Search

This study examines rehabilitation effectiveness among a cohort of 801 long term stroke residents in Virginia nursing homes. Multiple regression analysis was used to examine rehabilitation impact on six physical function outcomes after controlling for the influence of resident differences in rehabilitation potential. Rehabilitation was measured as physical (PT) and occupational (OT) therapy provision, but only the PT results are presented since so few residents received OT. PT was associated with an increase in overall physical activities of daily living (PADL) and eating independence. PT had a small effect on PADL improvement and appears to have more power to prevent PADL regression than to produce PADL improvement. [ABSTRACT FROM AUTHOR]

Rehabilitation potential among chronic stroke residents in Virginia nursing homes was examined. Discriminant analysis was used to determine which rehabilitation potential characteristics discriminated between 46 stroke residents who improved in their physical activities of daily living (PADL) function and 34 residents who regressed. Improved residents were initially more PADL dependent, less depressed or anxious, had less paralysis/paresis, and were less demented than regressed residents. Initial PADL dependence was the strongest discriminator, followed by depression/anxiety, paralysis, and dementia. Nursing home rehabilitation staff can use these results to screen stroke candidates and classify residents for quality assurance evaluation. [ABSTRACT FROM AUTHOR]

An approach that utilizes functional outcomes to evaluate the quality of geriatric rehabilitation is described. Regulators advocate functional outcome-based quality assurance, but the literature provides little guidance in this area. A six-step approach is proposed that compares patient goal attainment with preset thresholds. This method accounts for the influence that rehabilitation potential and patient complications may have on goal attainment. The approach can be used in different geriatric rehabilitation programs to meet government and Joint Commission for the Accreditation of Health Services Organizations quality assurance requirements. [ABSTRACT FROM AUTHOR]

Background: The recent expansion of immunotherapy for stage IIB/IIC melanoma highlights a growing clinical need to identify patients at high risk of metastatic recurrence and, therefore, most likely to benefit from this therapeutic modality., Objective: To develop time-to-event risk prediction models for melanoma metastatic recurrence., Methods: Patients diagnosed with stage I/II primary cutaneous melanoma between 2000 and 2020 at Mass General Brigham and Dana-Farber Cancer Institute were included. Melanoma recurrence date and type were determined by chart review. Thirty clinicopathologic factors were extracted from electronic health records. Three types of time-to-event machine-learning models were evaluated internally and externally in the distant versus locoregional/nonrecurrence prediction., Results: This study included 954 melanomas (155 distant, 163 locoregional, and 636 1:2 matched nonrecurrences). Distant recurrences were associated with worse survival compared to locoregional/nonrecurrences (HR: 6.21, P < .001) and to locoregional recurrences only (HR: 5.79, P < .001). The Gradient Boosting Survival model achieved the best performance (concordance index: 0.816; time-dependent AUC: 0.842; Brier score: 0.103) in the external validation., Limitations: Retrospective nature and cohort from one geography., Conclusions: These results suggest that time-to-event machine-learning models can reliably predict the metastatic recurrence from localized melanoma and help identify high-risk patients who are most likely to benefit from immunotherapy., Competing Interests: Conflicts of interest YRS is an advisory board member/consultant and has received honoraria from Incyte Corporation, Castle Biosciences, Galderma, and Sanofi outside of the submitted work., (Copyright © 2023 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.)

Objective: To examine the association between patient race/ethnicity, insurance status, and their interaction with patient safety indicators among hospitalized patients., Methods: Cross-sectional study was conducted. Data were extracted from the 2009 National Inpatient Sample. A total of 3,052,268 patient safety indicator-related discharges were identified. Dependent variables were 11 patient safety indicators (PSI) whereas independent variables included race/ethnicity and insurance status., Results: As compared with White patients, African American patients were more likely to experience pressure ulcer, post-operative hemorrhage or hematoma, and post-operative pulmonary embolism (PE) or deep vein thrombosis (DVE); Asian/Pacific Islander patients were more likely to experience pressure ulcer, post-operative PE or DVT, and two obstetric care PSIs; whereas Hispanic/Latino patients were more likely to experience post-operative physiometabolic derangement and accidental puncture/laceration. As compared with patients with private insurance, Medicaid patients were more likely to experience pressure ulcer, post-operative physiological metabolic derangement, post-operative PE or DVT, post-operative respiratory failure, post-operative wound dehiscence, and death among surgeries. However, both obstetric care PSIs showed that African Americans, Hispanics, and uninsured patients were less likely to incur them in comparison with their respective counterparts. Furthermore, strong interactive effects between African American and Medicaid on PSIs were detected., Conclusions: Although mixed findings in disparities in PSIs were observed in our study, Asian/Pacific Islander patients and Medicaid patients seem to be the most vulnerable. Further, interactive effects between African American and Medicaid indicate that poverty may be a key factor related to disparities in health care. Future research is merited to identify underlying factors that are related to PSIs among Asian/Pacific Islander patients. Strategies are needed to improve PSIs among Medicaid patients, especially during the current Medicaid program expansion due to the implementation of the Affordable Care Act.

Background: Compare changes in types of hospital service revenues between traditional Chinese medicine (TCM) hospitals and Western-medicine based general hospitals., Methods: 97 TCM hospitals and 103 general hospitals were surveyed in years of 2000 and 2004. Six types of medical service revenue between the two types of hospitals were compared overtime. The national statistics from 1999 to 2008 were also used as complementary evidence., Results: For TCM hospitals, the percentage of service revenue from Western medicine increased from 44.3% to 47.4% while the percentage of service revenue from TCM declined from 26.4% to 18.8% from 1999 to 2004. Percentages of revenue from laboratory tests and surgical procedures for both types of hospitals increased and the discrepancy between the two types of hospitals was narrowed from 1999 to 2004. For TCM hospitals, revenues from laboratory tests increased from 3.64% to 5.06% and revenues from surgical procedures increased from 3.44% to 7.02%. General hospitals' TCM drug revenue in outpatient care declined insignificantly from 5.26% to 3.87%, while the decline for the TCM hospitals was significant from 19.73% to 13.77%. The national statistics from 1999 to 2008 showed similar trends that the percentage of revenue from Western medicine for TCM hospitals increased from 59.6% in 1999 to 62.2% in 2003 and 66.1% in 2008 while the percentage of revenue from TCM for TCM hospitals decreased from 18.0% in 1999, 15.4% in 2003, and 13.7% in 2008., Conclusion: Western medicine has become a vital revenue source for TCM hospitals in the current Chinese health care environment where government subsidies to health care facilities have significantly declined. Policies need to encourage TCM hospitals to identify their own special and effective services, improve public perception, increase demand, strengthen financial sources, and ultimately make contributions to preserving one of the national treasures.

The objective of this study was to examine the relationship between financial position and adoption of electronic health records (EHRs) in 2442 acute care hospitals. The study was cross-sectional and utilized a general linear mixed model with the multinomial distribution specification for data analysis. We verified the results by also running a multinomial logistic regression model. To measure our variables, we used data from (1) the 2007 American Hospital Association (AHA) electronic health record implementation survey, (2) the 2006 Centers for Medicare and Medicaid Cost Reports, and (3) the 2006 AHA Annual Survey containing organizational and operational data. Our dependent variable was an ordinal variable with three levels used to indicate the extent of EHR adoption by hospitals. Our independent variables were five financial ratios: (1) net days revenue in accounts receivable, (2) total margin, (3) the equity multiplier, (4) total asset turnover, and (5) the ratio of total payroll to total expenses. For control variables, we used (1) bed size, (2) ownership type, (3) teaching affiliation, (4) system membership, (5) network participation, (6) fulltime equivalent nurses per adjusted average daily census, (7) average daily census per staffed bed, (8) Medicare patients percentage, (9) Medicaid patients percentage, (10) capitation-based reimbursement, and (11) nonconcentrated market. Only liquidity was significant and positively associated with EHR adoption. Asset turnover ratio was significant but, unexpectedly, was negatively associated with EHR adoption. However, many control variables, most notably bed size, showed significant positive associations with EHR adoption. Thus, it seems that hospitals adopt EHRs as a strategic move to better align themselves with their environment.

The study compared the prenatal care programs in the Central-East, Northwest, and Southwest regions of China. Data were collected on 14 indicators of the quality of the prenatal care process, as well as the percentage of women with high-risk pregnancies who were screened. The average number of prenatal examinations for those women who received prenatal care was 5.01, and 62.6% of pregnant women had their first examination within 12 weeks of their pregnancy. About 35% of these pregnant women had at least 1 high-risk screening, and 20.8% had 3 high-risk screenings. Among the 3 regions, the Central-East region had the best overall quality prenatal services, and the Northwest area had the poorest quality. The quality of prenatal health care in poor, rural China is in need of improvement.

Hospitals provide diversity activities for a number of reasons. The authors examined community demand, resource availability, managed care, institutional pressure, and external orientation related variables that were associated with acute care hospital diversity plans and translation services. The authors used multiple logistic regression to analyze the data for 478 hospitals in the 2006 National Inpatient Sample (NIS) dataset that had available data on the racial and ethnic status of their discharges. We also used 2004 and 2006 American Hospital Association (AHA) data to measure the two dependent diversity variables and the other independent variables. We found that resource, managed care, and external orientation variables were associated with having a diversity plan and that resource, managed care, institutional, and external orientation variables were associated with providing translation services. The authors concluded that more evidence for diversity's impact, additional resources, and more institutional pressure may be needed to motivate more hospitals to provide diversity planning and translation services.

The authors used a panel study to analyze the role of mimetic isomorphism in determining the strategic posture of hospitals as measured by their community orientation. They divided the sample into 3 groups ranging from most isomorphic to least isomorphic with regard to the dependent variables of community-orientation activities and health-promotion programs. Over time, the most isomorphic group of hospitals scored significantly higher on both dependent variables.

Background: The hospital industry has exhibited a pattern of isomorphic change with regard to business operations. Many states have enacted community benefit laws to compel hospitals to provide community benefits to improve their community orientation., Purposes: We seek to identify what kinds of isomorphic change might be associated with the enactment of these state community benefit laws. To do this, we conducted a longitudinal study of changes in community benefit provided by hospitals in both states with community benefit laws and states without community benefit laws., Methodology/approach: This study used a quasi-experimental panel design with the passage of community benefit laws/guidelines as the treatment variable. Our sample was composed of 390 not-for-profit hospitals and 129 investor-owned hospitals in 9 treatment states and 1,493 not-for-profit and 714 investor-owned hospitals in 35 control states. Community benefit was measured by the (a) community orientation activities reported and the (b) health promotion services offered by hospitals., Findings: The not-for-profit hospitals in the states without community benefit laws had increased their community orientation activities and health promotion services in a manner similar to that of the not-for-profit hospitals in the states with community benefit laws. There was no significant difference between the not-for-profit hospitals in the states without community benefit laws and those in the states with community benefit laws in 1994 or 2006 for either dependent variable. The changes in the community benefit for the not-for-profit hospitals in the states without community benefit laws and in the states with community benefit laws were significant and positive for both dependent variables., Practice Implications: Managers of acute care hospitals should engage in community orientation activities to maintain their legitimacy, differentiate themselves from other hospitals, avoid regulation, and manage resource dependency on managed-care payers.

General hospitals are becoming the safety net provider for the seriously mentally ill (SMI) in the United States, but these patients are faced with a number of potential barriers when accessing these hospitals. Hospital ownership and market forces are two potential organizational and healthcare system barriers that may affect the SMI patient's access, because the psychiatric and medical services they need are unprofitable services. This study examines the relationship among hospital ownership, market forces, and admission of the SMI patient from the emergency department into the general hospital. This was a cross-sectional study of a large sample of SMI patients from the 2002 State Inpatient Datasets for five states. Multiple logistic regression was applied in the multivariable analysis. After controlling for patient, hospital, and county covariates and when compared with not-for-profit hospitals, public hospitals were more likely to admit while investor-owned hospitals were less likely to admit SMI patients. Hospitals in competitive markets were less likely to admit while hospitals with capitation revenues were slightly less likely to admit these patients. Policy options that can address this "market failure" include strengthening the public psychiatric inpatient care system, making private health insurance coverage of the SMI more equitable, revising Medicare prospective payment system to better reimburse the treatment of the SMI, and allowing not-for-profit hospitals to count care of the SMI as a community benefit. Results of this study will be useful to healthcare managers searching for ways to reduce unnecessary administrative costs while continuing to maintain the level of administrative activities required for the provision of safe, effective, and high-quality care.

Objective: To explore associations between access to care and environmental stressors with emergency room admissions; to evaluate patterns of complications across diverse ethnic groups related to affective psychosis., Methods: Data from the National Inpatient Sample were used to evaluate complications and frequency of hospitalization through the emergency room as a proportion of all hospital admissions for affective psychosis across diverse ethnic groups. Unemployment data, variations of trends of proportions of emergency room admissions after the September 11th tragedy, and ratios of primary care physicians/psychiatrists to the general population were evaluated., Results: Admissions through the emergency room as a percentage of all admissions for affective psychosis decreased from 1995 through 1999 but increased in 2001, showing a potential association with increasing unemployment rates and the September 11th tragedy. Over the same period, relatively higher frequencies of emergency room admissions as a proportion of all hospital admissions among African Americans decreased. No significant differences for complications or emergency room utilization were observed between African Americans and Whites by 2001. During the entire period, frequencies of complications in the Hispanic and Asian populations remained lower than frequencies in both African American and White populations. No associations were found between physician-to-population ratios and utilization of the emergency room., Conclusion: Patterns of emergency room utilization and complications in African American and White populations appear to show some association with environmental stressors. Further study is warranted to evaluate protective factors associated with lower risk of complications in both Hispanic and Asian populations.

This study examined the effect of state community benefit laws and guidelines on the community health orientation and the provision of hospital-based health promotion services in hospitals. The sample included all not-for-profit and investor-owned acute-care hospitals in the United States during the year 2000. Multiple regression procedures were used to test the effect of community benefit laws and type of ownership while controlling for organizational and environmental variables. The results of these procedures indicated that, on average, not-for-profit hospitals in the ten states with community benefit laws/guidelines reported significantly more community health orientation activities than did not-for-profit hospitals in the forty other states. The results of the multiple regression procedures also indicated that, on average, the investor-owned hospitals in the ten states with laws/guidelines reported significantly more community health orientation activities than did the investor-owned hospitals in the forty other states. The study found that community benefit laws had the effect of decreasing ownership-related differences in reported community health orientation activities. Further, Levene's test of equality of variance showed that the not-for-profit hospitals in community benefit states exhibited significantly lower variance in the community health orientation activities when compared with the not-for-profit hospitals in non-community benefit states. However, none of the statistical tests supported the hypotheses that community benefit laws compelled or induced hospitals to offer significantly more health promotion services. The study concluded that coercive measures such as community benefit laws were effective in compelling not-for-profit hospitals to report increased community orientation activities, and it also concluded that the mimetic pressures associated with these laws were effective in inducing investor-owned hospitals to report increased community orientation activities.

The objective of the study presented in this article was to examine the relationship between hospital community orientation and the provision of health promotion services. The study used data from the 2000 American Hospital Association survey and the 2000 Area Resource File to examine acute care hospitals throughout the United States. The study was a cross-sectional multiple regression analysis. Hospital community orientation was measured by two independent variables: (1) community health orientation and (2) community-based quality orientation. Health promotion services were represented by two dependent variables: (1) hospital-based health promotion services and (2) collaborative health promotion services. Organizational control variables included bed-size code, not-for-profit ownership, network participation, and joint venture/alliance membership. Environmental control variables included the proportion of population over age 65, the percentage of population below the poverty level, the square root of the proportion of Medicaid inpatient revenue, the presence of state community benefit laws/guidelines, a Herfindahl-Hirschman Index of level of competition, and an index of managed care influence. Results of regression analyses showed that community health and community-based quality orientations were positively and significantly related to both the direct provision of health promotion services by hospitals and the collaborative provision of health promotion services through systems, joint ventures, and networks. The study concludes that a community health orientation and a community-based quality orientation lead to greater provision of health promotion services.

Continuous Quality Improvement (CQI) methods offer healthcare organizations valuable tools for improving services to their patients. These tools are also useful in improving the way an organization delivers its services. In this case study, the authors describe the use of quality improvement activities for improving the enrollment and screening for breast and cervical cancer for the Women's Health Connection (WHC). The WHC is operated by the Nevada Department of Human Resources, Health Division, to provide screening for income eligible women between the ages of 40-64. Funding for the WHC was provided by the Department of Health and Human Services' Centers for Disease Control and Prevention (CDC) through the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). By using Quality Improvement Teams, the WHC was able to restructure the way women were being enrolled in the program in order to increase the number of women screened and to help the program meet CDC performance indicators. This article documents the quality improvement process used in the case study, highlights the areas improved, and demonstrates how quality improvement was useful in improving services provided to women. It also describes staff acceptance of the quality improvement process and its potential future applications.

This article is an examination of the impact of physical restraints on physical activities of daily living (PADL), walking, and orientation to reality outcomes among nursing home residents. Computerized assessment data for a cohort of 5073 Virginia Medicaid nursing home admissions with complete data for their first and second post-admission assessments were analyzed. Multiple regression analysis was used to compare the outcomes of restrained and nonrestrained residents, after controlling statistically for the influence of case mix variables that might impact outcomes. Restraint use was associated with increased PADL dependence and disorientation for residents restrained at first and second assessment, both assessments, and either assessment. Restraint was associated with increased walking dependence for residents restrained at their second assessment and either assessment.

The 1990 Omnibus Budget and Reconciliation Act (OBRA) nursing home regulations limit the use of indwelling urinary catheterization to certain appropriate cases. This study examines the impact of OBRA on catheterization among 3149 pre-OBRA and 5073 post-OBRA Virginia residents. The two cohorts were similar in activities of daily living function and medical status, but the post-OBRA cohort was more incontinent. A higher percentage of residents were catheterized pre-OBRA than post-OBRA. Post-OBRA, catheterized residents were more likely to meet OBRA conditions for appropriate catheterization than noncatheterized residents, and less than 1% of long-term catheterized residents were catheterized inappropriately. Long-term catheterized residents had more urinary tract infections than short-term catheterized residents, however. Also, some nursing homes may substitute ostomies for catheters. Catheter use may no longer be a reliable indicator of quality of care at the nursing home level, if homes are minimizing catheterization in response to OBRA.

A Nevada Geriatric Education Center (NGEC) study examined the relationship between gerontology content in the curriculum at two southern Nevada academic institutions and the usefulness of that content to community allied health providers. Course content for 20 gerontology topics was compared with community respondents' perceptions of topic usefulness. Rank-ordered topic content and usefulness means were associated positively for the total sample, nonwhites, social workers, managers and supervisors and nurses for all the courses with gerontology content, as well as for social workers and social work courses. They were not associated for nurses and nursing courses, however. Study results were disseminated to NGEC staff and board members, gerontology faculty and community agency administrators.

Using secondary data, an analysis was done of the prevalence of inappropriate clinical care among 3,149 Virginia Medicaid nursing home residents. Six types of inappropriate care were examined: the underprovision of skilled nursing care, physical rehabilitation and routine medical care; and the overuse of psychotropic drugs, physical restraints and urinary catheterization. Thirty-two (32) percent of the residents received inappropriate care in at least one care area and 7% received inappropriate care in two or more areas. Residents who received the most inappropriate care were more dependent in their activities of daily living, uncommunicative, incontinent, likely to have had a stroke, and less disruptive. Residents who received the most inappropriate care are among the most vulnerable residents, and stronger regulation and outside advocacy may be needed to protect them from inappropriate care.