National Overview Research Articles

MEDICAID MANAGED LONG-TERM CARE PROGRAMS VS. THE TRADITIONAL MODEL: COMPARATIVE COSTS AND OUTCOMES

Several states have adopted Medicaid Managed Long-Term Care (MLTC) programs over the last several years. At this point at least 30 states are either administering such models or have plans to in the near future. We do not, however, know much yet about the relative cost-effectiveness of the MLTC model when compared to the traditional non-profit model of Medicaid LTC. Is the for-profit MLTC model actually generating savings in the Medicaid program while improving the quality of care? This symposia is designed to address the question through three presentations on experiences with MLTC programs in the states of Ohio, Texas and Pennsylvania and a fourth presentation offering a national overview and critique of Medicaid MLTC in comparison to the traditional Medicaid LTC program still administered through non-profit Aging Network organizations. The state focused presentations describe the current status and results of MLTC in three states that vary in their specific features, extent of formal accountability for outcomes and the political contexts in which the programs currently function. The presentations also include discussions of the implications of each states experiences for the future of Medicaid LTC policy at the state and federal levels. The fourth presentation is a critical analysis of the main differences between the traditional non-profit model of Medicaid LTC services and the for-profit MLTC programs in terms of commonly accepted criteria of cost-effective LTC services, such as access, quality of care and per-person costs and differences in the roles of advocacy and accountability.

Ambientes de aprendizaje

Este artículo expone la conceptualización, características, investigaciones nacionales e internacionales acerca de los ambientes de aprendizaje. Para esto, se realizó una revisión bibliográfica de aproximadamente cincuenta fuentes. A partir de estas, se elaboró la conceptualización y las características que según los autores consultados deberían tener los ambientes de aprendizaje para ser efectivos en los procesos de enseñanza-aprendizaje. Asimismo, se desarrolló un panorama internacional, estructurado por continentes, de investigaciones en las que se identificaron diversos elementos de estudio; y uno nacional, divido por regiones, en el que se evidencian definiciones, investigaciones y trabajos realizados, todo esto siguiendo un orden cronológico. Finalmente, se enfocó en cómo Colombia puede mejorar los ambientes de aprendizaje a través del rol del docente y su formación.

EXPO-S.T.O.P. 2016 and 2017 blood exposure surveys: An alarming rise

The annual Exposure Survey of Trends in Occupational Practice (EXPO-S.T.O.P.), conducted by the Association of Occupational Health Professionals in Healthcare, provides a U.S. national overview of sharps injuries (SIs) and mucocutaneous exposures (MCEs). This study presents the 2016 and 2017 surveys. An 18-item survey was distributed to Association of Occupational Health Professionals in Healthcare members and colleagues and requested total SIs and MCEs; SI in nurses, doctors, and surgery; staffed beds; teaching status; full-time equivalent staff (FTE), nurse FTE, and average daily census (ADC). In 2016, 170 hospitals reported 10,271 exposures (72.9% SIs); in 2017, 224 hospitals reported 12,672 exposures (74.4% SIs). In 2016, SI rates were 27.0 per 100 ADC, 2.3 per 100 FTE, and 2.8 per 100 nurse FTE. Of the total SIs, 36.4% were nurses, 35.6% were doctors, and 39.0% occurred during surgery. In 2017, the respective SI rates were 27.7 per 100 ADC, 2.5 per 100 FTE, and 2.7 per 100 nurse FTE. Of the total SIs, 37.6% were nurses, 32.7% were doctors, and 39.9% occurred during surgery. In 2016, MCE rates were 11.2 per 100 ADC and 0.82 per 100 FTE, and in 2017, MCE rates were 9.6 per 100 ADC and 0.87 per 100 FTE. Teaching hospitals had higher rates than nonteaching hospitals. EXPO-S.T.O.P. SI rates have risen year-on-year for 3 years and now match 2001-2005 levels. There is an urgent need for aggressive SI-reduction strategies, including leadership support, safety-engineered devices (SED) training/education, and adoption of safer, less user-dependent SED. Further research on SI mechanisms, SED effectiveness, and reduction strategies is required.

Predictors of 30-day Postdischarge Readmission to a Multistate National Sample of State Psychiatric Hospitals.

ABSTRACTBackground:Early discharge from psychiatric inpatient care may pose challenges for the patient's recovery and may incite a rapid return to the hospital. This study identified demographic, clinical, and the continuing of care characteristics associated with rapid readmission into a sample of psychiatric inpatient hospitals.Methods:Cross-sectional analysis of 60,254 discharges from state psychiatric hospitals. Logistic regression explored the relationship between predictors of rapid readmission.Results:Eight percent of discharges were readmitted to the same hospital within 30 days after discharge. Factors significantly related with rapid readmission included white (odds ratio, 1.23; 95% confidence interval, 1.13–1.34), non-Hispanic (1.48, 1.26–1.73), not married (1.53, 1.32–1.76), voluntarily admitted (1.18, 1.05–1.33), with length of stay (LOS) ≤ 7 days (3.52, 3.04–4.08), or LOS 8–31 days (3.20, 2.79–3.66), or LOS 32–92 days (1.91, 1.65–2.22), with a schizophrenia or other psychotic disorders (1.69, 1.46–1.96) or personality disorder (1.76, 1.50–2.06), referred to a setting different from the outpatient (1.27, 1.16–1.40), or with a living arrangement different from private residence (1.54, 1.40–1.68).Conclusions:Disparities in rapid readmission rates exist among state psychiatric hospitals. A national overview of the individuals with mental illness at risk of being prematurely discharged may suggests insights into quality initiatives aimed at reducing rapid readmissions into psychiatric inpatient care.

A national overview of surgical misadventures in head and neck surgery: "Oh No, You Cut It".

To examine the risk and prevalence of accidental intraoperative injury reported during head and neck surgeries and the associated outcomes. Retrospective cross-sectional analysis. An analysis utilizing the Nationwide Readmissions Database, 2010 to 2014. Adult patients with a reported accidental intraoperative injury were compared to controls without such injuries. A total of 173 cases and 105,659 controls were included. Most cases were reported in surgeries of the mouth/tonsils (29.4%) and maxillofacial bones/mandible (22.5%). The remaining cases were reported in surgeries of the pharynx/larynx (17.5%), nose/paranasal sinuses (15.4%), salivary glands and ducts (6.2%), thyroid/parathyroid (5.2%), and ear (3.8%). The multivariate logistic regression model demonstrated that surgeries of the pharynx/larynx were associated with the highest risk of injuries compared to other site surgeries (odds ratio [OR]: 2.51, 95% confidence interval [CI]: 1.49, 4.25, P < .001]. Concomitant neck dissection was also independently associated with the risk of injury (OR: 4.07, 95% CI: 2.05, 8.09, P < .001]. Compared to controls, cases were not associated with an increased risk of mortality (P = .63) or readmission (P = .29); however, those cases had a significantly longer hospital stay on average by 3.64 ± 0.95 days/case (P < .001) and a higher cost of treatment on average by $13,478 ± 119.42/case (P < .001). This study reports on the prevalence and outcomes of accidental intraoperative injuries reported in head and neck surgeries. The prevalence is relatively low, and the annual trend appears stable; however, it is associated with a significant burden on the health system. NA Laryngoscope, 130:918-924, 2020.

Cost analysis of outbreaks with Methicillin-resistant Staphylococcus aureus (MRSA) in Dutch long-term care facilities (LTCF).

ObjectivesHighly resistant microorganisms (HRMOs) are of high concern worldwide and are becoming increasingly less susceptible for antibiotics. To study the cost effectiveness of infection prevention measures in long-term care, it is essential to first fully understand the impact of HRMOs. The objective of this study is to identify the costs associated with outbreaks caused by Methicillin-resistant Staphylococcus aureus (MRSA) in Dutch long-term care facilities (LTCF).MethodsAfter an outbreak of MRSA, Dutch LTCF can submit a reimbursement form to the Dutch Healthcare Authority (“Nederlandse Zorgautoriteit”; NZa) to get a part of the total costs reimbursed. In this study, we requested NZa forms for financial impact analysis. Details regarding the costs of the outbreak have been extracted from these forms and additionally specific LTCF have been visited in person to validate the data.Results34 complete reimbursement forms from the period between 2011 and 2016 were received from the NZa and have been included. The median cost per patient per day was estimated at €83.80, varying between €16.89 and €1,820.09. We validated five reimbursement forms by visiting the facility and recalculating the costs. We found a non-significant positive difference of €26.07 compared with the original data (p = 0.068).ConclusionsThis study is to our knowledge the first to give a national overview of total costs associated with an MRSA outbreak in LTCF in the Netherlands. Overall, costs per patient per day seem lower than in a hospital setting, although total costs are much higher due to the long term of care.

Immunoglobulin use in immune deficiency in the UK: a report of the UKPID and National Immunoglobulin Databases

Supply of immunoglobulin in the UK faces pressures due to increasing demand, cost and variable supply. This paper describes immunoglobulin replacement therapy (IGRT) in primary immunodeficiency (PID) and secondary immunodeficiency (SID) to assist in the ongoing planning of UK immunoglobulin provision. A retrospective analysis of the National Immunoglobulin Database and the UKPID registry was carried out. In total, 3,222 patients are registered as receiving IGRT for immunodeficiencies. Predominately antibody disorders made up the largest diagnostic category (61% of patients). The total cost of IGRT for immunodeficiency for 2015/16 was £40,673,350; an average annual cost of £1,099,254 per centre and £12,124 per PID patient. SCIg accounted for 43.8% and 50.1% of IGRT, with home therapy accounting for 42.7% and 57.5% of place of therapy in the National Immunoglobulin Database and UKPID registry respectively. In 2015/16 use of immunoglobulin in SID increased by 24% over the previous financial year. The overall trends of increasing demand in immunology are mirrored in other specialties, most notably neurology and haematology. These data are the first national overview of IGRT for immunodeficiencies, providing a valuable resource for clinicians and policy makers in the ongoing management of UK immunoglobulin supply.

The Methodology for the CLER National Report of Findings 2018.

The Methodology for the CLER National Report of Findings 2018.

A national assessment of landslide hazard from Outside Party Slopes to the rail network of Great Britain

In recent years, a number of high profile landslide events have caused disruption, derailments or damage to railway infrastructure in Great Britain. A landslide susceptibility model of the entire railway network was created, designed to give a national overview of potential landslide hazard originating from Outside Party Slopes. The current assessment was compiled using Geographic Information System (GIS) techniques and desktop modelling to apply a structured analysis of each buffered Earthwork Inspection 5 Chain ( c . 100 m; EI5C). Data analysed along the network included the BGS GeoSure instability model and newly updated national models for debris flow, earth flow and rock fall, supported by historical landslide data. In order to further focus the Outside Party Slope zone, a buffer of External Natural Geological Influence (BENGI) was created using a 5 m Digital Terrain Model. Landslide susceptibility for each EI5C was categorized using a ‘Classification of Hazards on Outside Party Slopes’ (CHOPS) score; representing the modelled potential for landslide hazard. The outputs were combined as a series of matrices to present the CHOPS and Network Rail Derailment Criticality Band interactions. This research will allow further focused analysis of the network, in order to prioritize and direct future investigation and policy decisions.

Exercise therapy in medical rehabilitation: Study protocol of a national survey at facility and practitioner level with a mixed method design.

BackgroundThe importance of physical activity and the orientation of exercise therapy in rehabilitation has changed for many chronic health conditions. Exercise therapy is the most applied therapy form within multidisciplinary rehabilitation programs for almost all chronic health conditions. Despite the scientifically discussed need to refine exercise therapy, there is relatively little knowledge of how exercise therapy is actually conducted. This study protocol describes the methodological procedure used in the project “Exercise therapy in medical rehabilitation: a survey at facility and practitioner level”, which aims to take a national survey of exercise therapy in rehabilitation practice in Germany.MethodsThe project was implemented using an explanatory sequential mixed method design. Quantitative and qualitative methods were integrated in two consecutive project phases. Phase 1 used a standardized, quantitative written survey of the heads of exercise therapy departments to compile a national overview of concepts and process features of exercise therapy of individual rehabilitation facilities. Phase 2 recorded individual perspectives and opinions concerning exercise therapy goals, content and methods and current developments in the rehabilitation context (e.g., physical activity promotion, interdisciplinarity, standardization) of exercise therapy practitioners. Over the course of two one-and-a-half day workshops, central themes were introduced and prepared with standardized written individual surveys from Phase 1 and combined with qualitative surveys using facilitated group discussions (focus groups in mixed methods design).DiscussionThe project generates a comprehensive picture of exercise therapy in medical rehabilitation at facility level and inserts further information at the practitioner level into this context. The chosen methodology of a mixed method design combines the perspective of the facility with that of the practitioner, thus allowing for a complex and multifaceted description of the status quo in exercise therapy practice and makes it possible to identify facilitators and barriers for the refinement of exercise therapy in specific everyday rehabilitation. These findings form the basis for the systematic development of quality exercise therapy in rehabilitation, in particular in terms of the refinement, implementation and dissemination of biopsychosocial concepts of exercise therapy.

Measuring and monitoring diversity in organizations through functional instruments with an application to ethnic workforce diversity of the U.S. Federal Agencies

The role of diversity in organizations has been widely discussed in recent decades; nevertheless, both theoretical perspectives and empirical results appear conflicting and inconsistent. Scholars identify many possible reasons such as the definition of diversity, theoretical perspectives, variables, and methodological approaches; this study focuses on the methodological issue of assessing variety. To evaluate the role of diversity, most studies adopt static approaches and refer to the classical univariate indices; this research shows their limitations and stresses the importance of treating diversity with a multivariate dynamic approach. Taking advantage of functional data analysis and some recent ecological studies, this dual gap of the organizational literature is addressed by proposing a new methodological approach for measuring and monitoring diversity in organizations. We illustrate an application of this method by using a real dataset concerning the workforce diversity of the “Corporation For National And Community Service Overview” within the project “Federal Equal Opportunity Recruitment Program (FEORP)” of the Government of the United States of America. The goal of this research is to provide human resources specialists, policy makers, and scholars with additional techniques to improve the understanding of the dynamics of workforce diversity and minority employment within organizations.

Mental illness in the Western Cape Province, South Africa: A review of the burden of disease and healthcare interventions.

Neuropsychiatric disorders were ranked third as contributors to disability-adjusted life-years in South Africa (SA). Despite this high morbidity, mental health is often overlooked on the public health agenda. This article reviews evidence on the burden of mental illness in the Western Cape Province of SA, as well as current provincial interventions to decrease the burden of mental illness. Available evidence supports the need for improved integration of mental health services in primary healthcare and strengthening of community services. Challenges include a lack of capacity due to staff shortages and inadequate availability and allocation of resources. Evidence from large epidemiological studies to quantify the burden of disease as well as cost-effectiveness studies of interventions are required to successfully plan and implement interventions. Similar reviews may provide a national overview of mental health issues as well as allow improvement through better understanding of research and best practices in various provinces.

Threatened species conservation of invertebrates in Australia: an overview

AbstractInvertebrates make up about 80% of all species, yet they rarely attract conservation attention compared to the more ‘charismatic’ vertebrates such as birds and mammals. Threatened species conservation, a field of conservation biology in which individual species are targeted for protection and conservation management, complements the landscape approach to biodiversity conservation and could be used more effectively to promote the plight of threatened or imperilled invertebrates given the global biodiversity crisis and estimated rates of anthropogenic species extinction. In this overview, steps in the species‐oriented conservation process are outlined, including conservation status evaluation, listing under legislation, preparation of Action and Recovery Plans, recovery actions, recovery teams and monitoring, in order to prevent extinction or minimise risk of extinction. The process is not without its challenges, but it does provide valuable information that is not always obtainable with the protection and management of threatened ecological communities and habitats. However, to be most effective, a more strategic approach to listing species is required. It is recommended that more national Action Plans, either of higher taxonomic groups or of ‘indicator’ species – suites of species indicative of threatened ecological communities, habitats, biomes, key threatening processes, co‐dependent threatened host species or short‐range endemics – are needed. These plans would provide a national overview of threatened and imperilled invertebrates in conservation need that is far more comprehensive than presently available. A detailed national list of threatened invertebrate species could then be promoted (and nominated for listing under the EPBC Act) for greater conservation advocacy.

Dietary Management in the Immediate Preoperative Period of Bariatric Surgery: a National Overview : Bariatric Preoperative Diets.

Although widely applied, there is no consensus about the characteristics of the diets prescribed in the immediate preoperative period of bariatric surgery (BS). The objective of this study was to perform a survey on preoperative dietary management in BS centers. This was a cross-sectional study with BS Brazilian centers. Only BS centers with certificate of excellence by Surgical Review Corporation were included. An electronic questionnaire was applied to assess details about the dietary management in the immediate preoperative period of BS. Of the 15 centers invited, 80% (n = 12) answered the questionnaire. Preoperative weight loss was required to patients in all 12 centers. For 8.3% (n = 1), this request was applied to all patients; 91.7% (n = 11) of the centers requested weight loss in specific cases. Ten (83.3%) centers prescribed restrictive diets; none of these adopted a standard dietary protocol. The caloric value of the diets ranged from 800 to 2000kcal/day. The duration of the diet ranged from 10 to 20days in 40% (n = 4) of the centers and from 20 to 90days in 60% (n = 6) of the centers. Dietary prescription was based on team consensus in 100% (n = 12) of the centers. In 33.3% (n = 4) of the centers, scientific evidence supporting dietary prescription was cited. This study identified the frequent practice of requesting preoperative weight loss and the diversity of diets used in the immediate preoperative period by Brazilian BS centers. Future guideline proposal is needed on preoperative BS diets.

AN INVESTIGATION OF INTERCONNECTION BETWEEN BUSINESS EXCELLENCE MODELS AND CORPORATE SUSTAINABILITY APPROACH

The paper provides a general approach to explore the suitability of business excellence models (BEMs) to include corporate sustainability (CS) and on examples of awarded organizations in national quality awards (NQAs) found the synergic approach in deploying issues of BEMs and sustainability. The aim of the paper is to provide an overview of the BEMs approach in the Czech Republic and found the relevance with the issues of corporate sustainability. As an example was involved the Czech organizations awarded in NQAs in the area of excellence and sustainability in 2016. Based on a reflection of the current situation, there is a clear lack of organizations' approach to principles or strategic management tools that are suitable for implementation to enhance organization excellence including corporate sustainability. Then, an analysis is deployed in order to identify common synergy between BEMs and issues of corporate sustainability. This study is based on information gathered through an extensive literature review using print media and research databases like Emerald, EBSCO, Pro-Quest and we also employed the available sustainable reporting for awarded companies. The study is expected to help in reviewing national business excellence strategies and overview of the collected samples of organizations may help other entities to effectively process reports to use of the synergy of the criteria of the BEMs and corporate sustainability within the relevant NQAs or to target on appropriate stakeholders. Keywords: corporate sustainability, business excellence models, National Quality Awards, EFQM excellence model

Residential archetypes in urban energy simulation models in Chile: Determining factors of residential energy consumption

The national and international overview has shown that residential energy consumption is increasing. As a result, efforts have focused on reducing the initial demand for housing and its associated consumption. One of the most used tools for this purpose is bottom-up energy modelling, specifically on the archetypes branch. This method proposes that energy demand of a dwelling can estimated from the interaction of several parameters and factors. However, the method’s main limitation, is the complexity of defining the variables and factors to be used. This article presents a review of specialized literature, concerned with, determining and characterizing residential archetypes. From this literature, It was possible to determine the most influential factors in energy consumption. The results showed 19 factors that were categorized into five groups; general, geometric, thermal, operational, and systems and equipment characteristics. The applicability of these factors to Chile was verified. This article, is intended a guide to generating representative archetypes and characterizing dwellings in an efficiente manner.

The Population health management as the road map of Italian Regional healthcare systems’ reforms for tackling chronic care

The Italian Health Ministry recently approved a national plan for tackling chronic care, which sets out the prevailing organisational models and the clinical governance guide lines for major conditions. On the top of these addresses, the plan identified the Population Health Management (PHM) approach as a road map for Regional Healthcare Services (RHS) and organizations. The PHM identifies five pillars: 1) demand analysis, segmentation and targeting; 2) set up of clinical pathways from early prevention to treatment and follow up; 3) identify models of care for chronic care management; 4) personalized care pathways; 5) Results, outcome evaluation and quality improvement.The paper aims to provide a national overview of the PHM development in different RHSs, starting from the five pillars as the key variables for analyzing regional patterns further reinforced by the institutional context analysis of reforms driven by the PHM attainments. For instance, the call for population-based system has accelerated yet the processes of merges and establishment of bigger LHAs as healthcare services commissioners serving population of almost 1 billion inhabitants, on average; yet the processes for centralizing the support management processes and programme planning within the regional governance. The paper analyses in depth five regional cases that firstly underwent the PHM model, detangling the policy and management strategies developed compared to the five pillars as well as the resources, tools, infrastructure and ICT technologies put in place and the models of care. The analysis provides insights from the lessons learnt by these RHSs and the challenges they are facing today, in order to understand the implementation matters with the national endowment of the PHM.

Trends in the provision of residential educational placements available for young people with learning disabilities/autism in England

PurposeLittle is known about the characteristics of residential educational settings for young people with intellectual or developmental disabilities (IDD) in England. Previous research has focussed on the characteristics and experiences of the young people attending such settings rather than the setting itself; therefore, an overview of national provision is needed. The paper aims to discuss these issues.Design/methodology/approachAs part of a larger project, data were collected for all residential schools and colleges in England. Data relate to settings offering residential provision for at least 4 nights per week for 30 weeks per year, either at the school/college itself, or in an associated residential home. Due to the remit of the main project, settings offering placements only to young people aged under 16 were excluded. Data were collected from a range of sources, including school/college websites, Ofsted and Department for Education resources, and liaison directly with the setting.FindingsIn total, 342 residential educational settings were identified with 57 of these offering post-16 provisions only. A range of data is presented about these settings, including location, placement numbers and types available, age range catered for, special educational needs categories registered for, governance arrangements (e.g. LA maintained, privately owned, and charitable organisation), and Ofsted educational ratings.Originality/valueThese data provide a national overview of residential educational settings for young people with IDD. This enables a clearer picture of the location and type of provision offered and allows comparisons both within and between areas.

A5307 - Dietary Management in the Immediate Pre-operative Period of Bariatric Surgery: A National Overview

A5307 - Dietary Management in the Immediate Pre-operative Period of Bariatric Surgery: A National Overview

A National Overview of Climate Change Education Policy: Policy Coherence between Subnational Climate and Education Policies in Canada (K-12)

This article analyses the depth of engagement with climate change education policy across all 13 provinces and territories in Canada. A comparative content analysis of 13 climate action plans (CAP) and 90 K-12 education policy documents shows a major gap existing between Canada’s climate and education policies. While subnational climate policy calls for education to contribute substantially to addressing climate change, education policy is not aligned towards this call. Three themes emerged within the overview of the provinces and territories: shallow engagement with climate change within education policies; the predominance of energy efficiency upgrades for schools as a foremost education sector objective; and policy gaps that show a lack of attention to many areas of climate education. Further detailing the climate change education objectives in four provinces identified as playing a leadership role in climate policy, this research suggests that even among these climate leaders, K-12 education policy minimally attends to climate change. Alignment between Canadian and international trends in climate change education is also assessed.