Association of Hospital Readmission Rates With Discharge Disposition for Patients With Psychotic Disorders.

GOAL: We explored how readmissions may result from patients' lack of access to aftercare services, failure to adhere to psychotropic medication plans, and inability to understand and follow hospital discharge recommendations. We also investigated whether insurance status, demographics, and socioeconomic status are associated with hospital readmissions. This study is important because readmissions contribute to increased personal and hospital expenses and decreased community tenure (the ability to maintain stability between hospital admissions). Addressing hospital readmissions will promote optimal discharge practices beginning on day one of hospital admission. METHODS: The study examined the differences in hospital readmission rates for patients with a primary psychotic disorder diagnosis. Discharge data were drawn in 2017 from the Nationwide Readmissions Database. Inclusion criteria included patients aged 0-89 years who were readmitted to a hospital between less than 24 hr and up to 30 days from discharge. Exclusion criteria were principal medical diagnoses, unplanned 30-day readmissions, and discharges against medical advice. The sampling frame included 269,906 weighted number of patients diagnosed with a psychotic disorder treated at one of 2,355 U.S. community hospitals. The sample size was 148,529 unweighted numbers of patients discharged. PRINCIPAL FINDINGS: In a logistic regression model, weighted variables were calculated and used to determine an association between the discharge dispositions and readmissions. After controlling for hospital characteristics and patient demographics, we found that the odds for readmission for routine and short-term hospital discharge dispositions decreased for home health care discharges, which indicated that home health care can prevent readmissions. The finding was statistically significant when controlling for payer type and patient age and gender. PRACTICAL APPLICATIONS: The findings support home health care as an effective option for patients with severe psychosis. Home health care reduces readmissions and is recommended, when appropriate, as an aftercare service following inpatient hospitalization and may enhance the quality of patient care. Improving healthcare quality involves optimizing, streamlining, and promoting standardized processes in discharge planning and direct transitions to aftercare services.

After the Storm Has Passed: Barriers to Preparing U.S. Community Hospitals for the Next Pandemic and Other Disasters.

The COVID-19 pandemic illuminated shortcomings in the ability of community hospitals in the United States to respond to crises of this nature. This has led to questions about the effectiveness of community hospital disaster preparedness. A study of hospital preparedness in New York State in 2017 revealed a number of barriers to preparedness. Among the most significant are economic barriers, given that disaster preparedness is not a reimbursable cost like patient care. The economic challenges have been exacerbated by a decline in federal disaster preparedness funding in recent years. Reflecting on previous writings, the author provides several options for overcoming these barriers to ensure hospitals are better prepared for future disasters.

When Surgeons Are "Too Old" to Practice Surgery: Recommendations to Balance the Imperatives of Public Safety and Practical Necessity.

Few countries have legally set a maximum age for practicing surgery. This is difficult to sustain as surgeon shortages in many localities require hospitals to grant surgical privileges based on internal peer review systems. This approach is not without problems. Some hospitals and medical societies have developed competency assessment programs. Based on the literature and the experience of various jurisdictions, the authors recommend a policy approach that does not mandate a retirement age for surgeons, but rather a mandatory age of 65 at which surgeons shall be legally subject to periodic assessment of physical dexterity, eye/hand coordination, and cognitive skills.

A Review of 2020 State and DC Face Mask Guidelines for U.S. Healthcare Workers during the Covid-19 Pandemic.

This study reviewed state and District of Columbia (DC) health department guidelines for the use of face masks by healthcare workers during the COVID-19 pandemic via an October 2020 internet search and compared these guidelines to those from the World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC). Guidelines varied between states and DC with respect to N95 face mask and surgical mask use, as well as to extended use and re-use of N95 masks. Uniform guidance based on emerging evidence should be required for creating policy and procedures for healthcare workers during this and future pandemics.

Ethical allocation of COVID-19 vaccine in the United States: an evaluation of competing frameworks for the current pandemic and future events.

The COVID-19 pandemic, caused by the SARS-CoV-2 virus, created the need for an effective vaccine. Questions arose about allocating the initial limited supplies in the United States. We present four allocation models and compare their characteristics for ethically meeting the health needs of the population. The literature shares broad agreement on guiding ethical principles with those of the four proposed models for vaccine allocation, featuring the concepts of utilitarianism, prioritarianism, equity, and reciprocity. We conclude that the "Interim Framework for COVID-19 Vaccine Allocation and Distribution in the United States" from the Johns Hopkins Bloomberg School of Public Health is the most comprehensive and ethically sound. We recommend government officials and policymakers at all levels consider the principles and objectives in this model as US COVID-19 vaccination distribution efforts continue. This model may serve as an effective framework for initial vaccine distribution efforts during future epidemic and pandemic events.

Comparison of Disaster Preparedness Between Urban and Rural Community Hospitals in New York State.

OBJECTIVE: The intent of this study was to determine whether there are differences in disaster preparedness between urban and rural community hospitals across New York State. METHODS: Descriptive and analytical cross-sectional survey study of 207 community hospitals; thirty-five questions evaluated 6 disaster preparedness elements: disaster plan development, on-site surge capacity, available materials and resources, disaster education and training, disaster preparedness funding levels, and perception of disaster preparedness. RESULTS: Completed surveys were received from 48 urban hospitals and 32 rural hospitals.There were differences in disaster preparedness between urban and rural hospitals with respect to disaster plan development, on-site surge capacity, available materials and resources, disaster education and training, and perception of disaster preparedness. No difference was identified between these hospitals with respect to disaster preparedness funding levels. CONCLUSIONS: The results of this study provide an assessment of the current state of disaster preparedness in urban and rural community hospitals in New York. Differences in preparedness between the two settings may reflect differing priorities with respect to perceived threats, as well as opportunities for improvement that may require additional advocacy and legislation. (Disaster Med Public Health Preparedness. 2019;13:424-428).

Assessment of community hospital disaster preparedness in New York State.

OBJECTIVE: The intent of this study was to assess disaster preparedness in community hospitals across New York. DESIGN: Descriptive and analytical cross-sectional survey study. The survey instrument consisted of 35 questions that examined six elements of disaster preparedness: disaster plan development, onsite surge capacity, available materials and resources, disaster education and training, disaster preparedness funding levels, and perception of disaster preparedness. SETTING: Community hospitals in New York. SUBJECTS: Contact information was obtained for 207 of 208 community hospitals. Email invitations to participate in the survey were sent to hospital CEOs and disaster preparedness coordinators. Completed surveys were received from 80 hospitals. MAIN OUTCOME MEASURES: Hospital responses to questions related to the six elements of disaster preparedness. RESULTS: Most (87.5 percent) hospitals had experienced a disaster event during the past 5 years (2012-2016). Eighty percent had disaster plans that addressed all of six major types of disasters. Only 17.5 percent believed their disaster plans were "very sufficient" and did not require any revisions. Nearly three-quarters (73.3 percent) of hospitals could continue operations for less than a week without external resources. Less than half (49.4 percent) reported being satisfied or very satisfied with the level of funding that they received from the Hospital Preparedness Program. Most (88.8 percent) respondents felt that barriers to disaster preparedness exist for their organizations. CONCLUSIONS: The results demonstrate the current level of disaster preparedness among New York hospitals. The study's approach is discussed as a model that will enable hospitals to identify focus areas for improvement and opportunities for legislation and advocacy.

Comparison of disaster preparedness between Upstate and Downstate community hospitals in New York.

OBJECTIVE: This study sought to determine whether differences exist in disaster preparedness between Upstate and Downstate community hospitals in New York. DESIGN: A descriptive and analytical cross-sectional survey study was conducted using a 35-element questionnaire. These questions examined six disaster preparedness components: disaster plan development, onsite surge capacity, available materials and resources, disaster education and training, disaster preparedness funding levels, and perception of disaster preparedness. SETTING: The population surveyed included community hospitals across New York. SUBJECTS: Invitations to participate in the survey were emailed to the CEOs and disaster preparedness coordinators at 207 of the 208 community hospitals in New York. Eighty hospitals completed surveys, including 41 Upstate hospitals and 39 Downstate facilities. MAIN OUTCOME MEASURES: Responses to questions pertaining to the six disaster preparedness elements. RESULTS: There were differences in disaster preparedness between Upstate and Downstate hospitals with respect to disaster plan development, available materials and resources, and disaster education and training. No differences were identified in onsite surge capacity, disaster preparedness funding levels, or perception of disaster preparedness. CONCLUSIONS: The results demonstrate the current condition of disaster preparedness in Upstate and Downstate community hospitals in New York. Differences in preparedness between hospitals in the two locations may reflect factors such as availability of resources and differing priorities with regard to threat levels. They also suggest opportunities for improvement in disaster preparedness, which may require additional government resources and advocacy organization efforts.