scholarly journals Socioeconomic Factors Affecting Discharge Status of Patients with Uncomplicated Transsphenoidal Adenohypophysectomy

2018 ◽  
Vol 79 (05) ◽  
pp. 501-507
Author(s):  
Jennifer Villwock ◽  
Kevin Sykes ◽  
Roukoz Chamoun ◽  
D. Beahm ◽  
Chelsea Hamill
Keyword(s):  
Socioeconomic Factors ◽  
Private Insurance ◽  
Organizational Factors ◽  
Healthcare Research ◽  
Median Income ◽  
Factors Affecting ◽  
Discharge Disposition ◽  
Discharge Status ◽  
The Impact ◽  
Total Charges

Objectives The number of transsphenoidal adenohypophysectomies (TSAs) surgeries has grown significantly since 1993. While there has been an overall decreasing trend in length of stay (LOS), socioeconomic factors may impact hospitalization. This study explores the impact of socioeconomic factors on LOS and total charges in uncomplicated patients undergoing TSA. Design Retrospective cohort. Setting 2009 to 2013 Nationwide Inpatient Sample. Participants Patients undergoing TSA without medical complications. Main Outcomes Measures LOS and total charges. Results A total of 6,457 patients were identified, of which 17.2% had secreting tumors. Patients with secreting tumors stayed 2.95 days versus those with nonsecreting tumors stayed 3.26 days (p < 0.001). Discharge to other than self-care was the largest contributing variable for both subsets, increasing both LOS and total charges. Patient factors that drove longer LOS and increased total charges for both subsets included metropolitan domicile, having a lower median income, Hispanic ethnicity, and having an increased amount of Agency for Healthcare Research and Quality (AHRQ) comorbidity indices. Having private insurance predicted a shorter LOS and lower total charges. Conclusions These results demonstrate that, even without complications, patients can be delayed in their discharge. While several socioeconomic factors significantly predict LOS and charges, the discharge disposition ultimately has the greatest effect. This suggests that efforts should focus on improving organizational factors such as coordination with social work and outside facilities to decrease LOS and charges for this patient population.

Association of socioeconomic disparities with underutilization of palliative care in patients with metastatic foregut cancer.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 502-502
Author(s):  
Michelle Ju ◽  
Matthew R. Porembka
Keyword(s):  
Palliative Care ◽  
Socioeconomic Factors ◽  
Private Insurance ◽  
Community Setting ◽  
Education Level ◽  
Median Income ◽  
Integrated Network ◽  
Cancer Program ◽  
The Impact ◽  
To Receive

502 Background: Metastatic foregut cancers (MFC) are frequently associated with debilitating symptoms that have significant negative impact on patients’ quality of life. Palliative care (PC) is effective in mitigating disease-, psychosocial-, and treatment-related effects. However, PC remains heavily underutilized. The aim of our study was to characterize the rate of PC utilization in MFC and determine the impact of various clinicopathologic and socioeconomic factors associated with the receipt of PC. Methods: We conducted a retrospective review of 277,957 National Cancer Database patients diagnosed with MFC between 2004-2013. Chi-squared tests were used to analyze differences between groups. Logistic regression was performed to assess the impact of factors on the likelihood of receiving PC. Results: PC utilization increased among all groups over time (12.3% 2004-2006 vs. 14.7% 2007-2010 vs. 16.4% 2011-2013 for all cancers). Female sex, Medicaid, median income < $46,000/year, higher education level, higher Charlson/Deyo Score, and pancreatic or biliary cancers were associated with increased likelihood of PC interventions. Additionally, patients treated at an academic center or integrated network cancer program were more likely to receive PC than patients treated in the community setting. When receipt of PC was stratified by race, Hispanics were significantly less likely to have undergone palliative interventions compared to non-Hispanic Whites (OR 0.70, 95% CI 0.66-0.73). Patients with Medicare or private insurance were less likely to receive PC than uninsured patients (OR 0.92, 95% CI 0.87-0.97 and 0.81, 95% CI 0.77-0.89, respectively). Conclusions: Differences in palliative care receipt rates exist with regards to racial/ethnic and socioeconomic factors such as insurance status, median household income, and education level. Patients receiving care in the community setting were also less likely to receive palliative care than those treated at academic or integrated network cancer program centers. Further studies are needed to delineate why these disparities exist with regards to palliative care utilization.

Information Technology Audit Quality: An Investigation of the Impact of Individual and Organizational Factors

2020 ◽  
pp. 0000-0000
Author(s):  
M. Dale Stoel ◽  
Doug Havelka
Keyword(s):  
Information Technology ◽  
Audit Quality ◽  
Organizational Factors ◽  
Quality Factors ◽  
Factors Affecting ◽  
News Stories ◽  
Audit Planning ◽  
Additional Education ◽  
It Audit ◽  
The Impact

Major news stories demonstrate the importance and vulnerability of information technology (IT); highlighting the need to understand how to reduce risk. This study investigates the key factors affecting IT audit quality (ITAQ), focusing on individual auditor and organizational factors. We utilize multiple approaches to understand professionals' general perceptions of ITAQ and results from specific audits. Our results suggest that the importance of IT audit quality factors differs between participants' general perceptions and those reported for specific IT audit experiences. Participants' general perceptions indicated that the most important factors for ITAQ were auditors' knowledge and skills, specifically IT and business process knowledge. By comparison, actual audit experiences suggest organizational factors as more important, specifically audit planning and the auditor-client relationship. We believe these differences between general perceptions and reported results suggest a potential opportunity to improve ITAQ via additional education and upfront development of the audit teams and processes.

The effect of socioeconomic factors on the outcome of intrahepatic cholangiocarcinoma.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 465-465
Author(s):  
Cortlandt Sellers ◽  
Johannes M Ludwig ◽  
Johannes Uhlig ◽  
Stacey Stein ◽  
Jill Lacy ◽  
...  
Keyword(s):  
Socioeconomic Factors ◽  
Intrahepatic Cholangiocarcinoma ◽  
Private Insurance ◽  
Tertiary Care ◽  
Locoregional Therapy ◽  
Care Hospital ◽  
Proportional Hazard ◽  
Cox Proportional Hazard ◽  
Kaplan Meier ◽  
The Impact

465 Background: To investigate the impact of socioeconomic factors on overall survival (OS) for patients with intrahepatic cholangiocarcinoma (ICC) at an inner-city tertiary care hospital. Methods: Consecutive patients treated for ICC diagnosed between 2005 and 2016 in the cancer registry were studied. Patients were stratified by demographic, socioeconomic variables, and treatment course. Kaplan-Meier curves and Cox proportional hazard modeling were performed. Results: Patients were 52% male (95 pts) and 74% white (136 pts) with mean age of 65.7 yrs (SD 10.7 yrs). 82% of patients were married or had been previously married (148 pts). 11% of patients had Medicaid as their primary insurance (20 pts), 45% of patients had Medicare (78 pts) and 44% of patients had private insurance (77 pts). Patients with private insurance (66 pts, 87%) and Medicare (64 pts, 83%) were more likely to have been married than Medicaid (12 pts, 60%) (p = 0.036). Patients with Medicare (mean 72.0 yrs, SD 6.9 yrs) were older than private insurance patients (mean 60.3 yrs, SD 10.3 yrs) and Medicaid patients (mean 61.8 yrs, SD 12.4 yrs) (p < 0.001). Gender and ethnicity were similarly distributed by primary insurance. Median OS stratified by primary insurance demonstrated median OS in private insurance of 13.2 mo (95% CI: 8.2–18.7 mo) vs 7.3 mo (95% CI: 3.8–10.6 mo) for Medicare (HR 1.3, p = 0.11) vs 4.7 mo (95% CI: 1.7–11.3 mo) for Medicaid (HR 1.8, p = 0.0488), (p = 0.0465). Cancer-directed treatments were utilized by 81% in private insurance vs. 67% in Medicare vs 67% in Medicaid (p = 0.18). Median OS stratified by main treatment demonstrated 43.3 mo in resection (37 pts, 21%), 17.3 mo in locoregional therapy (LRT) (22 pts, 13%), 10.0 mo in chemotherapy or radiation (79 pts, 45%), and 1.4 mo in palliative or no treatment (37 pts, 21%) (p < 0.0001). Increased age was associated with decreased median OS (correlation -0.23, p = 0.0019). No differences in median OS were seen with ethnicity, gender, or marital status. Conclusions: Screening and early treatments appear to affect the OS of patients with ICC. Further investigations for preventive care for vulnerable populations to enhance survivals are warranted.

Socioeconomic factors affecting mortality in rural Tanzania

1983 ◽  
Vol 15 (4) ◽  
pp. 487-500 ◽  
Author(s):  
Israel S. L. Sembajwe
Keyword(s):  
Socioeconomic Factors ◽  
Socioeconomic Development ◽  
Health Facilities ◽  
Factors Affecting ◽  
Rural Tanzania ◽  
The Impact

SummaryIn rural Tanzania, evidence is provided that socioeconomic development is more important in lowering mortality than the provision of health facilities and services. The impact of socioeconomic development on mortality is shown in the study.

Impact of admission month and hospital teaching status on outcomes in subarachnoid hemorrhage: evidence against the July effect

2012 ◽  
Vol 116 (1) ◽  
pp. 157-163 ◽  
Author(s):  
Robert J. McDonald ◽  
Harry J. Cloft ◽  
David F. Kallmes
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Hospital Mortality ◽  
Hospital Admissions ◽  
Adverse Outcomes ◽  
Discharge Disposition ◽  
July Effect ◽  
Teaching Status ◽  
Discharge Status ◽  
The Impact ◽  
Hospital Characteristics

Object The authors sought to identify the presence of a “July effect,” a transient increase in adverse outcomes during July, among a cohort of spontaneous subarachnoid hemorrhage (SAH) admissions recorded in the National Inpatient Sample (NIS). Methods The discharge status, admission month, patient demographics, treatment parameters, and hospital characteristics among spontaneous SAH admissions were extracted from the 2001–2008 NIS. Multivariate regression was used to determine whether an unfavorable discharge status and/or in-hospital mortality significantly increased in summer months in a pattern suggestive of a July effect. Additional models were generated to assess the impact of hospital teaching status on these outcomes. Results Among 57,663,486 hospital admissions from the 2001–2008 NIS, 52,879 cases of spontaneous SAH (ICD-9-CM 430) were treated at teaching (36,914 cases [70%]) and nonteaching (15,965 cases [30%]) facilities. Regression models failed to reveal a July effect for in-hospital mortality (χ2 = 0.75, p = 1.000) or unfavorable discharges (χ2 = 1.69, p = 0.999) among monthly SAH admissions, although they did suggest a significant reduction in these outcomes (in-hospital mortality, OR = 0.89, p < 0.001; unfavorable discharges, OR = 0.88, p < 0.001) among teaching hospitals as compared with nonteaching hospitals after adjustment for disparities in demographic, treatment, and hospital characteristics. Conclusions The discharge disposition among SAH admissions within the NIS was not suggestive of a July effect but did reveal that teaching institutions have significantly lower rates of adverse outcomes when compared with nonteaching hospitals. Note, however, that the origins of this difference related to teaching status remain unclear.

Interrelationships of factors causing delays in the relocation of utilities

2016 ◽  
Vol 23 (3) ◽  
pp. 349-368 ◽  
Author(s):  
Aneetha Vilventhan ◽  
Satyanarayana N. Kalidindi
Keyword(s):  
Construction Projects ◽  
Cognitive Mapping ◽  
Organizational Factors ◽  
Mapping Technique ◽  
Critical Factors ◽  
Content Type ◽  
Factors Affecting ◽  
Lack Of Information ◽  
Underground Utilities ◽  
The Impact

Purpose – Relocation of utilities is a major source of delay in Indian infrastructure projects. This delay is particularly critical in road and bridge construction projects. The purpose of this paper is to identify the various factors and also the interrelationships between the factors which influence the delays in the relocation of utilities. Design/methodology/approach – Case studies were conducted on 11 road and bridge projects in India with varying levels of complexity and size. Factors causing relocation delays were identified using computer aided qualitative analysis methodology. Cognitive mapping technique was used to map the interrelationships between the factors and to identify the critical delay factors. Findings – Factors affecting delays were identified across two groups, namely, technical and organizational factors. The study offers insights into the kinds of interactions of factors that can lead to delays in a project. The critical factors causing delays were identified as slow response from utility agencies, difficulty in identification of underground utilities, lack of information on underground utilities and conflict between agencies. Research limitations/implications – The limitations of the study are that the interview respondents are not evenly distributed among the type of organizations which may have induced some bias in responses. The impact of the utility relocation delays on the overall project delay has to be detailed further. Practical implications – The interrelationships between factors has the potential to help the officials of highway department, contractors, utility agencies and others understand how various interactions/linkages of factors contributes to delays in utility relocations. Recommendations are provided for the practical use and to reduce the impact of delays. Originality/value – Utility relocation has received very little attention in the extant literature and this paper seeks to contribute to knowledge in this area by identifying the linkages between factors and the critical factors of utility relocation delays in India.

scholarly journals Investigating the reasons for failures and delays in R&D projects with the project management approach

2020 ◽  
Vol 1 (4) ◽  
pp. 319-334
Author(s):  
Saeed Ghorbani ◽  
◽  
Shayan Naghdi Khanachah ◽  
Keyword(s):  
Organizational Factors ◽  
Research Area ◽  
Influential Factors ◽  
Management Approach ◽  
Research Projects ◽  
Organizational Productivity ◽  
Factors Affecting ◽  
Effective Factors ◽  
The Subject ◽  
The Impact

Purpose: This study aimed to identify and investigate the reasons for failures and delays in R&D projects with an organizational productivity approach. Research methodology: In order to identify the most influential factors in the research area, a questionnaire with a Likert spectrum of five options was designed and distributed among the stakeholders of research projects. The questionnaire results were analyzed and 10 more effective factors were identified and solutions were used to improve the situation. Result: In the present study, after reviewing the background of the subject and reviewing previous studies, 149 factors affecting the failure and delay of projects were identified and after aggregating and summarizing the factors, a model was designed to classify the causes of delay in which 55 effective factors in two general categories. Intra-organizational and extra-organizational factors were examined. Limitations: This research only described Research-oriented organizations. Contribution: According to the analysis results regarding the more effective causes, problems and challenges related to each of the factors were studied and to reduce the impact of existing factors, various solutions and suggestions in the field of research variables using Expert opinion was provided.

Configurations of factors affecting triage decision-making

2018 ◽  
Vol 56 (10) ◽  
pp. 2148-2171 ◽  
Author(s):  
Cristina Ponsiglione ◽  
Adelaide Ippolito ◽  
Simonetta Primario ◽  
Giuseppe Zollo
Keyword(s):  
Decision Making ◽  
Comparative Analysis ◽  
Fuzzy Set ◽  
Qualitative Comparative Analysis ◽  
Organizational Factors ◽  
Public Hospitals ◽  
Content Type ◽  
Factors Affecting ◽  
Triage Decision ◽  
The Impact

Purpose The purpose of this paper is to explore the configuration of factors affecting the accuracy of triage decision-making. The contribution of the work is twofold: first, it develops a protocol for applying a fuzzy-set qualitative comparative analysis (fsQCA) in the context of triage decision-making, and second, it studies, through two pilot cases, the interplay between individual and organizational factors in determining the emergence of errors in different decisional situations. Design/methodology/approach The methodology adopted in this paper is the qualitative comparative analysis (QCA). The fuzzy-set variant of QCA (fsQCA) is implemented. The data set has been collected during field research carried out in the Emergency Departments (EDs) of two Italian public hospitals. Findings The results of this study show that the interplay between individual and contextual/organizational factors determines the emergence of errors in triage assessment. Furthermore, there are some regularities in the patterns discovered in each of the investigated organizational contexts. These findings suggest that we should avoid isolating individual factors from the context in which nurses make their decisions. Originality/value Previous research on triage has mainly explored the impact of homogeneous groups of factors on the accuracy of the triage process, without considering the complexity of the phenomenon under investigation. This study outlines the need to consider the not-linear relationships among different factors in the study of triage’s decision-making. The definition and implementation of a protocol to apply fsQCA to the triage process in EDs further contributes to the originality of the research.

The effect of socioeconomic factors on the outcome of hepatocellular carcinoma.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 466-466
Author(s):  
Cortlandt Sellers ◽  
Johannes M Ludwig ◽  
Johannes Uhlig ◽  
Stacey Stein ◽  
Tamar Hamosh Taddei ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Socioeconomic Factors ◽  
Private Insurance ◽  
Tertiary Care ◽  
Stage Iv ◽  
Care Hospital ◽  
Never Married ◽  
Kaplan Meier ◽  
Stage Iv Cancer ◽  
The Impact

466 Background: To investigate the impact of socioeconomic factors on overall survival (OS) for patients with hepatocellular carcinoma (HCC) at an inner-city tertiary care hospital. Methods: Consecutive patients treated for HCC diagnosed between 2005 and 2016 in the cancer registry were studied. Patients were stratified by demographic, socioeconomic variables and treatment course. Kaplan-Meier curves and Cox proportional hazard modeling were performed. Results: Patients were 79% male (770 pts) with mean age of 62.8 yrs (SD 10.2 yrs). 25% of patients (239 pts) had private insurance, 38% (363 pts) with Medicare, and 34% (239 pts) with Medicaid. Median OS stratified by primary insurance demonstrated a survival benefit for private insurance with 27.8 mo (95% CI 23.1–33.1) vs 21.0 mo (95% CI 16.5–26.5) for Medicare (HR 0.82, p = 0.0344) vs 13.3 mo (95% CI 10.2–19.7) for Medicaid (HR 0.80, p = 0.0002) (p = 0.0007). When further stratified by AJCC Stage, median OS in Stage II was 55.3 mo (95% CI: 32.4–67.1 mo) for private insurance vs 26.0 mo (95% CI: 18.7–36.3 mo) in Medicare vs 13.2 mo (95% CI: 9.0–38.1 mo) in Medicaid (p = 0.0309). Private insurance in Stage III had a median OS of 23.8 mo (95% CI: 10.9–39.8 mo) vs 14.6 mo (95% CI: 7.5–30.8 mo) in Medicare vs 6.7 mo in Medicaid (95% CI: 2.5–12.2 mo) (p = 0.0069). No differences were seen in Stage I and Stage IV. Cancer-directed treatments were utilized in 91% of private insurance vs 84% in Medicare vs 78% in Medicaid (p < 0.0001). Median OS stratified by marital status showed 23.7 mo (95% CI: 21.0–28.1 mo) for married (720 pts, 76%) vs 5.2 mo (95% CI: 9.6–20.1 mo) for never-married (227 pts, 24%) (p = 0.0009) (HR 1.4, p = 0.0013). Cancer-directed treatments were utilized by 87% of married vs 77% of never-married (p = 0.0016). Increased age was associated with decreased median OS (correlation -0.14, p < 0.0001). No differences in OS were seen with ethnicity or gender. Multivariate Cox proportional analysis demonstrated survival advantage for private insurance versus Medicaid (HR 1.3, p = 0.0435) and Medicare (HR 1.2, p = 0.0472). Conclusions: Primary insurance and social support appear to affect the OS of patients with HCC. Further investigations to elucidate the socioeconomic determinants to enhance survivals are warranted.

scholarly journals Individual, Interpersonal, and Organizational Factors Affecting Physical Activity of School Adolescents in Pakistan

2021 ◽  
Vol 18 (13) ◽  
pp. 7011
Author(s):  
Tayyaba Kiyani ◽  
Sumaira Kayani ◽  
Saima Kayani ◽  
Iffat Batool ◽  
Si Qi ◽  
...  
Keyword(s):  
Physical Activity ◽  
Public Health Intervention ◽  
Organizational Factors ◽  
Environmental Characteristic ◽  
Factors Affecting ◽  
Individual Level ◽  
Equipment Safety ◽  
Demographic Correlates ◽  
Multiple Levels ◽  
The Impact

The purpose of this study was to explore individual, interpersonal, and organizational factors that may influence the physical activity of adolescents (ages 10–14) in Pakistani schools. A set of questionnaires that included individual, interpersonal, and organizational factors and PA behavior was completed by the 618 students selected from Pakistani schools. Stepwise forward regression model was applied to check the possible effects of multilevel variables on physical activity and to extract the stronger predictors. The results showed that physical activity was significantly predicted by individual level factors such as self-efficacy, motivation, and attitude. Among the demographic correlates, gender, age, and BMI did not affect physical activity, while socioeconomic status and geographic characteristics had a meaningful association with PA. At the interpersonal level, adolescents’ perception of family support had a potential influence on physical activity, while there was no impact of friends/peers and teachers support on adolescents’ PA. A school environmental characteristic, such as PA facility, was positively related to PA; however, the impact of PA equipment, safety, and policy and PA culture were statistically non-significant. The findings suggest that public health intervention strategies aimed at promoting PA in adolescents should recognize multiple levels of influences that may either enhance or impede the likelihood of PA among adolescents.

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