Should a Healthcare System Facilitate Racially Concordant Care for Black Patients?

Addressing racial disparities in health outcomes is an urgent priority for many health care organizations, leading health care managers to explore the potential for organization-level interventions to yield substantive health gains. In recent literature, it is suggested that Black patients who are treated by Black physicians may achieve superior health outcomes in some settings. In this case discussion, we consider a case in which a medical director considers implementing a voluntary program to promote racially concordant care for Black patients. Commentators consider the precedent for such a program, both in current informal care networks and 20th century medical history, as well as the burden such a program may place on Black physicians and the risks of reducing patients' intersectional identities to be solely about race. A subset of commentators suggest that these risks are mitigated by the voluntary nature of the program, whereas others offer caution about relying solely on Black physicians to remedy health disparities. Others view multiple paths as morally defensible but emphasize the need for managers to take proactive steps to communicate and evaluate their choices in the face of such a complex social challenge.

Terapia ciega: Lo que la pandemia nos dejó

Experiencia del equipo de salud mental del Hospital Vélez Sarsfield, de la Ciudad de Buenos Aires, que ante la aparición de la pandemia de Covid-19, cambió la modalidad de atención, mayormente por llamadas telefónicas a los pacientes, donde se atendió a pacientes que no el equipo no conocía, en sesiones de home office, con el celular del profesional. Esta experiencia se emparenta con una obra de teatro ciego, donde el analista es el actor de la consulta terapéutica.

Evaluation of an interactive showroom to increase general knowledge about welfare technology and its potential in municipal care settings.

Background: Welfare Technology (WT) can promote participation in activity. Thus, initiatives to support the implementation of WT products and services in municipality care settings needs to be developed and evaluated to benefit end-users.Objective: To evaluate an interactive showroom of WT.Material and method: Municipal employees (n = 217) filled in a questionnaire before and after they visited an interactive showroom of WT.Findings: The number of participants confirming WT's potential to contribute to municipal operation areas increased in seven out of eight areas after their visits (p < 0.05). A statistically significant increase was also found regarding general knowledge of and confidence in WT and its potential value.Conclusion: A visit to the interactive showroom increased the perceived general knowledge and appreciated value of WT. The perception of the possibility of implementing WT in various municipal operation areas also increased, which may contribute to the implementation of WT in municipal care settings.

Moral Distress and Intention to Leave the Profession: Lithuanian Nurses in Municipal Hospitals.

PURPOSE: The purpose of this study was to describe the level of moral distress experienced by nurses, situations that most often caused moral distress, and the intentions of the nurses to leave the profession. METHODS: A descriptive, cross-sectional, correlational design was applied in this study. Registered nurses were recruited from five large, urban Lithuanian municipal hospitals representing the five administrative regions in Lithuania. Among the 2,560 registered nurses, from all unit types and specialities (surgical, therapeutic, and intensive care), working in the five participating hospitals, 900 were randomly selected to be recruited for the study. Of the 900 surveys distributed, 612 questionnaires were completed, for a response rate of 68%. Depending on the hospital, the response rate ranged from 61% to 81%. Moral distress was measured using the Moral Distress Scale-Revised (MDS-R). The MDS-R is designed to measure nurses' experiences of moral distress in 21 clinical situations. Each of the 21 items is scored using a Likert scale (0-4) in two dimensions: how often the situation arises (frequency) and how disturbing the situation is when it occurs (intensity). On the Likert scale, 0 correlates to situations that have never been experienced, and 4 correlates to situations that have occurred very often. RESULTS: Among the 612 participants, 206 (32.3%) nurses reported a low level of moral distress (mean score 1.09); 208 (33.9%) a moderate level of distress (mean score 2.53), and 207 (33.8%) a high level of distress (mean score 3.0). The most commonly experienced situations that resulted in moral distress were as follows: "Carrying out physician's orders for what I consider to be unnecessary tests and treatments" (mean score 1.66); "Follow the family's wishes to continue life support even though I believe it is not in the best interest of the patient" (mean score 1.31); and "Follow the physician's request not to discuss the patient's prognosis with the patient or family" (mean score 1.26). Nurses who had a high moral distress level were three times more likely to consider leaving their position compared with respondents who had a medium or low moral distress level (8.7% and 2.9%, respectively; p < .05). CONCLUSIONS: Our findings provide evidence on the association between moral distress and intention to leave the profession. Situations that may lead health professionals to be in moral distress seem to be mainly related to the unethical work environment. CLINICAL RELEVANCE: The findings of this study reported that moral distress plays a role in both personal and organizational consequences, including negative emotional impacts upon employees.

Rethinking Private-Public Partnership in the Health Care Sector: The Case of Municipal Hospital affiliation.

By the late 1950s, New York City's public hospital system-more extensive than any in the nation-was falling apart, with dilapidated buildings and personnel shortages. In response, Mayor Robert Wagner authorized an affiliation plan whereby the city paid private academic medical centers to oversee training programs, administrative tasks, and resource procurement. Affiliation sparked vigorous protest from critics, who saw it as both an incursion on the autonomy of community-oriented public hospitals and the steamrolling of private interests over public ones. In the wake of the New York City fiscal crisis of 1975, however, the viability of a purely public hospital system withered, given the new economic climate facing the city. In its place was a new institutional form: affiliation and the public-private provision of public health care.

Situación epidemiológica de los casos de sífilis en el Hospital General de Agudos Dr. Cosme Argerich: Años 2016 y 2017 / Epidemiological situation of syphilis at the Acute General Hospital Dr Cosme Argerich: 2016 and 2017

La sífilis es una enfermedad infectocontagiosa producida por la bacteria Treponema pallidum. Se transmite fundamentalmente por contacto sexual y por transmisión perinatal durante el embarazo y a través del canal de parto. Afecta tanto a varones como a mujeres y los síntomas surgen dos o tres semanas después del contacto sexual sin protección. Las infecciones perinatales por sífilis representan en la actualidad una problemática por su gran impacto en la morbilidad y mortalidad materno-infantil. A pesar de existir medidas profilácticas eficaces y de que podría eliminarse mediante un control prenatal eficaz y el tratamiento de las embarazadas infectadas, la sífilis sigue constituyendo un problema de Salud Pública a escala mundial, con 12 millones de personas infectadas cada año. Su eliminación reduciría el número de abortos, muertes fetales, partos prematuros, neonatos de bajo peso al nacer y muertes perinatales. En América Latina y el Caribe, la prevalencia en embarazadas varía de un país a otro (del 0,1% al 7,0%). En 2015, la tasa de sífilis congénita estimada fue de 1,7 casos por 1000 nacidos vivos en la Región. En Argentina, de las embarazadas estudiadas para sífilis durante el 2016 2,68% resultaron positivas para pruebas no treponémicas (PNT), mientras que en 2017 el 3,16% fueron positivas para dichas pruebas.En residentes de la Ciudad Autónoma de Buenos Aires (CABA), se notificaron 1336 casos de sífilis en el año 2016 al módulo SNVS- C2 con modalidad agrupada y 1899 casos durante 2017. Las PNT en embarazadas residentes de CABA fueron positivas en 1,7% en 2016 y 5,1% en 20176. Este informe especial se centra en los casos notificados en el Hospital General de Agudos Cosme Argerich, de la Ciudad de Buenos Aires, donde se realizó un estudio descriptivo con los datos de los casos de sífilis notificados a la División de Promoción y Protección del hospital, desde la Semana Epidemiológica (SE) 1 a 52 de 2016 y 2017 .

Health policy making through operative actions: a case study of provider capacity reduction in a public safety-net system.

This article describes and assesses the implications of policy decisions affecting health provider capacity in the Los Angeles County municipal safety-net health system from 1980 to 2000. Although never articulated in law or a county ordinance, the county pursued a sustained and discernable policy of cost reductions that affected capacity at King/Drew Medical Center from 1980 to 2000 without the input of beneficiaries or their advocates. Year after year, the county reduced personnel, supplies, and available beds either by reducing formal budgets or through operative actions of facility administrators that prevented the implementation of formally approved expenditures. This policy appears to have undermined the hospital system's mission of providing health services to at-risk populations with nowhere else to go. Decision making during the two decades under study revealed a decision-making pattern that challenged traditional models of policy decision making.