Organizational, Regional, and Community Factors Determining Protocol Compliance for Patients With Acute Myocardial Infarction.

This study examined factors determining hospital compliance to Hospital Quality Alliance's protocol for patients with myocardial infarction. Using a spatially matched sample of 132 Magnet and 264 non-Magnet hospitals, multivariate regressions determined significant hospital characteristics associated with compliance per Hospital Quality Alliance protocol. Adherence to the Hospital Quality Alliance protocols varied widely by hospital characteristics. Registered nurse staffing/bed was a key factor determining patient care quality variation. Quality of care practices such as protocol compliance should be measured and examined separately.

Organizational and Community Factors Associated With Magnet Status of U.S. Hospitals.

EXECUTIVE SUMMARY: The Magnet Recognition Program for healthcare organizations promotes excellence in nursing services and professional practices. However, organizational and community characteristics that contribute to the adoption of Magnet status remain unexplained. Investigating organizational and community factors will help determine systematic structural and contextual dimensions of Magnet hospitals previously shown to be more cost-effective in comparison with non-Magnet hospitals. Using the baseline 2005 database of all Magnet hospitals in the United States, the authors selected a matched sample to determine key organizational and community characteristics associated with Magnet adoption while controlling for regional and local factors. Four tertiary databases were merged to identify measures of organizational and community characteristics of 132 Magnet hospitals and 264 non-Magnet pairs matched in closest proximity. The authors used bivariate tests and logistic regression to analyze the data. The findings show that Magnet adoption was positively associated with teaching affiliation, hospital size, nonprofit ownership, admission rates, and registered nurse (RN) staffing rates, but was negatively associated with licensed practical nurse (LPN) staffing rates. In the logit model, key organizational factors associated with the likelihood of Magnet adoption were larger hospitals, higher RN staffing rates, and lower LPN staffing rates. Key community factors were location in less densely populated counties and higher emergency department visit rates. The study findings reinforce previously established hypotheses that better RN staffing of Magnet hospitals is associated with higher cost-effectiveness. The study also adds key organizational and community factors that differentiate Magnet adoption. The Magnet concept as an innovative strategic choice assists healthcare leaders in better managing their resources to improve the cost-effectiveness of hospital care.

Monitoring unmet needs: using 2-1-1 during natural disasters.

BACKGROUND: Hurricanes Katrina and Rita struck the Gulf Coast forcing unprecedented mass evacuation and devastation. Texas 2-1-1 is a disaster communication hub between callers with unmet needs and community services at disaster sites and evacuation destinations. PURPOSE: To describe the location and timing of unmet disaster needs collected in real-time through Katrina-Rita disaster phases. METHODS: In 2008-2010, a total of 25 data sets of Texas 2-1-1 calls from August-December 2005 were recoded and merged. In 2011-2012, analysis was performed of unmet need types, with comparisons over time and location; mapping was adjusted by population size. RESULTS: Of 635,983 total 2-1-1 calls during the study period, 65% included primary disaster unmet needs: housing/shelter (28%); health/safety (18%); food/water (15%); transportation/fuel (4%). Caller demand spiked on Mondays, decreasing to a precipitous drop on weekends and holidays. Unmet needs surged during evacuation and immediate disaster response, remaining at higher threshold through recovery. Unmet need volume was concentrated in metropolitan areas. After adjusting for population size, "hot-spots" showed in smaller evacuation destinations and along evacuation routes. CONCLUSIONS: New disaster management strategies and policies are needed for evacuation destinations to support extended evacuation and temporary or permanent relocation. Planning and monitoring disaster resources for unmet needs over time and location could be targeted effectively using real-time 2-1-1 call patterns. Smaller evacuation communities were more vulnerable, exhausting their limited resources more quickly. Emergency managers should devise systems to more quickly authorize vouchers and reimbursements. As 2-1-1s expand and coordinate disaster roles nationwide, opportunities exist for analysis of unmet disaster needs to improve disaster management and enhance community resiliency.

Cost-benefit analysis of childhood asthma management through school-based clinic programs.

Asthma is a leading chronic illness among American children. School-based health clinics (SBHCs) reduced expensive ER visits and hospitalizations through better healthcare access and monitoring in select case studies. The purpose of this study was to examine the cost-benefit of SBHC programs in managing childhood asthma nationwide for reduction in medical costs of ER, hospital and outpatient physician care and savings in opportunity social costs of lowing absenteeism and work loss and of future earnings due to premature deaths. Eight public data sources were used to compare costs of delivering primary and preventive care for childhood asthma in the US via SBHC programs, including direct medical and indirect opportunity costs for children and their parents. The costs of nurse staffing for a nationwide SBHC program were estimated at $4.55 billion compared to the estimated medical savings of $1.69 billion, including ER, hospital, and outpatient care. In contrast, estimated total savings for opportunity costs of work loss and premature death were $23.13 billion. Medical savings alone would not offset the expense of implementing a SBHC program for prevention and monitoring childhood asthma. However, even modest estimates of reducing opportunity costs of parents' work loss would be far greater than the expense of this program. Although SBHC programs would not be expected to affect the increasing prevalence of childhood asthma, these programs would be designed to reduce the severity of asthma condition with ongoing monitoring, disease prevention and patient compliance.