Pregnancy among residents enrolled in general surgery: a nationwide survey of attitudes and experiences

Background

Medical student interest in general surgery has declined, and the lack of adequate accommodation for pregnancy and parenting during residency training may be a deterrent. We explored resident and program director experiences with these issues in general surgery programs across Canada.

Methods

Using a web-based tool, residents and program directors from 16 Canadian general surgery programs were surveyed regarding their attitudes toward and experiences with pregnancy during residency.

Results

One hundred seventy-six of 600 residents and 8 of 16 program directors completed the survey (30% and 50% response rate, respectively). Multiple issues pertaining to pregnancy during surgical residency were reported including the lack of adequate policies for maternity/parenting, the major obstacles to breast-feeding, and the increased workload for fellow resident colleagues. All program directors reported the lack of a program-specific maternity/parenting policy.

Conclusions

General surgery programs lack program-specific maternity/parenting policies. Several issues have been highlighted in this study emphasizing the importance of creating and implementing such a policy.     

Assessing production characteristics, influential factors and administrative policies in a multicenter dental organization

BackgroundIn multicenter service organizations, managers often make centralized decisions without considering the effects of differing production characteristics and influential factors on each center.MethodsIn this study, the author examines differences in production characteristics and factors that influence production, as well as their likely effect on policy formulation, in a large, six-center dental group in the Chicago area.ResultsThe results of the study show that the six centers (in two groups) exhibited two distinct production patterns, with three having logarithmic distributions and three having normal distributions. Production differences between the groups likely resulted from differences in managed care, staffing and dental procedures performed.ConclusionsInstead of being monolithic, the organization exhibited two types of centers, each with its own production characteristics and factors that influenced production.Practice ImplicationsThe study results suggest that large service corporations and partnerships would benefit from conducting analyses of production characteristics and factors that influence production before making policy decisions that affect the entire organization.     

Time well spent: The duration of foster care and early adult labor market,educational, and health outcomes

Individuals who spent time in foster care as children fare on average worse than non-placed peers in early adult life. Recent research on the effect of foster care placement on early adult life outcomes provides mixed evidence. Some studies suggest negative effects of foster care placement on early adult outcomes, others find null effects. This study shows that differences in the average duration of foster care stays explain parts of these discordant findings and then test how foster care duration shapes later life outcomes using administrative data on 7220 children. The children experienced different average durations of foster care because of differences in exposure to a reform. Later born cohorts spent on average 3 months longer in foster care than earlier born cohorts. Isolating exogenous variation in duration of foster care, the study finds positive effects of increased duration of foster care on income and labor market participation.     

Patient and Provider-Identified Factors Contributing to Surgical Readmission After Colorectal Surgery

Purpose: Nearly one in seven surgical patients is readmitted to the hospital within 30 days of discharge. Few studies have identified patient-centric factors that raise the risk of both preventable and nonpreventable postoperative readmissions. Materials and Methods: Over 6 months in 2012, 48 colorectal surgical patients were identified on re-admission within 30 days of discharge. We prospectively obtained information on the patient's and primary surgeon's views on factors that contributed to readmission, and compiled data to produce an external list of contributing factors. A standard cost analysis was performed. Results: 48 colorectal surgery patients participated, and 47 were included in this patient-centric evaluation of factors leading to readmission. The three primary readmission diagnoses included dehydration, fever, and ileus or small bowel obstruction. Of all readmissions, 23% were considered to be preventable. 38% of patients had scheduled follow-up appointments that were documented in the medical record at the time of discharge. Providers identified several factors contributing to readmission including difficulty understanding discharge plan, medication management and premature discharge. Per patient, the cost of preventable readmission was $15,366 (±20%; $12,293–$18,439). Total preventable cost was $169,025 (±20%; $135,220–$202,829). Conclusions: The ability to obtain an outpatient postoperative appointment and the understanding of their own postoperative care were the most commonly identified barriers. Interventions to help reduce unnecessary readmissions include a standard discharge process and coordinator, and routine (<7 days) postdischarge outpatient appointments. Successful reduction of preventable readmissions would result in approximately $3.6 million in cost savings per 1,000 colorectal readmissions.     

Participant Satisfaction with a Food Benefit Program with Restrictions and Incentives

Background

Policy makers are considering changes to the Supplemental Nutrition Assistance Program (SNAP). Proposed changes include financially incentivizing the purchase of healthier foods and prohibiting the use of funds for purchasing foods high in added sugars. SNAP participant perspectives may be useful in understanding the consequences of these proposed changes.

深圳市罗湖区医改政策分析

区级医改是中国医药卫生体制改革中重要但却经常被忽视的改革环节。2015年以来,深圳市罗湖区依据国家政策导向,结合辖区内的医疗卫生需求与问题,以推进"罗湖医院集团"建设为基本策略,进行了一系列富有成效的改革措施。罗湖区的改革在有利的政策时机和外部条件下,区级政府部门探索创新,走出了一条具有特色的区级医改之路,也体现了区级政府完全可能也应该成为中国地方医改中的一个积极的行动主体。当然,罗湖医改仍在继续,很多改革效果仍待观察,但其改革经验对于其他城市的医改具有重要借鉴意义。     

兼顾效率与公平的中国卫生资源配置:问题发现及政策路径

目的:探讨卫生资源公平且有效率的配置方式,促进居民公平有效分享公共卫生资源。方法:基于我国31个省级区域2010~2014年的数据,通过超效率DEA模型测算各地区卫生资源配置效率,以各地医疗卫生机构获得的人均财政补贴收入来考察卫生资源配置的公平情况,对卫生公平和效率进行静态差异分析和动态固化分析。结果:无论是地区之间还是内部,我国卫生资源公平的差异程度以及固化程度都比效率大,卫生资源存在不公平和不合理两大问题。结论:中央政府应加大卫生资源调节力度,精准扶持那些"低公平、高效率"的地区,并形成稳定的激励机制。     

Impacts of the Affordable Care Act's Medicaid Expansion on Women of Reproductive Age: Differences by Parental Status and State Policies

Introduction

We use data from the Behavioral Risk Factor Surveillance System (BRFSS) from 2012 to 2015 to estimate the effects of the Affordable Care Act's (ACA) Medicaid expansions on insurance coverage and access to care for low-income women of reproductive age (19–44).