Pennsylvania Scope of Practice Policy Brief
Pennsylvania is one of 28 states that has not expanded the scope of practice in its licensure laws for certified registered nurse practitioners (NPs), who must maintain formal collaborative agreements with physicians to practice. For many years, proposals to update licensure and adapt it to make it more compatible with current models of collaborative care could not overcome legislative logjams. Recognizing an opportunity to break the logjam, the University of Pennsylvania held a virtual workshop on November 20, 2020, bringing together researchers, health professionals, and consumers to chart a new path forward. This policy brief summarizes their recommendations to update scope of practice regulation to better meet the primary care needs of Pennsylvanians.
Bringing Gynecologic Cancer Care Closer to Patients
For patients with gynecologic cancers, treatment by a specialist—a gynecologic oncologist—is crucial for improving chances of survival. However, in 2015, as many as 10% of women in the U.S. lived in a county that was more than 50 miles from the closest gynecologic oncologist.
Informal Caregivers and Health Policy
Duty Hour Reform and the Outcomes of Patients Treated by New Surgeons
Despite concerns that duty hour reform might adversely affect the performance of new surgeons, this national study found no impact on patient outcomes, including 30-day mortality rates, failure-to-rescue, length of stay, and use of intensive care units. These findings should allay fears that reduced work hours during residency would produce surgeons less prepared for practice than their more experienced colleagues.
Evaluation of Hospital Nurse-to-Patient Staffing Ratios and Sepsis Bundles on Patient Outcomes
Karen B. Lasater, Douglas M. Sloane, Matthew D. McHugh, Jeannie P. Cimiotti, Kathryn A. Riman, Brendan Martin, Maryann Alexander, Linda H. Aiken
Abstract [from journal]
Background: Despite nurses’ responsibilities in recognition and treatment of sepsis, little evidence documents whether patient-to-nurse staffing ratios are associated with clinical outcomes for patients with sepsis.
Methods: Using linked data sources from 2017 including MEDPAR patient claims, Hospital Compare, American Hospital Association, and a large survey of nurses, we estimate the effect of hospital patient-to-nurse staffing ratios and adherence to the Early Management Bundle for patients with Severe Sepsis/...
Inside The Complexity of COVID Vaccine Distribution
Expanding Therapeutic Jurisprudence Across the Federal Judiciary
Benjamin A. Barsky, Heather Ellis Cucolo, Dominic A. Sisti
Abstract [from journal]
A patchwork of drug courts and other problem-solving courts currently exists to divert individuals with mental illness and substance use disorders away from the criminal justice system. We call for a broader implementation of problem-solving courts, particularly at the federal level, that would operate according to the principles of therapeutic jurisprudence (i.e., a framework that aims to maximize the health benefits of judicial and legislative policies and practices). Expanding federal problem-solving courts will better serve
...Scope of Practice Restrictions and Vulnerable Populations
Alzheimer’s Dementia After Exposure to Anesthesia and Surgery in the Elderly: A Matched Natural Experiment Using Appendicitis
Jeffrey H. Silber, Paul R. Rosenbaum, Joseph G. Reiter, Alexander S. Hill, Siddharth Jain, David A. Wolk, Dylan S. Small, Sean Hashemi, Bijan A. Niknam, Mark D. Neuman, Lee A. Fleisher, Roderic...
Abstract [from journal]
Objective: To determine if surgery and anesthesia in the elderly may promote Alzheimer's Disease and Related Dementias (ADRD).
Background: There is a substantial conflicting literature concerning the hypothesis that surgery and anesthesia promotes ADRD. Much of the literature is confounded by indications for surgery or has small sample size. This study examines elderly patients with appendicitis, a common condition that strikes mostly at random after controlling for some known associations.
...Using Nationally Representative Percentiles to Interpret PROMIS Pediatric Measures
Adam C. Carle, Katherine B. Bevans, Carole A. Tucker, Christopher B. Forrest
Abstract [from journal]
Purpose: This study's aim was to use a representative sample of the US pediatric population to estimate percentiles for several PROMIS pediatric measures: Anger, Anxiety, Depressive Symptoms, Family Relationships, Fatigue, Global Health, Life Satisfaction, Meaning and Purpose, Pain Behavior, Pain Interference, Physical Activity, Physical Function Mobility, Physical Function Upper Extremity, Physical Stress Experiences, Positive Affect, Psychological Stress Experiences, Sleep Disturbance, Sleep Impairment, and Peer
...Are There Enough Experienced Physicians to Treat Patients Hospitalized With COVID?
In this national study of 438,895 physicians, 45% provided care to hospitalized patients and 7% provided critical care. At the high estimate of patients requiring hospitalization at the projected peak of the pandemic, 18 states and Washington, DC would have patient to physician ratios greater than 15:1 (a level associated with poor outcomes among hospitalized patients). There was considerable geographic variation in the availability of physicians: 41% of hospital service areas did not have a physician with critical care experience.
Expectations and Experiences With Physician Care Among Patients Receiving Post-Acute Care in U.S. Skilled Nursing Facilities
Kira L. Ryskina, Kierra A. Foley, Jason H. Karlawish, Joshua D. Uy, Briana Lott, Erica Goldberg, Nancy A. Hodgson
Abstract [from journal]
Background: In the US, post-acute care in skilled nursing facilities (SNFs) is common and outcomes vary greatly across facilities. Little is known about the expectations of patients and their caregivers about physician care during the hospital to SNF transition. Our objectives were to (1) describe the experiences and expectations of patients and their caregivers with SNF physicians in SNFs, and (2) identify patterns that differed between patients with vs. without cognitive impairment.
Methods:
...Biden Advisor Ezekiel Emanuel's COVID Vision: Public Health Science and Comprehensive National Measures
When A Family Seeks To Exclude Residents From Their Child's Care
Emily A. Largent, Ross Newman, Christopher E. Gaw, John D. Lantos
Abstract [from journal]
A primary goal of our medical education system is to produce physicians qualified to promote health, prevent and treat disease, and relieve suffering. Although some aspects of the practice of medicine can be learned in classrooms, from textbooks, or with simulators, other aspects can only be learned through the direct provision of patient care. Residency programs therefore offer essential educational experiences that support residents' acquisition of knowledge, skills, and professional judgment through the assumption of progressive
...Assessment of Perceptions of Professionalism Among Faculty, Trainees, Staff, and Students in a Large University-Based Health System
Dominique A. Alexis, Matthew D. Kearney, J. Corey Williams, Chang Xu, Eve J. Higginbotham, Jaya Aysola
Abstract [from journal]
Importance: With a renewed focus on medical professionalism, an opportunity exists to better define its standards and application to meet the needs of an increasingly diverse workforce given the important association between interprofessional behavior and patient care.
Objective: To examine the context of how professionalism is operationalized and perceived in diverse health care work and learning environments.
Design, setting, and participants: A qualitative mixed-
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