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Improved training and support are thought to improve retention among direct care workers. However, few studies have examined actual retention. This study examined satisfaction and retention among home health aides enrolled in the "Homecare Aide Workforce Initiative" (HAWI) at three New York agencies. Data included surveys of HAWI trainees and new hires and payroll data for HAWI graduates and others. Three months after hire, 91% of HAWI hires reported they were "very satisfied" or "satisfied" with the job; 57% reported they were "not at all likely" to leave their job in the coming year. At 365 days, 60% were still working. In logistic regression, the odds of being retained at 3, 6, and 12 months were significantly higher among HAWI graduates than non-HAWI new hires. Although not a randomized trial, the study demonstrates an association between participation in an innovative entry-level workforce program and superior 3-, 6-, and 12-month retention. [ABSTRACT FROM AUTHOR]

Objective: To compare the effectiveness of two "treatments"-early, intensive home health nursing and physician follow-up within a week-versus less intense and later postacute care in reducing readmissions among heart failure (HF) patients discharged to home health care.Data Sources: National Medicare administrative, claims, and patient assessment data.Study Design: Patients with a full week of potential exposure to the treatments were followed for 30 days to determine exposure status, 30-day all-cause hospital readmission, other health care use, and mortality. An extension of instrumental variables methods for nonlinear statistical models corrects for nonrandom selection of patients into treatment categories. Our instruments are the index hospital's rate of early aftercare for non-HF patients and hospital discharge day of the week.Data Extraction Methods: All hospitalizations for a HF principal diagnosis with discharge to home health care between July 2009 and June 2010 were identified from source files.Principal Findings: Neither treatment by itself has a statistically significant effect on hospital readmission. In combination, however, they reduce the probability of readmission by roughly 8 percentage points (p < .001; confidence interval = -12.3, -4.1). Results are robust to changes in implementation of the nonlinear IV estimator, sample, outcome measure, and length of follow-up.Conclusions: Our results call for closer coordination between home health and medical providers in the clinical management of HF patients immediately after hospital discharge. [ABSTRACT FROM AUTHOR]

Background: Health information exchange (HIE), the electronic transmission of patient medical information across healthcare institutions, is on the forefront of the national agenda for healthcare reform. As healthcare consumers are critical participants in HIE, understanding their attitudes toward HIE is essential.Objective: To determine healthcare consumers' attitudes toward physician and personal use of HIE, and factors associated with their attitudes.Design: Cross-sectional telephone survey.Participants: English-speaking residents of the Hudson Valley of New York.Main Measure: Consumer reported attitudes towards HIE.Key Results: Of 199 eligible residents contacted, 170 (85%) completed the survey: 67% supported physician HIE use and 58% reported interest in using HIE themselves. Multivariate analysis suggested supporters of physician HIE were more likely to be caregivers for chronically ill individuals (OR 4.6, 95% CI 1.06, 19.6), earn more than $100,000 yearly (OR 3.5, 95% CI 1.2, 10.0), and believe physician HIE would improve the privacy and security of their medical records (OR 2.9, 95% CI 1.05, 7.9). Respondents interested in using personal HIE were less likely to be female (OR 0.4, 95% CI 0.1, 0.98), and more likely to be frequent Internet-users (OR 3.3, 95% CI 1.03, 10.6), feel communication among their physicians was inadequate (OR 6.7, 95% CI 1.7, 25.3), and believe personal HIE use would improve communication with their physicians (OR 4.7, 95% CI 1.7, 12.8).Conclusions: Consumer outreach to gain further support for ongoing personal and physician HIE efforts is needed and should address consumer security concerns and potential disparities in HIE acceptance and use. [ABSTRACT FROM AUTHOR]

The ability to copy and paste text within computerized physician documentation facilitates electronic note writing, but may affect the quality of physician notes and patient care. Little is known about physicians’ collective experience with the copy and paste function (CPF). To determine physicians’ CPF use, perceptions of its impact on notes and patient care, and opinions regarding its future use. Cross-sectional survey. Resident and faculty physicians within two affiliated academic medical centers currently using a computerized documentation system. Responses on a self-administered survey. A total of 315 (70%) of 451 eligible physicians responded to the survey. Of the 253 (80%) physicians who wrote inpatient notes electronically, 226 (90%) used CPF, and 177 (70%) used it almost always or most of the time when writing daily progress notes. While noting that inconsistencies (71%) and outdated information (71%) were more common in notes containing copy and pasted text, few physicians felt that CPF had a negative impact on patient documentation (19%) or led to mistakes in patient care (24%). The majority of physicians (80%) wanted to continue to use CPF. Although recognizing deficits in notes written using CPF, the majority of physicians used CPF to write notes and did not perceive an overall negative impact on physician documentation or patient care. Further studies of the effects of electronic note writing on the quality and safety of patient care are required. [ABSTRACT FROM AUTHOR]

Background: The prognostic value of CD4[sup+] cell counts and HIV-1 RNA levels attained after the initiation of highly active antiretroviral therapy (HAART) compared with before the initiation of HAART has not been well defined. Objective: To determine the prognostic value for clinical outcomes of CD4[sup+] cell counts and HIV-1 RNA levels attained after initiating therapy. Design: Prospective cohort study. Setting: Women's Interagency HIV Study. Patients: 1132 participants in the Women's Interagency HIV Study. Measurements: HIV-1 RNA level, CD4[sup+] cell counts, AIDS defining illness, and death. Results: In multivariate analyses with a median follow-up of 3.9 years, women with CD4[sup+] cell counts of less than 0.200 × 10[sup9] cells/L compared with women with CD4[sup+] cell counts of greater than 0.350 × 10[sup9] cells/L after HAART initiation had a relative hazard of death from all causes of 2.66 (95% CI, 1.42 to 4.99) and a relative hazard of death from AIDS of 47.61 (CI, 5.69 to 398.40). The relative hazard of all-cause death was 3.44 (CI, 1.67 to 7.09) in women with RNA levels of more than 10 000 copies/mL compared with women with attained RNA levels of less than 80 copies/mL. The relative hazard of AIDS-related or all cause death did not increase for women with post-HAART CD4[sup+] cell counts between 0.200 and 0.350 × 10[sup9] cells/L compared with women with CD4[sup+] cell counts of greater than 0.350 × 10[sup9] cells/L. Also, the relative hazard did not increase in women with post-HAART HIV-1 RNA levels between 80 and 10 000 copies/mL compared with women with post-HAART HIV-1 RNA levels of less than 80 copies/mL. Of the laboratory markers, only the post-HAART CD4[sup+] cell count and HIV-1 RNA level were predictive of new AIDS-defining illness. Conclusion: Post-HAART laboratory markers predicted death and new AIDS-defining illness. Pre-HAART CD4[sup+] cell count and HIV-1 RNA level were not predictive of clinical outcomes if adjusted for values attained after HAART initiation, suggesting that even advanced immune suppression can be overcome with HAART that results in CD4[sup+] cell counts of greater than 0.200 × 10[sup9] cells/L and RNA levels of less than 10 000 copies/mL. [ABSTRACT FROM AUTHOR]

Throughout the COVID-19 pandemic New York City home health aides continuously provided care, including to patients actively infected or recovering from COVID-19. Analyzing survey data from 1316 aides, we examined factors associated with perceptions of how well their employer prepared them for COVID-19 and their self-reported availability for work (did they "call out" more than usual). Organizational work environment and COVID-19-related supports were predominant predictors of self-reported perceptions of preparedness. Worker characteristics and COVID-19-related stressors were predominant predictors of self-reported availability. Mental distress, satisfaction with employer communications, and satisfaction with supervisor instructions were significantly associated with both outcomes. The study uniquely describes self-reported perceptions of preparedness and availability as two separate worker outcomes potentially modifiable by different interventions. Better public health emergency training and adequate protective equipment may increase aides' perceived preparedness; more household supports could facilitate their availability. More effective employer communications and mental health initiatives could potentially improve both outcomes. Industry collaboration and systemic changes in federal, state, and local policies should enhance intervention impacts., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The introduction of electronic health records has produced many challenges for clinicians. These include integrating technology into clinical workflow and fragmentation of relevant information across systems. Dashboards, which use visualized data to summarize key patient information, have the potential to address these issues. In this article, we outline a usability evaluation of a dashboard designed for home care nurses. An iterative design process was used, which consisted of (1) contextual inquiry (observation and interviews) with two home care nurses; (2) rapid feedback on paper prototypes of the dashboard (10 nurses); and (3) usability evaluation of the final dashboard prototype (20 nurses). Usability methods and assessments included observation of nurses interacting with the dashboard, the system usability scale, and the Questionnaire for User Interaction Satisfaction short form. The dashboard prototype was deemed to have high usability (mean system usability scale, 73.2 [SD, 18.8]) and was positively evaluated by nurse users. It is important to ensure that technology solutions such as the one proposed in this article are designed with clinical users in mind, to meet their information needs. The design elements of the dashboard outlined in this article could be translated to other electronic health records used in home care settings.

Clinical dashboards that display targets compared to performance metrics are increasingly used by healthcare organizations in their quality improvement efforts. However, few studies have evaluated the extent to which healthcare professionals can readily understand and interpret these data. This study explored associations between measures of graph literacy and numeracy in home care nurses from two agencies (N=195) with comprehension of quality targets presented in a graphical dashboard format. Data were collected using an online survey. Results from linear regression models indicated that nurses' levels of graph literacy and numeracy were positively associated with comprehension of quality targets. Nurses with low levels of both graph literacy and numeracy tended to have the lowest target comprehension scores compared to those who had high levels of both graph literacy and numeracy. Nurses with low graph literacy and high numeracy also had significantly lower scores for comprehension of quality targets compared to those with high graph literacy and numeracy. These findings suggest that developers of clinical dashboards that incorporate quality target information need to evaluate users' ability to understand the information displayed in graphs and tables before they release the product for general use in healthcare settings.

The ability to copy and paste text within computerized physician documentation facilitates electronic note writing but may affect the quality of physician notes and patient care. Little is known about physicians' collective experience with the copy and paste function (CPF). We surveyed resident and faculty physicians within two affiliated academic medical centers in order to describe physicians' CPF use, perceptions of its impact on notes and patient care, and opinions regarding its future use.

Sex-based differences in CD4 T-cell (CD4) counts are well recognized, but the basis for these differences has not been identified. Conceivably, homeostatic factors may play a role in this process by regulating T-cell maintenance and repletion. Interleukin (IL)-7 is essential for normal T-cell production and homeostasis. We hypothesized that differences in IL-7 might contribute to sex-based differences in CD4 counts. Circulating IL-7 levels were analyzed in 299 HIV-1-infected women and men. Regression analysis estimated that IL-7 levels were 40% higher in women than in men (P = 0.0032) after controlling for CD4 count, age, and race. Given the important role of IL-7 in T-cell development and homeostasis, these findings suggest that higher IL-7 levels may contribute to higher CD4 counts in women.

To delineate the relationship between adherence to human immunodeficiency virus (HIV) therapy and sexual behavior among HIV type 1-infected women in the United States, data were collected from October 1998 through March 1999 from 766 HIV-positive women on adherence to therapy, risk behavior, and disease markers. Adherence rates of >/=95% were reported by 66% of the patients. In multivariate analyses, patients with lower rates of adherence tended to be younger (odds ratio [OR], 1.69), to be active drug users (OR, 2.27), to have detectable virus load levels (OR, 2.00), and to have a lower quality of life (OR, 1.20). Among sexually active women, lower adherence rates were associated with an increased risk for inconsistent condom use (adjusted OR, 2.17). Although counseling regarding sexual behavior and adherence to treatment regimens are often addressed separately, our data highlight the importance of discussing these factors in relation to one another, particularly with regard to patients experiencing virologic failure.