Search

Community-based palliative care (CBPC) models address the growing needs of patients and caregivers with chronic and serious illnesses. From pediatrics to geriatrics, individuals prefer to receive care within their local community and at home. Delivering care at the community level and within the home improves health outcomes, reduces disparities, and supports local economic activity. Various models of CBPC have developed through partnerships with existing services, such as home health agencies, but ongoing challenges and barriers exist for further expansion of specialty palliative care. Advanced practice registered nurses increasingly manage chronic and serious illnesses and are essential for all health care teams, particularly for CBPC. As trusted providers within the community, advanced practice registered nurses create lasting relationships that allow for meaningful exchanges with patients and caregivers. This article reviewed the concept and features of CBPC offered within the United States and describes an advanced practice registered nurse-led embedded palliative care program for advanced lung disease. [ABSTRACT FROM AUTHOR]

As an outreach recruitment endeavor, a hospital system and an affiliated college of nursing collaborated to host an immersive nursing learning experience for diverse high school participants. The program included hospital tours, speakers, educational games, and wellness activities to promote pursual of nursing as a future career path. The authors describe details of the development of the program, lessons learned, program outcomes, and implications for future programs and applicability in different settings. [ABSTRACT FROM AUTHOR]

The main objective of food safety is to protect consumers of food products from food-related illnesses. Within countries, ensuring the safety of the food supply comes under the auspices of national food safety agencies. In the European Union, the agency charged with the safety evaluation of food products is the European Food Safety Authority (EFSA). Its equivalent in the United States is the Food and Drug Administration. What EFSA is and its role in risk analysis of food chemicals is the subject of this article. It also looks how EFSA as a scientific organization operates and comes to an opinion on the safety of a food chemical. This article also examines the interaction of EFSA with the Food and Drug Administration in the United States. In addition, some examples of where these institutions differ in how they evaluate and regulate food products are highlighted, emphasizing the importance of cooperation and the sharing of expertise between EFSA and the Food and Drug Administration to ensure consumer trust in the foods they consume. [ABSTRACT FROM AUTHOR]

Within the United States, approximately 330 000 military veterans die annually, but only 5% of deaths occur in Veterans Health Administration (VHA) facilities. To help provide end-of-life care for veterans, the VHA built community partnerships with community hospice and palliative care (HPC) organizations. Veterans experience unique psychosocial factors making it vital to ensure HPC organizations have access to veteran-specific knowledge and resources to reduce suffering. To better understand the strengths and limitations of these partnerships, community HPC staff (N = 483) responded to quantitative and qualitative survey questions developed using an access to care theory for veterans. Survey responses demonstrated variable perceptions of access to VHA care and resources. Respondents reported excellent experiences (44%) and relationships with their local facility (50%) and had a reliable contact who provided needed assistance (92%). Thematic analysis identified a need for VHA care and barriers to access, which were associated with technical characteristics, and geographical and cultural issues. These findings can help inform future research and policy regarding access to VHAresources for end-of-life care for veterans in the community and guide resource development for community HPC providers. [ABSTRACT FROM AUTHOR]

Nursing professional development practitioners are integral leaders who continue to seek tangible ways to show their value. A tool was designed to capture workload based upon the scope and standards of nursing professional development practice and successfully captured the workload of over 200 practitioners. Themeasures used in this project can serve as a guide for others to describe nursing professional development practitioner workload. [ABSTRACT FROM AUTHOR]

Background: Increasingly, hospitals are expected to provide patient-centered care that attends to patients' health needs, including spiritual care needs. Chaplaincy services help to meet patients' spiritual care needs, which have been shown to have a positive impact on health outcomes. Variation in the provision of chaplaincy services suggests hospitals do not uniformly conform to the expectation of making chaplaincy services available. Purpose: The aim of this study was to examine the availability and factors that influence hospitals' provision of chaplaincy services. Methodology: Data were combined from the American Hospital Association annual surveys with the Area Health Resource File at the county level from 2010 to 2019. Observations on general, acute-care community hospitals were analyzed (45,384 hospital-year observations) using logistic regression that clustered standard errors at the hospital level. Results: Hospitals with Joint Commission accreditation, more staffed beds, nonprofit and government ownership, teaching status, one or more intensive care units, a higher percentage of Medicare inpatient days, church affiliation, and system membership were more likely to provide chaplaincy services than their counterparts. Certification as a trauma hospital and market competition showed no influence on the provision of chaplaincy services. Conclusion: The lack of chaplaincy services in many hospitals may be due to limited resources, workforce shortage, or a lack of consensus on scope and nature of chaplaincy services. Practice Implications: Chaplaincy services are an underutilized resource that influences patient experience, clinician burnout and turnover, and the goal of ensuring care is patient-centered. Administrators should consider stronger partnerships where services are provided; researchers and policymakers should consider how the lack of these services in some hospitals may reinforce existing health disparities. [ABSTRACT FROM AUTHOR]

Nursing is a demanding profession that calls for nurses to devote time, energy, advocacy, and compassion to improving clients' lives while providing safe, efficient care. Nurses make personal sacrifices to meet their clients' needs, which do not come without costs to their well-being. An increased migration of novice nurses out of the profession and the need to increase the volume of the nursing workforce by an average of 8% annually to address the projected nursing shortage presents a compelling need for immediate action. Reimagining the concept of academic-service partnerships to provide exposure to opportunities that can equip and empower novice nurses as they emerge into professional practice cannot be underestimated. Implementing approaches to assess, support, and nurture the health and well-being of nurses and health care organizations is foundational to retention. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is Available in the Text. Introduction.: All Doctor of Physical Therapy (DPT) programs in the United States prepare students to demonstrate entry-level clinical performance upon graduation. Clinical residency programs are an option for DPT graduates seeking to specialize in a practice area. Review of Literature.: There is little research published on why DPT graduates decide to pursue residency education (RE) or not. This study aimed to determine factors influencing a Physical Therapist's (PT) decision-making process in choosing to pursue a postgraduate residency. Subjects.: PTs within 3 years of graduation and third-year DPT program students were surveyed. Most respondents were from DPT programs in the northeastern United States. Methods.: A survey was created, piloted, and disseminated to various DPT programs. The survey asked participants their perceptions of motivating factors or barriers to pursuing a RE using multiple choice questions and Likert items. Descriptive statistics and frequencies were reported. One-way analysis of variances, chi-square analysis, and unpaired t tests were used. Results.: Students who considered residency in their second year are 26.5× more likely to apply for a residency (P <.001). Participants strongly agreed with the statements that residency will increase confidence when practicing in their specialty area (1.39 ± 0.48), expand their knowledge as clinicians (1.39 ± 0.051), and expedite proficient practice (1.72 ± 0.057). Participants considered student burnout, the cost of residency, student loan debt, and geographical relocation as the top barriers to pursuing residency. Men were significantly more confident in their ability to apply to residency (F = 8.219, P =.005). Married individuals perceived loans or financial obligations (F = 3.607, P =.029), family obligations (F = 17.170, P <.001), and geographical limitations (F = 3.825, P =.024) as barriers more than single individuals. Discussion and Conclusion.: There are many variables DPT students and recent graduates consider when deciding whether to pursue RE. RPs and entry-level DPT programs should consider these factors to promote increased participation in postprofessional RE. [ABSTRACT FROM AUTHOR]

This article gives an overview of the 10 years' experience of the first dedicated geriatric surgery service in Khoo Teck Puat Hospital, Singapore. Frailty and its adverse impact on emergency and elective surgical procedures are elaborated and strategies to optimize outcomes explained. Via transdisciplinary transinstitutional collaboration, geriatric surgery service instituted trimodal intervention of prehabilitation, nutrition, and psychological support for frail patients, achieved consistent perioperative results, shortened length of hospital stay, and restored baseline function for patients undergoing major elective oncological surgery. Efforts are made to teach transdisciplinary collaboration to the next generation of doctors to meet the challenges of the Era of Geriatric Surgery. [ABSTRACT FROM AUTHOR]

Innovation is needed to solve nursing workforce issues during times of crisis. A collaborative effort between a hospital system and several universities resulted in the Bridge to Professional Practice Program that was implemented during a period of high patient volume and nursing student downtime. The program provided support for staffing needs and clinical hours to promote readiness for practice for students. The program evaluation outcomes and recommendations for improvement are addressed. [ABSTRACT FROM AUTHOR]

Nursing is in a challenging place, and we are facing many incredibly complex issues that are steeped in culture and tradition. These "wicked problems" often arise when organizations face constant change or unprecedented challenges. In this article, we discuss current issues that hinder all nurse leaders from elevating nursing as a profession, with a particular focus on the role and contributions of the academic nurse leader in creating and sustaining positive change. By prioritizing meaningful collaboration, reimagining education for nursing outside the hospital walls, investing in evidence for practice, and advocating by amplifying new voices, we can identify shared goals and develop coordinated plans of action. The goal of academic nursing is to work to understand wicked disciplinary problems while also analyzing and critiquing what is not working, articulating possible solutions, and collaborating with other nurse leaders to address these complex issues. This also means that academic nursing should be held equally accountable for delivering results. [ABSTRACT FROM AUTHOR]

Background: Community–academic health partnerships (CAHPs) have become increasingly common to bridge the knowledge-to-practice gap in health care. Because working in such partnerships can be excessively challenging, insights into the individual-level enablers of high performance will enable better management of CAHPs. Purpose: Steered by the goal-setting theory, this study examined the relations between goal clarity, goal stress, goal importance, and their interactions on perceived project performance among individuals working in CAHPs' constituting projects. Methodology: Using a convergent mixed-method research design, online survey data were collected from 268 participants working in a variety of CAHP projects in three German-speaking countries. We tested the hypotheses using structural equation modeling, after which thematic analysis was carried out on the 209 open-ended responses. Results: CAHP project performance was positively associated with goal clarity and negatively associated with goal stress. A three-way interaction analysis showed that when goal importance was high, the relationship between goal clarity and project performance remained positive regardless of the level of goal stress. The qualitative data corroborate this finding. Conclusion: In CAHP projects, high goal importance offsets the negative effect of goal stress on project performance, indicating that workers who perceive the project goals as important can manage the stress associated with demanding goals better. Practice Implications: To achieve high project performance in CAHPs, organizational and project leaders should (a) set clear project goals, (b) facilitate project workers in dealing with stress resulting from overly demanding goals, and (c) emphasize the importance of the project goals, especially when goal stress is high. [ABSTRACT FROM AUTHOR]

Addressing the social determinants of health (SDoH) to advance health equity for persons with heart failure is a complex endeavor. Best results are achieved in partnership with multiple sectors beyond just the health care industry. We describe the evolution of an academic-practice-community partnership addressing the SDoH to advance health equity for a population of underresourced heart failure patients. Using a bundled approach to care delivery within a nurse-led interprofessional collaborative practice model and cultivating multisector partnerships, we initiated a systematic approach to addressing the SDoH within a heart failure clinic in the southeastern United States. Through our SDoH program, our clinic has improved access to care, medications, and food for our patients, thus advancing health equity and reducing hospital readmissions. Our multisector partnerships to address SDoH and advance health equity provide a foundation to improve population health outcomes for underresourced persons with heart failure. An SDoH program such as ours would not have been possible without strong leadership and collaboration of colleagues from multiple disciplines and sectors. In keeping with the Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity report, we showcase our actions consistent with the report's recommendations. [ABSTRACT FROM AUTHOR]

Background and Purpose.: Strong academic–clinical partnerships have been advocated to optimize the training of the next generation of health professionals and to best meet the needs of patients and society. Despite the benefits of partnerships, there is a lack of literature describing successful models for collaboration between physical therapist (PT) schools and academic medical center hospitals. The purpose of this article was to describe the formal partnership between the Northwestern University, Feinberg School of Medicine, Department of Physical Therapy and Human Movement Sciences (DPTHMS) and Shirley Ryan AbilityLab in Chicago, Illinois. Method/Model Description and Evaluation.: The partnership is presented through the lens of D'Amour's 4-dimensional model of collaboration highlighting 4 critical dimensions of collaboration: shared goals and activities , internalization , formalization , and governance. Outcomes.: The establishment of this partnership has fostered the institutions' achievement of mutual goals supporting their interconnected visions and missions. Examples of the collaboration's shared goal and activities include: the tripling of clinical education experiences for professional Doctor of Physical Therapy (DPT) students; establishment of 2 post professional PT residency programs; proliferation of DPT teaching opportunities for Shirley Ryan AbiltyLab clinical PTs with formal university academic appointments for 6 Shirley Ryan Ability Lab PTs; and clinical appointments for 7 of 34 eligible DPTHMS faculty members. The internalization dimension is evidenced by regularly scheduled communications; promotion of opportunities for mutual acquaintanceship through shared boards and teams; socialization opportunities; and trust-building across institutions. The primary example of formalization is the legal collaboration agreement signed in 2013 and amended in 2019. Partnership governance is achieved through a structure of designated liaisons, shared boards, and regular interinstitutional leadership meetings. Discussion and Conclusion.: D'Amour's structuration model describes predictors for successful interinstitutional clinical–academic partnerships. The model's 4 collaboration dimensions facilitate the assessment of partnership success for both established partnerships and for institutions in the planning stage of such collaborations. [ABSTRACT FROM AUTHOR]

The coronavirus disease-2019 (COVID-19) pandemic posed unprecedented challenges for health care organizations, schools of nursing, and surrounding communities. Health care organizations encountered rapidly changing guidelines and shortages in the health care workforce and critical medical supplies. Schools of nursing were responding to abrupt suspensions of clinical placements, uncertainties about the transmission of the novel virus, and shortages of personal protective equipment. Despite these challenges, health care organizations and schools of nursing were laser-focused on the need to ensure a competent nursing workforce and timely pandemic response efforts. Thus, an innovative academic-practice collaboration between Yale New Haven Hospital and Quinnipiac University School of Nursing was developed to meet community vaccination and testing needs. The partnership was designed to provide undergraduate student nurses with valuable community health clinical hours during the spring 2021 semester while meeting the hospital's needs for supporting the COVID-19 vaccine clinics and testing sites. The positive outcomes of the collaboration and specific lessons learned are discussed. [ABSTRACT FROM AUTHOR]

Supplemental digital content is available in the text. As part of a clinical-academic partnership, graduate nursing students initiated evidence-based quality improvement projects in a large, metropolitan, 5-time Magnet®-designated pediatric hospital to encourage continuous innovation and evidence-based practice. This article describes the evolution and strategies used by leadership and staff to sustain the projects over time. Data collected by the organization report trended outcomes, highlight themes for success from graduate nursing students from 2017 through 2020, and report the implications for nurse executives. [ABSTRACT FROM AUTHOR]

During the COVID-19 pandemic, many health care facilities closed their doors to nursing students, depriving them of the experience of caring for patients, a foundation of nursing education. The purpose of this article is to report on how the National Council of State Boards of Nursing convened nurse leaders from around the country to explore this problem and develop possible solutions. Coming together virtually, these leaders recommended a national model, the practice–academic partnership, to provide nursing students with in-person clinical experiences during the pandemic. This model is unique in its recognition of the important role of nursing regulatory bodies in these partnerships. The practice–academic partnership model creates clinical education opportunities for students during a public health crisis, such as the COVID-19 pandemic. Further, the model could be applied to meet the chronic challenges nursing education programs have often faced in securing clinical sites, even in the absence of a global or national public health emergency. We provide the context in which the practice–academic partnership model was developed, along with keys to its successful implementation and suggestions for its evaluation. We also discuss the implications of using this model once the pandemic ends. This article outlines a model to provide nursing students with in-person clinical experiences during a public health crisis such as COVID-19, as well as the implications of using this model once the pandemic ends. [ABSTRACT FROM AUTHOR]

The Association of Academic Physiatrists, the home of academic physiatry, is interested in advancing industry partnerships in research among academic physiatrists. There are limited existing resources that outline opportunities for academic physiatrists in engaging the translational research continuum through industry partnerships and the skill sets that academic physiatrists need to successfully navigate these partnerships. In 2019, then President of the Association of Academic Physiatrists, John Chae, MD, ME, assembled a group of interested physician-scientists in physical medicine and rehabilitation to form the Research and Industry Partnerships Task Force to address this problem. The Task Force implemented a live educational session titled "Collaborating with industry" at Physiatry '19, the Annual Meeting of the Association of Academic Physiatrists held in Puerto Rco. To extend the reach of this valuable information, the Task Force is creating resources that can be easily distributed and accessed by all physiatrists. The goal of this white paper is to provide a roadmap to help academic physiatrists begin to navigate the field of academia-industry relationships with the ultimate goal of accelerating discovery for the benefit of physiatry and rehabilitation patients. [ABSTRACT FROM AUTHOR]

The article describes how the academic-practice partnership between the medical center and an affiliated university was reimagined amid the COVID-19 pandemic. It discusses the needed for baccalaureate nursing education to prepare competent graduates through effective communication, delegation, supervision ad teamwork which are consistent with Quality and Safety Education for Nurses competencies. Using an innovative approach to the partnership, the needs of stakeholders were successfully net.

Background: The Toronto Academic Health Sciences Network Health Professions Innovation Fellowship Program began in 2014 as a pilot initiative among 4 academic teaching hospitals in Toronto, Ontario. The purpose of the Program was to cultivate applied leadership, interprofessional collaboration, and quality improvement capacity among health professionals. Purpose: This article reports on the evaluation findings from the initial year as well as an update on current program status and sustainability. Methods: A formative evaluation was conducted focused on the impact on clinical practice, participant skill development, participant experience, and cross-organizational partnerships. Data were collected through a focus group, interviews, and pre- and postsurveys. Results: Data from the initial pilot showed increases in leadership practices, project management, and quality improvement knowledge, with changes in leadership practices being significant. Positive changes in clinical practice at both the individual and unit/team levels and capacity for building relationships were also reported. Since the pilot, more than 160 participants from 15 health professions and 9 organizations have participated. Several graduates have taken on leadership roles since their participation in the Program. Conclusions: Health care organizations wishing to advance academic practice may benefit from implementing a similar collaborative program to reap benefits beyond organizational silos. [ABSTRACT FROM AUTHOR]

Supplemental digital content is available in the text. Academic-practice partnerships are formalized relationships encouraged by the American Association of Colleges of Nursing to meet healthcare and societal needs. While Academic-practice partnerships have existed for decades, the process for evaluating their outcomes often lacks a robust, standardized structure. The purpose of this article is to describe one organization's process for developing and implementing an evaluation blueprint for appraising an Academic-practice partnership. [ABSTRACT FROM AUTHOR]

Supplemental digital content is available in the text. OBJECTIVE: The aim of this study was to review organizational factors influencing successful large-scale change (LSC) in healthcare. BACKGROUND: LSC is necessary to achieve sustained and meaningful healthcare improvement. However, organizational readiness needs to be considered to promote successful LSC. METHODS: Four databases were searched for articles published between 2009 and 2018. Thematic analysis was used to identify enabling or hindering factors to LSC. RESULTS: Seven organizational factors were consistently described as facilitators of or barriers to successful LSC in healthcare: infrastructure support, organizational culture, leadership, change management approach, roles and responsibilities, networks, and measurement and feedback. CONCLUSION: The factors that emerged from this review are consistent with concepts of implementation but broadened and highlight learning organizations in successful LSC. The results of this review informed the development of a reflective tool on LSC for nurse leaders. [ABSTRACT FROM AUTHOR]

EXECUTIVE SUMMARY: The formation of regional strategic alliances continues to be a well-evidenced response to a varying array of market forces that are challenging the ability of healthcare institutions to realize their missions. Organizations that serve rural communities especially feel pressure to initiate the formation of these collaborative arrangements. In response to concerns of Pennsylvania legislators regarding the impact of these alliances on rural healthcare entities, the Center for Rural Pennsylvania funded a study of outcomes of regional strategic alliances involving rural healthcare institutions. Although the research focused on outcomes, the data also revealed organizational characteristics and patterns of decisions and actions that separated rural healthcare institutions with greater alliance outcome success from their peers serving other rural communities. Strategic leadership and interorganizational management expertise serve as the foundation for decisions and actions beginning before an active search for an alliance and culminating with the achievement of alliance goals. Commitments to collaborative leadership, purposeful partnership, coordination, and progress thematically represent the series of critical decisions and actions collectively required to achieve strategic alliance success. The case of the Laurel Health System illustrates these commitments. Although the findings are based on an intensive review of regional strategic alliances involving rural healthcare institutions, the lessons presented here are transferable to community healthcare organizations regardless of location. [ABSTRACT FROM AUTHOR]

This article describes an academic-clinical partnership program between a school of nursing and an American Nurse Credentialing Center Magnet®– and National Cancer Institute–designated Comprehensive Cancer Center based on a shared vision and multifaceted for optimal new graduate operating room (OR) recruitment and use of clinical partner resources. The program, now in its 3rd year, has a 100% retention rate among the cohorts. Implementing a multifaceted OR partnership program based on nursing theory is a strategy for workforce development to increase retention of new graduate OR nurses. [ABSTRACT FROM AUTHOR]

This month's column highlights the importance of established health system academic partnerships in strengthening the advanced practice RN workforce. [ABSTRACT FROM AUTHOR]

The COVID-19 crisis has nakedly exposed the problems and huge holes in the health care system of the United States. For today, we need to address the current pandemic from the point of view of both control and suppression. But such efforts could also provide insights into a post-pandemic restructuring of health care. If one or several states succeed in addressing the COVID pandemic together with an associated modest economic resurgence, citizens could develop the trust in state leadership necessary to finally make fundamental changes in our health care system. Such change is a once in a century opportunity. [ABSTRACT FROM AUTHOR]

Background: Most hospitals outsource supply procurement to purchasing alliances, or group purchasing organizations (GPOs). Despite their early 20th century origin, we lack both national and trend data on alliance utilization, services, and performance. The topic is important as alliances help hospitals control costs, enjoy tailwinds from affiliated regional/local alliances, and face headwinds from hospital self-contracting and criticism of certain business practices. Purpose: We compare the utilization, services, and performance of alliances in 2004 and 2014. Approach: We analyze alliances using two comparable surveys of hospitals. We use significance tests to assess changes in alliance utilization, services, and performance (e.g., cost savings). We also assess the use of regional/local alliances affiliated with national GPOs. Results: Purchasing through national alliances has somewhat diminished. Over 10 years, hospitals have diversified GPO memberships to include regional/local alliances (many affiliated with their national GPO) and engaged in self-contracting. At the same time, hospitals have increased purchases of many categories of supplies/services through national GPOs and endorsed their value-added functions and increasingly important role. Hospitals report greater satisfaction with several GPO functions; performance on most dimensions has not changed. Conclusions: National alliances still play important roles that hospitals find valuable. Practice Implications: Purchasing alliances continue to play an important role in helping hospitals with both cost savings and new services. Their growing complexity, along with growing use of self-contracting, poses managerial challenges for hospital purchasing staff that may require greater hospital investment. [ABSTRACT FROM AUTHOR]

Sustainability is an important concept in implementation science, yet little about sustainability is published in leadership journals. Leaders are charged on a daily basis with initiating programs that make a difference; however, they are often not well prepared to design effective strategies to sustain their efforts. In a value-based health care industry where facilitating access to care, enhancing the patient experience, improving health outcomes, and reducing the cost of care are imperative, creating sustainability strategies that achieve these results is key. In this article, we describe the successful efforts within an academic-practice partnership to implement a sustainable interprofessional collaborative practice model emphasizing transitional care coordination in chronic disease management for advancing population health with underserved populations. A sustainability framework is presented along with lessons learned. [ABSTRACT FROM AUTHOR]

Since the 1970s, the state of Maryland has operated on a different payment system for Medicare than that in the rest of the country. Known as the Maryland Waiver, recent terms have focused on reducing cost and wastewhile increasing value and scope toward population health. This article describes a partnership between 2 community hospitals in Maryland to meet the goals of the waiver. The partnership addressed the triple aim: improving access and population health; improving the experience of care; and decreasing per capita hospital costs for the patients both organizations serve. The goals of the partnership were to develop and implement cross-organizational, multidisciplinary tools and processes to reduce potentially avoidable utilization; integrate behavioral health into primary care settings; and improve all hospital patient outcomes and satisfaction for the target population. The success of the interventions implemented has exceeded the metrics in the proposal. [ABSTRACT FROM AUTHOR]

Supplemental digital content is available in the text. A practice-focused academic-practice partnership merging the strengths and resources of 2 faith-based community organizations built evidence-based practice, nursing research, and innovative nursing programs. The unique partnership emphasizing quality care and patient outcomes resulted in hospital-acquired infection reduction, interventional research reducing readmissions, clinical redesign, increased percentage of bachelor's degree–prepared nurses, and dissemination through publication and presentation. Key elements to partnership success were shared mission and vision, program oversight, strong contract, and annual plans with specific measurable outcomes. [ABSTRACT FROM AUTHOR]

Background: Community orientation refers to hospitals' efforts to assess and meet the health needs of the local population. Variations in the number of community orientation-related activities offered by hospitals may be attributed to differences in organizational and environmental characteristics. Therefore, hospitals have to strategically respond to these internal and external constraints to improve community health. Understanding the facilitators and barriers of hospital community orientation is important to health care managers facing pressure from the external environment to meet the expectations of the community as well as Affordable Care Act guidelines. Purpose: The purpose of this study was to examine the organizational and environmental factors that promote or impede hospital community orientation. Methodology: A multivariate regression with random effects was conducted using data from the American Hospital Association Annual Survey from 2007 to 2010 and county level data from the Area Health Resource Files. Findings: Not-for-profit, system-affiliated, network-affiliated, and larger hospitals have a higher degree of community orientation. In addition, the percentage of the county residents under the age of 65 years with health insurance and hospitals in states with certificate-of-need laws were also positively related to the degree of community orientation. During the study period, it appears that organizational factors mattered more in determining the degree of community orientation. Practice Implications: Overall, a better understanding of the factors that influence community orientation can assist hospital administrators and policymakers in stimulating the hospital's role in improving population health and its responsiveness to community health needs. These efforts may occur by building interorganizational relationships or by incentivizing those hospitals that are least likely to be community oriented. [ABSTRACT FROM AUTHOR]

Academic-clinical research partnerships can benefit academic and clinical partners when goals are clearly articulated and mutually determined and include increased research dissemination and lower research costs. This article explores the history of academic-clinical research partnerships and discusses the drivers of collaborative academic-clinical research relationships, resources from academia and clinical sites, and sustainability of collaborative partnerships. Through collaboration, academic-clinical partners can improve clinical outcomes and reduce healthcare costs. [ABSTRACT FROM AUTHOR]

The authors present the implementation of a grand rounds program at their naval hospital, and demonstrate how nursing grand rounds can support professional growth and strengthen partnerships. In 2017, Navy Nurse Corps executives launched a new nursing professional practice model that promotes operational readiness, professional development, and transformational leadership. This directive prompted nursing leadership at Naval Hospital Jacksonville (NH JAX) to conduct a needs assessment survey to determine what kind of educational initiative nursing staff members would most welcome in support of the goals of the new practice model. Survey respondents favored case studies presented in a nursing grand rounds format. Our change implementation team designed and executed the grand rounds program, offering lunchtime presentations every other month. Topics included a wide range of "high-risk/low-volume" procedures—those infrequently performed at participants' clinical sites. Ten months after the initiation of grand rounds, surveys were distributed to NH JAX participants to assess their perceptions of the value of the sessions in terms of professional development, interdisciplinary teamwork, and strengthened institutional partnerships. Of the 161 nursing grand rounds participants, 41 (25%) responded to the postimplementation survey. Responses indicated that participants valued nursing grand rounds in enhancing clinical knowledge (83% agreed), discussing research and evidence-based practices (71% agreed), supporting professional development (88% agreed), improving interdisciplinary teamwork (83% agreed), and solidifying interorganizational partnerships (73% agreed). This article presents the implementation of the NH JAX grand rounds program and demonstrates how nursing grand rounds can serve as an excellent forum in which to develop knowledge, showcase research and evidence-based practices, support professional growth, improve collaboration, and strengthen partnerships. [ABSTRACT FROM AUTHOR]

Background: Quality improvement collaboratives (QICs) have emerged as an important strategy to improve processes and outcomes of clinical care through interorganizational learning. Little is known about the organizational factors that support or deter physician practice participation in QICs. Purpose: The aim of this study was to examine organizational influences on physician practices" propensity to participate in QICs. We hypothesized that practice affiliation with an accountable care organization (ACO) and practice ownership by a system or community health center (CHC) would increase the propensity of physician practices to participate in a QIC. Methodology: Data from the third wave of the National Study of Physician Organizations, a nationally representative sample of medical practices (n = 1,359), were analyzed. Weighted multivariate regression analyses were estimated to examine the association of ACO affiliation, ownership, and QIC participation, controlling for practice size, health information technology capacity, public reporting participation, and practice revenue from Medicaid and uninsured patients. The Sobel-Goodman Test was used to explore the extent to which practice use of quality improvement (QI) methods such as Lean, Six Sigma, and use of plan-do-study-act cycles mediates the relationship between ACO affiliation and QIC participation. Findings: Only 13.6% of practices surveyed in 2012-2013 participated in a QIC. In adjusted analyses, ACO affiliation (odds ratio [OR] = 1.51, p < .01), CHC ownership (OR = 6.57, p < .001), larger practice size (OR = 14.72, p < .001), and health information technology functionality (OR = 1.15, p < .001) were positively associated with QIC participation. Practice use of QI methods partially mediated (13.1%-46.7%) the association of ACO affiliation with QIC participation. Practice Implications: ACO-affiliated practices are more likely than non-ACO practices to participate in QICs. Practice size rather than system ownership appears to influence QIC participation. QI methods often promoted and used by health care systems such as CHCs and ACOs may promote QIC participation. [ABSTRACT FROM AUTHOR]

To avoid penalty through the Hospital Readmission Reduction Program, an academic practice partnership, Health Transitions Alliance, was formed with the local university, resulting in adoption of an innovative transitional care model. Key to the model was a health coach who operationalized transition care to the home setting. Health coaches, interns in their last semester of college, used motivational interviewing to help patients set disease management goals. As a result of this model, the readmission rate for program participants in the initial 7 months was reduced by 72%. [ABSTRACT FROM AUTHOR]

The article informs that American Association of Nurse Practitioners (AANP) recognized the following platinum members of the 2019 Corporate Council, including Exact Sciences Corporation, Johnson & Johnson, and AstraZeneca. It reports the corporate Council members are organizations that elect to work with and support AANP's efforts to improve health care by recognizing and promoting the work and opinions of NPs.

Objectives: The American Medical Association has reported that 2016 was the first year in which fewer than half (47.1%) of all practicing physicians owned their own practice. Across the United States, there has been consolidation of physicians and hospital and health systems, resulting in questions about the effect of this on healthcare expenditures. The aim of this study was to compare the expenditures per patient between hospital- and health system-affiliated physicians and independent physicians.Methods: The author used Virginia's new statewide all-payer claims database to analyze expenditures and quality for 3 years for hospital- and health system-affiliated physicians versus independent physicians. The database had all claims statewide for Virginians with individual or group commercial insurance coverage: 1.95 million patients in 2013, 2 million in 2014, and 2.1 million in 2015. The average annual expenditure for each physician was adjusted for average patient condition burden (risk) and differences in geographic input costs using regression analysis. Measures of primary care quality were obtained from the claims data using evidence-based measures from national health quality organizations.Results: Hospital- and health system-affiliated physicians had annual expenditures per patient ranging from 10.3% to 14.6% higher than independent physicians. Most of the measures of primary care quality were not significantly different.Conclusions: Virginia patients, employers, and managed care companies incurred higher per-patient expenditures with hospital and health system physicians than with independent physicians. [ABSTRACT FROM AUTHOR]

Background: Interorganizational relationships (IORs) between hospitals and other health care providers have many potential benefits for critical access hospitals (CAHs) that operate in resource-constrained environments. Given the potential benefits of IORs, especially for CAHs, it is important to identify the conditions that support or hinder IOR development. However, most research examining IORs isolates individual types of relationships while ignoring the practical reality that many hospitals participate in a portfolio of relationships simultaneously. Purpose: The aim of the study was to examine the IOR strategies of CAHs as a function of market and organizational characteristics. Methodology: The sample consisted of CAHs operating in the United States between the years 2002 and 2012. For each year, hospitals were assigned to one of four mutually exclusive IOR categories: (a) no IOR, (b) vertical IOR only, (c) horizontal IOR only, and (d) both vertical and horizontal IOR. Organizational characteristics were categorized as structural, operational, and financial. Environmental characteristics were categorized as sociodemographic, physical, and health delivery system-related. A multinomial logistic regression model was used to assess the relationship between IOR strategies and organizational and environmental characteristics, with results reported as average marginal effects. Results: Approximately 41% of the CAHs were pursuing a combined vertical and horizontal IOR strategy, 20% were pursuing a vertical IOR-only strategy, 18% were pursuing a horizontal IOR-only strategy, and 21% were not engaged in an IOR strategy.Among the organizational characteristics, the type of IOR strategy used by a hospital varied as a function of ownership, total margin, days cash on hand, number of community orientation activities, and census. In contrast, among the environmental characteristics, only the number of community health centers in the community was associated with the type of IOR strategy pursued. Conclusion: CAHs_ construction of IOR portfolios may be more dependent on organizational attributes than by environmental conditions. [ABSTRACT FROM AUTHOR]

Background and purpose: The purpose of this pilot study was to describe the impact of one aspect of an academic-clinical partnership that showed how assigning nurse practitioner faculty to deliver home-based primary care services to clinically complex patients would decrease rehospitalizations and emergency department visit rates. Methods: Rehospitalizations and emergency department visits of a cohort of 82 patients were recorded from April 15, 2016 to August 25, 2016 and compared with the same cohort during the two pre-home care inception periods (6 months and 1 year) using insurance claims-based data. Conclusions: Compared with the 1-year pre-home care inception period, there was a decrease of 23.7% in emergency department visits and 34.9% decrease in rehospitalizations after the implementation of the home-based primary care program and a decrease of 35.6% in emergency department visits and 59.4% decrease in rehospitalizations compared with 6 months of pre-home care inception. Implications for practice: Allowing nurse practitioners with full practice authority to deliver home-based primary health care services to homebound, chronically ill, recently discharged, and/or disabled patients can decrease costs and promote optimum health care in this population. In addition, these programs provide valuable learning experiences for nurse practitioner students and their preceptors. [ABSTRACT FROM AUTHOR]

The article discusses how implementation of academic-practice partnerships or the collaborative relationships between schools of nursing and clinical practice settings has the potential to improve patient outcomes. Topics discussed include a strong positive correlation between higher academic preparation of nurses and quality patient outcomes and benefits of the partnership between academic faculty and acute care nurse leaders.

Safety net settings care for a disproportionate share of low-resource patients often have fewer resources to invest in nursing research. To address this dilemma, an academic-clinical partnership was formed in an effort to increase nursing research capacity at a safety net setting. Penn Presbyterian Medical Center and the Center for Health Outcomes and Policy Research located at the University of Pennsylvania partnered researchers and baccalaureate-prepared nurses in an 18-month research skill development program. This article describes the programmatic design, conceptual framework, resource requirements, and effect on the institutional partners and participants. [ABSTRACT FROM AUTHOR]

Nurses' active involvement in clinical scholarship is necessary to advance the nursing profession and improve patient outcomes. Yet, definitional confusion and numerous barriers exist to clinical scholarship in and across academic and patient care settings. We discuss factors that pose barriers to the continuum of clinical scholarship and suggest opportunities for clinician-researcher collaborations that promote nurses' engagement in evidence-based practice, quality improvement, and research. [ABSTRACT FROM AUTHOR]

Background: The development of performance indicators that enable benchmarking between organizations is an important mechanism for accountability, organizational learning, and performance improvement. In the province of Quebec (Canada), 21 rehabilitation organizations developed a common set of performance indicators through interorganizational collaboration. Purpose: The aims of this study were to describe the rehabilitation organizations' use of a common set of performance indicators and to identify the factors influencing such use. Approach: A qualitative survey was performed. Individual semistructured interviews were conducted with executives (n = 18) working at 16 rehabilitation organizations using a common set of performance indicators. A thematic analysis of the factors of use was performed according to the Consolidated Framework for Implementation Research. The use of performance indicators was categorized as purposeful, political, or passive. Findings: Our results showed that all organizations used the common set of performance indicators. Four factors were identified as important to all the rehabilitation organizations to explain their interest in comparative performance indicators: the need to develop their own performance indicators, the compatibility of performance information with organizational needs, complexity/simplicity of performance information, and the support offered by their common association. Sixty-three percent of rehabilitation organizations made purposeful or political use of performance indicators. Three main factors contributed to typify those organizations from the others: the perceived quality of the performance indicators, the leadership of decision makers, and the resources available. Practice Implications: Our results showed that use of performance indicators can support the initiation of projects for improving the quality of care. Key recommendations are proposed to decision makers that may enhance performance indicators' use. [ABSTRACT FROM AUTHOR]

This article summarizes experience and outcomes for a large, faith-based health system on a journey to ensure that its nearly 29 000-person nurse workforce has the foundational academic preparation to deliver superior, compassionate, and future-focused nursing care. The health system’s bachelor of science in nursing completion strategy is summarized, including (a) programmatic structure, (b) curriculum themes, (c) participant experience, and (d) outcomes. Executive leadership’s commitment and engagement are highlighted. [ABSTRACT FROM AUTHOR]

The article discusses a collaborative Nightingale Experience (NE) initiative that hospitals and nursing programs can implement to meet community service outcomes for national nursing program accreditation and Magnet recognition. Topics covered include percentage of registered nurses who have a bachelor of science in nursing degree by 2020, influence of high school counselors on students' career choices, and two reasons why high school sophomores are selected for the NE.

An innovative interprofessional disaster preparedness program was designed and implemented through an academic-practice partnership between a large mid-western children's hospital and a community-based state university. This course was part of a constellation of courses developed in response to Presidential Directive (HSPD) 8, a mandate to standardize disaster response training that was issued after the inefficiencies following Hurricane Katrina. A hybrid immersive and didactic approach was used to train senior leadership and frontline clinicians. Included were simulated experiences at the National Center for Medical Readiness, a workshop, and online modules. The program that focused on crisis leadership and disaster management was developed and implemented to serve patient-centered organizations. [ABSTRACT FROM AUTHOR]

Background: Interorganizational collaboration management theory contends that cooperation between distinct but related organizations can yield innovation and competitive advantage to the participating organization. Yet, it is unclear if a multi-institutional collaborative can improve quality outcomes across communities. Methods: We developed a large regional collaborative network of 15 hospitals and 24 emergency medical service agencies surrounding Dallas, Texas, and collected patient-level data on treatment times for acute myocardial infarctions. Using a pre-/posttest research design, we applied median tests of differences to explore outcome changes between groups and over the 6-year period, using data extracted from participating hospital electronic health records. Results: We analyzed temporal trends and changes in treatment times for 2302 patients with ST-elevation myocardial infarction between the pre- and posttest groups. We found a statistically significant 19-minute median reduction in the key outcome metric (total ischemic time, the time difference between the patient's first reported symptoms and the definitive opening of the artery). This represents a 10.8% community-wide improvement over time. Conclusions: Interorganizational collaboration focused on quality improvement can impact population health across a community. This study provides a basis for broader understanding and participation by health care organizations in multi-institutional community change efforts. [ABSTRACT FROM AUTHOR]