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.

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.

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.

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.

The Association Between Facility Affiliations and Revenue Generation in Skilled Nursing Facilities - An Exploratory Study.

Background: Although hospitals have been the traditional setting for interventional and rehabilitative care, skilled nursing facilities (SNFs) can offer a high-quality and less costly alternative than hospitals. Unfortunately, the financial health of SNFs is often a matter of concern. To partially address these issues, SNF leaders have increased engagement in a number of affiliations to assist in improving quality and reducing operational costs, including Accountable Care Organizations (ACOs), Health Information Exchanges (HIEs), and participation in Bundled Payment for Care Improvement (BPCI) programs. What is not well understood is what impact these affiliations have on the financial viability of the host organizations. Given these factors, this study aims to identify what association, if any, exists between SNF affiliations and revenue generation. Methods: Data from calendar year 2022 for n=13,447 SNFs in the US were assessed using multivariate regression analysis. We evaluated two separate dependent measures of revenue generation capacity: net patient revenue per bed and net patient revenue per discharge and considered three unique facility affiliations including (1) ACOs, (2) HIEs, and (3) BPCI participants. Results: Six multivariable linear regressions revealed that ACO affiliation is negatively associated with revenue generation on both dependent measures, while HIE affiliation and BPCI participation reflected mixed results. Conclusion: A better understanding of the financial impact of SNFs' affiliations may prove insightful. By carefully considering the value of each affiliation, and how each is applicable to any given market, policymakers, funding agencies, and facility leaders may be able to better position SNFs for more sustainable financial performance in a challenging economic environment.

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.

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.

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.

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.

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.

Does Geographic Location Affect the Quality of Care? The Difference in Readmission Rates Between the Border and Non-Border Hospitals in Texas.

Purpose: Previous literature has limited empirical evidence describing the association between border location and readmission rates among hospitals in the U.S.-Mexico border region. Thus, our study explores this novel connection in Texas border hospitals using a non-experimental longitudinal study design. Materials and Methods: Using longitudinal panel data (2013~2016) drawn from the American Hospital Association Annual Survey Database, Hospital Compare, and Area Health Resource File, a random-effects linear regression analysis was performed to quantify the impact of border location on the readmission rates of the same sample at multiple timed points. Results: We found a positive relationship between border location and 30-day hospital readmission rates for heart failure and pneumonia in Texas. Border hospitals in Texas had approximately a 4.17% higher heart failure readmission rate and a 3.46% higher pneumonia readmission rate than non-border hospitals. We also identified several hospital organizational and market factors associated (eg, registered nurse [RN]-to-patient ratio) with hospital readmission rates. Conclusion: The results suggest that improving RN staffing levels can be the most feasible action to lower the readmission rates among border Texas hospitals. Decreasing readmission rates by increasing RN staffing levels would also help them avoid reimbursement reduction under the Hospital Readmission Reduction Program (HRRP) and enhance overall health in Texas border communities. Further, to improve border health in Texas, decision-makers in state and local governments must consider incentivizing border hospitals to improve RN staffing levels and modulating the market factors affecting hospital readmission rates that are mostly beyond the control of hospitals.

Assessing the Effectiveness of Intergenerational Virtual Service-Learning Intervention on Loneliness and Ageism: A Pre-Post Study.

BACKGROUND: Service-learning is an effective intervention to solve social issues. The purpose of this study is to assess the effectiveness of intergenerational virtual service-learning on loneliness and ageism. METHOD: This study used a pre-post design. A group of undergraduate students were randomly assigned to a "service-learning" project (n = 18). They were paired with seniors (n = 22) to have at least a 30-min weekly virtual interaction for six weeks. The following scales were used: the Aging Semantic Differential (ASD) Scale, the UCLA Loneliness Scale, a one-item researcher generated Likert-rating of loneliness, and two-item researcher generated Likert-rating of student competence. RESULTS: Among college students, the service-learning group showed lower ASD and ageism scores at the post-test compared to the non-service-learning group, t (1, 40) = -2.027, p = 0.049; t (1, 40) = -2.102, p = 0.042, respectively. Among seniors, loneliness scores on the UCLA Scale and the one-item scale of loneliness dropped significantly from pre- to post-interactions with students, t (1, 19) = 2.301, p = 0.033, and t (1, 22) = 2.412, p = 0.009, respectively. CONCLUSION: Virtual service-learning is an effective way to solve social issues such as loneliness and ageism.

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.

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.

Preventative diabetes self-care management practices among individuals with diabetes and mental health stress.

BACKGROUND: The study purpose examines diabetes self-care management practices among individuals diagnosed with diabetes with and without mental health stress. METHODS: Pooled cross-sectional data (2011-2016) from the Household Component of the Medical Expenditure Panel Survey (HC-MEPS) were used. The sample consisted of individuals ages 25-85 years (n = 13,193; weighted n = 23,559,975). Dependent variables were engagement in moderate/vigorous physical exercise five times weekly, receiving dilated eye exams, foot checks, treating diabetes with diet modification or insulin injections, and eating fewer high fat/cholesterol foods. The independent variable was diabetes with and without mental health stress. The study controlled for predisposing, enabling, and need factors. RESULTS: Compared with individuals with diabetes without mental health stress, findings indicate individuals with diabetes and low or mild/moderate mental health stress were more likely to treat diabetes with diet modification and to restrict high fat/cholesterol food. Individuals with diabetes and severe mental health stress were more likely to restrict high fat/cholesterol. Additionally, individuals with mild/moderate to severe mental health stress were less likely to engage in diabetes care behavior. LIMITATIONS: Mental health stress is represented as a non-specific psychological distress index summary during the past 30 days and may not be an actual representation of overall distress in a person's life. There were no variables distinguishing diabetes type or severity. The study uses self-reported data and is cross-sectional. CONCLUSIONS: Mental health stress may contribute to individuals not engaging in self-management practices. It would be beneficial to incorporate psychosocial services for individuals with diabetes and mental health stress.

Testing Kissick's Iron Triangle-Structural Equation Modeling Analysis of a Practical Theory.

BACKGROUND/PURPOSE: The purpose of this research is to determine if the tradeoffs that Kissick proposed among cost containment, quality, and access remain as rigidly interconnected as originally conceived in the contemporary health care context. Although many have relied on the Kissick model to advocate for health policy decisions, to our knowledge the model has never been empirically tested. Some have called for policy makers to come to terms with the premise of the Kissick model tradeoffs, while others have questioned the model, given the proliferation of quality-enhancing initiatives, automation, and information technology in the health care industry. One wonders whether these evolutionary changes alter or disrupt the originality of the Kissick paradigms themselves. METHODS: Structural equation modeling (SEM) was used to evaluate the Kissick hypothetical relationships among the unobserved constructs of cost, quality, and access in hospitals for the year 2018. Hospital data were obtained from Definitive Healthcare, a subscription site that contains Medicare data as well as non-Medicare data for networks, hospitals, and clinics (final n = 2766). RESULTS: Reporting significant net effects as defined by our chosen study variables, we find that as quality increases, costs increase, as access increases, quality increases, and as access increases, costs increase. Policy and Practice Implications: Our findings lend continued relevance to a balanced approach to health care policy reform efforts. Simultaneously bending the health care cost curve, increasing access to care, and advancing quality of care is as challenging now as it was when the Kissick model was originally conceived.

Patient Throughput Initiatives in Ambulatory Care Organizations during the COVID-19 Pandemic: A Systematic Review.

BACKGROUND AND OBJECTIVES: Ambulatory (outpatient) health care organizations continue to respond to the COVID-19 global pandemic using an array of initiatives to provide a continuity of care for both COVID-19 and non-COVID-19 patients. The purpose of this study is to systematically identify the facilitators and barriers experienced by outpatient health care organizations in an effort to maintain effective and efficient patient throughput during the pandemic. MATERIALS AND METHODS: This study systematically reviewed articles focused on initiatives taken by ambulatory care organizations to maintain optimal outpatient throughput levels while balancing pandemic precautions, published during 2020. RESULTS: Among the 30 articles that met the inclusion criteria, three initiatives healthcare organizations have taken to maintain throughput were identified: the use (and enhanced use) of telehealth, protocol development, and health care provider training. The research team also identified three barriers to patient throughput: lack of telehealth, lack of resources, and overall lack of knowledge. CONCLUSIONS: To maintain patient throughput during the COVID-19 pandemic, healthcare organizations need to develop strategies such as the use of virtual consultation and follow-up, new guidelines to move patients along the care delivery value-chain, and ongoing training of providers. Additionally, the availability of required technology for telehealth, availability of resources, and adequate knowledge are vital for continuous patient throughput to ensure continuity of care during a pandemic.

A Report Card on Prevention Efforts of COVID-19 Deaths in US.

COVID-19 (otherwise known as coronavirus disease 2019) is a life-threatening pandemic that has been combatted in various ways by the government, public health officials, and health care providers. These interventions have been met with varying levels of success. Ultimately, we question if the preventive efforts have reduced COVID-19 deaths in the United States. To address this question, we analyze data pertaining to COVID-19 deaths drawn from the Centers for Disease Control and Prevention (CDC). For this purpose, we employ incidence rate restricted Poisson (IRRP) as an underlying analysis methodology and evaluate all preventive efforts utilized to attempt to reduce COVID-19 deaths. Interpretations of analytic results and graphical visualizations are used to emphasize our various findings. Much needed modifications of the public health policies with respect to dealing with any future pandemics are compiled, critically assessed, and discussed.

Accreditation and Certification: Do They Improve Hospital Financial and Quality Performance?

The relationship between healthcare organizational accreditation and their leaders' professional certification in healthcare management is of specific interest to institutions of higher education and individuals in the healthcare management field. Since academic program accreditation is one piece of evidence of high-quality education, and since professional certification is an attestation to the knowledge, skills, and abilities of those who are certified, we expect alumni who graduated from accredited programs and obtained professional certification to have a positive impact on the organizations that they lead, compared with alumni who did not graduate from accredited programs and who did not obtain professional certification. The authors' analysis examined the impact of hiring graduates from higher education programs that held external accreditation from the Commission on Accreditation of Healthcare Management Education (CAHME). Graduates' affiliation with the American College of Healthcare Executives (ACHE) professional healthcare leadership organization was also assessed as an independent variable. Study outcomes focused on these graduates' respective healthcare organization's performance measures (cost, quality, and access) to assess the researchers' inquiry into the perceived value of a CAHME-accredited graduate degree in healthcare administration and a professional ACHE affiliation. The results from this study found no effect of CAHME accreditation or ACHE affiliation on healthcare organization performance outcomes. The study findings support the need for future research surrounding healthcare administration professional graduate degree program characteristics and leader development affiliations, as perceived by various industry stakeholders.