Nonprofit Hospitals Research Articles

Commercial Price Variation for Breast Reconstruction in the Era of Price Transparency

Breast reconstruction is costly, and negotiated commercial rates have been hidden from public view. The Hospital Price Transparency Rule was enacted in 2021 to facilitate market competition and lower health care costs. Breast reconstruction pricing should be analyzed to evaluate for market effectiveness and opportunities to lower the cost of health care. To evaluate the extent of commercial price variation for breast reconstruction. The secondary objective was to characterize the price of breast reconstruction in relation to market concentration and payer mix. This was a cross-sectional study conducted from January to April 2022 using 2021 pricing data made available after the Hospital Price Transparency Rule. National data were obtained from Turquoise Health, a data service platform that aggregates price disclosures from hospital websites. Participants were included from all hospitals with disclosed pricing data for breast reconstructive procedures, identified by Current Procedural Terminology (CPT) code. Price variation was measured via within- and across-hospital ratios. A mixed-effects linear model evaluated commercial rates relative to governmental rates and the Herfindahl-Hirschman Index (health care market concentration) at the facility level. Linear regression was used to evaluate commercial rates as a function of facility characteristics. A total of 69 834 unique commercial rates were extracted from 978 facilities across 335 metropolitan areas. Commercial rates increased as health care markets became less competitive (coefficient, $4037.52; 95% CI, $700.12 to $7374.92; P = .02; for Herfindahl-Hirschman Index [HHI] 1501-2500, coefficient $3290.21; 95% CI, $878.08 to $5702.34; P = .01; both compared with HHI ≤1500). Commercial rates demonstrated economically insignificant associations with Medicare and Medicaid rates (Medicare coefficient, -$0.05; 95% CI, -$0.14 to $0.03; P = .23; Medicaid coefficient, $0.14; 95% CI, $0.07 to $0.22; P < .001). Safety-net and nonprofit hospitals reported lower commercial rates (coefficient, -$3269.58; 95% CI, -$3815.42 to -$2723.74; P < .001 and coefficient, -$1892.79; -$2519.61 to -$1265.97; P < .001, respectively). Extra-large hospitals (400+ beds) reported higher commercial rates compared with their smaller counterparts (coefficient, $1036.07; 95% CI, $198.29 to $1873.85, P = .02). Study results suggest that commercial rates for breast reconstruction demonstrated large nationwide variation. Higher commercial rates were associated with less competitive markets and facilities that were large, for-profit, and nonsafety net. Privately insured patients with breast cancer may experience higher premiums and deductibles as US hospital market consolidation and for-profit hospitals continue to grow. Transparency policies should be continued along with actions that facilitate greater health care market competition. There was no evidence that facilities increase commercial rates in response to lower governmental rates.

Impact of an On-going Pandemic: Influence of Wearing a Mask on Therapist Communication

<h3>Research Objectives</h3> To investigate the impact of provider mask wearing on communication during wheelchair education. <h3>Design</h3> A voluntary survey designed by physical therapists and speech language pathologist to question perceived impact of mask wearing on communication and communication strategies. <h3>Setting</h3> Urban nonprofit rehabilitation hospital. <h3>Participants</h3> Sixty-six physical and occupational therapists from inpatient, outpatient, and day rehabilitation participated. <h3>Interventions</h3> Not Applicable. <h3>Main Outcome Measures</h3> Clinician perceived impact per survey response. <h3>Results</h3> Clinicians identified that mask wearing impacted communication at least some of the time as it relates to clarity (80.3%), efficiency (78%), and ability to establish rapport (60.6%). Clinicians reported a variety of strategies to limit communication breakdowns, at least some of the time repeating statements (84.8%), raising their voice (78.8%), increasing patient proximity (78.8%), using nonverbal cues (75.8%), conducting sessions in an alternative location (68.2%) using pictures or video supports (47.0%), and using written communication (40.9%). Clinicians would like further training in printed resources (68.2%), ways to integrate communication tools (51.5%), nonverbal communication techniques (31.8%), and vocal hygiene strategies (30.3%). <h3>Conclusions</h3> Results indicate clinicians used a variety of communication strategies to reduce communication breakdowns while wearing a mask. Clinicians reported their communication remained effective for wheelchair education activities, though multiple strategies were utilized to minimize the impact. Staff identified additional training and resources necessary to support effective patient-provider communication while wearing a mask. <h3>Author(s) Disclosures</h3> There are no conflicts to disclose by the authors.

Overview of the Most Commonly Identified Public Health Needs and Strategies in a Nationally Representative Sample of Nonprofit Hospitals.

Nonprofit hospitals have been required to conduct Community Health Needs Assessments and develop implementation strategies for almost a decade, yet little is known about this process on the national level. Using a nationally representative dataset of 2019 to 2021 nonprofit hospital community benefit reports, we assessed patterns in hospital identification of community health needs and investments in corresponding programs. The five most common needs identified by hospitals were mental health (identified by 87% of hospitals), substance use (76%), access (73%), social determinants of health (69%), and chronic disease (67%). The five most common needs addressed were: mental health (87%), access (81%), substance use (77%), chronic disease (72%), and obesity (71%). Institutional and community-level factors were associated with whether hospitals identified and addressed health needs. Hospitals often addressed needs that they did not identify, particularly related to the provision of medical services-which has important implications for population health improvement.

Characteristics of US nonprofit hospitals using equity as a guiding framework for developing their community health needs assessments and implementation strategies

Characteristics of US nonprofit hospitals using equity as a guiding framework for developing their community health needs assessments and implementation strategies

Influence of Not-for-Profit Hospital Ownership Type on Community Benefit and Charity Care.

Non-profit hospitals are expected to provide charity care and other community benefits to adjust their tax exemption status. Using the Medicare Hospital Cost Report, American Hospital Association Annual Survey, and the American Community Survey datasets, we examined if church-affiliated hospitals spent more on charity care and community benefit. For this analysis, we defined five main categories of community benefits were measured: total community benefit; charity care; Medicaid shortfall; unreimbursed other means-tested services; and the total of unreimbursed education and unfunded research.Multiple regression was used to examine the effect of church ownership, controlling for other factors, on the level of community benefit in 2644 general acute care non-profit hospitals. Descriptive analyses and multiple regression were used to show the relationship between the provision of community benefits and church affiliation including Catholic (CH), other church-affiliated hospitals (OCAH), and non-church affiliated hospitals (NCAH). The non-profit hospital on average spent 6.5% of its total expenses on community benefits. NCAH spent 6.09%, CH spent 7.5%, and OCAH spent 9.4%. Non-profits spent 2.8% of their total expenses on charity care, with the highest charity care spending for OCAH (5.2%), followed by CH (3.9%), and NCAH (2.4%). Regression results showed that CH and OCAH, on average, spent 1.08% and 2.16% more on community benefits than NCAHs. In addition, CH and OCAH spent more on other categories of community benefits except for education and research. Church-affiliated hospitals spend more on community benefits and charity care than non-church affiliated nonprofit hospitals.

The impact of price transparency and competition on hospital costs: a research on all-payer claims databases

BackgroundPublic reporting has been considered effective in reducing health care costs by mitigating information asymmetry in the market as payers have incorporated publicly available information mandates into pay-for-performance programs and value-based purchasing. Therefore, hospitals have faced increasing pressures to provide price transparency. Despite the widespread promotion of healthcare transparency, the effectiveness of public reporting has not yet been sufficiently understood. This study analyzed the impact of transparency policy and competition on hospital costs by taking the state operations of all-payer claims databases (APCDs) as a case of interest.MethodsWe employed a fixed-effects regression, which allows the generation of hospital-specific effects, in accordance with the suggestion by the Hausman test. The study samples comprise nonprofit and for-profit general acute care hospitals in the United States for 2011–2017. The finalized dataset ranges from 3547 observations in 2011 to 3405 observations in 2015 after removing missing values.ResultsWe found that hospitals in the states with APCDs tend to bear higher average operating expenses than those without APCDs, which may indicate that states maintaining higher healthcare expenditures are more attentive to a price transparency initiative and tend to adopt APCDs. With regard to competition, the results showed that weak market competition is significantly associated with higher operating costs, supporting the traditional competition theory. However, the combined effect of APCDs and competition did not indicate a significant association with operating expenses. Further investigation showed a continued tendency for a weak intensity of competition to be linked to lower hospital operating costs in states without APCDs. For those located in non-APCD adopted states, market consolidation helped hospitals coordinate care more effectively, economize operating costs, and enjoy economies of scale due to their large size. Similar trends did not appear in APCD-adopted states except for in 2015.ConclusionsThis study observed limited evidence of the impact of APCDs and market competition. Our findings suggest that states need to make multifaceted efforts to contain hospital costs, not solely depending on the rollout of cost information or market competition. Market concentration may lead to coordinated care or cost economization in some cases. Still, the existing literature also demonstrates some potentially harmful impacts of increased concentration in the healthcare market, such as inefficient use of resources, unilateral market power, and deterrence of innovation. The introduction of a price transparency tool may require additional policy actions that take market competition into consideration.

Community Engagement in Nonprofit Hospital Community Health Needs Assessments and Implementation Plans.

Nonprofit hospitals are required to provide community benefits in exchange for their tax-exempt status. This includes a community health needs assessment (CHNA) to identify community needs and an implementation plan (IP) with strategies to address top needs every 3 years. In addition, hospitals are required to engage community members in these assessments. The objective of this study was to explore community engagement and representation in CHNAs and IPs. The researchers conducted a content analysis of CHNAs and IPs from a nationally representative sample of 503 nonprofit hospitals between 2018 and 2021. For CHNAs, a coding sheet was used to record the types of community members engaged by hospitals. For IPs, the team coded whether community engagement was reported at all and then performed an in-depth analysis to identify categories of community members, engagement methods used, and roles of community input. Finally, frequencies of categories across IPs were quantified. Eighty-nine percent of hospitals (n = 449) engaged community members in their CHNA, but only 14% (n = 71) engaged community members in their IP. An in-depth look at these IPs found that hospitals engaged underserved/minority populations, low-income populations, high school students, public health experts, and stakeholder organizations. Community members were involved in multiple steps, including brainstorming ideas, narrowing down needs, developing strategies, and reacting to proposed strategies. Although IPs are intended to benefit the community, there is a lack of community involvement reported in IPs. Hospitals may need incentives, resources, and personnel support to ensure representation of community members throughout the entire CHNA and IP process.

Measuring the State Dependence Effect in Hospital Payment Adjustment.

Since FY 2013, as a part of the Affordable Care Act (ACA) program, the Hospital Value-Based Purchasing (HVBP) program has adjusted Medicare's payments to hospitals based on the total performance score of the hospital. First, the program reduces a portion of the hospital's Medicare payments in a specific fiscal year, and then, by the end of the same fiscal year, the amount of the payment reductions will be awarded to the hospitals based on the total performance score; thus, the hospitals that do not receive the reward will lose the portion of money reduced by Medicare. In this research, we apply the theory of state dependence and use the dynamic random effect probit model to estimate this effect. The results show that the hospital payment adjustment dynamics have a very significant state dependence effect (0.341); this means that hospitals that received a reward in the previous year are 34.1% more likely to receive a reward this year than the ones that received a penalty in the previous year. Meanwhile, we also find that the state dependence effect varies significantly across hospitals with different ownership (proprietary/government owned/voluntary nonprofit), and the results show that voluntary nonprofit hospitals exhibit the largest effect of state dependence (0.370), while government-owned hospitals exhibit the lowest effect of state dependence (0.293), and proprietary hospitals are in the middle. Among the factors that influence the likelihood that a hospital receives a reward, we find that teaching hospitals with a large number of beds (>400) are less likely be rewarded; in terms of ownership, we find that voluntary nonprofit hospitals are more likely be rewarded; in terms of demographic factors, hospitals where the average household income are higher within the region are more likely be rewarded.

Understanding the relationship between nonprofit hospital community benefit spending and system membership: An analysis of independent hospital acquisitions

The Internal Revenue Service (IRS) requires nonprofit hospitals to report community benefit spending to justify their nonprofit tax exemption. We examined whether nonprofit hospital acquisitions influence the amount and type community benefit spending. We analyzed 2011–2018 data on urban, nonprofit hospitals. The analysis dataset included 57 hospitals that were acquired and a matched control group. We estimated difference-in-differences specifications to measure the effect of acquisitions on total community benefit spending, and three subcategories – clinical, population health, and other spending types. We found that acquisitions led to decreased population health spending (−$0.32 million, p < 0.01) and other spending categories (−$1.5 million, p < 0.05), but no significant change in total or clinical spending. If the acquirer was located out-of-state, total community benefit spending declined by $2.4 million (p < 0.10). Our findings support the need for community benefit spending to be considered, along with quality, efficiency, and prices, when evaluating the welfare impact of acquisitions.

Non-Technical Skills Training for Nigerian Surgical Teams: Which Way Forward?

INTRODUCTION: The non-technical skills (NTS) of situational awareness, decision making, leadership, and communication and teamwork, are significant for enhancing surgical safety. Considered soft skills, they can be overlooked, particularly in low-income contexts. A survey was designed to explore exposure to NTS in north central Nigeria and identify felt needs for the design of a contextualized curriculum. METHODS: Six institutions with high surgical volumes, including private nonprofit and government-owned teaching hospitals, were purposively identified. Using snowball sampling through surgical team leads, a 19-item, web-based survey was distributed to 71 surgical providers, anesthetists and perioperative nurses between August and November 2021. Data were analyzed using proportions and Fisher’s exact test. RESULTS: The survey had a 95.7% completion rate. Respondents included 17 anesthetists, 21 perioperative nurses, and 29 surgeons. Over half were unaware of the concept of NTS, and 96% had never heard of a NTS framework for variable resource contexts. Only 8% had NTS training. Communication and teamwork was considered the most deficient personal skill (38, 57%), and most needed for team improvement (45, 67%). There was a high demand for training (64, 96%) motivated by expectations of improved patient safety and better team dynamics. Respondents preferred week-long, hybrid training courses with in-person and online components. Perceived barriers to attendance were time conflicts and costs. Facilitators included a desire for self-improvement and patient safety (Table). CONCLUSION: Surgical teams in north central Nigeria are strongly motivated for NTS training believing it can improve patient safety, team dynamics, and personal performance. Implementation should emphasize communication and teamwork. Table. - Barriers and Facilitators to Participating in Non-Technical Skill Training in Nigeria Themes Number Percentage Example phrases Barriers Hindrances from the perioperative and institutional work environment 40 59.7 Challenges with the “Release by my employer “; “Work stress”; Non-technical skills training may “Clash with normal duties” or be limited by “tight schedule of residency training programme”; “Scheduled time of training coinciding with work” Barriers Lack of funding to pay for non-technical skills courses 14 20.9 A barrier is “Cost”; “Financial constraints” Barriers Lack of access to non-technical skills courses, particularly if in-person 10 14.6 Limited access to courses due to the “Insecurity Nigeria is now experiencing”; “Poor Internet services in Nigeria”; “Distance if the program is not online” Facilitators The motivation of improved patient safety 34 50.7 “To improve patient outcomes”; “Quest for improvement in surgical outcome”; “Patient safety and satisfaction”; “achieving global excellence for the maximum patient benefit”; “Desire to improve surgical outcome for my patience”; “prevent errors during surgery” Facilitators A drive for self-improvement 18 26.9 Facilitated by a desire “To add value to myself”; “Skill acquisition “; “personal aim at achieving global excellence “; Desire to “To improve my skills and knowledge” Facilitators The motivation of experiencing an improved work environment 10 14.9 Motivated by “reduce toxicity in the Operating Room”; “Strengthening teamwork”; “To see the change in attitude of my colleagues and other workers”; “A better working relationship with other health professionals”; “Improving interpersonal relationships” Facilitators Funding and financial incentives for training 4 6.0 Non-technical skills training would be facilitated by “Sponsorship”; “Scholarship”; “Financial motivation” Facilitators Support from work hierarchy, and removal of workplace barriers 3 4.5 Facilitated by “Convenience”; “Permission from my work place” Facilitators The award of certificates of training or attendance 1 1.5 The award of a formal “certificate” of attendance or other certification in non-technical skills

Comparison of Nonprofit Hospital Community Benefit Substance Abuse Identification and Practice Implementation in Appalachian and Non-Appalachian Counties.

As substance use continues to be a public health crisis nationally, it disproportionately affects the Appalachian region. Our research seeks to explore whether there is a greater substance use burden in Appalachia and whether that burden is being prioritized in local hospital systems' community health needs assessments (CHNAs) and implementation strategies (ISs). The setting for this study is the 13 states that are represented within the Appalachian region. This study examines CHNAs and ISs of a stratified random sample (n = 140) representing 20% of the hospital population within the identified states (those with counties within the Appalachian region). Each sampled hospital is labeled as Appalachian or non-Appalachian based on its county designation. Our main outcome measures were the percentage of hospitals listing substance abuse in their CHNAs, with comparisons between Appalachian and non-Appalachian subgroups, and percent addressing substance use in their ISs in Appalachia and non-Appalachia. Community health needs assessments and ISs produced between the years 2018 and 2021 were gathered for each hospital within the sample; each document was then coded for the inclusion of substance use. Chi-square tests and logistic regression were employed to conduct the analysis and draw conclusions. Although all non-Appalachian Counties that had substance use listed as a need within a CHNA correspondingly addressed that need in their ISs, only 75% of Appalachian counties that listed substance use a need went on to prioritize substance use in an IS. In addition, logistic regression indicated no significant link between overdose rates and addressing substance use. These findings further support other literature that suggests that lack of resources is limiting Appalachian health care organizations' ability to address substance use issues.

S630 Characterizing Racial Disparities in Follow-Up Care in an Open-Access Endoscopy Cohort

Introduction: Open-access endoscopy (OAE) describes access to endoscopic procedures for patients who are not office-established patients of a gastroenterologist. OAE has expanded access to endoscopy and can decrease healthcare disparities. Previous studies have explored factors associated with non-attendance to OAE. However, disparities in follow-up care after OAE have not been described. Methods: Barnes-Jewish Hospital (BJH) is a large nonprofit hospital in St. Louis, MO. BJH offers OAE to the St. Louis community. Utilizing the procedure list for open-access esophagogastroduodenoscopies (EGD), we completed a retrospective analysis of all patients who received an open-access EGD during 2019. During this time, 677 open-access EGDs were scheduled. Demographic and clinical variables, EGD indication, EGD findings, recommended follow-up, and completed follow-up care were collected from the electronic health record. Means ± standard deviations (SD) were used to express continuous variables. Student’s t-tests were utilized to compare means. Chi-square test or Fisher Exact Test were used to determine the unadjusted odds ratio (OR) and 95% confidence interval. A two-sided p-value of < 0.05 was considered statistically significant. Results: Of the 677 open-access EGDs, 294 (43.4%) were male, 414 (61.2%) identified as white, and 259 (38.3%) identified as minority. Within minority patients, 223/259 (86.1%) identified as Black. Some type of follow-up care was recommended in 176/677 patients (26.0%). Of the 176 patients who were recommended for follow-up, 130/176 (73.9%) were able to obtain the recommended follow-up. Of the 176 patients who were recommended for follow-up care, 37 (21.0%) were found to have HP. When stratifying the population who required some type of follow-up care by race, minority patients with HP were more likely than minority patients without HP to receive appropriate follow-up (OR=2.3; 95% CI 1.2 – 3.9). For white patients, those with HP were just as likely as those with a differing diagnosis to receive proper follow-up (OR 0.85, 95% CI 0.2 - 3.9). Conclusion: OAE has the potential to decrease healthcare disparities by providing access to endoscopies for patients who do not have a primary gastroenterologist. Minority patients with HP were more likely to receive the appropriate follow-up care than minority patients who required follow-up care without HP. Implementing strategies to ensure that all patients receive follow-up care after OAE, regardless of the findings made during OAE, is necessary.

One Decade Later: The Generalizability, Diversity, and Inclusion of Community Health Needs Assessments.

The 2010 Patient Protection and Affordable Care Act aimed to reduce health disparities and change medicine to be more community-driven. To maintain tax-exempt status, hospitals must complete a Community Health Needs Assessment (CHNA) every 3 years. This assessment must ( a ) integrate input from individuals the community serves, ( b ) make the report publicly assessable, and ( c ) adopt an implementation strategy based on community health needs identified in the assessment. However, there is little information on how representative CHNAs are of the community. A content analysis was performed on a random sample of CHNA reports. This investigation examined nonprofit hospitals across the United States. This investigation analyzed the quality of CHNAs and described existing CHNA practices through 4 means: (1) identified the type of data included; (2) examined the frequency in the methods of data collection; (3) understood how representative those data are of the hospital's service region; and (4) explored to what extent the hospital addressed diversity and inclusion such as through recruitment. A stratified random sample was drawn of CHNAs published in the past 3 years (n = 450 reports). The sample was stratified by the US Department of Agriculture's Rural-Urban Continuum codes to balance hospital representation from metro and nonmetro areas. A series of dependent t tests revealed that these hospitals' reports represented a significantly more female, White, college-educated, and older population than the service area. In addition, only 3.12% of hospitals collected primary youth data. Finally, results also found that survey recruitment was not inclusive of individuals who did not have Internet access, could not read, or did not speak English fluently.

Equity as a Guiding Theme in Hospitals’ Community Health Needs Assessments

This study explores the relationship between nonprofit hospitals' use of equity as a guiding theme in the development of their community health needs assessments and the level of alignment between the health needs identified in the community health needs assessment and those addressed in hospitals' implementation strategy. Using data from a nationally representative data set of 485 nonprofit hospital community health needs assessments for the years 2018-2021, this study employed a multivariate logistic regression model to examine the association between hospitals' use of equity as a guiding theme in the community health needs assessment and binary indicators of alignment for 6 common community health needs: access to care, chronic illness, obesity, mental health, substance use, and social determinants of health. Hospitals using equity as a guiding theme in their community health needs assessment reported significantly greater alignment for 3 needs: access to care (OR=3.40), substance use (OR=2.75), and social determinants of health (OR=3.60). Using equity as a guiding theme in the needs assessment process can help to align hospitals' community health initiatives with the most pressing health needs, thus contributing to public health improvement.

Exploring the Role of Community Social Capital in Not-for-profit Hospitals' Decision to Engage Community Partners in the Community Health Needs Assessment Process.

Not-for-profit hospitals (NFPs) frequently partner with community organizations to conduct internal revenue service-mandated community health needs assessment (CHNA), yet little is known about the number of partnerships that hospitals enter into for this purpose. This article uses "American Hospital Associations' 2020 Annual Survey" data to examine hospital-community partnerships around the CHNA and the role that community social capital defined as, "the networks that cross various professional, political and social boundaries to reflect community level trust needed to pursue shared objectives" plays in hospitals' choices to partner with community organizations for the CHNA. After controlling for a set of hospital, community, and state characteristics, we found that hospitals present in communities with higher social capital were likely to partner with more community organizations to conduct CHNA. Greater social capital may thus promote community health by facilitating the partnerships NFPs develop with community organizations to conduct the CHNA.

Association between non-profit hospital community benefit spending and health outcomes.

To determine if greater non-profit hospital spending for community benefits is associated with better health outcomes in the county where they are located. Community benefit data from IRS Form 990/Schedule H was linked to health outcome data from Area Health Resource Files, Map the Meal Gap, and Medicare claims from the Center for Medicare and Medicaid Services at the county level. Counties with at least one non-profit hospital in the United States from 2015 to 2019 (N=5469 across the 5 years) were included. We ran multiple regressions on community benefit expenditures linked with the number of health professionals, food insecurity, and adherence to diabetes and hypertension medication for each county. The three outcomes were chosen based on prior studies of community benefit and a recent survey sent to 12 health care executives across four regions of the U.S. Data on community benefit expenditures and health outcomes were aggregated at the county level. Average hospital community benefit spending in 2019 was $63.6 million per county ($255 per capita). Multivariable regression results did not demonstrate significant associations of total community benefit spending with food insecurity or medication adherence for diabetes. Statistically significant associations with the number of health professionals per 1000 (coefficient, 12.10; SE, 0.32; p < 0.001) and medication adherence for hypertension (marginal effect, 0.27; SE, 0.09; p=0.003) were identified, but both would require very large increases in community benefit spending to meaningfully improve outcomes. Despite varying levels of non-profit hospital community benefit investment across counties, higher community benefit expenditures are not associated with an improvement in the selected health outcomes at the county level. Hospitals can use this information to reassess community benefit strategies, while federal, state, and local governments can use these findings to redefine the measures of community benefit they use to monitor and grant tax exemption.

Costs of matched-sibling, unrelated, and haploidentical hematopoietic cell transplantation and risk factors for greater financial burden - a Brazilian FACT-accredited single-center analysis.

The complexity and costs of hematopoietic cell transplantation (HCT) have increased over the last decades with the popularization of unrelated donor (URD) transplantation and the introduction of haploidentical transplantation with posttransplant cyclophosphamide. Few studies have addressed this issue. The objective of this study was to analyze HCT costs in a single FACT-accredited private non-profit hospital. We included 79 patients who underwent HCT between 2018 and 2020. We have included all costs from admission day until D + 180. We used a lognormal regression. Median age was 53 y/o and most donors were unrelated (51%). Costs were higher with haploidentical donor (42%, p = 0.017, compared with URD), higher HCT-CI (15% for each point, p = 0.0056), and in patients with liver or gastrointestinal GVHD (45%, p = 0.033), and lower in patients who received CD34 > 2.5 × 10E6/kg (42%, p = 0.0038). We built a score based on the following risk factors: HCT-CI > 3, CD34 ≤ 2.5 × 10E6/kg, haploidentical donor, and donor age > 30 y/o. Patients with 2 + risk factors (N = 53) had a median cost of USD 226,156.00, compared with USD 93,048.00 in patients with zero or 1 point (N = 26, p < 0.0001). In summary, we have shown that HCT costs are higher with lower doses of CD34 cells, haploidentical HCT (provided that the costs of stem cell procurement and ATG are not included), and in patients with higher HCT-CI. Prospective and refined cost analyses comparing haploidentical and URD transplants, as well as effective strategies for patients with higher HCT-CI scores, are warranted. We found no difference in costs between URD and MSD transplantation.

The Role of Local Health Departments in Strengthening the Alignment Between Nonprofit Hospitals' Community Health Needs Assessments and Their Implementation Strategies.

Nonprofit hospitals frequently partner with their local health department on developing community health needs assessments (CHNAs); yet, little is known about the role that such partnerships play in strengthening the alignment between needs identified in hospitals' assessments and the strategies adopted by hospitals to address identified needs. Using data for 486 hospitals from the third round of CHNAs (spanning the years 2018-2021), this study showed strong alignment between the health needs identified in the CHNAs and those addressed in hospitals' implementation strategies, independent of collaboration with the local health department. One noteworthy exception to this finding was that hospital-public health collaboration remained important for improved alignment of needs related to substance use. Involvement of the local health department may strengthen hospitals' capacity to address needs outside their traditional areas of expertise, such as substance use.

Discussion Guide for the Alves Article.

Discussion Guide for the Alves Article.

Sociodemographic Disparities in Access to Cleft Rhinoplasty.

Various sociodemographic factors affect patient access to care. This study aims to assess how factors such as government-funded insurance and socioeconomic status impact the ability of adolescents with cleft lip-associated nasal deformities to access secondary rhinoplasty procedures. Patients older than 13 years old with a history of cleft lip/palate were identified in the National Inpatient Sample database from 2010 to 2012. Those who received a secondary rhinoplasty were identified using the International Classification of Diseases, Ninth Revision (ICD-9) procedural codes. A multivariate logistic regression model with post hoc analyses was performed to analyze if insurance status, socioeconomic status, and hospital-level variables impacted the likelihood of undergoing rhinoplasty. Of the 874 patients with a cleft lip/palate history, 154 (17.6%) underwent a secondary rhinoplasty. After controlling for various patient-level and hospital-level variables, living in a higher income quartile (based on zip code of residence) was an independent predictor of receiving a secondary cleft rhinoplasty (odds ratio=1.946, P =0.024). Patients had lower odds of receiving a cleft rhinoplasty if care occurred in a private, nonprofit hospital compared with a government-owned hospital (odds ratio=0.506, P =0.030). Income status plays a significant role in cleft rhinoplasty access, with patients from lower income households less likely to receive a secondary cleft rhinoplasty. Hospital-specific factors such as geographic region, bed size, urbanization, and teaching status may also create barriers for patients and their families in accessing surgical care for cleft lip nasal deformities.