Identifying Best Practices in Pharmacy Experience: An Analysis of Military Treatment Facilities With the Highest Pharmacy Patient Experience Scores.

INTRODUCTION: Pharmacy patient experience within military treatment facilities (MTFs) is a significant indicator of healthcare quality, as hospital admissions correlate with medication use (Budnitz et al., 2006) and pharmacists have a unique opportunity to influence patients' health (Dalton & Byrne, 2017). To improve patient care across the military health system (MHS), we investigated best practices within MTF pharmacies with the highest patient experience scores. MATERIALS AND METHODS: Researchers performed semi-structured telephone interviews with pharmacists, pharmacy technicians, and patient experience officers from three of the highest ranked MTF pharmacies according to outpatient satisfaction survey results to glean "best practice" approaches to patient care. Researchers utilized the Gioia approach as a guiding theory for qualitative analysis of the interview data, and the study was excluded from a requirement to obtain institutional review board approval due to the number of respondents in accordance with the Paperwork Reduction Act of 1980 guidelines. RESULTS: Interview participants from highly rated pharmacies emphasized the importance of communication among and between staff and patients, staff engagement and morale, and supportive leadership at their facilities for creating a positive patient experience and clinical environment. CONCLUSION: These findings provide valuable insights to improve public health in military-connected populations through improved patient care practices in pharmacies across the MHS. Initiatives aimed at improving health care for pharmacy patients should prioritize improved communication and structural support for team members to create patient-friendly environments, which enables pharmacists and technicians to connect with patients and positively impact health outcomes. Limitations include lack of comparison data for lower performing pharmacies; future research will explore practices at lower ranking pharmacies to provide insights into communication practices, environments, and staff relationships impacting patient experience scores as well as the role patient demographics (e.g., retirees vs. active duty) and characteristics including facility size play in potential improvements.

Health Care Experience Among Women Who Completed Group Prenatal Care (CenteringPregnancy) Compared to Individual Prenatal Care Within Military Treatment Facilities.

This study compared TRICARE, the health care program of the United States Department of Defense Military Health System, beneficiaries in CenteringPregnancy, an enhanced prenatal care model, to women in individual prenatal care within the same military treatment facility. Maternity patient experience ratings from May 2014 to February 2016 were compiled from the TRICARE Outpatient Satisfaction Survey. Centering patients had 1.91 higher odds of being satisfied with access to care (p < .01, 95% CI = 1.2-3.1) than women in individual care. Specifically, the saw provider within 15 minutes of appointment measure found Centering patients to have 2.00 higher odds of being satisfied than women in individual care (p < .01, 95% CI = 1.2-3.3). There were no other statistically significant differences between cohorts. Qualitative responses indicate most Centering patients surveyed had good experiences, appreciated the structure and communication with others, and would recommend the program. Providers identified command/leadership support, dedicated space, and buy-in from all staff as important factors for successful implementation. Enhanced prenatal care models may improve access to and experiences with care. Program evaluation will be important as the military health system continues to implement such programs.

Prevalence Of Unplanned Readmissions Among Patients Of Military Treatment Facilities.

Understanding readmissions within the Military Health System (MHS) provides important insights to better understand and improve health outcomes for military personnel and their families. We assessed all-cause seven- and thirty-day readmission rates in military treatment facilities by treatment service for patients ages 18-64 for fiscal years 2011-18 using inpatient data from the MHS and the private sector. We compared unplanned readmission rates for the obstetric, medical, and surgical product lines. Readmission rates differed by product line. Seven-day readmission rates ranged from 1.5 percent to 3.3 percent by product line, and thirty-day rates ranged from 3.2 percent to 8.8 percent. The obstetric line had the greatest number of readmissions (391,463) but the lowest seven-day readmission rate (1.5 percent). Readmission rates were lower for the military population than for people in other insurance groups, but military readiness is disrupted by unplanned readmissions. Product-line differences in readmission rates in the MHS suggest opportunities for improvement.

Implementing a peer-learning approach for the clinical education of respiratory therapy students.

INTRODUCTION: With recent clinical placement demands exceeding supply, the University Health Network (UHN) Respiratory Therapy (RT) department implemented a 2:1 student-to-preceptor model where a focus on peer learning (PL) becomes a key component of program success. PL can be defined as students learning from and with each other in both formal and informal ways. The shift towards facilitative student-directed models in other health care professions can be seen globally with the literature suggesting that 2:1 models not only support increases in student capacity but also improve the student learning experience through PL strategies. The aim of this study was to explore the perceptions of RT preceptors and students regarding the 2:1 model as an educational strategy in the context of their clinical experience. The study further explored experiences of PL to understand how learning is enabled in RT practice-based education, particularly within 2:1 models. METHODS: A qualitative descriptive study using single-episode semi-structured interviews with RT preceptors (n = 10) and students (n = 10) was conducted during the 2015-2016 RT student clinical year. Twelve open-ended interview questions were designed to draw out study participants' PL experiences and exploration of issues using a 2:1 model in the context of their clinical experience. Data were recorded, transcribed verbatim, and analyzed using thematic analysis. RESULTS: The content analysis resulted in two broad themes with respect to the RT 2:1 educational model: "enablers" and "barriers" to a PL approach. The 2:1 model was preferred by students and preceptors early on in the clinical training due to the benefits of PL, whereas opportunities to showcase independent practice was preferred towards the end of their clinical year. Furthermore, careful planning, resources, and supports need to be implemented to augment benefits and diminish potential disadvantages of using a 2:1 model structure. CONCLUSION: Participants felt that a 2:1 model strongly contributes to a supportive learning environment and can have a positive influence on the RT student clinical experience at UHN. Along with the improved critical thinking and student engagement opportunities that a 2:1 model offers, increased placement numbers are also supported.

Military Hospital Spending on Environmental Services and Inpatient Satisfaction Ratings.

EXECUTIVE SUMMARY: To assess the impact of military hospital expenditures on environmental services (EVS) on inpatient satisfaction, the authors collected Defense Health Agency TRICARE Inpatient Satisfaction Survey data from fiscal years 2011 through 2013, military hospital EVS spending and workload data, facility construction/renovation data, and military health system inpatient administrative claims data. Multivariate logistic regression for panel data was performed independently for medical/surgical and obstetric product lines and each satisfaction question. A statistically significant positive relationship was found between hospital EVS spending and patient satisfaction, with the highest expenditure levels generally exhibiting a greater association with satisfaction. Statistically significant increases in satisfaction with cleanliness were associated with higher levels of hospital expenditures on EVS.

Evaluation of a Comprehensive Oral Health Services Program in School-Based Health Centers.

Objectives In 2011, the Maternal and Child Health Bureau, within the Health Resources and Services Administration, awarded a 4-year grant to increase access to and assure the delivery of quality oral health preventive and restorative services to children. The grant was awarded to organizations serving high-need communities through school-based health centers (SBHCs). This article describes an independent evaluation investigating program efficacy, integration, and sustainability. Methods Program process and outcomes data were gathered from interim and final reports. Interviews with key informants were conducted by phone, and analyzed in NVivo qualitative software. Results Students had great need for comprehensive services: on average, 45% had dental caries at enrollment. Enrollment increased from 5000 to more than 9700, and the percent receiving preventive services increased from 58 to 88%. Results of the analytically weighted linear regression show statistically significant increases in the proportion of enrollees who had their teeth cleaned in the past year (t(4) = 5.19, ß = 8.85, p < 0.05) and those receiving overall preventive services (t(4) = 13.52, ß = 10.93, p < 0.01). Grantees integrated into existing programs using clear, consistent, and open communication. Grantees sustained the full suite of services beyond the grant period by increasing billing and insurance claims while still offering free and reduced-cost services to those uninsured or otherwise unable to pay. Conclusions for Practice This project demonstrates that access to comprehensive oral health care for children can be expanded through SBHCs. State Title V Block Grant and other similar federal initiatives can learn from the strategic approaches used to overcome challenges in the school-based environment.

A Statewide Profile of Frequent Users of School-Based Health Centers: Implications for Adolescent Health Care.

BACKGROUND: The purpose of this study is to describe patterns of care and service use among adolescent school-based health center (SBHC) users in New Mexico and contrast patterns and services between frequent and infrequent users. METHODS: Medical claims/encounter data were analyzed from 59 SBHCs located in secondary schools in New Mexico during the 2011-2012 school year. We used Pearson's chi-square test to examine the differences between frequent (≥ 4 visits/year) and infrequent users in their patterns of SBHC care, and we conducted logistic regression to examine whether frequent use of the SBHC predicted receipt of behavioral, reproductive, and sexual health; checkup; or acute care services. RESULTS: Most of the 26,379 adolescent SBHC visits in New Mexico were for behavioral health (42.4%) and reproductive and sexual health (22.9%). Frequent users have greater odds of receiving a behavioral, reproductive, and sexual health; and acute care visit than infrequent users (p < .001). American Indians, in particular, have higher odds of receiving behavioral health and checkup visits, compared with other races/ethnicities (p < .001). CONCLUSIONS: SBHCs deliver core health care services to adolescents, including behavioral, reproductive, and checkup services, to high need populations. American-Indian youth, more than their peers, use SBHCs for behavioral health and checkups.

Trends in complicated newborn hospital stays & costs, 2002-2009: implications for the future.

BACKGROUND: With the steady growth in Medicaid enrollment since the recent recession, concerns have been raised about care for newborns with complications. This paper uses all-payer administrative data from the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS), to examine trends from 2002 through 2009 in complicated newborn hospital stays, and explores the relationship between expected sources of payment and reasons for hospitalizations. METHODS: Trends in complicated newborn stays, expected sources of payment, costs, and length of stay were examined. A logistic regression was conducted to explore likely payer source for the most prevalent diagnoses in 2009. RESULTS: Complicated births and hospital discharges within 30 days of birth remained relatively constant between 2002 and 2009, but average costs per discharge increased substantially (p<.001 for trend). Most strikingly, over time, the proportion of complicated births billed to Medicaid increased, while the proportion paid by private payers decreased. Among complicated births, the most prevalent diagnoses were preterm birth/low birth weight (23%), respiratory distress (18%), and jaundice (10%). The top two diagnoses (41% of newborns) accounted for 61% of the aggregate cost. For infants with complications, those with Medicaid were more likely to be complicated due to preterm birth/low birth weight and respiratory distress, while those with private insurance were more likely to be complicated due to jaundice. CONCLUSIONS: State Medicaid programs are paying for an increasing proportion of births and costly complicated births. Policies to prevent common birth complications have the potential to reduce costs for public programs and improve birth outcomes.

Early elective deliveries accounted for nearly 9 percent of births paid for by Medicaid.

Reducing early elective deliveries has become a priority for Medicaid medical directors and their state partners. Such deliveries lead to poor health outcomes for newborns and their mothers and generate additional costs for patients, providers, and Medicaid, which pays for up to 48 percent of all births in the United States each year. Early elective deliveries are non-medically indicated labor inductions or cesarean deliveries of infants with a confirmed gestational age of less than thirty-nine weeks. This retrospective descriptive study reports the results of a perinatal project, led by the state Medicaid medical directors, that sought to coordinate quality improvement efforts related to early elective deliveries for the Medicaid population. Twenty-two states participated in the project and provided data on elective deliveries in the period 2010-12. We found that 75,131 (8.9 percent) of 839,688 Medicaid singleton births were early elective deliveries. Thus, we estimate that there are 160,000 early elective Medicaid deliveries nationwide each year. In twelve states, early-term elective deliveries declined 32 percent between 2007 and 2011. Our study offers additional evidence and new tools for policy makers pursuing strategies to further reduce the number of such deliveries.