R. Tempier, E. M. Bouattane, Muadi Delly Tshiabo, J. Abdulnour
Background: Missed appointments (no-shows) are a problem and common in outpatient clinics especially in psychiatric setting. Objective: This study aimed to describe the extent of no-shows in a regular psychiatric outpatient clinic, and to assess associations of missed appointments with patients’ demographic and clinical characteristics and types of services provided. Methods: Data collection from a hospital psychiatric clinic charts was conducted from administrative years 2017-18 and 2018-19, using descriptive analyses. Results: In the administrative year of 2017-18, the no-show rate was 9.5%, adding 10.7% for cancellations, for a total of 20.2%. In 2016-17, rates were 9.7%, with 17.3% cancellations, for a total of 27%. Rates varied from clinical groups (2.5% for borderline personality disorders patients to 30% for young psychotic patients) and by professionals (psychiatrists 5.6%, psychotherapists 23.3%) and for crisis services 21.9%. Conclusions: No-show numbers are comparable to other clinical sites but remain a challenge in delivering seamless and efficient services. A qualitative study will be conducted as a second phase to examine root causes and provide opportunities for service improvement.
{"title":"Missed appointments in mental health care clinics: A retrospective study of patients’ profile","authors":"R. Tempier, E. M. Bouattane, Muadi Delly Tshiabo, J. Abdulnour","doi":"10.5430/JHA.V10N3P41","DOIUrl":"https://doi.org/10.5430/JHA.V10N3P41","url":null,"abstract":"Background: Missed appointments (no-shows) are a problem and common in outpatient clinics especially in psychiatric setting. Objective: This study aimed to describe the extent of no-shows in a regular psychiatric outpatient clinic, and to assess associations of missed appointments with patients’ demographic and clinical characteristics and types of services provided. Methods: Data collection from a hospital psychiatric clinic charts was conducted from administrative years 2017-18 and 2018-19, using descriptive analyses. Results: In the administrative year of 2017-18, the no-show rate was 9.5%, adding 10.7% for cancellations, for a total of 20.2%. In 2016-17, rates were 9.7%, with 17.3% cancellations, for a total of 27%. Rates varied from clinical groups (2.5% for borderline personality disorders patients to 30% for young psychotic patients) and by professionals (psychiatrists 5.6%, psychotherapists 23.3%) and for crisis services 21.9%. Conclusions: No-show numbers are comparable to other clinical sites but remain a challenge in delivering seamless and efficient services. A qualitative study will be conducted as a second phase to examine root causes and provide opportunities for service improvement.","PeriodicalId":15872,"journal":{"name":"Journal of Hospital Administration","volume":"9 1","pages":"41"},"PeriodicalIF":0.0,"publicationDate":"2021-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78290276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Xiaoting Wu, M. Zhang, Ruyun Jin, G. Grunkemeier, C. Maynard, Ravi S Hira, T. Mackenzie, M. Herbert, Chang He, S. Holmes, M. Thompson, D. Likosky
During hospital quality improvement activities, statistical approaches are critical to help assess hospital performance for benchmarking. Current statistical approaches are used primarily for research and reimbursement purposes. In this multiinstitutional study, these established statistical methods were evaluated for quality improvement applications. Leveraging a dataset of 42,199 patients who underwent coronary artery bypass grafting surgery from 2014 to 2016 across 90 hospitals, six statistical approaches were applied. The non-shrinkage methods were: (1) indirect standardization without hospital effect; (2) indirect standardization with hospital fixed effect; (3) direct standardization with hospital fixed effect. The shrinkage methods were: (4) indirect standardization with hospital random effect; (5) direct standardization with hospital random effect; (6) Bayesian method. Hospital performance related to operative mortality and major morbidity or mortality was compared across methods based on variation in adjusted rates, rankings, and performance outliers. Method performance was evaluated across procedure volume terciles: small ( 171). Shrinkage methods reduced inter-hospital variation (min-max) for mortality (observed: 0%-10%; adjusted: 1.5%-2.4%) and major morbidity or mortality (observed: 2.6%-35%; adjusted: 6.9%-17.5%). Shrinkage methods shrunk hospital rates toward the group mean. Direct standardization with hospital random effect, compared to fixed effect, resulted in 16.7%-38.9% of hospitals changing quintile mortality ranking. Indirect standardization with hospital random effect resulted in no performance outliers among small and medium hospitals for mortality, while logistic and fixed effect methods identified one small and three medium outlier hospitals. The choice of statistical method greatly impacts hospital ranking and performance outlier’ status. These findings should be considered when benchmarking hospital performance for hospital quality improvement activities.
{"title":"A Comparison of statistical methods for hospital performance assessment","authors":"Xiaoting Wu, M. Zhang, Ruyun Jin, G. Grunkemeier, C. Maynard, Ravi S Hira, T. Mackenzie, M. Herbert, Chang He, S. Holmes, M. Thompson, D. Likosky","doi":"10.5430/JHA.V10N3P32","DOIUrl":"https://doi.org/10.5430/JHA.V10N3P32","url":null,"abstract":"During hospital quality improvement activities, statistical approaches are critical to help assess hospital performance for benchmarking. Current statistical approaches are used primarily for research and reimbursement purposes. In this multiinstitutional study, these established statistical methods were evaluated for quality improvement applications. Leveraging a dataset of 42,199 patients who underwent coronary artery bypass grafting surgery from 2014 to 2016 across 90 hospitals, six statistical approaches were applied. The non-shrinkage methods were: (1) indirect standardization without hospital effect; (2) indirect standardization with hospital fixed effect; (3) direct standardization with hospital fixed effect. The shrinkage methods were: (4) indirect standardization with hospital random effect; (5) direct standardization with hospital random effect; (6) Bayesian method. Hospital performance related to operative mortality and major morbidity or mortality was compared across methods based on variation in adjusted rates, rankings, and performance outliers. Method performance was evaluated across procedure volume terciles: small ( 171). Shrinkage methods reduced inter-hospital variation (min-max) for mortality (observed: 0%-10%; adjusted: 1.5%-2.4%) and major morbidity or mortality (observed: 2.6%-35%; adjusted: 6.9%-17.5%). Shrinkage methods shrunk hospital rates toward the group mean. Direct standardization with hospital random effect, compared to fixed effect, resulted in 16.7%-38.9% of hospitals changing quintile mortality ranking. Indirect standardization with hospital random effect resulted in no performance outliers among small and medium hospitals for mortality, while logistic and fixed effect methods identified one small and three medium outlier hospitals. The choice of statistical method greatly impacts hospital ranking and performance outlier’ status. These findings should be considered when benchmarking hospital performance for hospital quality improvement activities.","PeriodicalId":15872,"journal":{"name":"Journal of Hospital Administration","volume":"6 1","pages":"32"},"PeriodicalIF":0.0,"publicationDate":"2021-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80452211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
W. Sanders, Kimberley Greenwald, Joshua Foster, D. Meisinger, Richelle Payea, Harmony Gould, J. Kross, C. Janney
Approximately 53,000 patients/year are admitted to psychiatric hospitals in Michigan and treatment typically involves social gatherings and group therapies (SAMHSA 2017; Michigan DHS 2019). Often psychiatric inpatients are in close proximity placing them at high risk of infection and have comorbid medical conditions that predispose them to severe COVID-19 consequences. In March 2020, Pine Rest Christian Mental Health Services, Grand Rapids, MI initiated protocols and precautions to mitigate the spread of COVID-19 between patients and health care personnel (HCP) based on emerging CDC guidelines. Multiple strategies [COVID-19 testing, masking of patients and HCP, restricting visitors, and creation of Special Care Unit (SCU) with negative pressure] were effectively implemented and limited transmission of COVID-19 within Pine Rest. Admission to the SCU totaled 25 adults (three Pine Rest patients who tested positive during or after admission, and 22 COVID-19 positive patients who were transferred from other facilities). Average age of SCU inpatients was 38.5 ± 16.6 years with the majority being male. Average hospitalization was 9 ± 4 days. Among the 21 COVID-19 positive HCP, 15 [71%] provided direct clinical care on various units, zero provided care on the SCU, and six had roles with no direct patient care. Average age among COVID-19 positive HCP providing direct patient care[n = 15] was 29.5 ± 13.5 years, majority were female, and 3 [20%] were admitted to local medical hospital for treatment. This report demonstrates that quality behavioral health care can be safely provided at inpatient psychiatric facilities and serve as a guideline that other psychiatric facilities can follow to decrease transmission in future epidemics.
{"title":"Limiting transmission of COVID-19 in an inpatient psychiatric hospital using a special care unit as a behavioral health model - Michigan, March 1-August 31, 2020","authors":"W. Sanders, Kimberley Greenwald, Joshua Foster, D. Meisinger, Richelle Payea, Harmony Gould, J. Kross, C. Janney","doi":"10.5430/JHA.V10N3P25","DOIUrl":"https://doi.org/10.5430/JHA.V10N3P25","url":null,"abstract":"Approximately 53,000 patients/year are admitted to psychiatric hospitals in Michigan and treatment typically involves social gatherings and group therapies (SAMHSA 2017; Michigan DHS 2019). Often psychiatric inpatients are in close proximity placing them at high risk of infection and have comorbid medical conditions that predispose them to severe COVID-19 consequences. In March 2020, Pine Rest Christian Mental Health Services, Grand Rapids, MI initiated protocols and precautions to mitigate the spread of COVID-19 between patients and health care personnel (HCP) based on emerging CDC guidelines. Multiple strategies [COVID-19 testing, masking of patients and HCP, restricting visitors, and creation of Special Care Unit (SCU) with negative pressure] were effectively implemented and limited transmission of COVID-19 within Pine Rest. Admission to the SCU totaled 25 adults (three Pine Rest patients who tested positive during or after admission, and 22 COVID-19 positive patients who were transferred from other facilities). Average age of SCU inpatients was 38.5 ± 16.6 years with the majority being male. Average hospitalization was 9 ± 4 days. Among the 21 COVID-19 positive HCP, 15 [71%] provided direct clinical care on various units, zero provided care on the SCU, and six had roles with no direct patient care. Average age among COVID-19 positive HCP providing direct patient care[n = 15] was 29.5 ± 13.5 years, majority were female, and 3 [20%] were admitted to local medical hospital for treatment. This report demonstrates that quality behavioral health care can be safely provided at inpatient psychiatric facilities and serve as a guideline that other psychiatric facilities can follow to decrease transmission in future epidemics.","PeriodicalId":15872,"journal":{"name":"Journal of Hospital Administration","volume":"17 3","pages":"25"},"PeriodicalIF":0.0,"publicationDate":"2021-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91427915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Y. Huang, Narges Shahraki, Erin M. Wallin, Eric W. Klavetter, K. Klarich
Due to the rising demand with limited health service capacity, managing available resources effectively becomes an important task to reduce patient care delays and avoid unnecessary and costly capacity expansions. At the same time, staff satisfaction and/or burnout is a complementary consideration when designing optimal schedules. Deviation from the scheduled plan can cause delays in patient access and may lead to unsatisfaction among providers. Balancing demand management, staff satisfaction and generating optimized schedules quickly reveals the need for a tool that tracks provider time allotment over time, especially for the academic healthcare organization where providers are committed to multiple assignments, clinical and non-clinical. This tracking tool should allow management to proactively adjust allotment to unplanned changes in the schedule and increase participation. In this study, a tool is developed to track monthly provider assignments for the Department of Cardiovascular Medicine at Mayo Clinic, Rochester. The proposed tool produces two key outputs for each provider and assignment: 1) the recommended target workdays and 2) workday upper and lower bounds to accommodate for variability. This tracking tool is successfully implemented with implementation criteria, and the feedback is positive. The tool pulls the data systematically from the Mayo data platform and performs the necessary analysis on the data. It also automatically updates the values for the recommended target as well as upper and lower bounds for the remaining months in a year based on changes in the schedule so that provider commitment can be met at the end of year.
{"title":"Provider time allotment tracking tool to effectively manage assignment commitments","authors":"Y. Huang, Narges Shahraki, Erin M. Wallin, Eric W. Klavetter, K. Klarich","doi":"10.5430/JHA.V10N3P10","DOIUrl":"https://doi.org/10.5430/JHA.V10N3P10","url":null,"abstract":"Due to the rising demand with limited health service capacity, managing available resources effectively becomes an important task to reduce patient care delays and avoid unnecessary and costly capacity expansions. At the same time, staff satisfaction and/or burnout is a complementary consideration when designing optimal schedules. Deviation from the scheduled plan can cause delays in patient access and may lead to unsatisfaction among providers. Balancing demand management, staff satisfaction and generating optimized schedules quickly reveals the need for a tool that tracks provider time allotment over time, especially for the academic healthcare organization where providers are committed to multiple assignments, clinical and non-clinical. This tracking tool should allow management to proactively adjust allotment to unplanned changes in the schedule and increase participation. In this study, a tool is developed to track monthly provider assignments for the Department of Cardiovascular Medicine at Mayo Clinic, Rochester. The proposed tool produces two key outputs for each provider and assignment: 1) the recommended target workdays and 2) workday upper and lower bounds to accommodate for variability. This tracking tool is successfully implemented with implementation criteria, and the feedback is positive. The tool pulls the data systematically from the Mayo data platform and performs the necessary analysis on the data. It also automatically updates the values for the recommended target as well as upper and lower bounds for the remaining months in a year based on changes in the schedule so that provider commitment can be met at the end of year.","PeriodicalId":15872,"journal":{"name":"Journal of Hospital Administration","volume":"44 1","pages":"10"},"PeriodicalIF":0.0,"publicationDate":"2021-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83185889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: This aim of this project was to assess, develop and implement a paradigm for patient status assignment and more efficiently provide observation services. Patients who require hospitalization in the United States may remain an outpatient receiving observation services in the hospital, instead of inpatient status. Accurate and justifiable designation of patients to the right classification is of paramount importance because observation stays are reimbursed significantly less than inpatient admissions, incurring financial losses for hospitals, and sometimes patients. Methods: We reviewed the processes for patient status assignment and observation service delivery at seven hospitals over a 12 month period for each facility between February 2017 and December 2020, conducted interviews with key stakeholders, and reviewed medical records for medical necessity documentation and accuracy of patient status designation. We implemented a bundle of interventions to improve accurate patient status assignment and operational performance, such as the length of stay and proportion of patients undergoing status changes. Results: At all hospitals we achieved decreases in the proportion of patients assigned to observation services (38% to 17%, p < .001), average observation patients’ length of stay (from 34 to 23 hours), and average daily observation census (from 24 to 12 patients). The accuracy of initial status assignment and medical necessity documentation increased, with a decrease in the proportion of hospitalized patients undergoing any status change ( p < .001 for all). The annual post-intervention financial gain ranged from $2.5M to $20.8M. Conclusions: A comprehensive bundle of interventions achieved large operational and financial improvements in observation service delivery at hospitals of various sizes in the US.
{"title":"Financial and operational benefit of improving patient status assignment and observation services across seven hospitals in the United States","authors":"A. Munsiff, G. Dillon","doi":"10.5430/JHA.V10N3P17","DOIUrl":"https://doi.org/10.5430/JHA.V10N3P17","url":null,"abstract":"Objective: This aim of this project was to assess, develop and implement a paradigm for patient status assignment and more efficiently provide observation services. Patients who require hospitalization in the United States may remain an outpatient receiving observation services in the hospital, instead of inpatient status. Accurate and justifiable designation of patients to the right classification is of paramount importance because observation stays are reimbursed significantly less than inpatient admissions, incurring financial losses for hospitals, and sometimes patients. Methods: We reviewed the processes for patient status assignment and observation service delivery at seven hospitals over a 12 month period for each facility between February 2017 and December 2020, conducted interviews with key stakeholders, and reviewed medical records for medical necessity documentation and accuracy of patient status designation. We implemented a bundle of interventions to improve accurate patient status assignment and operational performance, such as the length of stay and proportion of patients undergoing status changes. Results: At all hospitals we achieved decreases in the proportion of patients assigned to observation services (38% to 17%, p < .001), average observation patients’ length of stay (from 34 to 23 hours), and average daily observation census (from 24 to 12 patients). The accuracy of initial status assignment and medical necessity documentation increased, with a decrease in the proportion of hospitalized patients undergoing any status change ( p < .001 for all). The annual post-intervention financial gain ranged from $2.5M to $20.8M. Conclusions: A comprehensive bundle of interventions achieved large operational and financial improvements in observation service delivery at hospitals of various sizes in the US.","PeriodicalId":15872,"journal":{"name":"Journal of Hospital Administration","volume":"29 1","pages":"17"},"PeriodicalIF":0.0,"publicationDate":"2021-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74275325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jongwha Chang, Jang-ik Cho, M. Medina, S. Falcon, Paulina Soto-Ruiz, Dong Yeong Shin
There is a lack of U.S. population-based research surrounding the marked decrease in health-related quality of life (HRQoL) caused by the morbidity of mental disorders in the U.S. Hispanic demographic. This cross-sectional study utilized data from the 2013-2017 Medical Expenditure Panel Survey (MEPS) to identify Hispanic community-dwelling residents with mental disorders in the U.S. The independent variable was the presence of mental disorders, and the dependent variable was HRQoL. HRQoL was measured with the Short Form 12 (SF-12) Physical Health Composite Scale (PCS) and Mental Health Composite Scale (MCS). A total of 34,434 patients met the inclusion criteria, representing about 38,683,299 Hispanic individuals. Of this group, those older than 18 were stratified by the presence of mental disorders. The two groups were those with mental disorders: 4,122 individuals representing a sample size of 4,789,634; and those without mental disorders: 30,312 individuals representing a sample size of 33,893,665. Based on our study, Hispanic patients with mental disorders were associated with lower HRQoL scores. SF-12 PCS scores (95% CI) were 45.3 (44.5, 46.1) for those with mental disorders and 50.8 (50.5, 51.0) for those without mental disorders. SF-12 MCS scores (95% CI) were 42.6 (42, 43.3) in patients with mental disorders and 52.6 (52.3, 52.8) in patients without mental disorders. These differences in scores denote the impact of mental health disorders on HRQoL scores in the Hispanic demographic and mark the way for further research on identifying means of improving such scores for Hispanic patients.
{"title":"Factors associated with Health-Related Quality of Life in Hispanic population with mental disorders using medical expenditure panel survey 2013-2017","authors":"Jongwha Chang, Jang-ik Cho, M. Medina, S. Falcon, Paulina Soto-Ruiz, Dong Yeong Shin","doi":"10.5430/JHA.V10N3P1","DOIUrl":"https://doi.org/10.5430/JHA.V10N3P1","url":null,"abstract":"There is a lack of U.S. population-based research surrounding the marked decrease in health-related quality of life (HRQoL) caused by the morbidity of mental disorders in the U.S. Hispanic demographic. This cross-sectional study utilized data from the 2013-2017 Medical Expenditure Panel Survey (MEPS) to identify Hispanic community-dwelling residents with mental disorders in the U.S. The independent variable was the presence of mental disorders, and the dependent variable was HRQoL. HRQoL was measured with the Short Form 12 (SF-12) Physical Health Composite Scale (PCS) and Mental Health Composite Scale (MCS). A total of 34,434 patients met the inclusion criteria, representing about 38,683,299 Hispanic individuals. Of this group, those older than 18 were stratified by the presence of mental disorders. The two groups were those with mental disorders: 4,122 individuals representing a sample size of 4,789,634; and those without mental disorders: 30,312 individuals representing a sample size of 33,893,665. Based on our study, Hispanic patients with mental disorders were associated with lower HRQoL scores. SF-12 PCS scores (95% CI) were 45.3 (44.5, 46.1) for those with mental disorders and 50.8 (50.5, 51.0) for those without mental disorders. SF-12 MCS scores (95% CI) were 42.6 (42, 43.3) in patients with mental disorders and 52.6 (52.3, 52.8) in patients without mental disorders. These differences in scores denote the impact of mental health disorders on HRQoL scores in the Hispanic demographic and mark the way for further research on identifying means of improving such scores for Hispanic patients.","PeriodicalId":15872,"journal":{"name":"Journal of Hospital Administration","volume":"7 1","pages":"1"},"PeriodicalIF":0.0,"publicationDate":"2021-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80061386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Daniel L. Hall, C. Luberto, A. Markowitz, Helen R. Mizrach, Nevita George, Giselle K. Perez, N. DeTore, G. Fricchione, D. Holt, L. Sylvia, E. Park
Objective: The degree to which healthcare workers experience uncertainty about their health has yet to be examined as a contributor to the psychological toll of the COVID-19 pandemic In this report, we aimed to (1) characterize health uncertainty levels among healthcare workers in a large, U S hospital system during the COVID-19 pandemic, and (2) examine factors associated with higher levels of health uncertainty Methods: From March to June 2020, healthcare workers in a large, urban U S healthcare system were invited via hospital emails and departmental announcements to complete an online questionnaire (REDCap) Self-report measures assessed sociodemographic characteristics and job roles, health uncertainty, and emotional wellbeing variables (anxiety, depression, loneliness, self-compassion, and coping confidence) Health uncertainty levels were compared using t-tests and ANOVAs Results: Healthcare workers (N=440) were on average 44 5 years of age, 88 9% female, and 84 5% non-Hispanic white Over half (52%) of healthcare workers reported at least some health uncertainty;pharmacists had the highest uncertainty, and technicians had significantly higher uncertainty than physicians (p< 05) and mental health and spiritual counselors (p< 05) Additionally, higher health uncertainty was associated with higher anxiety (p<0 001), depression (p<0 001), and loneliness (p<0 001), higher self compassion (p=0 02), and lower coping confidence (p<0 001) Conclusion: Collectively, these findings have implications for targeted coping skills interventions for healthcare workers, including particular pharmacists and technicians, who are essential in delivering healthcare services to the public during the COVID-19 pandemic
{"title":"Health uncertainty among healthcare workers during the COVID-19 pandemic","authors":"Daniel L. Hall, C. Luberto, A. Markowitz, Helen R. Mizrach, Nevita George, Giselle K. Perez, N. DeTore, G. Fricchione, D. Holt, L. Sylvia, E. Park","doi":"10.5430/JHA.V10N2P45","DOIUrl":"https://doi.org/10.5430/JHA.V10N2P45","url":null,"abstract":"Objective: The degree to which healthcare workers experience uncertainty about their health has yet to be examined as a contributor to the psychological toll of the COVID-19 pandemic In this report, we aimed to (1) characterize health uncertainty levels among healthcare workers in a large, U S hospital system during the COVID-19 pandemic, and (2) examine factors associated with higher levels of health uncertainty Methods: From March to June 2020, healthcare workers in a large, urban U S healthcare system were invited via hospital emails and departmental announcements to complete an online questionnaire (REDCap) Self-report measures assessed sociodemographic characteristics and job roles, health uncertainty, and emotional wellbeing variables (anxiety, depression, loneliness, self-compassion, and coping confidence) Health uncertainty levels were compared using t-tests and ANOVAs Results: Healthcare workers (N=440) were on average 44 5 years of age, 88 9% female, and 84 5% non-Hispanic white Over half (52%) of healthcare workers reported at least some health uncertainty;pharmacists had the highest uncertainty, and technicians had significantly higher uncertainty than physicians (p< 05) and mental health and spiritual counselors (p< 05) Additionally, higher health uncertainty was associated with higher anxiety (p<0 001), depression (p<0 001), and loneliness (p<0 001), higher self compassion (p=0 02), and lower coping confidence (p<0 001) Conclusion: Collectively, these findings have implications for targeted coping skills interventions for healthcare workers, including particular pharmacists and technicians, who are essential in delivering healthcare services to the public during the COVID-19 pandemic","PeriodicalId":15872,"journal":{"name":"Journal of Hospital Administration","volume":"123 1","pages":"45"},"PeriodicalIF":0.0,"publicationDate":"2021-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73440710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Barbera, Kayla Wilson, James D. Melton, F. Blind, D. Bhisitkul, D. Degroot, Donna Faviere, Joanne Fuell, Hal Escowitz, Tim Regan
Background: There have been many perceived barriers to the implementation of the mass use of monoclonal antibody therapy following the Food and Drug Administration’s Emergency Use Authorization in November 2020. These barriers include identifying eligible patients, physical resources including trained staff members, space, and materials for the administration away from others to reduce transmission, and cost of the resources. However, Lakeland Regional Health was able to create a safe and efficient protocol to administer Bamlanivimab in the treatment of high risk COVID positive patients and initiate this proposed pathway within 24 hours of receipt of the first shipment of medication. Methods: Critical to the development and success of this protocol was a multi-disciplinary approach focused on identifying and utilizing preexisting resources to ensure safe and efficient administration of this treatment to as many eligible patients as possible. Another crucial aspect was the utilization of the emergency department providers for identifying high risk eligible patients and as a safe and effective treatment setting. Results: This article is intended to demonstrate a best practice pathway to identify and administer Bamlanivimab, or similar treatments, and will not discuss outcomes or efficacy of the medication. To date Lakeland Regional Health has successfully treated over 1,000 high risk COVID-19 positive patients within our community. Conclusions: By identifying and utilizing similar resources and pathways available at individual medical centers, it is possible to safely and efficiently treat high risk COVID positive patients with monoclonal antibody therapy on a large scale.
{"title":"Emergency department use of monoclonal antibody therapy in high risk COVID positive patients","authors":"A. Barbera, Kayla Wilson, James D. Melton, F. Blind, D. Bhisitkul, D. Degroot, Donna Faviere, Joanne Fuell, Hal Escowitz, Tim Regan","doi":"10.5430/JHA.V10N2P38","DOIUrl":"https://doi.org/10.5430/JHA.V10N2P38","url":null,"abstract":"Background: There have been many perceived barriers to the implementation of the mass use of monoclonal antibody therapy following the Food and Drug Administration’s Emergency Use Authorization in November 2020. These barriers include identifying eligible patients, physical resources including trained staff members, space, and materials for the administration away from others to reduce transmission, and cost of the resources. However, Lakeland Regional Health was able to create a safe and efficient protocol to administer Bamlanivimab in the treatment of high risk COVID positive patients and initiate this proposed pathway within 24 hours of receipt of the first shipment of medication. Methods: Critical to the development and success of this protocol was a multi-disciplinary approach focused on identifying and utilizing preexisting resources to ensure safe and efficient administration of this treatment to as many eligible patients as possible. Another crucial aspect was the utilization of the emergency department providers for identifying high risk eligible patients and as a safe and effective treatment setting. Results: This article is intended to demonstrate a best practice pathway to identify and administer Bamlanivimab, or similar treatments, and will not discuss outcomes or efficacy of the medication. To date Lakeland Regional Health has successfully treated over 1,000 high risk COVID-19 positive patients within our community. Conclusions: By identifying and utilizing similar resources and pathways available at individual medical centers, it is possible to safely and efficiently treat high risk COVID positive patients with monoclonal antibody therapy on a large scale.","PeriodicalId":15872,"journal":{"name":"Journal of Hospital Administration","volume":"11 1","pages":"38"},"PeriodicalIF":0.0,"publicationDate":"2021-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81992988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Caroline A. Ricard, Janelle O. Poyant, Sharon Holewinski, Stanley A. Nasraway Jr
Objective: Early reports demonstrate that patients with Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection have high rates of hospitalization, intensive care unit (ICU) admission, and death. We sought to examine characteristics of ICU admissions with and without Coronavirus 2019 (COVID-19) and to compare outcomes between these two critically ill cohorts.Methods: A retrospective analysis of 600 unique adult ICU admissions was conducted at an academic medical center in Boston, MA from March 22 to May 31, 2020.Results: Of 600 ICU admissions, 170 (28.3%) tested positive for COVID-19. Those with COVID-19 had greater severity of illness and were more likely to require mechanical ventilation (MV). Hospital and ICU mortality rates were greater in the COVID-19 group (22.4% vs. 9.5%; 18.2% vs. 7.2%, respectively), but lower than previous reports. Unadjusted odds ratio (OR) for COVID-19 as a predictor of hospital mortality was 2.73 (95% CI 1.68 to 4.43), but when accounting for clinical characteristics and severity of illness, adjusted OR for hospital mortality was no different (1.09 [95% CI 0.50 to 2.41]) among those with and without COVID-19.Conclusions: COVID-19 admissions had greater severity of illness and suffered higher crude mortality rates compared to the non-COVID-19 cohort. However, there was no significant difference in the adjusted OR for hospital mortality between patients with and without COVID-19. This novel finding may be attributed to the “learning curve” from other healthcare system experiences, early hospital-wide preparation, and dedicated intensive care.
目的:早期报告表明，严重急性呼吸综合征冠状病毒-2 (SARS-CoV-2)感染患者的住院率、重症监护病房(ICU)入院率和死亡率高。我们试图研究患有和未患有2019冠状病毒(COVID-19)的ICU入院患者的特征，并比较这两个危重患者队列的结果。方法:回顾性分析2020年3月22日至5月31日在马萨诸塞州波士顿一家学术医疗中心收治的600例成人ICU住院病例。结果:600例ICU入院患者中，170例(28.3%)COVID-19检测呈阳性。COVID-19患者病情严重，更有可能需要机械通气(MV)。COVID-19组的医院和ICU死亡率更高(22.4% vs 9.5%;18.2% vs. 7.2%)，但低于之前的报道。COVID-19作为医院死亡率预测因子的未调整比值比(OR)为2.73 (95% CI 1.68至4.43)，但当考虑临床特征和疾病严重程度时，在患有和未患有COVID-19的患者中，调整后的OR与医院死亡率没有差异(1.09 [95% CI 0.50至2.41])。结论:与非COVID-19队列相比，入院的COVID-19患者疾病严重程度更高，粗死亡率更高。然而，在COVID-19患者和非COVID-19患者之间，调整后的医院死亡率OR没有显著差异。这一新颖的发现可能归因于从其他医疗保健系统的经验，早期全院范围的准备和专门的重症监护的“学习曲线”。
{"title":"Survival in critically ill admissions with and without COVID-19 at an academic medical center during the height of the pandemic","authors":"Caroline A. Ricard, Janelle O. Poyant, Sharon Holewinski, Stanley A. Nasraway Jr","doi":"10.5430/JHA.V10N2P29","DOIUrl":"https://doi.org/10.5430/JHA.V10N2P29","url":null,"abstract":"Objective: Early reports demonstrate that patients with Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection have high rates of hospitalization, intensive care unit (ICU) admission, and death. We sought to examine characteristics of ICU admissions with and without Coronavirus 2019 (COVID-19) and to compare outcomes between these two critically ill cohorts.Methods: A retrospective analysis of 600 unique adult ICU admissions was conducted at an academic medical center in Boston, MA from March 22 to May 31, 2020.Results: Of 600 ICU admissions, 170 (28.3%) tested positive for COVID-19. Those with COVID-19 had greater severity of illness and were more likely to require mechanical ventilation (MV). Hospital and ICU mortality rates were greater in the COVID-19 group (22.4% vs. 9.5%; 18.2% vs. 7.2%, respectively), but lower than previous reports. Unadjusted odds ratio (OR) for COVID-19 as a predictor of hospital mortality was 2.73 (95% CI 1.68 to 4.43), but when accounting for clinical characteristics and severity of illness, adjusted OR for hospital mortality was no different (1.09 [95% CI 0.50 to 2.41]) among those with and without COVID-19.Conclusions: COVID-19 admissions had greater severity of illness and suffered higher crude mortality rates compared to the non-COVID-19 cohort. However, there was no significant difference in the adjusted OR for hospital mortality between patients with and without COVID-19. This novel finding may be attributed to the “learning curve” from other healthcare system experiences, early hospital-wide preparation, and dedicated intensive care.","PeriodicalId":15872,"journal":{"name":"Journal of Hospital Administration","volume":"336 1","pages":"29"},"PeriodicalIF":0.0,"publicationDate":"2021-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84201786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rachel Vanderkruik, Helen R. Mizrach, Sydney Crute, Cayley C. Bliss, L. Sylvia, L. Traeger, Daniel L. Hall, C. Luberto, Joanna M. Streck, Amelia M. Stanton, Nevita George, Sara E Looby, D. Mehta, G. Fricchione, E. Park
Objective: The COVID-19 pandemic has strained healthcare systems worldwide, placing a high psychological burden on frontline clinicians. There is an urgent need to better understand their stressors and determine if stressors differ by clinical role. The present study assessed the concerns among frontline clinicians across a large healthcare system during the COVID-19 pandemic to inform the development of tailored supportive services. Methods: From March – June 2020, frontline clinicians across the Mass General Brigham healthcare system were invited to register for an adapted mind-body resiliency group program. Clinicians completed preand post-program assessments asking them to report their COVID-19-related concerns. Qualitative data were analyzed in aggregate and by clinical role using content analysis to identify overarching domains. Results: Frontline clinicians’ concerns fall within seven domains: concerns for self, patients, family members, staff, existential concerns, systems-level concerns, and job-level concerns. Concerns for self and existential concerns were most commonly reported across clinical roles. Long-term care clinicians were highly concerned about patients’ wellbeing while rehabilitation therapists were highly concerned about their family members’ health. Across groups, nurse practitioners and physician assistants more often reported job-level concerns. Concerns for staff and systems level concerns were less frequently reported across clinical roles. Conclusions: Frontline clinicians share common pandemic-related concerns, but nuances exist among the concerns most frequently reported across clinical roles. Interventions that offer stress management and resiliency training may be helpful for addressing pandemic-related concerns overall. Future research should determine if tailored support services by clinical role may be warranted.
{"title":"Frontline clinician concerns during the COVID-19 pandemic: A qualitative inquiry","authors":"Rachel Vanderkruik, Helen R. Mizrach, Sydney Crute, Cayley C. Bliss, L. Sylvia, L. Traeger, Daniel L. Hall, C. Luberto, Joanna M. Streck, Amelia M. Stanton, Nevita George, Sara E Looby, D. Mehta, G. Fricchione, E. Park","doi":"10.5430/JHA.V10N2P21","DOIUrl":"https://doi.org/10.5430/JHA.V10N2P21","url":null,"abstract":"Objective: The COVID-19 pandemic has strained healthcare systems worldwide, placing a high psychological burden on frontline clinicians. There is an urgent need to better understand their stressors and determine if stressors differ by clinical role. The present study assessed the concerns among frontline clinicians across a large healthcare system during the COVID-19 pandemic to inform the development of tailored supportive services. Methods: From March – June 2020, frontline clinicians across the Mass General Brigham healthcare system were invited to register for an adapted mind-body resiliency group program. Clinicians completed preand post-program assessments asking them to report their COVID-19-related concerns. Qualitative data were analyzed in aggregate and by clinical role using content analysis to identify overarching domains. Results: Frontline clinicians’ concerns fall within seven domains: concerns for self, patients, family members, staff, existential concerns, systems-level concerns, and job-level concerns. Concerns for self and existential concerns were most commonly reported across clinical roles. Long-term care clinicians were highly concerned about patients’ wellbeing while rehabilitation therapists were highly concerned about their family members’ health. Across groups, nurse practitioners and physician assistants more often reported job-level concerns. Concerns for staff and systems level concerns were less frequently reported across clinical roles. Conclusions: Frontline clinicians share common pandemic-related concerns, but nuances exist among the concerns most frequently reported across clinical roles. Interventions that offer stress management and resiliency training may be helpful for addressing pandemic-related concerns overall. Future research should determine if tailored support services by clinical role may be warranted.","PeriodicalId":15872,"journal":{"name":"Journal of Hospital Administration","volume":"41 1","pages":"21"},"PeriodicalIF":0.0,"publicationDate":"2021-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73870788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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