Community Characteristics and Readmissions: Hospitals in Jeopardy

2021 ◽  
Vol 21 (1) ◽  
pp. 131-158
Author(s):  
Michele L. Summers ◽  
Serdar Atav
Keyword(s):  
Primary Care ◽  
Ecological Model ◽  
Care Delivery ◽  
Pearson Correlation ◽  
Future Research ◽  
Community Characteristics ◽  
Readmission Rates ◽  
House Calls ◽  
Ex Post ◽  
Hospital Systems

Objective: The purpose was to identify community characteristics that contribute to reductions in readmission rates and reimbursement penalties for hospital systems in upstate New York.  Methods:  Hospitals in upstate NY were selected (N = 94). Using an ex post facto design and the ecological model, community characteristics of hospital systems were analyzed and coded. Independent t-tests, ANOVA, and Pearson Correlation tests were conducted. Results: Characteristicscorrelated with reduced hospital readmission rates and reimbursement penalties included hospitals (1) with critical access status; (2) located in counties with a better county health rank; and (3) located in a primary care shortage area that utilized house calls.  Discussion: Implications include supporting policies that increase access to services, improve formulas for reimbursement, and encourage innovation in care delivery models.  Future research efforts should focus on house calls in primary care shortage areas. Keywords: readmission rates, ecological model, house calls, community health DOI:   https://doi.org/10.14574/ojrnhc.v21i1.638

scholarly journals Identifying and Understanding Communities Using Twitter to Connect About Depression: Cross-Sectional Study

2018 ◽  
Vol 5 (4) ◽  
pp. e61 ◽  
Author(s):  
Amber D DeJohn ◽  
Emily English Schulz ◽  
Amber L Pearson ◽  
E Megan Lachmar ◽  
Andrea K Wittenborn
Keyword(s):  
Pearson Correlation ◽  
Future Research ◽  
Multilevel Regression ◽  
Community Characteristics ◽  
Cross Sectional ◽  
Web Based ◽  
Study Region ◽  
Community Factors ◽  
Single Person ◽  
Twitter Users

Background Depression is the leading cause of diseases globally and is often characterized by a lack of social connection. With the rise of social media, it is seen that Twitter users are seeking Web-based connections for depression. Objective This study aimed to identify communities where Twitter users tweeted using the hashtag #MyDepressionLooksLike to connect about depression. Once identified, we wanted to understand which community characteristics correlated to Twitter users turning to a Web-based community to connect about depression. Methods Tweets were collected using NCapture software from May 25 to June 1, 2016 during the Mental Health Month (n=104) in the northeastern United States and Washington DC. After mapping tweets, we used a Poisson multilevel regression model to predict tweets per community (county) offset by the population and adjusted for percent female, percent population aged 15-44 years, percent white, percent below poverty, and percent single-person households. We then compared predicted versus observed counts and calculated tweeting index values (TIVs) to represent undertweeting and overtweeting. Last, we examined trends in community characteristics by TIV using Pearson correlation. Results We found significant associations between tweet counts and area-level proportions of females, single-person households, and population aged 15-44 years. TIVs were lower than expected (TIV 1) in eastern, seaboard areas of the study region. There were communities tweeting as expected in the western, inland areas (TIV 2). Counties tweeting more than expected were generally scattered throughout the study region with a small cluster at the base of Maine. When examining community characteristics and overtweeting and undertweeting by county, we observed a clear upward gradient in several types of nonprofits and TIV values. However, we also observed U-shaped relationships for many community factors, suggesting that the same characteristics were correlated with both overtweeting and undertweeting. Conclusions Our findings suggest that Web-based communities, rather than replacing physical connection, may complement or serve as proxies for offline social communities, as seen through the consistent correlations between higher levels of tweeting and abundant nonprofits. Future research could expand the spatiotemporal scope to confirm these findings.

scholarly journals Identifying and Understanding Communities Using Twitter to Connect About Depression: Cross-Sectional Study (Preprint)

2017 ◽  
Author(s):  
Amber D. DeJohn ◽  
Emily English Schulz ◽  
Amber L Pearson ◽  
E Megan Lachmar ◽  
Andrea K Wittenborn
Keyword(s):  
Pearson Correlation ◽  
Future Research ◽  
Multilevel Regression ◽  
Community Characteristics ◽  
Cross Sectional ◽  
Web Based ◽  
Study Region ◽  
Community Factors ◽  
Single Person ◽  
Twitter Users

BACKGROUND Depression is the leading cause of diseases globally and is often characterized by a lack of social connection. With the rise of social media, it is seen that Twitter users are seeking Web-based connections for depression. OBJECTIVE This study aimed to identify communities where Twitter users tweeted using the hashtag #MyDepressionLooksLike to connect about depression. Once identified, we wanted to understand which community characteristics correlated to Twitter users turning to a Web-based community to connect about depression. METHODS Tweets were collected using NCapture software from May 25 to June 1, 2016 during the Mental Health Month (n=104) in the northeastern United States and Washington DC. After mapping tweets, we used a Poisson multilevel regression model to predict tweets per community (county) offset by the population and adjusted for percent female, percent population aged 15-44 years, percent white, percent below poverty, and percent single-person households. We then compared predicted versus observed counts and calculated tweeting index values (TIVs) to represent undertweeting and overtweeting. Last, we examined trends in community characteristics by TIV using Pearson correlation. RESULTS We found significant associations between tweet counts and area-level proportions of females, single-person households, and population aged 15-44 years. TIVs were lower than expected (TIV 1) in eastern, seaboard areas of the study region. There were communities tweeting as expected in the western, inland areas (TIV 2). Counties tweeting more than expected were generally scattered throughout the study region with a small cluster at the base of Maine. When examining community characteristics and overtweeting and undertweeting by county, we observed a clear upward gradient in several types of nonprofits and TIV values. However, we also observed U-shaped relationships for many community factors, suggesting that the same characteristics were correlated with both overtweeting and undertweeting. CONCLUSIONS Our findings suggest that Web-based communities, rather than replacing physical connection, may complement or serve as proxies for offline social communities, as seen through the consistent correlations between higher levels of tweeting and abundant nonprofits. Future research could expand the spatiotemporal scope to confirm these findings.

scholarly journals Risk assessment tools available to inform a nurse practitioner’s determination of tolerable risk

2020 ◽  
Author(s):  
◽  
Ricki Smith
Keyword(s):  
Risk Assessment ◽  
Primary Care ◽  
Nurse Practitioners ◽  
Care Delivery ◽  
Community Dwelling ◽  
Assessment Tools ◽  
Future Research ◽  
Tolerable Risk ◽  
Risk Assessment Tools

Risk in health care, often discussed in terms of its tolerability, is an abstract term that is patient- and context-specific. An older adult living at risk can be someone falling frequently at home risking a fractured hip, to someone self-neglecting. Family Nurse Practitioners working in Primary Care are well-situated to support patients over time and to mitigate risk. A better understanding of the risk assessment tools available to inform a level of risk tolerability for Nurse Practitioners working in Primary Care may enhance clinical reasoning and enhance their comfort with the concept of risk, resulting in consistent care delivery for patients. Evidencebased literature highlights the complexity of both defining and assessing risk, which is further reflected within the assessment tools. For these reasons, the purpose of this integrative literature review is to provide recommendations, founded in current literature findings, regarding the comprehensive risk assessment tools used to inform a Nurse Practitioner’s determination of tolerable risk for community-dwelling older adults. A search of three databases, as well as hand searches, resulted in nine tools for analysis. The interpretation of the findings suggested that risk assessment tools varied in their approach to risk, with some focused preventatively on risk mitigation while others could be applied in real-time to assess the severity of a perceived risk. Each tool included elements of risk which together, comprise a comprehensive, holistic risk assessment to be considered in the ongoing assessment of tolerable risk. A positive risk-based approach is also a shift in risk perception that Nurse Practitioners are encouraged to consider. The implications for practice include how the described approaches guide decision-making and the definitions of tolerable and intolerable risk can steer the Nurse Practitioner’s care, as well as to inform future research and the development of new risk assessment tools.

Technology-Mediated Communication between Patients and Primary Care Clinicians and Staff

2016 ◽  
Vol 60 (1) ◽  
pp. 556-560 ◽  
Author(s):  
Abigail R. Wooldridge ◽  
Pascale Carayon ◽  
Peter Hoonakker ◽  
Albert Musa ◽  
Philip Bain
Keyword(s):  
Primary Care ◽  
Care Delivery ◽  
Data Entry ◽  
Future Research ◽  
Clinical Workflow ◽  
Secure Messaging ◽  
Patient Reported ◽  
Primary Care Clinicians ◽  
Encrypted Communication ◽  
The Impact

Health information technology, i.e. secure messaging, can support high-quality, efficient care. Secure messaging – encrypted communication between patient and clinician or staff, similar to email – can facilitate patient-reported information and communication, but its fit with clinical workflow is not understood. Fifteen primary care clinicians and staff were interviewed and observed over 35 hours to understand the impact of secure messaging on ambiguity within the care delivery workflow. We developed a general workflow diagram for secure messaging, and identified three types of ambiguity relating to workflow, content of communication, and multiple points of data entry. While the use of secure messaging can help to clarify and document patient information, it can also increase ambiguity, particularly relating to the organization of work and workflow. Understanding how to design and implement technology to support multiple stakeholders, including patients, while considering the work system is a major area for future research.

1265-P: The Paradox of Care Delivery for Type 1 Diabetes in Primary Care Settings: A Call for Interventions to Reduce Health Disparities

Diabetes ◽  
2019 ◽  
Vol 68 (Supplement 1) ◽  
pp. 1265-P ◽  
Author(s):  
ASHBY F. WALKER ◽  
NICOLAS CUTTRISS ◽  
MICHAEL J. HALLER ◽  
KATARINA YABUT ◽  
CLAUDIA ANEZ-ZABALA ◽  
...  
Keyword(s):  
Primary Care ◽  
Type 1 Diabetes ◽  
Health Disparities ◽  
Care Delivery ◽  
Primary Care Settings

The Evolution of Physical Activity on Prescription (FaR) in Sweden

2014 ◽  
Vol 62 (2) ◽  
Keyword(s):  
Physical Activity ◽  
Primary Care ◽  
Healthcare Professionals ◽  
Systems Approach ◽  
Ecological Model ◽  
Controlled Trial ◽  
Professional Associations ◽  
Successful Implementation ◽  
Surgeon General ◽  
Positive Effects

In 1996, the first Report of the US Surgeon General on Physical Activity and Health provided an extensive knowledge overview about the positive effects of physical activity (PA) on several health outcomes and PA recommendations. This contributed to an enhanced interest for PA in Sweden. The Swedish Professional Associations for Physical Activity (YFA) were appointed to form a Scientific Expert Group in the project “Sweden on the Move” and YFA created the idea of Physical Activity on Prescription (FaR) and the production of a handbook (FYSS) for healthcare professionals. In Swedish primary care, licensed healthcare professionals, i.e. physicians, physiotherapists and nurses, can prescribe PA if they have sufficient knowledge about the patient’s current state of health, how PA can be used for promotion, prevention and treatment and are trained in patient-centred counselling and the FaR method. The prescription is followed individually or by visiting local FaR providers. These include sport associations, patient organisations, municipal facilities, commercial providers such as gyms, sports clubs and walking clubs or other organisations with FaR educated staff such as health promoters or personal trainers. In clinical practice, the FaR method increases the level of PA in primary care patients, at 6 and at 12 months. Self-reported adherence to the prescription was 65% at 6 months, similar to the known compliance for medications. In a randomised controlled trial, FaR significantly improved body composition and reduced metabolic risk factors. It is suggested that a successful implementation of PA in healthcare depends on a combination of a systems approach (socio-ecological model) and the strengthening of individual motivation and capability. General support from policymakers, healthcare leadership and professional associations is important. To lower barriers, tools for implementation and structures for delivery must be readily available. Examples include handbooks such as FYSS, the FaR system and the use of pedometers.

scholarly journals Learning from and Leveraging Multi-Level Changes in Responses to the COVID 19 Pandemic to Facilitate Breast Cancer Prevention Efforts

2021 ◽  
Vol 18 (13) ◽  
pp. 6999
Author(s):  
Deborah J. Bowen ◽  
Kelly E. Rentscher ◽  
Amy Wu ◽  
Gwen Darien ◽  
Helen Ghirmai Haile ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Health Care ◽  
Cancer Prevention ◽  
Care Delivery ◽  
Breast Cancer Prevention ◽  
Health Care Use ◽  
Economic Life ◽  
Future Research ◽  
Multi Level ◽  
And Shifts

The coronavirus pandemic (COVID-19) has had multilevel effects on non-COVID-19 health and health care, including deferral of routine cancer prevention and screening and delays in surgical and other procedures. Health and health care use has also been affected by pandemic-related loss of employer-based health insurance, food and housing disruptions, and heightened stress, sleep disruptions and social isolation. These disruptions are projected to contribute to excess non-COVID-19 deaths over the coming decades. At the same time municipalities, health systems and individuals are making changes in response to the pandemic, including modifications in the environmental to promote health, implementation of telehealth platforms, and shifts towards greater self-care and using remote platforms to maintain social connections. We used a multi-level biopsychosocial model to examine the available literature on the relationship between COVID-19-related changes and breast cancer prevention to identify current gaps in knowledge and identify potential opportunities for future research. We found that COVID-19 has impacted several aspects of social and economic life, through a variety of mechanisms, including unemployment, changes in health care delivery, changes in eating and activity, and changes in mental health. Some of these changes should be reduced, while others should be explored and enhanced.

A Scoping Review of Telehealth-Assisted Case Management for Chronic Illnesses

2021 ◽  
pp. 019394592110089
Author(s):  
Jee Young Joo ◽  
Megan F. Liu
Keyword(s):  
Health Care ◽  
Case Management ◽  
Scoping Review ◽  
Access To Health Care ◽  
Health Care Services ◽  
Care Delivery ◽  
Management Practice ◽  
Empirical Studies ◽  
Chronic Illnesses ◽  
Future Research

This scoping review aimed to examine telehealth-assisted case management for chronic illnesses and assess its overall impact on health care delivery. Guided by the PRISMA statement, this review included 36 empirical studies published between 2011 and 2020. This study identified three weaknesses and four strengths of telehealth-assisted case management. While the weaknesses were negative feelings about telehealth, challenges faced by patients in learning and using telehealth devices, and increased workload for case managers, the strengths included efficient and timely care, increased access to health care services, support for patients’ satisfaction, and cost savings. Future research can be designed and conducted for overcoming the weaknesses of telehealth-assisted case management. Additionally, the strengths identified by this review need to be translated from research into case management practice for chronic illness care. This review not only describes the value of such care strategy, but also provides implications for future nursing practice and research.

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