RESUMEN

Background: Various data quality issues have prevented healthcare administration data from being fully utilized when dealing with problems ranging from COVID-19 contact tracing to controlling healthcare costs. Objectives: (i) Describe the currently adopted approaches and practices for understanding and improving the quality of healthcare administration data. (ii) Explore the challenges and opportunities to achieve continuous quality improvement for such data. Materials and Methods: We used a qualitative approach to obtain rich contextual data through semi-structured interviews conducted at a state health agency regarding Medicaid claims and reimbursement data. We interviewed all data stewards knowledgeable about the data quality issues experienced at the agency. The qualitative data were analyzed using the Framework method. Results: Sixteen themes emerged from our analysis, collected under 4 categories: (i) Defect characteristics: Data defects showed variability, frequently remained obscure, and led to negative outcomes. Detecting and resolving them was often difficult, and the work required often exceeded the organizational boundaries. (ii) Current process and people issues: The agency adopted primarily ad-hoc, manual approaches to resolving data quality problems leading to work frustration. (iii) Challenges: Communication and lack of knowledge about legacy software systems and the data maintained in them constituted challenges, followed by different standards used by various organizations and vendors, and data verification difficulties. (iv) Opportunities: Training, tool support, and standardization of data definitions emerged as immediate opportunities to improve data quality. Conclusions: Our results can be useful to similar agencies on their journey toward becoming learning health organizations leveraging data assets effectively and efficiently.

RESUMEN

The evolving landscape of healthcare necessitates a paradigm shift in professional education, blending clinical expertise with business acumen. This paper delves into the need for healthcare professionals to acquire a comprehensive understanding of both clinical intricacies and business dynamics while examining the emergence of joint degree programs aimed to equip graduates with multifaceted skills required to navigate the complexities our of modern healthcare delivery systems. Drawing from a diverse literature review, this paper highlights the pros and cons of this dual-degree education and the benefits that it brings given today's challenging healthcare landscape. It explores the profound impact of such programs on student outcomes, emphasizing the cultivation of leadership, financial acumen, and strategic thinking alongside clinical competencies. Moreover, it addresses concerns regarding academic rigor and the feasibility of integrating business education into an already demanding healthcare curricula. Analysis of current trends and future projections underscores the growing demand for professionals who possess hybrid skill sets. With healthcare workforce shortages and evolving industry challenges, individuals equipped with both clinical and business proficiencies are poised to lead innovation and drive organizational success.

RESUMEN

There is a lack of understanding of how perceived racism in Veterans Healthcare Administration (VHA) healthcare providers affects the delivery of healthcare services to African American (AA) Veterans thus leading to health disparities in this population. Specifically, there is a lack of understanding of this phenomenon from the view of AA female Veterans who sought mental health care from providers within the VHA. The aim of this study was to determine if AA female Veterans have experiences of racism in their interactions with VHA mental health providers contributing to disparities. Using a phenomenological qualitative analysis approach with five AA female Veterans, the researcher was able to identify four qualitative themes: mental health service delivery, provider belief system about AA female Veterans, and the impact of microaggressions on AA female Veterans. Based on the results of this study, the following were determined: (1) there is an existence of perceived racism from VHA mental health providers to AA female Veterans, (2) we better understand AA female Veterans' perceptions of their VHA mental health providers based on their interactions, (3) there is a shared lived experience of the phenomenon racism from VHA mental health providers, and (4) there is a failure of VHA to address the needs of AA female Veterans despite VHA policies for support.

RESUMEN

Background Post-acute care (PAC) centers are facilities used for recuperation, rehabilitation, and symptom management in an effort to improve the long-term outcomes of patients. PAC centers include skilled nursing facilities, inpatient rehabilitation facilities, and long-term care hospitals. In the 1990s, Medicare payment reforms significantly increased the discharge rates to PAC centers and subsequently increased the length of stay (LOS) among these patient populations. Over the last several years, there have been national initiatives and multidisciplinary approaches to improve safe discharge rates to home. Multiple studies have shown that patients who are discharged to home have decreased rates of 30-day readmissions, reduced short-term mortality, and an improvement in their activities of daily living.  Objectives This study aimed to investigate how multidisciplinary approaches could improve a single institution's discharge rates to home. In doing so, we aim to lower hospital readmission rates, hospital length of stay, morbidity and mortality rates, and healthcare-associated costs. Methods A retrospective single-institution cohort study was implemented at Jersey Shore University Medical Center (JSUMC). Data from January 2015 to December 2019 served as the control period, compared to the intervention period from January 2020 to January 2024. Patients were either admitted to JSUMC teaching faculty, hospitalists, or "others," which is composed of various medical and surgical subspecialists. Interventions performed to improve home discharge rates can be categorized into the following: physician education, patient education, electronic medical record (EMR) initiatives, accountability, and daily mobility initiatives. All interventions were performed equally across the three patient populations. The primary endpoint was the proportion of patients discharged to home. Results There were 190,699 patients, divided into a pre-intervention group comprising 98,885 individuals and a post-intervention group comprising 91,814 patients. Within the pre-intervention group, the faculty attended to 8,495 patients, hospitalists cared for 39,145 patients, and others managed 51,245 patients. In the post-intervention period, the faculty oversaw 8,014 patients, hospitalists attended to 35,094 patients, and others were responsible for 48,706 patients. After implementing a series of multidisciplinary interventions, there was a significant increase in the proportion of patients discharged home, rising from 74.9% to 80.2% across the entire patient population. Specifically, patients under the care of the faculty experienced a more substantial improvement, with a discharge rate increasing from 73.6% to 84.4%. Similarly, the hospitalists exhibited a rise from 69.4% to 74.3%, and the others demonstrated an increase from 79.3% to 83.7%. All observed changes yielded a p-value < 0.001. Conclusions By deploying a multifaceted strategy that emphasized physician education, patient education, EMR initiatives, accountability measures, and daily mobility, there was a statistically significant increase in the rate of patient discharges to home. These initiatives proved to be cost-effective and led to a tangible reduction in healthcare-associated costs and patient length of stay. Further studies are required to look into the effect on hospital readmission rates and morbidity and mortality rates. The comprehensive approach showcased its potential to optimize patient outcomes.

RESUMEN

BACKGROUND: Abuse of healthcare workers (HCWs) and lack of public trust threaten the foundation of the physician-patient relationship. This growing global problem creates an even more difficult professional environment and hinders the delivery of high-quality clinical care. OBJECTIVE: The primary aim was to determine the prevalence of violence against Trinbagonian HCWs in the public sector. Secondary objectives included determining risk factors for violence and mistrust between the public and providers. METHOD: A cross-sectional analysis of 434 HCWs in the public sector of Trinidad and Tobago was conducted using a modified World Health Organization (WHO) data collection tool, distributed via social media and administrative emails, and snowballed for two months. Fifteen semi-structured interviews were conducted regarding trust in the healthcare system with patients selected from communities. RESULTS: Of the 434 respondents, 45.2% experienced violence and 75.8% witnessed violence against HCWs in the past two years. Verbal abuse (41.5%) was most common. Perpetrators were patients (42.2%) and patients' relatives (35.5%). Chi-square analysis highlighted that HCWs with the highest probability of being abused were aged 25-39 (63.8%), had two to five years of work experience (24.9%), specialized in emergency and internal medicine (48.6%), and cared for psychiatric and physically disabled patients (p-value < 0.001). HCWs believed the threat of violence negatively impacted performance (64.5%), and further action was necessary for mitigation (86.4%). Patients interviewed doubted physicians' altruism and competence (80%) and honesty (53.3%), expressed mistrust in their physician (46.7%), and cited poor infrastructure/management (66.7%) and dissatisfaction with care (60.0%) as factors that contributed to violence. CONCLUSION: Analysis revealed that violence against Trinbagonian HCWs in the public sector deteriorated patient experience and adversely affected psychological well-being, efficiency, and job satisfaction. Results suggested mistrust of HCWs by the population. Interventions should be instituted to support at-risk HCWs and educate the public to avoid recurrence.

RESUMEN

BACKGROUND: Resilience, in the field of Resilience Engineering, has been identified as the ability to maintain the safety and the performance of healthcare systems and is aligned with the resilience potentials of anticipation, monitoring, adaptation, and learning. In early 2020, the COVID-19 pandemic challenged the resilience of US healthcare systems due to the lack of equipment, supply interruptions, and a shortage of personnel. The purpose of this qualitative research was to describe resilience in the healthcare team during the COVID-19 pandemic with the healthcare team situated as a cognizant, singular source of knowledge and defined by its collective identity, purpose, competence, and actions, versus the resilience of an individual or an organization. METHODS: We developed a descriptive model which considered the healthcare team as a unified cognizant entity within a system designed for safe patient care. This model combined elements from the Patient Systems Engineering Initiative for Patient Safety (SEIPS) and the Advanced Team Decision Making (ADTM) models. Using a qualitative descriptive design and guided by our adapted model, we conducted individual interviews with healthcare team members across the United States. Data were analyzed using thematic analysis and extracted codes were organized within the adapted model framework. RESULTS: Five themes were identified from the interviews with acute care professionals across the US (N = 22): teamwork in a pressure cooker, consistent with working in a high stress environment; healthcare team cohesion, applying past lessons to present challenges, congruent with transferring past skills to current situations; knowledge gaps, and altruistic behaviors, aligned with sense of duty and personal responsibility to the team. Participants' described how their ability to adapt to their environment was negatively impacted by uncertainty, inconsistent communication of information, and emotions of anxiety, fear, frustration, and stress. Cohesion with co-workers, transferability of skills, and altruistic behavior enhanced healthcare team performance. CONCLUSION: Working within the extreme unprecedented circumstances of COVID-19 affected the ability of the healthcare team to anticipate and adapt to the rapidly changing environment. Both team cohesion and altruistic behavior promoted resilience. Our research contributes to a growing understanding of the importance of resilience in the healthcare team. And provides a bridge between individual and organizational resilience.

Asunto(s)

RESUMEN

BACKGROUND: Healthcare worker retention and burnout are confounding issues. Trust among workers and their employer, that is, organization, is an important yet underexplored concept in research. RESEARCH AIM: The aim of this qualitative study is to explore organizational actions and systems that promote or denigrate trust among registered nurses and patient care aides (aides). RESEARCH DESIGN: The study uses the Model of Psychological Contract as a theoretical framework. Focus groups were conducted to explore the concept of organizational trust and the consequences of broken trust. PARTICIPANTS: Registered nurses (RNs) (n=6) and aides (n=6) participated in the study. Six focus groups (three RN and three aide) were conducted, with two participants per group. Focus groups were conducted online. ETHICAL CONSIDERATIONS: The study's methods were reviewed by the University of Pittsburgh Institutional Review Board. FINDINGS: Among RNs and aides, a sense of trust and feeling valued were important to their sense of relationship with their employers. Trust was breached when resources were scarce, employees did not feel validated and listened to, and problems were not addressed. RNs and aides described feeling devalued when compensation practices were unjust or inequitable, they had limited autonomy, and the employer created an organizational climate where business needs superceded human caring. Consequences of trust breach included burnout, dejection, and feelings of non-belonging. DISCUSSION: Tangible organizational resources (compensation and staffing) and intangible resources (value, respect, autonomy) are important to RNs and aides alike. Inability to provide these resources diminishes trust and even causes a sense of betrayal. CONCLUSION: Future research can explore the concepts of organizational justice and interventions to restore lost trust and improve healthcare worker well-being. This is one of only a few identified studies to explore organizational factors and well-being among aides and more research among this healthcare worker population is warranted.

RESUMEN

BACKGROUND: An electronic health record-based tool could improve accuracy and eliminate bias in provider estimation of the risk of death from other causes among men with nonmetastatic cancer. OBJECTIVE: To recalibrate and validate the Veterans Aging Cohort Study Charlson Comorbidity Index (VACS-CCI) to predict non-prostate cancer mortality (non-PCM) and to compare it with a tool predicting prostate cancer mortality (PCM). DESIGN, SETTING, AND PARTICIPANTS: An observational cohort of men with biopsy-confirmed nonmetastatic prostate cancer, enrolled from 2001 to 2018 in the national US Veterans Health Administration (VA), was divided by the year of diagnosis into the development (2001-2006 and 2008-2018) and validation (2007) sets. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Mortality (all cause, non-PCM, and PCM) was evaluated. Accuracy was assessed using calibration curves and C statistic in the development, validation, and combined sets; overall; and by age (<65 and 65+ yr), race (White and Black), Hispanic ethnicity, and treatment groups. RESULTS AND LIMITATIONS: Among 107 370 individuals, we observed 24 977 deaths (86% non-PCM). The median age was 65 yr, 4947 were Black, and 5010 were Hispanic. Compared with CCI and age alone (C statistic 0.67, 95% confidence interval [CI] 0.67-0.68), VACS-CCI demonstrated improved validated discrimination (C statistic 0.75, 95% CI 0.74-0.75 for non-PCM). The prostate cancer mortality tool also discriminated well in validation (C statistic 0.81, 95% CI 0.78-0.83). Both were well calibrated overall and within subgroups. Owing to missing data, 18 009/125 379 (14%) were excluded, and VACS-CCI should be validated outside the VA prior to outside application. CONCLUSIONS: VACS-CCI is ready for implementation within the VA. Electronic health record-assisted calculation is feasible, improves accuracy over age and CCI alone, and could mitigate inaccuracy and bias in provider estimation. PATIENT SUMMARY: Veterans Aging Cohort Study Charlson Comorbidity Index is ready for application within the Veterans Health Administration. Electronic health record-assisted calculation is feasible, improves accuracy over age and Charlson Comorbidity Index alone, and might help mitigate inaccuracy and bias in provider estimation of the risk of non-prostate cancer mortality.

Asunto(s)

RESUMEN

Leadership training during residency is essential for the successful development of contemporary physicians. Creating a curriculum for healthcare leadership and administration for internal medicine residents is particularly challenging due to the heterogeneity of leadership curricula across programs, the emphasis on individual advancement rather than collective leadership, and the scarcity of published research on the topic. A healthcare administration and leadership rotation for medical residents is a valuable experience that emphasizes the importance of contextualizing education on leadership and building relationships to achieve organizational goals.

RESUMEN

BACKGROUND: US Veterans are four times more likely to be diagnosed with chronic obstructive pulmonary disease (COPD) compared to the civilian population with no care model that consistently improves Veteran outcomes when scaled. COPD Coordinated Access to Reduce Exacerbations (CARE) is a care bundle intended to improve the delivery of evidence-based practices to Veterans. To address challenges to scaling this program in the Veterans' Health Administration (VA), the COPD CARE Academy (Academy), an implementation facilitation package comprised of five implementation strategies was designed and implemented. METHODS: This evaluation utilized a mixed-methods approach to assess the impact of the Academy's implementation strategies on the RE-AIM framework implementation outcomes and the extent to which they were effective at increasing clinicians' perceived capability to implement COPD CARE. A survey was administered one week after Academy participation and a semi-structured interview conducted 8 to 12 months later. Descriptive statistics were calculated for quantitative items and thematic analysis was used to analyze open-ended items. RESULTS: Thirty-six clinicians from 13 VA medical centers (VAMCs) participated in the Academy in 2020 and 2021 and 264 front-line clinicians completed COPD CARE training. Adoption of the Academy was indicated by high rates of Academy session attendance (90%) and high utilization of Academy resources. Clinicians reported the Academy to be acceptable and appropriate as an implementation package and clinicians from 92% of VAMCs reported long-term utilization of Academy resources. Effectiveness of the Academy was represented by clinicians' significant increases (p < 0.05) in their capability to complete ten implementation tasks after Academy participation. CONCLUSIONS: This evaluation found that the use of implementation facilitation paired with additional strategies enhanced the capacity of clinicians to implement COPD CARE. Future assessments are needed to explore post-academy resources that would help VAMCs to strategize localized approaches to overcome barriers.

RESUMEN

Objective: The objective of this study was to better understand how rurality impacts the knowledge, diagnosis and management of vulvodynia by primary care providers (PCPs) practising in the geographically disparate province of Newfoundland and Labrador, Canada. Design: This was a qualitative case study using questionnaires and semi-structured interviews with PCPs, compared with semi-structured focus groups and interviews with vulvodynia patients conducted in a previous study phase. Results: Ten family physicians and 6 nurse practitioners participated. Over half had baseline knowledge that vulvodynia has a relatively high prevalence, but most underestimated the likelihood they would see a patient with vulvodynia in their practice. Three barriers to discussing and managing vulvodynia emerged: (1) discomfort initiating sexual/vulvar health conversations; (2) concerns about protecting patient privacy and confidentiality; and (3) time constraints and building therapeutic relationships. These issues were largely corroborated by previous findings with vulvodynia patients. Rural-informed solutions might include: (1) supporting increased education in vulvodynia and sexual health more broadly, including funding to attend continuing professional education and developing more clinical tools; (2) following practice guidelines regarding standardised initiation of sexual health conversations; (3) incentivising retention of rural providers and extending appointment times by reconsidering fee-for-service structures; and (4) researching a tailored vulvodynia toolkit and the potential advantage of mobile health units. Conclusion: Rurality exacerbates common concerns in the identification and management of vulvodynia. Acting on recommended solutions may address the impact of rurality on the provision of timely care for those experiencing vulvodynia and other sexual health concerns.

Résumé Objectif: Mieux comprendre l'impact de la ruralité sur la connaissance, le diagnostic et la prise en charge de la vulvodynie par les prestataires de soins primaires exerçant dans la province géographiquement disparate de Terre-Neuve-et-Labrador, au Canada. Conception: Étude de cas qualitative utilisant des questionnaires et des entretiens semi-structurés avec des prestataires de soins primaires, comparés à des groupes de discussion semi-structurés et à des entretiens avec des patientes atteintes de vulvodynie menés lors d'une phase précédente de l'étude. Résultats: Dix médecins de famille et six infirmières praticiennes y ont participé. Plus de la moitié d'entre eux savaient au départ que la vulvodynie a une prévalence relativement élevée, mais la plupart sous-estimaient la probabilité de voir une patiente atteinte de vulvodynie dans leur pratique. Trois obstacles à la discussion et à la prise en charge de la vulvodynie sont apparus: (1) la gêne à entamer des conversations sur la santé sexuelle/vulvaire; (2) les préoccupations relatives à la protection de la vie privée et de la confidentialité des patientes; et (3) les contraintes de temps et l'établissement de relations thérapeutiques. Ces problèmes ont été largement corroborés par les résultats obtenus précédemment avec des patientes atteintes de vulvodynie. Les solutions adaptées au milieu rural pourraient inclure (1) soutenir une meilleure formation sur la vulvodynie et la santé sexuelle en général, notamment le financement de la formation professionnelle continue et l'élaboration d'outils cliniques supplémentaires; (2) suivre les directives de pratique concernant l'amorce normalisée des conversations sur la santé sexuelle; (3) encourager la rétention des fournisseurs ruraux et prolonger les délais de rendez-vous en reconsidérant les structures de rémunération à l'acte; et 4) faire des recherches sur une trousse d'outils sur mesure pour la vulvodynie et sur l'avantage potentiel des unités de santé mobiles. Conclusion: La ruralité exacerbe les problèmes courants liés à l'identification et à la prise en charge de la vulvodynie. La mise en œuvre des solutions recommandées peut permettre de remédier à l'impact de la ruralité sur la fourniture de soins en temps opportun aux personnes souffrant de vulvodynie et d'autres problèmes de santé sexuelle. Mots-clés: Douleur vulvaire, dyspareunie, santé rurale, santé sexuelle, éducation sexuelle, structures tarifaires, administration des soins de santé, disparités géographiques dans les soins de santé, recherche qualitative, étude de cas qualitative.

Asunto(s)

RESUMEN

Background: U.S. Veterans are four-times more likely to be diagnosed with Chronic Obstructive Pulmonary Disease (COPD) compared to the civilian population with no care model that consistently improves Veteran outcomes when scaled. COPD Coordinated Access to Reduce Exacerbations (CARE) is a care bundle intended to improve the delivery of evidence-based practices to Veterans. To address challenges to scaling this program in the Veterans' Health Administration (VA), the COPD CARE Academy (Academy), an implementation facilitation package comprised of four implementation strategies was designed and implemented. Methods: This evaluation utilized a mixed-methods approach to assess the impact of the Academy's implementation strategies on the RE-AIM framework implementation outcomes and the extent to which they were effective at increasing clinicians' perceived capability to implement COPD CARE. A survey was administered one week after Academy participation and a semi-structured interview conducted eight to 12 months later. Descriptive statistics were calculated for quantitative items and thematic analysis was used to analyze open-ended items. Results: Thirty-six clinicians from 13 VA medical centers (VAMCs) participated in the Academy in 2020 and 2021 and 264 front-line clinicians completed COPD CARE training. Adoption of the Academy was indicated by high rates of Academy completion (97%), session attendance (90%), and high utilization of Academy resources. Clinicians reported the Academy to be acceptable and appropriate as an implementation package and clinicians from 92% of VAMCs reported long-term utilization of Academy resources. Effectiveness of the Academy was represented by clinicians' significant increases (p < 0.05) in their capability to complete ten implementation tasks after Academy participation. Conclusions: This evaluation found that the use of implementation facilitation paired with additional strategies seemed to demonstrate positive implementation outcomes across all RE-AIM domains and identified areas for potential improvement. Future assessments are needed to explore post-academy resources that would help VAMCs to strategize localized approaches to overcome barriers.

RESUMEN

With the widespread deployment of COVID-19 vaccines all around the world, billions of people have benefited from the vaccination and thereby avoiding infection. However, huge amount of clinical cases revealed diverse side effects of COVID-19 vaccines, among which cervical lymphadenopathy is one of the most frequent local reactions. Therefore, rapid detection of cervical lymph node (LN) is essential in terms of vaccine recipients' healthcare and avoidance of misdiagnosis in the post-pandemic era. This paper focuses on a novel deep learning-based framework for the rapid diagnosis of cervical lymphadenopathy towards COVID-19 vaccine recipients. Existing deep learning-based computer-aided diagnosis (CAD) methods for cervical LN enlargement mostly only depend on single modal images, e.g., grayscale ultrasound (US), color Doppler ultrasound, and CT, while failing to effectively integrate information from the multi-source medical images. Meanwhile, both the surrounding tissue objects of the cervical LNs and different regions inside the cervical LNs may imply valuable diagnostic knowledge which is pending for mining. In this paper, we propose an Tissue-Aware Cervical Lymph Node Diagnosis method (TACLND) via multi-modal ultrasound semantic segmentation. The method effectively integrates grayscale and color Doppler US images and realizes a pixel-level localization of different tissue objects, i.e., lymph, muscle, and blood vessels. With inter-tissue and intra-tissue attention mechanisms applied, our proposed method can enhance the implicit tissue-level diagnostic knowledge in both spatial and channel dimension, and realize diagnosis of cervical LN with normal, benign or malignant state. Extensive experiments conducted on our collected cervical LN US dataset demonstrate the effectiveness of our methods on both tissue detection and cervical lymphadenopathy diagnosis. Therefore, our proposed framework can guarantee efficient diagnosis for the vaccine recipients' cervical LN, and assist doctors to discriminate between COVID-related reactive lymphadenopathy and metastatic lymphadenopathy.

RESUMEN

COVID-19 has had a drastic, long-lasting impact on skilled nursing facilities (SNFs), forcing communities to continuously adapt to rapidly changing guidelines, restrictions, and challenges. In spring 2020, we conducted a sequential mixed-methods study with administrators of SNFs in the Midwest to understand the experience of administrators, staff, and residents during the pandemic. We collected 60 surveys with open-ended items related to the impact of the pandemic on communities as a whole, staff, and residents. Survey findings informed supplemental interviews with six administrators working in diverse regions. Due to the affective nature of the data, we present the findings in two found poems, which emphasize the lyrical, emotional, and poignant aspects of the participant voices. The first poem, Weight of the World, captures the struggle to adapt during the transition into the pandemic and its negative impacts on the lives of residents and their families. The second, I Want Them to Know, describes the resiliency with which administrators and staff responded to adversity while maintaining motivation to continue the work in the midst of unprecedented challenges. The two poems offer contrasting or balancing narratives of struggle and survival during the pandemic era.

Asunto(s)

RESUMEN

Introduction: Implementation of quality assessment methodologies at healthcare services enables the results achieved to be monitored in terms of established objectives and standards of care delivery. Objectives: To assess the quality of the processes involved in provision of periodic medical examinations at a University Hospital, from the workers' perspective. Methods: This is a cross-sectional study using questionnaires to conduct quality assessment of the periodic medical examination processes, including Net Promoter Score satisfaction questions. Statistical analysis of the results was performed using SPSS version 18. Data on categorical variables are expressed as absolute frequencies and data on continuous variables as means and standard deviations. Chi-square tests and analysis of variance were used to identify associations. A significance level of 0.05 was adopted to determine the statistical relevance of findings. Results: A total of 381 respondents with a mean age of 45.25 years were included, 66% of whom were female. There was a statistically significant (p < 0.001) association between duration of consultations and the number of items assessed in the periodic medical examination. In general, the findings from application of the Net Promoter Score for self-scheduling (45%) and service at reception (42%) indicate a need for process improvement, whereas clinical care (50%) rated as a quality process. Conclusions: This study identified a set of information that can be used to describe, analyze, and improve the care delivered by the institution's occupational health service and to identify opportunities for improvement of periodic medical examination processes.

RESUMEN

As college and university campuses re-open during the COVID-19 pandemic, there is increased concern for mental health crises. Current trends in campus mental health care emphasize providing quality care in a safe, non-judgmental, and non-punitive manner. Collegiate-based emergency medical services organizations are well-positioned to respond to acute mental health crises on college campuses. Campus health professionals and administrators seeking to promote a health-centered approach toward mental health crises should support the growth and development of collegiate-based emergency medical services organizations.

RESUMEN

Doll assessed sexual expressions, policies, and practices in Skilled Nursing Facilities (SNFs) in the state of Kansas. This study provided an updated and expanded assessment. A mixed-methods survey was distributed to administrators of all SNFs in the state of Kansas. Among 60 administrations, 84% reported any sexual expression among residents in their community within the past year and 55% reported expressions involving an individual with cognitive impairment. In response to sexual expressions, 70% of administrators believe staff would treat residents with dignity and respect and about 40% anticipated staff discomfort. About 40% of administrators reported having a policy related to sexual expression. Attitudes and responses of staff and administrators appear to be shifting in a sex-positive direction. While policies related to sexuality are more common than a decade ago, there is room for additional uptake, standardization, and infusion of person-centered language and practices.

RESUMEN

Healthcare unit managers are pivotal to promote nurses' Perceived Organizational Support and hence to ensure nurses' health and well-being, as well as high-quality care. Despite this fact, there is a dearth of studies addressing how healthcare unit managers act and organize their work to promote nurses' Perceived Organizational Support and which working conditions enable them to do so. Through a mixed methods approach, comprising qualitative interviews and quantitative surveys among healthcare unit managers and nurses, this paper underscores that healthcare unit managers' availability to their nursing staff was essential for their ability to promote nurses' Perceived Organizational Support, and that responsive support from the care unit managers' superior management, administration, and managerial colleagues constituted enabling working conditions. Superior manager support strongly promoted the care unit manager's own Perceived Organizational Support, which, in turn, was positively correlated with nurses' organizational climate of Perceived Organizational Support.

Asunto(s)

RESUMEN

Value-based, outcome-oriented care supported with innovative technology is the future of surgery. We established a novel fellowship in Perioperative Administration, Quality, and Informatics. The aim is to equip future surgeon scholars with the requisite knowledge base and skillset to serve as institutional leaders capable of transforming surgical healthcare delivery. The model was designed as a project-based, "operations-focused" education with supplemental didactics and mentored by surgical leaders and institutional executives. We describe our initial experience, successes, and challenges such that a similar model may be replicated elsewhere.

Asunto(s)