Engaging Frontline Staff in Performance Improvement: The American Organization of Nurse Executives Implementation of Transforming Care at the Bedside Collaborative.

BACKGROUND: Process improvement stresses the importance of engaging frontline staff in implementing new processes and methods. Yet questions remain on how to incorporate these activities into the workday of hospital staff or how to create and maintain its commitment. In a 15-month American Organization of Nurse Executives collaborative involving frontline medical/surgical staff from 67 hospitals, Transforming Care at the Bedside (TCAB) was evaluated to assess whether participating units successfully implemented recommended change processes, engaged staff, implemented innovations, and generated support from hospital leadership and staff. METHODS: In a mixed-methods analysis, multiple data sources, including leader surveys, unit staff surveys, administrative data, time study data, and collaborative documents were used. RESULTS: All units reported establishing unit-based teams, of which >90% succeeded in conducting tests of change, with unit staff selecting topics and making decisions on adoption. Fifty-five percent of unit staff reported participating in unit meetings, and 64%, in tests of change. Unit managers reported substantial increase in staff support for the initiative. An average 36 tests of change were conducted per unit, with 46% of tested innovations sustained, and 20% spread to other units. Some 95% of managers and 97% of chief nursing officers believed that the program had made unit staff more likely to initiate change. Among staff, 83% would encourage adoption of the initiative. CONCLUSIONS: Given the strong positive assessment of TCAB, evidence of substantial engagement of staff in the work, and the high volume of innovations tested, implemented, and sustained, TCAB appears to be a productive model for organizing and implementing a program of frontline-led improvement.

Neighborhood, family and individual characteristics related to adolescent park-based physical activity.

BACKGROUND: Local parks are an important community resource that may influence levels of physical activity among youth. However, few population-based studies have investigated park-based physical activity among youth. PURPOSE: This study examines sociodemographic, family, and neighborhood characteristics associated with park-based physical activity among adolescents. METHODS: Data were from the 2007 California Health Interview Survey (CHIS), a population-based survey of California households, and were analyzed in 2012-2013 and 2015. This study examined individual (age, gender, race/ethnicity, and nativity), family (household income, parental education, and nativity), and neighborhood characteristics (urbanicity, perceived park availability, perceived park safety, neighborhood income, and racial composition) associated with engaging in park-based physical activity among adolescents. RESULTS: In California, 71% of adolescents reported being physically active the last time they visited a park. In adjusted multinomial logistic regression analyses, older adolescents and females were less likely to be physically active in parks. Adolescents with a park within walking distance of home and those with a safe park nearby were more likely to be physically active during a park visit. CONCLUSIONS: Park availability and perceptions of park safety are important predictors of engaging in park-based physical activity among adolescents. These findings provide information that can help inform interventions intended to increase physical activity among youth. Strategies that increase availability and safety of parks and other recreation spaces may be particularly effective.

Asthma-related school absenteeism and school concentration of low-income students in California.

INTRODUCTION: Asthma is one of the leading causes of school absenteeism. Previous studies have shown that school absenteeism is related to family income of individual students. However, there is little research examining whether school absenteeism is related to school-level concentration of low-income students, independent of family income. The objective of this study was to examine whether the proportion of low-income students at a school was related to school absenteeism due to asthma. METHODS: Using data from the 2007 California Health Interview Survey, a population-based survey of California households, we examined the association between attending schools with high concentrations of low-income students and missing school because of asthma, adjusting for demographic characteristics, asthma severity, and health insurance status. Schools with high concentrations of low-income students were identified on the basis of the percentage of students participating in the free and reduced-price meal program, data publicly available from the California Department of Education. RESULTS: Students attending schools with the highest concentrations of low-income students were more likely to miss school because of asthma. Students from low-income families, younger students, those with more frequent asthma symptoms, or those taking prescription asthma medications also were more likely to miss school because of asthma. CONCLUSION: The use of school-level interventions to decrease school absenteeism due to asthma should be explored, especially in schools with high concentrations of low-income students. Potential interventions could include school-based asthma education and disease management or indoor and outdoor air pollution control.

The influence of integrated electronic medical records and computerized nursing notes on nurses' time spent in documentation.

We investigated nurses' time spent in documentation as it relates to the use of electronic charting. A cross-sectional analysis was completed using time and motion data collected during a nursing process improvement initiative for 105 units in 55 hospitals. Ordinary least squares regression with a cluster adjustment revealed very little difference in time spent in documentation with or without the use of electronic medical records or computerized nursing notes. Nurses spent 19% of their time completing documentation, regardless of electronic charting usage, compared with all other categories of care. These findings suggest that integrated electronic medical records and computerized nursing notes do not appear to increase the time nurses spend documenting.

Income disparities in obesity trends among California adolescents.

OBJECTIVES: We assessed income-specific trends in obesity rates among a diverse population of California adolescents. METHODS: We used data from 17,535 adolescents who responded to the California Health Interview Survey between 2001 and 2007 to examine disparities in obesity prevalence by family income and gender. RESULTS: Between 2001 and 2007, obesity prevalence significantly increased among lower-income adolescents but showed no statistically significant differences among higher-income adolescents after adjustment for age, gender, and race/ethnicity. Although the overall disparity in obesity by family income doubled in this time period, trends were more consistent among male adolescents than among female adolescents. CONCLUSIONS: The magnitude of the income disparity in obesity prevalence among California adolescents more than doubled between 2001-2007. The overall leveling off of adolescent obesity prevalence rates could indicate that efforts to decrease childhood obesity are having an impact; however, our results suggest that efforts to prevent childhood obesity may be failing to help adolescents from lower-income families, particularly male adolescents.

Sugary Beverage Consumption Among California Children and Adolescents.

This policy brief examines patterns of sugary beverage consumption among children and adolescents in California. Using data from the California Health Interview Survey (CHIS), this study found that while sugary beverage consumption decreased among adolescents ages 12-17 between 2011-12 and 2013-14, it increased among children under age 12 between 2009 and 2013-14. The trend among children under age 12 may be attributed to a shift in sugary beverage consumption from soda to sports and energy drinks. Establishing and strengthening policies that focus on reducing consumption of sugary beverages could counter the increasing consumption trend among younger children as well as result in further reductions in consumption among teens.

Civic Engagement Among California High School Teens.

This policy brief describes civic engagement among California adolescents in high school. Using data from the California Health Interview Survey (CHIS), the study found that the most common civic engagement activity among California high school teens is volunteering. Latino teens and those from low-income families have lower rates of civic engagement. Higher rates of civic engagement are associated with better health status, fewer days of missed school due to health, better grades, and greater perceived likelihood of attending college. Strategies to increase adolescent civic engagement could help promote healthy development. Policymakers, schools, and community organizations can promote civic engagement among all youth by expanding programs, encouraging youth participation in school and community organizations, and engaging youth who have not traditionally been included in civic activities.

Few California Children and Adolescents Meet Physical Activity Guidelines.

This policy brief describes physical activity among California children and adolescents. Using data from the California Health Interview Survey (CHIS), the study found that only 31 percent of children ages 5-11 and 18 percent of adolescents ages 12-17 meet the physical activity guidelines of engaging in at least one hour of physical activity every day. Neighborhood characteristics, including safety and proximity to parks, are related to physical activity levels among youth. Also, among older children, boys are more active than girls. Additional efforts by state and local policymakers, as well as communities, are needed to promote physical activity to increase the proportion of children and adolescents achieving recommended amounts of physical activity.

Walking Among California Adults.

This policy brief describes two types of walking among California adults: walking for transportation and walking for leisure. Using data from the 2013-14 California Health Interview Survey, the study found that the prevalence of both types of walking has increased since 2003. The prevalence of walking for both transportation and leisure varies with age, income, race/ethnicity, and neighborhood safety and cohesion. Additional efforts by state and local policymakers, as well as by communities, are needed to reduce disparities and promote walking among adults.

Disparities in Health Care Access and Health Among Lesbians, Gay Men, and Bisexuals in California.

This policy brief examines differences in health care access, health behaviors, and health outcomes by sexual orientation among California adults. Using data from the California Health Interview Survey, the study finds that although lesbian, gay, and bisexual women and men have similar or better rates of insurance coverage compared to straight women and men, they are more likely to experience delays in getting needed health care. Lesbians, bisexual women, and bisexual men have higher rates of smoking and binge drinking than straight women and men; however, gay men are less likely to consume sugary beverages and to be physically inactive. Lesbians and bisexuals had poorer health status and higher rates of disability than straight adults. Future research is needed to explain these disparities, as well as to identify health care and structural interventions that will improve access to care and health outcomes for this population.

Association of California Immigrants' Avoidance of Public Programs Due to Immigration Concerns With Delayed Access to Health Care.

This cross-sectional study examines the association of avoidance of public programs among California immigrants with delayed access to health care services and prescriptions owing to concerns about how their interaction with these services may affect their immigration status.

Prediabetes in California: Nearly Half of California Adults on Path to Diabetes.

In California, more than 13 million adults (46 percent of all adults in the state) are estimated to have prediabetes or undiagnosed diabetes. An additional 2.5 million adults have diagnosed diabetes. Altogether, 15.5 million adults (55 percent of all California adults) have prediabetes or diabetes. Although rates of prediabetes increase with age, rates are also high among young adults, with one-third of those ages 18-39 having prediabetes. In addition, rates of prediabetes are disproportionately high among young adults of color, with more than one-third of Latino, Pacific Islander, American Indian, African-American, and multiracial Californians ages 18-39 estimated to have prediabetes. Policy efforts should focus on reducing the burden of prediabetes and diabetes through support for prevention and treatment.

Role models and social supports related to adolescent physical activity and overweight/obesity.

Positive role models, social and community activities, and school support are protective social factors that promote youth health and well-being. Latino, African-American, Asian, multi-racial, and low-income adolescents are less likely to experience these protective social factors compared to other groups, which may contribute to health disparities. Adolescents who identify a role model, volunteer, participate in organizations outside of school, or experience high levels of teacher or other adult support at school engage in greater physical activity and are more likely to have a healthy weight. Strategies to increase these protective social factors among adolescents could help promote healthy weight and healthy behaviors.

Adolescent sedentary behaviors: correlates differ for television viewing and computer use.

PURPOSE: Sedentary behavior is associated with obesity in youth. Understanding correlates of specific sedentary behaviors can inform the development of interventions to reduce sedentary time. The current research examines correlates of leisure computer use and television viewing among adolescents in California. METHODS: Using data from the 2005 California Health Interview Survey, we examined individual, family, and environmental correlates of two sedentary behaviors among 4,029 adolescents: leisure computer use and television watching. RESULTS: Linear regression analyses adjusted for a range of factors indicated several differences in the correlates of television watching and computer use. Correlates of additional time spent watching television included male sex, American Indian and African American race, lower household income, lower levels of physical activity, lower parent educational attainment, and additional hours worked by parents. Correlates of a greater amount of time spent using the computer for fun included older age, Asian race, higher household income, lower levels of physical activity, less parental knowledge of free-time activities, and living in neighborhoods with higher proportions of nonwhite residents and higher proportions of low-income residents. Only physical activity was associated similarly with both watching television and computer use. CONCLUSIONS: These results suggest that correlates of time spent on television watching and leisure computer use are different. Reducing screen time is a potentially successful strategy in combating childhood obesity, and understanding differences in the correlates of different screen time behaviors can inform the development of more effective interventions to reduce sedentary time.

Physical activity, park access, and park use among California adolescents.

In California, 2.15 million adolescents (62.9%) do not engage in at least 60 minutes of physical activity five or more days per week. Adolescents who visited a park in the past month and those who live in a park service area are more likely to meet this goal. Lower-income California adolescents are less likely to visit local parks and more likely to believe local parks are unsafe. Actions by state and local policymakers to increase park access and attractiveness, especially to underserved populations, may be an effective way to promote physical activity among California's adolescents.

Adolescent physical education and physical activity in California.

In California, more than 1.3 million adolescents (38%) do not participate in physical education (PE) at school, and this rate increases dramatically with age, from just 5% at age 12 to 77% at age 17. In addition, only 19% of teens meet current physical activity recommendations. Participation in PE at school is associated with more overall physical activity. Policies that promote more opportunities for physical activity, including those that help schools meet or exceed current PE requirements, can contribute to greater levels of physical activity for adolescents.

Food environments near home and school related to consumption of soda and fast food.

In California, more than 2 million adolescents (58%) drink soda or other sugar-sweetened beverages every day, and more than 1.6 million adolescents (46%) eat fast food at least twice a week. Adolescents who live and go to school in areas with more fast food restaurants and convenience stores than healthier food outlets such as grocery stores are more likely to consume soda and fast food than teens who live and go to school in areas with healthier food environments. State and local policy efforts to improve the retail food environment may be effective in improving adolescents' dietary behaviors.

Obesity and diabetes: two growing epidemics in California.

The prevalence of both diabetes and obesity has grown significantly in California. Six million adults are obese and an additional 9.3 million are overweight. Obesity is a significant risk factor for diabetes; more than two million adults have been diagnosed with diabetes in California. Obesity and diabetes disproportionately affect people of color, the poor and those with the least education in California. Policy and environmental changes that promote and encourage physical activity and healthy eating will likely prove most effective in combating obesity and related conditions