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Scott NA, Kaiser JL, Jack BW, Nkabane–Nkholongo EL, Juntunen A, Nash T, Alade M, Vian T. Observational study of the clinical performance of a public-private partnership national referral hospital network in Lesotho: Do improvements last over time? PLoS One 2022; 17:e0272568. [PMID: 36170285 PMCID: PMC9518856 DOI: 10.1371/journal.pone.0272568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 07/21/2022] [Indexed: 11/18/2022] Open
Abstract
Public-private partnerships (PPP) may increase healthcare quality but lack longitudinal evidence for success. The Queen ‘Mamohato Memorial Hospital (QMMH) in Lesotho is one of Africa’s first healthcare PPPs. We compare data from 2012 and 2018 on capacity, utilization, quality, and outcomes to understand if early documented successes have been sustained using the same measures over time. In this observational study using administrative and clinical data, we assessed beds, admissions, average length of stay (ALOS), outpatient visits, and patient outcomes. We measured triage time and crash cart stock through direct observation in 2013 and 2020. Operational hospital beds increased from 390 to 410. Admissions decreased (-5.3%) while outpatient visits increased (3.8%). ALOS increased from 5.1 to 6.5 days. Occupancy increased from 82% to 99%; half of the wards had occupancy rates ≥90%, and Neonatal ward occupancy was 209%. The proportion of crash cart stock present (82.9% to 73.8%) and timely triage (84.0% to 27.6%) decreased. While overall mortality decreased (8.0% to 6.5%) and neonatal mortality overall decreased (18.0% to 16.3%), mortality among very low birth weight neonates increased (30.2% to 36.8%). Declines in overall hospital mortality are promising. Yet, continued high occupancy could compromise infection control and impede response to infections, such as COVID-19. High occupancy in the Neonatal ward suggests that the population need for neonatal care outpaces QMMH capacity; improvements should be addressed at the hospital and systemic levels. The increase in ALOS is acceptable for a hospital meant to take the most critical cases. The decline in crash cart stock completeness and timely triage may affect access to emergency treatment. While the partnership itself ended earlier than anticipated, our evaluation suggests that generally the hospital under the PPP was operational, providing high-level, critically needed services, and continued to improve patient outcomes. Quality at QMMH remained substantially higher than at the former Queen Elizabeth II hospital.
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Affiliation(s)
- Nancy A. Scott
- Department of Global Health, Boston University School of Public Health, Boston, MA, United States of America
- * E-mail:
| | - Jeanette L. Kaiser
- Department of Global Health, Boston University School of Public Health, Boston, MA, United States of America
| | - Brian W. Jack
- Department of Family Medicine, Boston Medical Center, Boston, MA, United States of America
| | - Elizabeth L. Nkabane–Nkholongo
- Lesotho Boston Health Alliance, Maseru, Lesotho
- School of Public Health, Sefako Makgatho University of Health Sciences, Pretoria, South Africa
| | - Allison Juntunen
- Department of Global Health, Boston University School of Public Health, Boston, MA, United States of America
| | - Tshema Nash
- Department of Global Health, Boston University School of Public Health, Boston, MA, United States of America
| | - Mayowa Alade
- Department of Global Health, Boston University School of Public Health, Boston, MA, United States of America
| | - Taryn Vian
- School of Nursing and Health Professions, University of San Francisco, San Francisco, CA, United States of America
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Duff E, Golonka R, O' Rourke T, Alraja AA. The Nurse Practitioner Workforce in Western Canada: A Cross-Sectional Practice Analysis Comparison. Policy Polit Nurs Pract 2021; 23:32-40. [PMID: 34939870 PMCID: PMC8801661 DOI: 10.1177/15271544211065432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Regular examination of health workforce data is essential given the pace of health system and legislative changes. Health workforce studies pertaining to nurse practitioner (NP) practice are needed to examine the gaps between work activities, policy, human resource supply, or for population needs. Jurisdictional comparison studies can provide essential information about NP practice for governments to respond to health workforce deficiencies or engage in service planning. In Canada, there is limited provincial-territorial jurisdictional NP workforce data to support health planning or policy change. This descriptive cross-sectional study was to examine the similarities and differences in practice patterns of Canadian NPs. In 2016 and 2017, an electronic survey was sent to all 852 registered NPs in three Canadian provinces, yielding a large convenience sample of 375 NP respondents. The results of this study underscore the value of NPs’ extensive registered nurse expertize as well as their ability to serve diverse patient populations, work in varied healthcare settings, and provide care to medically complex patients. The study findings also show that NPs in all three jurisdictions work to their full scope of practice, in both rural and urban settings. This study is the first to compare NP workforce data across multiple Canadian jurisdictions simultaneously. Studies of this type are valuable tools for understanding the demographics, education, integration, and employment activities of NPs and can aid governments in addressing workforce planning.
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Affiliation(s)
- E Duff
- Health Science, 8664University of Manitoba, Winnipeg, Manitoba, Canada
| | - Richard Golonka
- School of Public Health, 3158University of Alberta, Edmonton, Alberta, Canada
| | | | - Abeer A Alraja
- Health Science, 8664University of Manitoba, Winnipeg, Manitoba, Canada
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Huang J, Yapp M, Hennessy MP, Ly A, Masselos K, Agar A, Kalloniatis M, Zangerl B. Impact of referral refinement on management of glaucoma suspects in Australia. Clin Exp Optom 2019; 103:675-683. [PMID: 31852027 DOI: 10.1111/cxo.13030] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 08/09/2019] [Accepted: 11/10/2019] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND In ageing populations, the prevalence of chronic diseases such as glaucoma is projected to increase, placing additional demands on limited health-care resources. In the UK, the demand for secondary care in hospital eye clinics was inflated by high rates of false positive glaucoma referrals. Collaborative care models incorporating referral refinement, whereby glaucoma suspect referrals are triaged by suitably trained optometrists through further testing, can potentially reduce false positive referrals. This study examined the impact of a referral refinement model on the accuracy of glaucoma referrals in Australia. METHODS Optometrist-initiated glaucoma suspect referrals to the Glaucoma Management Clinic (Sydney, Australia) were prospectively recruited. Glaucoma suspect referrals arising from two pathways were eligible for inclusion, either directly from a community optometrist (standard care) or following comprehensive assessment at the Centre for Eye Health (referral refinement). Main outcome measures were the positive predictive value and false positive rate of referrals. The impact of referral letter content on management outcomes was also investigated. RESULTS Of 464 referrals received between March 2015 and June 2018, 252 were for treatment of naïve glaucoma suspects and eligible for inclusion. Following ophthalmological assessment, 45.6 per cent (n = 115/252) were prescribed treatment for open angle glaucoma or ocular hypertension. Positive predictive value of community optometry referrals was 33.8 per cent (n = 25/74) and 50.6 per cent (n = 90/178) following referral refinement. The first visit discharge (false positive) rate was 26 per cent (n = 19/74) for community referrals compared to four per cent (n = 8/178) with referral refinement. Positive predictive value increased with the number of abnormal clinical examination findings associated with referral (χ2 test, p < 0.0001). The number of abnormal findings reported in referrals was significantly higher with referral refinement compared to without (n = 1.9 versus 1.5, t-test, p < 0.0001). CONCLUSION Referral refinement can improve the diagnostic accuracy of optometry-initiated referrals for glaucoma suspects in Australia, thereby decreasing unnecessary referrals to hospital and other secondary clinics.
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Affiliation(s)
- Jessie Huang
- Centre for Eye Health, The University of New South Wales, Sydney, Australia.,School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
| | - Michael Yapp
- Centre for Eye Health, The University of New South Wales, Sydney, Australia.,School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
| | - Michael P Hennessy
- Centre for Eye Health, The University of New South Wales, Sydney, Australia.,Department of Ophthalmology, Prince of Wales Hospital, Sydney, Australia
| | - Angelica Ly
- Centre for Eye Health, The University of New South Wales, Sydney, Australia.,School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
| | - Katherine Masselos
- Centre for Eye Health, The University of New South Wales, Sydney, Australia.,Department of Ophthalmology, Prince of Wales Hospital, Sydney, Australia
| | - Ashish Agar
- Department of Ophthalmology, Prince of Wales Hospital, Sydney, Australia
| | - Michael Kalloniatis
- Centre for Eye Health, The University of New South Wales, Sydney, Australia.,School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
| | - Barbara Zangerl
- Centre for Eye Health, The University of New South Wales, Sydney, Australia.,School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
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Godin J, Theou O, Black K, McNeil SA, Andrew MK. Long-Term Care Admissions Following Hospitalization: The Role of Social Vulnerability. Healthcare (Basel) 2019; 7:healthcare7030091. [PMID: 31311101 PMCID: PMC6787656 DOI: 10.3390/healthcare7030091] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 07/09/2019] [Accepted: 07/11/2019] [Indexed: 11/16/2022] Open
Abstract
We sought to understand the association between social vulnerability and the odds of long-term care (LTC) placement within 30 days of discharge following admission to an acute care facility and whether this association varied based on age, sex, or pre-admission frailty. Patients admitted to hospital with acute respiratory illness were enrolled in the Canadian Immunization Research Network's Serious Outcomes Surveillance Network during the 2011/2012 influenza season. Participants (N = 475) were 65 years or older (mean = 78.6, SD = 7.9) and over half were women (58.9%). Incident LTC placement was rare (N = 15); therefore, we used penalized likelihood logistic regression analysis. Social vulnerability and frailty indices were built using a deficit accumulation approach. Social vulnerability interacted with frailty and age, but not sex. At age 70, higher social vulnerability was associated with lower odds of LTC placement at high levels of frailty (frailty index (FI) = 0.35; odds ratio (OR) = 0.32, 95% confidence interval (CI) = 0.09-0.94), but not at lower levels of frailty. At age 90, higher social vulnerability was associated with greater odds of LTC placement at lower levels of frailty (FI = 0.05; OR = 14.64, 95%CI = 1.55, 127.21 and FI = 0.15; OR = 7.26, 95%CI = 1.06, 41.84), but not at higher levels of frailty. Various sensitivity analyses yielded similar results. Although younger, frailer participants may need LTC, they may not have anyone advocating for them. In older, healthier patients, social vulnerability was associated with increased odds of LTC placement, but there was no difference among those who were frailer, suggesting that at a certain age and frailty level, LTC placement is difficult to avoid even within supportive social situations.
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Affiliation(s)
- Judith Godin
- Division of Geriatric Medicine, Nova Scotia Health Authority, Dalhousie University, 5955 Veterans' Memorial Lane, Halifax, NS B3H 2E1, Canada
| | - Olga Theou
- Division of Geriatric Medicine, Nova Scotia Health Authority, Dalhousie University, 5955 Veterans' Memorial Lane, Halifax, NS B3H 2E1, Canada
| | - Karen Black
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Shelly A McNeil
- Division of Infectious Diseases, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Melissa K Andrew
- Division of Geriatric Medicine, Nova Scotia Health Authority, Dalhousie University, 5955 Veterans' Memorial Lane, Halifax, NS B3H 2E1, Canada.
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