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This qualitative study used conventional content analysis of interview data to examine nursing staff members' experiences with Household Model implementation in a nursing home setting. Staff members were recruited from the skilled nursing center post implementation and completed individual interviews (N=16). Participants described the impact of implementation in relation to three categories: antecedents, explicit reactions and change consequences. Participants described barriers and facilitators to implementation as well as outcomes such as role strain, feelings of isolation and harder working conditions. This study provides opportunities for further examination of nursing staff members' experiences with person centered care models in nursing homes, how those experiences may relate to effectiveness of implementation and the need for support of nursing home staff.

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PURPOSE: To use a randomized controlled design to explore the effects of evidence-based medicine (EBM) education on physician assistant (PA) students' EBM knowledge, self-efficacy, and evidence-seeking behavior in a simulated clinical situation and to present a model of EBM competence. METHODS: Sixty-one didactic-year PA students from one Midwestern University (2 sequential cohorts) were randomized to receive the standard PA curriculum plus EBM training (intervention) or the standard PA curriculum only (control). Evidence-based medicine knowledge was measured with a validated Fresno test. Self-efficacy was measured with a validated Likert scale. Clinical application of EBM skills was measured with an objective structured clinical examination (OSCE). RESULTS: Evidence-based medicine education led to significant improvements on the Fresno and self-efficacy tests, both within and between groups. On the OSCE, the intervention group performed no better than the control group. Higher Fresno pretest scores were significantly related to decreasing improvements in the posttest scores: R = -0.634. CONCLUSION: Teaching EBM to PA students improved their EBM knowledge and self-efficacy but not their clinical application. Future research should focus on enhancing EBM evaluation and application in the clinical setting.

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OBJECTIVES: This study assessed the comprehensiveness and efficiency of existing Flint area public health community data using a novel method. One hundred thirty-eight community public health data reports were identified and screened for inclusion from Internet searches and community partner interviews. METHODS: Forty-two Centers for Disease Control and Prevention (CDC)-based health metrics were adopted as a standard for unbiased comparison. For each report, a percentage "match-to-standard" was calculated (i.e., we calculated the percentage of CDC recommended metrics that were covered in the report). The two locally generated reports with the highest match-to-standard scores were compared for overlap. RESULTS: There were 138 initially identified reports, and 110 unique reports remained after duplicates were removed. Twenty public health data reports met inclusion criteria and were included in the final sample. The top local public health data report yielded a 59.5% match-to-standard, indicating a 23.8% gap in current Flint area community data. Evaluation across all reports yielded an 89.3% match-to-standard with a 10.7% gap. An overlap of 70% exists between the two local reports with the highest match-to-standard scores. CONCLUSIONS: This research identified key health metrics not captured by current locally generated Flint public health reports. The 23.8% gap indicates an opportunity to improve local public health data report comprehensiveness. The 70% overlap across the two local reports with greatest match-to-standard scores generated locally, indicates potential duplication and an opportunity to improve efficiency.

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This cross-sectional study examines factors associated with the CMS Summary Star Ratings in Home Health Agencies (HHA). Using Home Health Compare, medical claims, and census data, negative binomial regression analysis was conducted at the HHA level. Positive associations were found between Summary Star Ratings and beneficiary age, the number of claims, the proportion for specific diagnoses, the agency being hospital based, HHA age since establishment, patient retainment, improved walking/moving/bathing, and homeownership. Negative associations were found for specific ICD diagnosis proportions, HHAs serving special populations, the rate of non-white patients, patients transferred to different HHAs, income, and marital status in the coverage area. These findings are relevant to both practitioners and policymakers, in that they highlight major non-service factors associated with perceived quality of care.

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Clinical Decision Support Systems (CDSS) provide aid in clinical decision making and therefore need to take into consideration human, data interactions, and cognitive functions of clinical decision makers. The objective of this paper is to introduce a high level reference model that is intended to be used as a foundation to design successful and contextually relevant CDSS systems. The paper begins by introducing the information flow, use, and sharing characteristics in a hospital setting, and then it outlines the referential context for the model, which are clinical decisions in a hospital setting. Important characteristics of the Clinical decision making process include: (i) Temporally ordered steps, each leading to new data, which in turn becomes useful for a new decision, (ii) Feedback loops where acquisition of new data improves certainty and generates new questions to examine, (iii) Combining different kinds of clinical data for decision making, (iv) Reusing the same data in two or more different decisions, and (v) Clinical decisions requiring human cognitive skills and knowledge, to process the available information. These characteristics form the foundation to delineate important considerations of Clinical Decision Support Systems design. The model includes six interacting and interconnected elements, which formulate the high-level reference model (CDSS-RM). These elements are introduced in the form of questions, as considerations, and are examined with the use of illustrated scenario-based and data-driven examples. The six elements /considerations of the reference model are: (i) Do CDSS mimic the cognitive process of clinical decision makers? (ii) Do CDSS provide recommendations with longitudinal insight? (iii) Is the model performance contextually realistic? (iv) Is the 'Historical Decision' bias taken into consideration in CDSS design? (v) Do CDSS integrate established clinical standards and protocols? (vi) Do CDSS utilize unstructured data? The CDSS-RM reference model can contribute to optimized design of modeling methodologies, in order to improve response of health systems to clinical decision-making challenges.

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Comorbidities are multiple co-occurring disorders associated with a primary diagnosis and affect health outcomes and cost of care. Using home health medical claims data, a comorbidity database with frequent item-sets, and an exemplar dashboard were created. The dashboard extends the decision making capacity of clinicians by providing data-driven information about (i) the frequency of comorbidities for any primary diagnosis, and (ii) primary diagnoses sufficiently exclusive to a given comorbidity. Regression models estimate total charges, for any underlying patient comorbidity profile. Using the exemplar dashboard, a panel of healthcare researchers recommended appropriate system parameters to adjust system sensitivity and improve construct validity. The comorbidity database will be useful in future research efforts to study comorbidity, while the exemplar dashboard can provide the foundation for integrated home healthcare decision support systems.

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This study used a unique approach to examine Florida county health department environmental health (EH) program performance of the 10 Essential Environmental Public Health Services (EEPHS) and its relationship with environment-related disease, described by enteric disease rates. Correlation analysis tested the association between performance of each EEPHS and five different enteric disease rates, while multivariate regression analysis further examined the relationships while considering program organizational characteristics as potential confounders. Correlation analyses revealed cryptosporidiosis was associated with EEPHS 2 diagnose (Tb = .195, p = .027) and EEPHS 8 workforce (Tb = .234, p = .006), and salmonellosis with EEPHS 4 mobilize (Tb = .179, p = .042) and EEPHS 6 enforce (Tb = .201, p = .020). Multivariate regression results showed EEPHS 2 diagnose (p = .04) and EEPHS 4 mobilize (p = .00) had statistically significant associations with cryptosporidiosis and salmonellosis, respectively, and suggested that improved performance of these two EEPHS may have decreased disease incidence. EH programs may benefit from improving the performance of EEPHS to address the incidence of certain enteric diseases. Continued efforts to develop a robust understanding of EH program performance and its impact on environment-related disease could enhance EH services delivery and ability to improve health outcomes.

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CONTEXT: Athletic trainers have the opportunity to treat unique populations. Determining athletes' satisfaction with the athletic training services supplied can offer insights into how to improve the health care provided to athletes. OBJECTIVE: To explore Deaflympians' satisfaction with athletic training services at the 2013 Deaflympic Summer Games. DESIGN: Cross-sectional survey. SETTING: The 2013 Deaflympic Summer Games in Sofia, Bulgaria. PATIENTS OR OTHER PARTICIPANTS: Of the 115 Deaflympians contacted, 55 completed the questionnaire, for a 48% response rate (women = 33, men = 22). MAIN OUTCOME MEASURE(S): The Medical Interview Satisfaction Survey-Athletic Training was used. The questionnaire gathered demographic data and included 25 Likert-scale items that assessed 6 components of athletic training. Descriptive statistics were calculated as normalized scores to adjust for the different numbers of questions for each item. On a 5-point scale, the scores ranged from 3.82 (management) to 4.24 (environment), with an overall satisfaction score of 3.89. We conducted comparison tests to assess possible differences in overall satisfaction and satisfaction components. Satisfaction with frequency of use of the athletic training room and knowledge were the only areas that showed statistically significant differences. Other differences were in perceptions of medical coverage among age groups and management between sexes. RESULTS: Satisfaction with the athletic training services provided was lower among these Deaflympians than among collegiate athletes in other studies. However, we observed no differences in overall satisfaction scores by age, sex, race, previous Deaflympic experience, or individual or team sport. Deaflympians who used and visited the athletic training facility more often had higher overall satisfaction scores than individuals who used and visited the facility less. CONCLUSIONS: Deaflympians were satisfied with the athletic training services provided at the 2013 Deaflympic Summer Games.

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PURPOSE: Personal statements are a required component of the Central Application Service for Physician Assistants (CASPA) application package submitted to physician assistant (PA) programs that participate in the service. Prior research involving the use of personal statements in the selection process of graduate and professional programs has found a significant amount of homogeneity within the statements. This study sought to determine the major theme content and frequency of occurrence of these themes in the personal statements submitted by applicants to a Midwestern PA program. METHODS: After receiving signed consent, personal statements were extracted from the application packages of 63 students. Statements were identified with a random number. Each statement was reviewed and content themes were identified and manually coded by two separate reviewers. The reviewers and primary investigator then met and determined the major content categories by consensus. RESULTS: The review identified seven major content themes. Four of these themes were present in 70% or more of the statements: health care experience, altruism, patient interaction, medical profession. CONCLUSION: The personal statements reviewed contained similar content, confirming prior research that these statements may follow some formula for success. This may be evidence that applicants feel these attributes demonstrate that they are qualified candidates for admission. Further study should be conducted to see how these statements are used in the PA program admissions process.

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Physician assistants (PAs) are more frequently finding themselves in positions where they are responsible for staff recruitment and retention. Staff turnover is associated with significant financial costs for organizations. Motivational theories focusing on job design indicate that paying attention to a combination of factors related to the work itself, in addition to the environment where the work is performed, increases satisfaction. This study asked a convenience sample of practicing PAs to rate the importance of a number of work-related factors known to influence job satisfaction. The results may be used as a basis for designing an environment to increase job satisfaction and improve recruitment and retention of highly qualified staff.

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BACKGROUND: With an anticipated increased use of nursing homes to serve an aging population in the United States, questions regarding the quality and cost of nursing home services come to the fore. Such questions are the concern of nursing home residents, their families, private and public payers, policy makers, regulators, and nursing home operators. PURPOSES: The purpose of this study was to examine the relationship between quality of care and efficiency of nursing homes to determine the characteristics of facilities that achieve high quality and high efficiency. The study sought also to determine the extent to which nursing homes can provide high-quality services and do so with a high level of efficiency. METHODOLOGY/APPROACH: This was a cross-sectional study of a 10% random sample of U.S. nursing homes, excluding those in hospitals and also those with fewer than 20 beds or more than 360 beds. Data sources were the Online Survey Certification and Reporting, the Area Resource File database, the U.S. Bureau of Labor Statistics, and the U.S. Bureau of Economic Analysis. Data envelopment analysis was employed in the analysis of data. FINDINGS: The average efficiency of nursing homes was 0.869 (SD = 0.1362), with a statistically significant higher average efficiency for nursing homes in urban areas; in counties with a higher level of competition, higher average income, or higher number of home health agencies; and in not-for-profit and governmental facilities. Quality measures were compared between efficient and inefficient nursing homes, showing mostly favorable quality outcomes for efficient nursing homes. PRACTICE IMPLICATIONS: Families and residents evaluating or in search of nursing homes can be confident that high-quality, efficient nursing homes exist. Legislators, policy makers, regulators, payers, and administrators can be confident that the setting of standards that encourage striving for both quality and efficiency simultaneously is indeed realistic.

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OBJECTIVE: To determine differences between children and their parents' perceptions regarding dietary behaviors, physical activity (PA), and screen time. STUDY DESIGN: This study included 292 children in the 3rd and 4th grades (mean age 8.48 years) and their parents/guardians. Eighty-eight parent/guardian-child pairs completed a modified version of the Centers for Disease Control and Prevention Youth Risk Behavior Survey that specifically asked parents about their child's health behaviors. A similar version of the survey was also given to their children to answer questions regarding their personal health behaviors. A paired t test was performed to assess the difference in parent-child responses. An independent t test was performed to assess the sex and age difference in nutritional habits, amount of screen time, and PA among children. RESULTS: Of 88 parent-child dyads, there was no single dyad that provided the same answers to all the questions. There are differences between children's and parent's perception of average food consumption, amount of screen time, and PA. Fourth graders reported higher number of PA days than did 3rd graders (4.65 vs 5.57, P < .05). CONCLUSIONS: The discrepancies found between parents and their children concerning food choices, juice and soft drinks, screen time, and PA are all troubling, particularly in a community where obesity risk is high. The findings indicate a continued need for information about parent and child perceptions of diet behaviors and PA.

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