Practice Model Trends in Medicare Payments Across States and Regions.

Anesthesia delivery models have long been shaped by workforce trends, state and federal regulations, economic incentives driven by reimbursement, and the normative preferences of provider and facility organizations. In recent years, there has been a significant shift toward greater use of more efficient certified registered nurse anesthetist (CRNA)-oriented delivery models observed at the national level Medicare data. However, given the wide range of these factors across states and regions, this shift has likely occurred at an uneven pace. This study analyzes the influence of provider workforce composition and CRNA scope of practice (SOP) regulations on usage of competing types of anesthesia delivery models, including anesthesiologist alone, care team, and undirected CRNA models. Results show that over the period from 2010-2019, anesthesia delivery models utilized under Medicare Part B have become increasingly oriented around the use of CRNAs. However, increases in the care team vs undirected CRNA model are highly uneven and inconsistent across states, even after adjusting for workforce and SOP. Speculation on additional normative or organization-driven reasons for persistent use of inefficient delivery models in some places is offered.

Chronic Pain Management Guidelines: Time for Review.

The American Association of Nurse Anesthesiology (AANA) Board of Directors in November 2021 approved updated Chronic Pain Management Guidelines. Input was collected from various stakeholders, including the AANA Practice Committee, AANA staff, subject matter experts, and feedback from the Nonsurgical Pain Management Advisory Panel. A 2-week open comment period was held to solicit feedback from AANA membership on the draft document. The document adopted the recently revised definition of pain by the International Association for the Study of Pain.

Point-of-Care Ultrasound in Anesthesia Care: New AANA Practice Document Adopted by AANA Board of Directors.

The American Association of Nurse Anesthetists recently released a practice considerations document titled, "Point-of-Care Ultrasound in Anesthesia Care," that clinicians, administrators, and other stakeholders are encouraged to download and read in their entirety, available at aana.com/PracticeManual.

Perceived Stress and Health among Home Care Aides: Caring for Older Clients in a Medicaid-Funded Home Care Program.

Home care aides (HCAs) provide housekeeping and personal care services to help older clients remain in the community. However, little is known about the health of HCAs, who themselves constitute an underserved population. The goal of this study was to investigate how HCAs' work and life contexts manifest themselves in HCAs' health as perceived by HCAs. Six focus groups were conducted with HCAs (N=45). Analysis revealed how HCAs' work-and life-related stress accumulated over time and affected HCAs' health and interaction with their older clients. Home care aides were interested in personal health promotion and client well-being. Home care aides may constitute an underused resource for the care of older adults with disabilities. Information about intricately intertwined work and life contexts should inform policymakers and home care providers in their efforts to improve the quality of publicly funded home care services.

Examining Certified Nursing Assistants' Perceptions of Work-Related Identity.

BACKGROUND: The purpose of this study was to examine certified nursing assistants' (CNAs') perceptions of their work identity within the context of their relationships with nursing facility residents and residents' family members. Such information can help clarify CNAs' roles and respond to their job needs. Although CNAs provide valuable care for residents, they often experience low status at work; it is important that they have opportunities to find value in their work. METHODS: Eight focus groups were conducted with 45 CNAs from 4 nursing facilities. Thematic analysis and role theory were used to analyze the data. RESULTS: Participants identified with the roles of connector, advocate, overloaded worker, and companion. CONCLUSIONS: CNAs expressed a lack of work-related control in the advocate and overloaded worker roles, and satisfaction in the companion role. Adequate organizational resources can help CNAs gain more satisfaction and effectiveness in their work.

A university--school collaboration to enhance healthy choices among children.

One factor contributing to the childhood obesity epidemic is easy access to foods with high fat content available in public schools. After several years of advocacy efforts conducted by a city-wide coalition, the public schools system in an urban Midwestern city introduced fresh salad bars for lunch in three schools. Researchers have argued, however, that the introduction of salad bars in schools, without nutrition education, is not enough to produce changes in eating patterns. In this study, researchers used a target and control school to evaluate the impact of a 5-month nutrition education program. The results indicated that once the nutrition education program was implemented, the number of children consuming salad entrees and salad items doubled and quadrupled respectively, and knowledge about fruits and vegetables increased. Implications for community researchers interested in addressing childhood obesity are discussed.

Serotonin syndrome: fentanyl and selective serotonin reuptake inhibitor interactions.

Serotonin syndrome is a rare but potentially fatal adverse drug reaction associated with increased serotonergic activity in the central nervous system. It is characterized by a triad of symptoms, which include altered mental status, neuromuscular hyperactivity, and autonomic instability or hyperactivity. Due to the potential of rapid onset, it is important for clinicians to recognize the signs and symptoms of serotonin syndrome. Serotonin syndrome symptoms may resemble other conditions. Although this article focuses on serotonin syndrome as a result of an adverse interaction of selective serotonin reuptake inhibitors (SSRI) and fentanyl, it is important for not only anesthesia professionals, but all clinicians--such as those in emergency medicine and critical care--to be aware of this syndrome and its management. This article discusses the clinical manifestations of the serotonin syndrome and highlights reported cases of serotonin syndrome specifically related to an interaction between SSRIs and fentanyl, a commonly used opioid in anesthesia practice.

Employment outcomes among African Americans and Whites with mental illness.

BACKGROUND: People with mental illness often experience major difficulties in finding and maintaining sustainable employment. African Americans with mental illness have additional challenges to secure a job, as reflected in their significantly lower employment rates compared to Whites. OBJECTIVE: To examine the factors that contribute to racial disparities in employment outcomes for African-American and White Vocational Rehabilitation (VR) consumers with mental illness. METHODS: This study used VR data from a Midwestern state that included 2,122 African American and 4,284 White participants who reported mental illness in their VR records. Logistic regression analyses were conducted. RESULTS: African Americans had significantly more closures after referral and were closed as non-rehabilitated more often than Whites. Logistic regressions indicated that African Americans are less likely to be employed compared to Whites. The regression also found differences by gender (females more likely to find jobs than males) and age (middle age consumers [36 to 50] were more likely to find jobs than younger consumers [18 to 35]). Case expenditures between $1,000 and $4,999 were significantly lower for African Americans. CONCLUSIONS: VR agencies need to remain vigilant of potential discrepancies in service delivery among consumers from various ethnic groups and work hard to assure as much equality as possible.

Culturally competent interventions to address obesity among African American and Latino children and youth.

While obesity impacts all ethnic groups in the United States, African Americans and Latinos are particularly at high risk for obesity. The purpose of this paper is to provide an analysis of the literature on evidence-based culturally competent strategies for addressing and preventing obesity and discuss roles for occupational therapists working with populations at risk for obesity in the school or therapeutic clinical environment. A review was conducted of over 80 research articles describing successful interventions conducted in schools and communities targeting African Americans and Latino children. Although unique single strategies are highlighted in this paper, obesity interventions are complex and involved a number of multilevel strategies. The results of the analysis of the literature are presented according to strategies that promote healthy eating, physical activity, and overall healthy lifestyles. Along with the cultural competent strategies, we recommend specific roles for occupational therapists in order to promote the implementation of each particular strategy. Lastly, implications for occupational therapy are discussed.