Low Adherence to Post Emergency Department Follow-Up Among Hypertensive Patients With Medical Insurance.

BACKGROUND: Improvement in hypertension control in the insured, adult population could improve morbidity and mortality associated with hypertension in the United States. The emergency department (ED) is a potential site of intervention, where individuals are diagnosed with asymptomatic hypertension and referred to primary care. OBJECTIVE: To inform intervention strategies, we identified risk factors of nonadherence to primary care follow-up among individuals aged 18-60 years with a primary discharge diagnosis of asymptomatic hypertension in the ED. METHODS: Data were obtained from a commercial claims database for January 2012-September 2015. A total of 84,929 individuals were included. Rate of nonadherence to primary care follow-up was determined for individuals billed for a primary discharge diagnosis of essential hypertension. Multivariate logistic regression was used to calculate adjusted odds ratios. The relationships between demographic and clinical variables with nonadherence to follow-up were assessed. RESULTS: Two-thirds of the study population did not adhere to follow-up within 30 days of ED discharge. Risk factors for nonadherence included no history of recent visit with primary care (odds ratio [OR] 1.87; 95% confidence interval [CI] 1.81-1.93) and multiple prior ED visits (OR 1.65; 95% CI 1.57-1.73). Protective characteristics included history of filling antihypertensive prescriptions in the last year (OR 0.42; 95% CI 0.40-0.43); or history of filling a 30-day antihypertensive prescription on day of diagnosis (OR 0.83; 95% CI 0.80-0.87). CONCLUSIONS: Individuals without a recent primary care visit or who visit the ED frequently are at higher risk of nonadherence to follow-up for hypertension, despite medical insurance. Insurance status may not overcome individual level barriers to follow-up.

Implementation, evaluation, and outcome of TeamSTEPPS in interprofessional education: a scoping review.

The ability to effectively work in interprofessional teams is listed as one of the five core competencies in health professions education. Though the importance of interprofessional education (IPE) has been established, results of studies have been difficult to compare due to the high variability of programs. We undertook a scoping review to examine the use of a prescribed curriculum, TeamSTEPPS, in IPE. Articles describing TeamSTEPPS implementations were extracted from Pubmed, Embase, and Scopus. Studies with two or more health professions students reporting on a clear evaluation and published in English were eligible for inclusion. Two researchers independently applied inclusion criteria to studies and reconciled conflicts for a final selection. The reference lists of selected papers were also searched for relevant studies. Data were extracted from each of the articles independently using a standard form. Twenty-four papers describing 23 unique programs were included. Programs used a variety of teaching modalities and included students from two to ten health professions, most commonly medical and nursing students. Programs used a range (n = 11) of validated IPE evaluation surveys, few of which were part of the TeamSTEPPS program. Methods included multimodal evaluations, self-assessment confidence and attitude surveys, pre/post-test models, and external evaluation of simulation performance. There was great variation in the implementation of TeamSTEPPS implying that while a consistent curriculum it can be adapted to meet the needs of different educational contexts. The variation in evaluation methods makes comparing and synthesis of results problematic. Future IPE research can expand on the use of this prescribed curriculum, especially with focus on uniform evaluation methods.

Emergency department visit frequency and health care costs following implementation of an integrated practice unit for frequent utilizers.

OBJECTIVES: The integrated practice unit (IPU) aims to improve care for patients with complex medical and social needs through care coordination, medication reconciliation, and connection to community resources. This study examined the effects of IPU enrollment on emergency department (ED) utilization and health care costs among frequent ED utilizers with complex needs. METHODS: We extracted electronic health records (EHR) data from patients in a large health care system who had at least four distinct ED visits within any 6-month period between March 1, 2018, and May 30, 2021. Interrupted time series (ITS) analyses were performed to evaluate the impact of IPU enrollment on monthly ED visits and health care costs. A control group was matched to IPU patients using a propensity score at a 3:1 ratio. RESULTS: We analyzed EHRs of 775 IPU patients with a control group of 2325 patients (mean [±SD] age 43.6 [±17]; 45.8% female; 50.9% White, 42.3% Black). In the single ITS analysis, IPU enrollment was associated with a decrease of 0.24 ED visits (p < 0.001) and a cost reduction of $466.37 (p = 0.040) in the first month, followed by decreases of 0.11 ED visits (p < 0.001) and $417.61 in costs (p < 0.001) each month over the subsequent year. Our main results showed that, compared to the matched control group, IPU patients experienced 0.20 more ED visits (p < 0.001) after their fourth ED visit within 6 months, offset by a reduction of 0.02 visits (p < 0.001) each month over the next year. No significant immediate or sustained increase in costs was observed for IPU-enrolled patients compared to the control group. CONCLUSIONS: This quasi-experimental study of frequent ED utilizers demonstrated an initial increase in ED visits following IPU enrollment, followed by a reduction in ED utilization over subsequent 12 months without increasing costs, supporting IPU's effectiveness in managing patients with complex needs and limited access to care.

Comparison of Financial Hardship and Healthcare Utilizations Associated with Cancer in the United States Medicare Programs during the COVID-19 Pandemic.

BACKGROUND: In the United States, Medicare beneficiaries diagnosed with cancer often face significant financial challenges due to the expensive nature of cancer treatments and increased cost-sharing responsibilities. However, there is limited knowledge regarding the financial hardships and healthcare utilizations faced by those enrolled in Medicare Advantage (MA) compared to those in traditional fee-for-service Medicare (TM) during the COVID-19 pandemic. Our study aims to investigate the subjective financial hardships experienced by individuals enrolled in TM and MA and to determine whether these two Medicare programs exhibit differences in healthcare utilization during the pandemic. METHODS: We utilized data from the 2020-2022 National Health Interview Survey (NHIS), focusing on nationally representative samples of cancer survivors aged 65 or older. Financial hardship was categorized into three distinct groups: material (e.g., problems with medical bills), psychological (e.g., worry about paying), and behavioral (e.g., delayed care due to cost). Healthcare utilization included wellness visits (preventive care), emergency care services, hospitalizations, and telehealth. We used survey design-adjusted analysis to compare the study outcomes between MA and TM. RESULTS: Among a weighted sample of 4.4 million Medicare beneficiaries with cancer (mean age: 74.9), 76% were enrolled in MA plans. Cancer survivors with a college degree (59.3% vs. 49.8%) and high family income (38.2% vs. 31.1%) were more likely to enroll in MA plans. There were no significant differences in any material, psychological, or behavioral financial hardship domains between beneficiaries with MA and TM plans except forgone counseling due to cost. For healthcare utilization measures, cancer survivors in MA were more likely than those in TM to have flu vaccination (77.2% vs. 70.1%) and experience lower hospitalizations (16.0% vs. 20.0%). However, there were no differences in other health service utilizations between MA and TM. CONCLUSION: While no significant differences were observed in any materialized, psychological, or behavioral financial hardships, older cancer survivors enrolled in MA plans were more likely to receive vaccinations and lower hospitalization rates during COVID-19. Although other preventive or primary care visits (i.e., wellness visits) were higher, their difference did not reach statistical significance. As MA grows in popularity, it is essential to consistently monitor and evaluate the performance and outcomes of Medicare plans for cancer survivors as we navigate the post-pandemic landscape.

An evaluation of copy and paste events in electronic notes of patients with hospital acquired conditions.

BACKGROUND: The increased use of the copy and paste function (CPF) in Electronic Health Records (EHRs) has raised concerns about possible clinician miscommunication and adverse patient outcomes. OBJECTIVE: This study investigated the prevalence and extent of CPF in the EHRs of patients diagnosed with Hospital-acquired Conditions (HACs). We also examined the association between the use of CPF and patient characteristics. MATERIALS AND METHODS: The prevalence and extent of CPF were investigated using electronic clinical notes of 50 patients hospitalized with HACs between 2017 and 2021 at a large academic medical center. Study patients were adults aged 21 and older with a length of stay greater than three days. ANOVA analysis was used to examine the differences in CPF use between patients with different characteristics. RESULTS: A total of 7,844 clinical notes across seven note types are compared in the study. The mean patient age was 63.7, with an average length of stay of 15.6 days. 54% of Discharge Summaries, 53% of Consults, and 47% of history and physical (H&P) notes had duplications with the same type of notes. In the Discharge Summary, ED notes, and Plan of Care, duplications accounted for 40% or higher of the full text. H&P and Consults, H&P and Discharge Summary, and Discharge Summary and Consults were more likely to have duplications than between other types of notes. Duplications accounted for 15.5% of the information provided in H&P and Consults. The prevalence of CPF was higher in the Discharge Summary of patients who were younger, female, and had longer hospital stays. CONCLUSION: Both prevalence and extent of duplication were high in the Discharge Summary, Consults, and H&P notes of patients with HACs. Future studies are needed to examine the intention and appropriateness of CPF use and its impact on patient outcomes.

Gastroenterology Specialist Supply and Early-Onset Colorectal Cancer Incidence and Mortality in the U.S., 2014-2018.

Background and Aims: The burden of early-onset colorectal cancer (EoCRC) has been increasing among young adult populations in the U.S. The aim of this study was to investigate the relationship between the incidence and mortality of EoCRC and the supply of gastroenterology (GI) specialists and primary care physicians (PCP). Methods: This was an ecological study of EoCRC cases among US counties that occurred between 2014 and 2018. Data was obtained from US cancer statistics. County-level data, including sociodemographic (eg, percentage of female, non-White residents, poverty rate, rurality) and physician supply (GI specialists and PCPs) was obtained from area health resources files. We estimated linear mixed-effects models with the county as a random effect to examine the association of physician supply with 5-year average age-adjusted EoCRC incidence and mortality. Models were adjusted for aggregate county-level socioeconomic characteristics. Multicollinearity was tested through variation inflation. Results: Analysis included 855 US counties. Mean age-adjusted EoCRC incidence and mortality rates between 2014-2018 were 9.5 (standard deviation [SD]: 2.7) and 2.7 (SD: 0.8) per 100,000 persons, respectively. In the adjusted model, GI supply was associated with lower EoCRC incidence (-5.6 percentage-point change per SD; 95% confidence interval, -11.0 to -0.1) but not with EoCRC mortality (P = .558). PCP supply was associated with lower EoCRC mortality (-27.0 percentage-point change per SD; 95% confidence interval, -46.1 to -7.8) but not with EoCRC incidence (P = .077). Conclusion: Greater GI specialist supply was associated with a reduction in EoCRC incidence but not improved mortality. Study findings suggest the need for early colorectal cancer screening efforts and the potential for expanding GI services and referrals in medically underserved areas.

Drivers of Individual and Regional Variation in CMS Hierarchical Condition Categories Among Florida Beneficiaries.

Objective: To explore hierarchical condition categories (HCC) risk score variation among Florida Fee for Service (FFS) Medicare beneficiaries between 2016 and 2018. Data Sources: This study analyzed HCC risk score variation using Medicare claims data for Florida beneficiaries enrolled in Parts A & B between 2016 and 2018. Study Design: The CMS methodology analyzed HCC risk score variation using annual mean county- and beneficiary-level risk score changes. The association between variation and beneficiary characteristics, diagnoses, and geographic location was characterized using mixed-effects negative binomial regression models. Data Collection: Not applicable. Principal Findings: Counties in the Northeast [marginal effect (ME)=-0.003], Central (ME=-0.021), and Southwest (ME=-0.009) Florida have relatively lower mean risk scores. A higher number of lifetime (ME=0.246) and treatable (ME=0.288) conditions were associated with higher county-level risk scores, while more preventable conditions (ME=-0.249) were associated with lower risk scores. Counties with older beneficiaries (ME=0.015) and more Blacks (ME=0.070) have higher risk scores, while having female beneficiaries reduced risk scores (ME=-0.005). Individual risk scores did not vary by age (ME=0.000), but Blacks (ME=0.001) had higher rates of variation relative to Whites, while other races had comparatively lower variation (ME=-0.003). In addition, individuals diagnosed with more lifetime (ME=0.129), treatable (ME=0.235), and preventable (ME=0.001) conditions had higher risk score variation. Most condition-specific indicators showed small associations with risk score changes; however, metastatic cancer/acute leukemia, respirator dependence/tracheostomy, and pressure ulcers of the skin were significantly associated with both types of HCC risk score variation. Conclusion: Results showed demographics, HCC condition classifications (ie, lifetime, preventable, and treatable), and some specific conditions were associated with higher variation in mean county-level and individual risk scores. Results suggest consistent coding and reductions in the prevalence of certain treatable or preventable conditions could reduce the county and individual HCC risk score year-to-year change.

Social Determinants of Health and After-Hours Electronic Health Record Documentation: A National Survey of US Physicians.

Identifying patients' social determinants of health (SDoH) can improve patient outcomes but may increase clinicians' documentation time. However, there is limited evidence of how many physicians document SDoH and the associated burden. To address this gap, this study examines documentation of SDoH and after-hours electronic health record (EHR) work among a nationally representative sample of US office-based physicians. This was a cross-sectional analysis of the 2018-2019 National Electronic Health Records Survey. A survey design-adjusted bivariate analysis was used to estimate the prevalence of SDoH documentation and compare this activity between physicians' and practices' characteristics. A modified multivariable Poisson model was used to estimate prevalence ratios of SDoH documentation and after-hours work. The study sample included a weighted sample of 303,389 US physicians (31.5%, female; 72.5%, aged ≥50 years; 48.8% primary care specialty). Of those, 84.3% reported documenting patients' SDoH information. Physicians documenting patients' SDoH tend to be younger (<50 years). Prevalence estimates of after-hours EHR documentation were comparable between physicians recording patients' SDoH and those not (33.7% vs. 33.0%) and this difference did not reach statistical significance in adjusted analysis (adjusted prevalence ratio, 0.94, 95% confidence interval, 0.64-1.39). Thus, documenting patients' SDoH appears to be common among US physicians, and this activity is not associated with after-hours EHR documentation. Future studies should examine how patients' SDoH information is used and its association with patient health outcomes.

A National Survey of Palliative Care Team Compositions.

Objective: It is unclear how well palliative care teams are staffed at US cancer centers. Our primary objective was to compare the composition of palliative care teams between National Cancer Institute (NCI)-designated cancer centers and non-NCI-designated cancer centers in 2018. We also assessed changes in team composition between 2009 and 2018. Methods: This national survey examined the team composition in palliative care programs at all 61 NCI-designated cancer centers and in a random sample of 60 of 1252 non-NCI-designated cancer centers in 2018. Responses were compared to those from our 2009 survey. The primary outcome was the presence of an interprofessional team defined as a palliative care physician, nurse, and psychosocial member. Secondary outcomes were the size and number of individual disciplines. Results: In 2018, 52/61 (85%) of NCI-designated and 27/38 (71%) non-NCI-designated cancer centers in the primary outcome comparison responded to the survey. NCI-designated cancer centers were more likely to have interprofessional teams than non-NCI-designated cancer centers (92% vs 67%; P = .009). Non-NCI-designated cancer centers were more likely to have nurse-led teams (14.8% vs 0.0%; P = .01). The median number of disciplines did not differ between groups (NCI, 6.0; non-NCI, 5.0; P = .08). Between 2009 and 2018, NCI-designated and non-NCI-designated cancer centers saw increased proportions of centers with interprofessional teams (NCI, 64.9% vs 92.0%, P < .001; non-NCI, 40.0% vs 66.7%; P = .047). Conclusion: NCI-designated cancer centers were more likely to report having an interprofessional palliative care team than non-NCI-designated cancer centers. Growth has been limited over the past decade, particularly at non-NCI-designated cancer centers.

Evaluating the robustness of the CMS Hospital Value-Based Purchasing measurement system.

BACKGROUND: The Hospital Value-Based Purchasing Program (HVBP) is a pay for performance system that impacts traditional Medicare fee-for-service payments to hospitals through rewards and penalties. OBJECTIVES: To explore variation in overall and individual-hospital total performance score (TPS) and embedded domains for hospitals during 2014-2018. DATA SOURCE: Hospital data were retrieved from the publicly available HOSArchive dataset. STUDY DESIGN: Distribution of annual TPS and HVBP domain scores for 2014-2018 was evaluated using descriptive statistics. Transitional probabilities were analyzed to evaluate annual movement in the TPS ranking for outlier hospitals in the Top and Bottom 5%. PRINCIPAL FINDINGS: TPS scores are positively skewed while the distribution of domain scores vary with patient experience, (clinical) outcome, and efficiency domains having a large number of (positive) outliers. Mean TPS score decreased from 40.54 in 2014 to 38.04 by 2018. Improvement was shown in mean domain scores for clinical process of care and clinical outcome using 95% confidence intervals, with hospitals gaining 10 points over the study period in clinical outcome. Changes in the mean scores for other domains did not show consistent increases or decreases. Chi-square analyses of hospital ranking categories showed some evidence that, as a group, hospitals initially ranked in the Bottom 5% are making consistent annual movements to higher categories. In contrast, over half of the hospitals ranking in the initial Top 5% remained in the top category across all study years. CONCLUSIONS: It may be time for CMS to redesign the HVBP incentive program to assure the measures accurately demonstrate sustained improvement, the domain weights appropriately reflect the level of importance, and the TPS comparative ranking methodology does not discourage lower-performing hospitals from actively improving the care they deliver and achieving top ranks.

Impact of External Environmental Dimensions on Financial Performance of Major Teaching Hospitals in the U.S.

Teaching hospitals have a unique mission to not only deliver graduate medical education but to also provide both inpatient and ambulatory care and to conduct clinical medical research; therefore, they are under constant financial pressure, and it is important to explore what types of external environmental components affect their financial performance. This study examined if there is an association between the short-term and long-term financial performance of major teaching hospitals in the United States and the external environmental dimensions, as measured by the Resource Dependence Theory. Data for 226 major teaching hospitals spanning 46 states were analyzed. The dependent variable for short-term financial performance was days cash on hand, and dependent variable for long-term financial performance was return on assets, both an average of most recently available 4-year data (2014-2017). Utilizing linear regression model, results showed significance between outpatient revenue and days cash on hand as well as significant relationship between population of the metropolitan statistical area, unemployment rate of the metropolitan statistical area, and teaching hospital's return on assets. Additionally, system membership, type of ownership/control, and teaching intensity also showed significant association with return on assets. By comprehensively examining all major teaching hospitals in the U.S. and analyzing the association between their short-term and long-term financial performance and external environmental dimensions, based upon Resource Dependence Theory, we found that by offering diverse outpatient services and novel delivery options, administrators of teaching hospitals may be able to increase organizational liquidity.

How healthcare organizations use the Internet to market quality achievements.

The increasingly competitive environment is having a strong bearing on the strategic marketing practices of hospitals. The Internet is a fairly new marketing tool, and it has the potential to dramatically influence healthcare consumers. This exploratory study investigates how hospitals use the Internet as a tool to market the quality of their services. Significant evidence exists that customers use the Internet to find information about potential healthcare providers, including information concerning quality. Data were collected from a random sample of 45 U.S. hospitals from the American Hospital Association database. The data included hospital affiliation, number of staffed beds, accreditation status, Joint Commission quality awards, and number of competing hospitals. The study's findings show that system-affiliated hospitals do not provide more, or less, quality information on their websites than do non-system-affiliated hospitals. The findings suggest that the amount of quality information provided on a hospital website is not dependent on hospital size. Research provides evidence that hospitals with more Joint Commission awards promote their quality accomplishments more so than their counterparts that earned fewer Joint Commission awards. The findings also suggest that the more competitors in a marketplace the more likely a hospital is to promote its quality as a potential differential advantage. The study's findings indicate that a necessary element of any hospital's competitive strategy should be to include the marketing of its quality on the organization's website.

RFIDs can improve the patient care supply chain.

Technologies that increase efficiency, enhance quality, and improve patient safety are essential for all healthcare organizations. Radio frequency identification devices (RFIDs) seem to be right for this challenge. RFIDs can be integrated into all areas of the internal patient supply chain, serving as clearinghouses of information. By providing timely information on patients, processes, and equipment, RFIDs can save time and reduce costs while simultaneously improving quality and patient safety. Healthcare leaders owe it to all constituencies to take a serious look at what RFIDs can offer.

Do We Get What We Pay For? Examining the Relationship Between Payments and Clinical Outcomes in High-Volume Elective Surgery in a Commercially-Insured Population.

Studies evaluating the cost and quality of healthcare services have produced inconsistent results. We seek to determine if higher paid hospitals have higher quality outcomes compared to those receiving lower payments, after accounting for clinical and market level factors. Using inpatient commercial claims from the IBM® MarketScan® Research Databases, we used an ordinal logistic regression to analyze the association between hospital median payments for elective hip and knee procedures and 3 quality outcomes: prolonged length of stay, complication rate, and 30-day readmission rate. Patient-level and market factor covariates were appropriately adjusted. Hospital-level payments were found to be not significantly correlated with hospital quality of care. This research suggests that higher payments cannot predict higher quality outcomes. This finding has implications for provider-payer negotiations, value-based insurance designs, strategies to increase high-value care provision, and consumer choices in an increasingly consumer-oriented healthcare landscape.

Achieving Triple Aim Outcomes: An Evaluation of the Texas Medicaid Waiver.

The Texas Medicaid Waiver, via the Delivery System Reform Incentive Payment (DSRIP) program, has provided a path for Texas to achieve the Triple Aim through its focus on a defined population at the project and system levels, and financial payment policy based on outcomes. Both iterations of the DSRIP program (Waiver 1.0 and 2.0) have helped define populations, created regional collaboration that sets the stage for a true integrator, and provided financial incentives for improving population health, enhancing patient experience, and controlling costs. The flexible design of project menus and measure bundles in DSRIP encouraged a variety of projects, numerous measures of success and (often) overlapping populations of individual served to achieve the ultimate goal of the Triple Aim. This research outlines the major features of Texas DSRIP and demonstrates the Medicaid Waiver effectively contributed to measurable improvements in health, suggesting Texas safety net providers are moving closer to Triple Aim achievement.

Do Bundled Payment Programs in Joint Replacement Care Hold Promise for Improving Patient Outcomes?

The Centers for Medicare and Medicaid Services (CMS) Innovation Center offers two alternative payment models for joint replacement: the voluntary Bundled Payment for Care Improvement (BPCI) model and the mandatory Comprehensive Care for Joint Replacement (CJR) model. As CMS considers methods for cost reduction, research is needed to understand patient-level outcomes and organizational-level success factors. A retrospective cross-sectional study of hospitals was performed, using regression models to evaluate an aggregate patient satisfaction score, complication rates, and operational differences among BPCI, CJR, and nonparticipating hospitals. Results show that BPCI hospitals received significantly better patient satisfaction scores (88.6) than CJR hospitals (86.0), but complication rates were not significantly different between CJR and BPCI hospitals (2.83 and 2.77, respectively). Factors associated with BPCI participation include academic affiliation, a Northeast region locale, and having a higher CMS efficiency score. Thus, requiring more hospitals to participate in CMS-bundled payment programs as a federal policy may not be the optimal way to improve patient satisfaction and outcomes. Rather, the CJR and BPCI programs should be further studied, and the results generalized for use by nonparticipating hospitals to encourage preparation and participation in CMS value-based initiatives.

Innovating patient care delivery: DSRIP's interrupted time series analysis paradigm.

INTRODUCTION: Adoption of Medicaid Section 1115 waiver is one of the many ways of innovating healthcare delivery system. The Delivery System Reform Incentive Payment (DSRIP) pool, one of the two funding pools of the waiver has four categories viz. infrastructure development, program innovation and redesign, quality improvement reporting and lastly, bringing about population health improvement. BACKGROUND: A metric of the fourth category, preventable hospitalization (PH) rate was analyzed in the context of eight conditions for two time periods, pre-reporting years (2010-2012) and post-reporting years (2013-2015) for two hospital cohorts, DSRIP participating and non-participating hospitals. The study explains how DSRIP impacted Preventable Hospitalization (PH) rates of eight conditions for both hospital cohorts within two time periods. METHODS: Eight PH rates were regressed as the dependent variable with time, intervention and post-DSRIP Intervention as independent variables. PH rates of eight conditions were then consolidated into one rate for regressing with the above independent variables to evaluate overall impact of DSRIP. An interrupted time series regression was performed after accounting for auto-correlation, stationarity and seasonality in the dataset. RESULTS: In the individual regression model, PH rates showed statistically significant coefficients for seven out of eight conditions in DSRIP participating hospitals. In the combined regression model, the coefficient of the PH rate showed a statistically significant decrease with negative p-values for regression coefficients in DSRIP participating hospitals compared to positive/increased p-values for regression coefficients in DSRIP non-participating hospitals. CONCLUSION AND IMPLICATIONS: Several macro- and micro-level factors may have likely contributed DSRIP hospitals outperforming DSRIP non-participating hospitals. Healthcare organization/provider collaboration, support from healthcare professionals, DSRIP's design, state reimbursement and coordination in care delivery methods may have led to likely success of DSRIP. LEVEL OF EVIDENCE: IV, a retrospective cohort study based on longitudinal data.

A Comparative Analysis of Academic and Nonacademic Hospitals on Outcome Measures and Patient Satisfaction.

Academic hospitals contribute to health care through patient care, research, and teaching; however, their outcomes may not be equivalent to nonacademic hospitals. Multivariate analysis of variance is used to compare publicly reported data on patient satisfaction, readmission rates, mortality rates, and hospital-acquired injury scores between 1906 academic and nonacademic hospitals, while controlling for hospital-level covariates. Results show that academic hospitals have higher levels of patient satisfaction on 7 of the 11 measures and are equivalent to nonacademic hospitals on the remaining 4 measures. Academic hospitals have lower pneumonia mortality rates than nonacademic hospitals, with no difference for other mortality or disease-specific readmissions. However, academic hospitals have a slightly higher overall readmission rate. Infection rates were equivalent between academic and nonacademic hospitals for central line-associated bloodstream infections, pressure ulcers, and wound dehiscence for abdominal and pelvic injuries, but academic hospitals have higher catheter-associated urinary tract infection rates.

Integrating Diverse Disciplines to Enhance Interprofessional Competency in Healthcare Delivery.

Interprofessional education (IPE) typically involves clinical simulation exercises with students from medical and nursing schools. Yet, healthcare requires patient-centered teams that include diverse disciplines. Students from public health and informatics are rarely incorporated into IPE, signaling a gap in current educational practices. In this study, we integrated students from administrative and non-clinical disciplines into traditional clinical simulations and measured the effect on communication and teamwork. From July 2017-July 2018, 408 students from five schools (medicine, nursing, dentistry, public health, and informatics) participated in one of eight three-hour IPE clinical simulations with Standardized Patients and electronic health record technologies. Data were gathered using a pre-test-post-test interventional Interprofessional Collaborative Competency Attainment Survey (ICCAS) and through qualitative evaluations from Standardized Patients. Of the total 408 students, 386 (94.6%) had matched pre- and post-test results from the surveys. There was a 15.9% improvement in collaboration overall between the pre- and post-tests. ICCAS competencies showed improvements in teamwork, communication, collaboration, and conflict management, with an average change from 5.26 to 6.10 (t = 35.16; p < 0.001). We found by creating new clinical simulations with additional roles for non-clinical professionals, student learners were able to observe and learn interprofessional teamwork from each other and from faculty role models.

A current look at the key performance measures considered critical by health care leaders.

The increased focus on health care quality is changing the face of performance measures. Traditional measures of financial performance are being complemented by indicators of satisfaction, medical error rates, infection control ,and more. This study surveyed health care executives to determine the performance indicators considered critical for organizational assessment and improvement. The findings suggest financial measures such as operating profit margin, days cash on hand, charity care, net profit margin, bad dept expense, and days in accounts receivable A/R continue to be critical for health care decision makers. These measures are complemented by non-financial indicators such as physician and employee satisfaction, hospital-acquired infection rates, surgical site infection rates, inpatient mortality, infection control outcomes, and medication error rates. The results of this study underscore the notion that health care administrators are concerned about delivering high-quality effective health care in which both customers and providers are satisfied and which is done in a strong financial environment.