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PURPOSE: Little is known regarding HIV/STI testing preferences for location, staffing, and hours of operation among young black men who have sex with men (YBMSM) in the Southeastern U.S, a population at high risk for HIV/STIs. We used a discrete choice experiment to explore these preferences. METHODS: YBMSM ages 16-35 in Birmingham, Alabama and Jackson, Mississippi completed online surveys evaluating their preferences (best/worst) for HIV/STI testing locations, staffing, hours, method of results notification, and cost. They also selected preferred combinations of these variables through choice tasks. Results were analyzed using joint best/worst and discrete choice experiment models. RESULTS: Between June 2018-December 2019, participants in Alabama (n = 54) and Mississippi (n = 159) completed online surveys. Both groups preferred stationary testing locations over mobile testing vans, with the most significant difference favoring STI testing-only clinics in Mississippi and local health departments in Alabama (p < 0.001). Technician-performed tests or self-testing were significantly less preferred compared to clinician-performed testing for both groups (p < 0.0001 and p < 0.0001, respectively). Free testing and phone results notification (versus text) were preferred by both groups. The most desirable combination among all participants was weekday clinician-performed testing at the health department for $5. CONCLUSION: YBMSM in the Southeastern U.S. prefer traditional testing locations staffed by experienced personnel. Combination choices are influenced by services that are low- or no-cost. More research is needed to inform the best way(s) to provide affordable, high-quality HIV/STI testing services for YBMSM, particularly in the post-COVID-19 era when sexual healthcare delivery models are evolving toward home-based and remote-health focused strategies.

BACKGROUND Interoperability—the exchange and integration of data across the health care system—remains a challenge despite ongoing policy efforts aimed at promoting interoperability. OBJECTIVE This study aimed to identify current challenges and opportunities to advancing interoperability across stakeholders. METHODS Primary data were collected through qualitative, semistructured interviews with stakeholders (n=24) in Ohio from July to October 2021. Interviewees were sampled using a stratified purposive sample of key informants from 4 representative groups as follows: acute care and children’s hospital leaders, primary care providers, behavioral health providers, and regional health information exchange networks. Interviews focused on key informant perspectives on electronic health record implementation, the alignment of public policy with organizational strategy, interoperability implementation challenges, and opportunities for health information technology. The interviews were transcribed verbatim followed by rigorous qualitative analysis using directed content analysis. RESULTS The findings illuminate themes related to challenges and opportunities for interoperability that align with technological (ie, implementation challenges, mismatches in interoperability capabilities across stakeholders, and opportunities to leverage new technology and integrate social determinants of health data), organizational (ie, facilitators of interoperability and strategic alignment of participation in value-based payment programs with interoperability), and environmental (ie, policy) domains. CONCLUSIONS Interoperability, although technically feasible for most providers, remains challenging for technological, organizational, and environmental reasons. Our findings suggest that the incorporation of end user considerations into health information technology development, implementation, policy, and standard deployment may support interoperability advancement.

As the COVID-19 pandemic took hold in the USA in early 2020, it became clear that knowledge of the prevalence of antibodies to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) among asymptomatic individuals could inform public health policy decisions and provide insight into the impact of the infection on vulnerable populations. Two Clinical and Translational Science Award (CTSA) Hubs and the National Institutes of Health (NIH) set forth to conduct a national seroprevalence survey to assess the infection’s rate of spread. This partnership was able to quickly design and launch the project by leveraging established research capacities, prior experiences in large-scale, multisite studies and a highly skilled workforce of CTSA hubs and unique experimental capabilities at the NIH to conduct a diverse prospective, longitudinal observational cohort of 11,382 participants who provided biospecimens and participant-reported health and behavior data. The study was completed in 16 months and benefitted from transdisciplinary teamwork, information technology innovations, multimodal communication strategies, and scientific partnership for rigor in design and analytic methods. The lessons learned by the rapid implementation and dissemination of this national study is valuable in guiding future multisite projects as well as preparation for other public health emergencies and pandemics.

Background Electronic health records (EHRs) demand a significant amount of physician time for documentation, orders, and communication during care delivery. Resident physicians already work long hours as they gain experience and develop both clinical and socio-technical skills. Objectives Measure how much time resident physicians spend in the EHR during clinic hours and after-hours, and how EHR usage changes as they gain experience over a 12-month period. Methods Longitudinal descriptive study where participants were 622 resident physicians across postgraduate year cohorts (of 948 resident physicians at the institution, 65.6%) working in an ambulatory setting from July 2017 to June 2018. Time spent in the EHR per patient, patients records documented per day, and proportion of EHR time spent after-hours were the outcome, while the number of months of ambulatory care experience was the predictor. Results Resident physicians spent an average of 45.6 minutes in the EHR per patient, with 13.5% of that time spent after-hours. Over 12 months of ambulatory experience, resident physicians reduced their EHR time per patient and saw more patients per day, but the proportion of EHR time after-hours did not change. Conclusion Resident physicians spend a significant amount of time working in the EHR, both during and after clinic hours. While residents improve efficiency in reducing EHR time per patient, they do not reduce the proportion of EHR time spent after-hours. Concerns over the impact of EHRs on physician well-being should include recognition of the burden of EHR usage on early-career physicians.

Public health systems exhibiting strong connections across the workforce experience substantial population health improvements. This is especially important for improving quality and achieving value among vulnerable populations such as mothers and infants. The purpose of this research was to demonstrate how Alabama's newly formed perinatal quality collaborative (Alabama Perinatal Quality Collaborative [ALPQC]) used evidenced-based processes to achieve consensus in identifying population quality improvement (QI) initiatives.This multiphase quantitative and qualitative study engaged stakeholders (n = 44) at the ALPQC annual meeting. Maternal and neonatal focused QI project topics were identified and catalogued from active perinatal quality collaborative websites. The Delphi method and the nominal group technique (NGT) were used to prioritize topics using selected criteria (impact, enthusiasm, alignment, and feasibility) and stakeholder input.Using the Delphi method, 11 of 27 identified project topics met inclusion criteria for stakeholder consideration. Employing the NGT, maternal projects received more total votes (n = 535) than neonatal projects (n = 313). Standard deviations were higher for neonatal projects (SD: feasibility = 10.9, alignment = 17.9, enthusiasm = 19.2, and impact = 22.1) than for maternal projects (SD: alignment = 5.9, enthusiasm = 7.3, impact = 7.9, and feasibility = 11.1). Hypertension in pregnancy (n = 117) and neonatal abstinence syndrome (n = 177) achieved the most votes total and for impact (n = 35 and n = 54, respectively) but variable support for feasibility.Together, these techniques achieved valid consensus across multidisciplinary stakeholders in alignment with state public health priorities. This model can be used in other settings to integrate stakeholder input and enhance the value of a common population QI agenda.

Background Interoperability—the exchange and integration of data across the health care system—remains a challenge despite ongoing policy efforts aimed at promoting interoperability. Objective This study aimed to identify current challenges and opportunities to advancing interoperability across stakeholders. Methods Primary data were collected through qualitative, semistructured interviews with stakeholders (n=24) in Ohio from July to October 2021. Interviewees were sampled using a stratified purposive sample of key informants from 4 representative groups as follows: acute care and children’s hospital leaders, primary care providers, behavioral health providers, and regional health information exchange networks. Interviews focused on key informant perspectives on electronic health record implementation, the alignment of public policy with organizational strategy, interoperability implementation challenges, and opportunities for health information technology. The interviews were transcribed verbatim followed by rigorous qualitative analysis using directed content analysis. Results The findings illuminate themes related to challenges and opportunities for interoperability that align with technological (ie, implementation challenges, mismatches in interoperability capabilities across stakeholders, and opportunities to leverage new technology and integrate social determinants of health data), organizational (ie, facilitators of interoperability and strategic alignment of participation in value-based payment programs with interoperability), and environmental (ie, policy) domains. Conclusions Interoperability, although technically feasible for most providers, remains challenging for technological, organizational, and environmental reasons. Our findings suggest that the incorporation of end user considerations into health information technology development, implementation, policy, and standard deployment may support interoperability advancement.

An introduction to the journal is presented in which the editor discusses various topics within the issue, including leadership development, the effects of the COVID-19 pandemic and racial injustice to employees, and Medicare's Hospital Value-based Purchasing program in the U S

Little is known about satisfaction with different modes of telemedicine delivery. The objective of this study was to determine whether patient satisfaction with phone-only was noninferior to video visits.We conducted a parallel group, randomized (1:1), single-blind, noninferiority trial in multispecialty clinics at a tertiary academic medical center. Adults age ≥ 60 years or with Medicare/Medicaid insurance were eligible. Primary outcome was visit satisfaction rate (9 or 10 on a 0-10 satisfaction scale). Noninferiority was determined if satisfaction with phone-only (intervention) versus video visits (comparator) was no worse by a -15% prespecified noninferiority margin. We performed modified intent-to-treat (mITT) and per protocol analyses, after adjusting for age and insurance.200 participants, 43% Black, 68% women completed surveys. Visit satisfaction rates were high. In the mITT analysis, phone-only visits were noninferior by an adjusted difference of 3.2% (95% CI, -7.6% to 14%). In the per protocol analysis, phone-only were noninferior by an adjusted difference of -4.1% (95% CI, -14.8% to 6.6%). The proportion of participants who indicated they preferred the same type of telemedicine visit as their next clinic visit were similar (30.2% vs 27.9% video vs phone-only, p = 0.78) and a majority said their medical concerns were addressed and would recommend a telemedicine visit.Among a group of diverse, established older or underserved patients, the satisfaction rate for phone-only was noninferior to video visits. These findings could impact practice and policies governing telemedicine.

The CAHPS Health Plan Survey (CAHPS 5.0) collects invaluable information regarding consumer experiences with their health plans, and these data inform healthcare policies at both the state and federal levels. The purpose of this paper was to explore unsolicited comments provided on the CAHPS 5.0 survey of one state's Medicaid program. Secondary data analysis was conducted of unsolicited, written comments received from Medicaid recipients who completed the CAHPS 5.0 adult or child postal survey between 2016 and 2018. The majority of unsolicited comments were moderately or very negative in attitude (or tone) for adult and child surveys. Analysis of unsolicited comments yielded 3 themes: positive experiences with Medicaid, limitations of coverage, and direct requests for assistance. Providing space for Medicaid patients to share comments and receiving further guidance for content analysis would provide valuable context for interpreting overall survey results. Comments may also help Medicaid program administrators respond to the frequently complex and challenging experiences of navigating a continually evolving state health insurance program by the most vulnerable populations.

Asymptomatic SARS-CoV-2 infection and delayed implementation of diagnostics have led to poorly defined viral prevalence rates. To address this, we analyzed seropositivity in US adults who have not previously been diagnosed with COVID-19. Individuals with characteristics that reflect the US population (n = 11,382) and who had not previously been diagnosed with COVID-19 were selected by quota sampling from 241,424 volunteers (ClinicalTrials.gov NCT04334954). Enrolled participants provided medical, geographic, demographic, and socioeconomic information and 9,028 blood samples. The majority (88.7%) of samples were collected between May 10(th) and July 31(st), 2020. Samples were analyzed via ELISA for anti-Spike and anti-RBD antibodies. Estimation of seroprevalence was performed by using a weighted analysis to reflect the US population. We detected an undiagnosed seropositivity rate of 4.6% (95% CI: 2.6 – 6.5%). There was distinct regional variability, with heightened seropositivity in locations of early outbreaks. Subgroup analysis demonstrated that the highest estimated undiagnosed seropositivity within groups was detected in younger participants (ages 18-45, 5.9%), females (5.5%), Black/African American (14.2%), Hispanic (6.1%), and Urban residents (5.3%), and lower undiagnosed seropositivity in those with chronic diseases. During the first wave of infection over the spring/summer of 2020 an estimate of 4.6% of adults had a prior undiagnosed SARS-CoV-2 infection. These data indicate that there were 4.8 (95% CI: 2.8-6.8) undiagnosed cases for every diagnosed case of COVID-19 during this same time period in the United States, and an estimated 16.8 million undiagnosed cases by mid-July 2020.

To study the association of EMR's clinical reminder use on a comprehensive set of diabetes quality metrics in U.S. office-based physicians and within solo- versus multi-physician practices. We conducted a retrospective cohort study on visits made by adults with diabetes identified from the National Ambulatory Medical Care Survey (2012-2014).Multiple logistic regression is used to test for associations between clinical reminder use and recommended services by the American Diabetes Association.Of 5508 visits, nationally representing 112,978,791 visits, 31% received HbA1c tests, 13% received urinalysis test, and10% received retinal or foot exams. Main effects of practice size and clinical reminder use were found for HbA1c, urinalysis, and foot exams. We find no statistically significant relationship to suggest that clinical reminder use improve diabetes process guidelines for solo practices.Resource efforts, beyond clinical reminders, are needed to reduce gaps in primary diabetes care between solo and non-solo practices.

16.8 million SARS-CoV-2 infections in the US went undiagnosed in the first 6 months of the pandemic compared to 3.5 million diagnosed infections., Elucidating seroprevalence in COVID-19 Symptoms of SARS-CoV-2 infection range from completely asymptomatic, to those of a common cold, to a drop in oxygen saturation and lung function, and death in some patients. To evaluate the proportion of the U.S. population who had an undiagnosed infection during the first wave of the COVID-19 pandemic, we measured antibody prevalence in study participants who had not previously been diagnosed with a SARS-CoV-2 infection. By mid-July of 2020, 16.8 million people had an undiagnosed SARS-CoV-2 infection, almost five times the rate of diagnosed infections., Asymptomatic SARS-CoV-2 infection and delayed implementation of diagnostics have led to poorly defined viral prevalence rates in the United States and elsewhere. To address this, we analyzed seropositivity in 9089 adults in the United States who had not been diagnosed previously with COVID-19. Individuals with characteristics that reflected the U.S. population (n = 27,716) were selected by quota sampling from 462,949 volunteers. Enrolled participants (n = 11,382) provided medical, geographic, demographic, and socioeconomic information and dried blood samples. Survey questions coincident with the Behavioral Risk Factor Surveillance System survey, a large probability-based national survey, were used to adjust for selection bias. Most blood samples (88.7%) were collected between 10 May and 31 July 2020 and were processed using ELISA to measure seropositivity (IgG and IgM antibodies against SARS-CoV-2 spike protein and the spike protein receptor binding domain). The overall weighted undiagnosed seropositivity estimate was 4.6% (95% CI, 2.6 to 6.5%), with race, age, sex, ethnicity, and urban/rural subgroup estimates ranging from 1.1% to 14.2%. The highest seropositivity estimates were in African American participants; younger, female, and Hispanic participants; and residents of urban centers. These data indicate that there were 4.8 undiagnosed SARS-CoV-2 infections for every diagnosed case of COVID-19, and an estimated 16.8 million infections were undiagnosed by mid-July 2020 in the United States.

Background Voluntary turnover (VTO) of nursing employees is expensive for hospital systems and is often associated with lower levels of patient satisfaction, as well as adverse patient outcomes such as falls and medication errors. Purpose The aim of this study was to establish nurses' electronic medical record (EMR) use patterns and test if they can be used to predict VTO. Methodology/approach The study followed 1,836 hospital nurses via the collection of EMR metadata through two 1-month time periods that were 1 year apart. Machine learning algorithms were then used to derive patterns of EMR utilization using VTO as a key variable for classification. Post hoc analysis of the most predictive variables was conducted. Results The predictive model was effective in identifying which nurses would turnover 73.4% of the time and which nurses would not turnover 84.1% of the time. Practice applications The ability to accurately predict nurses' intentions to leave is critical to reducing turnover. Early identification can lead to specific interventions to mitigate factors that are adversely impacting the nursing experience. Post hoc analysis and the key informant interviews indicated that many nurses do not appear to have good EMR navigation skills and spend significant effort in search of patient information.

Background The federal health care price transparency regulation from 2019 is aimed at bending the health care cost curve by increasing the availability of hospital pricing information for the public. Objective This study aims to examine the associations between publicly reported diagnosis-related group chargemaster prices on the internet and quality measures, process indicators, and patient-reported experience measures. Methods In this cross-sectional study, we collected and analyzed a random 5.02% (212/4221) stratified sample of US hospital prices in 2019 using descriptive statistics and multivariate analysis. Results We found extreme price variation in shoppable services and significantly greater price variation for medical versus surgical services (P=.006). In addition, we found that quality indicators were positively associated with standard charges, such as mortality (β=.929; P Conclusions We found that hospital chargemasters display wide variations in prices for medical services and procedures and match variations in quality measures. Further work is required to investigate 100% of US hospital prices posted publicly on the internet and their relationship with quality measures.

Background: Asthma is associated with a greater likelihood of e-cigarette use among young adults, which may increase the risk of pulmonary complications. Because substance use trajectories emerge in early adulthood, it is important to identify factors that may be important in addressing this new public health threat. One such factor may be poor mental health. Methods: Data were extracted from the 2018 Behavioral Risk Factor Surveillance System (BRFSS). Current and former asthma status was measured by self-reported lifetime and current asthma status, mental health functioning was measured by the number of self-reported bad mental health days during the past 30 days, e-cigarette use was measured by self-reported current e-cigarette use. We tested the hypothesis that mental health mediates the association between asthma status and e-cigarette use among young adults using structural equation modeling. Results: The prevalence of e-cigarette use was significantly higher among young adults with current (9.90%) or former asthma (13.09%) than those without asthma (9.58%). Furthermore, the number of bad mental health days in the past 30 days was significantly greater among young adults with current or former asthma than among those without asthma (Mean (Standard Deviation): 6.85 (0.42), 4.18 (0.85) versus 3.83 (0.17)), respectively. Finally, we found a statistically significant indirect effect of asthma on the likelihood of e-cigarette use through mental health such that the higher prevalence of e-cigarette use among those with current or former asthma was statistically accounted for by a greater number of bad mental health days in the past 30 days. Conclusions: Consistent with mediation, poorer mental health accounted for the higher prevalence of e-cigarette use among those with asthma. However, longitudinal studies are needed to interrogate causal relationships, including the effects of e-cigarette use on mental health. Mental health services may play an important role in improving health and wellbeing in this vulnerable population.

Since Jan. 1, 2019, the Centers for Medicare and Medicaid Services' (CMS) rule requiring hospitals publish their “standard charges” (also called “charge description masters” or “chargemasters”) in a public, machine-readable format has been in effect. The research at hand assesses hospital compliance with the federal regulation. In addition, a sentiment analysis of the chargemaster webpages compared to hospital homepages is performed to assess the consumer friendliness of the content in terms of language usage. A stratified sample of 212 hospitals was used to conduct observations. Strata were based on patient satisfaction scores drawn from the Hospital Consumer Assessment of health care Providers and Systems survey, and controls for hospital bed size and geographic US census region were utilized from the American Hospital Association Annual Survey. Descriptive statistics are presented, and chi-square testing is used to test for statistically significant differences. Key results are presented for compliance and sentiment. Most hospitals' websites are not presenting chargemaster data in a way that is readily collectable or comparable to other facilities. In addition, the tone of language used on chargemaster transparency webpages is generally more negative than that of hospitals' homepages. In particular, the messaging on transparency pages routinely suggests consumers to not use the data for decision-making purposes.

Background The Hospital Survey on Patient Safety Culture (HSOPSC) is widely utilized in multiple languages across the world. Despite culture and language variations, research studies from Latin America use the Spanish language HSOPSC validated for Spain and the United States. Yet, these studies fail to report the translation method, cultural adaptation process, and the equivalence assessment strategy. As such, the psychometric properties of the HSOPSC are not well demonstrated for cross-cultural research in Latin America, including Peru. The purpose of this study was to develop a target-language HSOPSC for cross-cultural research in Peru that asks the same questions, in the same manner, with the same intended meaning, as the source instrument. Methods This study used a mixed-methods approach adapted from the translation guideline recommended by Agency for Healthcare Research and Quality. The 3-phase, 7-step process incorporated translation techniques, pilot testing, cognitive interviews, clinical participant review, and subject matter expert evaluation. Results The instrument was translated and evaluated in 3 rounds of cognitive interview (CI). There were 37 problem items identified in round 1 (14 clarity, 12 cultural, 11 mixed); and resolved to 4 problems by round 3. The pilot-testing language clarity inter-rater reliability was S-CVI/Avg = 0.97 and S-CVI/UA = 0.86; and S-CVI/Avg = 0.96 and S-CVI/UA = 0.83 for cultural relevance. Subject matter expert agreement in matching items to the correct dimensions was substantially equivalent (Kappa = 0.72). Only 1 of 12 dimensions had a low Kappa (0.39), borderline fair to moderate. The remaining dimensions performed well (7 = almost perfect, 2 = substantial, and 2 = moderate). Conclusions The HSOPSC instrument developed for Peru was markedly different from the other Spanish-language versions. The resulting items were equivalent in meaning to the source, despite the new language and different cultural context. The analysis identified negatively worded items were problematic for target-language translation. With the limited literature about negatively worded items in the context of cross-cultural research, further research is necessary to evaluate this finding and the recommendation to include negatively worded items in instruments. This study demonstrates cross-cultural research with translated instruments should adhere to established guidelines, with cognitive interviews, based on evidence-based strategies.

Background Optimal cancer care entails coordination among multiple providers and continued follow-up and surveillance over time. The patient-centered care brings opportunities to improve the delivery of cancer care. The adoption of patient-centered oncology care (PCOC) is in its infancy. Evidence synthesis on the model's effectiveness is scant. Purposes This is the first systemic review and meta-analysis on associations of PCOC with cancer patients' adverse health care utilization, cost, patient satisfaction, and quality of care. Methods Our study was guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) framework. Quality appraisal was performed using Downs and Black's quality checklist. Study-level effect sizes of adverse health care utilization were computed using Cohen's d and summarized using forest plots. Funnel plots were constructed to examine publication bias. Results Of 334 studies that were reviewed, 10 met eligibility criteria and were included into the final analysis. Many included studies implemented almost all six of patient-centered care core attributes, plus three additional attributes that specifically addressed cancer patients' needs, including triage pathways, standardized and evidence-based symptom management, as well as support patient navigation. PCOC patients had lower utilization of inpatient care (standardized means difference [SMD] = -0.027, p = .049). Overall positive effect of PCOC on emergency department use was small and not significant (SMD = -0.023, p = .103). With regard to cost and quality of care, our narrative summaries showed an overall positive direction, though we found limitations in individual study quality that precluded a meta-analysis. Public implication The results showed that it is possible to utilize patient-centered model to support best practice of cancer care. Early evidence shows that the PCOC model has potential to improve health care utilization, cost, and quality of care, but limited numbers of included articles and heterogeneity of those studies implied that more rigorous research is expected to further investigate the model's effects.

Introduction Direct-to-consumer genetic tests for inherited disease risks have gained recent approvals from the Food and Drug Administration, and interest in these tests has continued to grow. Broad use of these tests coupled with planning and discussion with health providers regarding genetic risks and potential protective behavior changes have been proposed as preventive tools to reduce health disparities and improve equity in health outcomes. However, awareness of direct-to-consumer genetic testing has historically demonstrated differences by education, income, and race; these disparities could jeopardize potential benefits by limiting access and use. Methods The national survey data from the Health Information National Trends Survey was analyzed to understand how overall awareness of direct-to-consumer genetic testing and disparities in awareness across sociodemographic groups have changed since 2007. Results The findings showed persistent disparities, as well as a widening gap in awareness between Hispanics and non-Hispanic whites (OR2007 =1.52, OR2014 =0.58, pchange =0.0056), despite overall increases in awareness over time. Conclusions Given these findings, policies regulating direct-to-consumer genetic tests should prioritize equitable distribution of benefits by including provisions that counteract prevailing disparities in awareness.

Background The relationship between Chief Executive Officer (CEO) succession and hospitals' competitive performance is an area of interest for health services researchers. Of particular interest is the impact on overall strategic direction and health system performance that results from selecting a CEO from inside the firm as opposed to seeking outside leadership. Empirical work-to-date has yielded mixed results. Much of this variability has been attributed to design flaws; however, in the absence of a clear message from the evidence, the preference for hiring "outsiders" continues to grow. Purpose This paper investigates on the extent to which insider CEO succession versus outsider succession impacts hospitals' competitive advantage vis-a-vis a sample of organizations that compete in the same sector. Methods A hospital matching protocol based on propensity scores is used to control for endogeneity and makes comparisons of productivity across organizations through the use of stochastic frontier estimation. Findings Succession negatively impacts hospitals' productivity, and firms with outsider CEO succession events closed the gap toward the competitive advantage frontier faster than comparable firms with insider successions. Practice implications More research needs to be done on succession planning and its impact on CEO turnover.

Background : In 2019, the Centers for Medicare and Medicaid Services (CMS) mandated U.S. hospitals to publicly display their negotiated charges for health care services provided. The 2019 mandate is the second step in a CMS’ comprehensive, long-term price transparency initiative affecting several hospital pricing aspects. To date, little is known about potential implications of the 2019 CMS mandate on healthcare sector. Methods : To address this gap, we utilized rapid assessment technology and surveyed a nationally representative panel of health policy and management researchers (N = 216). Purpose : We asked the research panel about the likelihood of a complete hospital price transparency mandate implementation and whether it will achieve its intended goals. Results : The majority of panelists (68.6%) perceived that the hospital price transparency policy was not likely to be fully implemented. However, if the comprehensive price transparency policy would be enacted, respondents perceived that it would help control costs, but not by engaging consumers in price shopping behaviors. Respondents noted the significant technical challenges to producing and interpreting the health services pricing information would be a barrier to bending the healthcare cost curve. Conclusion : Rapid assessment technology proves useful and adds value in the healthcare sector to quickly evaluate potential policy outcomes.

Objective Evidenced-based processes of care improve patient outcomes, yet universal compliance is lacking, and perceptions of the quality of care are highly variable. The purpose of this study is to examine how differences in clinician and management perceptions on teamwork and communication relate to adherence to hospital processes of care. Methods Hospitals submitted identifiable data for the 2012 Hospital Survey on Patient Safety Culture and the Centers for Medicare and Medicaid Services' Hospital Compare. The dependent variable was a composite, developed from the scores on adherence to acute myocardial infarction, heart failure, and pneumonia process of care measures. The primary independent variables reflected 4 safety culture domains: communication openness, feedback about errors, teamwork within units, and teamwork between units. We assigned each hospital into one of 4 groups based on agreement between managers and clinicians on each domain. Each hospital was categorized as "high" (above the median) or "low" (below) for clinicians and managers in communication and teamwork. Results We found a positive relationship between perceived teamwork and communication climate and processes of care measures. If managers and clinicians perceived the communication openness as high, the hospital was more likely to adhere with processes of care. Similarly, if clinicians perceived teamwork across units as high, the hospital was more likely to adhere to processes of care. Conclusions Manager and staff perceptions about teamwork and communications impact adherence to processes of care. Policies should recognize the importance of perceptions of both clinicians and managers on teamwork and communication and seek to improve organizational climate and practices. Clinician perceptions of teamwork across units are more closely linked to processes of care, so managers should be cognizant and try to improve their perceptions.

Introduction Electronic cigarettes (e-cigarettes) are gaining in popularity as an alternative to regular cigarettes, as they are viewed as potentially less harmful. However, it remains unclear how awareness about e-cigarettes is permeating through the general U.S. population. This study seeks to extend previous research and examine trends in e-cigarette awareness and perceived harmfulness, and their association with smoking-cessation efforts. Methods Data from three cycles (2012, 2013, and 2014) of the Health Information National Trends Survey were combined into a single data set. Controlling for survey year, multivariate logit models were used to determine the association between demographic characteristics and e-cigarette awareness, perceived harmfulness, quit attempts, and quit intentions. Data were analyzed in 2015. Results Awareness of e-cigarettes increased from 77.1% in 2012 to 94.3% in 2014. Controlling for demographic characteristics, e-cigarette awareness significantly increased in both 2013 and 2014, relative to 2012. Perception that e-cigarettes were less harmful than regular cigarettes declined from 50.7% in 2012 to 43.1% in 2014. Among smokers, no relationship was observed between e-cigarette awareness and past-year quit attempts or quit intentions, but those that viewed e-cigarettes as less harmful were less likely to have a past-year quit attempt. Conclusions These analyses reveal a continued increase in overall public awareness of e-cigarettes and shifting harm perceptions relative to regular cigarettes. New regulatory oversight by the U.S. Food and Drug Administration may have major effects on both dimensions, which are worth continued monitoring.

Patients admitted to Level 1 trauma centers in the United States are rarely assessed for or educated about the potentially devastating effects of acute stress disorder (ASD) or posttraumatic stress disorder (PTSD). This descriptive research was conducted to describe current levels of assessment and education of ASD and PTSD in Level 1 trauma centers in the United States. The aims of this article are to (1) determine the extent to which Level 1 trauma centers in the United States assess and educate patients and providers about ASD and PTSD and (2) identify clinical staff who administer assessments and provide educational resources. A web-based survey was distributed to the trauma program managers and trauma medical directors of 209 adult and 70 pediatric Level 1 trauma centers in the United States. For PTSD, 26 (25.00%) adult and 17 (36.17%) pediatric centers had an assessment protocol for use with trauma patients. For ASD, 13 (12.50%) adult and 13 (27.66%) pediatric centers utilized an assessment protocol for use with trauma patients. For PTSD, 12 (12.37%) adult and 8 (20.00%) pediatric centers offered educational protocols for use with trauma patients. Seven (7.22%) adult and 7 (17.50%) pediatric centers maintain educational protocols for ASD in trauma patients. Fewer centers had assessment or educational protocols targeting formal and informal caregivers. This study was limited to Level 1 trauma centers in the United States. Results indicate that trauma patients are rarely assessed for or educated about the potential effects of PTSD or ASD. Formal and informal caregivers are also assessed and educated at low rates. Assessment, education, and incidence of PTSD and ASD should be included as universally measured health outcomes across trauma centers.