Associations between patient safety culture and workplace safety culture in hospital settings.

BACKGROUND: Strong cultures of workplace safety and patient safety are both critical for advancing safety in healthcare and eliminating harm to both the healthcare workforce and patients. However, there is currently minimal published empirical evidence about the relationship between the perceptions of providers and staff on workplace safety culture and patient safety culture. METHODS: This study examined cross-sectional relationships between the core Surveys on Patient Safety Culture™ (SOPS®) Hospital Survey 2.0 patient safety culture measures and supplemental workplace safety culture measures. We used data from a pilot test in 2021 of the Workplace Safety Supplemental Item Set, which consisted of 6,684 respondents from 28 hospitals in 16 states. We performed multiple regressions to examine the relationships between the 11 patient safety culture measures and the 10 workplace safety culture measures. RESULTS: Sixty-nine (69) of 110 associations were statistically significant (mean standardized ß = 0.5; 0.58 < standardized ß < 0.95). The largest number of associations for the workplace safety culture measures with the patient safety culture measures were: (1) overall support from hospital leaders to ensure workplace safety; (2) being able to report workplace safety problems without negative consequences; and, (3) overall rating on workplace safety. The two associations with the strongest magnitude were between the overall rating on workplace safety and hospital management support for patient safety (standardized ß = 0.95) and hospital management support for workplace safety and hospital management support for patient safety (standardized ß = 0.93). CONCLUSIONS: Study results provide evidence that workplace safety culture and patient safety culture are fundamentally linked and both are vital to a strong and healthy culture of safety.

Respiratory symptoms and outcomes among cigar smokers: findings from the Population Assessment of Tobacco and Health (PATH) study waves 2-5 (2014-2019).

BACKGROUND: The mechanisms by which cigarette smoking increases the risk of respiratory disease have been studied. However, less is known about risks of respiratory symptoms and outcomes associated with smoking cigars, and risks by cigar types have not been previously explored. The aim of this study was to examine associations between cigar use, including traditional cigars, cigarillos, filtered cigars, and dual cigar and cigarette use, and functionally important respiratory symptoms (FIRS), lifetime asthma diagnosis, uncontrolled asthma, and new cases of FIRS. METHODS: Data from Waves 2-5 (2014-19) of the Population Assessment of Tobacco and Health (PATH) Study, a nationally representative longitudinal study, were analyzed in two ways. For cross-sectional analysis, the analytic sample included adults 18 and older at each wave, resulting in 44,040 observations. Separately, longitudinal analyses were assessed among adults 18 and older at Wave 2, resulting in 7,930 individuals. Both analyses excluded adults with chronic obstructive pulmonary disease (COPD) or non-asthma respiratory disease. RESULTS: Current established cigarillo smokers had higher odds of having FIRS (Adjusted odds ratio (AOR): 1.72; 95% CI: 1.08, 2.74) compared to never smokers of cigarillos and cigarettes, after adjusting for covariates. Current established filtered cigar smokers had higher odds of asthma diagnosis (AOR: 1.35; 95% CI: 1.10, 1.66) while current established dual smokers of filtered cigars and cigarettes had higher odds of uncontrolled asthma (AOR: 5.13; 95% CI: 1.75, 15.02) compared to never smokers of filtered cigars or cigarettes. Both current established cigar smokers and current established dual smokers of cigarettes and cigars had higher odds of new FIRS compared to never cigar or cigarette smokers (AORs: 1.62; 95% CI: 1.02, 2.60 for exclusive cigars and 2.55; 95% CI 1.57, 4.14 for dual smokers). CONCLUSIONS: This study provides evidence that cigar smokers or dual smokers of cigars and cigarettes have greater odds of FIRS, asthma, and uncontrolled asthma and that new incidence of FIRS is higher among any cigar smokers compared to never cigar or cigarette smokers. Understanding health impacts associated with cigar use provides information for supporting policy development, as well as for designing clinical interventions focused on smoking cessation for cigars.

Cigarette and ENDS dual use longitudinal transitions among adults in the Population Assessment of Tobacco and Health (PATH) Study, Waves 4-5 (2016-2019).

Introduction: The study assessed longitudinal transitions among adult (18 and older) past 30-day daily and non-daily dual users of cigarettes and electronic nicotine delivery systems (ENDS). Methods: Using data from Wave 4 (W4; 2016/17) and Wave 5 (W5; 2018/19) of the Population Assessment of Tobacco and Health (PATH) Study, a nationally representative, longitudinal cohort study of US adults, multivariable regressions were conducted among W4 dual users of cigarettes and ENDS to examine past 30-day cigarette smoking at W5. The study also analyzed changes in frequency of past 30-day smoking and cigarettes smoked per day between W4 and W5, stratified by W4/W5 daily/non-daily ENDS use among W4 daily and non-daily cigarette smokers. Results: Among W4 dual users, those smoking daily and using ENDS non-daily had higher odds of daily cigarette smoking at W5 than daily users of both products (AOR: 2.32, 95 % CI: 1.38-3.90). W4 daily smokers who used ENDS daily at Wave 5 smoked cigarettes on fewer days at Wave 5 than W4 daily smokers who were either daily ENDS users at Wave 4 (B = -4.59; SE = 1.43, p < 0.01) or non-daily ENDS users at Wave 4 (B = -4.55; SE = 1.24, p < 0.001). Among W4 non-daily cigarette smokers, W4 non-daily ENDS users who used daily at W5 smoked cigarettes on fewer days (B = -4.04, SE = 1.82) at W5 than those who were non-daily ENDS users at W4 and W5. Conclusions: Findings highlight the importance of frequency of ENDS use in reducing cigarette smoking and could inform smoking cessation interventions among daily cigarette smokers.

Development, Pilot Study, and Psychometric Analysis of the AHRQ Surveys on Patient Safety Culture™ (SOPS®) Workplace Safety Supplemental Items for Hospitals.

Workplace safety is critical for advancing patient safety and eliminating harm to both the healthcare workforce and patients. The purpose of this study was to develop and test survey items that can be used in conjunction with the Agency for Healthcare Research and Quality (AHRQ) Surveys on Patient Safety Culture™ (SOPS®) Hospital Survey to assess how the organizational culture in hospitals supports workplace safety for providers and staff. After conducting a literature review and background interviews with workplace safety experts, we identified key areas of workplace safety culture (workplace hazards, moving/transferring/lifting patients, workplace aggression, supervisor/management support for workplace safety, workplace safety reporting, and work stress/burnout) and drafted survey items to assess these areas. Survey items were cognitively tested and pilot tested with the SOPS Hospital Survey 2.0 among providers and staff in 28 U.S. hospitals. We conducted psychometric analysis on data from 6684 respondents. Confirmatory factor analysis results (item factor loadings and model fit indices), internal consistency reliability, and site-level reliability were acceptable for the 16 survey items grouped into 6 composite measures. Most composite measures were significantly correlated with each other and with the overall rating on workplace safety, demonstrating conceptual convergence among survey measures. Hospitals and researchers can use the Workplace Safety Supplemental items to assess the dimensions of organizational culture that support provider and staff safety and to identify both strengths and areas for improvement.

Development and pilot testing of survey items to assess the culture of value and efficiency in hospitals and medical offices.

BACKGROUND: Given rising costs and changing payment models, healthcare organisations are increasingly focused on value and efficiency. The goal of our study was to develop survey items to assess clinician and staff perspectives about the extent to which the organisational culture in hospitals and medical offices supports value and efficiency. METHODS: Development began with a literature review and interviews with experts and clinicians and staff from hospitals and medical offices. We identified key areas of value and efficiency culture, drafted survey items and conducted cognitive testing. Using purposive sampling to select sites, the 36-item surveys were pilot tested in 47 hospitals and 96 medical offices. Psychometric analysis was conducted on data from 3951 hospital respondents (42% response) and 1458 medical office respondents (63% response). RESULTS: Factor loadings, multilevel confirmatory factor analysis model fit and reliability estimates were acceptable for the 13 items grouped into 4 composite measures: Empowerment to Improve Efficiency (3 items), Efficiency and Waste Reduction (3 items), Patient Centeredness and Efficiency (3 items) and Management Support for Improving Efficiency and Reducing Waste (4 items). All composite measures were significantly intercorrelated and related to the four Overall Ratings of Healthcare Quality, indicating adequate conceptual convergence among the measures. Eight items assessing Experiences With Activities to Improve Efficiency were also included. CONCLUSION: We developed psychometrically sound survey items measuring value and efficiency culture. When added to the Agency for Healthcare Research and Quality Surveys on Patient Safety Culture, the item sets extend those surveys by assessing additional dimensions of organisational culture that affect care delivery. Healthcare organisations can use these item sets to assess how well their organisational culture supports value and efficiency and identify areas for improvement.

Linking Patient Safety Culture to Quality Ratings in the Nursing Home Setting.

There is limited evidence on the associations between patient safety culture and measures of health care quality in nursing homes. This study examines the relationship between scores on the Agency for Healthcare Research and Quality (AHRQ) Surveys on Patient Safety Culture™ (SOPS®) Nursing Home Survey (NH SOPS) and Centers for Medicare and Medicaid Services Nursing Home Five-Star Quality Ratings. Using data from 186 nursing homes, we conducted multiple regression analyses predicting the Five-Star Quality Ratings from the NH SOPS survey measures. Five NH SOPS measures were related to the Overall, Health Inspections, and Quality Five-Star Ratings. Four NH SOPS measures were related to at least two of the four Five-Star Quality Ratings and three SOPS measures were related to one Five-Star Rating. None of the NH SOPS measures were significantly associated with the Staffing Five-Star Rating. Findings generally indicated that stronger patient safety culture is associated with higher quality ratings.

Development and psychometric properties of surveys to assess patient and family caregiver experience with care transitions.

BACKGROUND: The purpose of this study was to develop and administer surveys that assess patient and family caregiver experiences with care transitions and examine the psychometric properties of the surveys. The surveys were designed to ask about 1) the transitional care services that matter most to patients and their caregivers and 2) care outcomes, including the overall quality of transitional care they received, patient self-reported health, and caregiver effort/stress. METHODS: Survey items were developed based on a review of the literature, existing surveys, focus groups, site visits, stakeholder and expert input, and patient and caregiver cognitive interviews. We administered mail surveys with telephone follow up to patients recently discharged from 43 U.S. hospitals. Patients identified the caregivers who helped them during their hospital stay (Time 1 caregiver) and when they were home (Time 2 caregiver). Time 1 and Time 2 caregivers were surveyed by telephone only. The psychometric properties of the survey items and outcome composite measures were examined for each of the three surveys. Items that performed poorly across multiple analyses, including those with low variability and/or a high missing data, were dropped except when they were conceptually important. RESULTS: The analysis datasets included responses from 9282 patients, 1245 Time 1 caregivers and 1749 Time 2 caregivers. The construct validity of the three proposed outcome composite measures-Overall Quality of Transitional Care (patient and caregiver surveys), Patient Overall Health (patient survey) and Caregiver Effort/Stress (caregiver surveys) -was supported by acceptable exploratory factor analysis results and acceptable internal consistency reliability. Site-level reliability was acceptable for the two patient outcome composite measures, but was low for Caregiver Effort/Stress (< 0.70). In all surveys, the Overall Quality of Transitional Care outcome composite measure was significantly correlated with other outcome composite measures and most of the single-item measures. CONCLUSIONS: Overall, the final patient and caregiver surveys are psychometrically sound and can be used by health systems, hospitals, and researchers to assess the quality of care transitions and related outcomes. Results from these surveys can be used to improve care transitions, focusing on what matters most to patients and their family caregivers.

The Effect of National Family Caregiver Support Program Services on Caregiver Burden.

Extant evidence on the effectiveness of caregiver programs in alleviating caregiver burden is mixed, underscoring the need for further investigations. This study evaluated the effect of the National Family Caregiver Support Program (NFCSP) educational services and respite care on caregiver burden. We used survey data from caregivers assigned to program (n = 491) or comparison (n = 417) group based on their reported use of NFCSP services. Adjusted difference-in-differences (DiD) analysis found an increase in mean burden scores for both groups from baseline to 6 or 12 months. Among program caregivers receiving ≥4 hr of NFCSP respite care per week (n = 307) and matched comparisons (n = 370), burden scores decreased slightly for program caregivers (-0.095 points), but increased for comparison caregivers (+0.145 points). The DiD (0.239 points) was not statistically significant. More research is needed to determine the minimum amount of respite care needed to positively impact caregiver burden.

Predictors of Unmet Need Among Informal Caregivers.

OBJECTIVES: This study investigates the relationship of caregiver demographics, caregiving intensity, caregiver support use, and aspects of the caregiving situation to a self-reported measure of unmet need among U.S. informal caregivers of older adults living at home with various conditions. METHODS: Response data from 1,558 caregiver participants interviewed by telephone during the December 2016 baseline period of the Outcome Evaluation of the National Family Caregiver Support Program were used. Caregivers who responded "Definitely No" to the question "Are you receiving all the help you need?" were classified as reporting unmet need. Logistic regression was used to find significant factors associated with unmet need among the full sample and among caregivers tiered by three levels of burden. RESULTS: Unmet need was reported by 22% of the caregivers. In a fully adjusted model, unmet need was predicted by higher levels of caregiving intensity, non-White race of the caregiver, and the caregiver not feeling appreciated by their care recipient. Other predictors associated with unmet need were no use of caregiver educational services, fewer respite hours, not living in a rural area, and caregiver having an education past high school. DISCUSSION: Caregivers who do not feel appreciated by their care recipient and non-White caregivers should be identified as potential targets for intervention to address unmet need, especially if they are also reporting higher levels of caregiver burden. Understanding the factors associated with self-reported unmet need can assist caregiver support programs in measuring and addressing the needs of informal caregivers to support their continued caregiving.

The role of young adult social bonds, substance problems, and sexual risk in pathways between adolescent substance use and midlife risky sexual behavior among urban African Americans.

African Americans are disproportionately affected by HIV/AIDS and other sexually transmitted infections relative to other racial groups. Although substance use has been linked to risky sexual behavior, the understanding of how these associations develop over the life course remains limited, particularly the role of social bonds. This study uses structural equation modeling to examine pathways from adolescent substance use to young adult sexual risk, substance problems, and social bonds and then to midlife risky sexual behavior among African American men and women, controlling for childhood confounders. Data come from 4 assessments, 1 per developmental period, of a community-based urban African American cohort (N = 1,242) followed prospectively from ages 6 to 42 years. We found that greater adolescent substance use predicts greater young adult substance problems and increased risky sexual behavior, both of which in turn predict greater midlife sexual risk. Although greater adolescent substance use predicts fewer young adult social bonds for both genders, less young adult social bonding is unexpectedly associated with decreased midlife risky sexual behavior among women and not related for men. Substance use interventions among urban African American adolescents may have both immediate and long-term effects on decreasing sexual risk behaviors. Given the association between young adult social bonding and midlife risky sex among females, number of social bonds should not be used as a criterion for determining whom to screen for sexual risk among African American women. Future studies should explore other aspects of social bonding in linking substance use and risky sexual behavior over time. (PsycINFO Database Record

Mutual Influences Between Parental Psychological Distress and Alcohol Use and Child Problem Behavior in a Cohort of Urban African Americans.

Parental psychological distress, parental alcohol involvement, and child/adolescent behavior problems frequently occur together with deleterious effects on individuals and families. Extant evidence suggests that parental and child problems are related; however, less is known about the patterns and directions of their relationships over time, particularly among African Americans. This study examined mutual influences between parental psychological distress and alcohol use, and child/adolescent problem behavior over a 10-year period (N = 459), using data from a prospective cohort study of urban African Americans. Using structural equation modeling, we found statistically significant effects between young adult parents' alcohol use and later adolescent problem behavior, as well as child problem behavior and parental alcohol use 10 years later, even after taking into account potential extraneous influences. Findings also demonstrated continuity in parental and child behaviors over time, and several contemporaneous associations. These findings have potential implications for intervention planning among African American families.

Predictors of intent to pursue a college health science education among high achieving minority 10th graders.

Minority populations are underrepresented in fields of science, perhaps limiting scientific perspectives. Informed by recent studies using Social Cognitive Career Theory, this study examined whether three conceptual constructs: self-efficacy, perceived adult support, and perceptions of barriers, as well as several discrete and immutable variables, were associated with intent to pursue college science education in a sample (N = 134) of minority youth (70.1% female and 67.2% African American). A paper-and-pencil survey about pursuit of college science was administered to 10th graders with a B- or better grade point average from six high schools in an underserved community. Results indicated that the three conceptual constructs were bivariate correlates of intent to pursue college science education. Only perceived adult support and knowing whether a parent received college education were significant predictors in multivariate modeling. These results build on previous research and provide further insight into youth decision-making regarding pursuit of college science.

Early life predictors of adult depression in a community cohort of urban African Americans.

Depression among African Americans residing in urban communities is a complex, major public health problem; however, few studies identify early life risk factors for depression among urban African American men and women. To better inform prevention programming, this study uses data from the Woodlawn Study, a well-defined community cohort of urban African Americans followed from age 6 to 42 years, to determine depression prevalence through midlife and identify childhood and adolescent risk factors for adult depression separately by gender. Results indicate that lifetime depression rates do not differ significantly by gender (16.2 % of men, 18.8 % of women) in contrast to findings of a higher prevalence for women in national studies. Furthermore, rates of depression in this urban African American population are higher than those found in national samples of African Americans and more comparable to the higher rates found nationally among Whites. Regarding early predictors, for both men and women, family conflict in adolescence is a risk factor for adult depression in multivariate regression models. For women, vulnerability to depression has roots in early life, specifically, low maternal aspirations for school attainment. Females displaying more aggressive and delinquent behavior and those growing up in a female-headed household and a household with low maternal education have elevated rates of depression. Males growing up in persistent poverty, those engaging in greater delinquent behavior, and those with low parental supervision in adolescence also have elevated rates of depression. Effective prevention programming for urban African Americans must consider both individual characteristics and the family dynamic.

Childhood and adolescent risk factors for comorbid depression and substance use disorders in adulthood.

The comorbidity of major depression and substance use disorders is well documented. However, thorough understanding of prevalence and early risk factors for comorbidity in adulthood is lacking, particularly among urban African Americans. With data from the Woodlawn Study, which follows a community cohort of urban African Americans from ages 6 to 42, we identify the prevalence of comorbidity and childhood and adolescent risk factors of comorbid depression and substance use disorders, depression alone, and substance use disorders alone. Prevalence of comorbid substance use disorders and major depression in adulthood is 8.3% overall. Comorbidity in cohort men is twice that for women (11.1% vs. 5.7%). Adjusted multinomial regression models found few differences in risk factors for comorbidity compared to either major depression or a substance use disorder on its own. However, results do suggest distinct risk factors for depression without a substance use disorder in adulthood compared to a substance use disorder without depression in adulthood. In particular, low socioeconomic status and family conflict was related to increased risk of developing major depression in adulthood, while dropping out of high school was a statistically significant predictor of adult-onset substance use disorders. Early onset of marijuana use differentiated those with a substance use disorder with or without depression from those with depression without a substance use disorder in adjusted models. In conclusion, comorbid substance use disorders and depression are highly prevalent among these urban African Americans. Insight into the unique childhood and adolescent risk factors for depression compared to substance use disorders is critical to intervention development in urban communities. Results suggest that these programs must consider individual behaviors, as well as the early family dynamic.

Interrelationship of substance use and psychological distress over the life course among a cohort of urban African Americans.

BACKGROUND: Substance use and psychological problems are major public health issues because of their high prevalence, co-occurrence, clustering in socio-economically disadvantaged groups, and serious consequences. However, their interrelationship over time is not well understood. METHODS: This study identifies and compares the developmental epidemiology from age 6 to 42 of substance use and psychological distress in a population of African American men and women. Data come from the Woodlawn study, a longitudinal study of an urban community cohort followed since 1966. We use structural equation modeling to examine pathways between substance use (i.e., alcohol, marijuana, and cocaine) and psychological distress over time by gender. RESULTS: We find significant continuity from adolescence to midlife for substance use and for psychological distress, as well as significant correlations within time periods between substance use and psychological distress, particularly among women. We also find greater adolescent substance use predicts psychological distress in young adulthood for men, but no cross-lag associations for women. Women's adolescent psychological distress and substance use are linked uniquely to that of their mothers. Findings show additional gender differences in the developmental etiology of substance use and psychological distress. CONCLUSIONS: Findings demonstrate the continuity of substance use and psychological distress over time; the contemporaneous relationships between psychological distress and substance use within time periods, and minimal cross-lagged relationships. Findings also show that adolescent substance use may set boys on a pathway of long-term psychological distress, thus adding to evidence of negative consequences of frequent use.

Association between adolescent drinking and adult violence: evidence from a longitudinal study of urban African Americans.

OBJECTIVE: This study examined the relationship between adolescent alcohol use and adult violence from a developmental perspective, specifically whether frequent adolescent drinking predicts adult violence once shared risk factors are taken into account through propensity score matching. The research considered multiple types of violence, including assault, robbery, and suicidal behavior, as well as other types of offending. It tested whether educational attainment and adult alcohol use and problems contribute to the adolescent drinking-adult violence relationship. METHOD: Data came from a longitudinal epidemiological study of a community cohort of urban African Americans followed from age 6 to 42 (N = 702; 51% female). Frequent adolescent drinking was operationalized as 20 times or more by age 16. Data on violent arrests and offenses were collected throughout adulthood from self-reports and official criminal records. Matching variables came from childhood and adolescence and included such shared risk factors as childhood externalizing behaviors, school achievement, and family functioning. RESULTS: Adjusted logistic regression analyses on the sample matched on childhood and adolescent risk factors showed that frequent adolescent drinking was associated with an increased risk of violence in young adulthood (in particular assault) but not with other types of crime, self-directed violence, or violence in midlife. Findings varied by gender. Heavy episodic drinking in adulthood seemed to account for some of the association between frequent adolescent drinking and adult assault. CONCLUSIONS: The results of this study suggest that preventing frequent adolescent drinking could potentially decrease adult assault. This study adds to the growing body of literature suggesting long-term negative consequences of adolescent alcohol use.