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Kurtzman ET, Barnow BS. The impact of recreational cannabis laws on cannabis use disorder during "treat and release" visits to hospital emergency departments in four U.S. states, 2017-2020. Prev Med Rep 2023; 36:102492. [PMID: 38021411 PMCID: PMC10652101 DOI: 10.1016/j.pmedr.2023.102492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 10/31/2023] [Accepted: 11/01/2023] [Indexed: 12/01/2023] Open
Abstract
States' legalization of cannabis influences cannabis use and may increase cannabis use disorder (CUD)-a problematic pattern of use leading to significant impairment. Few studies have examined the influence of recreational cannabis legalization on CUD in the emergency department (ED). We used four years of data from the State Emergency Department Databases (SEDD) (2017-2020) from three states (CO, MD, OR) and three years of SEDD from Rhode Island (2017-2019) to examine the relationship between the recreational legalization of cannabis and CUD among "treat and release" ED visits. During the study period, CO and OR were legal for recreational cannabis while it was illegal in MD and RI. We examined the proportion of ED visits for CUD and used multivariate logistic regression to examine the association between recreational legalization and CUD diagnosis. The sample had 17,434,655 ED visits (56.2 % female). The proportion of ED visits for CUD was 0.63 %. Annual rates ranged from 0.67 % (2017) to 0.59 % (2019) and state-level rates were 0.39 % (CO), 0.35 % (OR), 1.03 % (MD), and 0.79 % (RI). Compared to ED visits in legal states, a higher proportion of ED visits in non-legal states were from women (56.8 % versus 55.7 %) and Blacks (40.9 % versus 5.9 %). Compared to states where recreational cannabis was illegal, legalizing cannabis for recreational use was associated with nearly a 50 % decrease in the adjusted odds of CUD (AOR = 0.49, 95 % CI 0.47, 0.52). In summary, CUD rates among "treat and release" ED visits were significantly lower in legalized states than in non-legal states.
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Affiliation(s)
- Ellen T. Kurtzman
- Edward J. Bloustein School of Planning and Public Policy, Rutgers University, The State University of New Jersey, 33 Livingston Street, #249, New Brunswick, NJ 08901, United States
| | - Burt S. Barnow
- Trachtenberg School of Public Policy and Public Administration, The George Washington University, 805 21 Street, NW, 6th Floor, Washington, DC 20052, United States
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Kurtzman ET, Wyche KF. PhD program faculty: Preparing the next generation of nurse researchers. J Prof Nurs 2023; 49:90-94. [PMID: 38042567 DOI: 10.1016/j.profnurs.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 09/16/2023] [Accepted: 09/18/2023] [Indexed: 12/04/2023]
Abstract
This article explores approaches to strengthening research education in nursing doctoral (PhD) programs with a focus on the roles of interdisciplinary faculty and the National Institute of Nursing Research (NINR), 2022-2026 Strategic Plan. Our view is that these components are interrelated and essential in educating the next generation of nurse researchers. To explore these topics, we undertook two analyses: (1) an examination of the preparation of PhD directors across the 119 AACN member schools; and (2) an evaluation of NIH funding levels to schools of nursing and the principal investigators' backgrounds among NINR grantees. We found significant homogeneity in the backgrounds of PhD directors in schools of nursing and considerable NINR funding to non-nurse researchers on topics within the nursing discipline. To strengthen the research infrastructure of PhD programs and achieve the American Association of Colleges of Nursing's (AACN) vision for doctoral education, we suggest incorporating interdisciplinary faculty and greater utilization of the NINR Strategic Plan.
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Affiliation(s)
- Ellen T Kurtzman
- Edward J. Bloustein School of Planning and Public Policy, Rutgers University, 33 Livingston Avenue, New Brunswick, NJ 08901, United States of America.
| | - Karen Fraser Wyche
- School of Nursing, The George Washington University, 1919 Pennsylvania Avenue, NW, Suite 500, Washington, DC 20006, United States of America.
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Kurtzman ET, Barnow BS, Deoli A. A comparison of the practice patterns of emergency department teams that include physicians, nurse practitioners, or physician assistants. Nurs Outlook 2023; 71:102062. [PMID: 37866300 DOI: 10.1016/j.outlook.2023.102062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 09/21/2023] [Accepted: 09/24/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Physicians see most emergency department (ED) patients, but, recently, nurse practitioners (NPs) and physician assistants (PAs) have provided an increasing amount of ED care. PURPOSE Compare NP and PA teams' practice patterns to physician teams in EDs. METHODS Using 12 years of data from the National Hospital Ambulatory Medical Care Survey (2009-2020), we used multivariate regression analysis to separately examine the associations between the ED practice patterns (i.e., number of diagnostic services, number of procedures, waiting time, boarding time, length of visit, and hospital admission) of patients seen by NP or PA teams compared with physician teams. DISCUSSION Patient visits to NP and PA teams received fewer diagnostic services and procedures, had shorter visits, and were less likely to be hospitalized. CONCLUSION If the additional diagnostic services, procedures, and hospital admission provided by physician teams were unnecessary for the patients studied, NP and PA team care could be more efficient.
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Affiliation(s)
- Ellen T Kurtzman
- Edward J. Bloustein School of Planning and Public Policy, Rutgers University, New Brunswick, NJ.
| | - Burt S Barnow
- Trachtenberg School of Public Policy and Public Administration, The George Washington University, Washington, DC
| | - Aakanksha Deoli
- Edward J. Bloustein School of Planning and Public Policy, Rutgers University, New Brunswick, NJ
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Kurtzman ET, Greene J. How Are Patients Who Legally Use Medical Marijuana Treated When Hospitalized? Policy Polit Nurs Pract 2023; 24:225-230. [PMID: 37125427 DOI: 10.1177/15271544231168607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
The majority of U.S. states have legalized marijuana for medical use and some states have legalized marijuana for recreational use; yet, marijuana remains illegal federally. Given the misalignment between state and federal policies, this paper seeks to explore how hospitals handle inpatients' medical marijuana use in states where medical marijuana is legal. To examine this phenomenon, we conducted an anonymous, online, cross-sectional survey of nurse leaders working in acute care inpatient settings in states that had legalized medical marijuana. Using descriptive statistics, we report on these nurse leaders' experiences. There were 811 survey responses-291 who worked in an acute care inpatient setting in a state that had legalized medical marijuana. Among those respondents, only a small percentage reported that inpatients had some access to their medical marijuana: 5.8% reported that the drug was kept in the pharmacy and dispensed like other prescriptions; another 3.4% indicated that patients kept the medical marijuana in their rooms and took it, as needed. Most respondents (55.6%) reported that patients were switched to an alternative medication during their inpatient hospital stays. Almost half (49.4%) of the nurse leaders who reported that alternative medications were used, reported that opioids were substituted, and the majority reported that the marijuana was safer than the opioids. These findings are concerning given the increase in opioid overdose deaths.
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Affiliation(s)
- Ellen T Kurtzman
- Health Administration, Edward J. Bloustein School of Planning and Public Policy, Rutgers University, New Brunswick, NJ, USA
| | - Jessica Greene
- Marxe School of Public and International Affairs, Baruch College, City University of New York, New York, NY, USA
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Kurtzman ET, Barnow BS, Korer B. Differences in the Patterns of Care Between Emergency Department Visits with and Without a Physician. J Emerg Med 2023; 65:e337-e354. [PMID: 37709576 DOI: 10.1016/j.jemermed.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 05/20/2023] [Accepted: 05/26/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND A variety of clinicians practice in emergency departments (EDs). Although most ED patients prefer seeing physicians, a subset sees no physician. OBJECTIVES We sought to determine the factors that predict when an ED patient is seen by at least one physician and compared the practice patterns of patient visits seen by at least one physician compared with those seen by no physician. METHODS We used 11 years of cross-sectional data from the National Hospital Ambulatory Medical Care Survey and focused on the sample of ED patient visits seen by at least one physician and those seen by no physician. We used bivariate statistics to compare characteristics between samples and used multivariate logistic regression analysis to identify the factors that predicted being seen by a physician. Finally, we compared the practice patterns of patient visits seen by at least one physician compared with those seen by no physician. RESULTS Approximately 10% of the sample was not seen by any physician. Patients seen by at least one physician had, on average, 0.8 more diagnostic services ordered/provided and 0.1 more procedures provided compared with patients who were not seen by any physician. Patients seen by at least one physician had longer visits by 29.4 min, on average, and had increased odds of being hospitalized (adjusted odds ratio 3.9, 95% confidence interval 2.9-5.2). CONCLUSIONS A variety of patient and hospital characteristics influenced whether ED patients were seen by physicians. Diagnostic services, procedures, visit length, and hospital admission differed by physician presence. Findings have implications for ED practice and future research.
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Affiliation(s)
- Ellen T Kurtzman
- Health Administration, Edward J. Bloustein School of Planning and Public Policy, Rutgers University, New Brunswick, New Jersey
| | - Burt S Barnow
- Department of Public Service and Economics, Trachtenberg School of Public Policy and Public Administration
| | - Burton Korer
- Graduate Research, The School of Nursing, George Washington University, Washington, DC
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Kurtzman ET, Greene J. Are Patients Who Trust Their Providers More Likely to Use Medical Cannabis? Am J Hosp Palliat Care 2023; 40:264-270. [PMID: 35512367 DOI: 10.1177/10499091221097090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Trust is an essential element of the patient-provider relationship and has been associated with better patient outcomes; however, it is not clear what role trust might play in influencing patients' willingness to try medical cannabis when it is recommended in states where it has been legalized for medical use. Objectives: To explore the relationship between peoples' trust in their health care clinicians and hospitals and their willingness to consider using medical cannabis if it is recommended by their clinician or hospital. Methods: We conducted an anonymous, cross-sectional, online survey of adults who participated in the Qualtrics Research Company Panel and used quotas to match our sample to the characteristics of the U.S. population. Results: We received 1120 completed surveys. The vast majority of respondents (84.4%) reported having a regular provider and 42.5% of those who reported having a regular physician and nearly 35.6% of those who reported having another regular provider (e.g., nurse practitioner, physician assistant) reported that they "completely" trusted that clinician. Those who reported "completely" trusting their usual clinician were more than twice as likely to report they would definitely use medical cannabis if recommended (42.5% vs 20.6%). Similarly, the greater respondents' trust in hospitals, the more likely they were to report a willingness to consider using recommended medical cannabis. Conclusion: Patient trust in their health providers is related to patients' willingness to use recommended medical cannabis.
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Affiliation(s)
- Ellen T Kurtzman
- School of Nursing, 8367The George Washington University, Washington, DC, USA
| | - Jessica Greene
- Marxe School of Public and International Affairs, Baruch College, 5920City University of New York, Newyork, NY, USA
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Kurtzman ET, Greene J, Begley R, Drenkard KN. "We want what's best for patients." nurse leaders' attitudes about medical cannabis: A qualitative study. Int J Nurs Stud Adv 2022; 4:100065. [PMID: 38745605 PMCID: PMC11080284 DOI: 10.1016/j.ijnsa.2022.100065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 01/07/2022] [Accepted: 01/29/2022] [Indexed: 10/19/2022] Open
Abstract
Background The majority of states have legalized medical cannabis. Nurse leaders must be prepared for an increase in patients' use of the drug across all care settings. Objectives To explore nurse leaders' attitudes towards, knowledge of, and experiences with medical cannabis. Design : Descriptive qualitative study design. Participants 28 nurse leaders-19 in four focus groups of 3-7 participants and another 9 in interviews. Methods Semi-structured, one-on-one interviews and focus groups of nurse leaders about their attitudes towards and experiences with patients' use of medical cannabis. Thematic analysis was used to identify themes and subthemes. Results Four major themes were identified: overwhelming support for legalized medical cannabis; importance of overcoming the stereotype of a gateway drug; problematic mismatch between federal and state cannabis policies; and nursing needs to be move involved. Conclusions There was strong support for legalized medical cannabis to meet patients' needs; yet, respondents reported little discussion about or education regarding medical cannabis among nurses. Inconsistent federal and state cannabis policies were viewed as especially problematic and in need of alignment.
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Affiliation(s)
- Ellen T. Kurtzman
- Associate Professor, School of Nursing, The George Washington University, 1919 Pennsylvania Ave., NW, Ste. 500, Washington, DC 20006, U.S
| | - Jessica Greene
- Professor and Luciano Chair of Health Care Policy, Marxe School of Public and International Affairs, Baruch College, City University of New York, 135 East 22nd Street, New York, NY
| | - Robyn Begley
- Chief Executive Officer, American Organization for Nursing Leadership, 155 N. Wacker Dr., Suite 400, Chicago, IL 60606
| | - Karen Neil Drenkard
- Associate Dean, Clinical Practice and Community Engagement, School of Nursing, The George Washington University, 1919 Pennsylvania Ave., NW, Ste. 500, Washington, DC 20006
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Kurtzman ET, Dowling NM, Beebe SL. Marijuana Use and Older Adults' Self-Reported Difficulty Concentrating, Remembering, or Making Decisions. J Stud Alcohol Drugs 2022; 83:893-900. [PMID: 36484587 DOI: 10.15288/jsad.21-00318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE This study investigated the relationship, in adults 50 years and older, between self-reported past-month marijuana use and difficulty concentrating, remembering, or making decisions (SDCRMD) because of a physical, mental, or emotional condition, using the Behavioral Risk Factor Surveillance System (BRFSS). METHOD We relied on a sample of 294,000 adults (53.4% female), 50 years and older, from 21 U.S. states and two territories over 4 years (2016-2019). We conducted descriptive analyses to examine the prevalence of past-month marijuana use and SDCRMD and used multivariate logistic regression to examine the association between marijuana use and SDCRMD, controlling for demographic and health-related variables. RESULTS The overall prevalence of SDCRMD was 11.0%, 95% confidence interval (CI) [10.6%, 11.5%], and the prevalence of self-reported past-month marijuana use was 7.1%, 95% CI [6.7%, 7.5%]. Of those reporting past-month marijuana use, 19.9%, 95% CI [17.8%, 22.1%] reported SDCRMD. Past-month marijuana users were 1.5, 95% CI [1.1, 2.1] times more likely to report SDCRMD than nonusers. Prevalence of past-month marijuana use was higher in states with legalization of both medical and recreational marijuana; however, prevalence of SDCRMD was not. CONCLUSIONS We found a strong, positive, and statistically significant relationship between past-month marijuana use and SDCRMD. This finding serves as an important first step in identifying the relationship between older adults' self-reported marijuana use and their difficulty concentrating, remembering, and decision-making because of a physical, mental, or emotional condition; however, additional research is needed.
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Affiliation(s)
- Ellen T Kurtzman
- Edward J. Bloustein School of Planning and Public Policy, Rutgers University, New Brunswick, New Jersey
| | - N Maritza Dowling
- Center for Aging, Health, & Humanities, School of Nursing, The George Washington University, Washington, DC.,Department of Acute & Chronic Care, School of Nursing, The George Washington University, Washington, DC.,Department of Epidemiology, Milken Institute School of Public Health, The George Washington University, Washington, DC.,Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Washington, DC
| | - Sarah L Beebe
- Graduate Medical Education, Bayhealth Medical Center, Dover, Delaware
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Kurtzman ET, Greene J, Begley R, Drenkard KN. Nurse Leaders’ Attitudes Toward and Experiences With Medical Marijuana. Journal of Nursing Regulation 2022. [DOI: 10.1016/s2155-8256(22)00063-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Kurtzman ET, Ghazal LV, Girouard S, Ma C, Martin B, McGee BT, Pogue CA, Riman KA, Root MC, Schlak AE, Smith JM, Stolldorf DP, Townley JN, Turi E, Germack HL. Nursing Workforce Challenges in the Postpandemic World. Journal of Nursing Regulation 2022; 13:49-60. [PMID: 35880143 PMCID: PMC9299514 DOI: 10.1016/s2155-8256(22)00061-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ellen T Kurtzman
- AcademyHealth Interdisciplinary Research Group on Nursing Issues (IRGNI) Advisory Committee
| | - Lauren V Ghazal
- AcademyHealth Interdisciplinary Research Group on Nursing Issues (IRGNI) Advisory Committee
| | - Shirley Girouard
- AcademyHealth Interdisciplinary Research Group on Nursing Issues (IRGNI) Advisory Committee
| | - Chenjuan Ma
- AcademyHealth Interdisciplinary Research Group on Nursing Issues (IRGNI) Advisory Committee
| | - Barbara Martin
- AcademyHealth Interdisciplinary Research Group on Nursing Issues (IRGNI) Advisory Committee
| | - Blake T McGee
- AcademyHealth Interdisciplinary Research Group on Nursing Issues (IRGNI) Advisory Committee
| | - Colleen A Pogue
- AcademyHealth Interdisciplinary Research Group on Nursing Issues (IRGNI) Advisory Committee
| | - Kathryn A Riman
- AcademyHealth Interdisciplinary Research Group on Nursing Issues (IRGNI) Advisory Committee
| | - Maggie C Root
- AcademyHealth Interdisciplinary Research Group on Nursing Issues (IRGNI) Advisory Committee
| | - Amelia E Schlak
- AcademyHealth Interdisciplinary Research Group on Nursing Issues (IRGNI) Advisory Committee
| | - Jamie M Smith
- AcademyHealth Interdisciplinary Research Group on Nursing Issues (IRGNI) Advisory Committee
| | - Deonni P Stolldorf
- AcademyHealth Interdisciplinary Research Group on Nursing Issues (IRGNI) Advisory Committee
| | | | - Eleanor Turi
- AcademyHealth Interdisciplinary Research Group on Nursing Issues (IRGNI) Advisory Committee
| | - Hay-Ley Germack
- AcademyHealth Interdisciplinary Research Group on Nursing Issues (IRGNI) Advisory Committee
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Young-Wolff KC, Sarovar V, Tucker LY, Ansley D, Goler N, Conway A, Ettenger A, Foti TR, Brown QL, Kurtzman ET, Adams SR, Alexeeff SE. Trends in Cannabis Polysubstance Use During Early Pregnancy Among Patients in a Large Health Care System in Northern California. JAMA Netw Open 2022; 5:e2215418. [PMID: 35666502 PMCID: PMC9171564 DOI: 10.1001/jamanetworkopen.2022.15418] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
IMPORTANCE Rates of prenatal cannabis use are increasing alongside perceptions that cannabis is a harmless therapeutic for pregnancy-related ailments, while rates of prenatal use of alcohol and tobacco are decreasing. It is important to examine whether cannabis use during pregnancy is increasing similarly among patients with and patients without co-occurring substance use. OBJECTIVES To examine trends in cannabis polysubstance use during pregnancy and to test differences in cannabis use over time among pregnant individuals who use only cannabis vs those who use cannabis and other substances. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional time-series study used data from 367 138 pregnancies among 281 590 unique pregnant patients universally screened for prenatal substance use as part of standard care in Kaiser Permanente Northern California from January 1, 2009, to December 31, 2018. Statistical analysis was performed from October 5, 2021, to April 18, 2022. EXPOSURES Time (calendar year). MAIN OUTCOMES AND MEASURES Use of substances during early pregnancy was assessed via universal screening with a self-administered questionnaire (for cannabis, alcohol, stimulants, and nicotine) and/or positive results of a urine toxicology test (for cannabis, alcohol, stimulants, and pharmaceutical opioids), and data were extracted from the electronic health record. RESULTS The study sample of 367 138 pregnancies from 281 590 unique pregnant patients (median gestation at time of screening, 8.6 weeks [IQR, 7.3-10.6 weeks]) was 25.9% Asian or Pacific Islander, 6.6% Black, 25.8% Hispanic, 38.0% non-Hispanic White, and 3.6% other race or ethnicity; 1.1% were aged 11 to 17 years, 14.9% were aged 18 to 24 years, 61.9% were aged 25 to 34 years, and 22.1% were aged 35 years or older; and the median neighborhood household income was $70 455 (IQR, $51 563-$92 625). From 2009 to 2018, adjusted rates of use of only cannabis during pregnancy (no other substances) increased substantially from 2.39% (95% CI, 2.20%-2.58%) in 2009 to 6.30% (95% CI, 6.00%-6.60%) in 2018, increasing at an annual relative rate of 1.11 (95% CI, 1.10-1.12). The rate of use of cannabis and 1 other substance also increased (annual relative rate, 1.04 [95% CI, 1.03-1.05]), but not as rapidly (P < .001 for difference), while the rate of use of cannabis and 2 or more other substances decreased slightly (annual relative rate, 0.97 [95% CI, 0.96-0.99]). Adjusted rates of prenatal use of cannabis and alcohol (1.04 [95% CI, 1.03-1.06]) and cannabis and stimulants (1.03 [95% CI, 1.01-1.06]) increased over time, while rates of prenatal use of cannabis and nicotine (0.97 [95% CI, 0.96-0.98]) decreased. CONCLUSIONS AND RELEVANCE In this cross-sectional time-series study, rates of prenatal cannabis use during early pregnancy increased significantly more rapidly among patients without co-occurring substance use, which could reflect increased acceptability of cannabis and decreased perceptions of cannabis-related harms. Furthermore, increased rates of use of cannabis with alcohol and stimulants warrant continued monitoring.
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Affiliation(s)
- Kelly C. Young-Wolff
- Division of Research, Kaiser Permanente Northern California, Oakland
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco
| | - Varada Sarovar
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Lue-Yen Tucker
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Deborah Ansley
- Regional Offices, Kaiser Permanente Northern California, Oakland
| | - Nancy Goler
- Regional Offices, Kaiser Permanente Northern California, Oakland
| | - Amy Conway
- Regional Offices, Kaiser Permanente Northern California, Oakland
| | - Allison Ettenger
- Regional Offices, Kaiser Permanente Northern California, Oakland
| | - Tara R. Foti
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Qiana L. Brown
- School of Social Work, Rutgers, The State University of New Jersey, New Brunswick
| | | | - Sara R. Adams
- Division of Research, Kaiser Permanente Northern California, Oakland
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Abstract
Background: Adverse childhood experiences (ACEs) are potentially traumatic events, which can have long-term, negative consequences. Few studies have examined ACEs' relationship to marijuana use. Objectives: We examined the association between ACEs and past-month marijuana use among adults and the pathways between childhood adversity and marijuana use. Methods: Adults from five states (n = 22,991) who responded to the 2019 Behavioral Risk Factors Surveillance System were included. We examined the prevalence of ACEs and marijuana use. We employed generalized structural equation modeling to assess the relationship between ACEs and marijuana use and the role of depression and poor mental and physical health as possible mediators. Results: Overall, 65.0% of the population reported 1+ ACE. Heavy marijuana use and past-month marijuana use prevalence rates were 10.3% and 5.0%, respectively. We found mediation effects for depression and poor mental health but not poor physical health. The number of ACEs was associated with a statistically significant increase in any past-month marijuana use-indirect effects ranged from 1.0 (95% CI, 1.0-1.0) to 1.4 (95% CI, 1.2-1.7), direct effects ranged from 1.1 (95% CI, 07-1.7) to 5.3 (95% CI 3.2-8.8), and total effects ranged from 1.1 (95% CI, 0.7-1.7) to 5.9 (95% CI, 3.6-9.8). Women, married persons, and middle aged and older adults had a lower odds of marijuana use. Reporting at least one HIV risk behavior was associated with an increased odds of marijuana use. Conclusion: ACE exposure was positively associated with marijuana use. Depression and poor mental health separately mediated this relationship.
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Affiliation(s)
- Ellen T Kurtzman
- School of Nursing, The George Washington University, Washington, DC, USA
| | - Jessica Greene
- Marxe School of Public and International Affairs, Baruch College, City University of New York, New York, New York, USA
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Kurtzman ET, Wyche KF. Prevalence and Correlates of HIV Testing among Sexual Minorities. Am J Health Behav 2021; 45:879-894. [PMID: 34702435 DOI: 10.5993/ajhb.45.5.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objectives: We established baseline prevalence rates of HIV testing among adult, sexual minorities and identified the correlates of never being HIV tested. Methods: We used a 20-state sample of the 2017-2019 Behavioral Risk Factor Surveillance System to identify sexual minorities who responded to the HIV testing question (N=433,042). Using weighted multivariate logistic regression analysis, we identified the characteristics associated with never being HIV tested and the impact of state health departments' HIV testing messages on testing status. Results: Overall, 41.6% of sexual minorities reported never being HIV tested with statistically significant state-level variation. Being younger (18-24 years) or older (65+ years), not black, married, and in good health significantly increased the odds of never being HIV tested as did lacking regular healthcare access and reporting no high-risk HIV behaviors. States' HIV testing messages had no statistically significant effect on HIV testing status. Conclusions: Although sexual minorities were less likely than straight respondents to report never being HIV tested, a sizable population remained untested. Specific characteristics associated with sexual minorities' HIV testing status can be used to tailor public health messages and optimize testing rates.
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Affiliation(s)
- Ellen T. Kurtzman
- Ellen T. Kurtzman, Associate Professor, School of Nursing, The George Washington University, Washington, DC, United States;,
| | - Karen Fraser Wyche
- Karen Fraser Wyche, Clinical Professor, School of Nursing, The George Washington University, Washington, DC, United States
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Abstract
BACKGROUND Marijuana is the most commonly used illicit drug in the United States; yet, little is known about why adults use it. We examined the prevalence of past-month marijuana use by users' reasons for use-medical, recreational, and both-and identified correlates of each group. METHODS Data from 20 states, which participated in the 2017-2019 Behavioral Risk Factor Surveillance System and fielded the marijuana use module, and multinomial logistic regression analysis were used to identify risk factors for past-month marijuana use by reason for use. User profiles were developed to illustrate how states' policy environments influenced reported reasons for use. RESULTS The average predicted probabilities of past-month marijuana use for medical, recreational, and both reasons were 28.6 %, 38.2 %, and 33.1 %, respectively. Age, gender, marital and employment status, income, mode and frequency of administration, and health status were associated with reasons for use. The reasons that young adult males who were infrequent marijuana users and binge drinkers gave for their marijuana use varied by state policy environment-in legal states, the average predicted probabilities were 5.3 % lower for recreational reasons and 5.0 % higher for both reasons. Reported reasons for past-month marijuana use did not significantly differ by state policy environment among daily users who were older women in poor mental and physical health. DISCUSSION Significant differences existed in the characteristics of past-month marijuana users by reasons for use. Our estimates can serve as a baseline against which post-legalization marijuana users' reasons for use can be compared as state policy environments shift.
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Affiliation(s)
- Ellen T Kurtzman
- The George Washington University, School of Nursing, 1919 Pennsylvania Ave., NW, Suite 500, Washington, DC, 20006, United States.
| | - Kelly C Young-Wolff
- Kaiser Permanente Northern California Division of Research, 2000 Broadway, Oakland, CA, 94612, United States.
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Kurtzman ET, Barnow BS, Johnson JE, Simmens SJ, Infeld DL, Mullan F. Does the Regulatory Environment Affect Nurse Practitioners' Patterns of Practice or Quality of Care in Health Centers? Health Serv Res 2017; 52 Suppl 1:437-458. [PMID: 28127773 DOI: 10.1111/1475-6773.12643] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To examine the impact of state-granted nurse practitioner (NP) independence on patient-level quality, service utilization, and referrals. DATA SOURCES/STUDY SETTING The National Ambulatory Medical Care Survey's community health center (HC) subsample (2006-2011). Primary analyses included approximately 6,500 patient visits to 350 NPs in 220 HCs. STUDY DESIGN Propensity score matching and multivariate regression analysis were used to estimate the impact of state-granted NP independence on each outcome, separately. Estimates were adjusted for sampling weights and NAMCS's complex design. DATA COLLECTION/EXTRACTION METHODS Every "NP-patient visit unit" was isolated using practitioner and patient visit codes and, using geographic identifiers, assigned to its state-year and that state-year's level of NP independence based on scope of practice policies. Nine outcomes were specified using ICD-9 codes, standardized drug classification codes, and NAMCS survey items. PRINCIPAL FINDINGS After matching, no statistically significant differences in quality were detected by states' independence status, although NP visits in states with prescriptive independence received more educational services (aIRR 1.66; 95 percent CI 1.09-2.53; p = .02) and medications (aIRR 1.26; 95 percent CI 1.04-1.53; p = .02), and NP visits in states with practice independence had a higher odds of receiving physician referrals (AOR 1.88; 95 percent CI 1.10-3.22; p = .02) than those in restricted states. CONCLUSIONS Findings do not support a quality-scope of practice relationship.
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Affiliation(s)
- Ellen T Kurtzman
- School of Nursing, The George Washington University, Washington, DC
| | - Burt S Barnow
- Trachtenberg School of Public Policy and Public Administration, The George Washington University, Washington, DC
| | - Jean E Johnson
- School of Nursing, The George Washington University, Washington, DC
| | - Samuel J Simmens
- Milken Institute School of Public Health, The George Washington University, Washington, DC
| | - Donna Lind Infeld
- Trachtenberg School of Public Policy and Public Administration, The George Washington University, Washington, DC
| | - Fitzhugh Mullan
- Milken Institute School of Public Health and School ofMedicine & Health Sciences, The George Washington University, Washington, DC
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Abstract
Concerns about nurse staffing in hospitals, nursing's influence on patient safety and health care outcomes, and nurses' work environment (e.g., equipment failures, documentation burden) have led to increased interest in measuring and reporting nursing's performance. This article reviews recent efforts and issues involved in identifying a set of nursing-sensitive performance measures. Sustaining and strengthening current efforts requires developing measures that address all the domains of nursing, addressing technical issues needed to analyze the impact of nursing on patient safety and health care outcomes, developing data systems that provide the information needed to implement the model system, regularly improving the set of endorsed standards to reflect the most current science and empirical evidence, and persuading all health care stakeholders that measurement and reporting nursing-sensitive standards make a difference in the care and quality that are delivered. Each of these tasks requires substantial development work and construction and maintenance of the infrastructure to sustain the performance measurement efforts.
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Kurtzman ET, Greene J. Effective presentation of health care performance information for consumer decision making: A systematic review. Patient Educ Couns 2016; 99:36-43. [PMID: 26277826 DOI: 10.1016/j.pec.2015.07.030] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 07/27/2015] [Accepted: 07/28/2015] [Indexed: 05/28/2023]
Abstract
OBJECTIVE This systematic review synthesizes what is known about the effective presentation of health care performance information for consumer decision making. METHODS Six databases were searched for articles published in English between September 2003 and April 2014. Experimental studies comparing consumers' responses to performance information when one or more presentation feature was altered were included. A thematic analysis was performed and practical guidelines derived. RESULTS All 31 articles retained, the majority which tested responses to various presentations of health care cost and/or quality information, found that consumers better understand and make more informed choices when the information display is less complex. Simplification can be achieved by reducing the quantity of choices, displaying results in a positive direction, using non-technical language and evaluative elements, and situating results in common contexts. CONCLUSION While findings do not offer a prescriptive design, this synthesis informs approaches to enhancing the presentation of health care performance information and areas that merit additional research. PRACTICE IMPLICATIONS Guidelines derived from these results can be used to enhance health care performance reports for consumer decision making including using recognizable, evaluative graphics and customizable formats, limiting the amount of information presented, and testing presentation formats prior to use.
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Affiliation(s)
- Ellen T Kurtzman
- The George Washington University, School of Nursing, 2030 M Street, NW, Suite 300, Washington, D.C. 20036, USA.
| | - Jessica Greene
- The George Washington University, School of Nursing, 2030 M Street, NW, Suite 300, Washington, D.C. 20036, USA.
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Naylor MD, Kurtzman ET, Miller EA, Nadash P, Fitzgerald P. An Assessment of State-Led Reform of Long-Term Services and Supports. J Health Polit Policy Law 2015; 40:531-574. [PMID: 25700376 DOI: 10.1215/03616878-2888460] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Health care in the United States is fragmented, inefficient, and rife with quality concerns. These shortcomings have particularly serious implications for adults with disabilities and functionally impaired older adults in need of long-term services and supports (LTSS). Three strategies have been commonly pursued by state governments to improve LTSS: expanding noninstitutional care, integrating payment and care delivery, and realigning incentives through market-based reforms. These strategies were analyzed using an evaluation framework consisting of the following dimensions: ease of access; choice of setting/provider; quality of care/life; support for family caregivers; effective transitions among multiple providers and across settings; reductions in racial/ethnic disparities; cost-effectiveness; political feasibility; and implementability. Although the analysis highlights potential benefits and drawbacks associated with each strategy, the limited breadth of the evidentiary base precludes an assessment of impact across all nine dimensions. More importantly, the analysis exposes the interdependent, complex system of care within which LTSS is situated, suggesting that policy makers will require a holistic and long-term perspective to achieve needed changes. Addressing the nation's LTSS needs will require a multipronged strategy incorporating a range of health and social services to meet the complex care needs of a diverse population in a variety of settings.
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Abstract
BACKGROUND A key consideration in designing pay-for-performance programs is determining what entity the incentive should be awarded to-individual clinicians or to groups of clinicians working in teams. Some argue that team-level incentives, in which clinicians who are part of a team receive the same incentive based on the team's performance, are most effective; others argue for the efficacy of clinician-level incentives. This study examines primary care clinicians' perceptions of a team-based quality incentive awarded at the clinic level. METHODS This research was conducted with Fairview Health Services, where 40% of the primary care compensation model was based on clinic-level quality performance. We conducted 48 in-depth interviews to explore clinicians' perceptions of the clinic-level incentive, as well as an online survey of 150 clinicians (response rate 56%) to investigate which entity the clinicians would consider optimal to target for quality incentives. RESULTS Clinicians reported the strengths of the clinic-based quality incentive were quality improvement for the team and less patient "dumping," or shifting patients with poor outcomes to other clinicians. The weaknesses were clinicians' lack of control and colleagues riding the coattails of higher performers. There were mixed reports on the model's impact on team dynamics. Although clinicians reported greater interaction with colleagues, some described an increase in tension. Most clinicians surveyed (73%) believed that there should be a mix of clinic and individual-level incentives to maintain collaboration and recognize individual performance. CONCLUSION The study highlights the important advantages and disadvantages of using incentives based upon clinic-level performance. Future research should test whether hybrid incentives that mix group and individual incentives can maintain some of the best elements of each design while mitigating the negative impacts.
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Affiliation(s)
- Jessica Greene
- School of Nursing, The George Washington University, Washington, DC
| | - Ellen T Kurtzman
- School of Nursing, The George Washington University, Washington, DC
| | - Judith H Hibbard
- Department of Planning, Public Policy, and Management, Health Policy Research Group, University of Oregon
| | - Valerie Overton
- Vice President Quality and Innovation, Fairview Medical Group
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Pittman PM, Kurtzman ET, Johnson JE. Academic Progression Models in Nursing: Design Decisions Faced by Administrators in Four Case Studies. J Nurs Educ 2014; 53:329-35. [DOI: 10.3928/01484834-20140520-03] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Accepted: 01/16/2014] [Indexed: 11/20/2022]
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Naylor MD, Kurtzman ET, Grabowski DC, Harrington C, McClellan M, Reinhard SC. Unintended consequences of steps to cut readmissions and reform payment may threaten care of vulnerable older adults. Health Aff (Millwood) 2012; 31:1623-32. [PMID: 22722702 DOI: 10.1377/hlthaff.2012.0110] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The US health care system is characterized by fragmentation and misaligned incentives, which creates challenges for both providers and recipients. These challenges are magnified for older adults who receive long-term services and supports. The Affordable Care Act attempts to address some of these challenges. We analyzed three provisions of the act: the Hospital Readmissions Reduction Program; the National Pilot Program on Payment Bundling; and the Community-Based Care Transitions Program. These three provisions were designed to enhance care transitions for the broader population of adults coping with chronic illness. We found that these provisions inadequately address the unique needs of vulnerable subgroup members who require long-term services and supports and, in some instances, could produce unintended consequences that would contribute to avoidable poor outcomes. We recommend that policy makers anticipate such unintended consequences and advance payment policies that integrate care. They should also prepare the delivery system to keep up with new requirements under the Affordable Care Act, by supporting providers in implementing evidence-based transitional care practices, recrafting strategic and operational plans, developing educational and other resources for frail older adults and their family caregivers, and integrating measurement and reporting requirements into performance systems.
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Affiliation(s)
- Mary D Naylor
- New Courtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA.
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Naylor MD, Aiken LH, Kurtzman ET, Olds DM, Hirschman KB. The care span: The importance of transitional care in achieving health reform. Health Aff (Millwood) 2011; 30:746-54. [PMID: 21471497 DOI: 10.1377/hlthaff.2011.0041] [Citation(s) in RCA: 467] [Impact Index Per Article: 35.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Under the Affordable Care Act of 2010, a variety of transitional care programs and services have been established to improve quality and reduce costs. These programs help hospitalized patients with complex chronic conditions-often the most vulnerable-transfer in a safe and timely manner from one level of care to another or from one type of care setting to another. We conducted a systematic review of the research literature and summarized twenty-one randomized clinical trials of transitional care interventions targeting chronically ill adults. We identified nine interventions that demonstrated positive effects on measures related to hospital readmissions-a key focus of health reform. Most of the interventions led to reductions in readmissions through at least thirty days after discharge. Many of the successful interventions shared similar features, such as assigning a nurse as the clinical manager or leader of care and including in-person home visits to discharged patients. Based on these findings, we recommend several strategies to guide the implementation of transitional care under the Affordable Care Act, such as encouraging the adoption of the most effective interventions through such programs as the Community-Based Care Transitions Program and Medicare shared savings and payment bundling experiments.
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Affiliation(s)
- Mary D Naylor
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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Kurtzman ET, O’Leary D, Sheingold BH, Devers KJ, Dawson EM, Johnson JE. Performance-Based Payment Incentives Increase Burden And Blame For Hospital Nurses. Health Aff (Millwood) 2011; 30:211-8. [DOI: 10.1377/hlthaff.2010.0573] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Ellen T. Kurtzman
- Ellen T. Kurtzman ( ) is an assistant research professor at the George Washington University School of Nursing, in Washington, D.C
| | - Dennis O’Leary
- Dennis O’Leary is president emeritus of the Joint Commission, in Oakbrook Terrace, Illinois
| | - Brenda H. Sheingold
- Brenda H. Sheingold is an assistant professor at the George Washington University School of Nursing
| | - Kelly J. Devers
- Kelly J. Devers is a senior fellow at the Urban Institute Health Policy Center, in Washington, D.C
| | - Ellen M. Dawson
- Ellen M. Dawson is senior associate dean of academic affairs at the George Washington University School of Nursing
| | - Jean E. Johnson
- Jean E. Johnson is dean of the George Washington University School of Nursing
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Kurtzman ET. A transparency and accountability framework for high-value inpatient nursing care. Nurs Econ 2010; 28:295-306. [PMID: 21158250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Transparency and accountability are terms that typically refer to activities aimed at measuring and holding providers responsible for their performance through such vehicles as public disclosure of comparative results. Today, transparency and accountability policies are widely accepted strategies to drive quality improvement and stimulate consumer choice. Yet nursing, the single largest health care profession, has not yet been engaged in these policy directions nor considered in their design or implementation. The framework reported here offers nurses and their professional organizations a model for which to advocate for policy change. Hospital and health system executives who have the freedom to establish institutional policies might implement this framework to achieve higher value. This framework provides both the context and components of a system that, if implemented, would measure, report, and reward hospital nursing's contributions to high value.
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Affiliation(s)
- Ellen T Kurtzman
- School of Nursing, The George Washington University, Washington, DC, USA
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Farquhar M, Kurtzman ET, Thomas KA. What Do Nurses Need to Know About the Quality Enterprise? J Contin Educ Nurs 2010; 41:246-56; quiz 257-8. [DOI: 10.3928/00220124-20100401-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Affiliation(s)
- Mary D. Naylor
- Mary D. Naylor ( ) is the Marian S. Ware Professor of Gerontology and director of the NewCourtland Center for Transitions and Health, School of Nursing, University of Pennsylvania, in Philadelphia
| | - Ellen T. Kurtzman
- Ellen T. Kurtzman is an assistant research professor in the Department of Nursing Education, George Washington University, in Washington, D.C
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Abstract
Reports of suboptimal health care quality and rising expenditures have led payers to institute policies intended to improve outcomes and lower costs. Referred to as value--driven health care, these policies have multiplied in recent years. Despite their appeal, nursing--the nation's single largest provider of health care-has largely been excluded from these policy directions. This article describes the nature of the evidence substantiating nursing's contribution to quality and cost and explores the reasons--scientific, economic, societal, and political--that these contributions have been largely ignored in the formulation of federal policy. Recommendations are made to strengthen the nurse-value case and convince health care stakeholders, including policy makers, that the relationship is established, enduring, and sufficient for national action.
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Abstract
RATIONALE Over the last decade, in order to close the safety and health care quality chasm, there has been a growing imperative to translate evidence-based research into practice. AIMS AND OBJECTIVES This study examines the major facilitators and barriers of implementing in a large US insurance organization - Aetna Corporation - an evidence-based model of care, the Transitional Care Model, which has been rigorously tested over the past twenty years by a multidisciplinary team at the University of Pennsylvania. METHODS Semi-structured interviews of 19 project leaders, case managers, and transitional care nurses were conducted during two phases of translation - start-up and roll out. Qualitative analysis was used to identify more than a dozen key barriers to and facilitators of translation in these two critical phases. Results Six facilitators and seven barriers that are consistent with the literature were identified during and categorized as either start-up or roll-out. CONCLUSION The combined results have important practical implications for other, subsequent translational efforts and for assisting providers, policy makers, payers, and other change agents in integrating evidence-based practice with "real world" management.
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Affiliation(s)
- Mary D Naylor
- Director, NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, PA 19104, USA.
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Abstract
Elderly long-term care recipients who require acute hospitalizations must navigate a fragmented system with poor "handoffs," often resulting in negative outcomes. This article makes the case that reducing preventable hospitalizations and improving transitions to and from hospitals will enhance health care quality and outcomes among these elders. Immediate action targeting diffusion of evidence-based care is recommended to decrease avoidable rehospitalizations and achieve cost savings. Policy changes are needed to address barriers to high-quality transitional care, including deficits in health professionals' and caregivers' knowledge and resources, regulatory obstacles, and inadequate financial incentives and clinical information systems.
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Kurtzman ET. Unifying nursing's policy voice. Policy Polit Nurs Pract 2009; 10:6. [PMID: 19324894 DOI: 10.1177/1527154408330012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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Abstract
Over the last decade, there has been a substantial investment in holding health care providers accountable for the quality of care provided in hospitals and other settings of care. This investment has been realized through the proliferation of national policies that address performance measurement, public reporting, and value-based purchasing. Although nurses represent the largest segment of the health care workforce and despite their acknowledged role in patient safety and health care outcomes, they have been largely absent from policy setting in these areas. This article provides an analysis of current nursing performance measurement and public reporting initiatives and presents a summary of emerging trends in value-based purchasing, with an emphasis on activities in the United States. The article synthesizes issues of relevance to advancing the current climate for nursing quality and concludes with key issues for future policy setting.
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Affiliation(s)
- Ellen T Kurtzman
- Department of Nursing Education, The George Washington University, NW, Washington, DC 20037, USA.
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Abstract
Nurses represent the single largest healthcare profession in the United States. A growing evidence base demonstrates nursing's direct influence on inpatient safety and healthcare outcomes. Support for nursing's essential role in quality and patient safety and mounting interest in publicly reporting performance results have led to efforts to standardized nursing-sensitive performance measures. To this end, in 2004, the National Quality Forum endorsed a set of 15 nursing-sensitive consensus standards intended for use by the public in assessing inpatient nursing care. However, until recently, only anecdotal knowledge existed regarding the implementation of these consensus standards. As a step toward better understanding the interest in and adoption of nursing performance measures, The Robert Wood Johnson Foundation funded a study that concluded in March 2007. In this article, findings from the study are summarized as they apply to nursing leadership and implications for the future role of the nurse executive.
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Affiliation(s)
- Ellen T Kurtzman
- Department of Nursing Education, School of Medicine and Health Sciences, George Washington University, Washington, DC 20037, USA.
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Abstract
In 2004, the National Quality Forum (NQF) endorsed a set of voluntary consensus standards for nursing-sensitive care that quantifies nursing's contribution to patient safety, health care outcomes, and a professional work environment. Since endorsement, these consensus standards have been the basis for research, quality improvement, and policy setting. This article provides a summary of NQF's consensus development process and various efforts that have cascaded from the endorsement of these consensus standards.
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Abstract
Increasing evidence demonstrates that the quality and stability of nursing personnel substantially influence patient outcomes and healthcare costs. However, standardized performance measures to quantify this influence are limited by the gaps in the understanding of this connection and the underdeveloped state of measure development. Given the importance of nurses and the growing trend to make healthcare quality information available to consumers and purchasers, the paucity of standardized nursing-sensitive performance measures is a major void. To address these needs, the National Quality Forum (NQF) undertook a consensus project to endorse an initial set of performance measures for nursing-sensitive care and to define a research agenda that supports future refreshment and expansion of the national voluntary consensus standards in this area. This article describes the innovative approach taken by NQF to endorse a set of national voluntary consensus standards for nursing-sensitive care and the implications for use.
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Kurtzman ET. Baldrige as a Quality Compass. J Healthc Qual 2002. [DOI: 10.1111/j.1945-1474.2002.tb00437.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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