Full-time Equivalent Staff Research Articles

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RREACT: A mobile multidisciplinary response to overdose.

Opioid overdose is a leading cause of death in the United States, and engaging with patients following overdose to provide harm reduction and recovery resources can prove difficult. Quick response models use mobile, multidisciplinary teams to establish a time-sensitive connection between individuals who overdosed and harm reduction and recovery resources that improve outcomes. These quick response models are consistent with the broader field of mobile-integrated health programs that are growing in number and acceptability, though the literature base is sparse and programs vary. We describe the 5-year reach, effectiveness, adoption, implementation and maintenance (RE-AIM) framework of the Rapid Response Emergency Addiction and Crisis Team (RREACT), a fire/emergency medical services-led, multidisciplinary (firefighter/paramedic, law enforcement officer, social worker) mobile outreach team. RREACT provides harm reduction, linkage/transportation to care and wrap-around services to individuals following a nonfatal opioid overdose that resulted in an emergency response in Columbus, Franklin County, Ohio, United States. Between 2018 and 2022, RREACT made 22,157 outreach attempts to 11,739 unique patients. RREACT recorded 3,194 direct patient contacts during this time, resulting in 1,200 linkages to care: 799 direct transports to opioid use disorder treatment and 401 warm handoffs to community treatment agencies. Furthermore, RREACT's staffing increased from 4 full-time equivalent staff in 2018 to 15.5 in 2022 and was supported by the surrounding community through 287 community outreach events and the development of an alumni program. These preliminary results further support the deployment of multidisciplinary mobile outreach teams to increase access to harm reduction and recovery resources following opioid overdose.

New Zealand’s bibliometric record in research and development: 1990–2008

Over the last two decades, the New Zealand government has sought to achieve improved outcomes in science and technology through structural reform, rather than increased levels of investment in the sector. How successful has this strategy been? Here we look at New Zealand’s bibliometric output over the last two decades, using the Thompson Reuters Web of Science database. The database reveals that bibliometric productivity has remained static over this time period, with changes in publication rate driven by increasing levels of full–time equivalent staff members, principally through growth in the tertiary sector. Although the citation impact of university publications has increased, the citation impact of the Crown research institutes has grown at a similar, if not faster, rate, suggesting that the performance-based research fund is not responsible for this increase.

Waiting in Pain II: An Updated Analysis of the Multidisciplinary Staffing Levels and Clinical Activity in Australian Specialist Persistent Pain Services

This study provides an update on multidisciplinary staffing and clinical activity in Australian specialist persistent pain services. Of the 109 services identified, 57 responded, met inclusion criteria and completed a study-specific questionnaire detailing service characteristics, staff resources, and clinical activities. Where possible, data were compared between the ‘Waiting in Pain’ (WIP) investigations (WIP-I: Dec’08–Jan’10, WIP-II: Jul’16–Feb’18). WIP-II found more pain services (Level 1 centres, rural services) and more full-time equivalent (FTE) staffing (overall, psychiatry, psychology, occupational therapy) than WIP-I. Although Level 1 centres employed more FTE staff (overall, medical) than Level 2 clinics, staffing was comparable when considered relative to clinical activity and this was stable over time for most disciplines. Clinical activity in metropolitan and rural services also remained stable, as did rural service staffing (type, FTE), suggesting that newer clinics replicated existing models. WIP-II highlighted greater diversity in group structures than WIP-I and an associated mean .02FTE allied health staff/patient seen (WIP-I = .03 FTE). Staffing (amounts, types) did not change significantly over time when considered relative to clinical activity, supporting the conclusion that these are workable clinical structures. However, changes in group format (duration, staffing) suggest a shift towards lower-intensity programmes that require less allied health staffing to deliver. PerspectiveThis article presents updated data regarding multidisciplinary staffing profiles, clinical activity, and group programme structures within Australian specialist persistent pain services and examines changes since the original investigation. As the only published staffing profile for multidisciplinary pain services, this project provides critical information to inform service (re)design and care delivery.

Optimizing Patient-Reported Outcome Collection and Documentation in Medical Music Therapy: Process-Improvement Study.

To measure the effectiveness of nonpharmacologic interventions delivered during clinical care, investigators need to ensure robust and routine data collection without disrupting individualized patient care or adding unnecessary documentation burden. A process-improvement study was undertaken to improve documentation consistency and increase the capture of patient-reported outcomes (PROs; ie, stress, pain, anxiety, and coping) within a medical music therapy (MT) team. We used 2 Plan-Do-Study-Act (PDSA) cycles to improve documentation processes among an MT team (13.3 clinical full-time equivalent staff). Trainings focused on providing skills and resources for optimizing pre- and postsession PRO collection, specific guidelines for entering session data in the electronic health record, and opportunities for the team to provide feedback. Two comparisons of therapists' PRO collection rates were conducted: (1) between the 6 months before PDSA Cycle 1 (T0) and PDSA Cycle 1 (T1), and (2) between T1 and PDSA Cycle 2 (T2). Music therapists' rates of capturing any PRO within MT sessions increased significantly (P<.001) from T0 to T1 and from T1 to T2 for all domains, including stress (4/2758, 0.1% at T0; 1012/2786, 36.3% at T1; and 393/775, 50.7% at T2), pain (820/2758, 29.7% at T0; 1444/2786, 51.8% at T1; and 476/775, 61.4% at T2), anxiety (499/2758, 18.1% at T0; 950/2786, 34.1% at T1; and 400/775, 51.6% at T2), and coping (0/2758, 0% at T0; 571/2786, 20.5% at T1; and 319/775, 41.2% at T2). Music therapists' feedback and findings from a retrospective analysis were used to create an improved electronic health record documentation template. Rates of PRO data collection improved within the medical MT team. Although the process improvement in this study was applied to a nonpharmacologic MT intervention, the principles are applicable to numerous inpatient clinical providers. As hospitals continue to implement nonpharmacologic therapies in response to the Joint Commission's recommendations, routine PRO collection will provide future researchers with the ability to evaluate the impact of these therapies on pain relief and opioid use.

Using the National Mental Health Service Planning Framework to inform integrated regional planning: a case study in Tasmania, Australia

BackgroundThe aim of this study was to demonstrate the application of a needs-based mental health service planning model in Tasmania, Australia to identify indicative directions for future service development that ensure the equitable provision of mental health services across the State.MethodsThe activity and capacity of Tasmania’s 2018–19 mental health services were compared to estimates of required care by: (1) generating estimates of required care using the National Mental Health Service Planning Framework (NMHSPF); (2) collating administrative mental health services data; (3) aligning administrative data to the NMHSPF; and (4) comparing aligned administrative data and NMHSPF estimates to identify priority areas for service development. Findings were contextualised using information about service location, population demographics, and upcoming service development.ResultsBed-based services capacity reached 85% of the NMHSPF estimate. However, access to certain bed types was inequitable across regional areas. Access to jurisdictional clinical ambulatory team-based services was lowest in the South, while overall full-time equivalent staff capacity reached 58% of the NMHSPF estimate. Access to Primary Health Tasmania (PHT) primary care services was highest in the North West; access to Medicare services was highest in the South. Collectively, activity across primary care (PHT, headspace and Medicare) reached 43% of the NMHSPF estimate. Over half of Community Managed Mental Health Support Services were state-wide services.ConclusionsThis study demonstrates the application of a needs-based planning model for mental health services. Findings revealed service priority areas across Tasmania and highlight considerations for needs-based planning.

The Landscape of Outpatient Pediatric Palliative Care: A National Cross-Sectional Assessment.

Inpatient pediatric palliative care (PPC) has grown substantially over the past 20 years; however, PPC in the outpatient setting remains underdeveloped. Outpatient PPC (OPPC) offers opportunities to improve access to PPC as well as facilitate care coordination and transitions for children with serious illness. This study aimed to characterize the national status of OPPC programmatic development and operationalization in the United States. Utilizing a national report, freestanding children's hospitals with existing PPC programs were identified to query OPPC status. An electronic survey was developed and distributed to PPC participants at each site. Survey domains included hospital and PPC program demographics; OPPC development, structure, staffing, and workflow; metrics of successful OPPC implementation; and other services/partnerships. Of 48 eligible sites, 36 (75%) completed the survey. Clinic-based OPPC programs were identified at 28 (78%) sites. OPPC programs reported a median age of 9 years [range: 1-18 years] with growth peaks in 2011, 2012 and 2020. OPPC availability was significantly associated with increased hospital size [P=0.05] and inpatient PPC billable full time equivalent staff [P=0.01]. Top referral indications included pain management, goals of care, and advance care planning. Funding primarily came from institutional support and billing revenue. Although OPPC remains a young field, many inpatient PPC programs are growing into the outpatient setting. Increasingly, OPPC services have institutional support and diverse referral indications from multiple subspecialties. However, despite high demand, resources remain limited. Characterization of the current OPPC landscape is crucial to optimize future growth.

Analysis of data items and gaps in Australia's national mental health services activity and capacity data collections for integrated regional service planning.

Background: Services data are an important source of information for policymakers and planners. In Australia, significant work has been undertaken to develop and implement collections of mental health services data. Given this level of investment, it is important that collected data are fit for purpose. Objective: This study aimed to: (1) identify existing national mandated and best endeavours collections of mental health services activity (e.g. occasions of service) and capacity (e.g. full-time equivalent staff) data in Australia; and (2) review the content of identified data collections to determine opportunities for data development. Method: A grey literature search was conducted to identify data collections. Where available, metadata and/or data were analysed. Results: Twenty data collections were identified. For services that received funding via multiple funding streams, data were often captured across several collections corresponding with each funder. There was significant variability in the content and format of collections. Unlike other service sectors, there is no national, mandated collection for psychosocial support services. Some collections have limited utility as they do not include key activity data; others do not include descriptive variables like service type. Workforce data are often not collected, and where data are collected, they are often not comprehensive. Conclusion: Findings are an important source of information for policymakers and planners who use services data to inform priorities. Implications: This study provides recommendations for data development, including mandating standardised reporting for psychosocial supports, filling workforce data gaps, streamlining data collections and including key missing data items in some collections.

Changes in Primary Care Quality Associated With Implementation of the Veterans Health Administration Preventive Health Inventory

The COVID-19 pandemic caused significant disruptions in primary care delivery. The Veterans Health Administration (VHA) launched the Preventive Health Inventory (PHI) program-a multicomponent care management intervention, including a clinical dashboard and templated electronic health record note-to support primary care in delivering chronic disease care and preventive care that had been delayed by the pandemic. To describe patient, clinician, and clinic correlates of PHI use in primary care clinics and to examine associations between PHI adoption and clinical quality measures. This quality improvement study used VHA administrative data from February 1, 2021, through February 28, 2022, from a national cohort of 216 VHA primary care clinics that have implemented the PHI. Participants comprised 829 527 veterans enrolled in primary care in clinics with the highest and lowest decile of PHI use as of February 2021. Templated electronic health record note documenting use of the PHI. Diabetes and blood pressure clinical quality measures were the primary outcomes. Interrupted time series models were applied to estimate changes in diabetes and hypertension quality measures associated with PHI implementation. Low vs high PHI use was stratified at the facility level to measure whether systematic differences in uptake were associated with quality. A total of 216 primary clinics caring for 829 527 unique veterans (mean [SD] age, 64.1 [16.9] years; 755 158 of 829 527 [91%] were men) formed the study cohort. Use of the PHI varied considerably across clinics. The clinics in the highest decile of PHI use completed a mean (SD) of 32 997.4 (14 019.3) notes in the electronic health record per 100 000 veterans compared with 56.5 (35.3) notes per 100 000 veterans at the clinics in the lowest decile of use (P < .001). Compared with the clinics with the lowest use of the PHI, clinics with the highest use had a larger mean (SD) clinic size (12 072 [7895] patients vs 5713 [5825] patients; P < .001), were more likely to be urban (91% vs 57%; P < .001), and served more non-Hispanic Black veterans (16% vs 5%; P < .001) and Hispanic veterans (14% vs 4%; P < .001). Staffing did not differ meaningfully between high- and low-use clinics (mean [SD] ratio of full-time equivalent staff to clinician, 3.4 [1.2] vs 3.4 [0.8], respectively; P < .001). After PHI implementation, compared with the clinics with the lowest use, those with the highest use had fewer veterans with a hemoglobin A1c greater than 9% or missing (mean [SD], 6577 [3216] per 100 000 veterans at low-use clinics; 9928 [4236] per 100 000 veterans at high-use clinics), more veterans with an annual hemoglobin A1c measurement (mean [SD], 13 181 [5625] per 100 000 veterans at high-use clinics; 8307 [3539] per 100 000 veterans at low-use clinics), and more veterans with adequate blood pressure control (mean [SD], 20 582 [12 201] per 100 000 veterans at high-use clinics; 12 276 [6850] per 100 000 veterans at low-use clinics). This quality improvement study of the implementation of the VHA PHI suggests that higher use of a multicomponent care management intervention was associated with improved quality-of-care metrics. The study also found significant variation in PHI uptake, with higher uptake associated with clinics with more racial and ethnic diversity and larger, urban clinic sites.

Physiotherapy services in intensive care. A workforce survey of Australia and New Zealand

BackgroundIn Australia and New Zealand, there are currently no recommendations to guide staffing levels for intensive care unit (ICU) physiotherapy services, and there is limited information about the current services provided. ObjectivesThe objective of this study was to document the profile of intensive care physiotherapy services currently offered in Australia and New Zealand. MethodsA binational survey was distributed to physiotherapists. The survey sought information on staffing and service profiles for weekday, weekend, and after-hour services including on-call and evening shifts. ResultsEighty-six sites completed the survey, with responses primarily from Level 3 (47/86, 55%) and public ICUs (74/86, 86%). For weekday services, the ratio of full-time equivalent physiotherapy staff allocated per bed was similar between all intensive care levels (0.11 [0.08–0.15], p = 0.421). Thirty respondents (35%) were satisfied with their staffing and reported higher levels of physiotherapy staff per bed (0.15 [0.1–0.2], p < 0.001). Most sites reported lower levels of staffing for weekend services (76/86, 88%), and many physiotherapists indicated that they were not satisfied with this service (55/86, 64%). Most Level 2, Level 3, and paediatric ICUs had a designated senior physiotherapist, with similar levels of senior physiotherapy staff allocated per bed between all ICU levels (0.05 [0.03–0.08], p = 0.844). Few sites reported dedicated staff attributed to intensive care education, research, tracheostomy service, or outreach roles. On-call physiotherapy services were available in 49 of 86 (57%) hospitals surveyed; however, utilisation of the service by ICUs was mainly reported to be less than once per month (19/49, 39%). ConclusionsPhysiotherapy staffing ratios were similar across different ICU levels. While weekend services are available for most ICUs, staffing levels are reduced. Higher staffing ratios were associated with higher levels of satisfaction to complete professional roles and responsibilities.

Enumeration of the Public Health Workforce in New York State: Workforce Changes in the Wake of COVID-19.

The governmental public health workforce in the United States has faced staffing shortages for over a decade that have been exacerbated by the COVID-19 pandemic. To assess this critical issue, the Region 2 Public Health Training Center collaborated with the New York State Association of County Health Officials to enumerate the city and county public health workforce in New York State. The organizations used an online survey to: (1) count employees and full-time equivalent (FTEs) staff in local health departments in 2021; (2) assess workforce trends since the COVID-19 pandemic; and, (3) identify challenges local health departments encounter in recruiting and retaining qualified public health workers. To assess trends, findings were compared with secondary data from 2019. Despite playing a central role in COVID-19 mitigation, local health departments experienced no overall increase in staffing in 2021 compared to 2019, with many health departments experiencing large increases in vacant positions. Recruitment challenges include noncompetitive salaries, difficulties finding qualified candidates, and lengthy hiring processes. This study complements accumulating evidence indicating that long-term investment in local public health infrastructure is needed to bolster the workforce and ensure that communities are protected from current and future health threats.

Did submission rules affect the submission sizes of the units to the UK’s Research Excellence Framework in 2014?

ABSTRACT The Research Excellence Framework (REF) follows a set of submission rules. Here we analyse whether the submission rules of the impact element arguably shaped the submission sizes of the submitting units – a group of academics researching on a specific subject area in higher education providers – to the REF in 2014. The number of impact case studies required was determined by the number of full-time equivalent (FTE) staff members submitted by the unit. We argue that units that did not have an extra impact case study or units’ perception of lower quality of additional impact case study made some units to lower their submission sizes. We show that there were proportionately more submissions with a size just below the threshold FTE – a threshold used to identify the numbers of impact case studies – than those just above the threshold, suggesting that some units arguably decreased their size to return fewer impact studies.

Allied health surge capacity in Australian intensive care units during the COVID-19 pandemic: A cross-sectional survey

BackgroundBased on the early international COVID-19 experience, it was anticipated that intensive care services and workforces in Australia would be placed under similar pressure. While surge capacity of medical and nursing workforces was estimated, little was known about baseline allied health staffing, making it difficult to estimate surge capacity and coordinate planning. ObjectivesThe purpose of this study was to (i) capture baseline allied health staffing levels in Australian adult intensive care units (ICUs) prior to the COVID-19 pandemic emergence in Australia and (ii) describe the allied health pandemic planning and surge response in Australian ICUs during the early waves of the pandemic. MethodsThis was a cross-sectional, investigator-devised, prospective survey study. The survey was administered via the national chief allied health network to a convenience sample of senior ICU allied health clinicians at hospitals throughout Australia. ResultsA total of 40 responses were received from tertiary and metropolitan hospitals; 12 (30%) physiotherapists and eight (20%) occupational therapists were the most frequent respondents. Prior to the COVID-19 pandemic, 28 (70%) allied health respondents had a mean (interquartile range) of 1.74 (2.00) full-time equivalent staff designated to the ICU, where these ICUs had a mean of 21.53 (15.00) ventilator beds. Few respondents serviced their ICU on a referral-only basis and did not have dedicated ICU full-time equivalent (12; 20%). Surge planning was mostly determined by discussion within the ICU, allied health department, and/or respective disciplines. This approach meant that allied health staffing and associated decision-making was ad hoc at a local level. ConclusionsThe baseline rate of allied health coverage in Australian ICUs remains unknown, and the variability across allied health and within the specific disciplines is undetermined. Further research infrastructure to capture ICU allied health workforce data is urgently needed to guide future pandemic preparedness.

Resource Savings Associated With Use of an Automated Symptom Monitoring Tool for COVID-19 Public Health Response, Summer 2020-Summer 2021.

Context:Active symptom monitoring is a key component of the public health response to COVID-19, but these activities are resource-intensive. Digital tools can help reduce the burden of staff time required for active symptom monitoring by automating routine outreach activities.Program:Sara Alert is an open-source, Web-based automated symptom monitoring tool launched in April 2020 to support state, tribal, local, and territorial jurisdictions in their symptom monitoring efforts.Implementation:As of October 2021, a total of 23 public health jurisdictions in the United States had used Sara Alert to perform daily symptom monitoring for more than 6.1 million individuals. This analysis estimates staff time and cost saved in 3 jurisdictions that used Sara Alert as part of their COVID-19 response, across 2 use cases: monitoring of close contacts exposed to COVID-19 (Arkansas; Fairfax County, Virginia), and traveler monitoring (Puerto Rico).Evaluation:A model-based approach was used to estimate the additional staff resources that would have been required to perform the active symptom monitoring automated by Sara Alert, if monitoring instead relied on traditional methods such as telephone outreach. Arkansas monitored 283 705 individuals over a 10-month study period, generating estimated savings of 61.9 to 100.6 full-time equivalent (FTE) staff, or $2 798 922 to $4 548 249. Fairfax County monitored 63 989 individuals over a 13-month study period, for an estimated savings of 24.8 to 41.4 FTEs, or $2 826 939 to $4 711 566. In Puerto Rico, where Sara Alert was used to monitor 2 631 306 travelers over the 11-month study period, estimated resource savings were 849 to 1698 FTEs, or $26 243 161 to $52 486 322.Discussion:Automated symptom monitoring helped reduce the staff time required for active symptom monitoring activities. Jurisdictions reported that this efficiency supported a rapid and comprehensive COVID-19 response even when experiencing challenges with quickly scaling up their public health workforce.

Exploring the relationship between women's experience of postnatal care and reported staffing measures: An observational study.

Women have reported dissatisfaction with care received on postnatal wards and this area has been highlighted for improvement. Studies have shown an association between midwifery staffing levels and postnatal care experiences, but so far, the influence of registered and support staff deployed in postnatal wards has not been studied. This work is timely as the number of support workers has increased in the workforce and there has been little research on skill mix to date. Cross sectional secondary analysis including 13,264 women from 123 postnatal wards within 93 hospital Trusts. Staffing was measured in each organisation as Full Time Equivalent staff employed per 100 births, and on postnatal wards, using Hours Per Patient Day. Women's experiences were assessed using four items from the 2019 national maternity survey. Multilevel logistic regression models were used to examine relationships and adjust for maternal age, parity, ethnicity, type of birth, and medical staff. Trusts with higher levels of midwifery staffing had higher rates of women reporting positive experiences of postnatal care. However, looking at staffing on postnatal wards, there was no evidence of an association between registered nurses and midwives hours per patient day and patient experience. Wards with higher levels of support worker staffing were associated with higher rates of women reporting they had help when they needed it and were treated with kindness and understanding. The relationship between reported registered staffing levels on postnatal wards and women's experience is uncertain. Further work should be carried out to examine why relationships observed using whole Trust staffing were not replicated closer to the patient, with reported postnatal ward staffing. It is possible that recorded staffing levels on postnatal wards do not actually reflect staff deployment if midwives are floated to cover delivery units. This study highlights the potential contribution of support workers in providing quality care on postnatal wards.

The Organization, Content, and Case-Finding Effectiveness of HIV Assisted Partner Services in High HIV Morbidity Areas of the United States.

The contemporary effectiveness of assisted partner notification services (APS) in the United States is uncertain. State and local jurisdictions in the United States that reported ≥300 new HIV diagnoses in 2018 and were participating in the Ending the Epidemic Initiative. The study surveyed health departments to collect data on the content and organization of APS and aggregate data on APS outcomes for 2019. Analyses defined contact and case-finding indices (i.e., sex partners named and newly diagnosed per index case receiving APS) and estimated staff case-finding productivity. Sixteen (84%) of 19 jurisdictions responded to the survey, providing APS outcome data for 14 areas (74%). Most health departments routinely integrated APS with linkage of cases and partners to HIV care (88%) and pre-exposure prophylaxis (88%). A total of 19,164 persons were newly diagnosed with HIV in the 14 areas. Staff initiated APS investigations on 14,203 cases (74%) and provided APS to 9937 cases (52%). Cases named 6799 partners (contact index = 0.68), of whom 1841 (27%) had previously diagnosed HIV, 2202 (32%) tested HIV negative, 541 (8% of named and 20% of tested partners) were newly diagnosed with HIV, and 2215 (33%) were not known to have tested. Across jurisdictions, the case-finding index was 0.054 (median = 0.05, range 0.015-0.12). Health departments employed 292 full-time equivalent staff to provide APS. These staff identified a median of 2.0 new HIV infections per staff per year. APS accounted for 2.8% of new diagnoses in 2019. HIV case-finding resulting from APS in the United States is low.

Estimating the Impact of Medicaid Expansion and Federal Funding Cuts on FQHC Staffing and Patient Capacity.

The Health Resources and Services Administration's Health Center Program (HCP) plays a critical role as the national ambulatory safety net, delivering services to patients in medically underserved areas, regardless of their ability to pay. As the program has grown, health policy initiatives may have altered access to care for the underserved population. Understanding how federally qualified health centers (FQHCs) have been affected by past policies is important for anticipating the effects of future policies. By analyzing a national data set from the Uniform Data System, we examined, using two sets of random effects regressions, the potential impact of alternative policy actions affecting FQHCs. Our primary equation models the number of full-time equivalent staff, of patients served, and of visits provided in the subsequent year as a function of Medicaid revenues, Section 330 grants, and other revenues. Our secondary equation is a difference-in-differences analysis that models Medicaid revenues as a function of the states' status of Medicaid expansion. The expansion of Medicaid in nonexpansion states could have increased Medicaid revenues by 138%, staffing by 25%, and patients' visits by 24% in 2017. Compared to the impact of a "repeal" of Medicaid expansion, the percentage of reductions in staffing would be similar to those predicted by a 50% cut in Medicaid revenues or in Section 330 grants. On a dollar-for-dollar basis, the effects of one dollar of Section 330 grants were more than double that of one dollar of Medicaid revenue. Both Medicaid eligibility and Section 330 funding support are important to the HCP, and Section 330 grants are particularly closely related to staffing and the provision of services. States' decisions not to participate in or to repeal Medicaid expansion, to reduce Medicaid payment rates, and federal funding cuts all could have a negative impact on FQHCs, resulting in thousands of low-income patients losing access to primary care.

Phlebotomy Staffing.

Laboratory directors are tasked with staffing laboratories in a manner that provides adequate services and maintains economic sustainability. To determine the national normative rates of phlebotomy staffing and the types of laboratory operational characteristics that may be associated with the magnitude of those staffing levels. Study participants provided data on inpatient and outpatient phlebotomy sites, including the numbers of patients receiving phlebotomy services, phlebotomy staff, and billable tests. From these data, we calculated performance indicators including the numbers of phlebotomies/phlebotomy full-time equivalent staff, outpatient phlebotomy visits/full-time equivalent staff, and average outpatient phlebotomy wait times. Participants also completed a survey of their laboratory phlebotomy practices. This study was conducted during the third quarter of 2017. Forty-two institutions participated in this study, providing eligible results for 40 selected inpatient sites and 70 selected outpatient sites. The ratios for all performance indicators spanned between 3.3- and 142-fold. The median average outpatient phlebotomy wait time was 8 minutes. None of the performance indicators were associated with the practice variables that we chose to test. The distribution of phlebotomy staffing performance indicators among the laboratories participating in this study varied widely, even among those groups performing similar volumes of tests.

Heterogeneity and Interoperability in Local Public Health Information Systems.

Heterogeneity and Interoperability in Local Public Health Information Systems.

Data Architecture to Support Real-Time Data Analytics for the Population-Based HIV Impact Assessments.

Electronic data capture facilitates timely use of data. Population-based HIV impact assessments (PHIAs) were led by host governments, with funding from the President's Emergency Plan for AIDS Relief, technical assistance from the Centers for Disease Control, and implementation support from ICAP at Columbia University. We described data architectures, code-based processes, and resulting data volume and quality for 14 national PHIA surveys with concurrent timelines and varied country-level data governance (2015-2020). PHIA project data were collected through tablets, point-of-care and laboratory testing instruments, and inventory management systems, using open-source software, vendor solutions, and custom-built software. Data were securely uploaded to the PHIA data warehouse daily or weekly and then used to populate survey-monitoring dashboards and return timely laboratory-based test results on an ongoing basis. Automated data processing allowed timely reporting of survey results. Fourteen data architectures were successfully established, and data from more than 450,000 participants in 30,000 files across 13 countries with completed PHIAs, and blood draws producing approximately 6000 aliquots each week per country, were securely collected, transmitted, and processed by 17 full-time equivalent staff. More than 25,600 viral load results were returned to clinics of participants' choice. Data cleaning was not needed for 98.5% of household and 99.2% of individual questionnaires. The PHIA data architecture permitted secure, simultaneous collection and transmission of high-quality interview and biomarker data across multiple countries, quick turnaround time of laboratory-based biomarker results, and rapid dissemination of survey outcomes to guide President's Emergency Plan for AIDS Relief epidemic control.