Examining the relationship between self-reported lifetime cancer diagnosis and nativity: findings from the National Health and Nutrition Examination Survey (NHANES) 2011-2018.

PURPOSE: Cancer incidence in the USA remains higher among certain groups, regions, and communities, and there are variations based on nativity. Research has primarily focused on specific groups and types of cancer. This study expands on previous studies to explore the relationship between country of birth (nativity) and all cancer site incidences among USA and foreign-born residents using a nationally representative sample. METHODS: This is a cross-sectional study of (unweighted n = 22,554; weighted n = 231,175,933) participants between the ages of 20 and 80 from the National Health and Nutrition Examination Survey (NHANES) 2011-2018. Using weighted logistic regressions, we analyzed the impact of nativity on self-reported cancer diagnosis controlling for routine care, smoking status, overweight, race/ethnicity, age, and gender. We ran a partial model, adjusting only for age as a covariate, a full model with all other covariates, and stratified by race/ethnicity. RESULTS: In the partial and full models, our findings indicate that US-born individuals were more likely to report a cancer diagnosis compared to their foreign-born counterparts (OR 2.34, 95% CI [1.93; 2.84], p < 0.01) and (OR 1. 39, 95% CI [1.05; 1.84], p < 0.05), respectively. This significance persisted only among non-Hispanic Blacks when stratified by race. Non-Hispanic Blacks who were US-born were more likely to report a cancer diagnosis compared to their foreign-born counterparts (OR 2.30, 95% [CI 1.31; 4.02], p < 0.05). CONCLUSION: A variety of factors may reflect lower self-reported cancer diagnosis in foreign-born individuals in the USA other than a healthy immigrant advantage. Future studies should consider the factors behind the differences in cancer diagnoses based on nativity status, particularly among non-Hispanic Blacks.

Pilot study of a culturally sensitive intervention to promote genetic counseling for breast cancer risk.

BACKGROUND: Despite the benefits of genetic counseling and testing, uptake of cancer genetic services is generally low and Black/African American (Black) women are substantially less likely to receive genetic services than non-Hispanic White women. Our team developed a culturally sensitive, narrative decision aid video to promote uptake of genetic counseling among Black women at risk for a hereditary breast cancer syndrome that can be incorporated in conjunction with population-based cancer risk assessment in a clinical setting. We report here a pilot study to demonstrate changes in intention to access genetic counseling and intervention satisfaction. METHODS: Black women who were personally unaffected by breast cancer and were recommended for genetic counseling based on family history screening in a mammography center were recruited at the time of the mammogram. A prospective, pre-post survey study design, guided by theoretical constructs, was used to evaluate baseline and immediate post-intervention psychosocial factors, including intention to participate in genetic counseling and intervention satisfaction. RESULTS: Pilot recruitment goals were met (n = 30). Pre-intervention, 50% of participants indicated that they were extremely likely to make a genetic counseling appointment, compared with 70% post-intervention (p = 0.05). After watching the intervention, 50% of participants indicated that the video changed their mind regarding genetic counseling. CONCLUSIONS: This study demonstrated cultural satisfaction with a decision aid intervention designed to motivate Black women with hereditary breast cancer risk to attend a genetic counseling appointment. Our study showed that intention may be a specific and key construct to target in interventions designed to support decision-making about genetic services. Study results informed the design of a subsequent large scale, randomized implementation study. TRIAL REGISTRATION: Trial registration: Clinicaltrials.gov NCT04082117 . Registered September 9, 2019. Retrospectively registered.

Adverse childhood experiences and mental health conditions among multiracial adolescents.

OBJECTIVE: The objective of this study was to verify the factor structure of the household dysfunction type of ACE using data from the National Survey of Children's Health (NSCH), and then examine whether household dysfunction (measured as a latent construct) was associated with mental health conditions among multiracial adolescents. DESIGN: We used cross-sectional data collected in 2016 from caregivers who completed the NSCH and analyzed data from a subpopulation of adolescents (12-17) who reported more than one race (n = 1,231). Mplus 8.4 was used to conduct confirmatory factor analysis and probit models from a structural equation modeling framework. RESULTS: Results from this study indicated that the household dysfunction type of ACE, as a latent construct, had good model fit and was significantly associated with depression [standardized coefficient [B] = .50, 95% confidence interval [CI] .36, .65], anxiety [B = .61, 95% CI .48, .73], behavior problems [B = .58, 95% CI .44, .72], and ADHD [B = .54, 95% CI .38, .69] for multiracial adolescents. CONCLUSIONS: Household dysfunction may result in adolescents being separated (physically or emotionally) from their caregivers, which may hinder adolescents' ability to establish or maintain one of the most important relationships needed to promote racial/ethnic identity development and mental health. Implications for advancements in theory and NSCH are presented.

Association of Electronic Health Record Vendors With Hospital Financial and Quality Performance: Retrospective Data Analysis.

BACKGROUND: Electronic health records (EHRs) are a central feature of care delivery in acute care hospitals; however, the financial and quality outcomes associated with system performance remain unclear. OBJECTIVE: In this study, we aimed to evaluate the association between the top 3 EHR vendors and measures of hospital financial and quality performance. METHODS: This study evaluated 2667 hospitals with Cerner, Epic, or Meditech as their primary EHR and considered their performance with regard to net income, Hospital Value-Based Purchasing Total Performance Score (TPS), and the unweighted subdomains of efficiency and cost reduction; clinical care; patient- and caregiver-centered experience; and patient safety. We hypothesized that there would be a difference among the 3 vendors for each measure. RESULTS: None of the EHR systems were associated with a statistically significant financial relationship in our study. Epic was positively associated with TPS outcomes (R2=23.6%; ß=.0159, SE 0.0079; P=.04) and higher patient perceptions of quality (R2=29.3%; ß=.0292, SE 0.0099; P=.003) but was negatively associated with patient safety quality scores (R2=24.3%; ß=-.0221, SE 0.0102; P=.03). Cerner and Epic were positively associated with improved efficiency (R2=31.9%; Cerner: ß=.0330, SE 0.0135, P=.01; Epic: ß=.0465, SE 0.0133, P<.001). Finally, all 3 vendors were associated with positive performance in the clinical care domain (Epic: ß=.0388, SE 0.0122, P=.002; Cerner: ß=.0283, SE 0.0124, P=.02; Meditech: ß=.0273, SE 0.0123, P=.03) but with low explanatory power (R2=4.2%). CONCLUSIONS: The results of this study provide evidence of a difference in clinical outcome performance among the top 3 EHR vendors and may serve as supportive evidence for health care leaders to target future capital investments to improve health care delivery.

Competency assessment of an undergraduate program using a third-party, objective pre-post examination.

BACKGROUND: Assessing competencies or program learning outcomes in educational programs is often a leadership challenge. This case study reports medical education program's efforts to document undergraduate competency attainment using a pre-post, third-party, objective testing service that allows for inter-university comparison, a testing service that is being adopted by some certification and accrediting bodies. METHODS: Students completed a pre-test after program acceptance and a post-test at the end of the last didactic semester (1.5 years later) just prior to their required internships. Scores and subscores were evaluated using t-tests (Holm-adjusted p-values). MANOVA models of sub-competency difference scores were also evaluated. RESULTS: Results indicate competency improvement for each of the 12 areas based on the n = 55 student sample, (p < .001 for all scores). These improvements were independent of ethnicity, age, gender, and grades. The average student improved by 12.85 points (95% CI of 10.52 to 15.18) with the largest improvements in strategic planning and leadership competency areas (21.30 and 18.33 percentage points, respectively). CONCLUSIONS: The third-party pre-post has some face validity given that student performance improved after completing a related curriculum as would be expected. Congruent with earlier studies, we find that repeated testing helps document competency attainment and that a single method for assessment is insufficient. We further document limitations of this 3d-party exam.

The impact of public hospitals' privatization on nurse staffing.

BACKGROUND: Privatization is one of the strategies that public hospitals may adopt to remain competitive. Privatized hospitals may implement nurse staffing cuts as a cost-saving mechanism and to increase financial performance. A better understanding of how privatization may affect nurse staffing is important given its association with patient and organizational outcomes. PURPOSE: The aim of this study was to examine the impact of not-for-profit (NFP) and for-profit (FP) privatizations of public hospitals on nurse staffing. METHODOLOGY/APPROACH: Based on secondary data sets from the American Hospital Association Annual Survey, the Centers for Medicare & Medicaid Services Impact Files, and the Area Health Resources File, this study used a nonexperimental longitudinal design consisting of negative binomial and linear regression models with hospital level and year fixed effects. Our sample consisted of nonfederal and noncritical access, acute care, public hospitals (n = 492) followed from 1997 to 2013 (8,335 hospital-year observations). Nurse staffing was measured as full-time equivalents (FTEs) and skill mix. Privatization was defined as conversion from public to either private NFP or private FP status. RESULTS: FP privatization was associated with greater decreases in registered nurse (RN) staffing FTEs (incidence rate ratio [IRR] = 0.93, p = .004) and total nurse staffing FTEs (IRR = 0.93, p = .001), compared with NFP privatization: RN staffing FTEs (IRR = 0.95, p = .003) and total nurse staffing FTEs (IRR = 0.96, p = .007). CONCLUSION: Overall, privatization was associated with decreased RN FTEs and total nurse staffing FTEs and no changes in licensed practical nurse FTEs and RN skill mix. PRACTICE IMPLICATIONS: A close monitoring of nurse staffing level, after privatization, is encouraged to prevent potential deterioration in quality of care.

Hospitals' use of hospitalists: Implications for financial performance.

BACKGROUND: Hospitalists, or physicians specializing in hospital-based practice, have grown significantly since they were first introduced in the United States in the mid-1990s. Prior studies on the impact of hospitalists have focused on costs and length of stay. However, there is dearth of research exploring the relationship between hospitals' use of hospitalists and organizational performance. PURPOSE: Using a national longitudinal sample of acute care hospitals operating in the United States between 2007 and 2014, this study explores the impact of hospitalists staffing intensity on hospitals' financial performance. METHODOLOGY: Data sources for this study included the American Hospital Association Annual Survey, the Area Health Resources File, and the Centers for Medicare & Medicaid Services' costs reports and Case Mix Index files. Data were analyzed using a panel design with facility and year fixed effects regression. RESULTS: Results showed that hospitals that switched from not using hospitalists to using a high hospitalist staffing intensity had both increased patient revenues and higher operating costs per adjusted patient day. However, the higher operating costs from high hospitalist staffing intensity were offset by increased patient revenues, resulting in a marginally significant increase in operating profitability (p < .1). PRACTICE IMPLICATIONS: These findings suggest that the rise in the use of hospitalists may be fueled by financial incentives such as increased revenues and profitability in addition to other drivers of adoption.

Public hospitals in financial distress: Is privatization a strategic choice?

BACKGROUND: As safety net providers, public hospitals operate in more challenging environments than private hospitals. Such environments put public hospitals at greater risk of financial distress, which may result in privatization and deterioration of the safety net. PURPOSE: The purpose of this study was to investigate whether financial distress is associated with privatization among public hospitals. METHODOLOGY/APPROACH: We used panel data merged from the American Hospital Association Annual Survey, Medicare Cost Reports, Area Resource File, and Local Area Unemployment Statistics. Our study population consisted of all U.S. nonfederal acute care public hospitals in 1997 tracked through 2009, resulting in 6,426 hospital-year observations. The dependent variable "privatization" was defined as conversion from public status to either private not-for-profit or private for-profit status. The main independent variable, "financial distress," was based on the Altman Z-score methodology. Control variables included market and organizational factors. Two random-effects logistic regression models with state and year fixed-effects were constructed. The independent and control variables were lagged by 1 year and 2 years for Models 1 and 2, respectively. FINDINGS: Public hospitals in financial distress had greater odds of being privatized than public hospitals not in financial distress: (OR = 4.53, p < .001) for Model 1 and (OR = 3.05, p = .001) for Model 2. PRACTICE IMPLICATIONS: Privatization eases access to resources and may provide financial relief to government entities from the burden of continuously funding a hospital operating at a loss, which in turn may help keep the hospital open and preserve access to care for the community. Privatizing a financially distressed public hospital may be a better strategic alternative than closure. The Altman Z-score could be used as a managerial tool to monitor hospitals' financial condition and take corrective actions.

Acupuncture Use in the United States: Who, Where, Why, and at What Price?

Despite the increase in acupuncture uses and greater than ever before interest of funding agencies to fund biomedical research in acupuncture, little is known about the profile of acupuncture users. We examined who these individuals are, where they reside, why they use acupuncture, and what price they pay. The increased use and high costs associated with each acupuncture visit poses questions to health care insurers regarding its coverage. Profiling will help conventional providers identify the segment of the population who are more likely to use acupuncture and educate them on the possible risks and benefits of using it with conventional medicine.

The Determinants of Medical Tourism Intentions: Applying the Theory of Planned Behavior.

This study introduces the theory of planned behavior to health care marketers by extending and replicating a prior study that predicted student's intention to engage in medical tourism. Based on a sample of 164 usable survey responses, our findings suggested that the MEDTOUR scale (developed and introduced a prior study) is robust and works reasonably well with a national sample. Based on these findings, MEDTOUR appears to be worthy of further consideration by health marketing scholars.

Public hospitals in peril: factors associated with financial distress.

As "safety net providers," public hospitals have played a major role in health care delivery, especially in serving the indigent and the uninsured. For several decades, public hospitals have been operating in a challenging environment, and some of them have experienced financial difficulties. The purpose of this study was to explore the organizational and environmental factors associated with public hospitals' financial distress. This study used a national sample of public hospitals based on longitudinal panel data from 1997 to 2009, resulting in a sample size of 7,257 hospital-year observations. The Altman Z-score method was applied to assess hospitals' financial condition. The significant findings from a random effects logistic regression model with state and year fixed-effects indicated that higher Medicare HMO penetration was associated with financial distress. Organizational variables such as health network, size, occupancy rate, and outpatient mix decreased the odds of financial distress; and membership in a multihospital system increased the odds of financial distress.

Factors Associated with Early and Periodic Screening, Diagnostic, and Treatment Services in a Medicaid Managed Care Pediatric Population.

Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services is a Medicaid benefit for children that addresses their health problems before they become advanced, debilitating, and expensive. We conducted a retrospective cross-sectional analysis of pediatric beneficiaries (newborn to younger than 21 years) enrolled in a Medicaid managed care organization to examine the factors associated with EPSDT screening services completion. We obtained 2018 administrative claims data for beneficiaries continuously enrolled for a minimum of 90 days (n=156,108). Completion of EPSDT screening services among our Medicaid managed care beneficiaries was low. Those having more emergency department visits and hospitalizations, having family medicine practitioners as primary care physicians, belonging to the racial/ethnic group Asian/Pacific Islander/Hawaiian/Alaskan Native/Native American, and 18 to younger than 21 years age group were less likely than others to complete EPSDT services. Our results provide information on segments of pediatric beneficiaries that can be targeted to increase EPSDT screening services completion.

Examining the Effect of Contactless Intergenerational Befriending Intervention on Social Isolation Among Older Adults and Students' Attitude Toward Companionship: Content Analysis.

BACKGROUND: Intergenerational friendship, a mechanism of social support, is an effective intervention to reduce the increasing risk of social isolation (SI) and develop companionship in the older adult population. The COVID-19 pandemic provided a unique opportunity to examine the psychosocial intervention of befriending via technology use as a primary form of contactless socialization. OBJECTIVE: The study aims to explore the effectiveness of the befriending intervention through a contactless, intergenerational service-learning project on older adult emotions, especially boredom and loneliness as the key attributes of SI, and on students' attitude toward companionship. METHODS: During the months of January to April 2022 , undergraduate students enrolled in a health administration course with a special focus on culture were asked to be involved in a contactless, intergenerational service-learning project (n=46). In this study, contactless intervention meant communication using the telephone and apps such as FaceTime and Zoom. Students were paired with older adults to have at least a 30-minute weekly conversation, for 8 weeks, via telephone or an internet-based app such as FaceTime. Students were asked to write a half-page diary after each interaction and a 1-page reflection at the end of the fourth week and at the end of the service-learning project. At the completion of the project, the researchers also surveyed the older adults to assess the impact of the project using a 5-item open-ended questionnaire. Following a heuristic approach and content analysis, student artifacts (110,970 words; 118-page, single-spaced Microsoft Word document) and the older adult surveys were analyzed using MAXQDA, (VERBI GmbH). Qualitative data were extracted to assess the impact of service learning on SI by measuring the attributes of boredom and loneliness among 46 older adults. Students' attitudes toward companionship were also assessed using data from their diaries and reflections. RESULTS: Overall, three major constructs were identified: (1) meaningful engagement, defined as feeling safe, having increased confidence, and having reduced boredom; (2) internal motivation to participate in the weekly interaction, defined as discussion about daily life experience, level of happiness, and ability to exert personal control over the situation; and (3) intergenerational befriending, defined as perceived benefits from the friendly nature of the interaction, ability to comfortably connect with students, and positive feeling and attitude toward the student. CONCLUSIONS: The contactless, intergenerational befriending intervention reduced boredom and loneliness among older adults and enhanced positive attitude and confidence among university students. Students helped older adults to develop digital skills for the use of apps and social media. Older adults showed interest in the intervention and shared their daily life experiences with the students, which helped to reduce the gap between generations. Findings indicate the effectiveness of an intergenerational service-learning intervention on SI reduction and increased positive attitude among college students.

When Agency Fails: An Analysis of the Association Between Hospital Agency Staffing and Quality Outcomes.

Introduction: Staffing is critical to hospital quality, but recent years have seen hospitals grappling with severe shortages, forcing them to rely on contract or agency staff for urgent patient care needs. This shift in staffing mix has raised questions about its impact on quality. Consequently, this study investigated whether the increased use of agency staff has affected healthcare quality in hospitals. Given the limited recent research on this topic, practitioners remain uncertain about the effectiveness of their staffing strategies and their potential impact on quality. Methods: Drawing from agency theory, data were obtained from Definitive Healthcare which consolidates information from numerous public access databases pertaining to hospitals such as the American Hospital Association Annual Survey (hospital profile) and the Hospital Value-Based Purchasing Program (quality data). We conducted a cross-sectional study using a multivariable linear regression model (2021-2022) with appropriate organizational and market- level control variables. Quality was measured across eight variables while the independent variable of interest was agency labor cost ratio operationalized as the percentage of net patient revenue consumed by agency labor expense. Results: Our results suggested that the employment of agency staff was significantly and negatively associated with six of eight quality measures tested, including the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) star rating, Hospital Compare rating, the hospital Total Performance Score (TPS), and three of the four sub-domains that comprise the TPS: clinical domain score, person and community engagement domain score, and the efficiency and cost reduction score. Discussion: Our results indicated that the increased use of agency labor may have a significant negative influence on quality outcomes at the hospital level. Our findings support the premise that interventions that promote full-time staffing may be more supportive of the quality of care delivered as well as patients' perceptions of care.

Systematic Review and Meta-Analysis of the Financial Impact of 30-Day Readmissions for Selected Medical Conditions: A Focus on Hospital Quality Performance.

BACKGROUND: The Patient Protection and Affordable Care Act (ACA) established the Hospital Quality Initiative in 2010 to enhance patient safety, reduce hospital readmissions, improve quality, and minimize healthcare costs. In response, this study aims to systematically review the literature and conduct a meta-analysis to estimate the average cost of procedure-specific 30-day risk-standardized unplanned readmissions for Acute Myocardial Infarction (AMI), Heart Failure (HF), Pneumonia, Coronary Artery Bypass Graft (CABG), and Total Hip Arthroplasty and/or Total Knee Arthroplasty (THA/TKA). METHODS: Eligibility Criteria: This study included English language original research papers from the USA, encompassing various study designs. Exclusion criteria comprise studies lacking empirical evidence on hospital financial performance. INFORMATION SOURCES: A comprehensive search using relevant keywords was conducted across databases from January 1990 to December 2019 (updated in March 2021), covering peer-reviewed articles and gray literature. Risk of Bias: Bias in the included studies was assessed considering study design, adjustment for confounding factors, and potential effect modifiers. SYNTHESIS OF RESULTS: The review adhered to PRISMA guidelines. Employing Monte Carlo simulations, a meta-analysis was conducted with 100,000 simulated samples. Results indicated mean 30-day readmission costs: USD 16,037.08 (95% CI, USD 15,196.01-16,870.06) overall, USD 6852.97 (95% CI, USD 6684.44-7021.08) for AMI, USD 9817.42 (95% CI, USD 9575.82-10,060.43) for HF, and USD 21,346.50 (95% CI, USD 20,818.14-21,871.85) for THA/TKA. DISCUSSION: Despite the financial challenges that hospitals face due to the ACA and the Hospital Readmissions Reduction Program, this meta-analysis contributes valuable insights into the consistent cost trends associated with 30-day readmissions. CONCLUSIONS: This systematic review and meta-analysis provide comprehensive insights into the financial implications of 30-day readmissions for specific medical conditions, enhancing our understanding of the nexus between healthcare quality and financial performance.

The effect of COVID-19 on cancer incidences in the U.S.

Fundamental data analysis assists in the evaluation of critical questions to discern essential facts and elicit formerly invisible evidence. In this article, we provide clarity into a subtle phenomenon observed in cancer incidences throughout the time of the COVID-19 pandemic. We analyzed the cancer incidence data from the American Cancer Society [1]. We partitioned the data into three groups: the pre-COVID-19 years (2017, 2018), during the COVID-19 years (2019, 2020, 2021), and the post-COVID-19 years (2022, 2023). In a novel manner, we applied principal components analysis (PCA), computed the angles between the cancer incidence vectors, and then added lognormal probability concepts in our analysis. Our analytic results revealed that the cancer incidences shifted within each era (pre, during, and post), with a meaningful change in the cancer incidences occurring in 2020, the peak of the COVID-19 era. We defined, computed, and interpreted the exceedance probability for a cancer type to have 1000 incidences in a future year among the breast, cervical, colorectal, uterine corpus, leukemia, lung & bronchus, melanoma, Hodgkin's lymphoma, prostate, and urinary cancers. We also defined, estimated, and illustrated indices for other cancer diagnoses from the vantage point of breast cancer in pre, during, and post-COVID-19 eras. The angle vectors post the COVID-19 were 72% less than pre-pandemic and 28% less than during the pandemic. The movement of cancer vectors was dynamic between these eras, and movement greatly differed by type of cancer. A trend chart of cervical cancer showed statistical anomalies in the years 2019 and 2021. Based on our findings, a few future research directions are pointed out.

An Exploratory Analysis of the Association between Hospital Quality Measures and Financial Performance.

Hospitals are perpetually challenged by concurrently improving the quality of healthcare and maintaining financial solvency. Both issues are among the top concerns for hospital executives across the United States, yet some have questioned if the efforts to enhance quality are financially sustainable. Thus, the aim of this study is to examine if efforts to improve quality in the hospital setting have a corresponding association with hospital profitability. Recent and directly relevant research on this topic is very limited, leaving practitioners uncertain about the wisdom of their investments in interventions which enhance quality and patient safety. We assessed if eight different quality measures were associated with our targeted measure of hospital profitability: the net patient revenue per adjusted discharge. Using multivariate regression, we found that improving quality was significantly associated with our targeted measure of hospital profitability: the net patient revenue per adjusted discharge. Significant findings were reported for seven of eight quality measures tested, including the HCAHPS Summary Star Rating (p < 0.001), Hospital Compare Overall Rating (p < 0.001), All-Cause Hospital-Wide Readmission Rate (p < 0.01), Total Performance Score (p < 0.001), Safety Domain Score (p < 0.01), Person and Community Engagement Domain Score (p < 0.001), and the Efficiency and Cost Reduction Score (p < 0.001). Failing to address quality and patient safety issues is costly for US hospitals. We believe our findings support the premise that increased attention to the quality of care delivered as well as patients' perceptions of care may allow hospitals to accentuate profitability and advance a hospital's financial position.

The Predictive Factors of Hospital Bankruptcy-An Exploratory Study.

The United States healthcare industry has witnessed a number of hospitals declare bankruptcy. This has a meaningful impact on local communities with vast implications on access, cost, and quality of care available. In our research, we seek to determine what contemporary structural and operational factors influence a bankruptcy outcome, and craft predictive models to guide healthcare leaders on how to best avoid bankruptcy in the future. In this exploratory study we performed, a single-year cross-sectional analysis of short-term acute care hospitals in the United States and subsequently developed three predictive models: logistic regression, a linear support vector machine (SVM) model with hinge function, and a perceptron neural network. Data sources include Definitive Healthcare and Becker's Hospital Review 2019 report with 3121 observations of 32 variables with 27 observed bankruptcies. The three models consistently indicate that 18 variables have a significant impact on predicting hospital bankruptcy. Currently, there is limited literature concerning financial forecasting models and knowledge detailing the factors associated with hospital bankruptcy. By having tailored knowledge of predictive factors to establish a sound financial structure, healthcare institutions at large can be empowered to take proactive steps to avoid financial distress at the organizational level and ensure long-term financial viability.

Resources availability and COVID-19 mortality among US counties.

The COVID-19 was declared a pandemic by WHO on 03/2020 has claimed millions of lives worldwide. The US leads all countries in COVID-19-related deaths. Individual level (preexisting conditions and demographics) and county-level (availability of resources) factors have been attributed to increased risk of COVID-19-related deaths. This study builds on previous studies to assess the relationship between county-level resources and COVID-19 mortality among 2,438 US counties. We merged 2019 data from AHA, AHRF, and USA FACTS. The dependent variable was the total number of COVID-19-related deaths. Independent variables included county-level resources: (1) hospital staffing levels (FTE RNs, hospitalists, and intensivists) per 10,000 population; (2) hospital capacity (occupancy rate, proportion of teaching hospitals, and number of airborne infection control rooms per 10,000 population); and (3) macroeconomic resources [per capita income and location (urban/rural)]. We controlled for population 65+, racial/ethnic minority, and COVID-19 deaths per 1,000 population. A negative binomial regression was used. Hospital staffing per 10,000 population {FTE RN [IRR = 0.997; CI (0.995-0.999)], FTE hospitalists [IRR = 0.936; CI (0.897-0.978)], and FTE intensivists [IRR = 0.606; CI (0.516-0.712)]} was associated with lower COVID-19-related deaths. Hospital occupancy rate, proportion of teaching hospitals, and total number of airborne infection control rooms per 10,000 population were positively associated with COVID-19-related deaths. Per capita income and being in an urban county were positively associated with COVID-19-related deaths. Finally, the proportion of 65+, racial/ethnic minorities, and the number of cases were positively associated with COVID-19-related deaths. Our findings suggest that focusing on maintaining adequate hospital staffing could improve COVID-19 mortality.

An Exploratory Analysis of the Association Between Hospital Labor Costs and the Quality of Care.

Introduction: The competent healing touch of a caregiver is a critical component to the care patients receive. The more skilled the provider, the higher the likelihood outcomes will be delivered in a safe and effective manner. Unfortunately, in recent years, hospitals in the United States have faced immense financial pressures that are threatening their economic sustainability and patients' access to care in the future. Through the recent COVID-19 pandemic, the cost of delivering healthcare has continued to escalate, while the demand for patient care has exceeded many hospitals' capacity. Most troubling is the impact that the pandemic has had on the healthcare workforce, which has resulted in many hospitals struggling to fill vacancies at ever-increasing cost - all while under immense pressure to deliver quality patient care. What remains uncertain is whether the increase in labor costs has been matched with a commensurate rise in the quality of care or if quality has deteriorated as the labor force mix has changed to include more contract and temporary staff. Thus, in the enclosed study, we sought to determine what association, if any, exists between hospitals' cost of labor and the quality of care delivered. Methods and Models: Drawing from a representative national sample of nearly 3214 short-term acute care hospitals' common quality measures from the year 2021, we examined the labor cost-quality relationship via multivariate linear and logistic regression and found there is a persistent negative association across all quality outcome variables studied. Discussion: These findings lead us to believe simply paying more for hospital labor does not, by itself, ensure a positive patient outcome. We contend cautious use of temporary staff, measured adoption of short-term financial incentives, and robust staff development all should be considered as features of future workforce planning.