Institution-level Characteristics Research Articles

Prescription of Nonpharmacologic Interventions in Memory Clinics: Data from the Clinical Pathway for Alzheimer's Disease in China (CPAD) Study

ObjectivesNonpharmacologic interventions are recommended to improve outcomes in dementia. Little is known about their prescription in practice, especially in non-Western populations. We investigated individual- and institution-level characteristics associated with nonpharmacologic interventions prescription in China. DesignA multicenter observational study. Setting and ParticipantsThis study used cross-sectional data from 889 community-dwelling outpatients living with dementia aged ≥45 years from a multicenter registry of 28 memory clinics in China. MethodsPrescription records of nonpharmacologic interventions, carer and clinic characteristics, and reasons for declining interventions were collected. Multilevel logistic regression was used to identify factors associated with the prescription. ResultsNonpharmacologic interventions were prescribed in 323 people (36.3%) with mild cognitive impairment or dementia. Cognitive activities and carer training/support were the most prescribed interventions. Multilevel logistic regression showed that 73% of the variance in prescription was attributed to institutional characteristics of the memory clinic. Greater caregiving gain [odds ratio (OR), 1.05; 95% CI, 1.02-1.09], lower burden (OR, 0.97; 95% CI, 0.95-1.00), worse carer-perceived dyad relationship (OR, 0.83; 95% CI, 0.70-0.99), and family history of dementia (OR, 2.08; 95% CI, 1.19-3.65) were individual-level factors associated with prescription. Among 440 people considered having a need but received no prescription, declined by user/carer was the main reason for not prescribing (70.7%). Skepticism about effectiveness by physicians/carers and carers being unable or lacking resources to use the interventions were the common reasons given. Conclusions and ImplicationsA relatively low prescription rate of nonpharmacologic interventions is related to both individual- and institution-level factors. Carer support and education, instrumental support, and prescription guidelines across specialties and sites are possible strategies to improve access to nonpharmacologic interventions in dementia care.

Mental health among U.S. College students: implications of COVID-19 and roles of institutional and individual characteristics

Previous research on college campus environments, student mental health, and COVID-19 has primarily focused on individual-level factors, with limited attention to the broader institutional characteristics. Objective and Methods: Using the national survey data from the American College Health Association, this study examines the influence of both individual-level and institutional-level characteristics on college students’ stress, psychological distress, and psychological well-being, before and during COVID-19. Results: (1) COVID-19 significantly impacted students’ mental health; (2) institutional-level factors, such as school size, locale, region, and religiously affiliation, were significant predictors of mental health outcomes; and (3) individual-level variables, including gender, age, race/ethnicity, relationship status, moderated the relationship between COVID-19 and mental health. Conclusion: This study suggests the need to consider various institutional contexts in future efforts to understand predictors of mental health conditions and resilience.

Why do Chinese High School Graduates Choose Sino-Foreign Cooperative Universities? A Grounded Theory Approach

Sino-foreign cooperative universities (SFCU) represent the advanced manifestation of transnational education in China and has profoundly shaped the country’s higher education landscape. Despite the tremendous development of SFCUs, there is limited research on the motivations and driving factors of students choosing to study at SFCUs. To bridge this research gap, this study employs the grounded theory approach to examine why Chinese high school graduates choose SFCUs as study destinations. This study reveals that Chinese students’ choice of SFCUs results from personal considerations, institution-level characteristics, and social contexts. A theoretical framework is further proposed to better understand Chinese students’ motivations behind their choice to SFCUs. We also draw theoretical contributions on students’ mobility and marketing strategies that attract Chinese students to study at SFCUs with the findings.

The Incidence and Risk Factors for Emergency Department Imaging in Acute Renal Colic.

Objective: To determine the incidence of and risk factors for imaging in patients presenting to the emergency department (ED) with renal colic. Subject/Patients and Methods: We conducted a population-based cohort study in the province of Ontario, utilizing linked administrative health data. Patients who presented to an ED with renal colic between April 1, 2010, and June 30, 2020, were included. The rate of initial imaging (CT scans and ultrasound [U/S]) and repeat imaging within 30 days was determined. Generalized linear models were utilized to evaluate patient and institutional-level characteristics associated with imaging, and specifically CT vs U/S. Results: There were 397,491 index renal colic events, of which 67% underwent imaging (CT 68%, U/S 27%, and CT+U/S same day 5%). Repeat imaging was performed in 21% of events (U/S in 12.5%, CT in 8.4%) at a median of 10 days. Of those with an initial U/S, 28% had repeat imaging compared with 18.5% for those with an initial CT. Undergoing an initial CT was associated with being male, urban residence, later year of cohort entry, history of diabetes mellitus and inflammatory bowel disease, and presentation to nonacademic hospitals of larger size, or with a higher volume of ED visits. Conclusion: Two-thirds of renal colic patients underwent imaging, and CT was the most utilized modality. Patients undergoing an initial CT had a lower likelihood of repeat imaging within 30 days. The utilization of CT increased over time and was more common in males and those presenting to nonacademic hospitals of larger size, or with higher ED volumes. Our study highlights the patient- and institution-level factors that need to be targeted with prevention strategies to reduce the utilization of CT scans, when possible, for cost reduction and to minimize patient exposure to ionizing radiation.

Resident- and Institutional-Level Factors, Frailty, and Nursing Homes Residents.

Frailty is a major cause of adverse health outcomes, such as hospitalization, falls, disability, and morbidity, among older adults; the elucidation of factors affecting frailty trends over time may facilitate the development of effective interventions. This study aimed to examine the trend of frailty over time (at baseline, 6-month follow-up, and 12-month follow-up) among Chinese nursing home residents and identify associated resident- and institutional-level factors. This longitudinal study included 353 residents who were admitted into 27 nursing homes in Jinan, China. Frailty was defined based on the seven self-reported components of the FRAIL-NH scale, which was designed for nursing home residents. Information was gathered using scales that assessed resident-level (sociodemographic characteristics and physical, psychological, and social factors) and institutional-level characteristics (hospital affiliation, fitness sites, green space, occupancy percentage, staff-resident ratio, and staff turnover rate). These data were subjected to a multilevel linear analysis. Frailty was identified in 49.7% of residents at baseline and exhibited a progressively worsening trend over 1 year. Among institutional-level characteristics, the provision of fitness sites in nursing homes was a protective factor for frailty. Among resident-level characteristics, undernutrition was a significant independent risk factor and played a key role in increasing frailty over time. Other risk factors for frailty included younger age, poorer self-rated health, lower physical function, chewing difficulty, loneliness, anxiety, and being less active in leisure activities. Frailty was highly prevalent among Chinese nursing home residents and gradually increased over time. The results of this study could be used to inform the development of interventions targeted at modifiable risk factors and shape public health policies aimed at promoting healthy aging and delaying frailty and its adverse outcomes.

Institutional and State-Level Factors Related to Paying Back Student Loan Debt Among Public, Private, and For-Profit Colleges

In this study, we examine whether institutional-level characteristics, student demographics, and state conditions are associated with student loan repayment rates and cohort-level loan default rates. We separately explore these characteristics for each of four higher education sectors: public 2-year colleges, for-profit colleges, public 4-year colleges, and private 4-year colleges. We conduct a series of multiple linear regressions on a sample of 2,375 colleges. Estimates suggest that across all sectors except at for-profits, colleges enrolling a higher percentage of historically underrepresented students, including first-generation and African American/Black students, report lower repayment rates. Additionally, a higher percentage of students enrolled who file as independents for tax purposes, as well as lower levels of family incomes among independent students, and lower graduation rates are all associated with lower repayment rates, across all four sectors. With the exception of for-profit colleges, the factors associated with higher cohort default rates include a smaller percentage of Asian students, a larger percentage of first-generation students, and lower median household incomes at the state level. Factors related to one-year and five-year loan repayment rates are similar, indicating that students who struggle to make progress on repaying their loans soon after leaving college continue to struggle in the future.

The safety net and the diversion effects of vocational upper-secondary education in European countries

ABSTRACT This paper presents a comparative analysis of the effect of different educational orientations at the upper-secondary level on labour market outcomes across European countries. The study separates safety net effect and the diversion effect of Vocational Education and Training (VET). Using PIAAC data, we show cross-national differences in the early career advantages of vocational qualifications. The results indicate that vocational effects vary according to outcome. In general, negative effects on occupational status are consistent with earlier research. The safety net function of VET is only observable in a few countries. We also studied the impact of different institutional level characteristics. The analysis of the impact of macro-level characteristics reveals VET’s safety net effect is observable only in countries with the highest occupational specificity of VET. At the same time, work-based VET is increasing its diversion effect. Crucial issues are the differences in general competencies between graduates of VET and general upper-secondary school graduates. The major differences are the simultaneous weakening of VET’s safety net effect and the strengthening of the diversion effect.

Variations in endorsed and perceived mental health treatment stigma across U.S. higher education institutions.

This study examines the association between six higher education institutional-level characteristics (institutional type, enrollment size, sector, housing, admissions selectivity, and graduation rate) and individual endorsed and perceived mental health treatment stigma scores among college students. We use nine years (2009-2017) of data from the Healthy Minds Study and our analysis sample includes 89,644 students at 105 unique institutions. We find a negative association between individual-level stigma scores and small enrollment institutions, private institutions, highly residential institutions, and institutions with the highest admissions selectivity and highest graduation rates. Moreover, these findings are generally similar across both individual measures of endorsed stigma and perceived stigma. Overall, our findings suggest that institutional environments where interactions are perhaps more frequent and personal (small enrollment institutions and highly residential institutions) are less likely to cultivate individual-level endorsements and perceptions of mental health treatment stigma. Our results have implications about higher education institutions’ ability to reduce stigma and increase mental health treatment-seeking behavior on campuses.

Is First-Year Seminar Type Predictive of Institutional Retention Rates?

Is First-Year Seminar Type Predictive of Institutional Retention Rates? Dallin George Young (bio) First-year seminars (FYS) are courses "intended to enhance the academic and/or social integration of first-year students" (Barefoot, 1992, p. 49). Colleges and universities initiate FYS to help first-year students develop a connection with the institution, provide orientation to campus resources and services, foster the development of academic skills, support the learning and developmental objectives of undergraduate education, and retain students from the first to second year of college (Greenfield, Keup, & Gardner, 2013; Young & Skidmore, 2019). Further, they form a connective thread for first-year experiences such as providing an orientation to campus resources, creating a sense of belonging, developing study skills, and serving as a curricular anchor for other high-impact practices (Greenfield et al., 2013; Young & Skidmore, 2019). Frequently, FYS represent what has been termed an extended orientation course, usually named college survival or success (Greenfield et al., 2013; Hunter & Linder, 2005); however, multiple varieties of the form exist (Young & Skidmore, 2019). Barefoot (1992) outlined a scheme that persists as the most widely adopted typology of FYS: (a) extended orientation seminars, (b) academic courses with uniform content across all sections, (c) academic courses with content that varies across sections, (d) preprofessional or discipline-linked courses, and (e) seminars with a focus on basic study skills. Tobolowsky and associates (2008) described a sixth type, hybrid courses, combining elements of the other types. The literature base is replete with evidence that FYS contribute to improvements in academic performance; interaction with faculty; use of campus services; satisfaction with the institution; active involvement in cocurricular activities; positive perceptions of self-as-learner; enhanced lifelong-learning orientation; and development of academic, interpersonal, and communication skills (see Koch, Foote, Hinkle, Keup, & Pistilli, 2007; Padgett, Keup, & Pascarella, 2013; Pascarella & Terenzini, 2005). Additionally, large-scale reviews of the published research on the effects of participation in FYS have indicated that FYS had at least indirect effects from the first to second year in college (Mayhew, Rockenbach, Bowman, Seifert, & Wolniak, 2016; Pascarella & Terenzini, 2005; Permzadian & Credé, 2016). Notwithstanding these results, recent research has emerged that questions whether FYS have any effect at all on student success (Culver & Bowman, 2020). The flexibility of the FYS to meet the needs of a wide variety of institutional contexts is a feature seen as part of its widespread success (Greenfield et al., 2013); however, the research record is unclear about which seminar types have greater impact on student outcomes. Some researchers found that extended orientation types are connected to improved outcomes (see Friedman & Marsh, 2009; Ryan & Glenn, 2004), while others point to the benefits of [End Page 379] academic seminars (see Swing, 2002; Zerr & Bjerke, 2016). Other studies have found mixed results in outcomes based on FYS type. Permzadian and Credé (2016) found that extended orientation seminars were positive and significant predictors of first-to-secondyear retention, and academic seminars were positive predictors of first-year GPA. Weissman and Magill (2008) reported that the benefits of one seminar type over another were related to the type of student who participated. Confounding the interpretation of the opus of literature linking FYS type and student retention is the fact that the research on the topic comprises only single-institution studies and studies conducted at the student level. Only a limited number of studies have included the influence of institution-level characteristics on student retention or intent to persist. For example, Porter and Swing (2006) found that improved academic engagement in FYS at the institution level was associated with higher levels of students' intent to persist to the second year. CONCEPTUAL FRAMEWORK/JUSTIFICATION FOR THE STUDY In 2008, the Association of American Colleges and Universities (AAC&U) introduced a list of 10 high-impact practices (HIPs) that had been tested and found to have significant positive influence on student engagement and retention (Kuh, 2008), including FYS and experiences. Kuh and O'Donnell (2013) identified 8 elements of HIPs that explained the educational and pedagogical practices that led to the impact found in HIPs: (a) high performance expectations; (b) significant investment of time and effort by students; (c) interactions with faculty and peers about substantive matters; (d) experiences...

Nationwide trends in the use of subtotal cholecystectomy for acute cholecystitis

BackgroundSubtotal cholecystectomy is a viable alternative approach to the proverbial “difficult” gallbladder. To date, only a few studies have observed the establishment of those bail-out procedures as an increasingly common surgical practice. The purpose of this study is to assess nationwide trends of subtotal cholecystectomy through evaluation of operative variables and patient- and institution-level characteristics in procedure preference. MethodsData were obtained from the National Inpatient Sample for the years between 2003 and 2014. Patients with acute cholecystitis were categorized based on the ninth revision International Classification of Disease Clinical Modification procedure codes for open total, laparoscopic total, open subtotal, or laparoscopic subtotal cholecystectomy. Any patient younger than 18 years of age or with a preoperative stay >1 week was excluded. Logistic regression analysis was performed to evaluate significant patient- and institution-level characteristics associated with the performance of subtotal cholecystectomy. ResultsA total of 290,855 patients were evaluated. During the study period, the rate of open and laparoscopic subtotal cholecystectomy sharply increased (0.10% of all cholecystectomy procedures to 0.52% and 0.12% to 0.28%, respectively). The conversion rate from laparoscopic to open total cholecystectomy decreased from 10.5% to 7.6%. Subtotal cholecystectomies were performed at significantly higher rates in men (odds ratio: 1.95, P < .001), Asian Americans (odds ratio: 2.21, P = .037), and patients with alcohol abuse (odds ratio: 2.23, P < .001). Teaching hospitals (odds ratio: 2.41, P < .001) and those in rural areas (odds ratio: 2.26, P < .001) were more likely to perform subtotal cholecystectomies. ConclusionGrowing trends in the use of subtotal cholecystectomy suggest evolving surgical practices for acute cholecystitis. Our data suggests that several patient- and hospital-level characteristics might play a deciding role in procedure preference.

Capitalizing Baccalaureate Degree Attainment: Identifying Student and Institution Level Characteristics that Ensure Success for Latinxs

ABSTRACT Baccalaureate degree completion is essential for future development as a nation. Latinxs are the largest minority group in the country and by 2050 nearly one out of every three individuals will be of Latinx descent. While Latinx enrollment may increase, the proportion completing college is not comparable. This study explored the pre-college student characteristics and institutional environments through a capital theoretical perspective (Bourdieu, 1986) that fosters degree attainment measured six years after initial enrollment. The national (459 institutions), longitudinal study of 15,745 Latinx students quantitatively examined the impact of differing institutional contexts while accounting for individual characteristics. High school GPA and the number of college applications submitted are positive key factors while concerns about financing college have a negative effect at the student-level on predicting Latinx six year degree attainment. The institutional graduation rate and compositional diversity positively influence graduation. Results further illustrate that campus context matters. Disaggregated results revealed distinct predictors among each of the subgroups. Implications inform postsecondary institutional practices by highlighting mechanisms of inequity embedded within the system of higher education and how to enact transformational change.

Racial and ethnic disparities in birth outcomes and labour and delivery-related charges among women with intellectual and developmental disabilities.

Women with intellectual and developmental disabilities (IDD) in the USA are bearing children at increasing rates. However, very little is known whether racial and ethnic disparities in birth outcomes and labour and delivery-related charges exist in this population. This study investigated racial and ethnic disparities in birth outcomes and labour and delivery-related charges among women with IDD. The study employed secondary analysis of the 2004-2011 Healthcare Cost and Utilization Project National Inpatient Sample, the largest all-payer, publicly available US inpatient healthcare database. Hierarchical mixed-effect logistic and linear regression models were used to compare the study outcomes. We identified 2110 delivery-associated hospitalisations among women with IDD including 1275 among non-Hispanic White women, 527 among non-Hispanic Black women and 308 among Hispanic women. We found significant disparities in stillbirth among non-Hispanic Black and Hispanic women with IDD compared with their non-Hispanic White peers [odds ratio=2.50, 95% confidence interval (CI): 1.16-5.28, P<0.01 and odds ratio=2.53, 95% CI: 1.08-5.92, P<0.01, respectively]. There were no racial and ethnic disparities in caesarean delivery, preterm birth and small-for-gestational-age neonates among women with IDD. The average labour and delivery-related charges for non-Hispanic Black and Hispanic Women with IDD ($18889 and $22481, respectively) exceeded those for non-Hispanic White women with IDD ($14886) by $4003 and $7595 or by 27% and 51%, respectively. The significant racial and ethnic differences in charges persisted even after controlling for a range of individual-level and institutional-level characteristics and were 6% (ln(β)=0.06, 95% CI: 0.01-0.11, P<0.05) and 9% (ln(β)=0.09, 95% CI: 0.03-0.14, P<0.01) higher for non-Hispanic Black and Hispanic Women with IDD compared with non-Hispanic White women with IDD. Our findings highlight the need for an integrated approach to the delivery of comprehensive perinatal services for racial and ethnic minority women with IDD to reduce their risk of having a stillbirth. Additionally, further research is needed to examine the causes of racial and ethnic disparities in hospital charges for labour and delivery admission among women with IDD and ascertain whether price discrimination exists based on patients' racial or ethnic identities.

Transfer Student Success: Exploring Community College, University, and Individual Predictors

ABSTRACTThis paper investigates community college transfer success by exploring the relationship between individual and institutional-level characteristics at students’ two- and four-year institutions. Using statewide administrative data from North Carolina, this study employs a cross-classified multilevel model to investigate the impact that a student’s community college and four-year transfer institution have on post-transfer success. Our findings offer important and compelling insights into the relationship between transfer students, the community college they attended, the four-year transfer institution, and educational outcomes. While individual effects were small, we find several institutional factors associated with student success. Attendance at a large community college or having a public university in the same county as their community college is positively associated with student success, whereas size of the university is negatively related to grades during the first year and persistence to the second year. While the four-year institution’s selectivity is negatively related to many of our outcomes, transferring to a Historically Black College or University is positively associated with GPA, college persistence, and degree completion.

Variations in Endorsed and Perceived Mental Health Treatment Stigma Across U.S. Higher Education Institutions

This study examines the association between six higher education institutional-level characteristics (institutional type, enrollment size, sector, housing, admissions selectivity, and graduation rate) and individual endorsed and perceived mental health treatment stigma scores among college students. We use nine years (2009-2017) of data from the Healthy Minds Study and our analysis sample includes 89,644 students at 105 unique institutions. We find a negative association between individual-level stigma scores and small enrollment institutions, private institutions, highly residential institutions, and institutions with the highest admissions selectivity and highest graduation rates. Moreover, these findings are generally similar across both individual measures of endorsed stigma and perceived stigma. Overall, our findings suggest that institutional environments where interactions are perhaps more frequent and personal (small enrollment institutions and highly residential institutions) are less likely to cultivate individual-level endorsements and perceptions of mental health treatment stigma. Our results have implications about higher education institutions’ ability to reduce stigma and increase mental health treatment-seeking behavior on campuses.

The national landscape of unplanned 30-day readmissions after total laryngectomy.

Examine rates of readmission after total laryngectomy and determine primary etiologies, timing, and risk factors for unplanned readmission. Retrospective cohort study. The Nationwide Readmissions Database was queried for patients who underwent total laryngectomy between January 2013 and November 2013. Patient-, procedure-, admission-, and institution-level characteristics were compared for patients with and without unplanned 30-day readmission. Outcomes of interest included rates, etiology, and timing of readmission. Multivariate logistic regression was used to identify predictors of 30-day readmission. There were 2,931 total laryngectomies performed in 2013 with an unplanned readmission rate of 17.5%. Postoperative fistula accounted for 13.7% of readmissions. The odds of readmission were elevated for patients undergoing concurrent procedures, including primary tracheoesophageal fistulization (adjusted odds ratio [aOR]: 2.44, 95% confidence interval [CI]: 1.15-5.18, P = .02) and/or pedicle graft or flap procedures (aOR: 1.73, 95% CI: 1.13-2.66, P = .01). Additionally, patients with comorbid coagulopathy (aOR: 3.04, 95% CI: 1.13-8.22, P = .03), liver disease (aOR: 2.48, 95% CI: 1.08-5.71, P = .03), and valvular heart disease (aOR: 3.18, 95% CI: 1.20-8.41, P = .02) had increased risk for unplanned 30-day readmission. Private insurance and longer lengths of stay were associated with decreased odds of readmission. Nearly one-fifth of total laryngectomy patients are readmitted to the hospital within 30 days of discharge. Risk factors identified in this nationally representative cohort should be carefully considered during the postoperative period to reduce preventable readmissions after total laryngectomy. 2c Laryngoscope, 1842-1850, 2018.

Sexual Violence Among College Students: An Examination of Individual and Institutional Level Factors Associated With Perpetration.

Sexual violence incidents involving college students have received media attention and increased awareness of this public health problem in the United States; prevention efforts are needed that target potential perpetrators. We examined characteristics of self-reported perpetrators of sexual violence on campuses. This study used a secondary data analysis of the 2015 College Student Health Survey, an annual survey, which was completed by students attending 17 colleges/universities in Minnesota. The analytic sample included 6,548 18-to 24-year-old college students who answered at least one of two questions assessing perpetration in the past 12 months (i.e., sex/sexual touch without consent). Chi-square tests were used to detect associations between perpetration and individual (e.g., age, race, substance use, victimization) and institutional (e.g., school type, location) level characteristics. Multiple logistic regression analyses identified predictive models for being a perpetrator of sexual violence. Fifty-two students reported perpetration of sexual violence in the past year, including 29 rapes. Overall, self-reported perpetrators of sexual violence are more likely to be men, to have been a victim in his or her lifetime, to have smoked marijuana in the past 12 months (but not the past month), and to be younger (18 or 19 years old). Institutional level characteristics, including school type and location, did not yield significant associations with perpetration. Sexual violence prevention and response efforts toward college students need to be inclusive, especially targeting individual level factors, and considerate of the victimization-perpetration comorbidity experienced by many students.

Variations in survival after cardiac arrest among academic medical center-affiliated hospitals.

BackgroundVariation exists in cardiac arrest (CA) survival among institutions. We sought to determine institutional-level characteristics of academic medical centers (AMCs) associated with CA survival.MethodsWe examined discharge data from AMCs participating with Vizient clinical database–resource manager. We identified cases using ICD-9 diagnosis code 427.5 (CA) or procedure code 99.60 (CPR). We estimated hospital-specific risk-standardized survival rates (RSSRs) using mixed effects logistic regression, adjusting for individual mortality risk. Institutional and community characteristics of AMCs with higher than average survival were compared with those with lower survival.ResultsWe analyzed data on 3,686,296 discharges in 2012, of which 33,700 (0.91%) included a CA diagnosis. Overall survival was 42.3% (95% CI 41.8–42.9) with median institutional RSSR of 42.6% (IQR 35.7–51.0; Min-Max 19.4–101.6). We identified 28 AMCs with above average survival (median RSSR 61.8%) and 20 AMCs with below average survival (median RSSR 26.8%). Compared to AMCs with below average survival, those with high CA survival had higher CA volume (median 262 vs.119 discharges, p = 0.002), total beds (722 vs. 452, p = 0.02), and annual surgical volume (24,939 vs. 13,109, p<0.001), more likely to offer cardiac catheterization (100% vs. 72%, p = 0.007) or cardiac surgery (93% vs. 61%, p = 0.02) and cared for catchment areas with higher household income ($61,922 vs. $49,104, p = 0.004) and lower poverty rates (14.6% vs. 17.3%, p = 0.03).ConclusionUsing discharge data from Vizient, we showed AMCs with higher CA and surgical case volume, cardiac catheterization and cardiac surgery facilities, and catchment areas with higher socioeconomic status had higher risk-standardized CA survival.

Identifying social and economic barriers to regular care and treatment for Black men who have sex with men and women (BMSMW) and who are living with HIV: a qualitative study from the Bruthas cohort

BackgroundThere is little research regarding the ability of Black men who have sex with men and women (BMSMW) to access and maintain HIV-related health care and treatment adherence. This population, who often insist on secrecy about their same-sex desire, may experience unique barriers to seeking regular care and treatment.MethodsFrom March 2011-April 2014, we recruited 396 BMSMW in the San Francisco Bay Area to be enrolled in our randomized controlled trial. At baseline we administered a behavioral survey assessing: demographics, homelessness, employment, history of incarceration, HIV status and disclosure practices, care and treatment adherence. 64 men reported living with HIV at intake. To learn more about their experiences, we recruited N = 25 to participate in qualitative interviews, which were conducted April-December 2014. Topics included: current living situation, diagnosis story, disclosure practices, experiences of accessing and maintaining care and treatment, and HIV-related stigma. Recordings were transcribed and coded for major themes.ResultsDespite being located in an area where treatment is plentiful, men faced social and economic barriers to maintaining regular care and treatment adherence. Several findings emerged to shed light on this quandary: (1) Competing needs particularly around attaining stable housing, food security, and money created barriers to treatment and care; (2) Side effects of HIV medications discouraged men from adhering to treatment; (3) Provider and Institutional level characteristics influenced care engagement; (4) Disclosure and social support made a difference in care and treatment behaviors; and (5) Participants expressed a desire for group-based intervention activities to support treatment and care among HIV+ BMSMW. Inadequate engagement in the continuum of care for HIV was born out in the quantitative data where 28% of participants did not know their Viral Load.ConclusionsA holistic approach to HIV health for BMSMW would appear to translate to better outcomes for men living with HIV, where a goal of viral suppression must also include attending to their basic social and economic support needs.

Organizational barriers associated with the implementation of national essential medicines policy: A cross-sectional study of township hospitals in China

This study identifies potential organizational barriers associated with the implementation of the Chinese National Essential Medicines Policy (NEMP) in rural primary health care institutions. We used a multistage sampling strategy to select 90 township hospitals from six provinces, two from each of eastern, middle, and western China. Data relating to eight core NEMP indicators and institutional characteristics were collected from January to September 2011, using a questionnaire. Prescription-associated indicators were calculated from 9000 outpatient prescriptions selected at random. We categorized the eight NEMP indicators using an exploratory factor analysis, and performed linear regressions to determine the association between the factor scores and institution-level characteristics. The results identified three main factors. Overall, low levels of expenditure of medicines (F1) and poor performance in rational use of medicines (F2) were evident. The availability of medicines (F3) varied significantly across both hospitals and regions. Factor scores had no significant relationship with hospital size (in terms of number of beds and health workers); however, they were associated with revenue and structure of the hospital, patient service load, and support for health workers. Regression analyses showed that public finance per health worker was negatively associated with the availability of medicines (p < 0.05), remuneration of prescribers was positively associated with higher performance in the rational use of medicines (p < 0.05), and drug sales were negatively associated with higher levels of drug expenditure (p < 0.01). In conclusion, irrational use of medicines remains a serious issue, although the financial barriers for gaining access to essential medicines may be less for prescribers and consumers. Limited public finance from local governments may reduce medicine stock lines of township hospitals and lead them to seek alternative sources of income, jeopardizing their capacity to meet the needs of local consumers.

Applicants' Self-Reported Priorities in Selecting a Residency Program.

Residency recruitment is a high-stakes activity for all participants, yet there is limited information about how applicants choose among programs. This study evaluated the importance applicants place on various residency program attributes; whether applicant priorities vary by sex, race/ethnicity, or specialty choice; and whether the importance of these factors changes over time. Highly ranked applicants to residency programs at 2 academic medical centers were surveyed annually from 2004 to 2012 regarding the importance of 26 characteristics in selecting a program. Mean ratings of importance for each factor were analyzed to assess priority for the overall applicant group, and whether priorities differed for subgroups (by sex, race/ethnicity, and specialty). Of 9669 applicants surveyed, 6285 (65%) responded. The 5 factors with highest rating of importance (overall and across all subgroups) were the program's ability to prepare residents for future training or position, resident esprit de corps, faculty availability and involvement in teaching, depth and breadth of faculty, and variety of patients and clinical resources. Small but significant differences in the ratings of some factors by sex and/or specialty group were identified. Institution-level characteristics, such as call rooms, salary, and benefits, were relatively unimportant. Applicant priorities were stable over the 9-year study period. Highly ranked applicants to competitive residency programs value educational aspects of the program most highly, along with resident morale. Top factors were consistent across subgroups and over the 9years of the study. These findings have implications for resident recruitment strategies.