Failing to Complain: Do Nursing Homes with more Residents with Dementia have Fewer Complaints?

The majority of nursing home (NH) residents have Alzheimer’s Disease or Related Dementias (ADRD). However, the association of ADRD prevalence and NH quality is unclear. The objective of the current study is to understand the association of NH characteristics, including the proportion of ADRD residents, with the prevalence of NH complaints as an indicator of quality of care and quality of life. We merged data from the ASPEN Complaints/Incident Tracking System with national NH data from the Certification and Survey Provider Enhanced Reports, the Minimum Data Set, the Area Health Resource File, and zip-code level rural-urban codes in 2017. Three groups of NHs were created, including those whose proportion of residents with ADRD was in the top decile (i.e., high-dementia NHs (N=1,473)) and those whose proportion of ADRD residents was in the lowest decile (i.e., low-dementia NHs (N=1,524)). Bivariate results revealed high-ADRD NHs had higher percentages of Medicaid-paying residents, were less likely to be for-profit and chain-affiliated, had lower staffing hours and lower percentages of Black, Hispanic, and Asian residents. Using NHs in the middle deciles as reference, negative binomial regression models showed that having a low proportion of ADRD residents was significantly associated with higher numbers of total complaints (p<.001) and substantiated complaints (p<.001), whereas having a high proportion of ADRD residents was significantly associated with lower numbers of substantiated complaints (p=.001). The findings suggest the proportion of residents with ADRD in NHs is associated with quality, as measured by complaints. Policy implications of these findings will be discussed.

Wilsher v Essex Area Health Authority [1988] 1 AC 1074

Essential Cases: Tort Law provides a bridge between course textbooks and key case judgments. This case document summarizes the facts and decision in Wilsher v Essex Area Health Authority [1988] 1 AC 1074. The document also included supporting commentary from author Craig Purshouse.

Organizational Culture Compensation And Spiritual Intelligence on Work Productivity

This study aims to explain the relationship between organizational culture, compensation and spiritual intelligence on work productivity in the special area health office in Yogyakarta simultaneously and partially to work productivity in the special area health office in Yogyakarta. This research uses quantitative research methods. The research population sample shows that the Yogyakarta Special Region Health Service has 48 employees. The sample data collection technique is a probability sampling technique (saturated sampling) by taking a sample of 48 employees. The data collection method was using a questionnaire. The analysis technique used is simple regression with a significant level of 0.05. The results of this study indicate that (1) organizational culture has a positive effect on work productivity (2) compensation has a positive effect on work productivity (3) spiritual intelligence has a positive effect on work productivity (4) ) organizational culture, compensation, spiritual intelligence simultaneously influence work productivity.

Analysis of the Effect of Health Service Quality on Patient Satisfaction in Internal Medicine Inpatient Room of Hospital Level II Military Area Health Medan

The purpose of this study was to determine the effect of quality on patient satisfaction in the hospital room for the Level II Military area health Medan in 2020. The research design used in this study was an analytic survey with a cross sectional design. The population in this study were all patients in the Internal Medicine Room of hospital Level II Military area health Medan as many as 167 people. The number of samples that will be studied is 118 people. Data analysis was performed using univariate, bivariate and multivariate analyzes. The statistical test used was the chi square test and logistic regression.The results of the chi square test showed that the technical competence variable obtained p-value = 0,000, efficiency p-value = 0,000, and patient safety p-value = 0,000 < α 0.05, meaning that there was an influence between technical competence, efficiency and Patient safety on patient satisfaction, from the results of the multivariate analysis, it was found that the most influential variable in this study was the patient safety variable. The conclusion is that there is an influence between technical competence, efficiency and patient safety, while multivariate analysis shows that the most dominant factor is the variable of patient safety on family satisfaction. It is recommended that the hospital be able to improve the technical competence of nurses in the inpatient room of the Public Health Service in Medan by holding training and workshops both internal and external training.

Variations in breast cancer surgical treatment and timing: determinants and disparities

Purpose To describe clinical and non-clinical factors associated with receipt of breast conserving surgery (BCS) versus mastectomy and time to surgical intervention. Methods Cross-sectional retrospective study of January 1, 2012 through March 31, 2018 data from the IBM MarketScan Commercial Claims and Encounter and Medicare Supplemental Databases. Area Health Resource Files provided non-clinical characteristics and sociodemographic data. Eligibility: Female sex, claim(s) with ICD-9-CM or ICD-10-CM diagnosis of non-metastatic invasive breast cancer, > 6 months of continuous insurance pre- and post-diagnosis, evidence of BCS or mastectomy following initial ICD9/10 code diagnosis. Logistic and quantile multivariable regression models assessed the association between clinical and non-clinical factors and the outcome of BCS and time to surgery, respectively. Results A total of 53,060 women were included in the study. Compared to mastectomy, BCS was significantly associated with older age (ORs: 1.54 to 2.99, 95% CIs 1.45 to 3.38; ps < .0001) and higher community density of medical genetics (OR: 5.88, 95% CIs 1.38 to 25.00; p = 0.02) or obstetrics and gynecology (OR: 1.13, 95% CI 1.02 to 1.25; p = .02) physicians. Shorter time-to-BCS was associated with living in the South (−2.96, 95% CI −4.39 to −1.33; p < .0001). Longer time-to-BCS was associated with residence in more urban (4.18, 95% CI 0.08 to 8.29; p = 0. 05), educated (9.02, 95% CI 0.13 to 17.91; p = 0.05), or plastic-surgeon-dense (4.62, 95% CI 0.50 to 8.73; p = 0.03) communities. Conclusions Clinical and non-clinical factors are associated with adoption of BCS and time to treatment, suggesting opportunities to ensure equitable and timely care.

THE EPIDEMIOLOGY OF HEALTH AND SOCIAL CARE COST AND CAPACITY SHOCKS

The financial and capacity pressures experienced by hospitals and social care organisations are far higher than has been realized. End-of-life is a time of high utilization of acute and social care. The absolute number of deaths (and its year-to-year variation) then acts to drive the marginal pressures in both capacity and costs for these organisations. Higher weighted population density is associated with higher year-to-year volatility in deaths, hospital admissions and sickness absence, which seems to work via a multitude of (local) infectious outbreaks from the >2,000 known species of human pathogens. The funding formulae used to distribute money to area health boards and social care organisations around the world do not generally contain any recognition for the role of the absolute number of deaths in the costs incurred by such organisations. A far more nuanced approach is required by governments around the world to equalising these pressures which are beyond the control of the organisations involved in delivering health and social care.

Approach to Sample Collection, Transport and Processing of Suspected or Confirmed COVID-19 Patients for Biochemistry Investigations

During this global pandemic period of COVID-19, the health care system is the most affected area. Health care workers including clinicians, laboratory professionals, and other allied health workers pose a high threat for acquiring and transmission the disease. Apart from the diagnosis of disease by the RT-PCR, other laboratory investigations are equally essential in disease prognosis and monitoring. This biosafety guidance is intended to provide and insight to the clinicians, nurses, and laboratory professionals in handling the blood and other body fluid samples for biochemical investigations concerning the proper methods of sample collection, transport, processing, and disposal. Every day, the laboratory receives samples of the patient with confirmed and suspected cases of COVID-19 patients. This poses a high threat of contamination to the health professionals and thus, a proper risk assessment and standard precautions protocol must be followed to ensure safety, minimize the risk of contamination and disease transmission.