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1.
Dana Beth Weinberg Ph.D. Ariel Chanan Avgar Ph.D. Noreen M. Sugrue Dianne Cooney‐Miner Ph.D. RN 《Health services research》2013,48(1):319-332
Objective
To examine the benefits of a high-performance work environment (HPWE) for employees, patients, and hospitals.Study Setting
Forty-five adult, medical-surgical units in nine hospitals in upstate New York.Study Design
Cross-sectional study.Data Collection
Surveys were collected from 1,527 unit-based hospital providers (68.5 percent response rate). Hospitals provided unit turnover and patient data (16,459 discharge records and 2,920 patient surveys).Principal Findings
HPWE, as perceived by multiple occupational groups on a unit, is significantly associated with desirable work processes, retention indicators, and care quality.Conclusion
Our findings underscore the potential benefits for providers, patients, and health care organizations of designing work environments that value and support a broad range of employees as having essential contributions to make to the care process and their organizations. 相似文献2.
3.
Context
The Centers for Medicare and Medicaid Services will introduce the reporting of patient surveys in 2008. The Consumer Assessment of Health Care Providers and Systems (CAHPS®) Hospital Survey contains 18 questions about hospital care. Internal consistency reliability of the discharge information scale is relatively low and some important domains of care are not represented.Objective
To determine whether adding questions increases the reliability and validity of the survey.Data Sources and Study Setting
Surveys of patients at 181 hospitals participating in the California Hospitals Assessment and Reporting Taskforce (CHART), an initiative for voluntary public reporting of hospital performance in California.Study Design
CHART added nine questions to the CAHPS Hospital Survey; two to improve reliability of the discharge information domain, five to create a coordination of care domain, and two relating to interpreter services.Data Collection
Surveys were sent to randomly selected patients from each CHART hospital.Principal Findings
A total of 40,172 surveys were included. Adding the new discharge information questions improved the internal consistency reliability from 0.45 to 0.72 and the hospital-level reliability from 0.75 to 0.81. New coordination of care composites had good internal consistency reliabilities ranging from 0.58 to 0.70 and hospital-level reliabilities ranging from 0.84 to 0.87. The new coordination of care composites were more closely correlated with overall hospital ratings and willingness to recommend than six of the seven original domains.Conclusions
The additional discharge information questions and the new coordination of care questions significantly improved the psychometric properties of the CAHPS Hospital Survey. 相似文献4.
Objective
To examine the relationship between hospital volume and in-hospital adverse events.Data Sources
Patient safety indicator (PSI) was used to identify hospital-acquired adverse events in the Nationwide Inpatient Sample database in abdominal aortic aneurysm, coronary artery bypass graft, and Roux-en-Y gastric bypass from 2005 to 2008.Study Design
In this observational study, volume thresholds were defined by mean year-specific terciles. PSI risk-adjusted rates were analyzed by volume tercile for each procedure.Principal Findings
Overall, hospital volume was inversely related to preventable adverse events. High-volume hospitals had significantly lower risk-adjusted PSI rates compared to lower volume hospitals (p < .05).Conclusion
These data support the relationship between hospital volume and quality health care delivery in select surgical cases. This study highlights differences between hospital volume and risk-adjusted PSI rates for three common surgical procedures and highlights areas of focus for future studies to identify pathways to reduce hospital-acquired events. 相似文献5.
Context
In 2008, researchers at the Institute for Healthcare Improvement (IHI) described the Triple Aim as simultaneously “improving the individual experience of care; improving the health of populations; and reducing the per capita costs of care for populations.” IHI and its close colleagues had determined that both individual and societal changes were needed.Methods
In 2007, IHI began recruiting organizations from around the world to participate in a collaborative to implement what became known as the Triple Aim. The 141 participating organizations included health care systems, hospitals, health care insurance companies, and others closely tied to health care. In addition, key groups outside the health care system were represented, such as public health agencies, social services groups, and community coalitions. This collaborative provided a structure for observational research. By noting the contrasts between the contexts and structures of those sites in the collaborative that progressed and those that did not, we were able to develop an ex post theory of what is needed for an organization or community to successfully pursue the Triple Aim.Findings
Drawing on our 7 years of experience, we describe the 3 major principles that guided the organizations and communities working on the Triple Aim: creating the right foundation for population management, managing services at scale for the population, and establishing a learning system to drive and sustain the work over time.Conclusions
The concept of the Triple Aim is now widely used, because of IHI''s work with many organizations and also because of the adoption of the Triple Aim as part of the national strategy for US health care, developed during the implementation of the Patient Protection and Affordable Care Act of 2010. Even those organizations working on the Triple Aim before IHI coined the term found our concept to be useful because it helped them think about all 3 dimensions at once and organize their work around them. 相似文献6.
Objective
Hospital care for blacks is concentrated among a small number of hospitals and whether they have worse outcomes across common medical conditions is unknown.Data Source
We used the 2007 100% Medicare file to calculate 30- and 90-day mortality rates for white and black patients admitted for acute myocardial infarction (AMI), congestive heart failure (CHF), or pneumonia.Study Design
We ranked all hospitals in the country by their proportion of discharged black patients and identified the top 10 percent of these hospitals as black serving. We examined race-specific adjusted mortality rates and adjusted for differences in hospital characteristics.Principal Findings
At 30 days, black-serving hospitals had, compared with nonblack-serving hospitals, similar mortality for AMI, lower mortality for CHF, and higher mortality for pneumonia. At 90 days, mortality was higher at black-serving hospitals for both AMI and pneumonia and comparable for CHF compared with nonblack-serving hospitals. White patients had worse outcomes at black-serving hospitals for two conditions at 30 days and all three conditions at 90 days. Blacks also had worse outcomes at black-serving hospitals.Conclusions
Hospitals with a high proportion of black patients had worse outcomes than other hospitals for both their white and black elderly patients. 相似文献7.
8.
Objective
To determine whether safety net and non-safety net hospitals influence inpatient breast cancer care in insured and uninsured women and in white and African American women.Data Sources
Six years of Virginia Cancer Registry and Virginia Health Information discharge data were linked and supplemented with American Hospital Association data.Study Design
Hierarchical generalized linear models and linear probability regression models were used to estimate the relationship between hospital safety net status, the explanatory variables, and the days from diagnosis to mastectomy and the likelihood of breast reconstruction.Principal Findings
The time between diagnosis and surgery was longer in safety net hospitals for all patients, regardless of insurance source. Medicaid insured and uninsured women were approximately 20 percent less likely to receive reconstruction than privately insured women. African American women were less likely to receive reconstruction than white women.Conclusions
Following the implementation of health reform, disparities may potentially worsen if safety net hospitals’ burden of care increases without commensurate increases in reimbursement and staffing levels. This study also suggests that Medicaid expansions may not improve outcomes in inpatient breast cancer care within the safety net system. 相似文献9.
Megan L. Clayton Katherine Clegg Smith Roni A. Neff Keshia M. Pollack Margaret Ensminger 《International journal of occupational and environmental health》2015,21(4):314-327
Background
Foodborne disease is a significant problem worldwide. Research exploring sources of outbreaks indicates a pronounced role for food workers'' improper health and hygiene practice.Objective
To investigate food workers'' perceptions of factors that impact proper food safety practice.Method
Interviews with food service workers in Baltimore, MD, USA discussing food safety practices and factors that impact implementation in the workplace. A social ecological model organizes multiple levels of influence on health and hygiene behavior.Results
Issues raised by interviewees include factors across the five levels of the social ecological model, and confirm findings from previous work. Interviews also reveal many factors not highlighted in prior work, including issues with food service policies and procedures, working conditions (e.g., pay and benefits), community resources, and state and federal policies.Conclusion
Food safety interventions should adopt an ecological orientation that accounts for factors at multiple levels, including workers'' social and structural context, that impact food safety practice. 相似文献10.
Peer Reviewed: A Methodology for Evaluating Organizational Change in Community-Based Chronic Disease Interventions
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Background
In 2003, the Monterey County Health Department, serving Salinas, California, was awarded one of 12 grants from the Steps to a HealthierUS Program to implement a 5-year, multiple-intervention community approach to reduce diabetes, asthma, and obesity. National adult and youth surveys to assess long-term outcomes are required by all Steps sites; however, site-specific surveys to assess intermediate outcomes are not required.Context
Salinas is a medically underserved community of primarily Mexican American residents with high obesity rates and other poor health outcomes. The health department''s Steps program has partnered with traditional organizations such as schools, senior centers, clinics, and faith-based organizations as well as novel organizations such as employers of agricultural workers and owners of taquerias.Methods
The health department and the Stanford Prevention Research Center developed new site-specific, community-focused partner surveys to assess intermediate outcomes to augment the nationally mandated surveys. These site-specific surveys will evaluate changes in organizational practices, policies, or both following the socioecological model, specifically the Spectrum of Prevention.Consequences
Our site-specific partner surveys helped to 1) identify promising new partners, select initial partners from neighborhoods with the greatest financial need, and identify potentially successful community approaches; and 2) provide data for evaluating intermediate outcomes matched to national long-term outcomes so that policy and organizational level changes could be assessed. These quantitative surveys also provide important context-specific qualitative data, identifying opportunities for strengthening community partnerships.Interpretation
Developing site-specific partner surveys in multisite intervention studies can provide important data to guide local program efforts and assess progress toward intermediate outcomes matched to long-term outcomes from nationally mandated surveys. 相似文献11.
Matthew B. Frank J.D./Ph.D. candidate John Hsu M.D. M.B.A. Mary Beth Landrum Ph.D. Michael E. Chernew Ph.D. 《Health services research》2015,50(5):1628-1648
Objective
To evaluate the effect of a tiered network on hospital choice for scheduled admissions.Data
The 2009–2012 patient-level claims data from Blue Cross Blue Shield of Massachusetts (BCBSMA).Study Design
BCBSMA''s three-tiered hospital network employs large differential cost sharing to encourage patients to seek care at hospitals on the preferred tier. During the study period, 44 percent of hospitals were moved to a different tier based on changes in cost or quality performance. We relied on this longitudinal variation for identification and specified conditional logit models to estimate the effect of the tiered network (TN) on patients'' hospital choices relative to a non-TN comparison group.Principal Findings
The TN was associated with increased use of hospitals on the preferred and middle tiers relative to the nonpreferred tier for planned admissions. The results suggest that if all members were in a TN plan, relative to all members being in a non-TN plan, scheduled admissions to hospitals on the nonpreferred tier would drop by 7.6 percentage points, while those to middle and preferred tier hospitals would rise by 0.9 and 6.6 percentage points, respectively.Conclusion
Differential cost sharing can steer patients toward preferred hospitals for planned admissions. 相似文献12.
Brook I. Martin Ph.D. M.P.H. Sohail K. Mirza M.D. M.P.H. Gary M. Franklin M.D. M.P.H. Jon D. Lurie M.D. M.S. Todd A. MacKenzie Ph.D. Richard A. Deyo M.D. M.P.H. 《Health services research》2013,48(1):1-25
Objective
To identify factors that account for variation in complication rates across hospitals and surgeons performing lumbar spinal fusion surgery.Data Sources
Discharge registry including all nonfederal hospitals in Washington State from 2004 to 2007.Study Design
We identified adults (n = 6,091) undergoing an initial inpatient lumbar fusion for degenerative conditions. We identified whether each patient had a subsequent complication within 90 days. Logistic regression models with hospital and surgeon random effects were used to examine complications, controlling for patient characteristics and comorbidity.Principal Findings
Complications within 90 days of a fusion occurred in 4.8 percent of patients, and 2.2 percent had a reoperation. Hospital effects accounted for 8.8 percent of the total variability, and surgeon effects account for 14.4 percent. Surgeon factors account for 54.5 percent of the variation in hospital reoperation rates, and 47.2 percent of the variation in hospital complication rates. The discretionary use of operative features, such as the inclusion of bone morphogenetic proteins, accounted for 30 and 50 percent of the variation in surgeons'' reoperation and complication rates, respectively.Conclusions
To improve the safety of lumbar spinal fusion surgery, quality improvement efforts that focus on surgeons'' discretionary use of operative techniques may be more effective than those that target hospitals. 相似文献13.
Context
While hospitals remain important centers of gravity in the health system, services are increasingly being delivered through ambulatory care. This shift to ambulatory care is giving rise to new delivery structures, such as retail clinics and urgent care centers, as well as reinventing existing ambulatory care capacity, as seen with the patient-centered medical home model and the movement toward team-based care. To protect the public''s interests, oversight of ambulatory care services must keep pace with these rapid changes. With this purpose, in January 2013 the New York Public Health and Health Planning Council undertook a redesign of the regulatory framework for the state''s ambulatory care services. This article describes the principles undergirding the framework as well as the regulatory recommendations themselves.Methods
We explored and analyzed the regulation of ambulatory care services in New York in accordance with the available gray and peer-reviewed literature and legislative documents. The deliberations of the Public Health and Health Planning Council informed our review.Findings
The vision of high-performing ambulatory care should be rooted in the Triple Aim (better health, higher-quality care, lower costs), with a particular emphasis on continuity of care for patients. There is a pressing need to better define the taxonomy of ambulatory care services. From the state government''s perspective, this clarification requires better reporting from new health care entities (eg, retail clinics), connections with regional and state health information technology hubs, and coordination among state agencies. A uniform nomenclature also would improve consumers’ understanding of rights and responsibilities. Finally, the regulatory mechanisms employed—from mandatory reporting to licensure to regional planning to the certificate of need—should remain flexible and match the degree of consensus regarding the appropriate regulatory path.Conclusions
Few other states have embarked on a wide-ranging assessment of their regulation of ambulatory care services. By moving toward adopting the regulatory approach described here, New York aims to balance sound oversight with pluralism and innovation in health care delivery. 相似文献14.
Peer Reviewed: The Role of State Health Departments in Supporting Community-based Obesity Prevention
Background
Recent national attention to obesity prevention has highlighted the importance of community-based initiatives. State health departments are in a unique position to offer resources and support for local obesity prevention efforts.Community Context
In North Carolina, one-third of children are overweight or obese. North Carolina''s Division of Public Health supports community-based obesity prevention by awarding annual grants to local health departments, providing ongoing training and technical assistance, and engaging state-level partners and resources to support local efforts.Methods
The North Carolina Division of Public Health administered grants to 5 counties to implement the Childhood Obesity Prevention Demonstration Project; counties simultaneously carried out interventions in the community, health care organizations, worksites, schools, child care centers, and faith communities.Outcome
The North Carolina Division of Public Health worked with 5 local health departments to implement community-wide policy and environmental changes that support healthful eating and physical activity. The state health department supported this effort by working with state partners to provide technical assistance, additional funding, and evaluation.Interpretation
State health departments are well positioned to coordinate technical assistance and leverage additional support to increase the strength of community-based obesity prevention efforts. 相似文献15.
Linda H. Aiken Jingjing Shang Ying Xue Douglas M. Sloane 《Health services research》2013,48(3):931-948
Objective
To determine the association between the use of agency-employed supplemental registered nurses (SRNs) to staff hospitals and patient mortality and failure to rescue (FTR).Data Sources
Primary survey data from 40,356 registered nurses in 665 hospitals in four states in 2006 were linked with American Hospital Association and inpatient mortality data from state agencies for approximately 1.3 million patients.Study Design
Logistic regression models were used to examine the association between SRN use and 30-day in-hospital mortality and FTR, controlling for patient and hospital characteristics, nurse staffing, the proportion of nurses with bachelor''s degrees, and quality of the work environment.Principal Findings
Before controlling for multiple nurse characteristics of hospitals, higher proportions of agency-employed SRNs in hospitals appeared to be associated with higher mortality (OR = 1.06) and FTR (OR = 1.05). Hospitals with higher proportions of SRNs have poorer work environments, however, and the significant relationships between SRNs and mortality outcomes were rendered insignificant when work environments were taken into account.Conclusions
Higher use of SRNs does not appear to have deleterious consequences for patient mortality and may alleviate nurse staffing problems that could produce higher mortality. 相似文献16.
Juliana Coelho Pina Suzana Alves de Moraes Maria Candida de Carvalho Furtado Débora Falleiros de Mello 《Revista latino-americana de enfermagem》2015,23(3):512-519
OBJECTIVE:
to analyze the presence and extent of the primary health care attributes among children hospitalized for pneumonia.METHOD:
observational and retrospective study with hospital-based case-control design, developed in three hospitals associated to the Brazilian Unified Health System, located in a city of the State of São Paulo, Brazil. The study included 690 children under five years old, with 345 cases and 345 controls.RESULTS:
both groups scored high for access to health services. In contrast, high scores for attributes such as longitudinality and coordination of care were observed for the controls. Despite low scores, integrality and family counseling were also high for the controls.CONCLUSION:
knowledge of the aspects involving the primary health care attributes and its provision for child care are very important because they have the potential to support professionals and managers of the Brazilian Unified Health System in the organization of health services. 相似文献17.
Thomas Isaac Alan M Zaslavsky Paul D Cleary Bruce E Landon 《Health services research》2010,45(4):1024-1040
Background
The extent to which patient experiences with hospital care are related to other measures of hospital quality and safety is unknown.Methods
We examined the relationship between Hospital Consumer Assessment of Healthcare Providers and Systems scores and technical measures of quality and safety using service-line specific data in 927 hospitals. We used data from the Hospital Quality Alliance to assess technical performance in medical and surgical processes of care and calculated Patient Safety Indicators to measure medical and surgical complication rates.Results
The overall rating of the hospital and willingness to recommend the hospital had strong relationships with technical performance in all medical conditions and surgical care (correlation coefficients ranging from 0.15 to 0.63; p<.05 for all). Better patient experiences for each measure domain were associated with lower decubitus ulcer rates (correlations −0.17 to −0.35; p<.05 for all), and for at least some domains with each of the other assessed complications, such as infections due to medical care.Conclusions
Patient experiences of care were related to measures of technical quality of care, supporting their validity as summary measures of hospital quality. Further study may elucidate implications of these relationships for improving hospital care. 相似文献18.
Background
Growing evidence of deficiencies in patient safety, health outcomes, cost, and overall quality of care in the United States has led to proposed initiatives and conceptual frameworks for improvement. A means for feasible, valid, and ongoing measurement of health care quality is necessary for planning and evaluating such initiatives.Community Context
We sought to assess and improve health care quality for the management of chronic diseases in Washington State. We used the Chronic Care Model to develop a survey for health care providers and systems that measured quality of care and monitored improvement for multiple chronic conditions.Methods
We surveyed a random sample of primary care providers and their clinic managers. We used 2 complementary tools: a provider questionnaire (administered by mail) and a clinic manager questionnaire (administered by telephone) to measure intermediate indicators of health care quality.Outcome
We achieved high response rates (78% for physicians, 82% for physician assistants, and 71% for clinic managers).Interpretation
Our survey administration methods, or modified versions of these methods, may be effective for obtaining high response rates as part of ongoing monitoring of health care quality. 相似文献19.
Objective
To assess the association between Medicaid-induced financial stress of a hospital and the probability of an adverse medical event for a pediatric discharge.Data Sources
Secondary data from the Nationwide Inpatient Sample, Agency for Healthcare Research and Quality''s Healthcare Cost and Utilization Project, and the American Hospital Association''s Annual Survey of Hospitals. Study examines 985,896 pediatric discharges (children age 0–17), from 1,050 community hospitals in 26 states (representing 63 percent of the U.S. Medicaid population) between 2005 and 2007.Study Design
We estimate the probability of an adverse event, controlling for patient, hospital, and state characteristics, using an aggregated, composite measure to overcome rarity of individual events.Principal Findings
Children in hospitals with relatively high proportions of pediatric discharges that are more reliant on Medicaid reimbursement are more likely than children in other hospitals (odds ratio = 1.62) to experience an adverse event. Medicaid pediatric inpatients are more likely than privately insured patients (odds ratio = 1.10) to experience an adverse event.Conclusions
Hospital reliance on comparatively low Medicaid reimbursement may contribute to the problem of adverse medical events for hospitalized children. Policies to reduce adverse events should account for differences in underlying, contributing factors of these events. 相似文献20.
Brad Wright Ph.D. Hye‐Young Jung Ph.D. Zhanlian Feng Ph.D. Vincent Mor Ph.D. 《Health services research》2014,49(4):1088-1107