Facility Ownership Research Articles

178. Implementation of the Core Elements of Antibiotic Stewardship in Nursing Homes – National Healthcare Safety Network (NHSN), 2016–2018

BackgroundSince 2016, nursing homes (NHs) enrolled in the Centers for Disease Control and Prevention’s NHSN Long-term Care Facility (LTCF) Component have reported on their implementation of the core elements of antibiotic stewardship. In 2016, 42% of NHs reported implementing all seven core elements. Recent regulations require antibiotic stewardship programs in NHs. The objectives of this analysis were to track national progress in implementation of the core elements and evaluate how time dedicated to infection prevention and control (IPC) is associated with the implementation of the core elements.MethodsWe used the NHSN LTCF 2016–2018 Annual Surveys to assess NH characteristics and implementation of the core elements, defined as self-reported implementation of at least one corresponding stewardship activity. We reported absolute differences in percent implementation. We used log-binomial regression models to estimate the association between weekly IPC hours and the implementation of all seven core elements, while controlling for confounding by facility characteristics.ResultsWe included 7,506 surveys from 2016–2018. In 2018, 71% of NHs reported implementation of all seven core elements, a 28% increase from 2016 (Fig. 1). The greatest increases in implementation from 2016–2018 were in Education (+19%), Reporting (+18%) and Drug Expertise (+15%) (Fig. 2). Ninety-eight percent of NHs had an individual responsible for antibiotic stewardship activities (Accountability), with 30% indicating that the role was fulfilled by an infection preventionist. Furthermore, 71% of NHs reported pharmacist involvement in improving antibiotic use, an increase of 27% since 2016. NHs that reported at least 20 hours of IPC activity per week were 14% more likely to implement all seven core elements, when controlling for facility ownership and affiliation, 95% CI: (1.07, 1.20). ConclusionNHs reported substantial progress in antibiotic stewardship implementation from 2016–2018. Improvements in accessing drug expertise, providing education and reporting antibiotic use may reflect increased stewardship awareness and use of resources among NH providers under new regulatory requirements. NHs with at least 20 hours dedicated to IPC per week may have greater capacity to implement all core elements.Disclosures All Authors: No reported disclosures

The organisation of community football, a barrier to environmental change

ABSTRACT Rationale/Purpose The aim of this research was to identify the extent of, and barriers, to pro-environmental activity within community-based, association football clubs in England. Design/Methodology/Approach Semi-structured interviews were undertaken with volunteers at community football clubs in the FA county of “North Country”. Findings The ownership and management of football facilities provides for a low level of independent decision making by clubs and negates the encouragement of pro-environmental activity. Practical implications Strategies for increased environmental activity in football need to look beyond individual clubs and volunteers to the way the sport is organised. Research contribution This research adds to a football and environment literature in its infancy and expands consideration of the non-professional sector of the game in academic work.

Cost effectiveness of community led total sanitation in Ethiopia and Ghana.

We conducted cost effectiveness analyses of four different CLTS interventions implemented in Ethiopia and Ghana. In each country, a pilot approach in which additional local actors were trained in CLTS facilitation was compared to the conventional approach. Data were collected using bottom-up costing, household surveys, and observations. We assessed variability of cost effectiveness from a societal perspective for latrine ownership and latrine use outcomes in different contexts. Cost effectiveness ranged from $34–$1897 per household ($5.85–$563 per person) gaining access to a private latrine or stopping open defecation, depending on the intervention, context, and outcome considered. For three out of four interventions, CLTS appeared more cost effective at reducing open defecation than at increasing latrine ownership, although sensitivity analysis revealed considerable variation. The pilot approaches were more cost effective at reducing open defecation than conventional approaches in Ethiopia, but not in Ghana. CLTS has been promoted as a low-cost means of improving the ownership and use of sanitation facilities. In our study, the cost of CLTS per household gaining latrine access was slightly higher than in other studies, and the cost of CLTS per household stopping OD was slightly lower than in other studies. Our results show that aggregate measures mask considerable variability in costs and outcomes, and thus the importance of considering and reporting context and uncertainty in economic analysis of sanitation interventions.

Customer relationship management and patient satisfaction and loyalty in selected hospitals in Ghana

Purpose This paper aims to examine the effect of customer relationship management (CRM) on patient satisfaction and patient loyalty, controlling for other socio-demographic characteristics. Design/methodology/approach The study used a two-stage sampling process and structured questionnaires to collect data from 788 patients from three health facilities (public, quasi-public and private) in Greater Accra, Ghana. The data collected was analyzed using descriptive statistics and regression via the partial least squares-based structural equation model. Findings The results suggest that CRM is significantly positively correlated with patient satisfaction and patient loyalty, with patient satisfaction also significantly correlated with patient loyalty. Additionally, the results suggest that the introduction of education, health facility ownership, health insurance status and gender, neither impact significantly on the relationship between CRM and patient satisfaction/patient loyalty nor influenced patient satisfaction and patient loyalty directly. Research limitations/implications The findings of the current paper can have substantial practice implications for operators in the health-care industry in Ghana. CRM components such as service quality, customer service, communication and the use of appropriate technology to deliver service will be fundamental if organizations operating in the health-care ecosystem in Ghana are to be able to compete effectively. Originality/value This is one of the very few papers on the relationship between CRM and patient satisfaction and patient loyalty in African health-care literature. Thus, the findings of the paper can constitute a great resource not only to academics but also to practitioners who are looking to be competitive in the health-care market.

Health facility readiness and provider knowledge as correlates of adequate diagnosis and management of pre-eclampsia in Kinshasa, Democratic Republic of Congo

BackgroundHypertensive disorders in pregnancy are the second most common cause of maternal mortality in the Democratic Republic of Congo (DRC), accounting for 23% of maternal deaths. This study aimed to assess facility readiness, and providers’ knowledge to prevent, diagnose, and treat pre-eclampsia.MethodsA facility-based cross-sectional study was conducted in 30 primary health centres (PHCs) and 28 referral facilities (hospitals) randomly selected in Kinshasa, DRC. In each facility, all midwives and physicians involved in maternal care provision (n = 197) were included. Data on facility infrastructure and providers’ knowledge about pre-eclampsia were collected using facility checklists and a knowledge questionnaire. Facility readiness score was defined as the sum of 13 health commodities needed to manage pre-eclampsia. A knowledge score was defined as the sum of 24 items about the diagnosis, management, and prevention of pre-eclampsia. The score ranges from 0 to 24, with higher values reflecting a better knowledge. The Mann-Witney U test was used to compare median readiness scores by facility type and ownership; and median knowledge scores between midwives in hospitals and in PHCs, and between physicians in hospitals and in PHCs.ResultsOverall, health facilities had 7 of the 13 commodities, yielding a median readiness score of 53.8%(IQR: 46.2 to 69.2%). Although all provider groups had significant knowledge gaps about pre-eclampsia, providers in hospitals demonstrated slightly more knowledge than those in PHCs. Midwives in public facilities scored higher than those in private facilities (median(IQR): 8(5 to 12) vs 7(4 to 8), p = 0.03). Of the 197 providers, 91.4% correctly diagnosed severe pre-eclampsia. However, 43.9 and 82.2% would administer magnesium sulfate and anti-hypertensive drugs to manage severe pre-eclampsia, respectively. Merely 14.2 and 7.1% of providers were aware of prophylactic use of aspirin and calcium to prevent pre-eclampsia, respectively.ConclusionOur study showed poor availability of supplies to diagnose, prevent and treat pre-eclampsia in Kinshasa. While providers demonstrated good knowledge regarding the diagnosis of pre-eclampsia, they have poor knowledge regarding its prevention and management. The study highlights the need for strengthening knowledge of providers toward the prevention and management of pre-eclampsia, and enhancing the availability of supplies needed to address this disease.

Assessment of health facility quality improvements, United Republic of Tanzania.

ObjectiveTo identify contextual factors associated with quality improvements in primary health-care facilities in the United Republic of Tanzania between two star rating assessments, focusing on local district administration and proximity to other facilities.MethodsFacilities underwent star rating assessments in 2015 and between 2017 and 2018; quality was rated from zero to five stars. The consolidated framework for implementation research, adapted to a low-income context, was used to identify variables associated with star rating improvements between assessments. Facility data were obtained from several secondary sources. The proportion of the variance in facility improvement observed at facility and district levels and the influence of nearby facilities and district administration were estimated using multilevel regression models and a hierarchical spatial autoregressive model, respectively.FindingsStar ratings improved at 4028 of 5595 (72%) primary care facilities. Factors associated with improvement included: (i) star rating in 2015; (ii) facility type (e.g. hospital) and ownership (e.g. public); (iii) participation in, or eligibility for, a results-based financing programme; (iv) local population density; and (v) distance from a major road. Overall, 20% of the variance in facility improvement was associated with district administration. Geographical clustering indicated that improvement at a facility was also associated with improvements at nearby facilities.ConclusionAlthough the majority of facilities improved their star rating, there were substantial variations between facilities. Both district administration and proximity to high-performing facilities influenced improvements. Quality improvement interventions should take advantage of factors operating above the facility level, such as peer learning and peer pressure.

Role of networking capability, socio-economic and institutional characteristics on adoption tendencies of clean seed potato agri-enterprises in central Rift Valley, Kenya

Even though quality of seed is a major yield determinant in potato (Solanum tuberosum L.) production and global food security, inadequate availability of and access to high quality (certified) seed is a major challenge to potato producers in Sub-Saharan Africa. The objective of this study was to examine farmer’s adoption tendency towards decentralised clean seed potato multiplication agri-enterprise (CSPMAE) in Central Rift Valley, Kenya, which aids in implementation of stage matched entrepreneurial interventions. A cross-sectional survey was conducted using a semi-structured questionnaire on 54 seed potato producers and 192 non-seed potato producers, through multistage sampling. Ordered logistic regression analysis, based on the trans-theoretical model, revealed that household head, partner knowledge, gender, land size allocated for potato production, level of education, ownership of transport and/or storage facilities, frequency of interaction with certified seed potato producers and agricultural extension officers influenced adoption tendencies of CSPMAE, positively and significantly. Seed potato value chain stakeholder platforms, development workers and donors should prioritise their support for clean seed agri-enterprises to farmers with such traits. This is likely to lead to increased supply of access to clean seed, thereby improving potato yields in Kenya.

Role of networking capability, socio-economic and institutional characteristics on adoption tendencies of clean seed potato agri-enterprises in central Rift Valley, Kenya

Even though quality of seed is a major yield determinant in potato (Solanum tuberosum L.) production and global food security, inadequate availability of and access to high quality (certified) seed is a major challenge to potato producers in Sub-Saharan Africa. The objective of this study was to examine farmer’s adoption tendency towards decentralised clean seed potato multiplication agri-enterprise (CSPMAE) in Central Rift Valley, Kenya, which aids in implementation of stage matched entrepreneurial interventions. A cross-sectional survey was conducted using a semi-structured questionnaire on 54 seed potato producers and 192 non-seed potato producers, through multistage sampling. Ordered logistic regression analysis, based on the trans-theoretical model, revealed that household head, partner knowledge, gender, land size allocated for potato production, level of education, ownership of transport and/or storage facilities, frequency of interaction with certified seed potato producers and agricultural extension officers influenced adoption tendencies of CSPMAE, positively and significantly. Seed potato value chain stakeholder platforms, development workers and donors should prioritise their support for clean seed agri-enterprises to farmers with such traits. This is likely to lead to increased supply of access to clean seed, thereby improving potato yields in Kenya.

Associations Between Length of Dialysis Facility Ownership and Vascular Access

Associations Between Length of Dialysis Facility Ownership and Vascular Access

TRANSFORMATION PROCESSES IN THE ECONOMIC SYSTEM OF FOOD INDUSTRY ENTERPRISES IN THE CONDITIONS OF STRUCTURAL CHANGES IN THE AGRICULTURAL SECTOR

Introduction. Against the background of the destruction of rules and principles of economic development that existed during the Soviet Union, and the struggle for independence, Ukraine has entered a period of profound transformation in all areas of the economy as a whole and individual economic entity. The new level of relations with the external environment and the consequences of the global economic crisis required urgent changes in the form of ownership of production facilities, principles of foreign economic activity, system of state control and taxation, monetary system, approaches to investment and innovation mechanisms. The purpose of this article is study of the causes of transformation processes in the system of food industry enterprises and substantiation of the peculiarities of their development in the conditions of reforming the agricultural sector of the country's economy. Results. The results of the study show that the prerequisites for transformations in the national economy as a whole and in particular, can be structured as follows: reforming the management system of the economy of the post-Soviet space in order to build market relations, the consequences of which make changes to the financial and economic system of the enterprise; Ukraine's integration into international cooperation, focus on EU cooperation, which is an impetus for innovative transformations; the purpose of entrepreneurial activity, which is an incentive to search for new ideas and transformation of business policy. Conclusions. The real preconditions which are an impetus for transformations of the enterprise are defined, namely: the consequences of global economic crises of the period of independence of Ukraine, which require the search for effective mechanisms for their elimination or leveling; reforming the management system of the economy of the post-Soviet space in order to build market relations; European integration and the processes of globalization that stimulate innovative development and related transformations; the goals and objectives of the business of a modern enterprise, which is an incentive to seek new ideas and transform business policy. Keywords: transformation, transformation processes, food industry enterprises, agricultural sector, structural changes.

Implementing remote supervision to improve HIV service delivery in rural Malawi

Background Viral load (VL) testing is critical to monitor response to ART and optimize HIV treatment and care outcomes. Unfortunately, VL testing coverage remains suboptimal in much of sub-Saharan Africa. With the COVID-19 pandemic significantly curtailing in-person supervision of HIV services delivery, low-cost and scalable ways of conducting remote supervision are needed. We evaluated the effects of remote supervision utilizing the WhatsApp platform, a form of supervision highly applicable in the times of COVID-19, on VL testing coverage in rural Malawi. Methods Remote supervision via WhatsApp was introduced at all 36 health facilities in Mangochi district in three phases from December 2018, starting with sites with the lowest VL coverage and high client volumes. Data were collected from VL testing registers over 35 weeks (pre-intervention=17 weeks; post-intervention=18 weeks). VL coverage was defined as the proportion of VL samples collected compared to the Ministry of Health’s target estimate of the number of VL samples that should be collected in that period. We used single-group interrupted time series design to analyze the effects of WhatsApp supervision and determined whether the effects varied by facility type and ownership. All regressions incorporated Newey-West standard errors to handle problems of heteroscedasticity and autocorrelation. Results A total of 23,754 VL samples were collected during the study period with nearly two-thirds (15,788) collected post-intervention. Post-intervention, average weekly VL coverage was 123% compared with 74% pre-intervention, an increase of 49 percentage points (t=13.5, p<0.001). There was an immediate step increase of 58 percentage points (95% CI: 48-68, p<0.001) from 58% to 116% following the intervention, which was followed by an increasing and sustained post-intervention trend in VL coverage of 2.5 percentage points per week (95% CI: 1.36, 3.67, p<0.001). Of the 15,788 VL samples collected post-intervention, 6,179 (or 40%) samples were deemed attributable to the intervention. Conclusions Remote supervision via WhatsApp may offer a simple, scalable, low-cost means of optimizing HIV service delivery in rural resource-limited settings to help to achieve national and regional goals in HIV treatment and care, particularly in the era of the COVID-19 pandemic where in-person supervision has been significantly curtailed.

205. The association of U.S. News & World Report hospital ranking and outcomes following anterior cervical fusions: an analysis of Medicare beneficiaries

BACKGROUND CONTEXT The U.S. News and World Report (USNWR) hospital rankings remain the most publicly referenced system for identifying top hospitals for each specialty. While these rankings are advertised by the media widely, and are routinely used by consumers (ie, patients) as a guide in seeking care for their ailments, evidence regarding whether these rankings are reflective of actual clinical outcome remains limited. PURPOSE The current study aims to evaluate whether there are any differences in outcomes and costs for patients undergoing elective 1-to-3 level anterior cervical fusions at ranked and unranked hospitals. STUDY DESIGN/SETTING Retrospective review of 2010-2014 100% Medicare claims PATIENT SAMPLE The 2010-2014 USNWR hospital rankings were used to identify ranked hospitals in “neurosurgery” and “orthopedics.” Because surgeons from both specialties routinely perform elective lumbar fusions, top ranked hospitals from both specialties were included in the study. The 2010-2014 100% Medicare Standard Analytical Files (SAF100) were used to identify patients undergoing elective 1-to-3 level anterior cervical fusions for degenerative spinal pathology. The study cohort was divided into two groups, 1) patients who received surgery at a ranked hospital vs 2) patients who received surgery at a unranked hospital. OUTCOME MEASURES Ninety-day complications, charges and costs. METHODS Multivariate logistic regression and generalized linear regression analyses were used to assess for differences in 90-day outcomes and costs between ranked and non-ranked hospitals, while controlling for age, gender, region, co-morbidity burden, socioeconomic status, hospital bed size, teaching status, location, facility ownership model and hospital volume. RESULTS A total of 110,520 patients undergoing elective 1-to-3 level anterior cervical fusions were included in the study, out of which 10,289 (9.3%) underwent surgery in one of the 100 ranked hospitals across the study time period. Ranked hospitals were more likely to have a higher annual case volume, be located in an urban location, have greater bed size, be teaching hospitals and have a voluntary/nonprofit or government ownership model. After adjusting for age, gender, region, comorbidity burden and hospital-level characteristics, there were no significant differences between ranked vs unranked hospitals with regards to wound complications (1.2% vs 1.1%; p=0.907), cardiac complications (12.9% vs 11.9%; p=0.0553), pulmonary complications (3.7% vs 6.7%; p=0.654), urinary tract infections (7.3% vs 5.8%; p=0.120), sepsis (9.3% vs 7.9%; p=0.847), deep venous thrombosis (1.9% vs 1.3%; p=0.077), refusion/revision surgery (0.3% vs 0.3%; p=0.617) and all-cause readmissions (4.7% vs 4.4%; p=0.266). Patients undergoing surgery at ranked hospitals vs unranked hospitals had a slightly lower odds of experiencing renal complications (7.0% vs 4.9%; OR 1.11 [95% CI 1.00-1.22]; p=0.047); however, these findings were not clinically significant. Elective anterior cervical fusions at ranked hospitals, however, had significantly higher risk-adjusted 90-day charges (+ $17,053; p CONCLUSIONS Patients undergoing anterior cervical fusions at ranked hospitals, have similar outcomes as compared to unranked hospitals, even though the former facilities (ie, ranked hospitals) have significantly higher costs and charges over the 90-day episode of care. The findings support the need of a more objective and clinical-based approach towards applying ranks to hospitals. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Patient safety culture and obstacles to adverse event reporting in nursing homes.

To investigate patient safety culture and its relationship with obstacles to adverse event reporting in Chinese nursing homes. Reporting obstacles are related to high incidences and unreported rates of adverse events. Patient safety culture is also associated with adverse events. However, the relationship between reporting obstacles and patient safety culture in nursing homes is unclear. A cross-sectional survey was conducted with a random sampling method among 549 staff members in six nursing homes using instruments of the Nursing Home Survey on Patient Safety Culture and the Adverse Event Reporting Obstacle Scale. The Pearson correlation coefficient, independent t tests, ANOVA tests and multivariate regression analysis were used. Patient safety culture in nursing homes was associated with facility ownership (p<.001), facility scale (p<.001), reporting management (p<.001), whether it was an integrated care institution (p=.006), frequency of concern about patient safety (p=.001), occurrence of adverse events in departments (p=.001) and a punitive atmosphere (p=.044). Adverse event reporting obstacles were negatively correlated with patient safety culture (p<.05). An improvement in patient safety culture was associated with a reduction in reporting obstacles in nursing homes. A barrier-free adverse event reporting system should be built to reduce reporting obstacles and create a non-punitive patient safety culture in nursing homes.

Measures of Care Coordination at Inpatient Psychiatric Facilities and the Medicare 30-Day All-Cause Readmission Rate.

Since late 2012, the Medicare Inpatient Psychiatric Facility Quality Reporting (IPFQR) program of the Centers for Medicare and Medicaid Services (CMS) has required inpatient psychiatric facilities to collect and publicly report a suite of quality measures. This study explored the association between facility-level 30-day risk-adjusted all-cause readmission (medical or psychiatric) after psychiatric hospitalization (READM-30-IPF) and care coordination process measures in the IPFQR program. The study used publicly reported IPFQR facility-level performance data of the Hospital Compare Web site for 1,343 inpatient psychiatric facilities, reflecting performance from July 2015 to June 2017. The authors used a cross-sectional design and linear regression models controlling for hospital and community characteristics and using state as fixed effect. The mean±SD facility-level READM-30-IPF was 20%±3%, with substantial variation by facility type, ownership status, rurality, and percentage of racial-ethnic minority residents in the county. Regression results showed that facilities with performance in the top tercile on the measure of 7-day mental health follow-up after discharge had readmission rates significantly lower than facilities in the bottom tercile (coefficient=-0.58, p<0.01), although the magnitude of this difference was small. READM-30-IPF, however, did not vary by facilities' performance on measures of discharge plan creation and transmission. Results suggest that facilities have substantial opportunities to reduce readmissions after psychiatric hospitalization. The association between hospital performance on care coordination process measures and the all-cause readmission measure currently included in the IPFQR program was minimal. The CMS should evaluate whether the IPFQR measures adequately capture compliance with evidence-based processes and desired outcomes.

The use of physical restraints in Chinese long-term care facilities and its risk factors: An observational and cross-sectional study.

To investigate the use of physical restraints among Chinese long-term care facilities older adults and to identify its risk factors. Observational and cross-sectional study. A total of 1,026 older adults from six long-term care facilities in Chongqing were recruited by cluster sampling method from July - November 2019. Data on physical restraint use and older adults' characteristics were collected using physical restraints observation forms and older adults' records. Organizational data were collected by questionnaires asking nursing managers. The independent risk factors for physical restraints use were assessed using chi-square test and binary logistic regression. The study found that the prevalence of physical restraints in six long-term care facilities in China was 25.83%. Waist belt (55.47%) and wrist restraint (52.83%) were most frequently used. Only 61.51% of physical restraints were signed with informed consent. 71.70% of physical restraints were caused by the prevention of falls, 89.06% of physical restraints were without nursing documentation, and 13.58% restrained older adults were observed to have physical complications. According to the binary logistic regression analysis, facility type and ownership, older adults per nursing assistant, length of residence, cognitive impairment, care dependency, mobility restriction, fall risk, physical agitation, and indwelling tubes emerged as important risk factors for the use of physical restraints. The use of physical restraints among Chinese long-term care facilities older adults was at a relatively high level and lack standardized and regulated practices. Moreover, Physical restraint use was associated with facility type and ownership, older adults per nursing assistant, length of residence, cognitive impairment, care dependency, mobility restriction, fall risks, physical agitation, and indwelling tube. This study will provide an effective reference for nursing staff in long-term care facilities to assess high-risk older adults in their use of physical restraints, which can support them to implement effective minimized restraint approaches to targeted people.

Long-Term Care Facility Ownership and Acute Hospital Service Use in British Columbia, Canada: A Retrospective Cohort Study

ObjectivePrevious studies report higher hospitalization rates in for-profit compared with nonprofit long-term care facilities (LTCFs), but have not included staffing data, a major potential confounder. Our objective was to examine the effect of ownership on hospital admission rates, after adjusting for facility staffing levels and other facility and resident characteristics, in a large Canadian province (British Columbia). DesignRetrospective cohort study. Setting and ParticipantsOur cohort included individuals resident in a publicly funded LTCF in British Columbia at any time between April 1, 2012 and March 31, 2016. MeasuresHealth administrative data were extracted from multiple databases, including continuing care, hospital discharge, and Minimum Data Set (MDS 2.0) assessment records. Cox extended hazards regression was used to estimate hospitalization risk associated with facility- and resident-level factors. ResultsThe cohort included 49,799 residents in 304 LTCF facilities (116 publicly owned and operated, 99 for-profit, and 89 nonprofit) over the study period. Hospitalization risk was higher for residents in for-profit (adjusted hazard ratio [adjHR] 1.34; 95% confidence interval [CI] 1.29–1.38) and nonprofit (adjHR 1.37; 95% CI 1.32–1.41) facilities compared with publicly owned and operated facilities, after adjustment for staffing, facility size, urban location, resident demographics, and case mix. Within subtypes, risk was highest in single-site facilities: for-profit (adjHR 1.42; 95% CI 1.36–1.48) and nonprofit (adjHR 1.38, 95% CI 1.33–1.44). Conclusions and ImplicationsThis is the first Canadian study using linked health data from hospital discharge records, MDS 2.0, facility staffing, and ownership records to examine the adjusted effect of facility ownership characteristics on hospital use of LTCF residents. We found significantly lower adjHRs for hospital admission in publicly owned facilities compared with both for-profit and nonprofit facilities. Our finding that publicly owned facilities have lower hospital admission rates compared with for-profit and nonprofit facilities can help inform decision-makers faced with the challenge of optimizing care models in both nursing homes and hospitals as they build capacity to care for aging populations.

Status of Infection Prevention and Control in Tanzanian Primary Health Care Facilities: Learning From Star Rating Assessment

SummaryBackgroundThe WHO estimates 10–30% of hospital admissions are associated with poor infection prevention and control (IPC). There are no reliable data on IPC status in Tanzanian healthcare facilities; hence the Star Rating Assessment (SRA) was established to address this. This study compared the health facility performances on adherence to IPC principles using baseline and reassessment data of SRA.MethodsA retrospective analysis of data from eight randomly selected regions across Tanzania. Data was gathered from an SRA database in which records of baseline assessments (2015/16) and reassessments (2017/18) were documented. Each healthcare facility's ownership and service level were investigated as independent variables.ResultsA total of 2,131 healthcare facilities at baseline and 2,185 at reassessment were analysed. Median adherence to IPC principles increased from 31% (IQR: 20%, 46%) to 57% (IQR: 41.4%, 73.2%) after interventions (p<0.001).Privately-owned facilities had higher adherence to IPC principles compared to publicly-owned facilities during baseline (p<0.001) however, the difference was not significant after intervention (p=0.751). On average, hospitals scored highest followed by health centres and then dispensaries during both assessments.Being a privately-owned facility was a predictor of attaining a recommended IPC score of 80% at baseline (POR=1.92 CI=1.06–3.48) but not after the intervention. Facility level was not a predictor during baseline assessment; however after intervention hospitals were twice as likely to attain the recommended score compared to dispensaries (POR=2.27 CI=1.15–4.45).ConclusionAssessment and rating of quality and organization of health services plus management support to healthcare facilities, leads to improved adherence to IPC principles.

Health Facility Ownership Type and Performance on HIV Indicator Data Reporting in Kenya.

In low- and middle-income countries, private and public facilities tend to have highly variable characteristics, which might affect their performance in meeting reporting requirements mandated by ministries of health. There is conflicting evidence on which facility type performs better across various care dimensions, and only few studies exist to evaluate relative performance around nationally-mandated indicator reporting to Ministries of Health. In this study, we evaluated the relationship between facility ownership type and performance on HIV indicator data reporting, using the case of Kenya. We conducted Mann-Whitney U tests using HIV indicator data extracted from years 2011 to 2018 for all the counties in Kenya, from the District Health Information Software 2 (DHIS2). Results from the study reveal that public facilities have statistically significant better performance compared to private facilities, with an exception of year 2017 in reporting of counselling and testing, and prevention of mother-to-child transmission indicator categories.

Role of Policy in Best-Practice Dissemination: Informal Professional Advice Networks in Canadian Long-Term Care.

This article examines provincial policy influence on long-term care (LTC) professionals' advice-seeking networks in Canada's Maritime provinces. The effects of facility ownership, geography, and region-specific political landscapes on LTC best-practice dissemination are examined. We used sociometric statistics and network sociograms, calculated from surveys with 169 senior leaders in LTC facilities, to identify advice-seeking network structures and to select 11 follow-up interview participants.Network structures were distinguished by density, sub-group number, opinion leader, and boundary spanner distribution. Network structure was affected by ownership model in Nova Scotia and Prince Edward Island, and by regional geography in New Brunswick. Political instability within each province's LTC system negatively affected network actors' capabilities to enact innovation. Moreover, provincial policy variations influence advice-seeking network structures, facilitating and constraining relationship development and networking. Consequently, local policy context is essential to informing dissemination strategy design or implementation.

Public money and private interests: United States government contract awardees’ contribution to industrial pollution production

Point source emissions generated by facilities that have been awarded government contracts raise questions regarding the relationship between the State and industrial facilities, particularly when those facilities’ emissions are disproportionately high. While providing public goods or services, many facilities also produce harmful emissions and toxic waste. We examine whether government contract awardees differ in the amount of hazardous pollution they produce when compared to their non-awardee counterparts. Using facility information from permitted industrial facilities over 12 years, we examine whether awardees produce more pollution than counterpart facilities. We theorize this difference using Louis Althusser’s structural theory of power in which he contends that the State acts above all to reproduce itself through the reinforcement of its economic base and the ruling class. As an economic determinist whose theories heavily engage ideology as a mechanism of control, Althusser’s structural approach provides a framework for understanding the apparatuses and mechanisms through which the State works to maintain power. Through a comparative analysis between proportionate contribution to industrial releases by government contract awardees and non-awardees, we find that awardees contribute to disproportionality within and across industries. In addition, linear mixed model regression methods are used to test whether the associations observed are due to contract awardee status or other variables such as facility size and ownership. We theorize that the act of awarding contracts to the lowest bidder supports the State’s goals but also results in awards being won by facilities with higher pollution production than counterpart facilities within their industrial sector.