Inequality Set in Concrete: Physical Resources Available for Care at Hospitals Serving People of Color and Other U.S. Hospitals

2020 ◽  
Vol 50 (4) ◽  
pp. 363-370 ◽  
Author(s):  
Gracie Himmelstein ◽  
Kathryn E. W. Himmelstein
Keyword(s):  
United States ◽  
The United States ◽  
People Of Color ◽  
American Hospital ◽  
American Hospital Association ◽  
Capital Assets ◽  
Physical Assets ◽  
Association Data ◽  
Hispanic Serving ◽  
Capital Intensive

Racial inequities in health outcomes are widely acknowledged. This study seeks to determine whether hospitals serving people of color in the United States have lesser physical assets than other hospitals. With data on 4,476 Medicare-participating hospitals in the United States, we defined those in the top decile of the share of black and Hispanic Medicare inpatients as “black-serving” and “Hispanic-serving,” respectively. Using 2017 Medicare cost reports and American Hospital Association data, we compared the capital assets (value of land, buildings, and equipment), as well as the availability of capital-intensive services at these and other hospitals, adjusted for other hospital characteristics. Hospitals serving people of color had lower capital assets: for example, US$5,197/patient-day (all dollar amounts in U.S. dollars) at black-serving hospitals, $5,763 at Hispanic-serving hospitals, and $8,325 at other hospitals ( P < .0001 for both comparisons). New asset purchases between 2013 and 2017 averaged $1,242, $1,738, and $3,092/patient-day at black-serving, Hispanic-serving, and other hospitals, respectively ( P < .0001). In adjusted models, hospitals serving people of color had lower capital assets (−$215,121/bed, P < .0001) and recent purchases (−$83,608/bed, P < .0001). They were also less likely to offer 19 of 27 specific capital-intensive services. Our results show that hospitals that serve people of color are substantially poorer in assets than other hospitals and suggest that equalizing investments in hospital facilities in the United States might attenuate racial inequities in care.

Abstract 23: Incidence of Adult In-Hospital Cardiac Arrest in the United States

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Mathias J Holmberg ◽  
Catherine Ross ◽  
Paul S Chan ◽  
Jordan Duval-Arnould ◽  
Anne V Grossestreuer ◽  
...  
Keyword(s):  
United States ◽  
Cardiac Arrest ◽  
The United States ◽  
Annual Incidence ◽  
Adult Patients ◽  
Negative Binomial Regression Model ◽  
American Hospital ◽  
American Hospital Association ◽  
Average Annual Incidence ◽  
Hospital Cardiac Arrest

Introduction: Current incidence estimates of in-hospital cardiac arrest in the United States are based on data from more than a decade ago, with an estimated 200,000 adult cases per year. The aim of this study was to estimate the contemporary incidence of in-hospital cardiac arrest in adult patients, which may better inform the public health impact of in-hospital cardiac arrest in the United States. Methods: Using the Get With The Guidelines®-Resuscitation (GWTG-R) registry, we developed a negative binomial regression model to estimate the incidence of index in-hospital cardiac arrests in adult patients (>18 years) between 2008 and 2016 based on hospital-level characteristics. The model coefficients were then applied to all United States hospitals, using data from the American Hospital Association Annual Survey, to obtain national incidence estimates. Hospitals only providing care to pediatric patients were excluded from the analysis. Additional analyses were performed including both index and recurrent events. Results: There were 154,421 index cardiac arrests from 388 hospitals registered in the GWTG-R registry. A total of 6,808 hospitals were available in the American Hospital Association database, of which 6,285 hospitals provided care to adult patients. The average annual incidence was estimated to be 283,700 in-hospital cardiac arrests. When including both index and recurrent cardiac arrests, the average annual incidence was estimated to 344,800 cases. Conclusions: Our analysis indicates that there are approximately 280,000 adult patients with in-hospital cardiac arrests per year in the United States. This estimate provides the contemporary annual incidence of the burden from in-hospital cardiac arrest in the United States.

Results of a Survey of Hospital Coagulation Laboratories in the United States, 2001

2005 ◽  
Vol 129 (1) ◽  
pp. 47-60
Author(s):  
Shahram Shahangian ◽  
Ana K. Stanković ◽  
Ira M. Lubin ◽  
James H. Handsfield ◽  
Mark D. White
Keyword(s):  
United States ◽  
Prothrombin Time ◽  
Therapeutic Range ◽  
Partial Thromboplastin Time ◽  
Sampling Rate ◽  
The United States ◽  
Activated Partial Thromboplastin Time ◽  
Sampling Frame ◽  
American Hospital ◽  
American Hospital Association

Abstract Context.—Coagulation and bleeding problems are associated with substantial morbidity and mortality, and inappropriate testing practices may lead to bleeding or thrombotic complications. Objective.—To evaluate practices reported by hospital coagulation laboratories in the United States and to determine if the number of beds in a hospital was associated with different practices. Design.—From a sampling frame of institutions listed in the 1999 directory of the American Hospital Association, stratified into hospitals with 200 or more beds (“large hospitals”) and those with fewer than 200 beds (“small hospitals”), we randomly selected 425 large hospitals (sampling rate, 25.6%) and 375 small hospitals (sampling rate, 8.8%) and sent a survey to them between June and October 2001. Of these, 321 large hospitals (75.5%) and 311 small hospitals (82.9%) responded. Results.—An estimated 97.1% of respondents reported performing some coagulation laboratory tests. Of these, 71.6% reported using 3.2% sodium citrate as the specimen anticoagulant to determine prothrombin time (81.3% of large vs 67.7% of small hospitals, P &lt; .001). Of the same respondents, 45.3% reported selecting thromboplastins insensitive to heparin in the therapeutic range when measuring prothrombin time (59.4% of large vs 39.8% of small hospitals, P &lt; .001), and 58.8% reported having a therapeutic range for heparin (72.9% of large vs 53.2% of small hospitals, P &lt; .001). An estimated 96.3% of respondents assayed specimens for activated partial thromboplastin time within 4 hours after phlebotomy, and 89.4% of respondents centrifuged specimens within 1 hour of collection. An estimated 12.1% reported monitoring low-molecular-weight heparin therapy, and to do so, 79% used an assay for activated partial thromboplastin time (58% of large vs 96% of small hospitals, P = .001), whereas 38% used an antifactor Xa assay (65% of large vs 18% of small hospitals, P = .001). Conclusions.—Substantial variability in certain laboratory practices was evident. Where significant differences existed between the hospital groups, usually large hospitals adhered to accepted practice guidelines to a greater extent. Some reported practices are not consistent with current recommendations, showing a need to understand the reasons for noncompliance so that better adherence to accepted standards of laboratory practice can be promoted.

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 Looking back at the lawsuit that transformed the chiropractic profession part 8: Judgment impact

2021 ◽  
Vol 35 (S1) ◽  
pp. 117-131 ◽  
Author(s):  
Claire D. Johnson ◽  
Bart N. Green
Keyword(s):  
United States ◽  
The United States ◽  
Qualitative Inquiry ◽  
Chiropractic Profession ◽  
Final Decision ◽  
Business Practices ◽  
American Hospital ◽  
American Hospital Association ◽  
Chiropractic Practice ◽  
Practice Education

Objective This paper is the eighth in a series that explores the historical events surrounding the Wilk v American Medical Association (AMA) lawsuit in which the plaintiffs argued that the AMA, the American Hospital Association, and other medical specialty societies violated antitrust law by restraining chiropractors' business practices. The purpose of this paper is to discuss the possible impact that the final decision in favor of the plaintiffs may have had on the chiropractic profession. Methods This historical research study used a phenomenological approach to qualitative inquiry into the conflict between regular medicine and chiropractic and the events before, during, and after a legal dispute at the time of modernization of the chiropractic profession. Our methods included obtaining primary and secondary data sources. The final narrative recount was developed into 8 papers following a successive timeline. This paper is the eighth of the series that discusses how the trial decision may have influenced the chiropractic that we know today in the United States. Results Chiropractic practice, education, and research have changed since before the lawsuit was filed. There are several areas in which we propose that the trial decision may have had an impact on the chiropractic profession. Conclusion The lawsuit removed the barriers that were implemented by organized medicine against the chiropractic profession. The quality of chiropractic practice, education, and research continues to improve and the profession continues to meet its most fundamental mission: to improve the lives of patients. Chiropractors practicing in the United States today are allowed to collaborate freely with other health professionals. Today, patients have the option to access chiropractic care because of the dedicated efforts of many people to reduce the previous barriers. It is up to the present-day members of the medical and chiropractic professions to look back and to remember what happened. By recalling the events surrounding the lawsuit, we may have a better understanding about our professions today. This information may help to facilitate interactions between medicine and chiropractic and to develop more respectful partnerships focused on creating a better future for the health of the public. The future of the chiropractic profession rests in the heads, hearts, and hands of its current members to do what is right.

Tonsillectomy and Adenoidectomy: Incidence and Mortality, 1968–1972

1979 ◽  
Vol 87 (2) ◽  
pp. 159-166 ◽  
Author(s):  
Loring W. Pratt ◽  
Ruth A. Gallagher
Keyword(s):  
United States ◽  
The United States ◽  
Mortality Rates ◽  
Morbidity And Mortality ◽  
Summary Report ◽  
American Hospital ◽  
American Hospital Association ◽  
Surgical Services ◽  
Incidence And Mortality

To determine the number of tonsillectomies and adenoidectomies (T-As) from 1968 to 1972 and their associated morbidity and mortality rates, a questionnaire was sent to all the hospitals listed in the Directory of the American Hospital Association (6,759). The data were analyzed and statistical projections were made. An analysis was also made of the summary report of the “Study on Surgical Services for the United States,” with regard to the incidence of T-A was also made. The results are presented in the following report.

Hepatitis B Vaccination Coverage Levels Among Healthcare Workers in the United States, 2002-2003

2007 ◽  
Vol 28 (7) ◽  
pp. 783-790 ◽  
Author(s):  
Edgar P. Simard ◽  
Jeremy T. Miller ◽  
Prethibha A. George ◽  
Annemarie Wasley ◽  
Miriam J. Alter ◽  
...  
Keyword(s):  
United States ◽  
At Risk ◽  
Hepatitis B ◽  
Vaccination Coverage ◽  
Healthcare Workers ◽  
The United States ◽  
Care Staff ◽  
Hepatitis B Vaccination ◽  
American Hospital ◽  
American Hospital Association

Background.Hepatitis B virus (HBV) infection is a well recognized risk for healthcare workers (HCWs), and routine vaccination of HCWs has been recommended since 1982. By 1995, the level of vaccination coverage among HCWs was only 67%.Objective.To obtain an accurate estimate of hepatitis B vaccination coverage levels among HCWs and to describe the hospital characteristics and hepatitis B vaccination policies associated with various coverage levels.Design.Cross-sectional survey.Methods.A representative sample of 425 of 6,116 American Hospital Association member hospitals was selected to participate, using probability-proportional-to-size methods during 2002-2003. The data collected included information regarding each hospital's hepatitis B vaccination policies. Vaccination coverage levels were estimated from a systematic sample of 25 HCWs from each hospital whose medical records were reviewed for demographic and vaccination data. The main outcome measure was hepatitis B vaccination coverage levels.Results.Among at-risk HCWs, 75% had received 3 or more doses of the hepatitis B vaccine, corresponding to an estimated 2.5 million vaccinated hospital-based HCWs. The coverage level was 81% among staff physicians and nurses. Compared with nurses, coverage was significantly lower among phlebotomists (71.1%) and nurses' aides and/or other patient care staff (70.9%; P < .05). Hepatitis B vaccination coverage was highest among white HCWs (79.5%) and lowest among black HCWs (67.6%; P < .05). Compared with HCWs who worked in hospitals that required vaccination only of HCWs with identified risk for exposure to blood or other potentially infectious material, hepatitis B vaccination coverage was significantly lower among HCWs who worked in hospitals that required vaccination of HCWs without identified risk for exposure to blood or other potentially infectious material (76.6% vs 62.4%; P < .05).Conclusions.In the United States, an estimated 75% of HCWs have been vaccinated against hepatitis B. Important differences in coverage levels exist among various demographic groups. Hospitals need to identify methods to improve hepatitis B vaccination coverage levels and should consider developing targeted vaccination programs directed at unvaccinated, at-risk HCWs who have frequent or potential exposure to blood or other potentially infectious material.

Ebola Preparedness Resources for Acute-Care Hospitals in the United States: A Cross-Sectional Study of Costs, Benefits, and Challenges

2017 ◽  
Vol 38 (4) ◽  
pp. 405-410 ◽  
Author(s):  
Michael A. Smit ◽  
Kenneth A. Rasinski ◽  
Barbara I. Braun ◽  
Linda L. Kusek ◽  
Aaron M. Milstone ◽  
...  
Keyword(s):  
United States ◽  
Acute Care ◽  
Ebola Virus ◽  
Virus Disease ◽  
Acute Care Hospitals ◽  
The United States ◽  
Labor Costs ◽  
Cross Sectional ◽  
American Hospital ◽  
American Hospital Association

OBJECTIVETo assess resource allocation and costs associated with US hospitals preparing for the possible spread of the 2014–2015 Ebola virus disease (EVD) epidemic in the United States.METHODSA survey was sent to a stratified national probability sample (n=750) of US general medical/surgical hospitals selected from the American Hospital Association (AHA) list of hospitals. The survey was also sent to all children’s general hospitals listed by the AHA (n=60). The survey assessed EVD preparation supply costs and overtime staff hours. The average national wage was multiplied by labor hours to calculate overtime labor costs. Additional information collected included challenges, benefits, and perceived value of EVD preparedness activities.RESULTSThe average amount spent by hospitals on combined supply and overtime labor costs was $80,461 (n=133; 95% confidence interval [CI], $56,502–$104,419). Multivariate analysis indicated that small hospitals (mean, $76,167) spent more on staff overtime costs per 100 beds than large hospitals (mean, $15,737; P<.0001). The overall cost for acute-care hospitals in the United States to prepare for possible EVD cases was estimated to be $361,108,968. The leading challenge was difficulty obtaining supplies from vendors due to shortages (83%; 95% CI, 78%–88%) and the greatest benefit was improved knowledge about personal protective equipment (89%; 95% CI, 85%–93%).CONCLUSIONSThe financial impact of EVD preparedness activities was substantial. Overtime cost in smaller hospitals was >3 times that in larger hospitals. Planning for emerging infectious disease identification, triage, and management should be conducted at regional and national levels in the United States to facilitate efficient and appropriate allocation of resources in acute-care facilities.Infect Control Hosp Epidemiol 2017;38:405–410

Analysis of Hospital Resource Availability and COVID-19 Mortality Across the United States

2021 ◽  
pp. E1-E4
Author(s):  
Alexander T Janke ◽  
Hao Mei ◽  
Craig Rothenberg ◽  
Robert D Becher ◽  
Zhenqiu Lin ◽  
...  
Keyword(s):  
United States ◽  
New York ◽  
New York Times ◽  
General Medicine ◽  
The United States ◽  
American Hospital ◽  
American Hospital Association ◽  
Hospital Referral ◽  
Hospital Resources ◽  
The Impact

While the impact of coronavirus disease 2019 (COVID-19) has varied greatly across the United States, there has been little assessment of hospital resources and mortality. We examine hospital resources and death counts among hospital referral regions (HRRs) from March 1 to July 26, 2020. This was an analysis of American Hospital Association data with COVID-19 data from the New York Times. Hospital-based resource availabilities were characterized per COVID-19 case. Death count was defined by monthly confirmed COVID-19 deaths. Geographic areas with fewer intensive care unit (ICU) beds (incident rate ratio [IRR], 0.194; 95% CI, 0.076-0.491), nurses (IRR, 0.927; 95% CI, 0.888-0.967), and general medicine/surgical beds (IRR, 0.800; 95% CI, 0.696-0.920) per COVID-19 case were statistically significantly associated with greater deaths in April. This underscores the potential impact of innovative hospital capacity protocols and care models to create resource flexibility to limit system overload early in a pandemic.

scholarly journals The History of Adversity and Collective Strength of Individuals of Mexican Ancestry in the United States: A Scoping Literature Review and Emerging Conceptual Framework

Genealogy ◽  
2021 ◽  
Vol 5 (2) ◽  
pp. 32
Author(s):  
Araceli Orozco-Figueroa
Keyword(s):  
United States ◽  
Scoping Review ◽  
Historical Trauma ◽  
The United States ◽  
People Of Color ◽  
Trauma Narratives ◽  
Treatment And Prevention ◽  
Scoping Literature Review ◽  
History Of ◽  
Baseline Knowledge

Recently, Black, Indigenous, and other People of Color (BIPOC) have encountered an escalation in adverse social conditions and trauma events in the United States. For individuals of Mexican ancestry in the United States (IMA-US), these recent events represent the latest chapter in their history of adversity: a history that can help us understand their social and health disparities. This paper utilized a scoping review to provide a historical and interdisciplinary perspective on discussions of mental health and substance use disorders relevant to IMA-US. The scoping review process yielded 16 peer reviewed sources from various disciplines, published from 1998 through 2018. Major themes included historically traumatic events, inter-generational responses to historical trauma, and vehicles of transmission of trauma narratives. Recommendations for healing from historical and contemporary oppression are discussed. This review expands the clinical baseline knowledge relevant to the diagnosis, treatment, and prevention of contemporary traumatic exposures for IMA-US.

scholarly journals Telepsychiatry adoption across hospitals in the United States: a cross-sectional study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Zhong Li ◽  
Sayward E. Harrison ◽  
Xiaoming Li ◽  
Peiyin Hung
Keyword(s):  
Continuity Of Care ◽  
Psychiatric Care ◽  
The United States ◽  
Psychiatric Services ◽  
Linear Regression Models ◽  
Cross Sectional ◽  
Promising Alternative ◽  
American Hospital ◽  
American Hospital Association ◽  
Inpatient Psychiatric Care

Abstract Background Access to psychiatric care is critical for patients discharged from hospital psychiatric units to ensure continuity of care. When face-to-face follow-up is unavailable or undesirable, telepsychiatry becomes a promising alternative. This study aimed to investigate hospital- and county-level characteristics associated with telepsychiatry adoption. Methods Cross-sectional national data of 3475 acute care hospitals were derived from the 2017 American Hospital Association Annual Survey. Generalized linear regression models were used to identify characteristics associated with telepsychiatry adoption. Results About one-sixth (548 [15.8%]) of hospitals reported having telepsychiatry with a wide variation across states. Rural noncore hospitals were less likely to adopt telepsychiatry (8.3%) than hospitals in rural micropolitan (13.6%) and urban counties (19.4%). Hospitals with both outpatient and inpatient psychiatric care services (marginal difference [95% CI]: 16.0% [12.1% to 19.9%]) and hospitals only with outpatient psychiatric services (6.5% [3.7% to 9.4%]) were more likely to have telepsychiatry than hospitals with neither psychiatric services. Federal hospitals (48.9% [32.5 to 65.3%]), system-affiliated hospitals (3.9% [1.2% to 6.6%]), hospitals with larger bed size (Quartile IV vs. I: 6.2% [0.7% to 11.6%]), and hospitals with greater ratio of Medicaid inpatient days to total inpatient days (Quartile IV vs. I: 4.9% [0.3% to 9.4%]) were more likely to have telepsychiatry than their counterparts. Private non-profit hospitals (− 6.9% [− 11.7% to − 2.0%]) and hospitals in counties designated as whole mental health professional shortage areas (− 6.6% [− 12.7% to − 0.5%]) were less likely to have telepsychiatry. Conclusions Prior to the Covid-19 pandemic, telepsychiatry adoption in US hospitals was low with substantial variations by urban and rural status and by state in 2017. This raises concerns about access to psychiatric services and continuity of care for patients discharged from hospitals.

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