RESUMEN
Hospital engagement networks (HENs) are part of the largest health care improvement initiative ever undertaken. This article explores whether engagement in improvement activities within a HEN affected quality measures. Data were drawn from 1174 acute care hospitals. A composite quality score was created from 10 targeted topic area measures multiplied by the number of qualifying topics. Scores improved from 5.4 (SD = 6.8) at baseline to 4.6 (5.9) at remeasurement; P < .0001. Hospitals with higher baseline scores demonstrated greater improvement ( P < .0001) than hospitals with lower baseline scores. Hospitals with larger Medicaid populations ( P = .023) and micropolitan ( P = .034) hospitals tended to have greater improvement, whereas hospitals in the West ( P = .0009) did not improve as much as hospitals in other regions. After adjusting for hospital characteristics, hospitals with improvement champions ( P = .008), a higher level of engagement with their state association ( P = .001), and more leadership involvement ( P = .005) in HEN demonstrated greater improvement.
Asunto(s)
Hospitales/normas , Cultura Organizacional , Mejoramiento de la Calidad/organización & administración , Indicadores de Calidad de la Atención de Salud/estadística & datos numéricos , Centers for Medicare and Medicaid Services, U.S. , Humanos , Liderazgo , Medicaid/estadística & datos numéricos , Mejoramiento de la Calidad/normas , Estados UnidosRESUMEN
Staff members, physicians, nurse practitioners, and physician assistants from a sample of hemodialysis facilities in Network 6 (North Carolina, South Carolina, and Georgia) and Network 11 (Michigan, Minnesota, North Dakota, South Dakota, and Wisconsin) completed a 10-item assessment with modified questions from the Hospital Survey on Patient Safety Culture, with an emphasis on safety culture related to vascular access infections. A composite score was constructed, which was the average of the percent-positive scores of the items. Overall, scores were high, indicating a positive patient safety culture. Composite scores varied by role type, with nurses, patient care technicians, and other technicians reporting the lowest composite scores. Network 6 participants reported higher scores on two of the survey items. Fewer staff within a facility were associated with higher composite scores.
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Lesión Renal Aguda/terapia , Actitud del Personal de Salud , Infecciones Relacionadas con Catéteres/prevención & control , Personal de Salud/psicología , Cultura Organizacional , Seguridad del Paciente , Dispositivos de Acceso Vascular/normas , Adulto , Educación Continua en Enfermería , Femenino , Personal de Salud/educación , Encuestas Epidemiológicas , Humanos , Masculino , Persona de Mediana Edad , Enfermería en Nefrología/organización & administración , Diálisis Renal , Estados Unidos , Lugar de Trabajo/psicologíaRESUMEN
OBJECTIVE: To determine the agreement of measures of care in different settings-hospitals, nursing homes (NHs), and home health agencies (HHAs)-and identify communities with high-quality care in all settings. DATA SOURCES/STUDY SETTING: Publicly available quality measures for hospitals, NHs, and HHAs, linked to hospital service areas (HSAs). STUDY DESIGN: We constructed composite quality measures for hospitals, HHAs, and nursing homes. We used these measures to identify HSAs with exceptionally high- or low-quality of care across all settings, or only high hospital quality, and compared these with respect to sociodemographic and health system factors. PRINCIPAL FINDINGS: We identified three dimensions of hospital quality, four HHA dimensions, and two NH dimensions; these were poorly correlated across the three care settings. HSAs that ranked high on all dimensions had more general practitioners per capita, and fewer specialists per capita, than HSAs that ranked highly on only the hospital measures. CONCLUSION: Higher quality hospital, HHA, and NH care are not correlated at the regional level; regions where all dimensions of care are high differ systematically from regions which score well on only hospital measures and from those which score well on none.
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Agencias de Atención a Domicilio/organización & administración , Hogares para Ancianos/organización & administración , Administración Hospitalaria/normas , Casas de Salud/organización & administración , Calidad de la Atención de Salud/estadística & datos numéricos , Servicios de Salud Comunitaria/normas , Agencias de Atención a Domicilio/normas , Hogares para Ancianos/normas , Humanos , Mortalidad , Casas de Salud/normas , Evaluación de Procesos y Resultados en Atención de Salud , Readmisión del Paciente , Indicadores de Calidad de la Atención de Salud , Características de la Residencia , Factores SocioeconómicosRESUMEN
BACKGROUND: Patient and family engagement (PFE) in healthcare is an important element of the transforming healthcare system; however, the prevalence of various PFE practices in the USA is not known. OBJECTIVE: We report on a survey of hospitals in the USA regarding their PFE practices during 2013-2014. RESULTS: The response rate was 42%, with 1457 acute care hospitals completing the survey. We constructed 25 items to summarise the responses regarding key practices, which fell into three broad categories: (1) organisational practices, (2) bedside practices and (3) access to information and shared decision-making. We found a wide range of scores across hospitals. Selected findings include: 86% of hospitals had a policy for unrestricted visitor access in at least some units; 68% encouraged patients/families to participate in shift-change reports; 67% had formal policies for disclosing and apologising for errors; and 38% had a patient and family advisory council. The most commonly reported barrier to increased PFE was 'competing organisational priorities'. SUMMARY: Our findings indicate that there is a large variation in hospital implementation of PFE practices, with competing organisational priorities being the most commonly identified barrier to adoption.
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Atención a la Salud/organización & administración , Hospitales/estadística & datos numéricos , Evaluación de Resultado en la Atención de Salud , Atención Dirigida al Paciente/organización & administración , Relaciones Profesional-Familia , Toma de Decisiones Clínicas , Estudios Transversales , Femenino , Encuestas de Atención de la Salud , Humanos , Masculino , Participación del Paciente/estadística & datos numéricos , Estados UnidosRESUMEN
The annual Kaiser Family Foundation/Health Research and Educational Trust Employer Health Benefits Survey found that in 2015, average annual premiums (employer and worker contributions combined) were $6,251 for single coverage and $17,545 for family coverage. Both premiums rose 4 percent from 2014, continuing several years of modest growth. The percentage of firms offering health benefits and the percentage of workers covered by their employers' plans remained statistically unchanged from 2014. Eighty-one percent of covered workers were enrolled in a plan with a general annual deductible. Among those workers, the average deductible for single coverage was $1,318. Half of large employers either offered employees the opportunity or required them to complete biometric screening. Of firms that offer an incentive for completing the screening, 20 percent provide employees with incentives or penalties that are tied to meeting those biometric outcomes. The 2015 survey included new questions on financial incentives to complete wellness programs and meet specified biometric outcomes as well as questions about narrow networks and employers' strategies related to the high-cost plan tax and the employer shared-responsibility provisions of the Affordable Care Act.
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Deducibles y Coseguros , Planes de Asistencia Médica para Empleados , Cobertura del Seguro , Deducibles y Coseguros/economía , Deducibles y Coseguros/estadística & datos numéricos , Planes de Asistencia Médica para Empleados/economía , Planes de Asistencia Médica para Empleados/estadística & datos numéricos , Humanos , Cobertura del Seguro/economía , Cobertura del Seguro/estadística & datos numéricos , Estados UnidosRESUMEN
OBJECTIVE: To examine the relationship between community factors and hospital readmission rates. DATA SOURCES/STUDY SETTING: We examined all hospitals with publicly reported 30-day readmission rates for patients discharged during July 1, 2007, to June 30, 2010, with acute myocardial infarction (AMI), heart failure (HF), or pneumonia (PN). We linked these to publicly available county data from the Area Resource File, the Census, Nursing Home Compare, and the Neilsen PopFacts datasets. STUDY DESIGN: We used hierarchical linear models to assess the effect of county demographic, access to care, and nursing home quality characteristics on the pooled 30-day risk-standardized readmission rate. DATA COLLECTION/EXTRACTION METHODS: Not applicable. PRINCIPAL FINDINGS: The study sample included 4,073 hospitals. Fifty-eight percent of national variation in hospital readmission rates was explained by the county in which the hospital was located. In multivariable analysis, a number of county characteristics were found to be independently associated with higher readmission rates, the strongest associations being for measures of access to care. These county characteristics explained almost half of the total variation across counties. CONCLUSIONS: Community factors, as measured by county characteristics, explain a substantial amount of variation in hospital readmission rates.
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Casas de Salud/normas , Readmisión del Paciente/estadística & datos numéricos , Apoyo Social , Anciano , Centers for Medicare and Medicaid Services, U.S. , Capacidad de Camas en Hospitales , Hospitales/clasificación , Humanos , Modelos Lineales , Análisis Multivariante , Infarto del Miocardio/terapia , Neumonía/terapia , Factores Socioeconómicos , Estados UnidosRESUMEN
The annual Kaiser Family Foundation/Health Research and Educational Trust Employer Health Benefits Survey found that in 2014 the average annual premium (employer and worker contributions combined) for single coverage was $6,025, similar to 2013. The premium for family coverage was $16,834--3 percent higher than a year ago. Average deductibles and most other cost-sharing amounts were similar to those in 2013. On average, in 2014 covered workers paid nearly $5,000 per year for family health insurance premiums, and 18 percent of covered workers were in a plan with an annual single coverage deductible of $2,000 or more. Fifty-five percent of employers offered health benefits in 2014, similar to 2013. The Affordable Care Act has not yet led to substantial changes in the employer-based market. However, the next few years could present a different picture as delayed provisions and other changes take effect. This year's survey included new questions on firms' policies related to enrolling spouses and dependents, enrollment in private exchanges, and the use of narrow networks and financial incentives for wellness programs.
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Planes de Asistencia Médica para Empleados/estadística & datos numéricos , Cobertura del Seguro/estadística & datos numéricos , Seguro de Salud/estadística & datos numéricos , Seguro de Costos Compartidos/economía , Seguro de Costos Compartidos/estadística & datos numéricos , Costos de los Medicamentos/estadística & datos numéricos , Planes de Asistencia Médica para Empleados/economía , Costos de la Atención en Salud/estadística & datos numéricos , Encuestas de Atención de la Salud , Gastos en Salud/estadística & datos numéricos , Humanos , Cobertura del Seguro/economía , Seguro de Salud/economía , Pensiones , Medicamentos bajo Prescripción/economía , Estados UnidosRESUMEN
BACKGROUND: Since development of the Institute for Safe Medication Practices (ISMP) Medication Safety Self Assessment for Hospitals in 2000, hospitals have used the tool to assess medication safety practices and identify opportunities for improvement. The Assessment was updated in 2011 to create a new baseline of hospital medication safety efforts and determine if progress has been achieved in the interim. METHODS: Hospitals in the United States were asked to voluntarily complete the 2011 Assessment and submit their data confidentially to ISMP from April to October 2011. The Assessment contained 270 items organized into 10 key elements and then further divided into 20 core characteristics. RESULTS: By October 2011, 1,310 hospitals had submitted data to ISMP for a response rate of 23% for all 5,786 hospitals. Scores in 2011 increased significantly from 2000. The largest percent improvements were in core characteristics related to communication of drug orders, patient education, and quality processes and risk management. Hospitals in 2011 scored lowest in areas related to patient information, staff competency and education, and drug information. Higher scores for the core characteristics related to the organizational culture and staff education about medication error prevention were associated with higher scores for the core characteristic associated with error detection, reporting, and analysis. Hospitals with a medication safety officer scored higher in all key elements than hospitals without. CONCLUSIONS: While substantial medication safety improvements have been achieved within the last decade, opportunities still exist to improve medication safety. Widespread adoption of key safety strategies will be more effective if influential groups work together and external forces provide the necessary pressure via regulations, standards, public policy, or incentives.
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Errores de Medicación/prevención & control , Sistemas de Medicación en Hospital/organización & administración , Calidad de la Atención de Salud/organización & administración , Administración de la Seguridad/organización & administración , Comunicación , Prescripción Electrónica , Capacitación en Servicio , Cultura Organizacional , Educación del Paciente como Asunto , Seguridad del Paciente , Estados UnidosRESUMEN
Employer-sponsored health insurance premiums rose moderately in 2013, the annual Kaiser Family Foundation/Health Research and Educational Trust (Kaiser/HRET) Employer Health Benefits Survey found. In 2013 single coverage premiums rose 5 percent to $5,884, and family coverage premiums rose 4 percent to $16,351. The percentage of firms offering health benefits (57 percent) was similar to that in 2012, as was the percentage of workers at offering firms who were covered by their firm's health benefits (62 percent). The share of workers with a deductible for single coverage increased significantly from 2012, as did the share of workers in small firms with annual deductibles of $1,000 or more. Most firms (77 percent), including nearly all large employers, continued to offer wellness programs, but relatively few used incentives to encourage employees to participate. More than half of large employers offering health risk appraisals to workers offered financial incentives for completing the appraisal.
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Honorarios y Precios/tendencias , Planes de Asistencia Médica para Empleados/economía , Cobertura del Seguro/economía , Estados UnidosRESUMEN
Health care premiums rose moderately for single and family employer-sponsored coverage this year, the 2012 annual Kaiser Family Foundation/Health Research and Educational Trust (HRET) Survey of Employer Health Benefits found. Even with the lingering effects of the recession, cost-sharing levels remained relatively stable in 2012. Also remaining stable was the rate at which employers offered coverage, according to the survey, which was based on telephone interviews with 2,121 public and private employers contacted from January through May 2012. The average annual premiums in 2012 were $5,615 for single coverage and $15,745 for family coverage, an increase of 3 and 4 percent, respectively, from 2011. The percentage of firms offering health benefits, 61 percent, was similar to last year's, as was the percentage of workers at offering firms who were covered by their firm's health benefits, 62 percent. One noteworthy change, because of a provision of the Affordable Care Act, is that 2.9 million young adults who would not otherwise have been enrolled in a parent's employer-sponsored health insurance were covered by that insurance in 2012.
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Planes de Asistencia Médica para Empleados/economía , Cobertura del Seguro/legislación & jurisprudencia , Patient Protection and Affordable Care Act/legislación & jurisprudencia , Recolección de Datos , Humanos , Investigación Cualitativa , Estados Unidos , Adulto JovenRESUMEN
Accountable care organizations (ACOs) are forming in communities across the country. In ACOs, health care providers take responsibility for a defined patient population, coordinate their care across settings, and are held jointly accountable for the quality and cost of care. This issue brief reports on results from a survey that assesses hospitals' readiness to participate in ACOs. Results show we are at the beginning of the ACO adoption curve. As of September 2011, only 13 percent of hospital respondents reported participating in an ACO or planning to participate within a year, while 75 percent reported not considering participation at all. Survey results indicate that physician-led ACOs are the second most common governance model, far exceeding payer-led models, highlighting an encouraging paradigm shift away from acute care and toward primary care. Findings also point to significant gaps, including the infrastructure needed to take on financial risks and to manage population health.
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Organizaciones Responsables por la Atención/organización & administración , Difusión de Innovaciones , Administración Hospitalaria , Hospitales/estadística & datos numéricos , Economía Hospitalaria , Humanos , Mecanismo de Reembolso , Reembolso de Incentivo , Riesgo , Estados UnidosRESUMEN
OBJECTIVE: The researchers sought to determine what factors might affect the outcomes of remediation, including the likelihood of recidivism, among nurses who had been the subject of disciplinary action and had been put on probation by a state board of nursing. METHODS: Boards of nursing in six states, Arizona, Maryland, Massachusetts, Minnesota, Nebraska, and North Carolina, chose to participate in this exploratory study. A 29-item questionnaire was used to investigate the records of 207 RNs, LPNs, and advanced practice RNs (APRNs) who were disciplined and put on probation by a state nursing board in 2001, as well as to collect data on their employment settings, the boards' actions, and remediation outcomes (the presence or absence of recidivism); 491 nurses who had not been disciplined served as controls. RESULTS: Among the disciplined nurses studied, 57% were RNs, 36% were LPNs, 3% held both RN and LPN licenses, and 3% were APRNs. Of the disciplined group, 39% recidivated between 2001 and 2005. Three factors were shown to influence the recidivism rate: having a history of criminal conviction, having committed more than one violation before the 2001 probation, and changing employers during the probationary period.Data on history of criminal conviction prior to state board disciplinary action were available for 112 (54%) of the 207 nurses. Among those 112, 35% (n = 39) had a history of criminal conviction, whereas only 3% of the control group reported one. The recidivism rate among those with a history of criminal conviction (56%; 22 of 39 nurses) was nearly twice as high as the rate among those without such a history (33%; 24 of 73). Also, 33% of the disciplined nurses changed employers during their probation; the recidivism rate among them was more than twice the rate among the disciplined nurses who stayed with the same employer. The recidivism rate of the 45 disciplined nurses who committed more than one practice-related violation from 1996 through 2001 was twice as high as the rate of those who committed only a single violation.The proportion of men who had been disciplined was more than twice the proportion of men in the national nursing workforce. Younger nurses (both men and women) were more likely to recidivate. CONCLUSIONS: All health care regulators and nursing employers should be aware of the association between a history of criminal conviction and the likelihood of committing a violation that requires state nursing board disciplinary action.
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Crimen/estadística & datos numéricos , Licencia en Enfermería/estadística & datos numéricos , Enfermeras y Enfermeros/estadística & datos numéricos , Adulto , Factores de Edad , Anciano , Arizona , Distribución de Chi-Cuadrado , Crimen/legislación & jurisprudencia , Disciplina Laboral/legislación & jurisprudencia , Disciplina Laboral/estadística & datos numéricos , Empleo/legislación & jurisprudencia , Empleo/estadística & datos numéricos , Femenino , Humanos , Licencia en Enfermería/legislación & jurisprudencia , Modelos Logísticos , Masculino , Maryland , Massachusetts , Persona de Mediana Edad , Minnesota , Nebraska , North Carolina , Enfermeras y Enfermeros/legislación & jurisprudencia , Investigación en Enfermería , Registros/legislación & jurisprudencia , Registros/estadística & datos numéricos , Factores Sexuales , Encuestas y CuestionariosAsunto(s)
Disciplina Laboral/tendencias , Licencia en Enfermería/tendencias , Mala Praxis/tendencias , Enfermeras y Enfermeros/tendencias , Inhabilitación Profesional/estadística & datos numéricos , Adulto , Bases de Datos Factuales , Decepción , Documentación/tendencias , Femenino , Fraude/tendencias , Humanos , Masculino , Trastornos Relacionados con Sustancias/epidemiología , Estados UnidosRESUMEN
The Institute of Medicine recommended establishing evidence-based teaching methods and curricula in health professions' education to meet the needs of the changing healthcare system. In an attempt to provide evidence-based information for nursing education, this study was designed to identify educational elements that best prepare nurses for practice. The study employed a two-tiered survey process for collecting and combining data from programs of nursing education and the graduates of those programs. Administrators of 410 nursing programs responded to questions related to elements of education in their programs (response rate = 51%), whereas 7,497 RN (76.5%) and LPN (23.5%) graduates of respondent programs answered questions related to the adequacy of educational preparation for practice, difficulty with current client care assignments, and other professional and practice issues (response rate = 45.4%). The majority of the nurses reported that their education had adequately prepared them to perform many, but not all, essential areas of the nursing functions examined. Nearly 20% of the RNs and 18% of the LPNs reported having difficulty with client care assignments. Inadequate preparation of several nursing functions were identified as predictive of difficulty with patient care assignments. These areas include working effectively within the healthcare team, administering medications to groups of patients, analyzing multiple types of data when making client-related decisions, delegating tasks to others, and understanding the pathophysiology underlying a client's conditions. In addition, it was found that the graduates were more likely to feel adequately prepared when nursing programs taught them use of information technology and evidence-based practice; integrated pathophysiology and critical thinking throughout the curriculum; taught content related to the care of client populations as independent courses; and had a higher percentage of faculty teaching both didactic and clinical components of the curriculum. The findings of this study are significant in broadening our understanding of the relationships between educational elements and preparedness of new nurses for practice.
Asunto(s)
Competencia Clínica , Curriculum , Educación en Enfermería , Docentes de Enfermería , Encuestas de Atención de la Salud , Humanos , Relaciones Interprofesionales , Enseñanza/métodos , Estados UnidosAsunto(s)
Acreditación/organización & administración , Bachillerato en Enfermería/organización & administración , Medicina Basada en la Evidencia/organización & administración , Administración de la Seguridad/organización & administración , Curriculum , Regulación y Control de Instalaciones/organización & administración , Necesidades y Demandas de Servicios de Salud , Humanos , Licencia en Enfermería , Evaluación de Resultado en la Atención de Salud , Autonomía Profesional , Estados UnidosRESUMEN
BACKGROUND: Increasingly, investigators are using administrative databases to answer research questions requiring physician characteristics information. This article provides a roadmap for investigators who use Medicare data to answer such questions, focusing on use of the Surveillance, Epidemiology, and End Results (SEER)-Medicare files. METHODS: Three data sources that can be linked to identify physician characteristics-Medicare claims, the Unique Physician Identification Number (UPIN) Registry, and the American Medical Association (AMA) Masterfile-were examined for data availability, linkage rates, and quality. These databases also were used to explore measurement issues regarding physician specialty and practice volume. RESULTS: Over 98 percent of UPINs identified from the Medicare claims could be linked with both the AMA Masterfile and the UPIN Registry. The AMA Masterfile is the best source of sociodemographic and medical training information; the Medicare claims are the best source of practice ZIP code; and the UPIN Registry is the best source of practice organization data. The operationalization of variables such as physician specialty and practice volume is dependent on the specific research question that is being addressed. CONCLUSION: Administrative databases, such as SEER-Medicare data linked to AMA Masterfile or UPIN Registry data, are an important resource for investigators interested in assessing the relationship between physicians' personal and practice characteristics and the content or outcomes of clinical care.