Potentially preventable hospitalizations for acute and chronic conditions in Alaska, 2010-2012.

OBJECTIVE: The U.S. Agency for Healthcare Research and Quality's Prevention Quality Indicators comprise acute and chronic conditions for which hospitalization can be potentially prevented by high-quality ambulatory care. The Healthy Alaska 2020 initiative (HA2020) targeted reducing potentially preventable hospitalizations (PPH) for acute and chronic conditions among its health indicators. We estimated the PPH rate for adults aged ≥ 18 years in Alaska during 2010-2012. METHODS: We conducted a cross-sectional analysis of state-wide hospital discharge data obtained from the Healthcare Cost and Utilization Project and the Indian Health Service. We calculated average annual PPH rates/1000 persons for acute/chronic conditions. Age-adjusted rate ratios (aRRs) were used for evaluating PPH rate disparities between Alaska Native (AN) and non-AN adults. RESULTS: Among 127,371 total hospitalizations, 4911 and 6721 were for acute and chronic PPH conditions, respectively. The overall crude PPH rate was 7.3 (3.1 for acute and 4.2 for chronic conditions). AN adults had a higher rate than non-AN adults for acute (aRR: 4.7; p < 0.001) and chronic (aRR: 2.6; p < 0.001) PPH conditions. Adults aged ≥ 85 years had the highest PPH rate for acute (43.5) and chronic (31.6) conditions. Acute conditions with the highest PPH rate were bacterial pneumonia (1.8) and urinary tract infections (0.8). Chronic conditions with the highest PPH rate were chronic obstructive pulmonary disease (COPD; 1.6) and congestive heart failure (CHF; 1.3). CONCLUSION: Efforts to reduce PPHs caused by COPD, CHF, and bacterial pneumonia, especially among AN people and older adults, should yield the greatest benefit in achieving the HA2020 goal.

A national study on nurses' retention in healthcare facilities in underserved areas in Lebanon.

BACKGROUND: Nursing shortages and maldistribution are priority issues for healthcare systems around the globe. Such imbalances are often aggravated in underserved areas, especially in developing countries. Despite the centrality of this issue, there is a dearth of studies that examine the retention of nurses in underserved areas in the Middle East Region. This study investigates the characteristic and the factors associated with the retention of nurses working in rural areas in Lebanon. METHODS: This study uses a non-experimental cross-sectional design to survey nurses working in underserved areas of Lebanon. Underserved areas in Lebanon were identified using WHO definition. A total of 103 health facilities (hospitals and primary healthcare centers) located in these areas were identified and all nurses working at these facilities received a copy of the survey questionnaire. The questionnaire included five sections: demographic, work-life, career plan, job satisfaction, and assessment of work environment. Analysis included univariate and bivariate (chi-square, Student's t-test and ANOVA) tests to describe the respondents and examine the significance between nurses' characteristics and their intent to stay. A logistic regression model was constructed to identify factors associated with nurses' intent to stay in underserved areas. RESULTS: A total of 857 nurses from 63 Primary Healthcare (PHC) centers and hospitals responded to the questionnaire (75.5% response rate). Only 35.1% of nurses indicated their intent to stay in their current job over the coming one to three years. Surveyed nurses were most satisfied with relationship with co-workers and least satisfied with extrinsic rewards. Rural nurses working in PHC centers were more satisfied than their hospital counterparts on all aspects of work and had significantly higher intention to stay (62.5% compared to 31.5% in hospitals, P < 0.001). Regression analysis revealed that nurses less likely to report intent to stay were younger, unmarried, with less years of work experience and were not working towards a higher degree. Analysis reveals a directly proportional relationship between nurses' reported job satisfaction and their intent to stay. CONCLUSION: This study reveals poor retention of nurses in rural and underserved areas in Lebanon, especially in the hospital sector. The status quo is disquieting as it reflects an unstable and dissatisfied nursing workforce. Developing targeted retention strategies for younger nurses and those working in hospitals as well as the offering of professional development opportunities and devising an incentive scheme targeting rural nurses is pivotal to enhance nurses' job satisfaction and retention in rural settings.

Managing health worker migration: a qualitative study of the Philippine response to nurse brain drain.

BACKGROUND: The emigration of skilled nurses from the Philippines is an ongoing phenomenon that has impacted the quality and quantity of the nursing workforce, while strengthening the domestic economy through remittances. This study examines how the development of brain drain-responsive policies is driven by the effects of nurse migration and how such efforts aim to achieve mind-shifts among nurses, governing and regulatory bodies, and public and private institutions in the Philippines and worldwide. METHODS: Interviews and focus group discussions were conducted to elicit exploratory perspectives on the policy response to nurse brain drain. Interviews with key informants from the nursing, labour and immigration sectors explored key themes behind the development of policies and programmes that respond to nurse migration. Focus group discussions were held with practising nurses to understand policy recipients' perspectives on nurse migration and policy. RESULTS: Using the qualitative data, a thematic framework was created to conceptualize participants' perceptions of how nurse migration has driven the policy development process. The framework demonstrates that policymakers have recognised the complexity of the brain drain phenomenon and are crafting dynamic policies and programmes that work to shift domestic and global mindsets on nurse training, employment and recruitment. CONCLUSIONS: Development of responsive policy to Filipino nurse brain drain offers a glimpse into a domestic response to an increasingly prominent global issue. As a major source of professionals migrating abroad for employment, the Philippines has formalised efforts to manage nurse migration. Accordingly, the Philippine paradigm, summarised by the thematic framework presented in this paper, may act as an example for other countries that are experiencing similar shifts in healthcare worker employment due to migration.