rate of school-based transmission per case. School-based transmission will also be assessed through qualitative contact interviews with positive contacts identified by the school contact tracers. Lastly, new total numbers of weekly cases and contacts within a school-based quarantine will provide guidance on transmission rates. Qualitative focus groups and interviews have been conducted to provide additional understanding to the acceptance of the intervention and barriers faced by the community regarding SARS-CoV-2 testing and vaccination. DISCUSSION: This study will provide greater understanding of the benefit that weekly screening testing can provide in reducing SARS-CoV-2 transmission within K-12 schools. Close collaboration with community partners and school districts will be necessary for the success of this and similar studies. TRIAL REGISTRATION: NCT04875520 . Registered May 6, 2021.

Which Factors Predict 30-Day Readmission After Total Hip and Knee Replacement Surgery?

Background The Centers for Medicare and Medicaid Services enacted the Hospital Readmissions Reduction Program to impose penalties for diagnoses with high readmission rates. Despite several elective orthopedic procedures being included in this program, readmission rates have not declined, and associated costs have reached critical levels for total knee and total hip arthroplasty. Readmissions drastically impact patient outcomes. There are many known contributors to patient readmission rates, including infection, pain, and hematomas. However, evidence is inconclusive regarding other aspects, such as demographics, insurance, and discharge disposition. The purpose of this manuscript is to 1) measure hospital readmission rates for total knee and total hip arthroplasty, 2) evaluate the causes of readmissions, and 3) provide a predictive profile of risk factors associated with hospital readmissions. Methods Patients who underwent total knee or total hip arthroplasty were identified through a retrospective database review. An electronic chart review extracted data concerning patient demographics, comorbidities, surgical information, 30-day outcomes, and reasons for 30-day readmissions. Continuous and categorical variables were assessed with the Wilcoxon rank-sum test and the Chi-square test, respectively. Results A total of 6,065 patients were included, with 269 (4.4%) having at least one surgery-related 30-day readmission. No differences in readmission were noted with age, sex, or ethnicity; however, differences were found in weight and body mass index. Statistically significant comorbidities were heart failure, chronic obstructive pulmonary disease, dialysis, and alcohol use or abuse. Conclusion Our research indicated that surgery type, length of stay, and heart failure most significantly impacted 30-day readmission rates. By assessing readmission rates, we can take steps to optimize care for non-elective surgeries that will improve patient outcomes and cost-effectiveness.

Demographics and surgery-related complications lead to 30-day readmission rates among knee arthroscopic procedures.

PURPOSE: The study objectives were (1) to evaluate risk factors related to 30-day hospital readmissions after arthroscopic knee surgeries and (2) to determine the complications that may arise from surgery. METHODS: The American College of Surgeons National Surgical Quality Improvement Program database data from 2012 to 2017 were researched. Patients were identified using Current Procedural Terminology codes for knee arthroscopic procedures. Ordinal logistic fit regression and decision tree analysis were used to examine study objectives. RESULTS: There were 83,083 knee arthroscopic procedures between 2012 and 2017 obtained from the National Surgical Quality Improvement Program database. The overall readmission rate was 0.87%. The complication rates were highest for synovectomy and cartilage procedures, 1.6% and 1.3% respectively. A majority of readmissions were related to the procedure (71.1%) with wound complications being the primary reason (28.2%) followed by pulmonary embolism and deep vein thrombosis, 12.7% and 10.6%, respectively. Gender and body mass index were not significant factors and age over 65 years was an independent risk factor. Wound infection, deep vein thrombosis, and pulmonary embolism were the most prevalent complications. CONCLUSION: Healthcare professionals have a unique opportunity to modify treatment plans based on patient risk factors. For patients who are at higher risk of inferior surgical outcomes, clinicians should carefully weigh risk factors when considering surgical and non-surgical approaches. LEVEL OF EVIDENCE: III.

Telehealth and hospital performance: Does it matter?

INTRODUCTION: Previous studies indicated that telehealth services may improve hospital performance. However, the extent to which these telehealth provisions would improve hospital total performance score under the hospital value-based purchasing (HVBP) programme is not clear. The aim of this study is to examine the association between telehealth provision and hospital performance. METHODS: We performed a retrospective analysis of the association between the provision of telehealth services and 2699 hospital's total performance score (TPS) on the 2018 HVBP programme and its four domains. Multivariate regression models were used to analyse TPS and hospital performance on each domain. Telehealth services offered by a hospital was categorically operationalized as hospitals with no telehealth services, with one to two telehealth services, and with three or more telehealth services. RESULTS: Hospitals with one to two telehealth services have TPS (ß coefficient = 1.50; 95% confident intervals (CI): 0.28, 2.73; p < 0.05) and hospitals with three or more telehealth services have higher efficiency and cost reduction (ß = 1.10; 95% CI: 0.32, 1.87; p < 0.01) domain scores. However, the impact of telehealth on clinical care, person and community engagement, and safety domain scores was not significant. DISCUSSION: The expansion of hospital telehealth service provision can improve not only the efficiency of care, but also the total performance of the hospital. Since total performance is directly associated with hospital payments from the government, these findings have significant practice and policy implications. In addition, the effect of telehealth on other quality measures such as clinical care and safety needs further investigation.

Corticosteroid Administration and Impaired Glycemic Control in Mechanically Ventilated COVID-19 Patients.

OBJECTIVE: Recent clinical trials confirmed the corticosteroid dexamethasone as an effective treatment for patients with COVID-19 requiring mechanical ventilation. However, limited attention has been given to potential adverse effects of corticosteroid therapy. The objective of this study was to determine the association between corticosteroid administration and impaired glycemic control among COVID-19 patients requiring mechanical ventilation and/or veno-venous extracorporeal membrane oxygenation. DESIGN: Multicenter retrospective cohort study between March 9 and May 17, 2020. The primary outcome was days spent with at least 1 episode of blood glucose either >180 mg/dL or <80 mg/dL within the first 28 days of admission. SETTING: Twelve hospitals in a United States health system. PATIENTS: Adults diagnosed with COVID-19 requiring invasive mechanical ventilation and/or veno-venous extracorporeal membrane oxygenation. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We included 292 mechanically ventilated patients. We fitted a quantile regression model to assess the association between steroid administration ≥320 mg methylprednisolone (equivalent to 60 mg dexamethasone) and impaired glycemic control. Sixty-six patients (22.6%) died within 28 days of intensive care unit admission. Seventy-one patients (24.3%) received a cumulative dose of least 320 mg methylprednisolone equivalents. After adjustment for gender, history of diabetes mellitus, chronic liver disease, sequential organ failure assessment score on intensive care unit day 1, and length of stay, administration of ≥320 mg methylprednisolone equivalent was associated with 4 additional days spent with glucose either <80 mg/dL or >180 mg/dL (B = 4.00, 95% CI = 2.15-5.85, P < .001). CONCLUSIONS: In this cohort study of 292 mechanically ventilated COVID-19 patients, we found an association between corticosteroid administration and higher incidence of both hyperglycemia and hypoglycemia.

Dabigatran Reversal With Idarucizumab in 2 Patients With Portal Vein Thrombosis Undergoing Orthotopic Liver Transplantation.

There are limited data to guide the use of anticoagulation in cirrhotic patients prior to liver transplantation especially when using direct oral anticoagulants. In this article, we present 2 cases. The first is a 42-year-old male with cirrhosis complicated by portal vein thrombosis (PVT) treated with dabigatran who underwent orthotopic liver transplantation without complication. The second case is a 65-year-old man with alcoholic cirrhosis complicated by PVT treated with dabigatran who underwent orthotopic liver transplantation and required reoperation for surgical bleeding. Both patients were treated with dabigatran's reversal agent idarucizumab prior to incision. In this case series, we discuss the treatment of cirrhotic patients with various anticoagulants, considerations for anticoagulant selection and reversal prior to liver transplant, and questions for future investigation.

Using the Hub and Spoke Model of Telemental Health to Expand the Reach of Community Based Care in the United States.

Community-based agencies are challenged with providing mental health care services with limited resources. When services are not provided, children are at increased risk for ongoing symptoms. The purpose of this study was to determine the effectiveness of the hub and spoke model of telemental services on the quality of function, access to care, and medication management. A retrospective case controlled design was used to examine study objectives. Five hundred and fifty-seven charts were reviewed for persons aged 6 to 17 from January 1, 2010 to December 31, 2015 and after propensity score matching was applied, 86 remained for analysis. Seventy-nine persons out of 301 (26%) in the comparison group; 43 persons out of 256 (17%) in the treatment group were selected due to having complete records. Results of the T-test suggested that telemental services were not inferior to face to face services. Access to care, analyzed via the Chi-Squared test, increased significantly across geographic regions and among person with different living arrangements. A T-test was conducted to compare medication non-adherence between groups; no statistical significance was noted. Telemental services are a viable option to increase access to community-based care and increase quality of function.

Optimizing the Cognitive Space of Nursing Work Through Electronic Medical Records.

The incorporation of electronic medical records into nursing practice highlights the need to facilitate communication among nurses. The extensive use of information suggests that electronic medical records should be considered in the cognitive workspace to manage information and facilitate communication. The purpose of this study was to construct an integrative model to explain the role of electronic medical records in the cognitive workspace. This work is grounded in the Theory of Swift and Even Flow and Distributive Cognition. The Distributive Cognitive model views the workplace as a cognitive system, such that cognitive processes do not occur in individual clinicians, but as a collaborative effort among nurses. The Theory of Swift and Even Flow was used to explain the flow of information among nurses. We used a qualitative approach to gather data from nurses at local inpatient facilities. Seven focus groups among three facilities were completed (n = 34). A semistructured questionnaire guided the focus group sessions. The results suggest that electronic medical records contribute to the cognitive workspace by serving as a conduit for information to be collected and distributed. These systems may positively influence nursing care when the quality, quantity, and timeliness of information are optimized.

Telehealth: Advances in Alternative Payment Models.

Introduction: The hospital sector has shifted its focus to advanced information and communication technologies to facilitate health care delivery through telehealth services to alleviate the industry's most pressing challenges in quality care and access, especially under changing reimbursement payment approaches. The aim of this study was to examine the association between alternative payment models (APMs), market competition, and telehealth provisions in the hospital setting. Materials and Methods: A secondary cross-sectional design to analyze 2018 census data of nonfederal short-term acute care hospitals in the United States was used. Multilevel logistic regressions models were used to analyze data from 4,257 hospitals across 1,874 counties. Counties with less than one hospital were excluded. Results: Regarding APMs, we found that hospital participation in accountable care organizations and participation in a bundled payment risk arrangement are significantly associated with the provision of telehealth services. From the market perspective, competitive advantage was found to be statistically associated with hospitals providing telehealth services. In addition, other hospital characteristics such as ownership, part of a system, part of a network, and major teaching affiliation also have impact on the provision of telehealth. Conclusions: The increase uptake of telehealth-related capabilities and their strong integration into care-delivery systems under APMs present exciting opportunities to enhance the merit of clinical care, and challenges as clinical professionals are not adept to using such technologies. There is a need to provide comprehensive of evidence on telehealth.

The Relationship between Health Information Technology Laboratory Tracking Systems and Hospital Financial Performance and Quality.

The objective of this study is to explore the relationship between hospitals Health Information Technology (HIT), and financial and quality performance. The study merged the 2017 Centers for Medicare & Medicaid Services (CMS) Healthcare Cost Report Information System, American Hospital Association Annual Survey, and two CMS Hospital Compare datasets. A total of 3002 hospitals were analyzed using multivariate analysis. We found that hospitals with laboratory tracking systems reported better financial performance on five financial performance measures. Policymakers should consider developing policies that facilitate exploration and adoption of various hospital HIT capabilities that measurably improves hospital quality of care.