Search

Purpose: Skilled nursing facility (SNF) care has historically been influenced by systemic issues that could impact speech-language pathology (SLP) service provision. However, there has been little study specifically on factors associated with SLP service provision in SNFs. Large administrative data sets are rarely analyzed in SLP research but can be used to understand real-world SLP services. This study investigated associations between patient and facility characteristics and SLP services. Method: Mixed-effects logistic regression models were used to evaluate factors associated with SLP service provision in 2018 Medicare administrative data representing 833,653 beneficiaries. Results: Beneficiaries had higher odds of receiving SLP services when they had neurologic diagnosis (odds ratio [OR] = 3.32), had SLP-related functional impairments (ORs = 1.19-3.41), and received other rehabilitative services (ORs = 3.11- 3.78). Beneficiaries had lower odds of receiving SLP services when they received care from SNFs located in hospitals versus freestanding (OR = 0.45), with need for interpreter services (OR = 0.76) and with thresholding (OR = 0.68), a financially motivated practice. Direction of association varied across racial and ethnic groups and measures of location. Odds of being provided SLP services decreased with increasing communication impairment severity. Conclusions: The results suggest that clinicians are identifying patients with diagnoses most likely to warrant SLP services. However, association disparities and weakening association of service provision with increasing impairment severity have concerning clinical implications. Health services research methods can be used to further explore SLP practices in SNFs to support equitable service provision. [ABSTRACT FROM AUTHOR]

Background: In recent years, there has been an increasing focus on enhancing frontline health professionals' ability to think and act innovatively, also known as their creative performance. However, previous research has had two limitations. First, only a few leadership styles and their associations with this capability have been examined. Second, there has been a lack of research on identifying potential process mediators and examining their role in the relationship between leadership styles and the professionals' capability. To address this knowledge gap, our study investigates the impact of ambidextrous leadership, a relatively new leadership style, on frontline health professionals' creative performance. Additionally, we explore whether frontline health professionals' learning orientation (an individual factor) and relationship learning (an organizational factor) act as process mediators in this association. No previous research has focused on these relationships. Thus, the study offers a unique contribution to health services research. Methods: This is a cross-sectional study with a convenience sample of N = 258 health professionals in nine Norwegian municipalities. The results of this study were analyzed using PLS-SEM with SmartPLS 3 software. The study examined both direct and indirect relationships through bootstrapping. Results: The results reveal a positive link between health professionals' creative performance and ambidextrous leadership = 0.224). Both relationship learning and learning orientation were found to operate as complementary process-mediating factors between health professionals' creative performance and ambidextrous leadership. The strength of the two individual relationships that constitute the process-mediating factors indicates that ambidextrous leadership has a stronger impact on relationship learning than on learning orientation = 0.504 versus = 0.276). However, when we examined the individual associations between the two factors and creative performance, the strength of the relationships was quite different. The findings reveal that learning orientation is significantly more positively associated with creative performance than relationship learning = 0.302 versus = 0.163). Ambidextrous leadership, learning orientation, and relationship learning explain 26% (R2 = 0.262) of the variance in professionals' creative performance. Conclusions: This study suggests that ambidextrous leadership can facilitate health professionals' creative performance directly and indirectly through the two process-mediating factors: relationship learning and learning orientation. Thus, a practical implication is the importance for health service organizations of clear awareness of the numerous advantages of having leaders who actively practice an ambidextrous leadership style. [ABSTRACT FROM AUTHOR]

Background: This analysis addresses the characteristics of two emergency department (ED) patient populations defined by three model diseases (hip fractures, respiratory, and cardiac symptoms) making use of survey (primary) and routine (secondary) data from hospital information systems (HIS). Our aims were to identify potential systematic inconsistencies between both data samples and implications of their use for future ED-based health services research. Methods: The research network EMANET prospectively collected primary data (n=1442) from 2017-2019 and routine data from 2016 (n=9329) of eight EDs in a major German city. Patient populations were characterized using socio-structural (age, gender) and health- and care-related variables (triage, transport to ED, case and discharge type, multi-morbidity). Statistical comparisons between descriptive results of primary and secondary data samples for each variable were conducted using binomial test, chi-square goodness-of-fit test, or one-sample t-test according to scale level. Results: Differences in distributions of patient characteristics were found in nearly all variables in all three disease populations, especially with regard to transport to ED, discharge type and prevalence of multi-morbidity. Recruitment conditions (e.g., patient non-response), project-specific inclusion criteria (e.g., age and case type restrictions) as well as documentation routines and practices of data production (e.g., coding of diagnoses) affected the composition of primary patient samples. Time restrictions of recruitment procedures did not generate meaningful differences regarding the distribution of characteristics in primary and secondary data samples. Conclusions: Primary and secondary data types maintain their advantages and shortcomings in the context of emergency medicine health services research. However, differences in the distribution of selected variables are rather small. The identification and classification of these effects for data interpretation as well as the establishment of monitoring systems in the data collection process are pivotal. Trial registration: DRKS00011930 (EMACROSS), DRKS00014273 (EMAAGE), NCT03188861 (EMASPOT) [ABSTRACT FROM AUTHOR]

1. Recognize the types of high-value economic evidence and the key barriers to development of such evidence in palliative care 2. Explain the key elements of the proposed research agenda on supply-side, demand-side, and methodological factors 3. Appraise and question the proposed priorities While people with serious medical illnesses account disproportionately for health care spending, the expenditure typically yields poor value. The number of people living with serious illness increases each year as the population ages, and inequities are growing over time. Without robust economic evidence to inform policy related to serious medical illness, the current paradigm of poor-value care and growing inequities will persist. To develop a research strategy to extend and strengthen economic evidence on palliative care. We convened an expert panel to develop a consensus-driven economic research agenda for palliative care. The panel included researchers in health economics, palliative and geriatric medicine, and health services research methods as well as payers, policymakers, and research funders. The derived agenda was organized into questions on supply-side, demand-side, and methodological factors. Supply-side questions focused on payment policy and access, where provider reimbursement policies influence both care delivery and patient treatment choices. Demand-side factors emphasized preferences and future needs. We must improve understanding of what people need and value in order to improve care and outcomes. Methods can be improved in the short run with the expanded use of quasiexperimental approaches on routine data. In the longer term, researchers need a strategic plan to bridge data gaps and improve linkage. Evidence of poor outcomes, high costs, and persistent inequities for people with serious medical illness suggests substantial scope to improve the quality and value of care provided. Economic analyses are essential to inform decision making, but there is a marked lack of high-quality studies. A consensus-driven palliative care research agenda can encourage and guide potential funders and researchers to begin building the economic evidence base needed by public and private payers to improve care across settings and conditions. [ABSTRACT FROM AUTHOR]