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Objectives: The primary objective of this report is to describe a quality improvement practice designed to identify and categorize potentially preventable medication-related hospital admissions. The secondary objective is to present data collected from this practice and describe how it was used to improve a pharmacist intervention focused on reducing medication-related readmissions.Setting: This practice was developed as part of the quality improvement system supporting a pharmacist-led care transition model that was implemented across rural and urban counties in Hawaii.Practice Description: Pharmacists systematically assessed readmissions of the high-risk patients who were enrolled in the care transition model to determine the reasons for the admission and whether each was potentially preventable and medication related. This information was then used to improve the care transition model.Practice Innovation: This admission categorization system is the first based on best practice in pharmaceutical care and identifies indication, effectiveness, safety, and adherence problems, as well as subcategories within each of those domains.Evaluation: This quality improvement practice was applied to 401 readmissions. A chi-square test was used to determine if there were differences between urban and more rural areas regarding percentage of readmissions that were potentially preventable and medication related.Results: Twenty-six percent of the readmissions were determined to be potentially preventable and medication related. The most common categories were nonadherence due to patient choice (23.8%), untreated condition for which medication is indicated (13.3%), dose too high (10.5%), and dose too low (10.5%). The percentage of readmissions that were potentially preventable and medication related was significantly higher in more rural areas (30%) compared with urban areas (17%). There were no significant rural-urban differences by major category of potentially preventable medication-related admissions.Conclusion: This systematic and actionable approach to reviewing and categorizing potentially preventable medication-related admissions can facilitate improvement in care and document the value of pharmacists serving in patient care roles. [ABSTRACT FROM AUTHOR]

The Community Culture Survey (CCS) was designed to advance the measurement of culture and its link to health by asking individuals to describe the attitudes and behaviors of people in the local community where they live. To assess preliminary validity, 130 respondents completed the CCS, a health survey, and demographic questions. Five subscales were derived from the CCS, 2 of which were correlated with health survey items. Residents living in neighborhoods described as higher in Social Responsibility and Friendliness were less likely to report experiencing bodily pain and more likely to report experiencing better quality of life. There were no differences based on demographics. While race or ethnicity is often used as a proxy for culture, the lack of correlation between this variable and community culture subscales supports the distinction between these constructs. The CCS has potential to advance understanding of the effect of community environment on health and disparities. [ABSTRACT FROM AUTHOR]

Current race/ethnicity categories established by the U.S. Office of Management and Budget are neither reliable nor valid for understanding health disparities or for tracking improvements in this area. In Hawaii, statewide hospitals have collaborated to collect race/ethnicity data using a standardized method consistent with recommended practices that overcome the problems with the federal categories. The purpose of this observational study was to determine the impact of this collaboration on key measures of race/ethnicity documentation. After this collaborative effort, the number of standardized categories available across hospitals increased from 6 to 34, and the percent of inpatients with documented race/ethnicity increased from 88 to 96%. This improved standardized methodology is now the foundation for tracking population health indicators statewide and focusing quality improvement efforts. The approach used in Hawaii can serve as a model for other states and regions. Ultimately, the ability to standardize data collection methodology across states and regions will be needed to track improvements nationally. [ABSTRACT FROM AUTHOR]

Background: Sugar cane harvesting by burning on Maui island is an environmental health issue due to respiratory effects of smoke. Volcanic smog ("vog") from an active volcano on a neighboring island periodically blankets Maui and could confound a study of cane smoke's effects since cane burning is not allowed on vog days. This study examines the association between cane burning and emergency department (ED) visits, hospital admissions, and prescription fills for acute respiratory illnesses.Methods: This retrospective study controlled for confounders that could increase respiratory distress on non-burn days by matching each burn day with a non-burn day and then comparing the ratio of patients with respiratory distress residing in the path of sugar burn smoke to those residing elsewhere on Maui on burn versus non-burn days. Patients with acute respiratory distress were defined as those with one or more acute respiratory diagnoses at one of the hospitals or emergency departments on Maui. Separately, patients with acute respiratory illness were identified through prescription records from four community pharmacies, specifically defined as those who filled prescriptions for acute respiratory distress.Results: There were 1,256 reports of respiratory distress prescriptions and 686 hospital/ED diagnoses of acute respiratory illness. The ratio of cases within to outside of smoke exposure was higher on burn days for both the ED/hospital data and the pharmacy, though not statistically significant. In post-hoc analyses of the pharmacy data based on the number of acres burned as a proxy for volume of smoke, there was a dose response trend for acreage burned such that the highest quartile showed a statistically significant higher proportion of acute respiratory distress in the exposed versus non-exposed regions (P = 0.015, OR 2.4, 95% CI [1.2-4.8]).Conclusions: After adjusting for confounders on non-burn days, there was a significantly higher incidence of respiratory distress in smoke-exposed regions when greater amounts of acres were burned. Health officials should consider actions to reduce the negative health outcomes associated with sugar cane burning practices. [ABSTRACT FROM AUTHOR]

The article relates the key elements of the Pharm2Pharm service model funded by the Centers for Medicare & Medicaid Services (CMS) Innovation Center aimed at improving care and reducing costs of medications across care settings in the U.S. Topics covered include the health information technology currently supporting the program, and the economics needed in sustaining this model of medication management.

Background: In light of the documented physician shortage on Hawai'i Island, the Hawai'i Clinician Recruitment and Retention survey was designed and implemented to assess perceptions of quality of life and the work environment among clinicians on Hawai'i Island and to identify aspects of the environment on Hawai'i Island that predict responses to questions regarding recruitment and retention. Methods: The respondents were 127 Hawai'i Island clinicians, specifically 96 physicians, 15 nurses, five pharmacists, four physician assistants, two social workers, and five "other" healthcare workers. The internal reliability of the survey was high (alpha=.91) and its convergent validity was supported by the significant correlation of item total scores with anchor items that measured overall ratings of the environment and likelihood of recruitment and retention. Given the small number of non-physician clinicians responding, descriptive analyses included only physicians. Physicians who indicated they plan to retire within 5 years were excluded from the correlation analyses to focus on patterns within the target group for retention. Results: Overall, results indicate that, while the majority of physicians who relocated to Hawai'i Island did so primarily for the quality of life, the best predictors of retention are financial sustainability, professional opportunities, community support, and access to good K-12 schools. Survey results also indicate that Hawai'i Island will lose 32% of its current physicians within the next five years due to retirement or other causes. Discussion: These findings indicate that increased urgency to find solutions is warranted. [ABSTRACT FROM AUTHOR]

The article discusses the role of organizational culture in health care, as well as ways to improve and measure culture in health care organizations. Organizational culture is the shared beliefs and values which guide attitudes within organizations. Evidence suggests a link between organizational culture and performance. The Work Environment Scale (WES) is recommended for measuring culture in health care organizations.

Objective: The authors evaluated the reliability and preliminary validity of the Charleston Psychiatric Outpatient Satisfaction Scale, a 15- item measure of patients' satisfaction designed for use in outpatient settings. The instrument uses a 5-point Likert-type response format that minimizes positive response bias and optimizes variability and predictive validity. Methods: The Charleston Psychiatric Outpatient Satisfaction Scale was administered to 282 patients seen in psychiatric outpatient clinics affiliated with a public-academic psychiatric institution over a one-week period in 1995. Results: The internal reliability of the instrument was high (alpha=.87), and its convergent validity was supported by the significant correlation of all items with anchor items that measured overall satisfaction with care and likelihood of recommending the clinic to others. The best predictors of overall ratings of care were the items measuring patients' satisfaction with helpfulness of the services and with the respect shown for patients' opinions about treatment. The best predictors of recommendation of the program to others were the items measuring satisfaction with matching of the treatment plan to patients' individual needs and with the respect shown for patients' opinions about treatment. Mean scores for all items ranged from 3.6 (satisfaction with parking) to 4.5 (satisfaction with helpfulness of the secretary and with the overall quality of care), indicating that overall satisfaction in this sample was high. Conclusions: The results provide preliminary support for the reliability and validity of the Charleston Psychiatric Outpatient Satisfaction Scale. [ABSTRACT FROM AUTHOR]

Focuses on the differentiation of depression and post-traumatic stress disorder (PTSD) symptoms in combat veterans. Outcome of the combination of questionnaire items from forms of psychopathology such as depression and PTSD; Factor analyses of combat PTSD and Beck depression inventory item sets.

Introduction: The availability of rural healthcare is a growing concern in the United States as fewer healthcare providers choose to work in rural areas. Accessing quality continuing education (CE) for rural healthcare practitioners (HCPs) remains a challenge and may pose a barrier to quality care., Methods: To maximize attendance at a live, in-person, free CE program focusing on geriatric medication and issues specifically targeted to HCPs in rural areas, two methods were implemented sequentially. The first method used formal advertising implemented by a professional marketing service to promote CE events. The second method enlisted local healthcare organizations and physician groups to promote the CE event to their employees. Cost per attendee was calculated for comparison., Results: Professional marketing services recruited 31 HCPs (March 2011) and resulted in a per-participant recruitment cost of US$428.62. Local healthcare organizations and physician groups' marketing recruited 48 HCPs (July-August 2011) and resulted in a per-participant recruitment cost of US$55.19., Discussion: Providing free CE coordinated through local healthcare organizations and physician groups was the most cost-effective method of recruiting rural HCPs for CE. Formal advertising added cost without increasing the number of participants per event. Although this is the first study of the cost-effectiveness of recruitment methods targeting HCPs in rural areas, results are consistent with research on cost-effectiveness of outreach to rural lay community members.