scholarly journals Culturally and Linguistically Appropriate Hospital Services Reduce Medicare Length of Stay

2020 ◽  
Vol 30 (4) ◽  
pp. 603-610
Author(s):  
Melody K. Schiaffino ◽  
Melissa Ruiz ◽  
Melissa Yakuta ◽  
Alejandro Contreras ◽  
Setareh Akhavan ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Negative Binomial ◽  
Care Delivery ◽  
Quality Care ◽  
The United States ◽  
Public Hospitals ◽  
Culturally Competent ◽  
American Hospital ◽  
American Hospital Association ◽  
Linguistically Appropriate

Introduction: Almost 40% of the 63 million Americans who speak a language other than English have limited English proficiency (LEP). This communication barrier can result in poor quality care and potentially adverse health outcomes. Of particular interest is that the greatest proportion of LEP adults are aged >65 years and will face barriers and delays in accessing high-quality care. Age cohort variation of LEP burden has not been widely addressed. Culturally and lin­guistically appropriate hospital care delivery can mitigate these barriers.Methods: In order to test whether culturally competent services reduced length-of-stay (LOS), we linked organizational cultural competence surveys across two-states (CA+FL) for comparison across Medicare acute care LOS. Using the 2013 American Hospital Association Database, and Hospital Compare Data from CMS (N=184), we compared hospital structure with cultur­ally and linguistically appropriate services related to improved care delivery for LEP populations and aging LEP populations. We utilized Kruskal-Wallis to test group differ­ences and a negative binomial regression to model median LOS. All analyses were conducted using SAS 9.4 (Cary, NC).Results: Median LOS across all hospitals was 4.7 days (mean 5.7, standard devia­tion 6.3). Most hospitals were not-for-profit (46.7%), small (<150 beds, 54.4%), Joint Commission accredited (67.9%), and in urban areas. We found shorter median LOS when hospital units identified cultural or language needs at admission (Wald χ2 3.82, P=.0506). Hospitals’ identification of these needs at discharge had no impact on LOS. Hospitals that accommodated patient cultural or ethnic dietary needs also reported lower median LOS (Wald χ2 12.93, P=.0003). Structurally, public hospitals, accredited hospitals, and hospitals that re­ported system membership were predictive of a lower median LOS.Discussion: Our findings demonstrate that patient outcomes are responsive to cultur­ally and linguistically appropriate services. Further, our findings suggest understanding of culturally competent care in hospitals is lacking. A larger and multi-level sample across the United States could yield a greater understanding of the role of cultur­ally and linguistically appropriate care for a rapidly growing population of diverse older adults. Ethn Dis. 2020;30(4):603-610; doi:10.18865/ed.30.4.603

Abstract 266: No Impact of Electronic Health Records on Quality of Care and Outcomes for Ischemic Stroke

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Karen E Joynt ◽  
Deepak L Bhatt ◽  
Lee H Schwamm ◽  
Ying Xian ◽  
Paul A Heidenreich ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Length Of Stay ◽  
Electronic Health Records ◽  
Clinical Outcomes ◽  
Quality Care ◽  
Health Records ◽  
American Hospital ◽  
American Hospital Association ◽  
Electronic Health

Background: Electronic Health Records (EHRs) may be a key tool for improving the quality of healthcare. They may be particularly important for conditions such as ischemic stroke, in which guidelines are rapidly evolving and timely care of the patient is critical. Methods: We used data from 1,236 hospitals participating in Get With The Guidelines-Stroke, representing 626,473 ischemic strokes between 2007 and 2010, and linked this with the American Hospital Association annual survey to characterize which study hospitals had an EHR. We conducted regression analyses to determine whether hospitals with an EHR demonstrated better performance on quality metrics, length of stay, discharge to home, and mortality. Results: 511 hospitals had an EHR by the end of the study period. Stroke patients at hospitals with EHRs were younger, more often male and non-white, and had a lower burden of medical comorbidities. Hospitals with EHRs were larger, and more often teaching hospitals and stroke centers than hospitals without EHRs. In unadjusted analyses, patients at hospitals with EHRs were more likely to receive “all-or-none” care (87.9% versus 82.6%, p<0.001), and less likely to have a length of stay over 4 days (42.4% versus 43.9%, p<0.001). However, there were no differences in discharge to a site other than home (50.9% versus 51.1%, p=0.12) or in-hospital mortality (5.3% versus 5.2%, p=0.40). In multivariate analyses, after controlling for patient and hospital characteristics, the presence of an EHR was no longer associated with better quality care, and continued to have no association with clinical outcomes (Table). Conclusions: In our sample of GWTG-Stroke hospitals, EHRs were not associated with higher-quality care or better clinical outcomes. Given that these systems often create significant added burden for clinicians, further work to ensure that they are better integrated with care and fully evidence-driven is critical.

scholarly journals Engaging Isolated and Underserved Older Adults in 4Ms Care: Age-Friendly Care, PA

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 315-315
Author(s):  
Diane Berish ◽  
Terry Fulmer
Keyword(s):  
Older Adults ◽  
Social Services ◽  
Care Delivery ◽  
The United States ◽  
Outcome Data ◽  
Policy Implications ◽  
American Hospital ◽  
American Hospital Association ◽  
Clinician Training ◽  
State College

Abstract Older adults, the largest segment of the US rural population, face significant disparities in health and healthcare compared to their non-rural peers, including more chronic health conditions, financial challenges, and social isolation. They have limited access to healthcare and social services for prevention, management and treatment of chronic conditions. Age-Friendly Care-PA, a partnership between Primary Health Network and Penn State College of Nursing, aims to reduce these disparities in care and services for rural older adults through co-designing their Geriatric Workforce Enhancement Program. Age-Friendly Health Systems, an initiative of the John A Hartford Foundation and the Institute for Healthcare Improvement, in partnership with the American Hospital Association and the Catholic Health Association of the United States, equips providers, older adults, and their care partners with the support necessary to address What Matters, Medication, Mentation, and Mobility. This symposium describes how the 4Ms are integrated into clinician training and competencies, older adult education, operations, care delivery, and quality improvement. Year two outcome data will be shared. Drs. Hupcey and Fick will provide an overview of the project and its reach. Dr. Berish will describe the process of engaging stakeholders in co-developing our 4M metrics and the data generated. Jenny Knecht, CRNP, will describe a pilot study to extend the reach and acceptability of telehealth to hard-to-reach older persons. Finally, Dr. Garrow will detail a new initiative focused on equity in care. Our discussant, Dr. Terry Fulmer will lead a discussion of this work as well as next steps and policy implications.

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.

Hospital Care in the United States, Commission on Hospital Care, New York, The Commonwealth Fund

PEDIATRICS ◽  
1950 ◽  
Vol 6 (1) ◽  
pp. 172-172
Keyword(s):  
New York ◽  
Hospital Care ◽  
The United States ◽  
Hospital Services ◽  
Source Book ◽  
American Hospital ◽  
American Hospital Association ◽  
Commonwealth Fund ◽  
Wide Range ◽  
Present Pattern

Many individuals and organizations have had a part in the making of this book. They have described influences and forces whose interaction has resulted in the present pattern of our hospital services, and documented their interpretations. The result is a source book of basic information which should be valuable for all students of hospital problems. The Commission was appointed by the American Hospital Association, and chosen to represent a wide range of those providing hospital, health and welfare services, as well as the consuming public.

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.

Are nurses still practicing coronary precautions? A national survey of nursing care of acute myocardial infarction patients

1996 ◽  
Vol 5 (2) ◽  
pp. 91-98 ◽  
Author(s):  
B Riegel ◽  
T Thomason ◽  
B Carlson ◽  
I Gocka
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Temperature Measurement ◽  
Rectal Temperature ◽  
Valsalva Maneuver ◽  
The United States ◽  
American Hospital ◽  
American Hospital Association ◽  
Survey Techniques ◽  
The 1960S

BACKGROUND: Coronary precautions were common when coronary care units were instituted in the 1960s. However, research has failed to provide evidence of the validity of most of these restrictions. Only the avoidance of the Valsalva maneuver is clearly indicated as a universal precaution in patients who have experienced acute myocardial infarction. OBJECTIVES: To determine if nurses continue to restrict iced and hot fluids, caffeine, rectal temperature measurement, and vigorous back rubs, and to feed and mandate bedrest for acute myocardial infarction patients. METHODS: Survey techniques were used to describe practice patterns of nurses working in hospitals across the United States. Two sampling methods were used to access a random sample. The survey was mailed to members of the American Association of Critical-Care Nurses and nonmembers working in a hospital accredited by the American Hospital Association and with an intensive care unit. RESULTS: Of the 2549 mailed surveys, 882 were returned with usable data (34.8% response rate). Iced (28.1%) and hot (8.7%) fluids continued to be restricted by nurses. Most (85.6%) restricted stimulant beverages such as coffee. Rectal temperature measurement was avoided by 55.7%, and only 73.3% taught avoidance of the Valsalva maneuver. In terms of rest, 15.6% reported avoiding vigorous back rubs, 8.4% still fed patients, and 33.8% offered bedpans to pain-free patients on the first day after admission. A complete bedbath was offered by 19.8% of nurses to stable, pain-free patients even a day after admission. CONCLUSIONS: The data supporting liberalization of coronary precautions have not been adequately disseminated.

scholarly journals STRENGTH IN AGE-FRIENDLY HEALTH SYSTEMS: AN INNOVATIVE INTEGRATED INTERPROFESSIONAL MODEL

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S829-S829
Author(s):  
Teri Kennedy
Keyword(s):  
Older Adults ◽  
Health System ◽  
Baby Boomers ◽  
Health Systems ◽  
Adult Population ◽  
The United States ◽  
Essential Elements ◽  
Conceptual Approach ◽  
American Hospital ◽  
American Hospital Association

Abstract This paper presents an innovative conceptual approach to health care policy for older adults: the Age-Friendly Health Systems Integrated Interprofessional Model. In 2017, the John A. Hartford Foundation and Institute for Healthcare Improvement, in partnership with the American Hospital Association and Catholic Health Association of the United States, advanced the concept of an Age-Friendly Health System. This initiative is designed to respond to the needs of a burgeoning U.S. older adult population, expected to double from 2012 to 2050, largely due to the aging of Baby Boomers and increased life expectancy. These Baby Boomers will demand a well-coordinated, communicative health system responsive to their values and preferences. In an Age-Friendly Health System, all older adults receive the best possible care, without care-related harms, and with satisfaction of care received. Essential elements include what matters, mentation, mobility, and medications, with a focus on patient-directed, family-engaged care. While a solid framework for improving healthcare for older adults, this model is further strengthened by incorporating the essential elements of person-, family-, and community-centered approaches to care; interprofessional team-based competencies, and Quadruple Aim outcomes. This enhanced model, referred to as the Age-Friendly Health System Integrated Interprofessional Model, combines elements essential to quality healthcare within the framework of an Age-Friendly Health System. This paper will present the original Age-Friendly Health System framework, the proposed Age-Friendly Health System Integrated Interprofessional Model, then compare and contrast each model’s essential principles. Implications for adoption of this enhanced model for policy, education, and practice will be explored.

scholarly journals Polypharmacy in Older Adults Hospitalized for Heart Failure

2020 ◽  
Vol 13 (11) ◽  
Author(s):  
Ozan Unlu ◽  
Emily B. Levitan ◽  
Evgeniya Reshetnyak ◽  
Jerard Kneifati-Hayek ◽  
Ivan Diaz ◽  
...  
Keyword(s):  
Heart Failure ◽  
Older Adults ◽  
Racial Differences ◽  
The United States ◽  
Negative Effects ◽  
Real World Data ◽  
American Hospital ◽  
American Hospital Association ◽  
Annual Survey ◽  
Regards Study

Background: Despite potential harm that can result from polypharmacy, real-world data on polypharmacy in the setting of heart failure (HF) are limited. We sought to address this knowledge gap by studying older adults hospitalized for HF derived from the REGARDS study (Reasons for Geographic and Racial Differences in Stroke). Methods: We examined 558 older adults aged ≥65 years with adjudicated HF hospitalizations from 380 hospitals across the United States. We collected and examined data from the REGARDS baseline assessment, medical charts from HF-adjudicated hospitalizations, the American Hospital Association annual survey database, and Medicare’s Hospital Compare website. We counted the number of medications taken at hospital admission and discharge; and classified each medication as HF-related, non-HF cardiovascular-related, or noncardiovascular-related. Results: The vast majority of participants (84% at admission and 95% at discharge) took ≥5 medications; and 42% at admission and 55% at discharge took ≥10 medications. The prevalence of taking ≥10 medications (polypharmacy) increased over the study period. As the number of total medications increased, the number of noncardiovascular medications increased more rapidly than the number of HF-related or non-HF cardiovascular medications. Conclusions: Defining polypharmacy as taking ≥10 medications might be more ideal in the HF population as most patients already take ≥5 medications. Polypharmacy is common both at admission and hospital discharge, and its prevalence is rising over time. The majority of medications taken by older adults with HF are noncardiovascular medications. There is a need to develop strategies that can mitigate the negative effects of polypharmacy among older adults with HF.

scholarly journals Effects of Distance and First-Time Visitation on Tourists’ Length of Stay

2016 ◽  
Vol 42 (7) ◽  
pp. 1023-1038 ◽  
Author(s):  
Juan L. Nicolau ◽  
Florian J. Zach ◽  
Iis P. Tussyadiah
Keyword(s):  
Length Of Stay ◽  
Negative Binomial ◽  
Positive Impact ◽  
Atlantic Coast ◽  
The United States ◽  
Tourism Management ◽  
Managerial Implications ◽  
First Time ◽  
Binomial Models ◽  
Central Factors

The analysis of length of stay and its determinants remains important in tourism due to its significant implications for tourism management. Results from previous studies show conflicting effects of the two central factors of length of stay: distance and first-time visitation. Hence, taking into account the not always unambiguous effect of distance and the variety-seeking and inertial behaviors of repeat visitation, the objective of this research is to add to the extant literature further empirical evidence. Data were collected from 908 U.S. visitors to a tourism destination in the Atlantic Coast of the United States and analyzed using the truncated negative binomial models. A positive impact of both distance and first-time visitation on length of stay is found. Managerial implications are provided.

scholarly journals Bundled Consent in US Intensive Care Units

2020 ◽  
Vol 29 (3) ◽  
pp. e44-e51
Author(s):  
Maria L. Espinosa ◽  
Aaron M. Tannenbaum ◽  
Megha Kilaru ◽  
Jennifer Stevens ◽  
Mark Siegler ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Intensive Care Units ◽  
The United States ◽  
Self Report ◽  
Medical Decision ◽  
Consent Rate ◽  
Surgical Intensive Care ◽  
American Hospital ◽  
American Hospital Association

Background Bundled consent, the practice of obtaining anticipatory consent for a predefined set of intensive care unit procedures, increases the rate of informed consent conversations and incorporation of patients’ wishes into medical decision-making without sacrificing patients’ or surrogates’ understanding. However, the adoption rate for this practice in academic and nonacademic centers in the United States is unknown. Objective To determine the national prevalence of use of bundled consent in adult intensive care units and opinions related to bundled consent. Methods A random sample of US hospitals with medical/surgical intensive care units was selected from the AHA [American Hospital Association] Guide. One intensive care unit provider (bedside nurse, nurse manager, or physician) from each hospital was asked to self-reportuse of per-procedure consent versus bundled consent, consent rate for intensive care unit procedures, and opinions about bundled consent. Results Of the 238 hospitals contacted, respondents from 100 (42%) completed the survey; 94% of respondents were nurses. The prevalence of bundled consent use was 15% (95% CI, 9%–24%). Respondents using per-procedure consent were more likely than those using bundled consent to self-report performing invasive procedures without consent. Users of bundled consent unanimously recommended the practice, and 49% of respondents using per-procedure consent reported interest in implementing bundled consent. Results Bundled consent use is uncommon in academic and nonacademic intensive care units, most likely because of conflicting evidence about the effect on patients and surrogate decision makers. Future work is needed to determine if patients, family members, and providers prefer bundled consent over per-procedure consent.

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