Integrating Social Drivers of Health into Hospital Ratings with Application to the 100 Top Hospitals Study.

The objective was to investigate the relationship between social drivers of health (SDOH) and hospital performance within the 100 Top Hospitals study, exploring methods to recognize hospitals serving marginalized communities. Publicly available data sourced from the Centers for Medicare and Medicaid Services and the 2023 100 Top Hospitals study was used. The study employed multivariable hierarchical generalized linear regression models to assess the association between an SDOH composite variable derived using principal component analysis and overall hospital performance measures within the 100 Top Hospitals study. The analysis revealed a statistically significant association between SDOH factors and study ranking results. The SDOH composite variable is a significant predictor of performance within the 100 Top Hospitals study. Accounting for SDOH is essential to recognize high-performing hospitals serving marginalized communities. The findings suggest a need for broader considerations of SDOH in hospital ranking methodologies across various industry programs.

Trends in the neonatal mortality rate in the last decade with respect to demographic factors and health care resources.

To understand factors contributing to the neonatal mortality rate (NMR), we studied trends in the NMR during 2000 to 2009 with respect to demographic factors and health care resources. Birth- and death-linked mortality data for 14,168 neonatal deaths that occurred between 2000 and 2009 were obtained from the Texas Department of Health and Human Services. Demographic factors and health care resource data were analyzed using analysis of variance, chi-square tests, and linear regression analysis. The average NMR increased from 3.37 in 2000 to 3.77 in 2009. The NMR in blacks ranged from 6.57 to 8.97 during the study period. Among the babies who died, the mean birthweight decreased from 1505 to 1275 g (P < 0.001) and the mean gestational age decreased from 28.4 to 27.8 weeks (P < 0.001). Cesarean section deliveries increased from 32.7% to 44.9% (P < 0.001). The percentage of mothers receiving prenatal care increased from 81.4% to 86.6% (P < 0.001). Mothers with a college education increased from 8.8% to 20.5% (P < 0.001). The median household income increased from $41,047 to $49,189 (P < 0.001). The number of neonatal intensive care unit beds increased from 33.4 to 56 per 10,000 births, and the number of neonatologists increased from 0.27 to 0.40 per 10,000 women of 15 to 44 years of age. In conclusion, the NMR didn't improve despite improvements in demographic factors and health care resources. Racial disparities persist, with a high NMR in the black population. We speculate a possible genetic predisposition related to ethnicity, and a potentially higher rate of extreme prematurity might have contributed to a high NMR in the study population.

Instructions and skill level influence reliability of dual-task performance in young adults.

The purpose of this study was to assess the trial-to-trial repeatability of dual-task performance and establish the minimal detectable change (MDC95) of gait-related dual-task interference. Thirty-one healthy young adults (22.5, SD 2.1 years) performed texting and walking tasks in isolation (single-task) and in combination (dual-task). The dual-task was repeated with three different instructional sets regarding how attention should be prioritized (no-priority, gait-priority, texting-priority) in two different environments (low-distraction, high-distraction). Participants performed two trials for each condition. Trial-to-trial repeatability of gait speed, texting speed, texting accuracy, and the relative dual-task effects (DTE) on each was examined using intraclass correlation coefficients and standard error of measurement. MDC95 scores were also computed for each performance measure. Among young adults, reliability of gait speed in a challenging dual-task situation is excellent, even in a high-distraction environment. In the absence of specific task prioritization instructions, changes in dual-task gait speed greater than 0.15m/s or 11.9% DTE represent real change. Reliability of the more novel, non-gait task has poor to good reliability. Dual-task effects are more reliable when participants are given specific instructions about how to prioritize their attention. The findings also suggest that reliability of dual-task performance in a novel or challenging task is greater when individuals are more skilled at the task. Implications for clinical assessment of dual-task performance are discussed.