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Background and Aim: COVID-19 highlighted significant criticalities of the Italian National Healthcare System (NHS) and recently the Italian Government approved the National Recovery and Resilience Plan (NRRP) to relaunch its economy and at the same time to promote health, sustainability and digital innovation. Specifically, M6C1 (Mission 6 Component 1) wants to introduce Community Health Centers (CHCs), Community Hospitals (CHs) and Local Operative Centers (LOCs) to strength territorial healthcare services. Starting from the Italian Ministerial Decree n. 77 (2022), AGENAS (National Agency for Regional Healthcare System) and POLIMI (Politecnico di Milano) working group developed the meta-design guidelines for CHCs, CHs and LOCs facilities with the aim of supporting decision-makers to define spatial features and building performances in order to be responsive to functional issues., Methods: The spatial strategies of these facilities have been elicited through three different steps: a) a survey about the current national and international scenario regarding the territorial healthcare; b) a review of all national and regional regulations; c) the development of the meta-design guidelines have been elaborated from the analysis of the a) and b) steps., Results: The regulatory instructions and scientific indications collected through the literature have been translated into spatial and functional layouts. The services have been organized by homogeneous macro-areas and defined in a synoptic framework which shows the performance approach and their features. Each macro-area, sorted by type of functions, has been subdivided into a list of all its specific spatial units., Conclusions: The study conducted aims at supporting the planning of these facilities in relation to the catchment area and their sizing. It will be necessary to define the location by evaluating the possibility of setting them up within existing hospitals, as well as to guarantee a sustainable approach in the realization of these infrastructures.

Purpose: To examine whether there are differences in meeting treatment goals between pelvic floor physical therapy (PFPT) patients who participated in a majority of telehealth visits versus those who participated in mostly traditional office visits at a community hospital., Methods: Retrospective chart review was performed among patients who received PFPT from April 2019 to February 2021. Cohorts were defined as "Mostly Office Visits" (> 50% office visits) and "Mostly Telehealth" (> / = 50% telehealth visits). Primary outcome measures included demographic data, number/type of visit for each patient, number of no-show/cancelation appointments, and number of patients discharged meeting PFPT goals. Statistical significance was defined as p < 0.05., Results: 234 subjects met criteria for the "Mostly Office Visit" cohort and 48 subjects met criteria for the "Mostly Telehealth" cohort. There were no significant differences observed in age (p = 0.919), BMI (p = 0.817), race/ethnicity (p = 0.170) or insurance type (p = 0.426) between cohorts. There was no significant difference in meeting PFPT goals between the "Mostly Office Visit" cohort (24.4%) and the "Mostly Telehealth" cohort (35.4%) (p = 0.113). There was no difference in the number of canceled visits per patient (mean cancelations "Office visit" 1.98; "Telehealth" 1.63; p = 0.246) and the number of no-show visits per patient (mean no-show's "Office visit" 0.23; "Telehealth" 0.31; p = 0.297) between cohorts., Conclusion: There was no difference in meeting discharge goals regardless of whether a patient participated in mostly telehealth visits versus mostly traditional office visits. Therefore, we can conclude that participating in mostly provider-led telehealth visits can be equally efficacious at providing competent PFPT care., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Tracheostomy dislodgment can lead to catastrophic neurological injury or death. A fresh tracheostomy amplifies the risk of such events, where an immature tract predisposes to false passage. Unfortunately, few resources exist to prepare healthcare professionals to manage this airway emergency., Aim: To create and implement an accidental tracheostomy dislodgement (ATD) bundle to improve knowledge and comfort when responding to ATD., Materials & Methods: A multidisciplinary team with expertise in tracheostomy developed a 3-part ATD bundle including (1) Tracheostomy Dislodgement Algorithm, (2) Head of Bed Tracheostomy Communication Tool and (3) Emergency Tracheostomy Kit. The team tested the bundle during the COVID-19 pandemic in a community hospital critical care unit with the engagement of nurses and Respiratory Care Practitioners. Baseline and post-implementation knowledge and comfort levels were measured using Dorton's Tracheotomy Education Self-Assessment Questionnaire, and adherence to protocol was assessed. Reporting follows the revised Standards for Quality Improvement Reporting Excellence (SQUIRE)., Results: Twenty-four participants completed pre-test and post-test questionnaires. The median knowledge score on the Likert scale increased from 4.0 (IQR = 1.0) pre-test to 5.0 (IQR = 1.0) post-test. The median comfort level score increased from 38.0 (IQR = 7.0) pre-test to 40.0 (IQR = 5.0) post-test). In patient rooms, adherence was 100% for the Head of Bed Tracheostomy Communication Tool and Emergency Tracheostomy Kit. The adherence rate for using the Dislodgement Algorithm was 55% in ICU and 40% in SCU., Discussion: This study addresses the void of tracheostomy research conducted in local community hospitals. The improvement in knowledge and comfort in managing ATD is reassuring, given the knowledge gap among practitioners demonstrated in prior literature. The ATD bundle assessed in this study represents a streamlined approach for bedside clinicians - definitive management of ATD should adhere to comprehensive multidisciplinary guidelines., Conclusions: ATD bundle implementation increased knowledge and comfort levels with managing ATD. Further studies must assess whether ATD bundles and other standardised approaches to airway emergencies reduce adverse events. Relevance to Clinical Practice A streamlined intervention bundle employed at the unit level can significantly improve knowledge and comfort in managing ATD, which may reduce morbidity and mortality in critically ill patients with tracheostomy., (© 2022 John Wiley & Sons Ltd.)

Background: Subspecialty, multidisciplinary care within community hospital settings are limited and remains a challenge. Improving outcomes for central nervous system (CNS) disease rely on integrated subspecialty care between radiation oncology (RadOnc) and neurosurgery (NS). Three-year experience with simultaneous patient evaluation with RadOnc and NS physicians in a community hospital-based CNS clinic model (RADIANS) for brain and skull base lesions (BSBL) are reported., Methods: Clinical and demographic data were prospectively collected for patients evaluated in RADIANS. Surveys administered and three-year data reviewed. Descriptive statistics reported as mean and percentages for patient characteristics, diagnosis, treatment and outcomes., Results: Sixty-seven patients with confirmed BSBL were evaluated between August 2016 and August 2019. Mean age and distance traveled was 61.0 years and 66.5 miles, respectively. Female (N.=39, 58.2%) and male (N.=28, 41.8%) patients had mean Patient Satisfaction Score of 4.77 (0-5 Scale, where 5 is very satisfied; 26 respondents). Forty-three patients had malignant disease (28 brain mets; six with both brain/spine; nine with primary brain), and 24 had benign disease. Post-evaluation treatment: radiation therapy (RT) only (N.=16), neurosurgery (NS) only (N.=12), both RT and NS (N.=15), and no RT/NS intervention (N.=24). Fractionated stereotactic radiosurgery was most common RT delivered; craniotomy with tumor resection was most common NS performed. Treatment outcomes: local control in 33 of 38 (86.8%); radiation necrosis in one of 31 (3.2%)., Conclusions: The multidisciplinary community hospital-based CNS clinic continues its high patient approval at extended follow-up. Results demonstrate the clinic serves as a regional referral center where patients with BSBL with varying degrees of co-morbidities, systemic disease status, and oncologic staging can be treated with evidence-based treatment modalities yielding high rates of local control and low rates of grade 3 and 4 radiation-induced toxicity, while having access to on-going clinical trials.

Rib plating has been shown to be beneficial among certain populations, such as patients with flail chest and failure to wean from the ventilator in patients without primary pulmonary pathology. Surgical intervention has been shown to decrease ventilatory requirements, decrease pain management modalities, and lower costs. A retrospective data analysis was done to determine the efficacy of rib plating in elderly trauma patients with rib fractures on a total of 244 patients, 63% male and 37% female, mean age is 64 ± 18.5 years, 76% had an associated comorbid condition, such as Diabetes Mellitus (DM), Chronic Obstructive Pulmonary Disease (COPD), Coronary Artery Disease (CAD), Chronic Kidney Disease (CKD), or any combination, with 111 (46%) on anticoagulant therapy. 95% patients presented to the emergency department (ED) with Mild GCS range (13-15). Moderate GCS (9-12) was 4% and 3% of patients Severe GCS (3-8). The overall mortality rate was 4.5%.

Objectives: To describe the epidemiology of complex colon surgical procedures (COLO), stratified by present at time of surgery (PATOS) surgical-site infections (SSIs) and non-PATOS SSIs and their impact on the epidemiology of colon-surgery SSIs., Design: Retrospective cohort study., Methods: SSI data were prospectively collected from patients undergoing colon surgical procedures (COLOs) as defined by the National Healthcare Safety Network (NHSN) at 34 community hospitals in the southeastern United States from January 2015 to June 2019. Logistic regression models identified specific characteristics of complex COLO SSIs, complex non-PATOS COLO SSIs, and complex PATOS COLO SSIs., Results: Over the 4.5-year study period, we identified 720 complex COLO SSIs following 28,188 COLO surgeries (prevalence rate, 2.55 per 100 procedures). Overall, 544 complex COLO SSIs (76%) were complex non-PATOS COLO SSIs (prevalence rate [PR], 1.93 per 100 procedures) and 176 (24%) complex PATOS COLO SSIs (PR, 0.62 per 100 procedures). Age >75 years and operation duration in the >75th percentile were independently associated with non-PATOS SSIs but not PATOS SSIs. Conversely, emergency surgery and hospital volume for COLO procedures were independently associated with PATOS SSIs but not non-PATOS SSIs. The proportion of polymicrobial SSIs was significantly higher for non-PATOS SSIs compared with PATOS SSIs., Conclusions: Complex PATOS COLO SSIs have distinct features from complex non-PATOS COLO SSIs. Removal of PATOS COLO SSIs from public reporting allows more accurate comparisons among hospitals that perform different case mixes of colon surgeries.

Antibiotic stewardship interventions are urgently needed to reduce antibiotic overuse in hospitalized COVID-19 patients, particularly in small community hospitals (SCHs), who often lack access to infectious diseases (ID) and stewardship resources. We implemented multidisciplinary tele-COVID rounds plus tele-antibiotic stewardship surveillance in 17 SCHs to standardize COVID management and evaluate concurrent antibiotics for discontinuation. Antibiotic use was compared in the 4 months preintervention versus 10 months postintervention. Interrupted time-series analysis demonstrated an immediate decrease in antibiotic use by 339 days of therapy/1000 COVID-19 patient days (p < .001), and an estimated 5258 antibiotic days avoided during the postintervention period. Thirty-day mortality was not significantly different, and a significant reduction in transfers was observed following the intervention (23.3% vs. 7.8%, p < .001). A novel tele-ID and tele-stewardship intervention significantly decreased antibiotic use and transfers among COVID-19 patients at 17 SCHs, demonstrating that telehealth is a feasible way to provide ID expertise in community and rural settings., (© 2023 Society of Hospital Medicine.)

Background: The COVID-19 pandemic highlighted the importance of maximizing same-day discharge after surgery to mitigate potential patient harms associated with inpatient admission and conserve valuable hospital resources. Adoption of same-day discharge after breast surgery, particularly mastectomy, has been slow despite recent research suggesting the physical and psychological benefits of same-day discharge after surgery. We sought to identify factors associated with inpatient compared with surgical day care mastectomy procedures at a community hospital in Vernon, British Columbia., Methods: We conducted a retrospective chart review of all patients who underwent a total mastectomy without reconstruction at Vernon Jubilee Hospital, a 196-bed community hospital, between April 2016 and March 2019. Patient characteristics, operative variables and pain management were compared between inpatient and surgical day care mastectomy procedures. We also compared 7-day readmission, reoperation and complications., Results: A total of 187 mastectomy patients were analyzed with 72 (38.5%) surgical day care procedures. Factors associated with inpatient procedures included longer operative time (66.1 min v. 53.5 min, p = 0.001), bilateral mastectomy (91% v. 9%, p = 0.01) and suspected or confirmed obstructive sleep apnea (32% v. 17%, p = 0.04). Preoperative acetaminophen (83% v. 17%, p < 0.001), multilevel intercostal block (83% v. 17%, p < 0.001) and a prescription for acetaminophen plus tramadol (58% v. 42%, p < 0.001) were associated with day care surgeries. There were no significant differences between the inpatient and surgical day care groups with respect to 7-day readmission, reoperation or postoperative complications., Conclusion: We found no significant differences in surgical outcomes between inpatients and those with same-day discharge after mastectomy procedures. These findings add to the growing body of evidence that surgical day care mastectomy procedures are safe in the community setting., Competing Interests: Competing interests: H. Hwang is an associate editor of CJS; he was not involved in the review or decision to accept this paper for publication. No other competing interests were declared., (© 2023 CMA Impact Inc. or its licensors.)

Background: This study was performed to determine the feasibility of Day-case loop ileostomy reversal (DLIR) in China based on the community hospital joined enhanced recovery after surgery (CHJ-ERAS) program., Method: Patients who underwent loop ileostomy were enrolled in the CHJ-ERAS program for DLIR after rigorous evaluation. The primary outcome was the results of short-term follow-ups., Results: From August 2017 to April 2022, 216 patients have been enrolled in the CHJ-ERAS program for DLIR. After DLIR, 14 patients (14/216, 6.5%) have recorded 17 episodes of postoperative complications within 1 month after surgery, including 10 readmission and 2 reoperation. Compared with in-patient loop ileostomy reversal, DLIR based on CHJ-ERAS did not increase the postoperative complications and reoperations., Conclusion: The CMJ-ERAS program for DLIR in our center is a safe and feasible alternative option for inpatient LIR and an acceptable transitional approach for the development of day-case DLIR in developing countries., Competing Interests: Declaration of competing interest We declare there is no conflict of interest., (Copyright © 2023. Published by Elsevier Inc.)

Purpose: During the coronavirus disease 2019 (COVID-19) pandemic, private practice, inpatient consult services, and academic residency programs in ophthalmology saw a decrease in patient encounters. This study elucidates how community hospital ophthalmology consult (OC) services were affected during the pandemic. We aim to determine whether there was a change in resident OC volume in a community-based ophthalmology program consult service during the COVID-19 pandemic. Secondary objectives included analyzing the change in the types of diagnoses and the number of patients seen for diabetic retinopathy over the same time., Methods: A retrospective cross-sectional study was conducted reviewing the electronic health record (EHR) charts from OCs for the period 2017-2021. Records were categorized by referral source and the nature of OCs (trauma, acute, or chronic); OCs were further grouped by year and weak of referral. An intermonth analysis of weekly OC counts in each category was performed for the average number of consults in February-April 2017-2019 and for February-April 2020. A one-tailed t-test was performed. All t-tests assumed equal variances., Results: Weekly OCs in 2020 revealed no statistically significant differences in overall cases or in acute or chronic cases when the volume before the COVID-19 pandemic was compared to the volume after the onset of the pandemic. However, a statistically significant increase in the average weekly trauma cases was noted when 2020 (an average of 2.7 cases per week) was compared to the weekly average for the same weeks of years 2017- 2019 (0.4; P = 0.016). This statistically significant increase in trauma in 2020 disappeared when comparing weeks 11-17 in 2020 (2.2 cases per week) and the average of 2017-2019 (1.1)., Conclusion: This report outlines no significant change in OCs before and after the onset of the pandemic compared to three previous years. There was, however, an increase in trauma consults during the pandemic and an increase in the number (though not the proportion) of diabetic retinopathy (DR+) patients seen by residents. This report uniquely describes no significant changes in the resident volume of patients seen during the COVID-19 global pandemic., Competing Interests: None

Background and Objectives: The majority of pediatric patients present to community-hospital emergency departments (EDs). Pneumonia is among the most common reasons for ED visits; however, prescribing narrow-spectrum antibiotics occurs at rates below established best practices. We sought to increase prescription of narrow-spectrum antibiotics for pediatric pneumonia in 5 community hospital EDs using an interdisciplinary learning collaborative. We aimed to increase use of narrow spectrum antibiotics from 60% to 80% by December 2018., Methods: A collaborative of 5 community hospitals developed quality improvement teams who held quarterly meetings over a 1 year period engaging teams in Plan-Do-Study-Act cycles. Interventions included deployment of an evidenced based guideline, educational interventions, and order set modification. Preintervention data were collected for 12 months. Using a standardized data form, teams collected monthly data during the intervention period and for an additional year after to assess for sustainability. Teams evaluated data using statistical process control charts and included any patient 3 months to 18 years with a diagnosis of pneumonia., Results: The aggregated rate of narrow-spectrum antibiotic prescriptions increased from 60% during the baseline period to 78% during the intervention period. During the year after active implementation, this aggregate rate increased to 92%. Differences in prescribing patterns were noted by provider type, but narrow-spectrum antibiotic use improved for both general emergency medicine and pediatric providers. No return visits to the ED for failure of antibiotic treatment within 72 hours occurred., Conclusions: An interdisciplinary community hospital learning collaborative increased prescribing narrow-spectrum antibiotics by both general and pediatric ED providers., (Copyright © 2023 by the American Academy of Pediatrics.)

Introduction: An updated stroke process was designed and implemented at an Acute Stroke Ready community hospital that relies on telestroke services. The objectives of the current quality improvement project were to describe the updates to the stroke process and compare pre- and postintervention data on nurse-driven elements of the process, namely telestroke notification and neurologist assessment., Methods: Our multidisciplinary team reviewed quality data over several months to identify areas of improvement in the stroke process. Delays in door to telestroke notification and neurologist assessment were identified. A new process was developed and implemented, including e-alert notification and storing the telestroke cart in the computed tomography suite. The study period was 14 months, with nonrandomized, convenience sample data collected for 7 months before and after intervention., Results: There was a significant reduction in door to telestroke notification and neurologist assessment after implementing the new process. Door to telestroke notification and neurologist assessment were also strongly correlated., Discussion: This project led to significant improvements in nurse-driven elements of the stroke process. It demonstrates effective implementation of e-alert and collaboration with telestroke services at an Acute Stroke Ready Hospital serving rural communities., (Copyright © 2022 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.)

As part of their annual tax report, nonprofit hospitals are asked to report their community-building activities (CBAs); yet, little is known to date about hospitals' spending on such activities. CBAs are activities that improve community health by addressing the upstream factors and social determinants that impact health. Using data from Internal Revenue Service Form 990 Schedule H, this study used descriptive statistics to examine trends in the provision of CBAs by nonprofit hospitals between 2010 and 2019. While the number of hospitals reporting any CBA spending remained relatively stable at around 60%, the share of total operating expenditures that hospitals contributed to CBAs decreased from 0.04% in 2010 to 0.02% in 2019. Despite the increasing attention paid by policy makers and the public to the contributions that hospitals make to the health of their communities, nonprofit hospitals have not made corresponding efforts to increase their spending on CBAs., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Recidivism after initial sleeve gastrectomy (SG) remains common. Revisional surgery to convert SG to Roux-en-Y gastric bypass (RYGB) or duodenal switch (DS) for additional weight loss is increasing. This study aims to compare the outcomes after conversion of SG to RYGB or DS., Methods: A retrospective single-institution review was conducted from 2015 to 2021, identifying 75 patients who underwent conversion from prior SG to either RYGB (40) or DS (35). Mean excess body weight loss (EBWL) at 3, 6, 12, and 24 months was assessed and compared. Secondary measures of length of stay (LOS), procedure length, and 30-day readmission rate were also reviewed., Results: Percentage EBWL for RYGB vs DS was 24.0% vs 18.8% at 3 months (N = 36 vs 26; P < 0.0491), 34.8% vs 29.0% at 6 months (N = 29 vs 17; P < 0.2192), 43.0% vs 40.1% at 12 months (N = 28 vs 12; P < 0.6828), and 36.2% vs 41.7% at 24 months (N = 27 vs 7; P < 0.5553). Average LOS was 2.6 days ± 1.4 for RYGB and 2.8 days ± 1.3 for DS (P < 0.6032). Average procedure length was 134.4 min for RYGB and 189.8 min for DS (P < 0.0001). 30-day readmission rate was 27.5% (N = 11) for RYGB and 14.3% (N = 5) for DS (P < 0.1645). Significant weight loss was observed in both subgroups up to 12 months, with no significant weight loss between 12 and 24 months (RYGB N = 21, P < 0.2961; DS N = 5, P < 0.7233)., Conclusion: Both revisional RYGB and revisional DS procedures had significant and sustained weight loss in the first 12 months. There was no significant excess body weight loss difference between revisional RYGB and revisional DS patients at 6, 12, and 24 months, with only significant greater weight loss for RYGB patients at 3 months. Additionally, procedure length was significantly longer for DS compared to RYGB, with no significant differences in LOS and 30-day readmission rates., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objectives: Warfarin, like many other anticoagulants, has been linked to an elevated risk of bleeding proportional to the amount of anticoagulation used. Not only was the incidence of bleeding raised by the dosage, but the subtherapeutic international normalized ratio (INR) was also associated with increased thrombotic events. This retrospective cohort and multi-center study evaluated the incidence and risk factors of warfarin therapy complications in community hospitals in Thailand's central and eastern regions from 2016 to 2021., Results: Among 335 patients (683.90 person-year of follow-up), The incidence rate of warfarin complications was 4.91 events per 100 person-year. The independent factor associated with warfarin therapy complications was propranolol prescription (Adjusted RR: 2.29, 95%CI: 1.12-4.71). The secondary analysis was divided according to the outcome of the major bleeding and thromboembolic event. Major bleeding events, hypertension (Adjusted RR: 0.40, 95%CI: 0.17-0.95), amiodarone prescription (Adjusted RR: 5.11, 95%CI: 1.08-24.15), and propranolol prescription (Adjusted RR: 2.86, 95%CI: 1.19-6.83) were the independent risk factors. While in the major thrombotic event, non-steroidal anti-inflammatory drugs (NSAIDs) prescription was an independent factor (Adjusted RR: 10.65, 95%CI: 1.26-90.35)., (© 2023. The Author(s).)

Hemolytic disease of the newborn is commonly diagnosed and managed by pediatric and newborn hospitalists. Severe cases, however, pose unique challenges for community hospitals without higher level neonatal intensive care units. This case highlights the challenges faced by pediatric hospitalists in the community and suggests a focused approach to management.

Background: Enhanced recovery after surgery (ERAS) pathways have been shown to improve pancreatic surgery outcomes, though feasibility in a community hospital remain unclear. We hypothesized that an ERAS protocol would reduce hospital length of stay (LOS) without increased morbidity., Methods: An ERAS pathway was initiated for patients undergoing pancreatic surgery at a community cancer center and compared to a historical cohort. The primary outcome was hospital LOS. Secondary outcomes included 30-day readmission rates, comprehensive complication index (CCI ® ), textbook outcomes (TO), and mortality., Results: A total of 144 patients were included, with 63 patients in the ERAS group and 81 in the control group. The mean LOS decreased significantly in the ERAS group (6.85 [± 4.8]) vs 9.96 [±6.8] days, P = .001), without an increase in 30-day admission rates or CCI., Conclusions: Implementation of an ERAS protocol in a community setting reduced LOS without a corresponding increase in readmission rates or morbidity.

Objectives: Implementing a predictive analytic model in a new clinical environment is fraught with challenges. Dataset shifts such as differences in clinical practice, new data acquisition devices, or changes in the electronic health record (EHR) implementation mean that the input data seen by a model can differ significantly from the data it was trained on. Validating models at multiple institutions is therefore critical. Here, using retrospective data, we demonstrate how Predicting Intensive Care Transfers and other UnfoReseen Events (PICTURE), a deterioration index developed at a single academic medical center, generalizes to a second institution with significantly different patient population., Design: PICTURE is a deterioration index designed for the general ward, which uses structured EHR data such as laboratory values and vital signs., Setting: The general wards of two large hospitals, one an academic medical center and the other a community hospital., Subjects: The model has previously been trained and validated on a cohort of 165,018 general ward encounters from a large academic medical center. Here, we apply this model to 11,083 encounters from a separate community hospital., Interventions: None., Measurements and Main Results: The hospitals were found to have significant differences in missingness rates (> 5% difference in 9/52 features), deterioration rate (4.5% vs 2.5%), and racial makeup (20% non-White vs 49% non-White). Despite these differences, PICTURE's performance was consistent (area under the receiver operating characteristic curve [AUROC], 0.870; 95% CI, 0.861-0.878), area under the precision-recall curve (AUPRC, 0.298; 95% CI, 0.275-0.320) at the first hospital; AUROC 0.875 (0.851-0.902), AUPRC 0.339 (0.281-0.398) at the second. AUPRC was standardized to a 2.5% event rate. PICTURE also outperformed both the Epic Deterioration Index and the National Early Warning Score at both institutions., Conclusions: Important differences were observed between the two institutions, including data availability and demographic makeup. PICTURE was able to identify general ward patients at risk of deterioration at both hospitals with consistent performance (AUROC and AUPRC) and compared favorably to existing metrics., Competing Interests: Mr. Cummings’s, Mr. Blackmer’s, Dr. Farzaneh’s, Ms. Cao’s, and Dr. Ansari’s institutions received funding from the Michigan Institute for Data Science and Airstrip Technologies. Mr. Cummings, Mr. Blackmer, Dr. Farzaneh, Ms. Cao, and Drs. Gillies, Medlin, Ward, and Ansari have disclosed that multiple patents have been filed for this work and invention disclosures have been submitted with the Office of Technology Transfer, University of Michigan, Ann Arbor, and that Airstrip Technologies has a license option for Predicting Intensive Care Transfers and other UnfoReseen Events from the University of Michigan. Mr. Motyka disclosed that he is currently employed by at Strata Oncology (Precision Oncology). Dr. Gillies disclosed that he is employed at Regeneron Pharmaceuticals. Dr. Admon’s institution received funding from the National Heart, Lung, and Blood Institute. Drs. Admon and Sjoding received support for article research from the National Institutes of Health (NIH). Dr. Singh’s institution received funding from Blue Cross Blue Shield of Michigan and Teva Pharmaceuticals; he received funding from Flatiron Health. Dr. Sjoding’s institution received funding from the NIH. The remaining authors have disclosed that they do not have any potential conflicts of interest., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine and Wolters Kluwer Health, Inc.)

Not-for-profit hospitals (NFPs) frequently partner with community organizations to conduct internal revenue service-mandated community health needs assessment (CHNA), yet little is known about the number of partnerships that hospitals enter into for this purpose. This article uses "American Hospital Associations' 2020 Annual Survey" data to examine hospital-community partnerships around the CHNA and the role that community social capital defined as, "the networks that cross various professional, political and social boundaries to reflect community level trust needed to pursue shared objectives" plays in hospitals' choices to partner with community organizations for the CHNA. After controlling for a set of hospital, community, and state characteristics, we found that hospitals present in communities with higher social capital were likely to partner with more community organizations to conduct CHNA. Greater social capital may thus promote community health by facilitating the partnerships NFPs develop with community organizations to conduct the CHNA.

Objectives: To examine the association of Catholic hospitals with receipt of postpartum tubal ligation and long acting, reversible contraception among Medicaid recipients., Study Design: We conducted a retrospective cohort study of live births from January 1, 2016 to October 31, 2016 to female Medicaid beneficiaries in the United States between ages 21 and 44. Our main exposure was the presence of a Catholic-affiliated sole community hospital, and our primary outcome was highly effective postpartum contraception. We examined rates of postpartum permanent contraception, along with the use of a long acting, reversible form of contraception (LARC) at 3 and 60 days are postpartum. We compared counties that had only a Catholic-affiliated hospital with counties with only a non-Catholic hospital., Results: Our study population included 14,545 postpartum Medicaid beneficiaries. Study participants came from 88 counties across 10 United States states. Only 7.7% of women in counties with Catholic sole community hospitals received permanent contraception by 3 days postpartum, compared to 11.3% in counties with non-Catholic sole community hospitals (RD: -3.92%; 95% CI: -6.01%, -1.83%). This difference was not mitigated by receipt of outpatient procedures or long-acting, reversible contraception. Importantly, women residing in counties with Catholic sole community hospitals were much less likely to return postpartum for an outpatient visit between 8 and 60 days postpartum than women in counties with non-Catholic sole community hospitals (35.4% vs 45.4%, RD: -9.29%; 95% CI: -16.71%, -1.86%)., Conclusions: In counties where the only hospital was Catholic, Medicaid recipients giving birth were significantly less likely to receive permanent contraception and to return for postpartum care., Implications: Catholic hospitals are increasing in the United States, which may restrict access to postpartum contraception, particularly in rural areas. We found that Medicaid recipients giving birth at a Catholic sole community hospital were less likely to receive permanent contraception and to return for care., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)

Policy Points Hospitals address population health needs and patients' social determinants of health by offering social care services. Tax-exempt hospitals are required to invest in community benefits, including social care services programs, though most community benefits spending is toward unreimbursed health care services. Tax-exempt hospitals offer about 36% more social care services than for-profit hospitals. Among tax-exempt hospitals, those that allocate more resources to community benefits spending offer more types of social care services, but those in states with minimum community benefits spending requirements offer fewer social care services. Policymakers may consider specifically incentivizing community benefits expenditures toward particular social care services, including linking tax exemptions to implementation, utilization, and outcome targets, to more directly help patients., Context: Despite growing interest in identifying patients' social needs, little is known about hospitals' provision of services to address them. We identify social care services offered by US hospitals and determine whether hospital spending or state policies toward community benefits are associated with the provision of these services by tax-exempt hospitals., Methods: National secondary data about hospitals were collected from the American Hospital Association Annual Survey, with additional Internal Revenue Service (IRS) Form 990 data on community benefits spending from CommunityBenefitInsight.org and state-level community benefits policies from HilltopInstitute.org. Descriptive statistics for types of social care services and hospital characteristics were calculated, with bivariate chi-square and t-tests comparing for-profit and tax-exempt hospitals. Multivariable Poisson regression was used to estimate associations between hospital characteristics and types of services offered and among tax-exempt hospitals to estimate associations between social care services and community benefits spending and policies. Multivariable logistic regressions modeled associations between community benefits spending/policies and each type of social care services., Findings: Private US hospitals offered an average of 5.7 types of social care services in 2018. Tax-exempt hospitals offered about 36% more social care services than for-profit hospitals. Larger number of beds, health system affiliation, and having community partnerships are associated with more social care services, whereas rural hospitals and those managed under contract offered fewer social care services. Among tax-exempt hospitals, greater community benefits spending is associated with offering more total (incidence rate ratio [IRR] = 1.10, p < 0.01) and patient-focused social care services (IRR = 1.16, p < 0.01). Hospitals in states with minimum community benefits spending requirements offered significantly fewer social care services., Conclusions: Although tax-exempt status and increased community benefits spending were associated with increased social care services provision, the observation that certain hospital characteristics and state minimum community benefits spending requirements were associated with fewer social care services suggests opportunities for policy reform to increase social care services implementation., (© 2023 The Authors. The Milbank Quarterly published by Wiley Periodicals LLC on behalf of The Milbank Memorial Fund.)

Background: Tobacco use commonly starts during adolescence and is the leading cause of preventable disease, disability, and death in the United States. Secondhand smoke (SHS) exposure increases asthma and respiratory infection hospitalizations and contributes to sudden unexpected infant death. Few pediatric hospitalist-led smoking cessation studies are formal quality improvement (QI), with most at academic institutions and studying caregivers., Objectives: To increase SHS exposure/tobacco use screening, smoking cessation discharge instructions, and Smokers' Helpline referrals for community hospital pediatric patients/caregivers through QI., Methods: All pediatric, newborn, and NICU admissions were eligible. The baseline period was December 2019 through November 2020 and intervention period December 2020 through June 2021. Interventions included hospitalist education, standardizing documentation, visual reminders, and Helpline wallet cards. The primary measure was monthly percentage of patients screened for SHS exposure/tobacco use. Secondary measures were percentage of patients/caregivers positive for SHS exposure/tobacco use who received (1) discharge instructions or (2) Helpline referral. Length of stay was a balancing measure. Primary and balancing measures were analyzed with statistical process control. Secondary measures were monitored on run charts., Results: Average SHS exposure/tobacco use screening rates increased from 14% to 90%, meeting special cause variation beginning December 2020. Median discharge instructions increased from 0% to 56%. Helpline referrals increased from 0% to 17%. Length of stay remained approximately 2 days., Conclusions: Pediatrician-led QI can increase SHS exposure/tobacco use screening and interventions in the community hospital setting to encourage smoke exposure reduction and smoking cessation for patients and caregivers., (Copyright © 2023 by the American Academy of Pediatrics.)