Abstract W P311: Demographic and Regional Characteristics Associated With Advanced Primary Stroke Center Designation

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Catherine McDonald ◽  
Steven Cen ◽  
Lucas Ramirez ◽  
William J Mack ◽  
Nerses Sanossian
Keyword(s):  
Univariate Analysis ◽  
American Hospital ◽  
American Hospital Association ◽  
Healthcare Facilities ◽  
For Profit ◽  
Home Value ◽  
Regional Factors ◽  
Stroke Center ◽  
Zip Code ◽  
Hospital Characteristics

Background: Nationwide less than a third of eligible hospitals have achieved advanced certification in stroke, and there may be disparities affecting less affluent areas serving a higher proportion of minorities. We aimed to characterize demographic and regional factors associated with achievement of stroke center certification while controlling for hospital characteristics. Methods: We linked the 2011 American Hospital Association survey of hospital characteristics to the 2010 national census for population and household data by region. Emergency medical services stroke routing data was obtained from communication with state and county contact. Only hospitals with ≥ 25 beds and 24-hour emergency departments were evaluated. The Joint Commission, Healthcare Facilities Accreditation Program and DNV Healthcare websites were used to determine certification status of each hospital. We controlled for hospital bed size, teaching affiliation (AMA, ACGME), emergency department volume, rural designation, hospital type (governmental/for-profit/nonprofit), and trauma center designation in analysis. Results: Of the 3696 hospitals to complete the survey, the 3069 fulfilling study criteria included 908 PSC (31%) and 2161 non-PSC. In univariate analysis PSC hospitals were located in areas with greater population in immediate vicinity (29, 316 vs. 20,901, p<0.0001), greater proportion of minorities (73% white, 16% black, 15% Hispanic vs. 80%/12%/11%, p<0.0001), greater number of households per zip code (11,540 vs. 8050, p<0.0001) and a higher regional mean income ($52,112 vs. $46,262, p<0.0001) and higher home value ($234,000 vs. $170,000, p<0.0001). More PSC hospitals were located in regions with preferential EMS routing of stroke (52% vs. 40%). While controlling for hospital-based factors, the demographic and regional factors independently associated with hospital PSC designation were number of households per zip code (per 1000 households OR 1.1, 95%CI 1.0-1.2), increasing Hispanic population (every 10% increase OR 1.1, 1.0-1.2), and income per household (per $10,000 OR 1.2, 1.1-1.3). Conclusions: Hospitals achieving PSC designation are located in more affluent and densely populated areas with higher population of Hispanic residents.

Abstract T MP54: Hospital Characteristics Associated with Advanced Primary Stroke Center Designation

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Catherine McDonald ◽  
Steven Cen ◽  
Lucas Ramirez ◽  
William J Mack ◽  
Nerses Sanossian
Keyword(s):  
Systems Of Care ◽  
Improve Patient Care ◽  
Federal State ◽  
National Guidelines ◽  
American Hospital ◽  
American Hospital Association ◽  
Community Provider ◽  
Primary Stroke Center ◽  
Stroke Center ◽  
Hospital Characteristics

Background: Organized stroke systems of care, including accreditation of hospitals as primary stroke centers (PSC), are meant to improve patient care and compliance with national guidelines. Nationwide, less than a third of eligible hospitals have achieved advanced certification in stroke. We aimed to characterize hospital factors associated with achievement of stroke center certification. Methods: We utilized the 2011 American Hospital Association survey to obtain data on hospital characteristics. Only hospitals with ≥ 25 beds and 24-hour emergency departments were evaluated. The Joint Commission (TJC), Healthcare Facilities Accreditation Program and DNV Healthcare websites were used to determine certification status of each hospital as a primary stroke center. All comprehensive SC were considered as PSC. Factors found to be associated with achievement of certification (P<0.010) were evaluated by logistic regression to determine a final model of independent association. Results: Of the 3696 hospitals to complete the survey, 3069 fulfilled study criteria, including 908 PSC (31%) and 2161 non-PSC. PSC were larger (mean 354 vs. 136 beds), had busier EDs (56,000 vs. 24,000 visits/year), were more often affiliated with ACGME residency programs (43% vs. 14%), AMA medical schools (51% vs. 21%), TJC-accreditation (95% vs. 65%), inpatient neurological services (94% vs. 46%) and trauma centers (55% VS 38%); and were less likely to be governmental (Federal/State/County 10% vs. 26%) and designated sole community provider (1% vs 9%). Independent hospital characteristics associated with PSC certification were TJC accreditation (OR 3.5, 95%CI 2.4-5.0), sole community provider (OR 0.22, 0.10-0.47), hospital type (governmental vs. non 0.61, 0.44-0.84), increasing size (per quartile in number of beds OR 2.5, 2.1-3.1) and neurological services (OR 3.2, 2.4-4.6). Conclusions: PSC hospitals are larger non-governmental hospitals with availability of neurological services. Increasing the low numbers of governmental (i.e. County or State) hospital achievement of PSC may be a potential area of focus.

Hospital Religious Affiliation and Outcomes for High-Risk Infants

2011 ◽  
Vol 69 (3) ◽  
pp. 316-338 ◽  
Author(s):  
Melissa M. Garrido ◽  
Kirk C. Allison ◽  
Mark J. Bergeron ◽  
Bryan Dowd
Keyword(s):  
Health Care ◽  
Religious Affiliation ◽  
Perinatal Outcomes ◽  
Extremely Low Birth Weight ◽  
American Hospital ◽  
American Hospital Association ◽  
For Profit ◽  
Annual Survey ◽  
Not For Profit ◽  
Organizational Affiliation

The effect of hospital organizational affiliation on perinatal outcomes is unknown. Using the 2004 American Hospital Association Annual Survey and Healthcare Cost and Utilization Project State Inpatient Databases, the authors examined relationships among organizational affiliation, equipment and service availability and provision, and in-hospital mortality for 5,133 infants across five states born with very low and extremely low birth weight and congenital anomalies. In adjusted bivariate probit selection models, the authors found that government hospitals had significantly higher mortality rates than not-for-profit nonreligious hospitals. Mortality differences among other types of affiliation (Catholic, not-for-profit religious, not-for-profit nonreligious, and for-profit) were not statistically significant. This is encouraging as health care reform efforts call for providers at facilities with different institutional values to coordinate care across facilities. Although there are anecdotes of facility religious affiliation being related to health care decisions, the authors did not find evidence of these relationships in their data.

Accountable care organizations: a strategy for future success?

2018 ◽  
Vol 21 (2) ◽  
pp. 113-121
Author(s):  
Jeffrey Harrison ◽  
Aaron Spaulding ◽  
Debra A. Harrison
Keyword(s):  
Community Dynamics ◽  
Accountable Care Organizations ◽  
Accountable Care ◽  
Healthcare Organizations ◽  
American Hospital ◽  
American Hospital Association ◽  
Content Type ◽  
For Profit ◽  
Annual Survey ◽  
Final Rule

Purpose The purpose of this paper is to assess the community dynamics and organizational characteristics of US hospitals that participate in accountable care organizations (ACO). Design/methodology/approach Data were obtained from the 2015 American Hospital Association annual survey and the 2015 medicare final rule standardizing file. The study evaluated 785 hospitals which operate ACO in contrast to 1,446 hospitals without an ACO. Findings In total, 89 percent of hospitals using ACO’s are located in urban communities and 87 percent are not-for-profit. Hospitals with a higher case mix index are more likely to have an ACO. Practical implications ACOs allow healthcare organizations to expand their geographic markets, achieve greater efficiencies, and enhance the development of new clinical services. They also shift the focus of care from acute care hospitalization to the full continuum of care. Originality/value This research found ACOs with hospital and physician networks are an effective mechanism to control healthcare costs and reduce medical errors.

Association of partial nephrectomy and presence of robotic surgery for kidney cancer in the United States.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 484-484
Author(s):  
Steven V. Kardos ◽  
Brian Shuch ◽  
Peter Schulam ◽  
Quoc-Dien Trinh ◽  
Maxine Sun ◽  
...  
Keyword(s):  
Robotic Surgery ◽  
Partial Nephrectomy ◽  
Multivariable Analysis ◽  
The United States ◽  
Population Based ◽  
Cancer Center ◽  
Treatment Technology ◽  
American Hospital ◽  
American Hospital Association ◽  
Hospital Characteristics

484 Background: While hospital and surgeon characteristics are associated with the type of nephrectomy performed for renal cell carcinoma (RCC), it is unknown whether hospital presence of robotic surgery increases the likelihood of patients receiving partial nephrectomy (PN). Therefore, we evaluate the relationship of PN and hospital presence of robotic surgery from a population-based cohort in the U.S. Methods: After merging the Nationwide Inpatient Sample (NIS) and the American Hospital Association (AHA) survey from 2006 to 2008, we identified 21,999 patients who underwent either PN or radical nephrectomy (RN) for RCC. The primary outcome of this study was the type of nephrectomy performed. Multivariable logistic regression was used to identify hospital characteristics associated with receipt of PN, after adjusting for patient case mix. Results: Overall, we identified 4,832 (22.0%) and 16,347 (88.0%) patients who were surgically treated for RCC with PN and RN, respectively. On multivariable analysis, patients undergoing surgery were more likely to receive PN at academic (OR: 2.77;p<0.001), urban (OR: 3.66; p<0.001), and American College of Surgeon (ACOS) designated cancer centers (OR: 1.10; p<0.05) compared to non-academic, rural, and non-designated hospitals, respectively. After adjusting for patient and hospital characteristics, patients undergoing surgery at hospitals with presence of robotic surgery were also associated with higher adjusted odds ratios for receipt of PN compared to those treated at hospitals without the presence of this advanced treatment technology (OR: 1.28; p<0.001). Conclusions: While academic status and urban locations are established characteristics influencing the type of nephrectomy performed for RCC, ACOS cancer center designation and hospital presence of robotic surgery were also associated with higher use of PN. Our results are informative in identifying key hospital characteristics which may facilitate greater adoption of PN.

DISSEMINATION AND CHARACTERISTICS OF ACUTE CARE FOR ELDERS (ACE) UNITS IN THE UNITED STATES

2003 ◽  
Vol 19 (1) ◽  
pp. 220-227 ◽  
Author(s):  
Ravishankar Jayadevappa ◽  
Bernard S. Bloom ◽  
Donna Brady Raziano ◽  
Risa Lavizzo-Mourey
Keyword(s):  
Logistic Regression ◽  
Acute Care ◽  
Average Length ◽  
The Elderly ◽  
The United States ◽  
Economic Benefits ◽  
Stepwise Logistic Regression ◽  
American Hospital ◽  
American Hospital Association ◽  
Hospital Characteristics

Objective: The objective of this paper is to determine prevalence and characteristics of acute care for elders (ACE) units and hospital characteristics associated with the presence of an ACE unit.Methods: Data on characteristics and prevalence of ACE units were obtained by surveying all established geriatric medical divisions across U.S. medical schools. Data on hospital characteristics such as number of beds, revenue, number of Medicare inpatients, and average length of stay were obtained from the 1999 American Hospital Association Annual Survey Data. Descriptive statistics and t test were used to analyze the characteristics of ACE units. Stepwise logistic regression was used to analyze the hospital characteristics associated with the presence of an ACE unit.Results: The survey identified 16 geriatric divisions and programs with ACE units. Hospitals that have ACE units differ significantly with respect to number of beds and total revenue, compared with institutions that do not have an ACE unit. Stepwise logistic regression indicated total hospital revenue was the only factor significantly associated with the presence of an ACE unit.Conclusions: ACE units are attractive interdisciplinary models to address the particular needs of the elderly during their hospital stay. Low presence of ACE units warrants further research as to reasons more hospitals have not included them, given the available evidence for clinical, functional, and economic benefits.

Abstract WP318: Mortality Among Newly Certified Stroke Centers and Other Hospitals in the U.S.

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Shumei Man ◽  
Jesse D Schold ◽  
Ken Uchino
Keyword(s):  
Metastatic Cancer ◽  
Stroke Care ◽  
Prior History ◽  
Medicare Beneficiaries ◽  
American Hospital ◽  
American Hospital Association ◽  
Annual Survey ◽  
Primary Stroke Center ◽  
Short Term Mortality ◽  
Stroke Center

Introduction: Primary Stroke Center (PSC) certification was established to improve stroke care. The numbers of PSCs have significantly increased in the past decade. However, it remains unclear whether PSC certification has any impact on stroke mortality. We examined the short term mortality of hospitals that received initial PSC certification between 2009 and 2013 (new PSCs), compared to those received PSC certification before 2009 (existing PSCs) and those never received PSC certification (NSCs). Method: The inclusion criteria was Medicare beneficiaries aged ≥65 years who were hospitalized between January 1, 2009 to December 31, 2013 with a primary discharge diagnosis of ischemic stroke. The patient information were obtained from the Medicare Provider Analysis and Review (MEDPAR) file. The list and characteristics of hospitals were obtained from the American Hospital Association Annual Survey Database. This study included only those general hospitals with emergency departments. All statistical analyses were performed using SAS Version 9.4 software. Results: Among 1165,960 Medicare beneficiaries included in this study, 28.9% were treated at 2640 NSCs, 24.6% were treated at 634 new PSCs, and 46.6% were treated at 785 existing PSCs. Higher percentages of patients at new and existing PSCs had complicated hypertension, myocardial infarction, congestive heart failure, atrial fibrillation, prior history of cerebrovascular disease, any malignancy, metastatic cancer, peripheral artery disease and smoking (p<0.0001). New PSCs had the lowest unadjusted in-hospital all-cause mortality, followed by NSCs and existing PSCs (4.2%, 4.6% and 5% respectively). Both New and existing PSC groups had lower unadjusted 30 day compared to NSCs (12.5%, 13.2% and 13.7%). New PSCs had lower unadjusted and adjusted 30 day mortality than existing PSCs (Hazard Ratio 0.981, 95% Confidence Interval (0.968, 0.993)). Conclusion: The PSCs that were newly certified between 2009 and 2013 had lower unadjusted in-hospital and 30 day mortality after stroke than existing PSCs and NSCs. It is important to further understand whether this difference results from change in patient population or quality of care.

Characteristics of US Rural Hospitals by Obstetric Service Availability, 2017

2020 ◽  
Vol 110 (9) ◽  
pp. 1315-1317
Author(s):  
Katy B. Kozhimannil ◽  
Julia D. Interrante ◽  
Mariana S. Tuttle ◽  
Carrie Henning-Smith ◽  
Lindsay Admon
Keyword(s):  
United States ◽  
Obstetric Care ◽  
The United States ◽  
Rural Hospitals ◽  
American Hospital ◽  
American Hospital Association ◽  
For Profit ◽  
Annual Survey ◽  
Obstetric Services ◽  
Delivery Obstetric

Objectives. To describe characteristics of rural hospitals in the United States by whether they provide labor and delivery (obstetric) care for pregnant patients. Methods. We used the 2017 American Hospital Association Annual Survey to identify rural hospitals and describe their characteristics based on the lack or provision of obstetric services. Results. Among the 2019 rural hospitals in the United States, 51% (n = 1032) of rural hospitals did not provide obstetric care. These hospitals were more often located in rural noncore counties (counties with no town of more than 10 000 residents). Rural hospitals without obstetrics also had lower average daily censuses, were more likely to be government owned or for profit compared with nonprofit ownership, and were more likely to not have an emergency department compared with hospitals providing obstetric care (P for all comparisons < .001). Conclusions. Rural US hospitals that do not provide obstetric care are located in more sparsely populated rural locations and are smaller than hospitals providing obstetric care. Public Health Implications. Understanding the characteristics of rural hospitals by lack or provision of obstetric services is important to clinical and policy efforts to ensure safe maternity care for rural residents.

scholarly journals Strategies to Prevent Healthcare-Associated Infections through Hand Hygiene

2014 ◽  
Vol 35 (08) ◽  
pp. 937-960 ◽  
Author(s):  
Katherine Ellingson ◽  
Janet P. Haas ◽  
Allison E. Aiello ◽  
Linda Kusek ◽  
Lisa L. Maragakis ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Scientific Evidence ◽  
Guidance Document ◽  
American Hospital ◽  
American Hospital Association ◽  
Healthcare Facilities ◽  
Adherence Data ◽  
Improvement Programs ◽  
Healthcare Associated ◽  
Healthcare Epidemiology

Previously published guidelines provide comprehensive recommendations for hand hygiene in healthcare facilities. The intent of this document is to highlight practical recommendations in a concise format, update recommendations with the most current scientific evidence, and elucidate topics that warrant clarification or more robust research. Additionally, this document is designed to assist healthcare facilities in implementing hand hygiene adherence improvement programs, including efforts to optimize hand hygiene product use, monitor and report back hand hygiene adherence data, and promote behavior change. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise. The list of endorsing and supporting organizations is presented in the introduction to the 2014 updates.

The effect of guidelines, policy initiatives, and feedback tools on hospital adherence with the 12-node measure for colon cancer.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 65-65
Author(s):  
Jennifer L. Paruch ◽  
Ryan P. Merkow ◽  
Mila H. Ju ◽  
David Porter Winchester ◽  
Clifford Y. Ko ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Hospital Performance ◽  
National Cancer Data Base ◽  
Process Measures ◽  
American Hospital ◽  
American Hospital Association ◽  
Cancer Data ◽  
Policy Initiatives ◽  
Academic Hospitals ◽  
Hospital Characteristics

65 Background: Examination of > = 12 lymph nodes after colectomy is one of few surgical process measures. Several initiatives have targeted this measure; one tool developed by the Commission on Cancer (CoC) provides benchmarked feedback on hospital performance (CP3R). Our objectives were to (1) examine changes in measure performance over time in response to guidelines, policy initiatives, and feedback, and (2) identify hospital characteristics associated with failure to improve adherence. Methods: Patients having surgery for Stage I-III colon cancer (1990-2010) were identified from the National Cancer Data Base (NCDB). For hospital-level analyses, NCDB and American Hospital Association (2010) data were merged. Hospital CP3R use was obtained from the user log system. Multivariable logistic regression adjusted for age and tumor factors was used to identify hospital characteristics associated with adherence in 2009-2010 (> = 12 nodes in > 80% of patients). Results: The percentage of patients with > = 12 nodes removed increased from 31.5% in 1990 to 84.1% in 2010 (p < 0.0001). The percentage of adherent hospitals increased from 2.2% in 1990 to 70% in 2010 (p < 0.0001). The steepest increase in adherence occurred with introduction of CP3R. Median CP3R use increased from 5 to 57 logins annually (2005-2010). Hospital predictors of poor adherence included low volume, community hospital type, private ownership, rural location, and lower number of specialists (Table). Conclusions: Guidelines, policy initiatives, and feedback tools have helped dramatically increase adherence with the 12-node measure, but small, non-academic hospitals have been slower to improve. Additional efforts are needed to understand barriers and improve adherence at these facilities. [Table: see text]

scholarly journals Information technology to support patient engagement: where do we stand and where can we go?

2017 ◽  
Vol 24 (6) ◽  
pp. 1088-1094 ◽  
Author(s):  
Daniel M Walker ◽  
Cynthia J Sieck ◽  
Terri Menser ◽  
Timothy R Huerta ◽  
Ann Scheck McAlearney
Keyword(s):  
Information Technology ◽  
Health Information Technology ◽  
Health Information ◽  
Patient Engagement ◽  
Ontology Mapping ◽  
Hospital System ◽  
American Hospital ◽  
American Hospital Association ◽  
Ordered Logit Model ◽  
Hospital Characteristics

Abstract Objective Given the strong push to empower patients and make them partners in their health care, we evaluated the current capability of hospitals to offer health information technology that facilitates patient engagement (PE). Materials and Methods Using an ontology mapping approach, items from the American Hospital Association Information Technology Supplement were mapped to defined levels and categories within the PE Framework. Points were assigned for each health information technology function based upon the level of engagement it encompassed to create a PE-information technology (PE-IT) score. Scores were divided into tertiles, and hospital characteristics were compared across tertiles. An ordered logit model was used to estimate the effect of characteristics on the adjusted odds of being in the highest tertile of PE-IT scores. Results Thirty-six functions were mapped to specific levels and categories of the PE Framework, and adoption of each item ranged from 23.5 to 96.7%. Hospital characteristics associated with being in the highest tertile of PE-IT scores included medium and large bed size (relative to small), nonprofit (relative to government nonfederal), teaching hospital, system member, Midwest and South regions, and urban location. Discussion Hospital adoption of PE-oriented technology remains varied, suggesting that hospitals are considering how technology can create partnerships with patients. However, PE functionalities that facilitate higher levels of engagement are lacking, suggesting room for improvement. Conclusion While hospitals have reached modest levels of adoption of PE technologies, consistent monitoring of this capacity can identify opportunities to use technology to facilitate engagement.

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