Racial, Ethnic, and Gender Representation in Leadership Positions at National Cancer Institute-Designated Cancer Centers.

Importance: Increasing diversity is beneficial for the health care system and patient outcomes; however, the current leadership gap in oncology remains largely unquantified. Objective: To evaluate the gender, racial, and ethnic makeup of the leadership teams of National Cancer Institute (NCI)-designated cancer centers and compare with the city populations served by each center. Design, Setting, and Participants: This retrospective cross-sectional study examined gender, race, and ethnicity of leadership teams via publicly available information for NCI-designated cancer centers and compared results with national and city US census population characteristics, as well as active physician data. Data were analyzed in August 2020. Main Outcomes and Measures: Racial, ethnic, and gender diversity (identified via facial recognition software and manual review) of leadership teams compared with institution rank, location, team member degree(s), and h-index. Results: All 63 NCI cancer centers were included in analysis, and all had identifiable leadership teams, with a total of 856 members. Photographs were not identified for 12 leaders (1.4%); of the remaining 844 leaders, race/ethnicity could not be identified for 7 (0.8%). Women make up 50.8% of the US population and 35.9% of active physicians; in NCI cancer centers, 36.3% (306 women) of cancer center leaders were women. Non-Hispanic White individuals comprise 60.6% of the US population and 56.2% of active physicians, but 82.2% of cancer center leaders (688 individuals) were non-Hispanic White. Both Black and Hispanic physicians were underrepresented when compared with their census populations (Black: 12.7% of US population, 5.0% of active physicians; Hispanic: 18.1% of US population, 5.8% of active physicians); however, Black and Hispanic individuals were even less represented in cancer center leadership positions (29 Black leaders [3.5%]; 32 Hispanic leaders [3.8%]). Asian physicians were overrepresented compared with their census population (5.6% of US population, 17.1% of active physicians); however, Asian individuals were underrepresented in leadership positions (92 Asian individuals [11.0%]). A total of 23 NCI cancer centers (36.5%) did not have a single Black or Hispanic member of their leadership team; 8 cancer centers (12.7%) had an all non-Hispanic White leadership team. A multivariate model found that leadership teams with more women (adjusted odds ratio, 1.73 [95% CI, 1.02-2.93]; P = .04) and institutions in the South (adjusted odds ratio, 2.31 [95% CI, 1.15 to 4.77]; P = .02) were more likely to have at least 1 Black or Hispanic leader. Pearson correlation analysis showed weak to moderate correlation between city Hispanic population and Hispanic representation on leadership teams (R = 0.5; P < .001), but no significant association between Black population and Black leadership was found. Conclusions and Relevance: This cross-sectional study found that significant racial and ethnic disparities were present in cancer center leadership positions. Establishing policy, as well as pipeline programs, to address these disparities is essential for change.

Hospital Readmission and Costs of Total Knee Replacement Surgery in 2009 and 2014: Potential Implications for Health Care Managers.

The purpose of this article is to describe changes in hospital readmissions and costs for US hospital patients who underwent total knee replacement (TKR) in 2009 and 2014. Data came from the Healthcare Cost and Utilization Project net-Nationwide Readmissions Database. Compared with 2009, overall 30-day rates of readmissions after TKR decreased by 15% in 2014. Rates varied by demographics: readmission rates were lower for younger patients, males, Medicare recipients, and those with higher incomes. Overall, costs rose 20% across TKR groups. This report is among the first to describe changes in hospital readmissions and costs for TKR patients in a national sample of US acute care hospitals. Findings offer hospital managers a mechanism to benchmark their facilities' performances.

O processo de conformação do perfil assistencial nos hospitais federais da cidade do Rio de Janeiro, Brasil / The process of defining the hospital care profile in federal hospitals in the city of Rio de Janeiro, Brazil

Resumo Este artigo analisa o processo de conformação do perfil assistencial nos hospitais federais no município do Rio de Janeiro. Trata-se de um estudo descritivo, de abordagem qualitativa e que utilizou entrevistas semiestruturadas realizadas junto a gestores hospitalares. A análise dos dados foi realizada a partir da formação do Discurso do Sujeito Coletivo. Na percepção dos gestores esse processo é decorrente de um conjunto de estratégias emergentes, as propostas e as necessidades de mudança se constituem de reações adaptativas que as unidades desenvolvem de forma desarticulada visando à resolução de problemas identificados pelos profissionais e gestores. O processo é considerado muito mais a partir de uma perspectiva política do que racional e sistêmica. Algumas experiências de trabalho com a missão hospitalar, como o enfoque da démarche stratégique, já apontam para uma construção mais colegiada na definição do perfil assistencial, que considera o hospital como componente de uma rede integrada de serviços e que adota um processo de decisão menos incremental e mais integrador.

Abstract This article analyzes the process of shaping the care profile of federal hospitals in the city of Rio de Janeiro. This is a qualitative, descriptive study that draws on semi-structured interviews with hospital administrators. Data analysis used the Collective Subject Discourse approach. Managers believe this process is the result of a set of emerging strategies, proposals and need for change, which result in adaptive reactions that hospitals develop with no coordination between them to resolve problems identified by professionals and managers. The process is analyzed much more from a political point of view than from a rational and systemic one. Some of the experience with the hospital mission, such as the focus on a strategic approach, already signals a more collegiate approach to defining the profile of care, where the hospital is one component of an integrated network of services, with a decision process that is less incremental and more integrating.

Clinical staff resource use with intravenous patient-controlled analgesia in acute postoperative pain management: results from a multicenter, prospective, observational study.

The purpose of this study was to evaluate hospital resource utilization associated with intravenous patient-controlled analgesia (IV-PCA), with a focus on nursing, pharmacy, and central supply/engineering time spent from a hospital perspective. Data were collected during a multicenter (29 sites), prospective observational study in the United States of subjects who underwent total knee replacement (TKR), total hip replacement (THR), or abdominal hysterectomy (AH) and were administered analgesia through IV PCA for the management of acute postoperative pain. Nursing staff recorded the IV PCA-related tasks they performed for a subject and the duration of time required to perform each task from initial IV PCA set-up to discontinuation. Hospital administrators, nursing managers, central supply/engineering staff, and pharmacy directors were interviewed to obtain data regarding other IV PCA labor resource use. The distribution of surgery type among the 457 subjects was 31.1% THR, 35.9% TKR, and 33.0% AH. The average duration of IV PCA use was 32.6 hours. Nurses reported having to perform an average of 39.6 IV PCA-related tasks, which required an average of 67.4 minutes. The most common IV PCA-related tasks were evaluating pump use and settings, assessing the IV site, evaluating and addressing analgesia side effects, instructing/reinstructing the subject on use, administering supplemental pain medications, assisting with self-care or moving the subject, and assisting the subject with use of the button. Pharmacists reported that they spend approximately 7.9 minutes and pharmacy technicians spend approximately 9.8 minutes, per subject daily course of IV PCA therapy, on the following tasks: checking and verifying the order, doing inventory of the analgesia, preparing the analgesia (ie, filling reservoirs), checking the analgesia, and delivering the analgesia to the nursing units. In addition, pharmacists and RNs spend an average of 47.3 and 40.7 minutes per year in IV PCA-related training. Intravenous patient-controlled analgesia postoperative care requires coordination and involvement of numerous hospital departments. It is labor intensive and involves numerous time-consuming tasks, oversight of IV PCA, and ongoing training. Alternative methods of patient-controlled pain management with similar efficacy that reduces labor resource utilization may be warranted.