Adverse Events In Health Care Research Articles

Analysis of Critical Incident Reports Using Natural Language Processing.

To demonstrate how natural language processing (NLP) methods can help in retrieving valuable information from such incident data. We analyzed frequently occurring terms and sentiments as well as topics in data from the Swiss National CIRRNET database from 2006 to 2023 using NLP and BERTopic modelling. We grouped the topics into 10 major themes out of which 6 are related to medication. Overall, they reflect the global trends in adverse events in healthcare (surgical errors, venous thromboembolism, falls). Additionally, we identified errors related to blood testing, COVID-19, handling patients with diabetes and pediatrics. 40-50% of the messages are written in a neutral tone, 30-40% in a negative tone. The analysis of CIRS messages using text analysis tools helped in getting insights into common sources of critical incidents in Swiss healthcare institutions. In future work, we want to study more closely the relations, for example between sentiment and topics.

Grace Under Pressure: a mixed methods impact assessment of a verbatim theatre intervention to improve healthcare workplace culture

BackgroundHealthcare workplace mistreatment has been documented globally. Poor workplace behaviour, ranging from incivility to bullying and harassment, is common in healthcare, and contributes significantly to adverse events in healthcare, poor mental health among healthcare workers, and to attrition in the healthcare workforce, particularly in junior years. Poor workplace behaviour is often normalised, and is difficult to address. Verbatim theatre, a form of research informed theatre in which plays are created from informants’ exact words only, is particularly suited to facilitating workplace culture change by raising awareness about issues that are difficult to discuss. The objective of this study was to assess the impact of the verbatim theatre play ‘Grace Under Pressure’ on workplace culture in NSW hospitals.MethodsThe intervention was conducted in 13 hospitals from 8 Local Health Districts (LHDs) in NSW, Australia, in October and November 2019, with aggregated impact across all sites measured by a bespoke survey (‘Pam McLean Centre (PMC) survey’) at the conclusion of the intervention. This study was conducted in 3 Local Health Districts (one urban, one regional, one remote), with data collection conducted in November–December 2019 and December 2020. The study design was a mixed methods assessment of the play’s impact using (1) validated baseline measures of psychosocial risk, analysed descriptively, (2) overall findings from the PMC survey above, analysed descriptively, (3) interviews conducted within a month of the intervention, analysed thematically and (4) interviews conducted one year later, analysed thematically.ResultsHalf (51.5%) of the respondents (n = 149) to the baseline survey had scores indicating high risk of job strain and depressive symptoms. Of 478 respondents to the PMC survey (response rate 57%), 93% found the play important, 92% recommended others see the play, 89% considered that it stimulated thinking about workplace behaviour, and 85% that it made discussing these issues easier. Thematic analysis of interviews within one month (n = 21) showed that the play raised awareness about poor workplace behaviour and motivated behaviour change. Interviews conducted one year later (n = 6) attributed improved workplace culture to the intervention due to improved awareness, discussion and capacity to respond to challenging issues.ConclusionsVerbatim theatre is effective in raising awareness about difficult workplace behaviour in ways that motivate behaviour change, and hence can be effective in catalysing real improvements in healthcare workplace culture. Creative approaches are recommended for addressing similarly complex challenges in healthcare workforce retention.

The Role of Human Factors in Maintaining Service Quality in Hospitals

The delivery of high-quality healthcare services is a multifaceted endeavor influenced by various factors, among which human factors play a pivotal role. This paper explores the significance of human factors in upholding service quality within hospital settings. Drawing upon interdisciplinary research from fields such as psychology, sociology, and healthcare management, it examines the intricate interplay between healthcare professionals, patients, and organizational structures. In today's healthcare landscape, where patient-centric care is increasingly emphasized, understanding the impact of human factors is paramount. One of the primary focuses is on patient satisfaction, which is not only influenced by clinical outcomes but also by the quality of interactions with healthcare providers. Effective communication between healthcare professionals and patients is essential for building trust, managing expectations, and ensuring informed decision-making. Moreover, the demeanor, empathy, and interpersonal skills of healthcare staff significantly contribute to patients' overall experience and satisfaction levels. Safety is another critical aspect of service quality in hospitals, and human factors play a central role in patient safety initiatives. Research has shown that the majority of adverse events in healthcare are attributable to human error, highlighting the importance of addressing factors such as fatigue, stress, and workload among healthcare professionals. Furthermore, teamwork and collaboration are vital for promoting a culture of safety, where healthcare providers work together cohesively to identify and mitigate risks, thereby enhancing patient outcomes and reducing preventable harm. Effective leadership within healthcare organizations is also instrumental in shaping service quality. Strong leadership sets the tone for organizational culture, values, and priorities, influencing the behavior and performance of healthcare staff. Leaders who prioritize patient-centered care, employee well-being, and continuous quality improvement foster an environment conducive to delivering high-quality services. To optimize service quality, hospitals must invest in staff training, development, and support programs. Ongoing education ensures that healthcare professionals stay abreast of the latest evidence-based practices, technological advancements, and regulatory requirements. Moreover, initiatives to promote staff well-being, such as employee assistance programs, work-life balance initiatives, and resilience training, are essential for preventing burnout and maintaining morale. In conclusion, human factors play a multifaceted role in maintaining service quality in hospitals, encompassing aspects such as communication, teamwork, leadership, and staff well-being. By recognizing the complexities of human interactions within healthcare systems and implementing targeted interventions, hospitals can enhance service delivery, improve patient outcomes, and cultivate a culture of excellence.

Characterization and evaluation of the use of dangerous abbreviations in a hospital in Quito, Ecuador

Introduction. The dangerous abbreviations not allowed used in the record of the Clinical History, due to an erroneous interpretation, could trigger associated adverse events in health care. Methods. Cross-sectional descriptive study, 15 786 cases registered in the Medical Records of Hospital General del Sur de Quito of 42 clinical and surgical units were reviewed, the use of dangerous abbreviations was included, the acronyms allowed according to the regulations of the Ministry of Public Health of Ecuador were excluded. The information was consolidated in a database in Excel 2017 format and the compliance and frequencies of abbreviations used with the SPSS Version 22.0 program were analyzed. Results. 69,84% (n=11 026 services) complied with the proper use of allowed abbreviations, the clinical area with 74,9% and the surgical area with 62,62%. 6 199 dangerous abbreviations were found, the most frequent being “(…) FR, FC, LPM, RPM, TA, TAM, RX, GSRN, CD4, M2, CD8, ASC, ECG, AQX, NPO, VIH, BH, FUM, HTA, RHB, SAT, GSM, TAC, RHA, DH, RP, APP, AM, TTO, IDG (…)”. Conclusions. Percentages of higher compliance were determined in the clinical units, followed by the surgical ones. The abbreviations used in the records of the Clinical Histories are not included in Ministerial Agreement 00000115, Patient Safety Manual - User, of the Ministry of Public Health of Ecuador.

Why Talking Is Not Cheap: Adverse Events and Informal Communication.

Healthcare management faces significant challenges related to upward communication. Sharing information in healthcare is crucial to the improvement of person-centered, safe, and effective patient care. An adverse event (AE) is an unintended or unexpected incident that causes harm to a patient and may lead to temporary or permanent disability. Learning from adverse events in healthcare is crucial to the improvement of patient safety and quality of care. Informal communication channels represent an untapped resource with regard to gathering data about the development of AEs. In this viewpoint paper, we start by identifying how informal communication played a key factor in some high-profile adverse events. Then, we present three Critical Challenge points that examine the role of informal communication in adverse events by (1) understanding how the prevailing trends in healthcare will make informal communication more important, (2) explaining how informal communication is part of the group-level sensemaking process, and (3) highlighting the potential role of informal communication in "breaking the silence" around critical and adverse events. Gossip, as one of the most important sources of informal communication, was examined in depth. Delineating the role of informal communication and adverse events within the healthcare context is pivotal to understanding and improving team and upward communication in healthcare organizations. For clinical leaders, the challenge is to cultivate a climate of communication safety, whereby informal communication channels can be used to collect soft intelligence that are paths to improving the quality of care and patient safety.

Harnessing of Artificial Intelligence for the Diagnosis and Prevention of Hospital-Acquired Infections: A Systematic Review.

Healthcare-associated infections (HAIs) are the most common adverse events in healthcare and constitute a major global public health concern. Surveillance represents the foundation for the effective prevention and control of HAIs, yet conventional surveillance is costly and labor intensive. Artificial intelligence (AI) and machine learning (ML) have the potential to support the development of HAI surveillance algorithms for the understanding of HAI risk factors, the improvement of patient risk stratification as well as the prediction and timely detection and prevention of infections. AI-supported systems have so far been explored for clinical laboratory testing and imaging diagnosis, antimicrobial resistance profiling, antibiotic discovery and prediction-based clinical decision support tools in terms of HAIs. This review aims to provide a comprehensive summary of the current literature on AI applications in the field of HAIs and discuss the future potentials of this emerging technology in infection practice. Following the PRISMA guidelines, this study examined the articles in databases including PubMed and Scopus until November 2023, which were screened based on the inclusion and exclusion criteria, resulting in 162 included articles. By elucidating the advancements in the field, we aim to highlight the potential applications of AI in the field, report related issues and shortcomings and discuss the future directions.

Predicting disease onset from electronic health records for population health management: a scalable and explainable Deep Learning approach.

The move from a reactive model of care which treats conditions when they arise to a proactive model which intervenes early to prevent adverse healthcare events will benefit from advances in the predictive capabilities of Artificial Intelligence and Machine Learning. This paper investigates the ability of a Deep Learning (DL) approach to predict future disease diagnosis from Electronic Health Records (EHR) for the purposes of Population Health Management. In this study, embeddings were created using a Word2Vec algorithm from structured vocabulary commonly used in EHRs e.g., Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT) codes. This study is based on longitudinal medical data from ~50 m patients in the USA. We introduced a novel method of including binned observation values into an embeddings model. We also included novel features associated with wider determinants of health. Patient records comprising these embeddings were then fed to a Bidirectional Gated Recurrent Unit (GRU) model to predict the likelihood of patients developing Type 2 Diabetes Mellitus, Chronic Obstructive Pulmonary Disorder (COPD), Hypertension or experiencing an Acute Myocardial Infarction (MI) in the next 3 years. SHapley Additive exPlanations (SHAP) values were calculated to achieve model explainability. Increasing the data scope to include binned observations and wider determinants of health was found to improve predictive performance. We achieved an area under the Receiver Operating Characteristic curve value of 0.92 for Diabetes prediction, 0.94 for COPD, 0.92 for Hypertension and 0.94 for MI. The SHAP values showed that the models had learned features known to be associated with these outcomes. The DL approach outlined in this study can identify clinically-relevant features from large-scale EHR data and use these to predict future disease outcomes. This study highlights the promise of DL solutions for identifying patients at future risk of disease and providing clinicians with the means to understand and evaluate the drivers of those predictions.

The Effect of Coronavirus Disease 2019 on Adverse Events in Health Care: A Retrospective Study in Ground and Helicopter Emergency Medical Services

ObjectiveThe coronavirus disease 2019 (COVID-19) pandemic has proven to be a significant hardship for the entire world. Health care systems and their workers have been stretched to their limits. Research regarding whether this increased strain has affected patient safety has not been sufficient, especially in emergency medical services. The aim of this study was to determine if there has been an increased rate of adverse events in ground and helicopter emergency medical services since the onset of the COVID-19 pandemic. MethodsA 2-year retrospective review was performed at a Midwest regional critical care transport service. The rate of adverse events for 1-year periods before and after March 13, 2020, was the primary outcome. All adverse events that generated a quality improvement incident report form (QIRF) were included, except those generated for non–clinical-related incidents. Additionally, a smaller time frame between May 1st and August 31st of both years was included containing all flagged adverse events from peer reviewers; not all of these generated a QIRF. ResultsIn the time period between March 13, 2019, and March 12, 2020, 5 of 3,154 (0.16%) calls generated a QIRF versus 21 of 3,185 (0.66%) calls between March 13, 2020, and March 12, 2021. There was a significant relationship showing an adverse event was more likely to happen after the onset of COVID-19 compared with before (χ21 [N = 6,339] = 8.643, P ≤ .001). Additionally, from May 1st to August 31st, the total adverse event rates were 16.86% (143/848 calls) and 24.46% (387/1,582 calls) for 2019 and 2020, respectively. Similarly, statistical significance existed for adverse events occurring after onset of the pandemic versus before (χ21 [N = 2,430] = 18.253, P ≤ .001). ConclusionA higher rate of adverse events for the year after the onset of COVID-19 existed. Additional studies looking at the causes of adverse events and patient outcomes should be undertaken to further understand this increase.

The Role of Machine Learning in Identifying Risk Factors for Adverse Events in Healthcare: A Comprehensive Overview

This paper presents a comprehensive exploration of the use of machine learning (ML) in identifying risk factors for adverse events in healthcare. It delves into the challenges and opportunities associated with ML techniques, emphasizing the potential impact of ML-based risk factor identification on clinical decision-making. The paper also discusses the need for interdisciplinary collaboration and continuous innovation to maximize the potential of ML in enhancing patient safety and healthcare quality. By examining various ML techniques, challenges in utilization, opportunities and impact, interdisciplinary collaboration, and future prospects, this paper provides valuable insights for researchers, healthcare professionals, and policymakers.

Quality of the record of drug-related problems in a database for voluntary adverse event reporting

ObjectiveTo determine the number and type of errors found in the record of drug-related problems in the SINEA database, an electronic system for voluntary reporting of adverse events in healthcare, in order to quantify the differences between the raw and refined databases, suggest improvements, and determine the need for refining said databases. Methods: A Pharmacist reviewed the database and refined the adverse events reported from January to August, 2014, considering the “descri-be_what_happened“ field as the gold standard. There was a comparison of the rates of medication errors, both potential and real, adverse reactions, impact on the patient, impact on healthcare, and medications more frequently involved in the raw and refined databases. Agreement was calculated through Cohen’s Kappa Coefficient. Results364 adverse events were reported: 66.7% were medication errors, 2.7% adverse reactions to the medication (2 were wrongly classified as both, showing a total percentage >100%) and 31% were other events. After refinement, the percentages were 69.5%, 5.8% and 24.7%, respectively (κ=0.85; CI95% [0.80-0.90]). Before refinement, 73.6°% of medication errors were considered potential vs. 82.3% after refinement (κ =0.65; CI95% [0.54-0.76]). The medication most frequently involved was trastuzumab (20.9%). The “molecule” field was blank in 133 entries. A mean of 1.8±1.9 errors per entry were detected. ConclusionsAlthough agreement is good, the refinement process cannot be avoided, as it provides valuable information to improve pharmacotherapy. Data quality could be improved by reducing the number of type-in text fields, using drop-down lists, and by increasing the training of the reporters.

Impact of individual, household, and area characteristics on health and social care outcomes for people with multimorbidity: Protocol for a multilevel analysis.

Multimorbidity is one of the greatest challenges facing health and social care systems globally. It is associated with high rates of health service use, adverse healthcare events, and premature death. Despite its importance, little is known about the effects of contextual determinants such as household and area characteristics on health and care outcomes for people with multimorbidity. This study protocol presents a plan for the examination of associations between individual, household, and area characteristics with important health and social care outcomes. The study will use a cross-section of data from the SAIL Databank on 01 January 2019 and include all people alive and registered with a Welsh GP. The cohort will be stratified according to the presence or absence of multimorbidity, defined as two or more long-term conditions. Multilevel models will be used to examine covariates measured for individuals, households, and areas to account for social processes operating at different levels. The intra-class correlation coefficient will be calculated to determine the strength of association at each level of the hierarchy. Model outcomes will be any emergency department attendance, emergency hospital or care home admission, or mortality, within the study follow-up period. Household and area characteristics might act as protective or risk factors for health and care outcomes for people with multimorbidity, in which case results of the analyses can be used to guide clinical and policy responses for effective targeting of limited resources.

Comparing Virtual Simulations to Paper Case Studies in Combination With Manikin-Based Medication Administration Simulations: A Quasi-Experimental Study.

Medication errors are among the most common preventable adverse events in health care. A quasi-experimental approach with a pre/posttest design was used to explore the effectiveness of an enhanced medication administration simulation bundle that included the use of manikin-based simulation-based experiences (SBEs) in combination with either virtual SBEs (V-SBEs) for deliberate practice (DP) or traditional paper case studies for DP on safe medication administration in undergraduate nursing students. Nursing students (n = 101) participated in multiple medication administration-focused SBEs including DP via V-SBEs or DP via traditional paper case studies. Student performance in the medication administration SBEs improved after the third experience. There was no statistically significant difference between the V-SBE groups compared with the traditional paper case study groups across the 3 medication administration-focused SBEs. Findings from this study highlight the importance of DP with medication administration for undergraduate nursing students.

Association of patient-reported financial barriers with healthcare utilization among Medicare beneficiaries with a history of cancer.

We examined characteristics associated with financial barriers to healthcare and the association of financial barriers with adverse healthcare events among US adult cancer survivors enrolled in Medicare. We used nationally representative Medicare Current Beneficiary Survey data (2011-2013, 2015-2017) to identify adults with a history of non-skin cancer. We defined financial barriers as cost-related trouble accessing and/or delayed care in the prior year. Using propensity-weighted multivariable logistic regression, we examined associations between financial barriers and adverse healthcare events (any ED visits, any inpatient hospitalizations). Overall, 11.0% of adult Medicare beneficiaries with a history of cancer reported financial barriers in the prior year, with higher burden among beneficiaries < 65years of age vs. ≥ 65 (32.5% vs. 8.2%, p < 0.0001) and with annual income < $25,000 vs. ≥ $25,000 (18.1% vs. 6.9%, p < 0.0001). In bivariate models, financial barriers were associated with a 7.8 percentage point (95% CI: 1.5-14.0) increase in the probability of ED visits. In propensity-weighted models, this association was not statistically significant. The association between financial barriers and hospitalizations was not significant in the overall population; however, financial barriers were associated with a decreased probability of hospitalization among Black/African American beneficiaries. Despite Medicare coverage, beneficiaries with a history of cancer are at risk for experiencing financial barriers to healthcare. In the overall population, financial barriers were not associated with ED visits or hospitalizations. Policies limiting Medicare patient out-of-pocket spending and care models addressing health-related social needs are needed to reduce financial barriers experienced.

PATIENT SAFETY CULTURE IN PUBLIC GENERAL HOSPITALS: LITERATURE REVIEW

Background: The global prevalence of preventable adverse events in healthcare is a significant problem, with approximately 42.7 million annual accidents resulting in 23 million DALYs lost. Safety culture plays a crucial role in mitigating or exacerbating these incidents within hospitals. Objectives: To identify the results of the assessment of patient safety culture and the characteristics associated with patient safety culture in public general hospitals in various countries. Methods: This study was conducted between April-July 2021 utilizing a literature review approach using study searches through PubMed, Scopus, ScienceDirect, Google Scholar, and Garuda databases, and it discovered 17 papers from 2011-2021 that used the Hospital Survey on Patient Safety Culture (HSOPSC) as an instrument to assess patient safety culture. Results: This study found that patient safety culture at public general hospitals remains low, and hospital staff perception of safety has to be improved. Discussions: “Teamwork in hospital units” receives the most favorable replies, while “non-punitive response to error” receives the least positive responses. The majority of the employees assessed patient safety in their work unit as “excellent/very good/acceptable” and reported no incidents in the previous year. Staff and hospital characteristics were also found to be related to patient safety culture.

Effects of light-guided nudges on health care workers' hand hygiene behavior

Hospital-acquired infectionsare the most frequent adverse events in health care and can be reduced by improving thehand hygiene compliance (HHC) of health care workers (HCWs). We aimed to investigate the effect of nudging with sensor lights on HCWs' HHC. An 11-month intervention study was conducted in 2 inpatient departments at a university hospital. An automated monitoring system (Sani NudgeTM) measured theHHC. Reminder and feedback nudges with lights were displayed on alcohol-based hand rub dispensers. We compared the baseline HHC with HHC during periods of nudging and usedthefollow-up data to establishif a sustained effect had been achieved. A total of 91 physicians, 135 nurses, and 15 cleaning staff were enrolled in the study. The system registered 274,085 hand hygiene opportunities in patient rooms, staff restrooms, clean rooms, and unclean rooms. Overall, a significant, sustained effect was achieved by nudging with lights in relation to contact with patients and patient-near surroundings for both nurses and physicians. Furthermore, a significant effect was observed on nurses' HHC in restrooms and clean rooms. No significant effect was found for the cleaning staff. Reminder or feedback nudges with light improved and sustained physicians' and nurses' HHC, and constitute a new way of changing HCWs' hand hygiene behavior.

Naming the "baby" or the "beast"? The importance of concepts and labels in healthcare safety investigation.

This paper focuses on concepts and labels used in investigation of adverse events in healthcare. The aim is to prompt critical reflection of how different stakeholders frame investigative activity in healthcare and to discuss the implications of the labels we use. We particularly draw attention to issues of investigative content, legal aspects, as well as possible barriers and facilitators to willingly participate, share knowledge, and achieve systemic learning. Our message about investigation concepts and labels is that they matter and influence the quality of investigation, and how these activities may contribute to system learning and change. This message is important for the research community, policy makers, healthcare practitioners, patients, and user representatives.

Patient safety as a global health priority

Patient safety is a discipline that has arisen in response to the increasing complexity of health care delivery and the associated increase in patient harm. Adverse health care events are a serious problem, causing significant harm to the patient and increasing health care costs. The World Health Organization has identified patient safety as one of the key priorities for world health. The current review presents the historical background that led to the formation of the discipline of patient safety, the determinants of adverse events in medical practice, and the main tools for dealing with them.

Association of patient-reported financial barriers with healthcare utilization among Medicare beneficiaries with a history of cancer.

220 Background: Cancer survivors are at heightened risk of experiencing financial barriers to healthcare (FBs), which may increase the likelihood of adverse clinical outcomes. We aimed to (1) identify characteristics associated with experiencing FBs, and (2) examine the association of FBs with emergency department (ED) visits and inpatient hospitalizations among US adult cancer survivors enrolled in Medicare. Methods: We used 2011 – 2013 and 2015 – 2017 Medicare Current Beneficiary Survey (MCBS) data, a nationally representative survey, to identify adults with a history of non-skin cancer (N = 4511). We defined FBs as trouble accessing care and/or delayed care due to cost in the prior year. Healthcare utilization is captured in MCBS by reconciling self-reported events and fee-for-service claims. After examining bivariate associations between beneficiary characteristics and FBs, we used propensity-weighted logistic regression to examine associations between FBs and adverse healthcare events (any ED visits, any inpatient hospitalizations) in the year following report of FBs. Results: Overall, 11.8% (95% CI: 10.7% - 13.0%) of adult Medicare beneficiaries with a history of cancer reported FBs in the prior year, with higher burden among beneficiaries less than 65 years of age (35.6% vs. 8.6%, p&lt; 0.0001), with annual income &lt; $25,000 (19.4% vs. 7.4%, p&lt; 0.0001), and identifying as persons of color (15.7% vs. 11.2%, p= 0.01). Beneficiaries eligible for a Part D low-income subsidy were more likely to report FBs compared to those who were not eligible, with those with eligibility for only part of the year (vs. the full year) reporting the highest prevalence of FBs (36.5% vs. 20.8%, p&lt; 0.0001). The overall prevalence of ED visits and inpatient hospitalization was 18.2% and 18.8%, respectively. In bivariate models, reporting FBs was associated with an 8.1 percentage point (95% CI: 1.7 – 14.5) increase in the probability of ED visits. In propensity-weighted multivariate models, this association was insignificant (0.8; 95% CI: -3.7 – 5.3). The association between FBs and inpatient hospitalization was not significant. Number of chronic conditions was the strongest predictor of utilization, with having 5+ conditions (vs. cancer only) associated with a 21.1 (95% CI: 16.5 – 25.7) and 15.4 (95% CI: 9.2 – 21.7) percentage point increase in the probability of ED visits and inpatient hospitalizations, respectively. Conclusions: Over one in ten Medicare beneficiaries with a history of cancer report trouble accessing care or delayed care for cost-related reasons, with a heightened prevalence among beneficiaries less than 65 and those eligible for a low-income subsidy. Reporting FBs is not associated with increased ED and inpatient utilization. Nevertheless, identifying characteristics associated with FBs among cancer survivors can inform targeted clinic- and policy-level intervention.

Psychosocial and behavioral therapy in conjunction with medication for opioid use disorder: Patterns, predictors, and association with buprenorphine treatment outcomes

IntroductionCurrent evidence indicates that buprenorphine is a highly effective treatment for opioid use disorder (OUD), though premature medication discontinuation is common. Research on concurrent psychosocial and behavioral therapy services and related outcomes is limited.The goal of this study was to define patterns of OUD-related psychosocial and behavioral therapy services received in the first 6 months after buprenorphine initiation, identify patients' characteristics associated with service patterns, and examine the course of buprenorphine treatment, including the association of therapy with medication treatment duration. MethodsWe analyzed 2013–2018 MarketScan Multi-State Medicaid claims data. The sample included adults aged 18–64 years at buprenorphine initiation with treatment episodes of at least 7 days (n = 61,976). We used group-based trajectory models to define therapy service patterns and multinomial logistic regression to identify pre-treatment patient characteristics associated with therapy trajectories. Multinomial propensity-score weighted Cox proportional hazards regression estimated time to buprenorphine discontinuation and unweighted Cox proportional hazards models estimated risk of adverse health care events during buprenorphine treatment (all-cause and opioid-related inpatient and emergency department services, overdose treatment). ResultsWe identified three trajectories of psychosocial and behavioral therapy services: none (73.8%), low-intensity (17.2%), and high-intensity (9.0%). Compared to those without therapy, low-intensity and high-intensity service patterns were associated with behavioral health diagnoses and medical treatment for opioid overdose in the baseline period prior to buprenorphine initiation. The hazard of buprenorphine discontinuation was significantly lower for low-intensity (HR = 0.55; 95% CI, 0.54–0.57) and high-intensity (HR = 0.71; 95% CI, 0.67–0.74) therapy groups compared to those without therapy services. Yet patients in the high-intensity therapy group had increased risk of opioid-related health care events during buprenorphine treatment, including medical treatment for opioid overdose (HR = 1.29; 95% CI, 1.01–1.64). ConclusionMost patients received little or no OUD-related psychosocial and behavioral therapy after initiating buprenorphine treatment. Patients who received therapy had characteristics indicating greater treatment needs as well as more complex treatment courses. Concurrent therapy services may help to address premature buprenorphine discontinuation, particularly for patients with high-risk clinical profiles; however, future prospective research should determine whether therapy is effective for extending buprenorphine retention.

Effectiveness and sustainability of the WHO multimodal hand hygiene improvement strategy in the University Hospital Bouak\xe9, Republic of C\xf4te d'Ivoire in the context of the COVID-19 pandemic

IntroductionThe most frequent adverse events in healthcare are healthcare-associated infections, whose burden is highest in resource-limited settings. In addition, low resource settings often lack Hand Hygiene (HH) knowledge and reliable supply to disinfectant, a necessity emphasized by the past West African Ebola Epidemic and the ongoing COVID-19 pandemic. PASQUALE aims to increase patient safety by introducing the WHO multimodal HH strategy in the University Hospital Bouaké, Côte d’Ivoire.MethodsAssessment of HH knowledge, perception and compliance was performed 12 months before, right after the intervention and at a ten months interval using questionnaires for knowledge and perception and direct observation for compliance. The intervention consisted of a HH training and the introduction of local production of alcohol-based hand-rub. In the absence of a control group, the effectiveness of the intervention was assessed by a before-and-after study.ResultsBaseline knowledge score was 14/25, increased significantly to 17/25 (p < 0.001) upon first and decreased to 13/25 in second follow-up. Compliance showed a significant increase from 12.7% to 36.8% (p < 0.001) in first and remained at 36.4% in second follow-up. Alcohol-based hand-rub production and consumption almost doubled after first confirmed COVID-19 case in Côte d’Ivoire.ConclusionThe WHO HH improvement strategy is an effective and pandemic-adaptable method to increase long-term HH compliance. This study emphasizes that the implementation of the strategy to build a robust system is of utmost importance.