Management of the COVID-19 epidemic by public health establishments-Analysis by the Fédération Hospitalière de France.

The objective of this article is to detail the measures taken in public institutions to cope with the COVID-19 epidemic. It details the initial strategy, organizational evolution towards "all-COVID", coordination between the various stakeholders and the strategy for maintaining continuity of care. The Quebec experience is also used as an example. Finally, an exit strategy must be anticipated at this phase of the epidemic.

Translating Discharge Instructions for Limited English-Proficient Families: Strategies and Barriers.

BACKGROUND: Access to written hospital discharge instructions improves caregiver understanding and patient outcomes. However, nearly half of hospitals do not translate discharge instructions, and little is known about why. OBJECTIVES: To identify barriers to and potential strategies for translating children's hospital discharge instructions. METHODS: We conducted a mixed-methods, multimodal analysis. Data comprised closed- and open-ended responses to an online survey sent to Children's Hospital Association language services contacts (n = 31), an online environmental scan of Children's Hospital Association translation policies (n = 22), and county-level census data. We examined quantitative data using descriptive statistics and analyzed open-ended survey responses and written policies using inductive qualitative content analysis. RESULTS: Most survey respondents (81%) reported having a written translation policy at their hospital, and all reported translating a subset of hospital documents, for example, consent forms. Most but not all reported translating discharge instructions (74%). When asked how inpatient staff typically provide translated discharge instructions, most reported use of pretranslated documents (87%) or staff interpreters (81%). Reported barriers included difficulty translating uncommon languages, mismatched discharge and translation time frames, and inconsistent clinical staff use of translation services. Strategies to address barriers included document libraries, pretranslated electronic health record templates, staff-edited machine translations, and sight translation. Institutional policies differed regarding the appropriateness of allowing interpreters to assist with translation. Respondents agreed that machine translation should not be used alone. CONCLUSIONS: Children's hospitals experience similar operational and organizational barriers in providing language-concordant discharge instructions. Current strategies focus on translating standardized documents; collaboration and innovation may encourage provision of personalized documents.

The adoption and spread of hospital care coordination activities under value-based programs.

OBJECTIVES: To examine the relationship between participation in value-based programs and care coordination activities. STUDY DESIGN: Cross-sectional, observational study of 1648 US hospitals using the American Hospital Association (AHA)'s 2013 Survey of Care Systems. Value-based program participation included participation in either an accountable care organization (ACO) or a bundled payment program. We assessed adoption (whether a hospital was using any of a set of 12 care coordination activities in the AHA survey) and spread (in each hospital adopting care coordination activities, how extensively those activities were implemented throughout the hospital). METHODS: Ordinary least squares regression assessed associations between participation in an ACO or bundled payment program and the adoption and spread of 12 care coordination activities. RESULTS: Hospitals adopted nearly two-thirds of the possible care coordination activities (mean [SD] = 7.9 [4.4] of 12). Among those hospitals adopting care coordination activities, there was a relatively moderate spread of these activities (mean = 2.5; range, 1 [minimally used] to 4 [used hospitalwide]). Hospital participation in an ACO was associated with the adoption of 3.07 more care coordination activities (P <.001), on average, and 0.16 more points on the scale of spread of care coordination activities (P <.001) compared with hospitals that were not participating in an ACO. Hospital participation in a bundled payment program was associated with the adoption of 1.84 more care coordination activities (b = 1.84; P <.001) but not greater spread (b = -0.04; P = .54). CONCLUSIONS: Value-based programs such as ACOs appear to encourage the adoption and spread of care coordination activities by hospitals.

Collaborative Solutions to Antibiotic Stewardship in Small Community and Critical Access Hospitals.

The overuse and misuse of antibiotics affect patients in many ways, including by driving antibiotic resistance, a serious public health threat in the United States and around the world. To improve patient safety and address rising rates of resistance, an increasing number of health care facilities have created antibiotic stewardship programs (ASPs). ASPs have been successful in slowing the emergence of resistance and improving patient outcomes. However, there are serious geographic and resource barriers to ASP adoption in small community hospitals and critical access hospitals. Fortunately, many barriers can be overcome by using collaborative models to bring together key stakeholders, including large hospitals and health systems and academic medical centers; hospital associations; federal, state, and local public health organizations; and federal and state offices of rural health. These stakeholders are ideally positioned to assist with stewardship efforts in small community and critical access hospitals and, in doing so, can improve patient safety while stemming the spread of resistant bacteria.

Assessment of the impact of public hospital associations (PHAs) on the efficiency of hospitals under the ministry of health in Turkey with data envelopment analysis.

This study aimed to reflect the efficiency of hospitals under the Ministry of Health (MoH) before and after the implementation of Public Hospital Associations (PHAs). This study covered 3 years before (2010-2012) and 3 years after (2013-2015) the implementation. The population of the study included 865 hospitals under the MoH providing health care services in 81 provinces. No sample was selected; all hospitals were included under the scope of study. The provinces were chosen as the decision-making unit. Changes in the efficiency values of hospitals were analyzed with the Malmquist Total Factor Efficiency Index. The results showed that, for the pre-PHAs period, 24 provinces in 2010, 27 provinces from 2010 to 2011, and 32 provinces from 2011 to 2012 were assessed as efficient. From 2012, the year of implementation, to 2013, the number of efficient provinces dropped to 16. However, 20 provinces were subsequently found to be efficient from 2013 to 2014, and 26 from 2014 to 2015. The efficiency scores average of all provinces were found to be 0.89, 0.92, 0.92, 0.82, 0.88, and 0.90, respectively. Further, the efficiency score average of the 3 years before PHAs (0.91 ± 0.09) was significantly higher than the score obtained 3 years after PHAs (0.86 ± 0.11; p < 0.05). In consideration of such finding, the PHAs established at the provinces were identified as hampering increased efficiency.

Legionnaires Disease Surveillance in US Department of Veterans Affairs Medical Facilities and Assessment of Health Care Facility Association.

Importance: Legionnaires disease (LD) incidence is increasing in the United States. Health care facilities are a high-risk setting for transmission of Legionella bacteria from building water systems to occupants. However, the contribution of LD in health care facilities to national LD rates is not well characterized. Objectives: To determine the burden of LD in US Department of Veterans Affairs (VA) patients and to assess the amount of LD with VA exposure. Design, Setting, and Participants: Retrospective cohort study of reported LD data in VA medical facilities in a national VA LD surveillance system from January 1, 2014, to December 31, 2016. The study population included total veteran enrollees and enrollees who used the VA health care system. Main Outcomes and Measures: The primary outcome was assessment of annual LD rates, categorized by VA and non-VA exposure. Legionnaires disease rates for cases with VA exposure were determined on both population and exposure potential levels. Rates by VA exposure potential were calculated using inpatient bed days of care, long-term care resident days, or outpatient encounters. In addition, types and amounts of LD diagnostic testing were calculated. Case and testing data were analyzed nationally and regionally. Results: There were 491 LD cases in the case report surveillance system from January 1, 2014, to December 31, 2016. Most cases (447 [91%]) had no VA exposure or only outpatient VA exposure. The remaining 44 cases had VA exposure from overnight stays. Total LD rates from January 1, 2014, to December 31, 2016, increased for all VA enrollees (from 1.5 to 2.0 per 100 000 enrollees; P = .04) and for users of VA health care (2.3 to 3.0 per 100 000 enrollees; P = .04). The LD rate for the subset who had no VA exposure also increased (0.90 to 1.47 per 100 000 enrollees; P < .001). In contrast, the LD rate for patients with VA overnight stay decreased on a population level (5.0 to 2.3 per 100 000 enrollees; P < .001) and an exposure level (0.31 to 0.15 per 100 000 enrollees; P < .001). Regionally, the eastern United States had the highest LD rates. The urine antigen test was the most used LD diagnostic method; 49 805 tests were performed in 2015-2016 with 335 positive results (0.67%). Conclusions and Relevance: Data in the VA LD databases showed an increase in overall LD rates over the 3 years, driven by increases in rates of non-VA LD. Inpatient VA-associated LD rates decreased, suggesting that the VA's LD prevention efforts have contributed to improved patient safety.

'We need to have as many Americans covered as possible'.

Unable to influence debate in the House of Representatives on the American Health Care Act, lobbyists and trade group executives are hoping for a more receptive ear in the Senate. "It really is a new day," said Chip Kahn, CEO of the Federation of American Hospitals, alluding to the fact that key Senate leaders have said they are writing their own bill. Among the federation's top priorities, Kahn said, is addressing Medicare cuts enacted in the Affordable Care Act, especially if a new law results in dramatic increases in the uninsured. Kahn recently spoke with Modern Healthcare Managing Editor Matthew Weinstock about the health reform debate, as well as Kahn's call to streamline quality measures. The following is an edited transcript.

Palliative care development in the Asia-Pacific region: an international survey from the Asia Pacific Hospice Palliative Care Network (APHN).

BACKGROUND: Although palliative care is an important public healthcare issue worldwide, the current situation in the Asia-Pacific region has not been systematically evaluated. OBJECTIVES: This survey aimed to clarify the current status of palliative care in the Asia-Pacific region. METHODS: Questionnaires were sent to a representative physician of each member country/region of the Asia Pacific Hospice Palliative Care Network (APHN). The questionnaire examined palliative care service provision, information regarding physician certification in palliative care, the availability of essential drugs for palliative care listed by the International Association for Hospice and Palliative Care (IAHPC) and the regulation of opioid-prescribing practice. RESULTS: Of the 14 member countries/regions of the APHN, 12 (86%) responded. Some form of specialist palliative care services had developed in all the responding countries/regions. Eight member countries/regions had physician certifications for palliative care. Most essential drugs for palliative care listed by the IAHPC were available, whereas hydromorphone, oxycodone and transmucosal fentanyl were unavailable in most countries/regions. Six member countries/regions required permission to prescribe and receive opioids. CONCLUSIONS: The development of palliative care is in different stages across the surveyed countries/regions in the Asia-Pacific region. Data from this survey can be used as baseline data for monitoring the development of palliative care in this region.

Emerging Role of Olanzapine for Prevention and Treatment of Chemotherapy-Induced Nausea and Vomiting.

The prevention and treatment of chemotherapy-induced nausea and vomiting (CINV) continues to pose a challenge for clinicians. The development of 5-hydroxytryptamine (serotonin) antagonists and neurokinin-1 receptor antagonists (NK1 -RAs) have demonstrated significant improvements in acute and delayed CINV for highly and moderately emetogenic chemotherapy. Delayed and breakthrough CINV, however, continue to be difficult to manage despite available treatment agents. Randomized clinical trial data suggest that olanzapine, a second-generation thienobenzodiazepine, traditionally used in the treatment of manifestations of psychotic disorders, is an effective agent in these clinical settings. The short-term use of olanzapine has a favorable adverse event profile and was not associated with grade 3 or 4 toxicity in a phase III study. Olanzapine is recommended as an option within first-line prophylaxis for CINV in the National Comprehensive Cancer Network (NCCN) guidelines and is an option for treatment of refractory CINV in the Multinational Association of Supportive Care in Cancer/European Society for Medical Oncology and NCCN guidelines.

Intervenciones farmacéuticas: desarrollo e implementación metodológica a partir de la evaluación de dos cohortes / Pharmaceutical interventions: methodological development and implementation from the evaluation of two cohorts

La intervención farmacéutica (IF) son acciones que lleva a cabo el farmacéutico en la toma de decisiones en la terapia de los pacientes y en la evaluación de los resultados, con el fin de mejorar la terapia del paciente. Objetivo. Describir y desarrollar una metodología que permita realizar y registrar intervenciones farmacéuticas (IF) en la práctica clínica. Material y Métodos. Se realizó un estudio comparativo, transversal en dos cohortes de intervenciones farmacéuticas. Las variables de estudio se recolectan en una ficha diseñada adaptada de dos propuestas (una argentina y otra española) clasificando las IF según se realicen orientadas al medicamento, a la administración o a la prescripción médica. Resultados. Se realizaron 460 en dos cohortes, 256 y 194 respectivamente. El 83% de las intervenciones estuvieron centradas en el medicamento, en este grupo la IF más frecuente fue la terapia secuencial, dato que no presentó diferencias significativas entre las cohortes lo que no lleva a pensar que el instrumento y el método empleado son válidos. La aceptación de las IF fue en promedio del 95%. Las diferencias entre el resto de los grupos fue variable según el tipo de fármacos prescriptos. Conclusiones. En ambos períodos el instrumento de recolección permitió el registro adecuado de las IF realizadas. La IF más frecuente no presentó diferencias significativas entre ambas cohortes. En todos los casos el impacto clínico es determinante de seguridad del paciente

Pharmaceutical interventions (PI) are actions performed in the pharmaceutical decisions in therapy of patients and the evaluation of the results, in order to improve the patient’s therapy. Aim. The aim of this study is to describe and develop a methodology to perform and record pharmaceutical interventions (PI) in clinical practice. Material and Methods. A cross-sectional comparative study in two cohorts of pharmaceutical interventions. The study variables are collected in a form designed adapted from two proposals (one Argentina and other Spanish) PI are classified: oriented drugs, administration or medical prescription. Results. 460 were performed in two cohorts, 256 and 194 respectively. 83% of the interventions were focused on the drug; this group was the most frequent PI sequential therapy. This information does not show significant differences between cohorts, we think that the instrument and the method are valid. Acceptance of the PI was on average 95%. The differences between the other groups varied according to the type of prescribed drugs. Conclusions. In both periods the collection instrument allowed the proper registration of the PI conducted. The most common PI was no significant difference between the two cohorts. In all cases the clinical impact was decisive in patient safety

Enhancing the Voice of Faculty in the Association of American Medical Colleges: The Evolution of Faculty in U.S. Medical Schools and the Transformation of the Council of Academic Societies Into the Council of Faculty and Academic Societies.

Since its inception in 1966, the Council of Academic Societies (CAS) represented academic faculty in the governance structure of the Association of American Medical Colleges (AAMC). As the role of faculty in the academic health center of the 21st century has evolved (e.g., the number of faculty members has increased, contact hours with trainees per individual faculty member have decreased, the faculty has aged), new models for representation have become necessary. Because of the structure and requirements for organizational membership, CAS was not representing faculty as broadly as possible, so a redesign was necessary. In November 2012, the AAMC Assembly adopted changes to its bylaws creating the new Council of Faculty and Academic Societies. The new design increases the opportunity for all schools to be represented by both junior and senior faculty members while retaining society membership and, therefore, representation of the breadth of specialties in academic medicine. The new council's structure better facilitates meeting its charge: to identify critical issues facing academic medicine faculty members; to provide faculty with a voice as the AAMC addresses those issues through the creation and implementation of AAMC programs, services, and policies; and to serve as a communications conduit between the AAMC and faculty regarding matters related to the core missions of academic medicine.