"We are still tired": staff and administrators' experiences during the COVID-19 pandemic within California residential care facilities for older adults.

BACKGROUND: Extensive research has been conducted on the impacts of the COVID-19 pandemic on long-term care workers in specialized care facilities. However, little is known about the impacts faced by facilities that provide generalized long-term support and care, such as residential care facilities for older adults (RCFs). This study describes the challenges experienced by staff and administrators of RCFs during the COVID-19 pandemic. METHODS: An electronic questionnaire collecting data using both closed- and open-ended questions on staff experiences was sent to 5,721 unique RCF administrator emails within the state of California between June-December 2021. Email addresses were obtained from the public database of RCFs available through the California Health and Human Services Open Data Portal. Descriptive statistics were calculated on quantitative data regarding staff preparedness training, access to resources, and administrators' confidence in meeting recommended guidelines during the pandemic. Inductive thematic analysis was conducted on qualitative data regarding the confidence levels in meeting pandemic guidelines and challenges faced related to staff stress and morale. RESULTS: A total of 150 RCF administrators across California (response rate of 2.6%) completed the survey. Over three-fourths of respondents indicated their facilities had a designated staff member to train other staff members on emergency preparedness plans and the most frequently used resources during the COVID-19 pandemic were the Department of Social Services Community Care Licensing Division (88.7%), the county health department (86.7%), and the Centers for Disease Control and Prevention (80.7%). Administrators felt least confident in their facilities' ability to maintain adequate staffing (52.0%), communication with nearby hospitals (62.1%) and communication with state and local public health officials (69.8%) during the pandemic. Three central themes emerged from the thematic analysis on staff stress and morale: (1) physical safety, mental and emotional impact of the COVID-19 pandemic; (2) staffing issues; and (3) challenges with guidelines in managing the ongoing pandemic. CONCLUSIONS: Findings from this research study can be used to actively target training resources for facility administrators and staff that have been identified as most frequently used and relevant for emergency preparedness in these understudied facilities. Additionally, developing a better understanding of the staffing stress and morale difficulties in RCFs can provide insight on how policymakers can assist these critical facilities in better preparing for future crises.

Ready or not: Emergency preparedness in residential care facilities for the elderly (RCFE) in California.

This study examined the results of an electronic survey of residential care facilities for the elderly (RCFE) in California in 2021 to provide insight on key elements of emergency plans and facility preparedness for the COVID-19 pandemic and future emergencies. Surveys were distributed to RCFE administrators using publicly available emails found on the California Health and Human Services Open Data Portal. Responses from 150 facility administrators included data on their perception of current and future facility preparedness for COVID-19 and other emergency scenarios, items included in facility evacuation/shelter-in-place plans, and hazard vulnerability analyses and training practices of facility staff. Descriptive analyses were performed on collected data. The majority of results were from small facilities serving less than seven residents (70.7 percent). Prior to COVID-19, more than 90 percent of respondents included disaster drills, evacuation plans, and emergency transportation in their emergency preparedness plan. The majority of facilities added pandemic planning, vaccine distribution, and quarantine guidelines elements into their plans during COVID-19. Approximately half of facilities reported conducting proactive hazard vulnerability analyses. Around 75 percent of RCFEs felt well prepared for fires and infectious disease outbreaks, had mixed preparedness levels for earthquakes and floods, and felt least prepared for landslides and active shooter emergencies. During the pandemic, perceptions of preparedness rose, with 92 percent stating they felt very prepared currently and almost 70 percent felt very prepared for future pandemics. Preparedness of these essential facilities and their residents can continue to improve by conducting regular proactive hazard vulnerability analyses, improving communication lines and mutual aid agreements with local and state organizations, and preparing for critical emergencies such as landslides and active shooter scenarios. This can help to ensure adequate resources and investments are provided to care for older adults during emergencies.

Rural Access and Usage of Patient Portals: A 2019 Health Information National Trends Survey Analysis.

To examine differences in rural and urban respondents' use of and access to patient portals in the United States, this study used the 2019 National Cancer Institute's Health Information National Trends Survey (HINTS) 5, Cycle 3. A cross-sectional secondary data analysis utilizing jackknife weighting procedures was used to generalize the findings to be nationally representative. Despite similar rates of providers maintaining an electronic medical record system, adjusted analyses found that rural respondents had lower odds of being offered access to a patient portal by their healthcare provider (OR: 0.60; 95 percent CI: 0.39-0.91) and accessing their patient portals in the last 12 months (OR: 0.62; 95 percent CI: 0.43-0.91) when compared to their urban counterparts. Additional research is needed to determine effective strategies for overcoming geographic and structural barriers to adoption of this technology by rural residents.

Community-level electronic prescribing and adverse drug event hospitalizations among older adults.

This study sought to determine how the proportion of physicians using electronic prescribing in nine US states was associated with the hospitalization rate for adverse drug events among older adult patients. A discharge-level analysis of the relationship between county electronic prescribing and adverse drug event hospitalization rates was conducted. Data from the 2011 State Inpatient Databases, the Office of the National Coordinator Health IT Dashboard, and the Area Health Resource File were obtained for nine US states. The analysis examined the odds that a discharge for older adults would have been adverse drug event associated, versus other causes, using multivariable logistic regression models. After adjusting for patient, provider, health infrastructure, and community factors, the lowest county electronic prescribing rate quartile was associated with significantly greater odds of an adverse drug event hospitalization (odds ratio: 1.10; 95% confidence interval: 1.02-1.19). Early results indicate greater odds of adverse drug event hospitalizations among older adults living in counties with low electronic prescribing rates when compared to those in high electronic prescribing counties.

Consumer perceptions of health IT utilization and benefits.

OBJECTIVES: The objective of this article is to examine consumer perceptions of health information technology (health IT) utilization and benefits through an integrated conceptual framework. MATERIALS AND METHODS: This article employs an integrated conceptual framework to examine consumer perceptions of health IT. A consumer survey yielded 1125 completed responses. A factor-based scale was developed for each sub-construct. Bivariate analysis using χ2 tests was performed to determine differences in the percentage of respondents who agreed with each sub-construct based on whether their physician used an electronic health record (EHR) system. Multivariable logistic regression that controlled for demographic characteristics of respondents was performed to determine adjusted odds of agreeing with selected opinions of health information exchange (HIE). RESULTS: Results indicate that respondents whose physicians used an EHR system were significantly more likely to agree that there was a perceived benefit with HIE and to care provided; that the patient should have control over the record; that they trust the physician and security of the medical information; that they understand the need for HIE, and that HIE must be easy to use. DISCUSSION: The results suggest that consumers who have experienced the use of one technology in the healthcare setting can recognize the potential benefit of another technology. Race/ethnicity, gender, and education played some role in respondents' views of EHRs and HIE, more specifically, non-Hispanic African American participants indicated lower levels of trust in HIE when compared with non-Hispanic Whites. CONCLUSION: This cross-sectional survey indicated that physician use of EHRs significantly increases the odds of consumers' seeing perceived benefits of HIE and understanding the need for HIE.

Feasibility assessment for using telehealth technology to improve access to dental care for rural and underserved populations.

OBJECTIVE: South Carolina Dental Association members were surveyed on telehealth knowledge, need, and interest in using it for access to care improvements. METHODS: Dependent variables were Medicaid patient population size (less than or greater than 10%), career stage (early to middle and advanced), and National Health Service Corps participation (yes or no). Practice and provider characteristics were screener questions. Data were collected electronically and analyzed with SAS. Descriptive and bivariate analyses were conducted. RESULTS: Most (69.3%) reported some or no teledentistry knowledge. Distribution of needing consults was: endodontics (40.2%), oral-maxillofacial surgery (37.9%), orthodontia (30.7%), periodontics (28.4%), and pediatrics (12.5%). Consultations for diagnosis (72.9%), emergencies (56.7%), and continuing education (53.3%) were most frequently identified telehealth uses. Medicaid patient population size was the only dependent measure with statistical significance. Compared to <10% Medicaid, >10% was more likely to (1) frequently need consults for orthodontics (25.5% vs 43.4%, P = .0043) and pediatrics (5.9% vs 29.0%, P < .0001); (2) use telehealth for children with special health care needs (44.1% vs 65.8%, P = .0017), complex health conditions (54.3% vs 78.1%, P = .0004), conditions exacerbated by unmet dental needs (44.6% vs 65.8%, P = .0022); and (3) use telehealth for extending practice to underserved populations (14.6% vs 33.8%, P = .0004). CONCLUSIONS: Despite need for telehealth knowledge improvement, sufficient interest exists. Further study will determine if demand for teledentistry is in balance with consultant availability. It has been suggested that access to care improvements require capacity expansions in private practices. States will need to engage dental communities determine if teledentistry is an effective solution.

Disparities in home health service providers among Medicare beneficiaries with stroke.

This study examined the intensity of home health services, as defined by the number of visits and service delivery by rehabilitation specialists, among Medicare beneficiaries with stroke. A cross-sectional secondary data analysis was conducted using 2009 home health claims data obtained from the Centers for Medicare and Medicaid Services' Research Data Assistance Center. There were no significant rural-urban differences in the number of home health visits. Rural beneficiaries were significantly less likely than urban beneficiaries to receive services from rehabilitation specialists. Current home health payment reform recommendations may have unintended consequences for rural home health beneficiaries who need therapy services.

Health information exchange implementation: lessons learned and critical success factors from a case study.

BACKGROUND: Much attention has been given to the proposition that the exchange of health information as an act, and health information exchange (HIE), as an entity, are critical components of a framework for health care change, yet little has been studied to understand the value proposition of implementing HIE with a statewide HIE. Such an organization facilitates the exchange of health information across disparate systems, thus following patients as they move across different care settings and encounters, whether or not they share an organizational affiliation. A sociotechnical systems approach and an interorganizational systems framework were used to examine implementation of a health system electronic medical record (EMR) system onto a statewide HIE, under a cooperative agreement with the Office of the National Coordinator for Health Information Technology, and its collaborating organizations. OBJECTIVE: The objective of the study was to focus on the implementation of a health system onto a statewide HIE; provide insight into the technical, organizational, and governance aspects of a large private health system and the Virginia statewide HIE (organizations with the shared goal of exchanging health information); and to understand the organizational motivations and value propositions apparent during HIE implementation. METHODS: We used a formative evaluation methodology to investigate the first implementation of a health system onto the statewide HIE. Qualitative methods (direct observation, 36 hours), informal information gathering, semistructured interviews (N=12), and document analysis were used to gather data between August 12, 2012 and June 24, 2013. Derived from sociotechnical concepts, a Blended Value Collaboration Enactment Framework guided the data gathering and analysis to understand organizational stakeholders' perspectives across technical, organizational, and governance dimensions. RESULTS: Several challenges, successes, and lessons learned during the implementation of a health system to the statewide HIE were found. The most significant perceived success was accomplishing the implementation, although many interviewees also underscored the value of a project champion with decision-making power. In terms of lessons learned, social reasons were found to be very significant motivators for early implementation, frequently outweighing economic motivations. It was clear that understanding the guides early in the project would have mitigated some of the challenges that emerged, and early communication with the electronic health record vendor so that they have a solid understanding of the undertaking was critical. An HIE implementations evaluation framework was found to be useful for assessing challenges, motivations, value propositions for participating, and success factors to consider for future implementations. CONCLUSIONS: This case study illuminates five critical success factors for implementation of a health system onto a statewide HIE. This study also reveals that organizations have varied motivations and value proposition perceptions for engaging in the exchange of health information, few of which, at the early stages, are economically driven.