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1.
Am J Public Health ; 111(12): 2157-2166, 2021 12.
Article in English | MEDLINE | ID: covidwho-1559064

ABSTRACT

The COVID-19 pandemic caused substantial disruptions in the field operations of all 3 major components of the Medical Expenditure Panel Survey (MEPS). The MEPS is widely used to study how policy changes and major shocks, such as the COVID-19 pandemic, affect insurance coverage, access, and preventive and other health care utilization and how these relate to population health. We describe how the MEPS program successfully responded to these challenges by reengineering field operations, including survey modes, to complete data collection and maintain data release schedules. The impact of the pandemic on response rates varied considerably across the MEPS. Investigations to date show little effect on the quality of data collected. However, lower response rates may reduce the statistical precision of some estimates. We also describe several enhancements made to the MEPS that will allow researchers to better understand the impact of the pandemic on US residents, employers, and the US health care system. (Am J Public Health. 2021;111(12):2157-2166. https://doi.org/10.2105/AJPH.2021.306534).


Subject(s)
COVID-19/epidemiology , Health Expenditures/statistics & numerical data , Surveys and Questionnaires/statistics & numerical data , Electronic Health Records/statistics & numerical data , Health Services/statistics & numerical data , Humans , Insurance Coverage/organization & administration , Insurance Coverage/statistics & numerical data , Pandemics , Patient Acceptance of Health Care/statistics & numerical data , Population Health/statistics & numerical data , Quality of Health Care/statistics & numerical data , SARS-CoV-2 , Telemedicine/statistics & numerical data , United States/epidemiology
2.
J Healthc Manag ; 66(4): 258-270, 2021.
Article in English | MEDLINE | ID: covidwho-1475897

ABSTRACT

EXECUTIVE SUMMARY: Home hospital care (HHC) is a new and exciting concept that holds the promise of achieving all three components of the Triple Aim and reducing health disparities. As an innovative care delivery model, HHC substitutes traditional inpatient hospital care with hospital care at home for older patients with certain conditions. Studies have shown evidence of reduced cost of care, improved patient satisfaction, and enhanced quality and safety of care for patients treated through this model. The steady growth in Medicare Advantage enrollment and the expansion in 2020 of the Centers for Medicare & Medicaid Services (CMS) Hospitals Without Walls program to include acute hospital care at home creates an opportunity for hospitals to implement such programs and be financially rewarded for reducing costs. Capacity constraints exacerbated by the COVID-19 pandemic suggest that now is the ideal time for healthcare leaders to test and advance the concept of HHC in their communities.


Subject(s)
COVID-19 , Critical Care Nursing/economics , Critical Care Nursing/standards , Healthcare Disparities/standards , Home Care Services/economics , Home Care Services/standards , Quality of Health Care/standards , Adult , Aged , Aged, 80 and over , Female , Healthcare Disparities/economics , Healthcare Disparities/statistics & numerical data , Home Care Services/statistics & numerical data , Humans , Male , Middle Aged , Pandemics , Patient Satisfaction/statistics & numerical data , Practice Guidelines as Topic , Quality of Health Care/economics , Quality of Health Care/statistics & numerical data , SARS-CoV-2 , United States
4.
PLoS One ; 16(9): e0257270, 2021.
Article in English | MEDLINE | ID: covidwho-1416892

ABSTRACT

BACKGROUND: The prominence of telemental health, including providing care by video call and telephone, has greatly increased during the COVID-19 pandemic. However, there are clear variations in uptake and acceptability, and concerns that digital exclusion may exacerbate previous inequalities in access to good quality care. Greater understanding is needed of how service users experience telemental health, and what determines whether they engage and find it acceptable. METHODS: We conducted a collaborative framework analysis of data from semi-structured interviews with a sample of people already experiencing mental health problems prior to the pandemic. Data relevant to participants' experiences and views regarding telemental health during the pandemic were identified and extracted. Data collection and analysis used a participatory, coproduction approach where researchers with relevant lived experience, contributed to all stages of data collection, analysis and interpretation of findings alongside clinical and academic researchers. FINDINGS: The experiences and preferences regarding telemental health care of the forty-four participants were dynamic and varied across time and settings, as well as between individuals. Participants' preferences were shaped by reasons for contacting services, their relationship with care providers, and both parties' access to technology and their individual preferences. While face-to-face care tended to be the preferred option, participants identified benefits of remote care including making care more accessible for some populations and improved efficiency for functional appointments such as prescription reviews. Participants highlighted important challenges related to safety and privacy in online settings, and gave examples of good remote care strategies they had experienced, including services scheduling regular phone calls and developing guidelines about how to access remote care tools. DISCUSSION: Participants in our study have highlighted advantages of telemental health care, as well as significant limitations that risk hindering mental health support and exacerbate inequalities in access to services. Some of these limitations are seen as potentially removable, for example through staff training or better digital access for staff or service users. Others indicate a need to maintain traditional face-to-face contact at least for some appointments. There is a clear need for care to be flexible and individualised to service user circumstances and preferences. Further research is needed on ways of minimising digital exclusion and of supporting staff in making effective and collaborative use of relevant technologies.


Subject(s)
COVID-19/prevention & control , Delivery of Health Care/statistics & numerical data , Mental Health Services/statistics & numerical data , Mental Health/statistics & numerical data , Telemedicine/statistics & numerical data , Adolescent , Adult , COVID-19/epidemiology , COVID-19/virology , Delivery of Health Care/methods , Female , Health Personnel/statistics & numerical data , Humans , Male , Mental Health/standards , Middle Aged , Pandemics , Quality of Health Care/standards , Quality of Health Care/statistics & numerical data , SARS-CoV-2/physiology , Surveys and Questionnaires/statistics & numerical data , Telemedicine/methods , Young Adult
6.
Am J Trop Med Hyg ; 105(2): 372-374, 2021 Jun 15.
Article in English | MEDLINE | ID: covidwho-1371031

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic has demanded rapid institutional responses to meet the needs of patients and employees in the face of a serious new disease. To support the well-being of frontline staff, a series of debriefing sessions was used to drive a rapid-cycle quality-improvement process. The goals were to confidentially determine personal coping strategies used by staff, provide an opportunity for staff cross-learning, identify what staff needed most, and provide a real-time feedback loop for decision-makers to create rapid changes to support staff safety and coping. Data were collected via sticky notes on flip charts to protect confidentiality. Management reviewed the data daily. Institutional responses to problems identified during debrief sessions were tracked, visualized, addressed, and shared with staff. More than 10% of staff participated over a 2-week period. Feedback influenced institutional decisions to improve staff schedules, transportation, and COVID-19 training.


Subject(s)
Adaptation, Psychological , COVID-19/epidemiology , Faith-Based Organizations/statistics & numerical data , Tertiary Healthcare/methods , Tertiary Healthcare/statistics & numerical data , Faith-Based Organizations/standards , Hospitals/standards , Hospitals/statistics & numerical data , Humans , Kenya/epidemiology , Medical Staff, Hospital/education , Medical Staff, Hospital/psychology , Medical Staff, Hospital/statistics & numerical data , Quality of Health Care/organization & administration , Quality of Health Care/statistics & numerical data , Tertiary Healthcare/standards
7.
Respiration ; 100(9): 909-917, 2021.
Article in English | MEDLINE | ID: covidwho-1270908

ABSTRACT

BACKGROUND: During the first wave of the SARS-CoV-2 pandemic in Switzerland, confinement was imposed to limit transmission and protect vulnerable persons. These measures may have had a negative impact on perceived quality of care and symptoms in patients with chronic disorders. OBJECTIVES: To determine whether patients under long-term home noninvasive ventilation (LTHNIV) for chronic respiratory failure (CRF) were negatively affected by the 56-day confinement (March-April 2020). METHODS: A questionnaire-based survey exploring mood disturbances (HAD), symptom scores related to NIV (S3-NIV), and perception of health-care providers during confinement was sent to all patients under LTHNIV followed up by our center. Symptom scores and data obtained by ventilator software were compared between confinement and the 56 days prior to confinement. RESULTS: Of a total of 100 eligible patients, 66 were included (median age: 66 years [IQR: 53-74]): 35 (53%) with restrictive lung disorders, 20 (30%) with OHS or SRBD, and 11 (17%) with COPD or overlap syndrome. Prevalence of anxiety (n = 7; 11%) and depressive (n = 2; 3%) disorders was remarkably low. Symptom scores were slightly higher during confinement although this difference was not clinically relevant. Technical data regarding ventilation, including compliance, did not change. Patients complained of isolation and lack of social contact. They felt supported by their relatives and caregivers but complained of the lack of regular contact and information by health-care professionals. CONCLUSIONS: Patients under LTHNIV for CRF showed a remarkable resilience during the SARS-CoV-2 confinement period. Comments provided may be helpful for managing similar future health-care crises.


Subject(s)
COVID-19 , Communicable Disease Control , Home Care Services/standards , Noninvasive Ventilation , Respiratory Insufficiency , Aged , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/psychology , Chronic Disease , Communicable Disease Control/methods , Communicable Disease Control/statistics & numerical data , Female , Health Services Needs and Demand , Humans , Long-Term Care/methods , Male , Mood Disorders/epidemiology , Mood Disorders/physiopathology , Noninvasive Ventilation/methods , Noninvasive Ventilation/statistics & numerical data , Qualitative Research , Quality of Health Care/statistics & numerical data , Respiratory Insufficiency/epidemiology , Respiratory Insufficiency/etiology , Respiratory Insufficiency/psychology , Respiratory Insufficiency/therapy , SARS-CoV-2 , Social Support , Switzerland/epidemiology , Symptom Assessment/methods , Symptom Assessment/statistics & numerical data
8.
Global Health ; 17(1): 42, 2021 04 08.
Article in English | MEDLINE | ID: covidwho-1175328

ABSTRACT

BACKGROUND: The ongoing pandemic of coronavirus disease 2019 (COVID-19) has the potential to reverse progress towards global targets. This study examines the risks that the COVID-19 pandemic poses to equitable access to essential medicines and vaccines (EMV) for universal health coverage in Africa. METHODS: We searched medical databases and grey literature up to 2 October 2020 for studies reporting data on prospective pathways and innovative strategies relevant for the assessment and management of the emerging risks in accessibility, safety, quality, and affordability of EMV in the context of the COVID-19 pandemic. We used the resulting pool of evidence to support our analysis and to draw policy recommendations to mitigate the emerging risks and improve preparedness for future crises. RESULTS: Of the 310 records screened, 134 were included in the analysis. We found that the disruption of the international system affects more immediately the capability of low- and middle-income countries to acquire the basket of EMV. The COVID-19 pandemic may facilitate dishonesty and fraud, increasing the propensity of patients to take substandard and falsified drugs. Strategic regional cooperation in the form of joint tenders and contract awarding, joint price negotiation and supplier selection, as well as joint market research, monitoring, and evaluation could improve the supply, affordability, quality, and safety of EMV. Sustainable health financing along with international technology transfer and substantial investment in research and development are needed to minimize the vulnerability of African countries arising from their dependence on imported EMV. To ensure equitable access, community-based strategies such as mobile clinics as well as fees exemptions for vulnerable and under-served segments of society might need to be considered. Strategies such as task delegation and telephone triage could help reduce physician workload. This coupled with payments of risk allowance to frontline healthcare workers and health-literate healthcare organization might improve the appropriate use of EMV. CONCLUSIONS: Innovative and sustainable strategies informed by comparative risk assessment are increasingly needed to ensure that local economic, social, demographic, and epidemiological risks and potentials are accounted for in the national COVID-19 responses.


Subject(s)
COVID-19/economics , Drugs, Essential/economics , Drugs, Essential/supply & distribution , Universal Health Care , Vaccines/economics , Vaccines/supply & distribution , Africa , Developing Countries , Health Services Accessibility/statistics & numerical data , Humans , Patient Safety/statistics & numerical data , Prospective Studies , Quality of Health Care/statistics & numerical data , SARS-CoV-2
9.
Epidemiol Infect ; 149: e75, 2021 03 16.
Article in English | MEDLINE | ID: covidwho-1147817

ABSTRACT

We investigated whether countries with higher coverage of childhood live vaccines [BCG or measles-containing-vaccine (MCV)] have reduced risk of coronavirus disease 2019 (COVID-19)-related mortality, while accounting for known systems differences between countries. In this ecological study of 140 countries using publicly available national-level data, higher vaccine coverage, representing estimated proportion of people vaccinated during the last 14 years, was associated with lower COVID-19 deaths. The associations attenuated for both vaccine variables, and MCV coverage became no longer significant once adjusted for published estimates of the Healthcare access and quality index (HAQI), a validated summary score of healthcare quality indicators. The magnitude of association between BCG coverage and COVID-19 death rate varied according to HAQI, and MCV coverage had little effect on the association between BCG and COVID-19 deaths. While there are associations between live vaccine coverage and COVID-19 outcomes, the vaccine coverage variables themselves were strongly correlated with COVID-19 testing rate, HAQI and life expectancy. This suggests that the population-level associations may be further confounded by differences in structural health systems and policies. Cluster randomised studies of booster vaccines would be ideal to evaluate the efficacy of trained immunity in preventing COVID-19 infections and mortality in vaccinated populations and on community transmission.


Subject(s)
COVID-19/immunology , COVID-19/prevention & control , Immunity, Innate/immunology , SARS-CoV-2/immunology , Vaccination Coverage/statistics & numerical data , BCG Vaccine/administration & dosage , BCG Vaccine/immunology , COVID-19/mortality , Delivery of Health Care/standards , Delivery of Health Care/statistics & numerical data , Humans , Immunization, Secondary/standards , Immunization, Secondary/statistics & numerical data , Linear Models , Measles Vaccine/administration & dosage , Measles Vaccine/immunology , Quality of Health Care/standards , Quality of Health Care/statistics & numerical data
10.
Perm J ; 25: 1, 2021 01.
Article in English | MEDLINE | ID: covidwho-1106388

ABSTRACT

None: Telehealth has been a well-established system of care delivery at Kaiser Permanente Northwest Pediatric Gastroenterology since before the COVID-19 era, where 54% of our completed pediatric gastroenterology encounters in the past year were virtual visits. Although it was previously limited in its use across the majority of health care in the US, telehealth is now a widely accepted system in the face of the COVID-19 pandemic. However, this unprecedented rapid expansion of telehealth within both new and established telehealth systems is not without challenges or quality concerns. In this report, we present our single-center experience from the past year where virtual care was already an integral part of our clinical practice in pediatric gastroenterology and review satisfaction data and quality measures from the COVID-19 era where our existing telehealth system expanded to nearly exclusive virtual care.


Subject(s)
Gastroenterology/organization & administration , Pediatrics/organization & administration , Telemedicine/organization & administration , COVID-19 , Child , Health Care Surveys , Humans , Organizational Case Studies , Patient Satisfaction/statistics & numerical data , Quality of Health Care/statistics & numerical data , Telemedicine/statistics & numerical data , United States/epidemiology
11.
J Prev Med Public Health ; 54(1): 8-16, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-1097326

ABSTRACT

This article aims to introduce the inception and operation of the COVID-19 International Collaborative Research Project, the world's first coronavirus disease 2019 (COVID-19) open data project for research, along with its dataset and research method, and to discuss relevant considerations for collaborative research using nationwide real-world data (RWD). COVID-19 has spread across the world since early 2020, becoming a serious global health threat to life, safety, and social and economic activities. However, insufficient RWD from patients was available to help clinicians efficiently diagnose and treat patients with COVID-19, or to provide necessary information to the government for policy-making. Countries that saw a rapid surge of infections had to focus on leveraging medical professionals to treat patients, and the circumstances made it even more difficult to promptly use COVID-19 RWD. Against this backdrop, the Health Insurance Review and Assessment Service (HIRA) of Korea decided to open its COVID-19 RWD collected through Korea's universal health insurance program, under the title of the COVID-19 International Collaborative Research Project. The dataset, consisting of 476 508 claim statements from 234 427 patients (7590 confirmed cases) and 18 691 318 claim statements of the same patients for the previous 3 years, was established and hosted on HIRA's in-house server. Researchers who applied to participate in the project uploaded analysis code on the platform prepared by HIRA, and HIRA conducted the analysis and provided outcome values. As of November 2020, analyses have been completed for 129 research projects, which have been published or are in the process of being published in prestigious journals.


Subject(s)
COVID-19/prevention & control , Insurance Carriers/statistics & numerical data , Internationality , COVID-19/transmission , Databases, Factual/statistics & numerical data , Humans , Outcome Assessment, Health Care/standards , Outcome Assessment, Health Care/statistics & numerical data , Quality of Health Care/standards , Quality of Health Care/statistics & numerical data , Republic of Korea
12.
J Gerontol B Psychol Sci Soc Sci ; 76(3): e75-e80, 2021 02 17.
Article in English | MEDLINE | ID: covidwho-1087754

ABSTRACT

OBJECTIVES: The aim of this evidence-based theoretically informed article was to provide an overview of how and why the COVID-19 outbreak is particularly detrimental for the health of older Black and Latinx adults. METHODS: We draw upon current events, academic literature, and numerous data sources to illustrate how biopsychosocial factors place older adults at higher risk for COVID-19 relative to younger adults, and how structural racism magnifies these risks for black and Latinx adults across the life course. RESULTS: We identify 3 proximate mechanisms through which structural racism operates as a fundamental cause of racial/ethnic inequalities in COVID-19 burden among older adults: (a) risk of exposure, (b) weathering processes, and (c) health care access and quality. DISCUSSION: While the ongoing COVID-19 pandemic is an unprecedented crisis, the racial/ethnic health inequalities among older adults it has exposed are longstanding and deeply rooted in structural racism within American society. This knowledge presents both challenges and opportunities for researchers and policymakers as they seek to address the needs of older adults. It is imperative that federal, state, and local governments collect and release comprehensive data on the number of confirmed COVID-19 cases and deaths by race/ethnicity and age to better gauge the impact of the outbreak across minority communities. We conclude with a discussion of incremental steps to be taken to lessen the disproportionate burden of COVID-19 among older Black and Latinx adults, as well as the need for transformative actions that address structural racism in order to achieve population health equity.


Subject(s)
African Americans/ethnology , Aging/ethnology , COVID-19/ethnology , Health Services Accessibility/statistics & numerical data , Healthcare Disparities/statistics & numerical data , Quality of Health Care/statistics & numerical data , Racism/ethnology , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19/mortality , Child , Child, Preschool , Female , Humans , Infant , Male , Middle Aged , Risk , United States/ethnology , Young Adult
13.
Am J Public Health ; 111(2): 286-292, 2021 02.
Article in English | MEDLINE | ID: covidwho-1060799

ABSTRACT

As the COVID-19 pandemic has unfolded across the United States, troubling disparities in mortality have emerged between different racial groups, particularly African Americans and Whites. Media reports, a growing body of COVID-19-related literature, and long-standing knowledge of structural racism and its myriad effects on the African American community provide important lenses for understanding and addressing these disparities.However, troubling gaps in knowledge remain, as does a need to act. Using the best available evidence, we present risk- and place-based recommendations for how to effectively address these disparities in the areas of data collection, COVID-19 exposure and testing, health systems collaboration, human capital repurposing, and scarce resource allocation.Our recommendations are supported by an analysis of relevant bioethical principles and public health practices. Additionally, we provide information on the efforts of Chicago, Illinois' mayoral Racial Equity Rapid Response Team to reduce these disparities in a major urban US setting.


Subject(s)
African Americans/statistics & numerical data , COVID-19/therapy , Health Status Disparities , Healthcare Disparities/statistics & numerical data , COVID-19/ethnology , Health Services Accessibility/statistics & numerical data , Humans , Quality of Health Care/statistics & numerical data , Racism , Socioeconomic Factors , United States
14.
J Hosp Infect ; 111: 96-101, 2021 May.
Article in English | MEDLINE | ID: covidwho-1026140

ABSTRACT

BACKGROUND: COVID-19 placed a significant burden on the care home population during the first wave. Care Quality Commission's care quality ratings are given to all English care homes and could be used to identify whether care homes are at risk of COVID-19 outbreaks. METHODS: An audit was performed, April 2020, of Liverpool care homes to identify associations between COVID-19 status and care quality ratings from the Care Quality Commission. Univariable logistic regression was performed to identify whether the Care Quality Commissions ratings were associated with a care home experiencing a COVID-19 outbreak, or a home having asymptomatic cases. FINDINGS: Over half of the care homes (53.2%, n=41), had laboratory-confirmed clinical cases and 39 (95.1%) of these were reported as outbreaks. A small number of care homes (10.4%, n=8) had asymptomatic cases and over a third had no clinical or asymptomatic cases (36.4%, n=28). There was no significant difference between the overall Care Quality Commission rating of Liverpool and English care homes (p=0.57). There was no significant association between any of the Care Quality Commission rating domains and the presence of COVID-19 outbreaks and/or asymptomatic cases. CONCLUSIONS: During the first wave of the COVID-19 pandemic, Care Quality Commission ratings were not associated with COVID-19 outbreaks or asymptomatic cases in care homes. Infection prevention and control components of Care Quality Commission ratings need to be strengthened to identify care homes at a potential risk of infectious disease outbreaks that may require targeted support. Further large-scale studies will be required to test the findings from this study.


Subject(s)
COVID-19/epidemiology , Disease Outbreaks/statistics & numerical data , Forecasting , Homes for the Aged/statistics & numerical data , Nursing Homes/statistics & numerical data , Pandemics/statistics & numerical data , Quality of Health Care/statistics & numerical data , Aged , Aged, 80 and over , England/epidemiology , Female , Humans , Male , SARS-CoV-2
15.
J Hosp Med ; 15(12): 709-715, 2020 12.
Article in English | MEDLINE | ID: covidwho-967311

ABSTRACT

BACKGROUND: Academic medical centers have expanded their inpatient medicine services with advanced practice clinicians (APCs) or nonteaching hospitalists in response to patient volumes, residency work hour restrictions, and recently, COVID-19. Reports of clinical outcomes, cost, and resource utilization differ among inpatient team structures. OBJECTIVE: Directly compare outcomes among resident, APC, and solo hospitalist inpatient general medicine teams. DESIGN: Retrospective cohort study using multivariable analysis adjusted for time of admission, interhospital transfer, and comorbidities that compares clinical outcomes, cost, and resource utilization. SUBJECTS: Patients 18 years or older discharged from an inpatient medicine service between July 2015 and July 2018 (N = 12,716). MAIN MEASURES: Length of stay (LOS), 30-day readmission, inpatient mortality, normalized total direct cost, discharge time, and consultation utilization. KEY RESULTS: Resident teams admitted fewer patients at night (32.0%; P < .001) than did APC (49.5%) and hospitalist (48.6%) teams. APCs received nearly 4% more outside transfer patients (P = .015). Hospitalists discharged patients 26 minutes earlier than did residents (mean hours after midnight [95% CI], 14.58 [14.44-14.72] vs 15.02 [14.97-15.08]). Adjusted consult utilization was 15% higher for APCs (adjusted mean consults per admission [95% CI], 1.00 [0.96-1.03]) and 8% higher for residents (0.93 [0.90-0.95]) than it was for hospitalists (0.85 [0.80-0.90]). No differences in LOS, readmission, mortality, or cost were observed between the teams. CONCLUSION: We observed similar costs, LOS, 30-day readmission, and mortality among hospitalist, APC, and resident teams. Our results suggest clinical outcomes are not significantly affected by team structure. The addition of APC or hospitalist teams represent safe and effective alternatives to traditional inpatient resident teams.


Subject(s)
Academic Medical Centers , Health Resources/economics , Hospitalists/economics , Internal Medicine , Internship and Residency , Patient Outcome Assessment , Female , Humans , Internal Medicine/economics , Internal Medicine/education , Length of Stay/statistics & numerical data , Male , Middle Aged , Patient Readmission , Quality of Health Care/statistics & numerical data , Retrospective Studies
16.
J Aging Soc Policy ; 33(4-5): 414-430, 2021.
Article in English | MEDLINE | ID: covidwho-843234

ABSTRACT

With nursing homes being hit hard by the COVID-19 pandemic, it is important to know whether facilities that have any cases, or those with particularly high caseloads, are different from nursing homes that do not have any reported cases. Our analysis found that through mid-June, just under one-third of nursing homes in Ohio had at least one resident with COVID-19, with over 82% of all cases in the state coming from 37% of nursing homes. Overall findings on the association between facility quality and the prevalence of COVID-19 showed that having any resident case of the virus or even having a high caseload of residents with the virus is not more likely in nursing homes with lower quality ratings.


Subject(s)
COVID-19 Testing/statistics & numerical data , COVID-19/epidemiology , Nursing Homes/statistics & numerical data , Nursing Staff/statistics & numerical data , Quality of Health Care/statistics & numerical data , Humans , Medicaid/statistics & numerical data , Medicare/statistics & numerical data , Ohio/epidemiology , Prevalence , United States
18.
BMJ Qual Saf ; 30(8): 639-647, 2021 08.
Article in English | MEDLINE | ID: covidwho-724873

ABSTRACT

INTRODUCTION: Efforts to enact nurse staffing legislation often lack timely, local evidence about how specific policies could directly impact the public's health. Despite numerous studies indicating better staffing is associated with more favourable patient outcomes, only one US state (California) sets patient-to-nurse staffing standards. To inform staffing legislation actively under consideration in two other US states (New York, Illinois), we sought to determine whether staffing varies across hospitals and the consequences for patient outcomes. Coincidentally, data collection occurred just prior to the COVID-19 outbreak; thus, these data also provide a real-time example of the public health implications of chronic hospital nurse understaffing. METHODS: Survey data from nurses and patients in 254 hospitals in New York and Illinois between December 2019 and February 2020 document associations of nurse staffing with care quality, patient experiences and nurse burnout. RESULTS: Mean staffing in medical-surgical units varied from 3.3 to 9.7 patients per nurse, with the worst mean staffing in New York City. Over half the nurses in both states experienced high burnout. Half gave their hospitals unfavourable safety grades and two-thirds would not definitely recommend their hospitals. One-third of patients rated their hospitals less than excellent and would not definitely recommend it to others. After adjusting for confounding factors, each additional patient per nurse increased odds of nurses and per cent of patients giving unfavourable reports; ORs ranged from 1.15 to 1.52 for nurses on medical-surgical units and from 1.32 to 3.63 for nurses on intensive care units. CONCLUSIONS: Hospital nurses were burned out and working in understaffed conditions in the weeks prior to the first wave of COVID-19 cases, posing risks to the public's health. Such risks could be addressed by safe nurse staffing policies currently under consideration.


Subject(s)
Burnout, Professional/epidemiology , COVID-19/epidemiology , Nurses/psychology , Nurses/statistics & numerical data , Nursing Staff, Hospital/statistics & numerical data , Personnel Staffing and Scheduling/statistics & numerical data , Hospitals/statistics & numerical data , Humans , Illinois/epidemiology , New York/epidemiology , Quality of Health Care/statistics & numerical data , SARS-CoV-2 , Surveys and Questionnaires
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