California Health Care Facilities Research Articles

Measuring a Critical Component of Contraceptive Decision Making: The Contraceptive Concerns and Beliefs Scale

IntroductionConcerns about safety and side effects from contraceptives are widespread and related to reluctance to use them. Measuring these concerns is an essential component of understanding contraceptive decision-making and guiding contraceptive and interpregnancy clinical care.MethodsWe used qualitative research and item response theory to develop and test a psychometric instrument to measure contraceptive concerns and beliefs. We developed 55 candidate scale items and tested them among 572 adolescents and adults across nine California healthcare facilities in 2019–2020. We derived a 6-item scale and assessed differences by age and social determinants of health with multivariable regression.ResultsIn qualitative data, participants voiced both concerns and positive beliefs about contraception. Quantitative survey respondents were aged 21 years on average, and 24% were parous. Over half (54%) worried contraception has dangerous side effects, and 39% worried it is unnatural. The mean Contraceptive Concerns score, increasing with higher concerns, was 1.85 (SD: 1.00, range 0–4, α = 0.81). Items fit a partial credit item response model and met prespecified criteria for internal structure validity. Contraceptive use declined with increasing Concerns score (adjusted prevalence ratio [aPR] = 0.81 [0.72–0.92]). Scores were elevated among Black (mean: 2.06; aβ = 0.34 [0.09, 0.59]) and Multiracial or other race (2.11; aβ = 0.34 [0.02, 0.66]) respondents vs. White (1.66), but not Latinx respondents (1.81; aβ = 0.11 [− 0.11, 0.33]). Scores were also elevated among participants with lower maternal education (high school/Associate’s 1.89 versus college 1.60; aβ = 0.28 [0.04, 0.53]).DiscussionThe psychometrically robust Concerns instrument can be used in research to measure autonomous contraceptive decision-making and to design person-centered care.

Wildfire Threat to Inpatient Health Care Facilities in California, 2022.

Objectives. To assess wildfire risks to California inpatient health care facilities in 2022. Methods. Locations of inpatient facilities and associated inpatient bed capacities were mapped in relation to California Department of Forestry and Fire Protection fire threat zones (FTZs), which combine expected fire frequency with potential fire behavior. We computed the distances of each facility to the nearest high, very high, and extreme FTZs. Results. Half (107 290 beds) of California's total inpatient capacity is within 0.87 miles of a high FTZ and 95% (203 665 beds) is within 3.7 miles of a high FTZ. Half of the total inpatient capacity is within 3.3 miles of a very high FTZ and 15.5 miles of an extreme FTZ. Conclusions. Wildfires threaten a large number of inpatient health care facilities in California. In many counties, all health care facilities may be at risk. Public Health Implications. Wildfires in California are rapid-onset disasters with short preimpact phases. Policies should address facility-level preparedness including smoke mitigation, sheltering measures, evacuation procedures, and resource allocation. Regional evacuation needs, including access to emergency medical services and patient transportation, must also be considered. (Am J Public Health. 2023;113(5):555-558. https://doi.org/10.2105/AJPH.2023.307236).

Genomic description of human clinical Aspergillus fumigatus isolates, California, 2020.

Aspergillus fumigatus, an environmental mold, causes life-threatening infections. Studies on the phylogenetic structure of human clinical A. fumigatus isolates are limited. Here, we performed whole genome sequencing of 24 A. fumigatus isolates collected from 18 patients in U.S. healthcare facilities in California. Single-nucleotide polymorphism (SNP) differences between patient isolates ranged from 187 to 70 829 SNPs. For five patients with multiple isolates, we calculated the within-host diversities. Three patients had a within-host diversity that ranged from 4 to 10 SNPs and two patients ranged from 2 to 16 977 SNPs. Findings revealed highly diverse A. fumigatus strains among patients and two patterns of diversity for isolates that come from the same patient, low and extremely high diversity.

How California Prepared for Implementation of Physician-Assisted Death: A Primer.

Physician-assisted death is now legal in California, and similar laws are being considered in many other states. The California law includes safeguards, yet health care providers will face practical and ethical issues while implementing physician-assisted death that are not addressed by the law. To help providers and health care facilities in California prepare to provide optimal care to patients who inquire about physician-assisted death, we brought together experts from California, Oregon, and Washington. We convened a conference of 112 stakeholders in December 2015, and herein present their recommendations. Themes of recommendations regarding implementation include (1) institutions should develop and revise physician-assisted death policies; (2) legal physician-assisted death will have implications for California's culturally and socioeconomically diverse population, and for patients from vulnerable groups; (3) conscientious objection and moral distress for health care providers must be considered; and (4) palliative care is essential to the response to the law. The expert conference participants' insights are a valuable guide, both for providers and health care facilities in California planning or revising their response, and for other jurisdictions where physician-assisted death laws are being considered or implemented.

Pregnancy and the Risk of Aortic Dissection or Rupture: A Cohort-Crossover Analysis.

Case series have described aortic dissection and rupture in pregnancy. Few population-based data exist to support an association. We performed a cohort-crossover study using data on all emergency department visits and acute care hospitalizations at nonfederal healthcare facilities in California, Florida, and New York. We included women ≥12 years of age with labor and delivery or abortive pregnancy outcome between 2005 and 2013. Our outcome was a composite of aortic dissection or rupture. Based on the timing of reported aortic complications during pregnancy, we defined the period of risk as 6 months before delivery until 3 months after delivery. We compared each patient's likelihood of aortic complications during this period with an equivalent 270-day period exactly 1 year later. Incidence rates and incidence rate ratios were computed using conditional Poisson regression with robust standard errors. Among 6 566 826 pregnancies in 4 933 697 women, we identified 36 cases of aortic dissection or rupture during the pregnancy or postpartum period and 9 cases during the control period 1 year later. The rate of aortic complications was 5.5 (95% confidence interval, 4.0-7.8) per million patients during pregnancy and the postpartum period, in comparison with 1.4 (95% confidence interval, 0.7-2.9) per million during the equivalent period 1 year later. Pregnancy was associated with a significantly increased risk of aortic dissection or rupture (incidence rate ratio, 4.0; 95% confidence interval, 2.0-8.2) in comparison with the control period 1 year later. The risk of aortic dissection or rupture is elevated during pregnancy and the postpartum period.

Rural HIV-infected women's access to medical care: ongoing needs in California

HIV-infected women living in rural areas often have considerably less access to care than their urban and suburban counterparts. In much of the USA, little is known about HIV care among rural populations. This study elucidated barriers to care for rural women in California. Methods included retrospective structured interviews conducted with 64 women living in rural areas and receiving HIV care at 11 California healthcare facilities. Facilities were randomly sampled and all HIV-infected female patients seeking care at those facilities during a specified time period were eligible. The most commonly cited barriers to accessing care included physical health problems that prevented travel to care (32.8%), lack of transportation (31.2%), and lack of ability to navigate the healthcare system (25.0%). Being divorced/separated/widowed (compared to being either married or single) was associated with reporting physical health as a barrier to care (p=0.03); being unemployed (p=0.003) or having to travel 31–90 minutes (p=0.007, compared to less than 31 or greater than 90) were both associated with transportation as a barrier; and speaking English rather than Spanish was associated with reporting “difficulty navigating the system” (p=0.04). Twenty-nine women (45.3%) reported difficulty in traveling to appointments. Overall, 24 (37.5%) women missed an HIV medical appointment in the previous 12-month period, primarily due to their physical health and transportation limitations. Physical health and transportation problems were both the major barriers to accessing health services and the primary reasons for missing HIV care appointments among this population of HIV-infected women living in rural areas. Providing transportation programs and/or mobile clinics, as well as providing support for patients with physical limitations, may be essential to improving access to HIV care in rural areas.

The Food and Beverage Vending Environment in Health Care Facilities Participating in the Healthy Eating, Active Communities Program

Little has been done to ensure that the foods sold within health care facilities promote healthy lifestyles. Policies to improve school nutrition environments can serve as models for health care organizations. This study was designed to assess the healthfulness of foods sold in health care facility vending machines as well as how health care organizations are using policies to create healthy food environments. Food and beverage assessments were conducted in 19 California health care facilities that serve children in the Healthy Eating, Active Communities sites. Items sold in vending machines were inventoried at each facility and interviews conducted for information on vending policies. Analyses examined the types of products sold and the healthfulness of these products. Ninety-six vending machines were observed in 15 (79%) of the facilities. Hospitals averaged 9.3 vending machines per facility compared with 3 vending machines per health department and 1.4 per clinic. Sodas comprised the greatest percentage of all beverages offered for sale: 30% in hospital vending machines and 38% in clinic vending machines. Water (20%) was the most prevalent in health departments. Candy comprised the greatest percentage of all foods offered in vending machines: 31% in clinics, 24% in hospitals, and 20% in health department facilities. Across all facilities, 75% of beverages and 81% of foods sold in vending machines did not adhere to the California school nutrition standards (Senate Bill 12). Nine (47%) of the health care facilities had adopted, or were in the process of adopting, policies that set nutrition standards for vending machines. According to the California school nutrition standards, the majority of items found in the vending machines in participating health care facilities were unhealthy. Consumption of sweetened beverages and high-energy-density foods has been linked to increased prevalence of obesity. Some health care facilities are developing policies that set nutrition standards for vending machines. These policies could be effective in increasing access to healthy foods and beverages in institutional settings.

Did you think that it might be scabies? Identification of a case of Norwegian scabies on an acute care medical-surgical unit

BACKGROUND: Norwegian Scabies is a variant form of normal scabies caused by the parasitic mite, Sarcoptes scabei. The mite load and contagiousness of Norwegian (or crusted) scabies is extremely high. Typical scabies is difficult to transmit from patient to healthcare worker unless there is prolonged, unprotected skin-to-skin contact between the infested person and the healthcare worker. Persons with atypical or crusted scabies harbor hundreds to millions of mites in layers of crusted skin lesions. Additionally any exposure to contaminated bedding or upholstered furniture in close proximity to a patient with crusted scabies may be a source of transmission. The diagnosis of Norwegian Scabies can be difficult. This was the case at our 117-bed northern California acute care hospital. The index patient was a 72-year-old female admitted on May 12, 2004, with a diagnosis of weakness, severe dermatitis, shortness of breath, hypothermia, and rule-out sepsis. On May 28, 2004, a punch biopsy revealed the conclusive diagnosis of Norwegian scabies. PROJECT: Upon notification of the diagnosis, a multidisciplinary team was formed including the infectious disease chief, infection control manager, dermatology, employee health, in-patient and outpatient pharmacy, environmental services, medical-surgical leadership, director of quality, hospital leadership, and the county public health communicable disease department. Clear and concise communication was a key component of our rapid response. Contact precautions were implemented immediately upon notification of the diagnosis. Data collection consisting of a line listing of names of staff members who had cared for the patient prior to contact precautions was initiated. We did not have a policy and procedure specific to a scabies outbreak, but we did have an outbreak policy as well as the California Department of Health Services Division of Communicable Disease Control “Management of Scabies Outbreaks in California Health Care Facilities” to follow. Using the two documents as guidelines, we developed an outbreak definition, surveillance data collection document, and decided on an effective treatment plan for patients and staff. RESULTS: A total of 368 staff and patients were prophylaxed with permethrin cream, and 252 discharged patients notified and offered prophylaxis. CONCLUSIONS: Bedside staff learned an important lesson related to thinking of non-intact skin and the possibility of scabies and our team approach proved to be very successful with a total of only 19 secondary cases.

Sharps-related injuries in California healthcare facilities: pilot study results from the Sharps Injury Surveillance Registry.

In 1998, the California Department of Health Services invited all healthcare facilities in California (n = 2,532) to participate in a statewide, voluntary sharps injury surveillance project. The objectives were to determine whether a low-cost sharps registry could be established and maintained, and to evaluate the circumstances surrounding sharps injuries in California. Approximately 450 facilities responded and reported a total of 1,940 sharps-related injuries from January 1998 through January 2000. Injuries occurred in a variety of healthcare workers (80 different job titles). Nurses sustained the highest number of injuries (n = 658). In hospital settings (n = 1,780), approximately 20% of the injuries were associated with drawing venous blood, injections, or assisting with a procedure such as suturing. As expected, injuries were caused by tasks conventionally related to specific job classifications. The overall results approximate those reported by the Centers for Disease Control and Prevention's National Surveillance System for Health Care Workers and the University of Virginia's Exposure Prevention Information Network. These data further support findings from previous studies documenting the complex and persistent nature of sharps-related injuries in healthcare workers. In the future, mandated reporting using standardized forms and consistent application of decision rules would facilitate a more thorough analysis of injury events.

Sharps injury recordkeeping activities and safety product use in California health care facilities:: Pilot study results from the sharps injury control program

Background: In 1999, licensed health care facilities in California (N = 2532) were invited to participate in a survey about occupational bloodborne pathogens exposure surveillance activities, recordkeeping methods, and use of safety-enhanced sharps devices. Results: A total of 1274 facilities responded to the survey from January 1999 through August 1999 (response rate = 50%). Sharps-related injuries were recorded for multiple departments on various forms in diverse manners. Only 66% of hospitals, 37% of home health agencies, and 33% of skilled nursing facilities reported sharps injuries on a mandated sharps injury log. More than 70% of facilities stated that they used some type of safety device or needleless system, but this figure varied by type of device and facility type. Eighty-four percent of general acute care hospitals, 28% of home health agencies and skilled nursing facilities each had evaluated at least 1 safety-enhanced device. Almost 90% of all facilities expressed a need for educational materials on topics such as device selection and evaluation. Conclusions: Standardization of surveillance and recordkeeping activities does not exist across facility types. Standards and regulations demand complex recordkeeping activities. Increased funding for distribution of educational materials and on-site training should accompany changes in mandated reporting activities when appropriate. Increased testing and evaluation of devices across facility types are necessary to ensure that safety-enhanced devices are protective of health care workers and patients. (Am J Infect Control 2002;30:269-76.)

Repair and Retrofit of Health Care Facilities

While since 1973 the design and construction of new California Health Care Facilities have been regulated by special ordinances, pre-existing hospitals have remained largely non-compliant due to the prohibitive costs of upgrading. The special seismic design considerations that are needed for new and existing facilities, a program for assessing the projected performance of these facilities in terms of life-safety and ability to remain operational under various seismic conditions, as well as for developing effective, phased retrofit strategies to improve performance is discussed in this paper.

Employer Drug Testing:

Karen Hawley Henry is the Managing Partner of the Labor and Employment Law Department for Weissburg and Aronson, Inc., a multi-practice law firm which specializes in the representation of health care providers and employers. Ms. Henry received her law degree from Hastings College of Law in San Francisco, and previously received a Masters in Labor Economics from Iowa State Univirsity. She serves as labor counsel to the Affiliated Hospitals of San Francisco, a multi-employer collective bargaining group, and also represents a number of other public and private California health care facilities. In addition to her presentations at numerous seminars and programs on employment law issues, she participated in AHA's 1987 Teleconference on Drug Testing and Substance Abuse, is a member of AHA's Ad Hoc Labor Relations committee, and has authorized numerous publications, including the "Health Care Supervisor's Legal Guide." Her firm currently is working with a number of employers developing policies related to fitness for duty or drug testing.

A clinical ladder for nursing practice.

The authors discuss the clinical ladder concept of appointment and promotion for registered nurses employed by the nursing services of the University of California Health Care Facilities. The system, a behaviorally stated clinical series of four levels, was developed so that clinical competence, knowledge, and performance could be rewarded extrinsically and intrinsically.