scholarly journals Antecedents of patient health outcomes in dialysis clinics: a national study

2017 ◽  
Vol 10 (1) ◽  
pp. 25-48 ◽  
Author(s):  
Chenzhang Bao ◽  
Indranil Bardhan
Keyword(s):  
Health Outcomes ◽  
Practice Patterns ◽  
Quality Measures ◽  
Clinical Practices ◽  
Dialysis Adequacy ◽  
Process Measures ◽  
Clinical Quality ◽  
Content Type ◽  
Patient Health ◽  
The Usa

Purpose The purpose of this study is to evaluate the determinants of health outcomes of dialysis patients, while specifically focusing on the role of dialysis process measures and dialysis practice characteristics. The dialysis industry is facing a major transition from a volume-based health care system to a value-based cost-efficient care model, in the USA. Under the bundled Prospective Payment System, the treatment-based payment model is subject to meeting quality thresholds as defined by clinical process measures including dialysis adequacy and anemia management. Few studies have focused on studying these two processes and their association with the quality of patient health outcomes. Design/methodology/approach In this study, the authors focus on identifying the determinants of patient health outcomes among freestanding dialysis clinics, using a large cross-sectional data set of 4,571 dialysis clinics in the USA. The authors use econometric analyses to estimate the association between dialysis facility characteristics and practice patterns and their association with dialysis process measures and hospitalization risk. Findings The authors find that reusing dialyzers and increasing the number of dialysis stations is associated with higher levels of clinical quality. This research indicates that deploying more nurses on-site allows patients to avail adequate dialysis, while increasing the supply of physicians can hurt anemia control process. In addition, the authors report that offering peritoneal dialysis and late night shifts are not beneficial practices in terms of their impact on the hospitalization risk. Research limitations/implications While early studies of dialysis care mainly focused on the associations between practice patterns and patient outcomes, this research reveals the underlying mechanisms of these relationships by exploring the mediation effects of clinical dialysis processes on patient outcomes. The results indicate that dialysis process measures mediate the impact of the operational characteristics of dialysis centers on patient hospitalization rates. Practical implications This study offers several managerial insights for owners and operators of dialysis clinics with respect to the association between managerial and clinical practices that they deploy within dialysis clinics and their impact on clinical quality measures as well as hospitalization risk of patients. Managers can draw on this study to optimize staffing levels in their dialysis clinics, and implement innovative clinical practices. Social implications Considering the growth in healthcare expenditures in developing and developed countries, and specifically for costly diagnoses such as dialyses, this study offers several insights related to the inter-relationships between dialysis practice patterns and their clinical quality measures. Originality/value This study makes several major contributions. First, the authors address the extant gap in the literature on the relationships between dialysis facility and practice characteristics and clinical outcomes, while specifically highlighting the role of clinical process measures as antecedents of patient hospitalization ratio, a key metric used to measure performance of dialysis clinics. Second, this study sheds light on the underlying mechanisms that serve as enablers of the dialysis adequacy and anemia management. To the best of the authors’ knowledge, this is the first study to explore these relationships in the dialysis industry. The authors’ approach provides a new direction for future studies to explore the pathways that may impact clinical quality measures in the delivery of dialysis services.

scholarly journals Health disparities of Latino immigrant workers in the United States

2015 ◽  
Vol 11 (4) ◽  
pp. 282-298 ◽  
Author(s):  
Adam Hege ◽  
Quirina M. Vallejos ◽  
Yorghos Apostolopoulos ◽  
Michael Kenneth Lemke
Keyword(s):  
Health Disparities ◽  
Occupational Health ◽  
Health Outcomes ◽  
Intervention Programs ◽  
Immigrant Workers ◽  
Systems Science ◽  
Content Type ◽  
Latino Immigrant ◽  
The Usa ◽  
Latino Immigrant Workers

Purpose – The purpose of this paper is to provide an overview of the literature pertaining to occupational health disparities experienced by Latino immigrant workers in the USA and to advance a general framework based on systems science to inform epidemiological and intervention research. Design/methodology/approach – Using papers and other sources from 2000 to the present, the authors examined the employment conditions and health outcomes of Latino immigrant workers and critically analyzed the pervasive evidence of health disparities, including causal mechanisms and associated intervention programs. Findings – The occupations, including the work environment and resultant living conditions, frequently performed by Latino immigrants in the USA represent a distinct trigger of increased injury risk and poor health outcomes. Extant intervention programs have had modest results at best and are in need of more comprehensive approaches to address the complex nature of health disparities. Practical implications – An integrated, systems-based framework concerning occupational health disparities among Latino immigrant workers allows for a holistic approach encompassing innovative methods and can inform high-leverage interventions including public policy. Originality/value – Reductionist approaches to health disparities have had significant limitations and miss the complete picture of the many influences. The framework the authors have provided elucidates a valuable method for reducing occupational health disparities among Latino immigrant workers as well as other populations.

Implicit bias in US medicine: complex findings and incomplete conclusions

2017 ◽  
Vol 10 (1) ◽  
pp. 43-55 ◽  
Author(s):  
Makini Chisolm-Straker ◽  
Howard Straker
Keyword(s):  
Patient Outcomes ◽  
Implicit Bias ◽  
Clinical Encounter ◽  
Unconscious Bias ◽  
Content Type ◽  
Medline Search ◽  
Treatment Regimens ◽  
Black Patients ◽  
Patient Health ◽  
The Usa

Purpose Implicit bias is the application of an unconscious attitude or belief; in the clinical setting, a provider’s perception of a patient, based upon perceived race or ethnicity, is hypothesized to affect clinical decisions, provider-patient interactions and patient health. The purpose of this paper is to provide a brief synopsis of and critique the relevant works over the past 15 years while highlighting the strengths of this body of literature. Design/methodology/approach A MEDLINE search, from 2000 to 2015, using the terms “implicit bias,” “unconscious bias” and “aversive racism” was performed. US-based studies investigating the effect of racial or ethnic implicit bias on the clinical encounter or patient outcomes were assessed. In total, 15 articles were eligible for review. Findings Despite well-reasoned hypotheses that racial/ethnic bias negatively affects patient care, this review found mixed results. Largely, studies showed that US-providers hold an anti-black implicit bias negatively affecting patient-provider communication and patient satisfaction. But studies have not shown that this bias consistently negatively affects diagnosis and treatment regimens of black patients in comparison to white patients. There is a significant dearth of implicit bias literature addressing the care of other patient groups of color. Originality/value This review of the recent literature challenges the black-white dichotomy of most implicit bias research in the USA and highlights the lack of patient-oriented outcome research in this field. Furthermore, it demonstrates that regardless of the effect of implicit bias on patient outcomes, focus on eliminating implicit bias is insufficient to improve the health of people of color.

Assessing the relationship between patient satisfaction and clinical quality in an ambulatory setting

2016 ◽  
Vol 30 (7) ◽  
pp. 1063-1080 ◽  
Author(s):  
Tawnya Bosko ◽  
Kathryn Wilson
Keyword(s):  
Patient Satisfaction ◽  
Negative Relationship ◽  
Quality Measures ◽  
Quality Metrics ◽  
Ambulatory Setting ◽  
Clinical Quality ◽  
Content Type ◽  
Preventative Measures ◽  
Physician Performance ◽  
The Relationship

Purpose The purpose of this paper is to assess the relationship between patient satisfaction and a variety of clinical quality measures in an ambulatory setting to determine if there is significant overlap between patient satisfaction and clinical quality or if they are separate domains of overall physician quality. Assessing this relationship will help to determine whether there is congruence between different types of clinical quality performance and patient satisfaction and therefore provide insight to appropriate financial structures for physicians. Design/methodology/approach Ordered probit regression analysis is conducted with overall rating of physician from patient satisfaction responses to the Clinician and Groups Consumer Assessment of Healthcare Providers and Systems survey as the dependent variable. Physician clinical quality is measured across five composite groups based on 26 Healthcare Effectiveness Data and Information Set (HEDIS) measures aggregated from patient electronic health records. Physician and patient demographic variables are also included in the model. Findings Better physician performance on HEDIS measures are correlated with increases in patient satisfaction for three composite measures: antibiotics, generics, and vaccination; it has no relationship for chronic conditions and is correlated with decrease in patient satisfaction for preventative measures, although the negative relationship for preventative measures is not robust in sensitivity analysis. In addition, younger physicians and male physicians have higher satisfaction scores even with the HEDIS quality measures in the regression. Research limitations/implications There are four primary limitations to this study. First, the data for the study come from a single hospital provider organization. Second, the survey response rate for the satisfaction measure is low. Third, the physician clinical quality measure is the percent of the physician’s relevant patient population that met the HEDIS measure rather than if the measure was met for the individual patient. Finally, it is not possible to distinguish if the significant coefficient estimates on the physician age and gender variables are capturing systematic differences in physician behavior or capturing patient bias. Practical implications The results suggest patient satisfaction and physician clinical quality may be complementary, capturing similar aspects of overall physician quality, across some clinical quality measures but for other measures satisfaction and clinical quality are unrelated or negatively related. Therefore, for some clinical quality metrics, it will be important to separately compensate clinical quality and satisfaction and understand the relationship between metrics. Finally, the strong relationship between the level of patient satisfaction and physician age, physician gender, and patient age are important to consider when designing a physician compensation package based on patient satisfaction; if these differences reflect patient bias they could increase inequality among medical staff if compensation is based on patient satisfaction. Originality/value This study is the first to use physician organization data to examine patient satisfaction and physician performance on a variety of HEDIS quality metrics.

A systematic review on the health of African immigrants in the United States: synthesizing recommendations for future research

2020 ◽  
Vol 16 (2) ◽  
pp. 121-136
Author(s):  
Jason Semprini
Keyword(s):  
Systematic Review ◽  
Health Outcomes ◽  
Systematic Reviews ◽  
Full Text ◽  
African Immigrants ◽  
Future Research ◽  
Primary Study ◽  
Content Type ◽  
The Usa ◽  
Final Synthesis

Purpose The purpose of this paper is to conduct a systematic review of published literature studying the health of African immigrants in the USA and to develop a formal set of recommendations for future researchers aiming to improve the health outcomes in this population. Design/methodology/approach A comprehensive search was initiated on PubMed, Cochrane, ERIC, DOAJ, Prospero and Scopus databases. Final inclusion criteria were: systematic reviews, studying African Immigrants in the USA, measuring a clinical health outcome, since 1999. Articles were screened in four stages by title, abstract, full-text of the review and full-text of the primary studies within each review. Data was abstracted by identifying general information, study population, outcome measurements, conclusions and recommendations of each review. Findings In the initial search, 519 potential reviews were identified. After removing duplicates, 473 articles were excluded by screening the title or abstract. After a full-text review of each article and primary study within each article, nine reviews were included in the final synthesis. Reviews covered Female Genital Cutting and Pregnancy Outcomes, Caesarean Births, Gestational Diabetes, Cancer, HIV/AIDS, Body-weight and Acculturation. Among the primary reports included in the final synthesis, less than 50 per cent studied African immigrants in the USA. African Americans living in the USA made up only 11 per cent of the pooled study sample. Research limitations/implications Immigrants from Africa are one of the fastest-growing populations in the USA. This group has been underrepresented in health research, leading to a poor understanding of the group’s health outcomes. Health researchers must adopt recommendations and prioritize studies that meet the health needs of Africans during this time of demographic transition. Originality/value Systematic reviews represent a bedrock of medical evidence and signify a solid understanding of accepted knowledge in the field. Systematic reviews, however, do not necessarily constitute the end of discovery. Researchers can use existing systematic reviews to critique previous studies or initiate future research. There remain significant research gaps analyzing the health outcomes, behaviors and treatment of subgroups of African immigrants living in the USA. Future research should shift toward the growing needs of the population, leveraging the strengths and diversity of African immigrants now living in the USA.

A narrative literature review on the health of migrant farm worker children in the USA

2014 ◽  
Vol 10 (1) ◽  
pp. 1-17 ◽  
Author(s):  
Ann Connor ◽  
Laura Page Layne ◽  
Laura Ellis Hilb
Keyword(s):  
Well Being ◽  
Narrative Review ◽  
Care Utilization ◽  
Farm Worker ◽  
Clinical Practices ◽  
Pediatric Health ◽  
Content Type ◽  
Migrant Populations ◽  
The Usa ◽  
Migrant Farm

Purpose – The purpose of this paper is to provide a comprehensive narrative review of the literature on migrant farm worker child and adolescent health. It highlights current health issues and suggests methods to improve research and clinical practices with this underserved and vulnerable population. Design/methodology/approach – The methodology for this narrative review included a search of articles published between 2000 and 2012. From the primary search, 76 articles met the search criteria. A secondary search revealed three additional articles. Findings – The various methodologies used in the current literature have limited rigorous analysis of the health of pediatric migrant populations. The findings highlight the complex factors that influence migrant pediatric health. Despite the many challenges migrant farm worker children and their families face, they exhibit enormous resilience and strengths that may help counterbalance these challenges. Study categories that emerged from the analysis include health perspectives and behaviors, occupational health, access to care, utilization and satisfaction with health services, health outcomes and health disparities, and oral health. This review provides a strong foundation from which to work toward improving migrant pediatric health. Originality/value – This paper provides an original review of the unique health needs and the complex factors influencing the health of migrant farm worker children and adolescents. This will be of value to clinicians and researchers since migrant farm worker families are part of communities across the country. It offers public health professionals insight into services and programs that can improve the health and well-being of children, families, and communities.

Developing movement experiences with refugees to the United States who have undergone trauma

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Rebekka Dieterich-Hartwell ◽  
Craig Haen ◽  
Girija Kaimal ◽  
Sabine Koch ◽  
Augusta Villanueva ◽  
...  
Keyword(s):  
Grounded Theory ◽  
The United States ◽  
Theory Model ◽  
Treatment Modalities ◽  
Clinical Practices ◽  
Dance Movement ◽  
Content Type ◽  
Expressive Movement ◽  
Holistic Treatment ◽  
The Usa

Purpose The purpose of this study is to investigate what resources recent refugees to the USA tap into and how collaborative expressive movements were experienced with regard to coping and resourcing, and to derive a theoretical model that would inform the use of dance/movement therapy and other holistic treatment modalities with refugees. Design/methodology/approach A total of 13 refugees overall participated in parts of this study. Ten of these refugees completed movement sessions and semi-structured in-person interviews. Constructivist grounded theory methods and descriptive statistics were used to analyze the data. Findings The findings suggest that refugees draw on a number of resources. The collaborative movement experiences seemed to have both a settling and mobilizing effect with the most important phenomenon of connection to the self or to another person. A grounded theory model, developed based on the findings, shows a dynamic interaction between the encountered categories. Research limitations/implications The findings are preliminary and not transferrable because of limited size and potential researcher bias. Practical implications The findings contribute to an understanding of the resettlement and acculturation phase of refugees with potential implications and suggestions for current clinical practices and health services. Originality/value This study was original in its focus on understanding the role and the potential of body and expressive movement among refugees who have experienced trauma. Adherence to transformative paradigm principles invited participants to become co-researchers.

Don't Fear Clinical Quality Measures

2012 ◽  
Vol 42 (11) ◽  
pp. 51
Author(s):  
CHRISTOPHER NOTTE ◽  
NEIL SKOLNIK
Keyword(s):  
Quality Measures ◽  
Clinical Quality

Education and skills training for care partners of hospitalised older adults: A scoping review

2021 ◽  
pp. 001789692110341
Author(s):  
Madeline Carbery ◽  
Samantha Schwartz ◽  
Nicole Werner ◽  
Beth Fields
Keyword(s):  
Older Adults ◽  
Hospital Admission ◽  
Health Outcomes ◽  
Older Adult ◽  
Scoping Review ◽  
Hospital Care ◽  
Skills Training ◽  
Individual Care ◽  
Care Partners ◽  
The Usa

Background: The care partners of hospitalised older adults often feel dissatisfied with the education and skills training provided to them, resulting in unpreparedness and poor health outcomes. Objective: This review aimed to characterise and identify gaps in the education and skills training used with the care partners of older adults in the hospital. Methods: We conducted a scoping review on the education and skills training practices used with the care partners of hospitalised older adults in the USA via sources identified in the PubMed, PsychINFO and CINAHL databases. Results: Twelve studies were included in this review. Results illustrate that nurses utilise multiple modes of delivery and frequently provide education and skills training tailored to the needs of care partners at the latter end of hospital care. The provision of education and skills training varies greatly, however, including who provides education, in what way information is conveyed, and how care partner outcomes are measured. Conclusion: This is the first scoping review to describe and synthesise the education and skills training practices used with care partners of hospitalised older adults. Findings highlight the need for education and skills training to be interprofessional, tailored to individual care partners’ needs and begin at, or even before, the hospital admission of older adult patients.

scholarly journals The Rapid Mood Screener: A Novel and Pragmatic Screener Tool for Bipolar I Disorder

CNS Spectrums ◽  
2021 ◽  
Vol 26 (2) ◽  
pp. 167-168
Author(s):  
C. Brendan Montano ◽  
Mehul Patel ◽  
Rakesh Jain ◽  
Prakash S. Masand ◽  
Amanda Harrington ◽  
...  
Keyword(s):  
Risk Factors ◽  
Primary Care ◽  
Health Outcomes ◽  
Screening Tool ◽  
Clinical Interview ◽  
Clinical Practices ◽  
Predictive Values ◽  
Bipolar I Disorder ◽  
Manic Symptoms ◽  
Depressive Episodes

AbstractIntroductionApproximately 70% of patients with bipolar disorder (BPD) are initially misdiagnosed, resulting in significantly delayed diagnosis of 7–10 years on average. Misdiagnosis and diagnostic delay adversely affect health outcomes and lead to the use of inappropriate treatments. As depressive episodes and symptoms are the predominant symptom presentation in BPD, misdiagnosis as major depressive disorder (MDD) is common. Self-rated screening instruments for BPD exist but their length and reliance on past manic symptoms are barriers to implementation, especially in primary care settings where many of these patients initially present. We developed a brief, pragmatic bipolar I disorder (BPD-I) screening tool that not only screens for manic symptoms but also includes risk factors for BPD-I (eg, age of depression onset) to help clinicians reduce the misdiagnosis of BPD-I as MDD.MethodsExisting questionnaires and risk factors were identified through a targeted literature search; a multidisciplinary panel of experts participated in 2 modified Delphi panels to select concepts thought to differentiate BPD-I from MDD. Individuals with self-reported BPD-I or MDD participated in cognitive debriefing interviews (N=12) to test and refine item wording. A multisite, cross-sectional, observational study was conducted to evaluate the screening tool’s predictive validity. Participants with clinical interview-confirmed diagnoses of BPD-I or MDD completed a draft 10-item screening tool and additional questionnaires/questions. Different combinations of item sets with various item permutations (eg, number of depressive episodes, age of onset) were simultaneously tested. The final combination of items and thresholds was selected based on multiple considerations including clinical validity, optimization of sensitivity and specificity, and pragmatism.ResultsA total of 160 clinical interviews were conducted; 139 patients had clinical interview-confirmed BPD-I (n=67) or MDD (n=72). The screening tool was reduced from 10 to 6 items based on item-level analysis. When 4 items or more were endorsed (yes) in this analysis sample, the sensitivity of this tool for identifying patients with BPD-I was 0.88 and specificity was 0.80; positive and negative predictive values were 0.80 and 0.88, respectively. These properties represent an improvement over the Mood Disorder Questionnaire, while using >50% fewer items.ConclusionThis new 6-item BPD-I screening tool serves to differentiate BPD-I from MDD in patients with depressive symptoms. Use of this tool can provide real-world guidance to primary care practitioners on whether more comprehensive assessment for BPD-I is warranted. Use of a brief and valid tool provides an opportunity to reduce misdiagnosis, improve treatment selection, and enhance health outcomes in busy clinical practices.FundingAbbVie Inc.

scholarly journals When rebuilding no longer means recovery: the stress of staying put after Hurricane Sandy

2021 ◽  
Vol 165 (3-4) ◽  
Author(s):  
Liz Koslov ◽  
Alexis Merdjanoff ◽  
Elana Sulakshana ◽  
Eric Klinenberg
Keyword(s):  
Climate Change ◽  
Mental Health ◽  
Health Outcomes ◽  
Social Economic ◽  
Hurricane Sandy ◽  
Flood Insurance ◽  
Health Consequences ◽  
The Usa ◽  
Policy Shifts ◽  
Post Disaster

AbstractAfter a disaster, it is common to equate repopulation and rebuilding with recovery. Numerous studies link post-disaster relocation to adverse social, economic, and health outcomes. However, there is a need to reconsider these relationships in light of accelerating climate change and associated social and policy shifts in the USA, including the rising cost of flood insurance, the challenge of obtaining aid to rebuild, and growing interest in “managed retreat” from places at greatest risk. This article presents data from a survey of individuals who opted either to rebuild in place or relocate with the help of a voluntary home buyout after Hurricane Sandy. Findings show those who lived in buyout-eligible areas and relocated were significantly less likely to report worsened stress than those who rebuilt in place. This suggests access to a government-supported voluntary relocation option may, under certain circumstances, lessen the negative mental health consequences associated with disaster-related housing damage.

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