Attitudes of Black American Christian church leaders toward Opioid Use Disorder, overdoses, and harm reduction: a qualitative study.

Introduction: Black American Christian church leaders are trusted community members and can be invaluable leaders and planners, listeners, and counselors for Opioid Use Disorder (OUD) sufferers in the opioid overdose crisis disproportionately affecting the Black community. This qualitative study examines the extent to which the knowledge, attitudes, practices, and beliefs of Black American church leaders support medical and harm reduction interventions for people with OUD. Methods: A semi-structured interview guide was used to conduct in-depth interviews of 30 Black Rhode Island church leaders recruited by convenience and snowball sampling. Results: Thematic analysis of the interviews identified four themes: Church leaders are empathetic and knowledgeable, believe that hopelessness and inequity are OUD risk factors, are committed to helping people flourish beyond staying alive, and welcome collaborations between church and state. Conclusion: Black American Christian church leaders are a critical resource in providing innovative and culturally sensitive strategies in the opioid overdose crisis affecting the Black American communities. As such, their views should be carefully considered in OUD policies, collaborations, and interventions in the Black American community.

The Association Between Hospital Financial Performance and the Quality of Care - A Scoping Literature Review.

BACKGROUND: Improving the quality of hospital care is an important policy objective. Hospitals operate under pressure to contain costs and might face challenges related to financial deficits. The objective of this paper was to identify and map the available evidence on the association between hospital financial performance (FP) and quality of care (Q). METHODS: A scoping review was performed. Searches were conducted in 7 databases: Medline via PubMed, EMBASE, Web of Science, Scopus, EconLit, ABI/INFORM, and Business Source Complete. The search strategy combined multiple terms from 3 topics: hospital AND FP AND Q. The collected data were analysed using both quantitative and qualitative methods. RESULTS: 10 503 records were screened and 151 full text papers analysed. A total of 69 papers were included (60 empirical, 2 theoretical, 5 literature reviews, and 2 dissertations). The majority of identified studies were published within the last decade (2010-2021). Most empirical studies had been conducted in the United States (55/60), used cross-sectional approaches (32/60) and applied diverse regression models with FP measures as dependent variables, thus measuring the impact of Q on hospitals FP (34/60). The comparability of the studies' results is limited due to differences in applied methods and settings. Yet, the general overview shows that in almost half of the cases the association between hospital FP and Q was positive, while no study showed a clear negative association. CONCLUSION: This scoping review provides an overview of the available literature on the association between hospital FP and Q. The results highlight numerous research gaps: (1) systematic reviews and meta-analyses of existing studies with similar measures of FP and Q are unavailable, (2) further methodological/conceptual work is needed on the metrics measuring hospital FP and Q, and (3) more empirical studies should analyse the association between FP and Q in non-US healthcare settings.

Affordable Care Organizations and Bundled Pricing: A New Philosophy of Care.

Under the Patient Protection and Affordable Care Act (ACA), the Centers for Medicare and Medicaid Services' Innovation was chartered to develop new models of health care delivery. The changes meant a drastic need to restructure the health care system. To minimize costs and optimize quality, new laws encourage continuity in health care delivery within an integrated system. Affordable care organizations provided a model of high-quality care while reducing costs. Bundled payments can have a substantial effect on the national expenditures. This article examines new developments in bundle payments, affordable care organizations, and gainsharing agreements as they pertain to arthroplasty.

Improving patient flow in the cath lab.

Key steps that led to Kennestone Hospital's success in improving patient flow in the cath lab included: Developing an urgency classification system for patients. Creating a more accurate scheduling system to increase throughput and efficiency. Establishing a project team. Developing a time line. Recognizing ongoing challenges

Financial and operational analysis of non-operating room anesthesia: the wrong way versus the right way.

Most financial analysis regarding the cost of non-operating room anesthesia in hospitals is incorrect. This article indicates why this situation exists and suggests how to perform the cost analysis in the right way. It also reviews financial and operational strategies that can result in more efficient scheduling of anesthesia, thereby freeing up anesthesiologist time in the main operating room for non-operating room needs.

Exploring the relationship between inpatient hospital costs and quality of care.

This research explores the potential benefit of improving the clinical quality and reducing the cost of inpatient care using administrative data to inform or restrict provider choice. Cost and quality measures derived from this source are already available to purchasers, payers, and consumers in support of insurance products designed to provide financial incentives for consumers to seek high-quality, low-cost care. It will be important to further refine the clinical and cost data to take into account measurable differences in the severity of illness of patients, and to acknowledge that some of the differences in cost or quality variation among hospitals may not be captured despite such refinements. Medicare cost report data is merged with Uniform Hospital Discharge Abstracts to identify the additional direct cost of patients experiencing 1 of 6 poor clinical outcomes, or admissions for ambulatory care sensitive conditions, or selected surgical procedures at low volume hospitals. Variability in case mix-adjusted cost per case among community and teaching hospital groups is also quantified; measurable quality differences between low cost and other hospitals in each group is described. Our results suggest that, despite implementation challenges, purchaser and payer initiatives that encourage consumers to seek lower cost inpatient care without sacrificing clinical quality are worth pursuing.

Age and laboratory costs for hospitalized medical patients.

OBJECTIVE: To examine the hypothesis that older hospitalized patients have higher laboratory costs than younger patients in the same severity-adjusted diagnosis-related group (DRG). DESIGN: We obtained hospital case mix data sets (1995-1997) from the Massachusetts Division of Health Care Finance and Policy. We selected discharge abstracts from 4 medical DRGs, at 5 large academic hospitals (n = 15,265) and 5 midsized community hospitals (n = 10,540), for analysis. We converted laboratory and blood product charges to direct costs using the department-specific ratio of cost to charges. We adjusted diagnostic groups for severity of comorbid conditions and complications using the refined DRG method. MAIN OUTCOME MEASURES: Hospital length of stay (LOS), laboratory direct cost (LDC) per hospitalization, LDC per hospital day, and ratio of LDC to total direct cost. RESULTS: Hospital LOS was longer for older patients in all comparisons. Laboratory direct cost per hospitalization was higher for older patients in some DRGs, but lower in other DRGs. Laboratory direct cost per hospital day was almost always less for older patients than for younger patients, both at academic and community hospitals. Data stratification by gender, admission status, and principal diagnosis yielded substantially the same pattern of cost differences observed within the larger data set. CONCLUSIONS: Older medical patients have longer hospital stays and generally higher costs. These patients also have a significantly decreased rate of laboratory resource consumption over the course of hospitalization (LDC per hospital day), as well as lower laboratory costs as a proportion of total costs. Age-specific differences in LOS and cost parameters were essentially unchanged after controlling for several potential sources of bias.