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5.
Am J Med ; 134(11): 1380-1388.e3, 2021 11.
Article in English | MEDLINE | ID: covidwho-1397151

ABSTRACT

BACKGROUND: Whether the volume of coronavirus disease 2019 (COVID-19) hospitalizations is associated with outcomes has important implications for the organization of hospital care both during this pandemic and future novel and rapidly evolving high-volume conditions. METHODS: We identified COVID-19 hospitalizations at US hospitals in the American Heart Association COVID-19 Cardiovascular Disease Registry with ≥10 cases between January and August 2020. We evaluated the association of COVID-19 hospitalization volume and weekly case growth indexed to hospital bed capacity, with hospital risk-standardized in-hospital case-fatality rate (rsCFR). RESULTS: There were 85 hospitals with 15,329 COVID-19 hospitalizations, with a median hospital case volume was 118 (interquartile range, 57, 252) and median growth rate of 2 cases per 100 beds per week but varied widely (interquartile range: 0.9 to 4.5). There was no significant association between overall hospital COVID-19 case volume and rsCFR (rho, 0.18, P = .09). However, hospitals with more rapid COVID-19 case-growth had higher rsCFR (rho, 0.22, P = 0.047), increasing across case growth quartiles (P trend = .03). Although there were no differences in medical treatments or intensive care unit therapies (mechanical ventilation, vasopressors), the highest case growth quartile had 4-fold higher odds of above median rsCFR, compared with the lowest quartile (odds ratio, 4.00; 1.15 to 13.8, P = .03). CONCLUSIONS: An accelerated case growth trajectory is a marker of hospitals at risk of poor COVID-19 outcomes, identifying sites that may be targets for influx of additional resources or triage strategies. Early identification of such hospital signatures is essential as our health system prepares for future health challenges.


Subject(s)
Bed Occupancy/statistics & numerical data , COVID-19 , Hospital Bed Capacity/statistics & numerical data , Intensive Care Units/statistics & numerical data , Mortality , Quality Improvement/organization & administration , COVID-19/mortality , COVID-19/therapy , Civil Defense , Health Care Rationing/organization & administration , Health Care Rationing/standards , Hospital Mortality , Hospitalization/statistics & numerical data , Humans , Outcome Assessment, Health Care , Registries , Risk Assessment , SARS-CoV-2 , Triage/organization & administration , United States/epidemiology
6.
J Am Geriatr Soc ; 69(10): 2716-2721, 2021 10.
Article in English | MEDLINE | ID: covidwho-1325028

ABSTRACT

During the COVID-19 pandemic, frontline nursing home staff faced extraordinary stressors including high infection and mortality rates and ever-changing and sometimes conflicting federal and state regulations. To support nursing homes in evidence-based infection control practices, the Massachusetts Senior Care Association and Hebrew SeniorLife partnered with the Agency for Healthcare Research and Quality AHRQ ECHO National Nursing Home COVID-19 Action Network (the network). This educational program provided 16 weeks of free weekly virtual sessions to 295 eligible nursing homes, grouped into nine cohorts of 30-33 nursing homes. Eighty-three percent of eligible nursing homes in Massachusetts participated in the Network, and Hebrew SeniorLife's Training Center served the vast majority. Each cohort was led by geriatrics clinicians and nursing home leaders, and coaches trained in quality improvement. The interactive sessions provided timely updates on COVID-19 infection control best practices to improve care and also created a peer-to-peer learning community to share ongoing challenges and potential solutions. The weekly Network meetings were a source of connection, emotional support, and validation and may be a valuable mechanism to support resilience and well-being for nursing home staff.


Subject(s)
COVID-19 , Health Personnel , Nursing Homes , Online Social Networking , Resilience, Psychological , Skilled Nursing Facilities , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/psychology , Education, Distance/methods , Evidence-Based Practice/education , Health Personnel/education , Health Personnel/psychology , Humans , Infection Control/methods , Massachusetts/epidemiology , Nursing Homes/standards , Nursing Homes/trends , Quality Improvement/organization & administration , SARS-CoV-2 , Skilled Nursing Facilities/standards , Skilled Nursing Facilities/trends , Social Support
7.
Arch Phys Med Rehabil ; 102(12): 2482-2488, 2021 12.
Article in English | MEDLINE | ID: covidwho-1321988

ABSTRACT

The delivery of care in the inpatient rehabilitation setting was disrupted during the coronavirus disease 2019 (COVID-19) pandemic. As a 150-bed freestanding inpatient rehabilitation facility in the epicenter of the pandemic, Burke Rehabilitation Hospital was required to increase overall bed capacity for regional overflow needs and still maintain our mission to provide inpatient rehabilitation for patients with and without COVID-19. During the period between March and September 2020, Burke Rehabilitation Hospital treated over 300 rehabilitation patients who were COVID-19 positive and at one point had a census that was >50% COVID-19 positive. A model grounded in 5 priorities-communication, personal protective equipment, clinical service delivery, discharge planning, and patient/staff support-was implemented to reprioritize daily operations and ensure patient and staff safety while providing valuable rehabilitation services. The delivery of physical, occupational, speech, and recreational therapy services transformed, and a number of innovative clinical practices were developed. During the study period, 100% of our patients continued to be scheduled to receive therapy services. Patient length of stay values did increase during the pandemic (from 16.38d to 19.93d), and slightly more patients were discharged to home (68.7% compared with 68.3%). Despite modifications to rehabilitation care delivery, patients continued to make functional gains in the areas of self-care, mobility, and walking. Flexible leadership was pivotal in the development and implementation of new processes and procedures to meet the evolving needs of patients, staff, and the organization as a whole.


Subject(s)
COVID-19/rehabilitation , Delivery of Health Care/organization & administration , Hospitals, Rehabilitation/organization & administration , Patient Discharge , Quality Improvement/organization & administration , COVID-19/epidemiology , Humans , New York/epidemiology , Pandemics , Retrospective Studies , SARS-CoV-2
8.
BMC Fam Pract ; 22(1): 143, 2021 07 01.
Article in English | MEDLINE | ID: covidwho-1295441

ABSTRACT

BACKGROUND: Integrated primary care teams are ideally positioned to support the mental health care needs arising during the COVID-19 pandemic. Understanding how COVID-19 has affected mental health care delivery within primary care settings will be critical to inform future policy and practice decisions during the later phases of the pandemic and beyond. The objective of our study was to describe the impact of the COVID-19 pandemic on primary care teams' delivery of mental health care. METHODS: A qualitative study using focus groups conducted with primary care teams in Ontario, Canada. Focus group data was analysed using thematic analysis. RESULTS: We conducted 11 focus groups with 10 primary care teams and a total of 48 participants. With respect to the impact of the COVID-19 pandemic on mental health care in primary care teams, we identified three key themes: i) the high demand for mental health care, ii) the rapid transformation to virtual care, and iii) the impact on providers. CONCLUSIONS: From the outset of the COVID-19 pandemic, primary care quickly responded to the rising mental health care demands of their patients. Despite the numerous challenges they faced with the rapid transition to virtual care, primary care teams have persevered. It is essential that policy and decision-makers take note of the toll that these demands have placed on providers. There is an immediate need to enhance primary care's capacity for mental health care for the duration of the pandemic and beyond.


Subject(s)
COVID-19 , Delivery of Health Care, Integrated/organization & administration , Mental Health Services , Patient Care Team/organization & administration , Primary Health Care , Telemedicine , Adult , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/psychology , Female , Focus Groups , Health Services Needs and Demand , Humans , Male , Mental Health/trends , Mental Health Services/standards , Mental Health Services/supply & distribution , Ontario/epidemiology , Practice Patterns, Physicians'/trends , Primary Health Care/methods , Primary Health Care/trends , Quality Improvement/organization & administration , SARS-CoV-2 , Telemedicine/methods , Telemedicine/statistics & numerical data
10.
Natl Med J India ; 33(5): 298-301, 2020.
Article in English | MEDLINE | ID: covidwho-1289146

ABSTRACT

India has the largest global burden of new cases of tuberculosis (TB) and deaths due to TB. These occur predominantly in the poor who suffer catastrophic costs during diagnosis and treatment. The National Tuberculosis Elimination Programme has ambitious goals of 80% reduction of incidence of TB, 90% reduction in mortality due to TB by 2025 and 0% occurrence of catastrophic costs to households affected by TB by 2020. The Covid-19 pandemic and the resulting disruption to TB services are expected to worsen the situation. There are gaps in case finding at the peripheral level and access to care at the higher level for patients with TB. An estimated 32% patients with active TB do not access diagnostic services, while catastrophic costs associated with hospitalization are a barrier to access for seriously ill patients. Deaths due to TB in India occur largely at home and not in medical facilities, and are preventable with appropriate inpatient care. The Ayushman Bharat scheme with its Health and Wellness Centres (HWCs) and coverage for inpatient care under the Pradhan Mantri Jan Arogya Yojana (PM-JAY) can facilitate, the achievement of the goals of TB elimination. The HWCs provide an opportunity to close the case-finding gap as first point of contact by enabling sputum transport services to the designated microscopy centres. This will facilitate case detection, reduce diagnostic delays, and decrease community transmission and the incidence of TB. The benefit package of PM-JAY can cover patients with pulmonary TB, inpatient evaluation for other forms of TB, enhance the allocation for treatment and cover management of comorbid conditions such as severe undernutrition, anaemia, HIV and diabetes.


Subject(s)
COVID-19 , Communicable Disease Control/organization & administration , Early Diagnosis , Hospitalization , Patient Care Management , Tuberculosis , Universal Health Insurance , COVID-19/epidemiology , COVID-19/prevention & control , Health Expenditures , Health Services Accessibility/standards , Health Services Accessibility/statistics & numerical data , Health Services Needs and Demand , Humans , India/epidemiology , Mortality , Patient Care Management/methods , Patient Care Management/organization & administration , Patient Care Management/trends , Public Health/methods , Public Health/trends , Quality Improvement/organization & administration , SARS-CoV-2 , Time-to-Treatment , Tuberculosis/diagnosis , Tuberculosis/economics , Tuberculosis/mortality , Tuberculosis/therapy
13.
Scand J Public Health ; 49(1): 29-32, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-1207563

ABSTRACT

The emergence of COVID-19 has changed the world as we know it, arguably none more so than for older people. In Sweden, the majority of COVID-19-related fatalities have been among people aged ⩾70 years, many of whom were receiving health and social care services. The pandemic has illuminated aspects within the care continuum requiring evaluative research, such as decision-making processes, the structure and organisation of care, and interventions within the complex public-health system. This short communication highlights several key areas for future interdisciplinary and multi-sectorial collaboration to improve health and social care services in Sweden. It also underlines that a valid, reliable and experiential evidence base is the sine qua non for evaluative research and effective public-health systems.


Subject(s)
COVID-19/therapy , Interdisciplinary Research/organization & administration , Quality Improvement/organization & administration , Aged , COVID-19/epidemiology , COVID-19/mortality , Evidence-Based Practice , Humans , Residential Facilities/organization & administration , Residential Facilities/standards , Social Work/organization & administration , Social Work/standards , Sweden/epidemiology
14.
Implement Sci ; 16(1): 38, 2021 04 12.
Article in English | MEDLINE | ID: covidwho-1181114

ABSTRACT

BACKGROUND: The National Chest Pain Center Accreditation Program (CHANGE) is the first hospital-based, multifaceted, nationwide quality improvement (QI) initiative, to monitor and improve the quality of the ST segment elevation myocardial infarction (STEMI) care in China. The QI initiatives, as implementation strategies, include a bundle of evidence-based interventions adapted for implementation in China. During the pandemic of coronavirus disease 2019 (COVID-19), fear of infection with severe acute respiratory syndrome coronavirus 2, national lockdowns, and altered health care priorities have highlighted the program's importance in improving STEMI care quality. This study aims to minimize the adverse impact of the COVID-19 pandemic on the quality of STEMI care, by developing interventions that optimize the QI initiatives, implementing and evaluating the optimized QI initiatives, and developing scale-up activities of the optimized QI initiatives in response to COVID-19 and other public health emergencies. METHODS: A stepped wedge cluster randomized control trial will be conducted in three selected cities of China: Wuhan, Suzhou, and Shenzhen. Two districts have been randomly selected in each city, yielding a total of 24 registered hospitals. This study will conduct a rollout in these hospitals every 3 months. The 24 hospitals will be randomly assigned to four clusters, and each cluster will commence the intervention (optimized QI initiatives) at one of the four steps. We will conduct hospital-based assessments, questionnaire surveys among health care providers, community-based household surveys, and key informant interviews during the trial. All outcome measures will be organized using the RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework, including implementation outcomes, service outcomes (e.g., treatment time), and patient outcomes (e.g., in-hospital mortality and 1-year complication). The Consolidated Framework for Implementation Research framework will be used to identify factors that influence implementation of the optimized QI interventions. DISCUSSION: The study findings could be translated into a systematic solution to implementing QI initiatives in response to COVID-19 and future potential major public health emergencies. Such actionable knowledge is critical for implementors of scale-up activities in low- and middle-income settings. TRIAL REGISTRATION: ChiCTR 2100043319 . Registered on 10 February 2021.


Subject(s)
COVID-19/epidemiology , Quality Improvement/organization & administration , ST Elevation Myocardial Infarction/therapy , China/epidemiology , Humans , SARS-CoV-2 , Time-to-Treatment
15.
J Med Syst ; 45(5): 59, 2021 Apr 07.
Article in English | MEDLINE | ID: covidwho-1172395

ABSTRACT

Health systems are struggling to manage a fluctuating volume of critically ill patients with COVID-19 while continuing to provide basic surgical services and expand capacity to address operative cases delayed by the pandemic. As we move forward through the next phases of the pandemic, we will need a decision-making system that allows us to remain nimble as clinicians to meet our patient's needs while also working with a new framework of healthcare operations. Here, we present our quality improvement process for the adaptation and application of the Medically Necessary Time-Sensitive (MeNTS) toolto gynecologic surgical services beyond the initial COVID response and into recovery of surgical services; with analysis of the reliability of the modified-MeNTS tool in our multi-site safety net hospital network. This multicenter study evaluated the gynecology surgical case volume at three tertiary acute care safety net institutions within the LA County Department of Health Services: Harbor-UCLA (HUMC), Olive View Medical Center (OVMC), and Los Angeles County + University of Southern California (LAC+USC). We describe our modified-Delphi approach to adapt the MeNTS tool in a structured fashion and its application to gynecologic surgical services. Blinded reviewers engaged in a three-round iterative adaptation and final scoring utilizing the modified tool. The cohort consisted of 392 female consecutive gynecology patients across three Los Angeles County Hospitals awaiting scheduled procedures in the surgical queue.The majority of patients were Latina (74.7%) and premenopausal (67.1%). Over half (52.4%) of the patients had cardiovascular disease, while 13.0% had lung disease, and 13.8% had diabetes. The most common indications for surgery were abnormal uterine bleeding (33.2%), pelvic organ prolapse (19.6%) and presence of an adnexal mass (14.3%). Minimally invasive approaches via laparoscopy, robotic-assisted laparoscopy, or vaginal surgery was the predominant planned surgical route (54.8%). Modified-MeNTS scores assumed a normal distribution across all patients within our cohort (Median 33, Range 18-52). Overall, ICC across all three institutions demonstrated "good" interrater reliability (0.72). ICC within institutions at HUMC and OVMC were categorized as "good" interrater reliability, while LAC-USC interrater reliability was categorized as "excellent" (HUMC 0.73, OVMC 0.65, LAC+USC 0.77). The modified-MeNTS tool performed well across a range of patients and procedures with a normal distribution of scores and high reliability between raters. We propose that the modified-MeNTS framework be considered as it employs quantitative methods for decision-making rather than subjective assessments.


Subject(s)
COVID-19/epidemiology , Gynecologic Surgical Procedures/statistics & numerical data , Quality Improvement/organization & administration , Triage/organization & administration , Adult , Age Factors , Aged , Aged, 80 and over , Body Mass Index , Comorbidity , Delphi Technique , Female , Humans , Los Angeles/epidemiology , Middle Aged , Pandemics , Reproducibility of Results , SARS-CoV-2 , Time Factors , Young Adult
17.
Soc Work Health Care ; 60(2): 177-186, 2021.
Article in English | MEDLINE | ID: covidwho-1149805

ABSTRACT

Purpose: While global pandemics such as the COVID-19 public health crisis are known to increase the likelihood of frontline health care workers experiencing the negative effects of stress and trauma, many health care workers on the frontlines of the COVID-19 pandemic lack adequate support. This paper presents the findings of a social work led peer support model, COVID-19 Am I Resilient (cAIR), developed and deployed during the first wave of the COVID-19 pandemic.Methods: This quality improvement initiative was developed and piloted within the Clinical Education and Practice department at a large urban health care system. The pilot included provision of peer support through synchronous video presentations, one-on-one peer support, and resourcing and referral. Pilot outcomes of feasibility and staff engagement were evaluated using participant responses to an online survey as well as attendance records at project activities.Implications: Developed to help frontline health care workers thrive in the midst, and wake, of the COVID-19 pandemic, the pilot study of the cAIR peer support model has implications for further development and implementation of peer support for typically underrepresented health care disciplines working during the COVID-19 pandemic as well as future public health emergencies.


Subject(s)
COVID-19/epidemiology , Health Personnel/psychology , Mental Health Services/organization & administration , Peer Group , Social Work/organization & administration , Burnout, Professional/prevention & control , Burnout, Professional/psychology , Humans , Pandemics , Pilot Projects , Quality Improvement/organization & administration , Resilience, Psychological , SARS-CoV-2
20.
Anesth Analg ; 132(1): 31-37, 2021 01.
Article in English | MEDLINE | ID: covidwho-1124783

ABSTRACT

BACKGROUND: Care of the pregnant patient during the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic presents many challenges, including creating parallel workflows for infected and noninfected patients, minimizing waste of materials, and ensuring that clinicians can seamlessly transition between types of anesthesia. The exponential community spread of disease limited the time for development and training. METHODS: The goals of our workflow and process development were to maximize safety for staff and patients, minimize the risk of contamination, and reduce the waste of unused supplies and materials. We used a cyclical improvement system and the plus/delta debriefing method to rapidly develop workflows consisting of sequential checklists and procedure-specific packs. RESULTS: We designed independent workflows for labor analgesia, neuraxial anesthesia for cesarean delivery, conversion of labor analgesia to cesarean anesthesia, and general anesthesia. In addition, we created procedure-specific material packs to optimize supplies and prevent wastage. Finally, we generated sequential checklists to allow staff to perform standard operating procedures without extensive training. CONCLUSIONS: Collectively, these workflows and tools allowed our staff to urgently care for patients in high-risk situations without prior experience. Over time, we refined the workflows using a cyclical improvement system. We present our checklists and workflows as well as the system we used for their development, so that others may use them to their benefit.


Subject(s)
Anesthesia Department, Hospital/organization & administration , Anesthesia, Obstetrical , COVID-19/prevention & control , Checklist , Delivery of Health Care/organization & administration , Infection Control/organization & administration , Workflow , COVID-19/transmission , Critical Pathways/organization & administration , Female , Humans , Pregnancy , Quality Improvement/organization & administration , Quality Indicators, Health Care/organization & administration
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