Perceptions of Cheating Among Students of Health Professions.

For many decades, academic cheating has been prevalent across many institutions and majors. This problem has been exacerbated by new technology that has increased opportunities for students to access and use information dishonestly. There is fear amongst faculty that dishonesty in the academic world could negatively impact professionals in their future careers. The greater prevalence of cheating may be related to students misunderstanding what constitutes cheating. To better understand students' perceptions of cheating, a group of faculty surveyed students across 11 academic programs at a college of health professions using a slightly modified version of a validated tool via an online platform. Data about cheating perceptions were collected from more than 400 students. Although most respondents agreed that cheating is wrong, some were open to explanations of innocence related to possible cheating scenarios. Also, most respondents did not agree that a person who cheats is an unethical person. These findings suggest that students believe cheating can occur unintentionally. Although the findings support that more education about academic dishonesty would be valuable, this study can inform efforts to develop more targeted education and interventions to reduce cheating behaviors.

Social media: How hospital facebook activity may influence patient satisfaction.

Some hospitals use social media to promote accurate health-related education, information, and engage consumers. We performed multiple linear regression analyses to determine the associations between hospital Facebook activity and patient satisfaction for 390 hospitals. Hospitals that had a Facebook page were active on Facebook in the past 30 days and had more "likes," had more patients willing to definitely recommend the hospital, and had a higher overall satisfaction score. Practitioners can use the results when considering whether a minimal financial investment in social media may be worth customer loyalty and Centers for Medicare and Medicaid Systems (CMS) reimbursement benefits.

The non-directed living kidney donor: Why donate to strangers?

BACKGROUND: Kidney transplantation improves survival and quality of life for patients with end-stage kidney disease (ESKD). However, there is a shortage of donated organs, resulting in long wait times and the potential for death before a donor is found. Non-directed (also called altruistic) living kidney donation is a growing type of donation; however, few studies have examined the values and motivation of individuals evaluated to be a non-directed donor. OBJECTIVES: This qualitative study explores the motivations and values of individuals evaluated for non-directed donation. DESIGN: Focus groups were conducted with individuals who had been evaluated for non-directed living kidney donation. Grounded theory method guided the data analysis. PARTICIPANTS: Participants (N = 11) were individuals who completed the evaluation for a non-directed living kidney donation. FINDINGS: Qualitative analyses revealed eight major themes participants considered in making their decision to donate to a non-related person: (i) motivation to donate; (ii) minimise perceived risk; (iii) ideal selected recipient; (iv) change in lifestyle; (v) source of donation knowledge; (vi) history of altruistic acts; (vii) donation chain and (viii) others' response. CONCLUSIONS: Results suggest that non-directed living kidney donors think deeply about their decision and have a resolve to help others that is aligned with their values. As organ availability remains at a critical shortage, unwillingness to consider non-directed living donors (NDD) due to beliefs of ill motivations appears unsupported. Future directions call for the need of standard practice of care in kidney donation evaluations across transplant centers.

Assessing the relationship between patient safety culture and EHR strategy.

Purpose - The purpose of this paper is to explore the relationship between hospitals' electronic health record (EHR) adoption characteristics and their patient safety cultures. The "Meaningful Use" (MU) program is designed to increase hospitals' adoption of EHR, which will lead to better care quality, reduce medical errors, avoid unnecessary cost, and promote a patient safety culture. To reduce medical errors, hospital leaders have been encouraged to promote safety cultures common to high-reliability organizations. Expecting a positive relationship between EHR adoption and improved patient safety cultures appears sound in theory, but it has yet to be empirically demonstrated. Design/methodology/approach - Providers' perceptions of patient safety culture and counts of patient safety incidents are explored in relationship to hospital EHR adoption patterns. Multi-level modeling is employed to data drawn from the Agency for Healthcare Research and Quality's surveys on patient safety culture (level 1) and the American Hospital Association's survey and healthcare information technology supplement (level 2). Findings - The findings suggest that the early adoption of EHR capabilities hold a negative association to the number of patient safety events reported. However, this relationship was not present in providers' perceptions of overall patient safety cultures. These mixed results suggest that the understanding of the EHR-patient safety culture relationship needs further research. Originality/value - Relating EHR MU and providers' care quality attitudes is an important leading indicator for improved patient safety cultures. For healthcare facility managers and providers, the ability to effectively quantify the impact of new technologies on efforts to change organizational cultures is important for pinpointing clinical areas for process improvements.

A patient navigator and education program for increasing potential living donors: a comparative observational study.

BACKGROUND AND OBJECTIVES: Person-centered clinical environments may promote living donation for patients with end-stage renal disease (ESRD). We implemented an observational study design to explore whether a patient navigator (PN) program with person-centered education in nephrology practice settings could increase potential living donors (PLDs) and, subsequently, increase living transplantation. DESIGN, SETTING, PARTICIPANTS, AND MEASURES: Patients referred to (N = 4621) and/or transplanted at (N = 950) our transplant center during 2007-2012 were eligible for inclusion. Two analytical study populations were derived from propensity score matched patient groups. Outcomes comprised total PLDs per candidate and living vs. deceased transplantation for recipients. RESULTS: Multivariable generalized estimating equations logistic regression showed that PN practice candidates were significantly more likely to have an initial inquiry PLD (odds ratio [OR] = 1.21, 95% confidence interval [CI] = 1.01-1.44) and a preliminary screening PLD (OR = 1.27, 95% CI = 1.05-1.54), while there were no significant differences observed in evaluated PLD (OR = 0.94, 95% CI = 0.61-1.45). CONCLUSIONS: Our results suggest that our person-centered PN program stimulated willingness to seek living transplantation and was associated with a trend toward increased LD.

Variations in coping stages for individuals with chronic kidney disease: Results from an exploratory study with patient navigators.

Using a cross-sectional design, we examined coping stages (Kübler-Ross) among patients with end-stage renal disease at nephrology practices incorporating professional social workers as patient navigators, providing person-centered education and support (N = 420). We evaluated associations with behavioral counseling constructs (assess-advise-agree-assist-arrange). Coping stages comprised denial = 35.24 percent, acceptance = 24.05 percent, depression = 21.43 percent, bargaining = 12.86 percent, and anger = 6.43 percent. Compared to denial, other coping stages showed increased odds ratios for transplant referral agreement, transplant referral evaluations, understanding treatments, understanding donation procedures, plans to recruit donors, active donor recruitment, and potential living donor(s). Assessment of coping stages, and strategies to influence these, may be key factors in guiding patients to living donor kidney transplantation.

Impact of Outpatient Rehabilitation Medicare Reimbursement Caps on Utilization and Cost of Rehabilitation Care After Ischemic Stroke: Do Caps Contain Costs?

OBJECTIVE: To estimate the proportion of patients with ischemic stroke who fall within and above the total outpatient rehabilitation caps before and after the Balanced Budget Act of 1997 took effect; and to estimate the cost of poststroke outpatient rehabilitation cost and resource utilization in these patients before and after the implementation of the caps. DESIGN: Retrospective cohort study. SETTING: Medicare reimbursement system. PARTICIPANTS: Medicare beneficiaries from the state of South Carolina: the 1997 stroke cohort sample (N=2667) and the 2004 stroke cohort sample (N=2679). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Proportion of beneficiaries with bills within and above the cap before and after the cap was enacted, and total estimated 1-year rehabilitation Medicare payments before and after the cap. RESULTS: The proportion of patients with stroke exceeding the cap in 2004 after the Balanced Budget Act of 1997 was enacted was significantly lower (5.8%) than those in 1997 (9.5%) had there been a cap at that time (P=.004). However, when the proportion of individuals exceeding the cap among both the outpatient provider and facility files was examined, there was a greater proportion of patients with stroke in 2004 (64.6%) than in 1997 (31.9%) who exceeded the cap (P<.0001). The estimated average 1-year Medicare payments for rehabilitation services, when examining only the Part B outpatient provider bills, did not differ between the cohorts (P=.12), and in fact, decreased slightly from $1052 in 1997 to $833 in 2004. However, when examining rehabilitation costs using all available outpatient Medicare bills, the average estimated payments greatly increased (P<.0001) from $5691 in 1997 to $9606 in 2004. CONCLUSIONS: These findings suggest that billing practices may have changed after outpatient rehabilitation services caps were enacted by the Balanced Budget Act of 1997. Rehabilitation services billing may have shifted from Part B provider bills to being more frequently included in facility charges.

Health literacy and kidney transplant outcomes.

CONTEXT: Kidney disease is a common disease that is best treated through kidney transplant. The kidney transplant process is complex and can be difficult to navigate and most likely requires an adequate amount of health literacy. OBJECTIVE: To assess the relationship between health literacy and transplant outcomes, including whether a patient was listed for or received a transplant. DESIGN: A cross-sectional study measuring patients' health literacy and transplant outcomes. SETTING AND PARTICIPANTS: Participants from a single transplant center were invited to participate if they were referred to the center for transplant and spoke English. Of the 92 patients, 30 (33%) were in the vascular access clinic, 31 (34%) were posttransplant, and 31 (34%) were pretransplant. INTERVENTION: Health literacy was measured by using 3 tools: Rapid Estimate of Adult Literacy of Medicine-Transplant (REALM-T), Newest Vital Sign (NVS), and Decision-Making Capacity Assessment Tool (DMCAT). MAIN OUTCOME MEASURE: Two dichotomous variables: whether the patient was listed for transplant and/or received a transplant. Descriptive and univariate statistics were calculated. Six logistic regression models were used to test for a correlation between each of the tools and patients' likelihood to be listed for and/or receive a transplant. RESULTS: Fifty-three patients (58%) were formally listed for a transplant, and 36 (39%) received a transplant. The REALM-T, NVS, and DMCAT each significantly predicted whether or not a patient was listed for transplant (odds ratios, 1.044, 1.672, and 1.408). The NVS and DMCAT significantly predicted whether a patient received a transplant (odds ratios, 1.667 and 1.256). Health literacy is a positive and significant predictor of transplant outcomes. Clinicians should take assessments of health literacy into account when speaking to patients about kidney transplant.

African American patient knowledge of kidney disease: A qualitative study of those with advanced chronic kidney disease.

Kidney disease is a costly and prevalent condition that affects African Americans more than any other group. The purpose of this study was to determine the knowledge of kidney disease African American patients have about their disease. Four qualitative focus groups were conducted with kidney disease patients in which the patients gave thoughts and opinions on kidney disease and various components and factors of the condition. The data were independently reviewed and analyzed using Qualrus coding software. Dominant themes discussed in the focus groups included: causes of kidney disease, patient thoughts on dialysis as a treatment for kidney disease, information source for disease knowledge, thoughts on God and faith, reaction to kidney disease, and types of treatment available. The study found that the majority of patients were unaware of specific causes and risk factors of kidney disease, were unsure of available treatments, and had a severe lack of knowledge and support system in dealing with the condition. Early prevention and education programs aimed at high-risk populations would be very beneficial in decreasing the incidence and increase of kidney disease.

Patient awareness and perception of stroke symptoms and the use of 911.

BACKGROUND: Response to stroke symptoms and the use of 911 can vary by race/ethnicity. The quickness with which a patient responds to such symptoms has implications for the outcome and treatment. We sought to examine a sample of patients receiving a Remote Evaluation of Acute isCHemic stroke (REACH) telestroke consult in South Carolina regarding their awareness and perception of stroke symptoms related to the use of 911 and to assess possible racial/ethnic disparities. METHODS: As of September 2013, 2325 REACH telestroke consults were conducted in 13 centers throughout South Carolina. Telephone surveys assessing use of 911 were administered from March 2012-January 2013 among 197 patients receiving REACH consults. Univariate and multivariate logistic regression was performed to assess factors associated with use of 911. RESULTS: Most participants (73%) were Caucasian (27% were African-American) and male (54%). The mean age was 66 ± 14.3 years. Factors associated with use of 911 included National Institutes of Health Stroke Scale scores >4 (odds ratio [OR], 5.4; 95% confidence interval [CI], 2.63-11.25), unknown insurance which includes self-pay or not charged (OR, 2.90; 95% CI, 1.15-7.28), and perception of stroke-like symptoms as an emergency (OR, 4.58; 95% CI, 1.65-12.67). African-Americans were significantly more likely than Caucasians to call 911 (62% vs. 43%, P = .02). CONCLUSIONS: African-Americans used 911 at a significantly higher rate. Use of 911 may be related to access to transportation, lack of insurance, or proximity to the hospital although this information was not available. Interventions are needed to improve patient arrival times to telemedicine equipped emergency departments after stroke.

Effectiveness of audience response-enhanced case learning activities in graduate health professions education.

Few studies have investigated the use of audience response systems (ARS) to facilitate case teaching methods in graduate health professions education. The purpose of this paper is to report on the results of focus groups to evaluate the use of ARS-facilitated case activities in two graduate health professions courses. TEACHING METHOD: ARS, in conjunction with case scenarios, were used in Master's of Health Administration (MHA) and Doctor of Physical Therapy (DPT) courses. In the MHA course, the scenarios related to problem-solving and ethics, taught earlier. In the DPT course, scenarios related to treating patients with hip, knee, and foot pain. Students used ARS to respond to decisions regarding the scenarios. ASSESSMENT: Students' perceptions of activities were evaluated using focus groups. CONCLUSION: ARS-enhanced case activities were valuable for applying and reinforcing course concepts, allowing anonymity, and allowing peer comparison to gauge individual progress of course concepts. At the same time, nuances to benefits per student group were revealed.

Health care provider perception of chronic kidney disease: knowledge and behavior among African American patients.

BACKGROUND: Chronic Kidney disease (CKD) is prevalent in the population, but also disproportionately affects African Americans. Disparities in care of chronic kidney disease and transplant for African Americans have also been reported. The purpose of this study is to determine the knowledge and reactions of chronic kidney disease patients regarding their disease, as perceived by nephrologists and clinic nurses in South Carolina. METHODS: Using a qualitative approach, key informant interviews were conducted with nephrologists, and three focus groups were held with nurses who specialize in chronic kidney disease. The results were recorded, transcribed, and analyzed using Qualrus software and the Grounded Theory Method. RESULTS: Dominant themes in the interviews and focus groups include: reaction to chronic kidney disease, differences in race, patient thoughts on dialysis, patient knowledge of types of treatment available, information availability, compliance to treatment, information source, and thoughts on kidney transplantation. The study found that the majority of clinicians agreed that there is typically a wide range of reactions in patients with chronic kidney disease. CONCLUSIONS: The majority of chronic kidney disease patients remain in denial of their diagnosis and do not want to agree to the necessary treatment to improve their condition. In addition, the clinicians reported that the incidence of chronic kidney disease is highest in the African American population and this population of patients typically gets their information on the disease from peers, others they have known that have had renal failure. We find clinicians report that patients typically do not remain compliant to recommended treatment regimens due to lack of knowledge and feelings of denial and fear, and frequently use religiosity as a coping mechanism. Silent progression and complexity of chronic kidney disease frequently result in many patients lacking essential knowledge and developing poor coping mechanisms to seek appropriate follow-up care and prevent progression and optimize outcome. Health care providers are aware of the barriers but may lack the tools and resources to overcome them.

New hospital telemedicine services: potential market for a nighttime telehospitalist service.

BACKGROUND: A critical shortage in the supply of physicians in the United States has necessitated innovative approaches to physician service delivery. Telemedicine is a viable service delivery model for a variety of physician and health services. Telemedicine is most effective when applied where physician resources are scarce, patient care is time sensitive, and service volume may be distributed across a network. Shortages in critical care and neurology specialists have led to the use of tele-intensive care unit and telestroke services in hospital settings. These hospital-based telemedicine services have gained acceptance and recommendation. Hospitalist staffing shortages may provide an opportunity to apply similar telemedicine models to hospitalist medicine. This study assesses the potential market for a nighttime telehospitalist service. MATERIALS AND METHODS: An analysis of the Florida state hospital discharge dataset investigated the potential market for a new nighttime telehospitalist service. Admissions were filtered and stratified for common hospitalist metrics, time of day, and age of patients. Admissions were further expressed by hour of day and location. RESULTS: Nineteen percent of common hospitalist admissions occurred between 7:00 p.m. and 7:00 a.m., with a range of 17%-27% or 0.23-10.09 admissions per night per facility. Eighty percent of admissions occurred prior to midnight. Nonrural facilities averaged 6.69 hospitalist admissions per night, whereas rural facilities averaged 1.35 admissions per night. CONCLUSIONS: The low volume of nighttime admissions indicates an opportunity to leverage a telehospitalist physician service to deliver inpatient medical admission services across a network. Lower volumes of nighttime admissions in rural facilities may indicate a market for telehospitalist solutions to address the dilemma of hospitalist staffing shortages.

Marginal costing methods highlight the contributing cost of comorbid conditions in Medicare patients: a quasi-experimental case-control study of ischemic stroke costs.

BACKGROUND: Cost of illness studies are needed to provide estimates for input into cost-effectiveness studies and as information drivers to resource allocation. However, these studies often do not differentiate costs associated with the disease of interest and costs of co-morbidities. The goal of this study was to identify the 1-year cost of ischemic stroke compared to the annual cost of care for a comparable non-stroke group of South Carolina (SC) Medicare beneficiaries resulting in a marginal cost estimate. METHODS: SC data for 2004 and 2005 were used to estimate the mean 12 month cost of stroke for 2,976 Medicare beneficiaries hospitalized for Ischemic Stroke in 2004. Using nearest neighbor propensity score matching, a control group of non-stroke beneficiaries were matched on age, gender, race, risk factors, and Charlson comorbidity index and their costs were calculated. Marginal cost attributable to ischemic stroke was calculated as the difference between these two adjusted cost estimates. RESULTS: The total cost estimated for SC stroke patients for 1 year (2004) was $81.3 million. The cost for the matched comparison group without stroke was $54.4 million. Thus, the 2004 marginal costs to Medicare due to Ischemic stroke in SC are estimated to be $26.9 million. CONCLUSIONS: Accurate estimates of cost of care for conditions, such as stroke, that are common in older patients with a high rate of comorbid conditions require the use of a marginal costing approach. Over estimation of cost of care for stroke may lead to prediction of larger savings than realizable from important stroke treatment and prevention programs, which may damage the credibility of program advocates, and jeopardize long term funding support. Additionally, correct cost estimates are needed as inputs for valid cost-effectiveness studies. Thus, it is important to use marginal costing for stroke, especially with the increasing public focus on evidence-based economic decision making to be expected with healthcare reform.

Barriers facing patients referred for kidney transplant cause loss to follow-up.

End-stage renal disease affects many Americans; however, transplant is the best treatment option increasing life years and offering a higher quality of life than possible with dialysis. Ironically, many who are eligible for transplant do not follow through on the complex workup protocols required to be placed on the transplant waiting list. Here we surveyed vascular access clinic patients at an academic medical center referred for transplant, who did not follow up on the needed workup to be added to the national transplant waiting list. The most frequent responses of 83 patients for not pursuing transplantation were that the patients did not think they would pass the medical tests, they were scared of getting a transplant, and they could not afford the medicine or the transplantation. These impediments may result from unclear provider communication, misinformation received from peers or other sources, misperceptions related to transplant surgery, or limited health literacy/health decision-making capacity. Thus, patients with end-stage renal disease lost to follow-up after referral for kidney transplant faced both real and perceived barriers pursuing transplantation.

Hospital care for patients experiencing weekend vs weekday stroke: a comparison of quality and aggressiveness of care.

BACKGROUND: We examined the quality and aggressiveness of care for the treatment of acute ischemic stroke (AIS) on weekends vs weekdays. Acute ischemic stroke is a leading cause of death and disability in the United States, and aggressive treatment must be provided within 3 hours for optimal patient outcomes. Because of this short treatment window for the administration of tissue plasminogen activator, patients need around-the-clock access to high-quality and aggressive care. OBJECTIVE: To determine whether there is a difference in the quality or aggressiveness of care for patients experiencing AIS on weekends vs weekdays. DESIGN: Retrospective study. SETTING: Academic research. Patients We conducted a retrospective study of patients with AIS in Virginia. Two logistic regression analyses assessed the relationship between weekend admission and quality and aggressiveness of care, while controlling for appropriate patient-level and hospital-level control variables. A propensity score stratification approach controlled for selection bias. MAIN OUTCOME MEASURES: Treatment with tissue plasminogen activator and in-hospital mortality. RESULTS: Patients with AIS admitted on weekends are more likely to receive tissue plasminogen activator than those admitted on weekdays (P < .05). No statistically significant difference was noted in patient mortality based on day of admission (P >or= .05). We detected no difference in the likelihood to seek hospital care on weekends between patients with AIS vs patients with hemorrhagic stroke. CONCLUSIONS: Patients experiencing AIS are more likely to receive tissue plasminogen activator on weekends than on weekdays. Patients experiencing AIS who are admitted on weekends are no more likely to die than those who are admitted on weekdays. Further research is necessary to understand differences in weekend vs weekday care.

Do hospitals with electronic medical records (EMRs) provide higher quality care?: an examination of three clinical conditions.

This study investigates how hospital electronic medical record (EMR) use influences quality performance. Data include nonfederal acute care hospitals in the United States. Sources of the data include the American Hospital Association, Hospital Quality Alliance, the Healthcare Information and Management Systems Society, and the Centers for Medicare and Medicaid Services case-mix index sets. The authors use a retrospective cross-sectional format with linear regression to assess the relationship between hospital EMR use and quality performance. Quality performance is measured using 10 process indicators related to 3 clinical conditions: acute myocardial infarction, congestive heart failure, and pneumonia. The authors also use a propensity score adjustment to control for possible selection bias. After this adjustment, the authors identify a positive significant relationship between EMR use and 4 of the 10 quality indicators. They conclude that there is limited evidence of the relationship between hospital EMR use and quality.