Understanding the groups of care transition strategies used by U.S. hospitals: an application of factor analytic and latent class methods.

BACKGROUND: After activation of the Hospital Readmission Reduction Program (HRRP) in 2012, hospitals nationwide experimented broadly with the implementation of Transitional Care (TC) strategies to reduce hospital readmissions. Although numerous evidence-based TC models exist, they are often adapted to local contexts, rendering large-scale evaluation difficult. Little systematic evidence exists about prevailing implementation patterns of TC strategies among hospitals, nor which strategies in which combinations are most effective at improving patient outcomes. We aimed to identify and define combinations of TC strategies, or groups of transitional care activities, implemented among a large and diverse cohort of U.S. hospitals, with the ultimate goal of evaluating their comparative effectiveness. METHODS: We collected implementation data for 13 TC strategies through a nationwide, web-based survey of representatives from short-term acute-care and critical access hospitals (N = 370) and obtained Medicare claims data for patients discharged from participating hospitals. TC strategies were grouped separately through factor analysis and latent class analysis. RESULTS: We observed 348 variations in how hospitals implemented 13 TC strategies, highlighting the diversity of hospitals' TC strategy implementation. Factor analysis resulted in five overlapping groups of TC strategies, including those characterized by 1) medication reconciliation, 2) shared decision making, 3) identifying high risk patients, 4) care plan, and 5) cross-setting information exchange. We determined that the groups suggested by factor analysis results provided a more logical grouping. Further, groups of TC strategies based on factor analysis performed better than the ones based on latent class analysis in detecting differences in 30-day readmission trends. CONCLUSIONS: U.S. hospitals uniquely combine TC strategies in ways that require further evaluation. Factor analysis provides a logical method for grouping such strategies for comparative effectiveness analysis when the groups are dependent. Our findings provide hospitals and health systems 1) information about what groups of TC strategies are commonly being implemented by hospitals, 2) strengths associated with the factor analysis approach for classifying these groups, and ultimately, 3) information upon which comparative effectiveness trials can be designed. Our results further reveal promising targets for comparative effectiveness analyses, including groups incorporating cross-setting information exchange.

Improving evidence-based grouping of transitional care strategies in hospital implementation using statistical tools and expert review.

BACKGROUND: As health systems transition to value-based care, improving transitional care (TC) remains a priority. Hospitals implementing evidence-based TC models often adapt them to local contexts. However, limited research has evaluated which groups of TC strategies, or transitional care activities, commonly implemented by hospitals correspond with improved patient outcomes. In order to identify TC strategy groups for evaluation, we applied a data-driven approach informed by literature review and expert opinion. METHODS: Based on a review of evidence-based TC models and the literature, focus groups with patients and family caregivers identifying what matters most to them during care transitions, and expert review, the Project ACHIEVE team identified 22 TC strategies to evaluate. Patient exposure to TC strategies was measured through a hospital survey (N = 42) and prospective survey of patients discharged from those hospitals (N = 8080). To define groups of TC strategies for evaluation, we performed a multistep process including: using ACHIEVE'S prior retrospective analysis; performing exploratory factor analysis, latent class analysis, and finite mixture model analysis on hospital and patient survey data; and confirming results through expert review. Machine learning (e.g., random forest) was performed using patient claims data to explore the predictive influence of individual strategies, strategy groups, and key covariates on 30-day hospital readmissions. RESULTS: The methodological approach identified five groups of TC strategies that were commonly delivered as a bundle by hospitals: 1) Patient Communication and Care Management, 2) Hospital-Based Trust, Plain Language, and Coordination, 3) Home-Based Trust, Plain language, and Coordination, 4) Patient/Family Caregiver Assessment and Information Exchange Among Providers, and 5) Assessment and Teach Back. Each TC strategy group comprises three to six, non-mutually exclusive TC strategies (i.e., some strategies are in multiple TC strategy groups). Results from random forest analyses revealed that TC strategies patients reported receiving were more important in predicting readmissions than TC strategies that hospitals reported delivering, and that other key co-variates, such as patient comorbidities, were the most important variables. CONCLUSION: Sophisticated statistical tools can help identify underlying patterns of hospitals' TC efforts. Using such tools, this study identified five groups of TC strategies that have potential to improve patient outcomes.

Development and psychometric properties of surveys to assess provider perspectives on the barriers and facilitators of effective care transitions.

BACKGROUND: The quality of the discharge process and effective care transitions between settings of care are critical to minimize gaps in patient care and reduce hospital readmissions. Few studies have explored which care transition components and strategies are most valuable to patients and providers. This study describes the development, pilot testing, and psychometric analysis of surveys designed to gain providers' perspectives on current practices in delivering transitional care services. METHODS: We underwent a comprehensive process to develop items measuring unique aspects of care transitions from the perspectives of the three types of providers (downstream, ambulatory, and hospital providers). The process involved 1) an environmental scan, 2) provider interviews, 3) survey cognitive testing, 4) pilot testing, 5) a Stakeholder Advisory Group, 6) a Scientific Advisory Council, and 7) a collaborative Project ACHIEVE (Achieving Patient-Centered Care and Optimized Health in Care Transitions by Evaluating the Value of Evidence) research team. Three surveys were developed and fielded to providers affiliated with 43 hospitals participating in Project ACHIEVE. Web-based survey administration resulted in 948 provider respondents. We assessed response variability and response missingness. To evaluate the composites' psychometric properties, we examined intercorrelations of survey items, item factor loadings, model fit indices, internal consistency reliability, and intercorrelations between the composite measures and overall rating items. RESULTS: Results from psychometric analyses of the three surveys provided support for five composite measures: 1) Effort in Coordinating Patient Care, 2) Quality of Patient Information Received, 3) Organizational Support for Transitional Care, 4) Access to Community Resources, and 5) Strength of Relationships Among Community Providers. All factor loadings and reliability estimates were acceptable (loadings ≥ 0.40, α ≥ 0.70), and the fit indices showed a good model fit. All composite measures positively and significantly correlated with the overall ratings (0.13 ≤ r ≤ 0.71). CONCLUSIONS: We determined that the items and composite measures assessing the barriers and facilitators to care transitions within this survey are reliable and demonstrate satisfactory psychometric properties. The instruments may be useful to healthcare organizations and researchers to assess the quality of care transitions and target areas of improvement across different provider settings.

Development and psychometric properties of surveys to assess patient and family caregiver experience with care transitions.

BACKGROUND: The purpose of this study was to develop and administer surveys that assess patient and family caregiver experiences with care transitions and examine the psychometric properties of the surveys. The surveys were designed to ask about 1) the transitional care services that matter most to patients and their caregivers and 2) care outcomes, including the overall quality of transitional care they received, patient self-reported health, and caregiver effort/stress. METHODS: Survey items were developed based on a review of the literature, existing surveys, focus groups, site visits, stakeholder and expert input, and patient and caregiver cognitive interviews. We administered mail surveys with telephone follow up to patients recently discharged from 43 U.S. hospitals. Patients identified the caregivers who helped them during their hospital stay (Time 1 caregiver) and when they were home (Time 2 caregiver). Time 1 and Time 2 caregivers were surveyed by telephone only. The psychometric properties of the survey items and outcome composite measures were examined for each of the three surveys. Items that performed poorly across multiple analyses, including those with low variability and/or a high missing data, were dropped except when they were conceptually important. RESULTS: The analysis datasets included responses from 9282 patients, 1245 Time 1 caregivers and 1749 Time 2 caregivers. The construct validity of the three proposed outcome composite measures-Overall Quality of Transitional Care (patient and caregiver surveys), Patient Overall Health (patient survey) and Caregiver Effort/Stress (caregiver surveys) -was supported by acceptable exploratory factor analysis results and acceptable internal consistency reliability. Site-level reliability was acceptable for the two patient outcome composite measures, but was low for Caregiver Effort/Stress (< 0.70). In all surveys, the Overall Quality of Transitional Care outcome composite measure was significantly correlated with other outcome composite measures and most of the single-item measures. CONCLUSIONS: Overall, the final patient and caregiver surveys are psychometrically sound and can be used by health systems, hospitals, and researchers to assess the quality of care transitions and related outcomes. Results from these surveys can be used to improve care transitions, focusing on what matters most to patients and their family caregivers.

Analysis of Thoroughbred horse farm workers' compensation insurance claims in Kentucky: Injury frequency, cost, lost time, and associated occupational factors.

BACKGROUND: Thoroughbred horse farm workers self-report a high frequency of work-related injuries and pain. However, an analysis of Thoroughbred horse farm workers' compensation injury claims is absent from the literature, yet may benefit worker safety. METHODS: We analyzed workers' compensation insurance firm data containing 2276 claims filed between 2008 and 2015. Injury frequency, cost, and lost time per cause, nature, and body part injured were examined qualitatively and via univariate tests. Factors associated with high cost and high duration lost time claims were modeled via multivariable logistic regression. RESULTS: The average Thoroughbred worker claim cost $4,198 and accrued 10 days lost time, involving strikes (57% of total claims), sprains/strains (34%), and wrist/hand injuries (18%). Injuries primarily occurred on mornings (54%), weekdays (79%), and during the transition from breeding to sales (23%). Jobs with a high level of horse contact had significantly higher cost ($6,487) and higher duration lost time (16.8 days) claims, with significantly higher cost claims on the weekends ($6,471) and from the oldest workers ($7466), vs reference groups. Logistic models indicate significantly increased odds of a high-cost injury among high horse contact jobs (OR = 1.87; 95% C.I. = 1.53-2.29) and older age tertiles (1.38; 1.08-1.75; 1.70, 1.32-2.18). The odds of a high duration lost time injury are significantly increased among high horse contact jobs (1.91; 1.53-2.39) and males (1.50, 1.13-1.98), with significantly reduced odds among the most tenured workers (0.74; 0.56-0.99). CONCLUSIONS: Our findings elucidate factors to reduce injury frequency, cost, and lost time among Thoroughbred horse farm workers.

Working under conditions of social vulnerability: Depression among Latina/o immigrant horse workers.

OBJECTIVES: The American agricultural industry is heavily reliant on Latina/o workers, yet there is scant understanding regarding the mental health of this population. This gap in the literature is glaring as Latina/o farmworkers are a highly vulnerable group who experience high rates of occupational risks and health hazards. This study is the first, to our knowledge, to examine individual, social and work-related correlates of depression among Latina/o horse workers. METHOD: A community survey (N = 225) administered by lay health workers was implemented with Latina/o horse workers who were employed in thoroughbred horse farms in Kentucky. Study participants were on average 35 years old (9.6), largely male (85.8%), married (67.6%), dominant Spanish speakers (95.1%), born in Mexico (84.4%), made a modal average hourly wage of $10.24, and had spent an average of 14.5 years in the United States. Hierarchical regression analysis was conducted to examine the association between (a) individual and social factors and (b) work factors with depression. RESULTS: Women (ß = .13, p < .04), and those who reported higher job insecurity (ß = .23, p < .001) and number of days missed due to injury (ß = .20, p < .05) were more likely to report higher depressive symptoms. Work discrimination due to race/ethnicity (ß = .26, p < .001) was distinctly associated to depressive symptoms. CONCLUSIONS: Work-related discrimination was uniquely associated with depressive symptoms independent of the effects of occupational risks and stressors. This may be particularly salient in a rising anti-immigrant national context. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Pulmonary function among Latino thoroughbred horse farmworkers.

BACKGROUND: Latino thoroughbred workers may be at risk for developing abnormal pulmonary function related to occupational exposures. METHODS: Eighty worker participants were recruited via community-based purposive sampling. Questionnaires and spirometry tests were administered by trained lay health promoters. Demographic and occupational factors were assessed for associations with respiratory outcomes via multivariable logistic regression. RESULTS: Twenty-seven percent of participants exhibited abnormal pulmonary function (primarily restrictive), 79% reported any respiratory symptoms, and 94% infrequently used dust masks. Shorter duration of both current horse farm employment (≤5 years) and time living in the United States (≤10 years) increased the odds of abnormal pulmonary function. Shorter time living in the United States increased the odds of upper respiratory symptoms and shorter duration of current horse farm employment increased the odds of lower respiratory symptoms. CONCLUSIONS: Abnormal pulmonary function was high among this vulnerable worker group, suggesting the need for increased dust mask usage and further exposure assessment. Am. J. Ind. Med. 60:35-44, 2017. © 2016 Wiley Periodicals, Inc.

Individual and occupational characteristics associated with respiratory symptoms among Latino horse farm workers.

BACKGROUND: Latino workers are likely exposed to a variety of respiratory hazards in the horse barn, yet the potential impact of these exposures on respiratory health has not been investigated. METHODS: Using a community-based sample of 225 Latino horse farmworkers we investigated the prevalence of upper and lower respiratory symptoms and occupational characteristics associated with them. Multivariable logistic regression was used to identify factors associated with respiratory symptomology. RESULTS: Upper respiratory symptoms prevalence ranged from 24% to 45%. Half of workers reported lower respiratory symptoms. Workers with symptoms were more likely to be female and have lower levels of English understanding. Workers who never/rarely used dust masks while working in the barn experienced over two times the odds of reporting upper respiratory symptoms. CONCLUSIONS: Many Latino horse workers experienced upper and lower respiratory symptoms. Dust mask use may protect workers in this and other enclosed livestock operations from respiratory symptoms.

Using the consolidated framework for implementation research (CFIR) to guide implementation of cardio-oncology services.

Introduction: Cardio-oncology focuses on diagnosing and preventing adverse cardiovascular outcomes in cancer patients. Interdisciplinary cardio-oncology services address the spectrum of prevention, detection, monitoring, and treatment of cancer patients at risk of cardio-toxicity and aim to improve the continuum of cardiac care for oncology patients. The goal of this study was to engage clinician and administrative stakeholders to assess multilevel needs, barriers, and expectations regarding cardio oncology services. Methods: We interviewed clinicians and administrators at an academic medical center using the Consolidated Framework for Implementation Research (CFIR) to understand multilevel determinants influencing cardio-oncology service implementation. We also conducted a web-based survey to assess the knowledge, attitude, and perceptions of cardio-oncology services held by local and regional clinicians who may refer cardio-oncology patients to the study site. Results: Multiple facilitators to cardio-oncology service implementation emerged. Interview participants believed cardio-oncology services could benefit patients and the organization by providing a competitive advantage. A majority (74%) of clinicians surveyed thought a cardio-oncology service would significantly improve cancer patients' prognoses. Implementation barriers discussed included costs and a siloed organizational structure that complicated cross-service collaboration. In the clinician survey, differences in the views toward cardio-oncology services held by cardiology versus oncology providers would need to be negotiated in future cardio-oncology service development. For example, while most providers accepted similar risk of cardio-toxicity when consenting patients for cancer therapy in a curative setting, cardiologists accepted significantly higher levels of risk than oncologists in an incurable setting: 75% of oncologists accepted 1-5% risk; 77% of cardiologists accepted ≥5% risk). Conclusions: Participants supported implementation and development of cardio-oncology services. Respondents also noted multi-level barriers that could be addressed to maximize the potential for success. Engaging administrators and clinicians from cardiology and oncology disciplines in the future development of such services can help ensure maximal relevance and uptake.

Co-designing and piloting educational materials with patients and healthcare providers for syncope in the emergency department.

Objective: The purpose of this study was to identify barriers and design interventions to promote adherence to 2017 Guideline for Syncope Evaluation and Management. Methods: Focus groups and interviews were conducted to understand preferences, needs and barriers from patients and providers. Educational materials for patients were developed following a co-design, iterative process with patients, providers and hospital staff. The academic medical center's (AMC) Patient Education Department and Patient & Family Advisory Council reviewed materials to ensure health literacy. We piloted usability and feasibility of delivering the materials to a small cohort of patients. Results: From Feb to March 2020, 24 patients were asked to watch the video. Twenty-two watched the intake video; of those 8 watched the discharge video. 95% of participants found the intake video informational and 86% would recommend it to others; 100% found the discharge video informational and would recommend it to others. Patients who watched both videos reported the videos improved their overall stay. Conclusion: Our study described a patient-clinician-researcher codesign process and demonstrated feasibility of tools developed to communicate risk and uncertainty with patients and facilitate shared decision making in syncope evaluation. Innovation: Engaging end users in developing interventions is critical for sustained practice change.

Information exchange among providers and patient-centeredness in transitional care: A five-year retrospective analysis.

BACKGROUND: Responding to the shift toward value-based care, hospitals engaged in widespread experimentation of implementing transitional care (TC) strategies to improve patient experience and reduce unnecessary readmissions. However, which groups of these strategies are most strongly associated with better outcomes remains unknown. METHODS: Using a retrospective longitudinal design, we collected hospitals' TC strategy implementation data for 370 U S. hospitals and obtained claims data for 2.4 million Medicare fee-for-service beneficiaries hospitalized at them from 2009 to 2014. We applied estimated mixed-effects regression models controlling for patient, hospital, and community covariates to assess relationships between TC strategy groups and trends in hospitals' 30-day hospital readmissions, with observation stay and mortality rates as secondary outcomes. RESULTS: Hospitals' adoption of TC groups was associated with higher readmission rates at baseline and larger readmission rate reductions compared to not adopting any of 5 TC groups. The TC group including timely information exchange across care settings, engaging patients and caregivers in education, and/or identifying and addressing patients' transition needs was associated with the largest reductions. Hospitals not implementing any of the 5 TC groups had higher mortality rates and lower observation stay rates throughout the study period. CONCLUSIONS: Our findings suggest that timely information sharing among providers across the care continuum and engaging patients in discharge planning and education may correspond with reduced readmissions. IMPLICATIONS: Our research suggests that hospitals responded to shifts in policy by implementing a diversity of TC strategy combinations; it also provides guidance regarding which combinations of TC strategies corresponded with larger readmission reductions.

Effects of Different Transitional Care Strategies on Outcomes after Hospital Discharge-Trust Matters, Too.

BACKGROUND: As health systems shift toward value-based care, strategies to reduce readmissions and improve patient outcomes become increasingly important. Despite extensive research, the combinations of transitional care (TC) strategies associated with best patient-centered outcomes remain uncertain. METHODS: Using an observational, prospective cohort study design, Project ACHIEVE sought to determine the association of different combinations of TC strategies with patient-reported and postdischarge health care utilization outcomes. Using purposive sampling, the research team recruited a diverse sample of short-term acute care and critical access hospitals in the United States (N = 42) and analyzed data on eligible Medicare beneficiaries (N = 7,939) discharged from their medical/surgical units. Using both hospital- and patient-reported TC strategy exposure data, the project compared patients "exposed" to each of five overlapping groups of TC strategies to their "control" counterparts. Primary outcomes included 30-day hospital readmissions, 7-day postdischarge emergency department (ED) visits and patient-reported physical and mental health, pain, and participation in daily activities. RESULTS: Participants averaged 72.3 years old (standard deviation =10.1), 53.4% were female, and most were White (78.9%). Patients exposed to one TC group (Hospital-Based Trust, Plain Language, and Coordination) were less likely to have 30-day readmissions (risk ratio [RR], 0.72; 95% confidence interval [CI] = 0.57-0.92, p < 0.001) or 7-day ED visits (RR, 0.72; 95% CI, 0.55-0.93, p < 0.001) and more likely to report excellent physical and mental health, greater participation in daily activities, and less pain (RR ranged from 1.11 to 1.15, p < 0.01). CONCLUSION: In concert with care coordination activities that bridge the transition from hospital to home, hospitals' clear communication and fostering of trust with patients were associated with better patient-reported outcomes and reduced health care utilization.

"Passing Out is a Serious Thing": Patient Expectations for Syncope Evaluation and Management.

PURPOSE: Syncope is a complex symptom requiring thoughtful evaluation. The ACC/AHA/HRS published syncope management guidelines in 2017. Effective guideline implementation hinges on overcoming multilevel barriers, including providers' perceptions that patients prefer aggressive diagnostic testing when presenting to the emergency department (ED) with syncope, which conflicts with the 2017 Guideline on Syncope. To better understand this perceived barrier, we explored patient and family caregiver expectations and preferences when presenting to the ED with syncope. PATIENTS AND METHODS: We conducted semi-structured focus groups (N=12) and in-depth interviews (N=19) with patients presenting to the ED with syncope as well as with their family caregivers. Interviews were recorded, transcribed verbatim, and analyzed by a team of researchers following a directed content analysis. Results were reviewed and shared iteratively with all team members to confirm mutual understanding and agreement. RESULTS: Syncope patients and caregivers discussed three main desires when presenting to the ED with syncope: 1) clarity regarding their diagnosis,; 2) context surrounding their care plan and diagnostic approach; and 3) to feel seen, heard and cared about by their health care team. CONCLUSION: Clinicians have cited patient preferences for aggressive diagnostic testing as a barrier to adhering to the 2017 Guideline on Syncope, which recommends against routine administration of imaging testing (eg, echocardiograms). Our results suggest that while participants preferred diagnostic testing as a means to achieve clarity and even a feeling of being cared for, other strategies, such as a patient-engaged approach to communication and shared decision-making, may address the spectrum of patient expectations when presenting to the ED with syncope while adhering to guideline recommendations.

Evaluating the clinical dyad leadership model: a narrative review.

PURPOSE: Dyadic leadership models, in which two professionals jointly lead and share unit responsibilities, exemplifies a recent trend in health care. Nonetheless, much remains unknown about their benefits and drawbacks. In order to understand their potential impact, we conducted a review of literature evaluating dyad leadership models in health systems. DESIGN/METHODOLOGY/APPROACH: Our narrative review began with a search of PubMed, CINAHL, Web of Science and Scopus using key terms related to dyads and leadership. The search yielded 307 articles. We screened titles/abstracts according to these criteria: (1) focus on dyadic leadership model, i.e. physician-nurse or clinician-administrator, (2) set in health care environment and (3) peer-reviewed with an evaluative component of dyadic model. This yielded 22 articles for full evaluation, of which six were relevant for this review. FINDINGS: These six articles contribute an assessment of (1) teamwork and communication perceptions and their changes through dyad implementation, (2) dyad model functionality within the health system, (3) lessons learned from dyad model implementation and (4) dyad model adoption and model fidelity. RESEARCH LIMITATIONS/IMPLICATIONS: Research in this area remains nascent, and most articles focused on implementation over evaluation. It is possible that some articles were excluded due to our methodology, which excluded nonEnglish articles. PRACTICAL IMPLICATIONS: Findings provide guidance for health care organizations seeking to implement dyadic leadership models. Rigorous studies are needed to establish the impact of dyadic leadership models on quality and patient outcomes. ORIGINALITY/VALUE: This review consolidates evidence surrounding the implementation and evaluation of a leadership model gaining prominence in health care.

Associations of Work Stress, Supervisor Unfairness, and Supervisor Inability to Speak Spanish with Occupational Injury among Latino Farmworkers.

Little is known about how psychosocial work factors such as work stress, supervisor fairness, and language barriers affect risk of occupational injury among Latino farmworkers. This study attempts to address these questions. Surveys were administered via interviews to 225 Latino thoroughbred farmworkers. Multivariable logistic regression analyses were performed to calculate odds ratios (OR) and 95% confidence intervals (CI) of occupational injury in the past year in relation to occupational characteristics. Work stress (OR 6.70, 95% CI 1.84-24.31), supervisor unfairness (OR 3.34, 95% CI 1.14-9.73), longer tenure at farm (OR 2.67, 95% CI 1.13-6.34), and supervisor inability to speak Spanish (OR 2.29, 95% CI 1.05-5.00) were significantly associated with increased odds of occupational injury. Due to the associations between work stress, supervisor unfairness, supervisor inability to speak Spanish and injury, supervisor training to improve Spanish language ability and equitable management practices is merited. Future research is needed to understand the antecedents of work stress for Latino farmworkers.

Occupational exposures and associated risk factors among U.S. casino workers: a narrative review.

We conducted a narrative literature review of U.S. casino occupational health and safety research based on the following inclusion criteria: 1) focused on workers, 2) provided information pertaining to exposures present in the occupational environment (e.g., hazards, stressors, etc.), and 3) pertained to casino, gaming, or gambling workers. Following a multi-step process, a total of 11 articles were identified that related to the occupational health and safety of U.S. casino workers. These articles primarily focused on environmental tobacco smoke (ETS) exposures (n = 7 articles), with the remaining articles related to casino worker risk behaviors (i.e., problem gambling and drinking) (n = 2), and psychosocial stressors (n = 2). Our results demonstrate that the overwhelming consensus in the literature is that ETS leads to high respirable particulate matter (PM2.5), tobacco toxin levels and exposures among gaming employees. Our results also suggest that harassment, low autonomy at work, and unsafe work conditions may be of concern, especially for female workers. We identified major gaps in the casino worker occupational safety literature including a lack of studies that evaluated noise exposure, injury data, ergonomics, psychosocial hazards, or long term respiratory health outcomes related to ETS exposure. Future research regarding the occupational safety and health of U.S. casino workers should address these gaps in the literature.

Poor safety climate, long work hours, and musculoskeletal discomfort among Latino horse farm workers.

This study investigated the prevalence of self-reported musculoskeletal discomfort (MSD) and work-related factors associated with elevated MSD among Latino thoroughbred farm workers. Participants (N = 225) were recruited using a community-based purposive sampling approach to participate in in-person interviews. Of these workers, 85% experienced MSD. MSD was divided into tertiles; the upper tertile was defined as elevated. Multivariable Poisson regression revealed associations between any elevated MSD and longer tenure on horse farms, longer work hours, and poor safety climate. Elevated neck/back MSD was associated with longer tenure, longer work hours, and poor safety climate. Elevated upper extremity MSD was associated with age and poor safety climate. Elevated lower extremity MSD was associated with longer tenure, longer work hours, and being female. Musculoskeletal discomfort is common among these workers. Improving safety climate and minimizing long work hours is recommended.

From the Horse Worker's Mouth: A Detailed Account of Injuries Experienced by Latino Horse Workers.

Horse breeding farms are hazardous. Yet, little is known about the injuries of Latino horse workers. This study assesses Latino horse workers' injury prevalence, describes their injuries, and analyzes differences between injuries receiving medical versus those receiving first aid care. Data were gathered from 225 Latino thoroughbred workers via a community-based purposive sampling strategy. Questions included injury experiences in the past year and details about each person's two most severe injuries. Univariate and bivariate analyses were conducted. Nearly half of workers experienced an injury in the past year, often involving a horse. Bruises and sprains/strains were most common, as were injuries to upper/lower appendages. Head/face injuries more often resulted in medical care. The injury burden in this Latino worker population is high. Personal protective equipment (PPE) and training is advised due to the high prevalence of horse-related injuries. Future research should investigate aspects of the work environment that may influence injury risk.

Occupational health among Latino horse and crop workers in Kentucky: the role of work organization factors.

Agriculture is a dangerous industry often reliant on Latino workers, a vulnerable population. Using a work organization framework, this cross-sectional study analyzes the relationship between work organization variables and the occupational health of Latino crop (n = 49) and horse breeding (n = 54) workers in Kentucky. Increased levels of abusive supervision were associated with occupational injury (odds ratio [OR] = 2.97; 95% confidence interval [CI]: 1.0-8.77) and increased awkward postures were associated with occupational illness (OR = 3.85; 95% CI: 1.06-13.98). Although not statistically significant, abusive supervision increased the odds and a high safety climate score decreased the odds of injury, illness, and missed work. These findings suggest that the supervisor-subordinate relationship may play a critical role in the occupational health of Latino farmworkers.