Trends in Outpatient Antibiotic Use in 3 Health Plans.

OBJECTIVES: Previous analyses of data from 3 large health plans suggested that the substantial downward trend in antibiotic use among children appeared to have attenuated by 2010. Now, data through 2014 from these same plans allow us to assess whether antibiotic use has declined further or remained stable. METHODS: Population-based antibiotic-dispensing rates were calculated from the same health plans for each study year between 2000 and 2014. For each health plan and age group, we fit Poisson regression models allowing 2 inflection points. We calculated the change in dispensing rates (and 95% confidence intervals) in the periods before the first inflection point, between the first and second inflection points, and after the second inflection point. We also examined whether the relative contribution to overall dispensing rates of common diagnoses for which antibiotics were prescribed changed over the study period. RESULTS: We observed dramatic decreases in antibiotic dispensing over the 14 study years. Despite previous evidence of a plateau in rates, there were substantial additional decreases between 2010 and 2014. Whereas antibiotic use rates decreased overall, the fraction of prescribing associated with individual diagnoses was relatively stable. Prescribing for diagnoses for which antibiotics are clearly not indicated appears to have decreased. CONCLUSIONS: These data revealed another period of marked decline from 2010 to 2014 after a relative plateau for several years for most age groups. Efforts to decrease unnecessary prescribing continue to have an impact on antibiotic use in ambulatory practice.

Understanding specialist sharing: A mixed-method exploration in an increasingly price-competitive hospital market.

INTRODUCTION: Medical specialists seem to increasingly work in- and be affiliated to- multiple organizations. We define this phenomenon as specialist sharing. This form of inter-organizational cooperation has received scant scholarly attention. We investigate the extent of- and motives behind- specialist sharing, in the price-competitive hospital market of the Netherlands. METHODS: A mixed-method was adopted. Social network analysis was used to quantitatively examine the extent of the phenomenon. The affiliations of more than 15,000 medical specialists to any Dutch hospital were transformed into 27 inter-hospital networks, one for each medical specialty, in 2013 and in 2015. Between February 2014 and February 2016, 24 semi-structured interviews with 20 specialists from 13 medical specialties and four hospital executives were conducted to provide in-depth qualitative insights regarding the personal and organizational motives behind the phenomenon. RESULTS: Roughly, 20% of all medical specialists are affiliated to multiple hospitals. The phenomenon occurs in all medical specialties and all Dutch hospitals share medical specialists. Rates of specialist sharing have increased significantly between 2013 and 2015 in 14 of the 27 specialties. Personal motives predominantly include learning, efficiency, and financial benefits. Increased workload and discontinuity of care are perceived as potential drawbacks. Hospitals possess the final authority to decide whether and which specialists are shared. Adhering to volume norms and strategic considerations are seen as their main drivers to share specialists. DISCUSSION: We conclude that specialist sharing should be interpreted as a form of inter-organizational cooperation between healthcare organizations, facilitating knowledge flow between them. Although quality improvement is an important perceived factor underpinning specialist sharing, evidence of enhanced quality of care is anecdotal. Additionally, the widespread occurrence of the phenomenon and the underlying strategic considerations could pose an antitrust infringement.

Applying affiliation social network analysis to understand interfaith groups / Aplicación del análisis de redes sociales de afiliación para comprender los grupos interreligiosos

This study applies affiliation social network analysis to understand how interfaith groups provide resources to other community groups and link interfaith group members to resources for local community change. Based on a sample of 88 interfaith groups from across the U.S., affiliation social network analysis pictures show distinct patterns in how interfaith groups share resources with community groups and link members to community resources. Overall, results show how interfaith groups may be empowering community settings that provide resources and link members to other resources in the interest of community change. These findings imply that interfaith groups may be part of the social fabric within communities that hold potential to be partners and contributors of resources to promote community change efforts. Limitations and directions for future research also are discussed

Este estudio se basa en el análisis de redes de afiliación para comprender cómo los grupos interreligiosos proporcionan recursos a otros grupos comunitarios y vinculan a los miembros de los grupos interreligiosos con los recursos de cambio comunitario. Sobre la base de 88 grupos interreligiosos de Estados Unidos, las imágenes del análisis de redes sociales de afiliación muestran diferentes patrones en la manera en que los grupos interreligiosos comparten recursos con los grupos comunitarios y vinculan a sus miembros con los recursos comunitarios. En general, los resultados muestran cómo los grupos interreligiosos pueden empoderar los contextos comunitarios que proporcionan recursos y vinculan a los miembros con otros recursos a favor del cambio comunitario. Los resultados implican que los grupos interreligiosos pueden ser parte del tejido social en comunidad con potencial para ser socios y colaboradores en la promoción del cambio comunitario. También discutimos las limitaciones y las posibilidades de investigación futura

Predictors of hospital CEO affiliation with a professional association.

Based on a 2008 cross-sectional survey of 582 hospital CEOs in the United States, this study reports the findings of two logistic regression models designed to identify CEO and hospital characteristics associated with Member and Fellow status in the American College of Healthcare Executives (ACHE). The purpose of the study was to understand the personal and organizational characteristics of those CEOs who choose to be Members and Fellows of a professional association such as ACHE. The results showed that most (74 percent) of the respondents considered ACHE to be their primary professional association. The results also revealed that a master's degree in health administration [beta = .88, t(427) = 5.35, p < .0001], male gender [beta = .59, t(427) = 3.01, p = .002], and financial incentives provided by the parent hospital [beta = .25, t(427) = 2.73, p = .006] were statistically positively linked with Member status in ACHE. A master's degree in health administration [beta = .81, t(424) = 5.79, p < .0001], male gender [beta = .39, t(424) = 2.25, p = .02], and age [beta = .02, t(424) 2.32, p = .02] were also statistically positively associated with Fellow status in ACHE. Notably, organizational factors such as size, geographic location, for-profit status, and financial strength of the hospital do not seem to play an important role in the CEOs' decision to become a Member or Fellow of ACHE. The implication of these findings is that membership and fellowship at a professional association are influenced by characteristics of the individual, and incentives provided by employers can encourage employees to get involved with their professional associations.

[Social-psychiatric research in Germany--a literature review]. / Sozialpsychiatrische Forschung--Entwicklung über die letzten 10 Jahre im Spiegel deutschsprachiger Zeitschriften.

OBJECTIVE: This study aims at analysing content, authorship, type of journal and associated institution of scientific contributions on social psychiatry in 16 German-speaking journals. In order to detect development and change in respect to the aspects mentioned, two time periods are compared systematically (1997-1998/2007-2008). METHODS: The authors selected all original papers in 16 journals from German-speaking countries along common definitions of social psychiatry. These definitions are made transparent in the study. RESULTS: The systematic comparison of the named time periods resulted in equal numbers of papers contributed. The major part of the publications under study has been contributed by authors associated with universities. Content-wise, articles on matters discussed in the recent past and including topics like migration, subjectivity, parent-child care are increasing. CONCLUSIONS: Research on social psychiatry in German-speaking countries today is mainly related to research departments at university clinics. The impact of large centres of psychiatry however is declining. Content-wise, matters at stake during the reform period of psychiatry in German-speaking countries in the 1970 s and 1980 s are of less relevance today. Researches now tend to address research topics more closely related to what can be named patient-centred care.