Inpatient Palliative Care and Healthcare Utilization Among Older Patients With Alzheimer's Disease and Related Dementia (ADRD) and High Risk of Mortality in U.S. Hospitals

Background. Despite the potential of palliative care (PC) to enhance the quality of life for patients with advanced dementia, there is limited knowledge of its inpatient utilization patterns. This study investigated inpatient PC consultation utilization patterns and evaluated its impact on hospital length of stay (LOS) and medical costs among older patients diagnosed with Alzheimer's Disease and Related Dementia who were at a high risk of mortality (ADRD-HRM). Methods. Using the 2016-2019 National Inpatient Sample database, we conducted multivariable logistic regression analyses to identify individual and hospital characteristics influencing PC consultation utilization. We subsequently performed generalized linear models to estimate LOS (using Poisson distribution) and hospital charges (via log-transformation). Results. Our sample encompassed 965,644 hospital discharges (weighted n = 4,828,219) of patients aged 65 years and above with ADRD-HRM. Among them, 14.6% received inpatient PC. There was a notable uptrend in PC consultation utilization from 13.3% in 2016 to 16.3% in 2019 (p trend<.001). Factors positively influencing and associated with PC utilization included patients that are older, non-Hispanic White, with higher income, receiving care from teaching hospitals, and facilitated with greater bed capacity (all P < .05). Although patients who received PC were more likely to have 3.0% longer LOS (P < .001), they had 19.2% lower hospital charges (P < .001). Conclusions. PC substantially reduced hospital expenditures for older patients with ADRD-HRM, but the prevalence remained low at 14.6% in the study period. Future studies should explore the unmet needs of patients with lower sociodemographic status and those in rural hospitals to further increase their PC consultation utilization.

Exploring life stressors, depression, and coping strategies in college students

Objective: College students experience a variety of stressors that can increase the risk for mental health concerns, like depression. It is crucial for practitioners working on college campuses to understand the relationship among stressful life events, depression, and coping strategies. The purpose of this study was to explore life stressors' impact on reported depressive symptoms and how adaptive and maladaptive coping strategies moderate that relationship in college students. Participants: Data was used from a comprehensive health behavior survey. Participants included 969 college students. Methods: Multivariable logistic models were used to examine the association between stressful events, depression, and coping strategies. Results: Results from multiple logistic regression analyses indicated that college students who experienced life stressors and participated in more negative than positive coping strategies were 2.49 (95% CI = 1.34, 4.63) times more likely to experience depression. Conclusions: Implications and creative interventions are provided for mental health practitioners working on college campuses.

Marijuana use disorder among adults with functional disabilities-A US population-based cross-sectional study

BACKGROUND AND OBJECTIVES

Recent studies suggest a growing trend in marijuana use, compared to a stable prevalence of marijuana use disorder among US adults over the first 15 years of the 21st century. This study investigated the recent patterns of marijuana use disorder among people with disabilities (PWD).

METHODS

We extracted a nationally representative sample (N = 209,058) from the 2015-2019 National Survey on Drug Use and Health data set and examined associations by functional disability status (any disability, disability by type, and number of disabling limitations) with marijuana use disorder using a series of independent multivariable logistic regression models. We also performed trend analyses during the study period.

RESULTS

The prevalence of marijuana use disorder (from 1.7% to 2.3%) increased significantly among PWD between 2015 and 2019 (p-trend < .001). PWD were significantly more likely to report marijuana use disorder (odds ratio [OR], 1.37, 95% confidence interval [CI], 1.24-1.52) than people without disability (PWoD). Those with cognitive limitation only (OR, 1.78, 95% CI, 1.53-2.06) and ≥2 limitations (OR, 1.29, 95% CI, 1.10-1.51) were more likely to report marijuana use disorder than PWoD.

DISCUSSION AND CONCLUSIONS

PWD had a consistently higher prevalence of marijuana use disorder than PWoD. Additionally, the level of risk for marijuana use disorder varied by disability type and number of disabling limitations.

SCIENTIFIC SIGNIFICANCE

Our study provided new nuance on disparities in marijuana use disorder between PWD and PWoD and further revealed the varied risks for marijuana use disorder across different disability statuses.

Mental health initiatives: Providing stress management, wellness, and mindfulness workshops on college campuses

Objective: College students experience stressors that can increase the risk for mental health concerns and negatively impact retention rates. It is crucial for practitioners working on college campuses to find creative ways to meet the needs of their students and cultivate a campus culture that is dedicated to bolstering mental health. The purpose of this study was to explore if implementing 1-h mental health workshops covering stress management, wellness, mindfulness, and SMART goals was feasible and advantageous for students. Participants: Researchers hosted 1-h workshops in 13 classrooms. Participants included 257 students who completed the pretest and 151 students who completed the post-test. Methods: A quasi-experimental 1-group pre- and post-test design was utilized. Results: Means and standard deviations were utilized to examine knowledge, attitudes, and intentions in each domain. Results indicated statistically significant improvements in each. Conclusion: Implications and interventions are provided for mental health practitioner working on college campuses.

Examining regulatory focus in the acceleration and deceleration of engagement and exhaustion cycles among nurses

BACKGROUND

Given that emotional exhaustion and nurse engagement have significant implications for nurse well-being and organizational performance, determining how to increase nurse engagement while reducing nurse exhaustion is of value.

PURPOSE

Resource loss and gain cycles, as theorized in conservation of resources theory, are examined using the experience of emotional exhaustion to evaluate loss cycles and work engagement to evaluate gain cycles. Furthermore, we integrate conservation of resources theory with regulatory focus theory to examine how the ways in which individuals approach work goals serves as a facilitator to the acceleration and deceleration of both of these cycles.

METHODOLOGY/APPROACH

Using data from nurses working in a hospital in the Midwest United States at six time points spanning over 2 years, we demonstrate the accumulation effects of the cycles over time using latent change score modeling.

RESULTS

We found that prevention focus was associated with the accelerated accumulation effects of emotional exhaustion and that promotion focus was associated with the accelerated accumulation effects of work engagement. Furthermore, prevention focus attenuated the acceleration of engagement, but promotion did not influence the acceleration of exhaustion.

CONCLUSION

Our findings suggest that individual factors such as regulatory focus are key to helping nurses to better control their resource gain and loss cycles.

PRACTICE IMPLICATIONS

We provide implications for nurse managers and health care administrators to help encourage promotion focus and suppress prevention focus in the workplace.

Hospital COVID-19 preparedness: Are (were) we ready?

BACKGROUND

Terrorist attacks and natural disasters such as Hurricanes Katrina and Harvey have increased focus on disaster preparedness planning. Despite the attention on planning, many studies have found that hospitals in the United States are underprepared to manage extended disasters appropriately and the surge in patient volume it might bring.

AIM

This study aims to profile and examine the availability of hospital capacity specifically related to COVID-19 patients, such as emergency department (ED) beds, intensive care unit (ICU) beds, temporary space setup, and ventilators.

METHOD

A cross-sectional retrospective study design was used to examine secondary data from the 2020 American Hospital Association (AHA) Annual Survey. A series of multivariate logistic analyses were conducted to investigate the strength of association between changes in ED beds, ICU beds, staffed beds, and temporary spaces setup, and the 3,655 hospitals' characteristics.

RESULTS

Our results highlight that the odds of a change in ED beds are 44 percent lower for government hospitals and 54 percent for for-profit hospitals than not-for-profit hospitals. The odds of ED bed change for nonteaching hospitals were 34 percent lower compared to teaching hospitals. Small and medium hospitals have significantly lower odds (75 and 51 percent, respectively) than large hospitals. For ICU bed change, staffed bed change, and temporary spaces setup, the conclusions were consistently significant regarding the impact of hospital ownership, teaching status, and hospital size. However, temporary spaces setup differs by hospital location. The odds of change is significantly lower (OR = 0.71) in urban hospitals compared with rural hospitals, while for ED beds, the odds of change is considerably higher (OR = 1.57) in urban hospitals compared to rural hospitals.

CONCLUSION

There is a need for policymakers to consider not only resource limitations that were created from supply line disruptions during the COVID-19 pandemic but also a more global assessment of the adequacy of funding and support for insurance coverage, hospital finance, and how hospitals meet the needs of the populations they serve.

All-Cause 30-Day Readmission and Mortality: How the Health of Community Affects Magnet® Performance

OBJECTIVE

The aim of this study was to determine whether Magnet® and non-Magnet hospitals differ in the occurrence of 30-day readmission and mortality rates among the Medicare population when considering community health factors.

BACKGROUND

Magnet hospitals have shown favorable outcomes regarding 30-day readmission and mortality; however, previous research has not evaluated whether the hospital community influences the likelihood of the patient being readmitted to a hospital or how Magnet facilities may mitigate potential mortality risks.

METHOD

This study used a cross-sectional study design of 1791 hospitals using a propensity score matching technique to compare Magnet and non-Magnet hospitals with similar hospital and community characteristics.

RESULTS

Results reveal no differences in readmission scores between Magnet and non-Magnet hospitals. When considering mortality scores, Magnet hospitals had better performance for pneumonia, congestive heart failure, and chronic obstructive pulmonary disease compared with non-Magnet hospitals.

CONCLUSIONS

Our results suggest that there may be universal efforts to improve overall readmission rates taken by hospitals to minimize potential penalties and maximize patient outcomes.

Improving Health and Addressing Social Determinants of Health Through Hospital Partnerships

Hospitals and health systems are forming partnerships to develop an integrated social network of services that better address the needs of their surrounding communities and their social determinants of health (SDOH). There is little research on the association of these partnered services with hospital outcomes. This study examined the association between hospital social need partnerships and activities to improve hospital and community outcomes. A secondary cross-sectional design to analyze 2021 census data of nonfederal short-term acute care hospitals in the United States was utilized. Data were obtained from the American Hospital Association. Four multilevel logistic regression models were used to analyze data from 1005 hospitals. The authors found that hospital partnership type differed in association to social need outcomes. They found that hospitals with a partnership with health insurance providers were more likely to have better health outcomes. Hospitals partnered with health insurance providers, local organizations addressing housing insecurity, local businesses, or chambers of commerce were more likely to have decreased health care costs. Hospitals partnered with health care providers, health insurance providers, local organizations providing legal assistance, or law enforcement/safety forces were more likely to have decreased utilization of hospital services. However, hospitals partnered with other local or state government or social service organizations were less likely to indicate decreased utilization of services. Many hospitals and health systems across the United States are screening for SDOH and are advancing health care delivery and improving the community's overall health and well-being by identifying unmet social needs and partnering with the community to address them.

Effects of post-discharge telemonitoring on 30-day chronic obstructive pulmonary disease readmissions and mortality

INTRODUCTION

Much attention has been focused on decreasing chronic obstructive pulmonary disease (COPD) hospital readmissions. The US health system has struggled to meet this goal. The objective of this study was to assess the efficacy of telehealth services on the reduction of hospital readmission and mortality rates for COPD.

METHODS

We used a cross-sectional design to examine the association between hospital risk-adjusted readmission and mortality rates for COPD and hospital use of post-discharge telemonitoring (TM). Data for 777 hospitals were sourced from the Centers for Medicare & Medicaid Services and the American Hospital Association annual surveys. Propensity score matching using the kennel weights method was applied to calculate the weighted probability of being a hospital that offers post-discharge TM services.

RESULTS

Hospitals with post-discharge TM had about 34% significantly higher odds (adjusted odds ratio (AOR) = 1.34; 95% confidence interval (CI) 1.06-1.70) of 30-day COPD readmission and 33% significantly lower odds (AOR = 0.67; 95% CI 0.50-0.90) of 30-day COPD mortality compared to hospitals without post-discharge TM services.

DISCUSSION

Overall, hospitals that offer post-discharge TM services have seen an improvement in 30-day COPD mortality rates. However, those same hospitals have also experienced a significant increase in 30-day COPD readmissions. TM can potentially decrease mortality in patients recently admitted for acute exacerbation of COPD. The results provide further evidence that readmissions present a problematic assessment of health-care quality, as the need for readmission may or may not be directly related to the quality of care received while in hospital.

Association of dual COVID-19 and seasonal influenza vaccination with COVID-19 infection and disease severity

The clinical guideline states that COVID-19 vaccination can be administered concurrently with Influenza (flu) vaccination (dual vaccination). Using data from the 2021 National Health Interview Survey, we conducted descriptive analysis and multivariate logistic regressions to examine the association between dual vaccination status and self-reported COVID-19 infection and severity. Among 21,387 (weighted 185,251,310) U.S. adults, about 22% did not receive either the flu or COVID-19 vaccine, 6.0% received the flu vaccine only, 29.1% received the COVID-19 vaccine only, and 42.5% received both vaccines. In the multivariate analysis, individuals with dual vaccination (OR, 0.65, 95% CI, 0.56-0.75) and COVID-19 vaccine only (OR, 0.71, 95% CI, 0.61-0.82) were significantly less likely to report COVID-19 infection when compared with those unvaccinated. There was no significant difference in self-reported COVID-19 symptom severity by vaccination status. The results suggest that dual vaccination may be an effective strategy to reduce the contagious respiratory disease burden.

COVID-19 Deaths and the Impact of Health Disparities, Hospital Characteristics, Community, Social Distancing, and Health System Competition

The United States has one of the highest cumulative mortalities of coronavirus disease 2019 (COVID-19) and has reached 1 million deaths as of May 19th, 2022. Understanding which community and hospital factors contributed to disparities in COVID-19 mortality is important to inform public health strategies. This study aimed to explore the potential relationship between hospital service area (1) community (ie, health professional shortage areas, market competition, and uninsured percentage) and (2) hospital (ie, teaching, system, and ownership status) characteristics (2013-2018) on publicly available COVD-19 (February to October 2020) mortality data. The study included 2514 health service areas and used multilevel mixed-effects linear model to account for the multilevel data structure. The outcome measure was the number of COVID-19 deaths. This study found that public health, as opposed to acute care provision, was associated with community health and, ultimately, COVID-19 mortality. The study found that population characteristics including more uninsured greater proportion of those over 65 years, more diverse populations, and larger populations were all associated with a higher rate of death. In addition, communities with fewer hospitals were associated with a lower rate of death. When considering region in the United States, the west region showed a higher rate of death than all other regions. The association between some community characteristics and higher COVID-19 deaths demonstrated that access to health care, either for COVID-19 infection or worse health from higher disease burden, is strongly associated with COVID-19 deaths. Thus, to be better prepared for potential future pandemics, a greater emphasis on public health infrastructure is needed.

Hospital-Acquired Conditions Reduction Program, Racial and Ethnic Diversity, and Magnet Designation in the United States

OBJECTIVE

A key quality indicator in any health system is its ability to reduce morbidity and mortality. In recent years, healthcare organizations in the United States have been held to stricter measures of accountability to provide safe, quality care. This study aimed to explore the contextual factors driving racial disparities in hospital-acquired conditions incident rates among Medicare recipients in Magnet and non-Magnet hospitals.

METHODS

A cross-sectional observational study was performed using data from Hospital-Acquired Condition Reduction Program. Performance from 1823 hospitals were used to examine the association between Magnet recognition and community's racial and ethnic differences in hospital performance on the Hospital-Acquired Condition Reduction Program. The unit of analysis was the hospital level. A propensity score matching approach was used to take into account differences in baseline characteristics when comparing Magnet and non-Magnet hospitals. The outcome measures were risk-standardized hospital performance on the Hospital-Acquired Condition Reduction Program domains and overall performance.

RESULTS

Study findings show that Magnet hospitals had decreased methicillin-resistant Staphylococcus aureus (MRSA) rate (β = -0.22; 95% confidence interval, -0.36 to -0.08) compared with non-Magnet hospitals. No other statistical difference was identified.

CONCLUSIONS

Results from this study show community's racial and ethnic differences in hospital-acquired conditions occurrence differ between Magnet and non-Magnet hospitals for MRSA, indicating its association with nursing practice. However, because this improvement is limited to only MRSA, there are likely opportunities for Magnet hospitals to continue process improvements focused on additional Hospital-Acquired Condition Reduction Program measures.

The role of community-level characteristics in comparing United States hospital performance by magnet designation: A propensity score matched study

AIMS

To assess the impact of community-level characteristics on the role of magnet designation in relation to hospital value-based purchasing quality scores, as health disparities associated with geographical location could confound hospitals' ability to meet outcome metrics.

DESIGN

This cross-sectional study was carried out between October 2021 and March 2022 using data from 2016 to 2021.

METHODS

Propensity score analysis was used to match hospital and community-level characteristics, implementing nearest neighbour matching to adjust for pre-treatment differences between magnet and non-magnet hospitals to account for multi-level differences. Secondary data were obtained from all operational acute-care facilities in the United States that participated in the Centers for Medicare and Medicaid Services' hospital value-based purchasing (HVBP) program. Dependent variables were the four value-based purchasing domains that comprise the Total Performance Score (TPS; Clinical Care, Person and Community Engagement, Safety, and Efficiency and Cost Reduction).

RESULTS

Magnet hospitals had increased odds for better scores in the HVBP domains of Clinical Care and Person and Community Engagement, and decreased odds for having better Safety. However, no statistically significant difference was found for the Efficiency domain or the TPS.

CONCLUSION

Measuring performance equitably across organizations of various sizes serving diverse communities remains a key factor in ensuring distributive justice. Analysing the TPS components can identify complex influences of community-level characteristics not evident at the composite level. More research is needed where community and nurse-level factors may indirectly affect patient safety.

IMPACT

This study's findings on the role of community contexts can inform policymakers designing value-based care programs and healthcare management administrators deliberating on magnet certification investments across diverse community settings.

NO PATIENT OR PUBLIC CONTRIBUTION

For this study of US hospitals' organizational performance, we did not engage members of the patient population nor the general public. However, the multi-disciplinary research team does include diverse perspectives.

Grandparents' Mental Health and Lived Experiences while Raising Their Grandchildren at the Forefront of COVID-19 in Saudi Arabia

Understanding grandparents' lived experiences and healthy aging is essential to designing efficient, effective, and safe services to support a family structure in which grandparents care for their grandchildren. However, no study to date has explored this concept in an Arab and Muslim country during a pandemic. The purpose of this study was to examine grandparents' experiences raising their grandchildren to provide recommendations for needed mental health interventions during and after COVID-19. We used a phenomenological approach to gain a detailed and in-depth understanding of the lived experiences of 15 grandparents caring for their grandchildren. This study shows the need for support service interventions (support groups, health professional support, and respite care) for grandparents in Saudi Arabia, especially during global crises like COVID-19, that enhance social distance and social isolation. Raising grandchildren affects the physical, mental, and social wellbeing of the grandparents.

Cancer Risk Perceptions Among People Who Check Their Skin for Skin Cancer: Results from the 2017 U.S. Health Information National Trends Survey (HINTS)

When detected early, melanoma is highly treatable and rarely fatal. Self-skin checks can identify changes in moles that could be an indicator of melanoma. Cancer risk perceptions may influence the uptake of important preventive health behaviors such as self-skin checks. The purpose of this study is to examine cancer risk perception factors associated with those who have checked their skin for signs of skin cancer using the 2017 HINTS data. Retrospective cross-sectional analysis of a nationally representative sample of U.S. adults using the Health Information National Trends Survey (HINTS). Logistic regressions were performed to identify associations between having checked skin for signs of skin cancer, risk perceptions, and demographic variables. White women over the age of 45 with a college degree and annual incomes greater than $75,000 were more likely to check their skin for signs of skin cancer. More than a third reported they would rather not know if they had cancer and more than 60% had some level of worry about having cancer. Those with a personal or family history of cancer were more likely to check. HINTS is a cross-sectional survey which provides only a glimpse of behavioral predictors. Self-skin checks are simple and cost-effective to detect melanoma early and improve outcomes. Fear and worry about cancer were significant factors in the likelihood of checking skin for signs of skin cancer. Population-based strategies could be developed to reduce concerns about early detection.

Single-Vendor Electronic Health Record Use Is Associated With Greater Opportunities for Organizational and Clinical Care Improvements

Objective

To compare how hospitals that use single-vendor vs best-of-breed electronic health record (EHR) vendors utilize clinical and organizational evaluation capabilities.

Methods

Data from the 2018 (June 1, 2016, to December 31, 2017) American Hospital Association Information Technology Supplement Survey and Medicare Final Rule Standardizing File were used. Multinomial logistic regression analysis of hospitals (n=1902) was conducted to identify hospital characteristics associated with the use of EHRs for (1) clinical care evaluation capabilities and (2) organizational evaluation capabilities.

Results

Single-vendor EHR hospitals were more likely (relative risk ratio, 3.37; 95% confidence interval, 1.97-5.76) to use EHRs for clinical care and organizational evaluation capabilities. Not-for-profit hospitals were more likely to use EHRs for all organizational evaluation capabilities than government nonfederal hospitals. For-profit hospitals were less likely to use EHRs for organizational or clinical evaluation capabilities than government nonfederal hospitals.

Conclusion

Hospitals using the single-vendor EHR system were more likely to engage in clinical care and organizational evaluation than hospitals using best-of-breed EHR systems.

Impact of Change in Allocation Score Methodology on Post Kidney Transplant Average Length of Stay

Background

In December 2014, a new Kidney Allocation System (KAS) was implemented nationwide to improve access and quality of care to historically disadvantaged patients. However, no study to date has examined the relationship between the KAS and potential changes in hospital length of stay (LOS). This study aimed to examine the relationship between the KAS implemented in December 2014 and potential changes in hospital LOS.

Methods

We used data from the Florida Agency for Health Care Administration on kidney transplant surgeries completed between 2011 and 2018. A cross-sectional cohort study design included seven hospitals that performed kidney transplants for the duration of the study. A propensity score matching approach was used to examine the relationship between KAS and LOS. All acute general medical and surgical hospitals in Florida that performed kidney transplant surgery were included in the analysis.

Results

We included 7,795 patients, 6,119 discharged to home, and 1,676 discharged to home with home health services after transplant. The average LOS prior to KAS was 6.52 days and 6.08 days post KAS. Propensity matched results show that patients transferred to home experienced a decrease in the LOS (coefficient (β) = -0.68; 95% confidence interval (CI): -0.95, -0.42) after the new allocation score was implemented. Similarly, patients transferred to home with home health experienced a decrease in the LOS (β = -1.90; 95% CI: -2.69, -1.11) after the new allocation was implemented.

Conclusion

In conclusion, results indicate that KAS implementation did not add a burden on the health system by increasing LOS when considering patients with similar characteristics before and after KAS implementation. KAS is an important policy change that appears to not negatively affect the LOS when sicker patients could receive a kidney transplant. Our findings improve our understanding of the KAS policy and its influence on the health system.

Medicare and telehealth: The impact of COVID-19 pandemic

STUDY RATIONALE

The swift progression of the COVID-19 pandemic appeared to facilitate the increase in telehealth utilization. However, it is clear neither how telehealth was offered by providers nor how it was used by patients during this time of unusual and rapid change within the health industry.

AIM

To investigates the telehealth utilization patterns of Medicare beneficiaries during the height of the COVID-19 pandemic.

METHODS AND MATERIALS

A cross-sectional study design was used to examine the responses of 9686 Medicare beneficiaries to the Centers for Medicare and Medicaid Services (CMS) Medicare Current Beneficiary Survey, Fall 2020 COVID-19 Supplement. Multiple logistic regression analyses were conducted to examine the relationship between telehealth offering and beneficiaries' sociodemographic variables.

RESULTS

Over half (58%) of primary care providers provided telehealth services, while only 26%-28% of specialists did. Less than 8% of Medicare beneficiaries reported that they were unable to obtain care because of COVID-19.

CONCLUSIONS

This research found that changes in Medicare policy, associated with CMS' declaration of telehealth waivers during the Public Health Emergency (PHE), likely increased the proliferation and utilization of telehealth services during the COVID-19 pandemic, providing important access to care for certain populations. With the impending conclusion of the PHE, policymakers must 1) ascertain which elements of the new telehealth landscape will be retained, 2) modernize the regulatory, accreditation and reimbursement framework to maintain pace with care model innovation and 3) address disparities in access to broadband connectivity with a particular focus on rural and underserved communities.

Striking a Balance between Work and Play: The Effects of Work-Life Interference and Burnout on Faculty Turnover Intentions and Career Satisfaction

BACKGROUND

The interactions between work and personal life are important for ensuring well-being, especially during COVID-19 where the lines between work and home are blurred. Work-life interference/imbalance can result in work-related burnout, which has been shown to have negative effects on faculty members' physical and psychological health. Although our understanding of burnout has advanced considerably in recent years, little is known about the effects of burnout on nursing faculty turnover intentions and career satisfaction.

OBJECTIVE

To test a hypothesized model examining the effects of work-life interference on nursing faculty burnout (emotional exhaustion and cynicism), turnover intentions and, ultimately, career satisfaction.

DESIGN

A predictive cross-sectional design was used.

SETTINGS

An online national survey of nursing faculty members was administered throughout Canada in summer 2021.

PARTICIPANTS

Nursing faculty who held full-time or part-time positions in Canadian academic settings were invited via email to participate in the study.

METHODS

Data were collected from an anonymous survey housed on Qualtrics. Descriptive statistics and reliability estimates were computed. The hypothesized model was tested using structural equation modeling.

RESULTS

Data suggest that work-life interference significantly increases burnout which contributes to both higher turnover intentions and lower career satisfaction. Turnover intentions, in turn, decrease career satisfaction.

CONCLUSIONS

The findings add to the growing body of literature linking burnout to turnover and dissatisfaction, highlighting key antecedents and/or drivers of burnout among nurse academics. These results provide suggestions for suitable areas for the development of interventions and policies within the organizational structure to reduce the risk of burnout during and post-COVID-19 and improve faculty retention.

Hospital COVID-19 preparedness: Are (were) we ready?

BACKGROUND

Terrorist attacks and natural disasters such as Hurricanes Katrina and Harvey have increased focus on disaster preparedness planning. Despite the attention on planning, many studies have found that hospitals in the United States are underprepared to manage extended disasters appropriately and the surge in patient volume it might bring.

AIM

This study aims to profile and examine the availability of hospital capacity specifically related to COVID-19 patients, such as emergency department (ED) beds, intensive care unit (ICU) beds, temporary space setup, and ventilators.

METHOD

A cross-sectional retrospective study design was used to examine secondary data from the 2020 American Hospital Association (AHA) Annual Survey. A series of multivariate logistic analyses were conducted to investigate the strength of association between changes in ED beds, ICU beds, staffed beds, and temporary spaces setup, and the 3,655 hospitals' characteristics.

RESULTS

Our results highlight that the odds of a change in ED beds are 44 percent lower for government hospitals and 54 percent for for-profit hospitals than not-for-profit hospitals. The odds of ED bed change for nonteaching hospitals were 34 percent lower compared to teaching hospitals. Small and medium hospitals have significantly lower odds (75 and 51 percent, respectively) than large hospitals. For ICU bed change, staffed bed change, and temporary spaces setup, the conclusions were consistently significant regarding the impact of hospital ownership, teaching status, and hospital size. However, temporary spaces setup differs by hospital location. The odds of change is significantly lower (OR = 0.71) in urban hospitals compared with rural hospitals, while for ED beds, the odds of change is considerably higher (OR = 1.57) in urban hospitals compared to rural hospitals.

CONCLUSION

There is a need for policymakers to consider not only resource limitations that were created from supply line disruptions during the COVID-19 pandemic but also a more global assessment of the adequacy of funding and support for insurance coverage, hospital finance, and how hospitals meet the needs of the populations they serve.

Hospital Geographic Location and Unexpected Complications in term Newborns in Florida

INTRODUCTION

Birth trauma rates in term of neonates is a quality measure used by the Joint Commission. In the United States birth trauma rates occurs at a rate of 37 per 1000 live births and are on the decline. However, this decline has been significantly lower among term neonates born in rural facilities. There is a critical lack of evidence toward the influence geographical risk factors has on birth trauma rates for neonatal patients. We sought to measure rural community and hospital characteristics associated with birth trauma.

METHODS

A retrospective longitudinal study design was used to examine inpatient medical discharge data across 103 hospitals of neonates at birth from 2013 to 2018. Discharge data was linked to the American Hospital Association annual survey. We used a multi-level mixed effect model to investigate the relationship between individual and hospital-level attributes associated with increased risk of birth trauma among neonatal patients.

RESULTS

We found that rural hospitals were 3.99 times (p < 0.001) more likely to experience higher birth trauma than urban hospitals. Medium sized hospitals were 2.11 times (p < 0.001) more likely to experience higher birth trauma. Hospitals who indicate having a safety culture were more likely (p < 0.05) to have high rates of birth trauma.

DISCUSSION

Neonates born at rural hospitals, were more likely to experience a birth-related injury. Policy strategies focusing on improving health care quality in rural areas are critical to mitigating this increased risk of birth trauma. Further research is required to assess how physician characteristics may impact birth trauma rates.

The influence of community health on hospitals attainment of Magnet designation: Implications for policy and practice

AIMS

To determine if there is an association between better County Health Rankings and the increased odds of a hospital gaining Magnet designation in subsequent years (2014-2019) compared with counties with lower rankings.

BACKGROUND

The Magnet hospital model is recognized to have a great effect on nurses, patients and organizational outcomes. Although Magnet hospital designation is a well-established structural marker for nursing excellence, the effect of County Health Rankings and subsequent hospital achievement of Magnet status is unknown.

DESIGN

A descriptive, cross-sectional quantitative approach was adopted for this study.

METHODS

Data were derived from 2010 to 2019 U.S. County Health Rankings, American Hospital Association, and American Nursing Credentialing Center databases. Logistic regression models were utilized to determine associations between county rankings for health behaviours, clinical care, social and economic factors, physical environment and counties with a new Magnet hospital after 2014.

RESULTS

Counties with the worst rankings for clinical care and socio-economic status had reduced odds of obtaining a Magnet hospital designation compared with best-ranking counties. While middle-ranking counties for the physical environment ranking had increased odds of having Magnet designation compared with best-ranking counties. Additionally, having an increased percent of government non-federal hospital or a higher percentage of critical access hospitals in the county reduced the odds of having a Magnet-designated facility after 2014.

CONCLUSION

The findings underscore the important associations between Magnet-designated facilities' location and the health of its surrounding counties. This study is the first to examine the relationship between County Health Rankings and a hospital's likelihood of obtaining Magnet status and points to the need for future research to explore outcomes of care previously identified as improved in Magnet-designated hospitals.

IMPLICATIONS

Recognizing the benefits of Magnet facilities, it is important for health care leaders and policy makers to seek opportunities to promote centres of excellence in higher need communities through policy and financial intervention.

The Financial Burden of Opioid-Related Abuse among Surgical and Non-Surgical Patients in Florida: A Longitudinal Study

Florida is one of the eight states labeled as a high-burden opioid abuse state and is an epicenter for opioid use and misuse. The aim of our study was to measure multi-year total room charges and costs billed for opioid abuse-related events and to compare the costs of inpatient opioid abusers and non-opioid abusers for Florida hospitals from 2011 to 2017. We constructed a retrospective case-control longitudinal study design on inpatient administrative discharge data across 173 hospitals. Opioid abuse was defined using both ICD-9-CM and ICD-10-CM systems. We found a statistically significant association between opioid abuse diagnosis and total room charge. On average, opioid abuse status increased the room charges by 8.1%. We also noticed year-to-year variations in opioid abuse had a remarkable influence on hospital finances. We showed that since 2015, the differences significantly increased from 4–5% to 13–14% for both room charges and cost, which indicates the financial burden due to opioid abuse becoming more frequent. These findings are important to policymakers and hospital administrators because they provide crucial insight into Florida’s opioid crisis and its economic burden on hospitals.

Stress and Coping Strategies among Nursing Students in Clinical Practice during COVID-19

Stress is common among nursing students and it has been exacerbated during the COVID-19 pandemic. This study examined nursing students' stress levels and their coping strategies in clinical practice before and during the COVID-19 pandemic. A repeated-measures study design was used to examine the relationship between nursing students' stress levels and coping strategies before and during the pandemic. Confirmatory factor analyses were conducted to validate the survey and a student T-test was used to compare the level of stress and coping strategies among 131 nursing students. The STROBE checklist was used. During COVID-19, there was a reliable and accurate relationship between stress and coping strategies. Furthermore, both stress and coping strategy scores were lower before COVID-19 and higher during COVID-19. Nursing students are struggling to achieve a healthy stress-coping strategy during the pandemic. There is a need for the introduction of stress management programs to help foster healthy coping skills. Students are important resources for our health system and society and will continue to be vital long term. It is now up to both nursing educators and health administrators to identify and implement the needed improvements in training and safety measures because they are essential for the health of the patient as well as future pandemics.

Examining the Relationship Between Hospital-Community Partnerships and COVID-19 Case-Fatality Rates

Abtract During the COVID-19 pandemic, hospitals across the United States were tasked to develop partnerships with other hospitals and community organizations to overcome the unexpected challenges. The aim of this study is to examine COVID-19 case-fatality rates and explore their relationship with hospital-community partnerships. This study employed a cross-sectional design using a multilevel generalized linear model with a Poisson regression distribution and publicly available COVID-19 mortality data from February to October 2020 across 2526 hospital service areas (HSAs). HSAs with a greater number of partnerships were found to have a reduced risk of higher case-fatality rates than those with fewer health system partnerships. The findings indicated the need for greater cooperation between individual health care systems, state and local governments, and community programs for better outcomes in the ongoing and evolving COVID-19 pandemic, and to be better prepared for future pandemics or large-scale public health crises. This study provides the necessary insights for policy makers, hospital administrators, and public health leaders to understand the critical importance of community partnerships and their influence on reducing the COVID-19 case-fatality rate, as well as their potential effects on improving the health of vulnerable populations as a means to achieve the Centers for Disease Control and Prevention's goal of achieving health equity. This research illustrates the need for further inquiries into the importance of these health care partnerships for positive health care outcomes.

Covid-19 Impacts on Florida's Healthcare Professionals

This study described how COVID-19 impacted employment, telehealth usage, and interprofessional collaboration. A cross-sectional survey was deployed in June 2020 to healthcare professionals in Florida. Job status was uniquely separated by profession, with more nurses and medical doctors reported having no effect, and more mental health counselors transitioned to telehealth. Over a third of rehabilitation providers reported being furloughed. Over forty percent of providers had no training in telehealth, yet 33.1% reported an increase in usage. Interprofessional interactions are lower across professions during the pandemic, compared with before. This study shows the need for additional training on telehealth and interprofessional collaboration.

A cross-sectional study of trauma certification and hospital referral region diversity: A system theory approach

BACKGROUND

There are clear racial/ethnic disparities in the trauma care service delivery. However, no study has examined the relationships between structural determinants of trauma care designations (L-I through L-IV) or verification and social factors of the surrounding health region in the U.S.

OBJECTIVE

This study examined the relationship between U.S. community segregation in a hospital referral region (HRR) and hospitals' attainment of trauma certification and trauma designation L-I/II.

METHODS

Two-year retrospective analysis of 2,348 acute hospitals that participated in the Hospital Value-Based Purchasing (HVBP) Program. Multivariate Poisson and 1:2 matching ratio using Propensity Score Matching regressions were used. Our primary variables were composite segregation scores for each county-aggregated to the HRR level (n=303)-and hospital performance on the HVBP Program.

RESULTS

Segregated HRRs are 69% and 40% less likely to have an increase in the number of hospitals with trauma care designations L-I/II and trauma certification, respectively. Our matching ratio showed that hospitals with trauma certification or hospitals with trauma care designations L-I/II were more likely to be within HRRs with lower community diversity.

CONCLUSION

Our findings highlight that system disparities exist in trauma care. Research is needed to determine if other factors, such as resource allocation and reimbursement distribution, impact the availability of trauma facilities.

Older and Wiser? The Need to Reexamine the Impact of Health Professionals Age and Experience on Competency-Based Practices

INTRODUCTION

Delivery of healthcare services makes up a complex system and it requires providers to be competent and to be able to integrate each of the institute of medicine's (IOM) 5 core competencies into practice. However, healthcare providers are challenged with the task to be able to understand and apply the IOM core competencies into practice.

OBJECTIVE

The purpose of the study was to examine the factors that influence health professional's likelihood of accomplishing the IOM core competencies.

METHODS

A cross-sectional study design was used to administer a validated online survey to health providers. This survey was distributed to physicians, nursing professionals, specialists, and allied healthcare professionals. The final sample included 3,940 participants who completed the survey.

RESULTS

The study findings show that younger health professionals more consistently practice daily competencies than their older counterparts, especially in the use of evidence-based practice, informatics, and working in interdisciplinary teams. Less experienced health professionals more consistently applied quality improvement methods but less consistently used evidence-based practice compared to their more experienced counterparts.

CONCLUSION

There is a need to understand how health professionals' age and experience impact their engagement with IOM's core competencies. This study highlights the need for educational resources on the competencies to be tailored to health providers' age and experience.

Magnet Hospitals and 30-Day Readmission and Mortality Rates for Medicare Beneficiaries

BACKGROUND

US hospitals are penalized for excess 30-day readmissions and mortality for select conditions. Under the Centers for Medicare and Medicaid Services policy, readmission prevention is incentivized to a greater extent than mortality reduction. A strategy to potentially improve hospital performance on either measure is by improving nursing care, as nurses provide the largest amount of direct patient care. However, little is known as to whether achieving nursing excellence, such as Magnet status, is associated with improved hospital performance on readmissions and mortality.

OBJECTIVE

The purpose of this study was to examine the relationship between hospitals' Magnet status and performance on readmission and mortality rates for Medicare beneficiaries.

RESEARCH DESIGN

This is a cross-sectional analysis of Medicare readmissions and mortality reduction programs from 2013 to 2016. A propensity score-matching approach was used to take into account differences in baseline characteristics when comparing Magnet and non-Magnet hospitals.

SUBJECTS

The sample was comprised of 3877 hospitals.

MEASURES

The outcome measures were 30-day risk-standardized readmission and mortality rates.

RESULTS

Following propensity score matching on hospital characteristics, we found that Magnet hospitals outperformed non-Magnet hospitals in reducing mortality; however, Magnet hospitals performed worse in reducing readmissions for acute myocardial infarction, coronary artery bypass grafting, and stroke.

CONCLUSIONS

Magnet hospitals performed better on the Hospital Value-Based Purchasing Mortality Program than the Hospital Readmissions Reduction Program. The results of this study suggest the need for The Magnet Recognition Program to examine the role of nurses in postdischarge activities as a component of its evaluation criteria.

Smoke-Free Policies and 30-Day Readmission Rates for Chronic Obstructive Pulmonary Disease

INTRODUCTION

Previous evidence has shown that smoke-free policies reduce hospital admissions due to respiratory causes, but the impact on 30-day readmission has not been determined. As 25 states in the U.S. have not adopted comprehensive smoke-free legislation, it is likely that patients return to an environment that increases risk of a secondary event. The aim of this study is to investigate the impact of smoke-free policies on 30-day readmission rates for adults aged ≥65 years following hospitalization for chronic obstructive pulmonary disease in the U.S.

METHODS

Data from the U.S. Tobacco Control Laws Database, Centers for Medicare and Medicaid Services Hospital Readmissions Reduction Program, American Hospital Association, Area Health Resource File, and U.S. Census Bureau Current Population Survey were merged at the county level for years 2013-2016 and analyzed in 2018. Hierarchical Poisson regression models were utilized to calculate incidence rate ratios to determine the impact of full, partial, and no smoke-free policies on 30-day readmission rates after chronic obstructive pulmonary disease hospitalization.

RESULTS

Multivariable analysis adjusting for both county and hospital characteristics revealed that the presence of full (incidence rate ratio=0.81, 95% CI=0.76, 0.88) and partial (incidence rate ratio=0.87, 95% CI=0.81, 0.92) smoke-free policies were associated with fewer 30-day readmissions for chronic obstructive pulmonary disease-related hospitalizations when compared with counties with no smoke-free policy.

CONCLUSIONS

The implementation of smoke-free policies is an effective measure for reducing 30-day readmissions following hospitalization due to chronic obstructive pulmonary disease, with stronger policies resulting in decreased risk. Efforts to reduce chronic obstructive pulmonary disease-related 30-day readmissions should include the implementation of smoke-free policies.

The work engagement of nurses in multiple hospital sectors in Saudi Arabia: a comparative study

AIM

To examine the differences in work engagement among nurses in Saudi Arabia and its relationship with personal characteristics across different hospital affiliations.

BACKGROUND

Quality care requires an adequate supply of engaged nurses who are dedicated, energised and absorbed in their work. In the nursing profession, work engagement is of considerable importance, owing to the shortage of nurses and the continuing reduction in healthcare costs.

METHOD

An analytic comparative cross-sectional design was used. Eight hospitals from three provinces and different affiliation types participated in the study. The Utrecht work engagement scale (UWES) was used to measure 980 nurses' work engagement.

RESULTS

The findings indicate that nurses' total engagement scores were closer to the higher end of the Likert scale. The findings indicate generally high levels of work engagement, particularly regarding the element of dedication. Furthermore, the study shows significant differences in nurses' engagement among the various work settings and in nurses' age and experience.

CONCLUSIONS

A number of nurses' personal characteristics have independent influences on their work engagement.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse leaders should acknowledge that a statement of professional nursing scope of practice is a necessity to encourage and fulfil engagement.

Developing an understanding of research-based nursing pedagogy among clinical instructors: a qualitative study

BACKGROUND

Effective instruction is imperative to the learning process of clinical nursing instructors. Faculty members are required to provide high-quality teaching and training by using new ways of teaching pedagogical methods to clinical instructors, which have transformed pedagogies from an exclusive clinical model to a holistic model.

PURPOSE

The purpose of this study was to explore clinical instructors' use of planning, implementation, feedback loops, and reflection frameworks to apply research-based teaching and to examine the pedagogy used during field experience.

METHOD

Data for the qualitative study were obtained from twenty purposefully sampled clinical teachers (n=20) via lists of questioned instructional practices and discussions, semi-structured interviews, observational notes, field notes, and written reflections. Data were analyzed by using a triangulation method to ensure trustworthiness, credibility, and reliability.

FINDINGS

Three main themes emerged regarding the use of research-based teaching strategies: the need for learning about research-based pedagogy, support mechanisms to implement innovative teaching strategies, and transitioning from nursing student to nursing clinical instructors.

CONCLUSION

It has been well documented that the nursing profession faces a serious shortage of nursing faculty, impacting the quality of clinical teaching. Developing clinical instructor programs to give students opportunities to select instructor pathways, focusing on knowledge promoting critical thinking and life-long professional development, is essential. Nursing colleges must collaborate by using a partnership model to achieve competency in planning, implementation, feedback loops, and reflection. Applying research-based clinical teaching requires the development of programs that integrate low-fidelity simulation and assisted instruction through the use of computers in Nursing Colleges.