Adolescents, Psychiatric Hospitalization, and COVID-19
As we approach the sixth month of widespread community transmission of COVID-19 in the United States, our focus must shift beyond acute management of disease to the broader effects of this pandemic on health and wellbeing. In particular, it is important that we understand the consequences of the COVID-19 pandemic on the mental health of children and adolescents.
Does Hospitalization For Thromboembolism Improve Oral Anticoagulant Adherence In Patients With Atrial Fibrillation?
Thanh Phuong Pham Nguyen, Yong Chen, Dylan Thibault, Charles E. Leonard, Sean Hennessy, Allison Willis
Abstract [from journal]
Background: It is not known how medication adherence changes after hospitalization for a sentinel thromboembolic event.
Objective: The purpose of this study was to examine the impact of hospitalization for ischemic stroke or thromboembolism on postdischarge adherence to oral anticoagulants in patients with atrial fibrillation.
Methods: We conducted a quasi-experimental pre-post observational study using a large U.S. commercial insurance health care claims database.
...Chronic Hospital Nurse Understaffing Meets COVID-19
A study of hospitals in New York and Illinois at the start of the COVID-19 pandemic found that most did not meet benchmark patient-to-nurse staffing ratios for medical-surgical or intensive care units. New York City hospitals had especially low staffing ratios. Understaffed hospitals were associated with less job satisfaction among nurses, unfavorable grades for patient safety and quality of care, and hesitance by nurses and patients to recommend their hospitals.
COVID-19 Outbreak Among Adolescents At An Inpatient Behavioral Health Hospital
Polina Krass, Charles Zimbrick-Rogers, Chioma Iheagwara, Carol A. Ford, Michele Calderoni
Abstract [from journal]
Purpose: We report on a coronavirus disease 2019 (COVID-19) outbreak among adolescents at an inpatient behavioral health facility that was identified within 5 weeks of known viral transmission in the surrounding community.
Methods: Clinical records were reviewed for all inpatients aged <18 years with laboratory-confirmed COVID-19 between March 23 and April 21, 2020.
Results: A total of 19 COVID-19-positive patients aged 11-17 years were identified. Patients most
...Pediatric ED Utilization During COVID-19
Mobility Action Group: Using Quality Improvement Methods To Create A Culture Of Hospital Mobility
Songprod Jonathan Lorgunpai, Bruce Finke, Isaac Burrows, Cynthia J. Brown, Fred H. Rubin, Heidi R. Wierman, Susan J. Heisey, Sarah Gartaganis, Shari M. Ling, Matthew Press, Sharon K. Inouye
Abstract [from journal]
Background/objectives: To describe the Mobility Action Group (MACT), an innovative process to enhance implementation of hospital mobility programs and create a culture of mobility in acute care.
Design: Continuous quality improvement intervention with episodic data review.
Setting: Inpatient units including medical, surgical, and intensive care settings.
Participants: A total of 42 hospitals of varying sizes across the United States.
...Economic Outcomes Of Insurer-Led Care Management For High-Cost Medicaid Patients
Jordan M. Harrison, Arman Oganisian, David T. Grande, Nandita Mitra, Manik Chhabra, Krisda H. Chaiyachati
Abstract [from journal]
Objectives: To evaluate the impact of the Community-Based Care Management (CBCM) program on total costs of care and utilization among adult high-need, high-cost patients enrolled in a Medicaid managed care organization (MCO). CBCM was a Medicaid insurer-led care coordination and disease management program staffed by nurse care managers paired with community health workers.
Study design: Retrospective cohort analysis.
Methods: We obtained deidentified health plan claims
...Payment and Pricing Decisions in Health Care Reform
Any effort to reform health insurance in the United States must tackle the prices we pay for health care. There are many complex challenges to addressing prices. Some proposals build on the existing Medicare fee schedule, while others suggest promoting alternative payment mechanisms—or even starting from scratch. The stakes are substantial, as many reform proposals rely on reining in prices to achieve the savings necessary to expand health insurance to the uninsured. At Penn’s LDI Medicare for All and Beyond conference, a panel of researchers, hospital administrators, and policy experts considered issues related to health care payment and pricing that any health care reform proposal must address, including the implications of rate setting for providers and patients. At what level should these rates be set to assure access and quality of care, while incentivizing innovation and rewarding excellence?
Association of Homelessness with Hospital Readmissions—An Analysis of Three Large States
Sameed Ahmed M. Khatana, Rishi K. Wadhera, Eunhee Choi, Peter W. Groeneveld, Dennis P. Culhane, Margot Kushel, Dhruv S. Kazi, Robert W. Yeh, Changyu Shen
Abstract [from journal]
Background: Individuals experiencing homelessness have higher hospitalization and mortality rates compared with the housed. Whether they also experience higher readmission rates, and if readmissions vary by region or cause of hospitalization is unknown.
Objective: Evaluate the association of homelessness with readmission rates across multiple US states.
Design:...
Already in Fiscal Crisis, Rural Hospitals Face COVID-19
Association of State Medicaid Expansion With Hospital Community Benefit Spending
Genevieve P. Kanter, Bardia Nabet, Meredith Matone, David M. Rubin
Abstract [from journal]
Importance: Medicaid expansion was widely expected to alleviate the financial stresses faced by hospitals by providing additional revenue in the form of Medicaid reimbursements from patients previously receiving uncompensated care. Among nonprofit hospitals, which receive tax-exempt status in part because of their provision of uncompensated care, Medicaid expansion could have released hospital funds toward other community benefit activities.
Objective: To examine changes in nonprofit hospital spending on...
Impact Of Around-the-Clock Mental Health Staffing On Emergency Department Management of Patients Who Deliberately Self-Harm
Sara Wiesel Cullen, Amaya Diana, Mark Olfson, Ming Xie, Steven C Marcus
Abstract [from journal]
Objective: Emergency departments (EDs) offer opportunities to deliver critical frontline suicide prevention services via assessment, safety planning, and linkages with community-based mental health care after discharge. Because mental health crises can occur at any time, this study sought to evaluate whether around-the-clock mental health staffing in the ED influences the likelihood of providing these evidence-based mental health services.
Methods: ED nursing leadership from a national sample of 406...
A Randomized Trial of Behavioral Nudges to Improve Enrollment in Critical Care Trials
Dustin C. Krutsinger, Kelly L. O'Leary, Susan S. Ellenberg, Cody E. Cotner, Scott D. Halpern, Katherine R. Courtright
Abstract [from journal]
Rationale: Low and slow patient enrollment remains a barrier to critical care randomized controlled trials (RCTs). Behavioral economic insights suggest that nudges may address some enrollment challenges.
Objectives: To evaluate the efficacy of a novel pre-consent survey consisting of nudges on critical care RCT enrollment.
Methods: We conducted an RCT in 10 intensive care units (ICUs) among surrogate decision-makers (SDMs). The novel multi-component behavioral nudge survey was...
A Randomized Trial Of Behavioral Nudges To Improve Enrollment In Critical Care Trials
Dustin C Krutsinger, Kelly L O'Leary, Susan S Ellenberg, Cody E Cotner, Scott D Halpern, Katherine R Courtright
Abstract [from journal]
Rationale: Low and slow patient enrollment remains a barrier to critical care randomized controlled trials (RCTs). Behavioral economic insights suggest that nudges may address some enrollment challenges.
Objectives: To evaluate the efficacy of a novel pre-consent survey consisting of nudges on critical care RCT enrollment.
Methods: We conducted an RCT in 10 intensive care units (ICUs) among surrogate decision-makers (SDMs). The novel multi-component behavioral nudge survey was...
Nonprofit Hospitals and Antitrust: Is There a Case for Special Treatment?
In the wake of a pandemic that has decimated many hospitals’ budgets, many industry insiders foresee a spike in mergers and acquisitions, in both the for-profit and nonprofit sector. How should anti-trust regulators weigh the costs and benefits of this consolidation for consumers?