Hospital Providers Research Articles

Personalized 3D-printed frames to reduce leak from N95 filtering facepiece respirators: A prospective crossover trial in health care workers

Correctly fitting N95 filtering facepiece respirators (FFRs) have become increasingly important in health care throughout the COVID-19 pandemic. We evaluated the hypothesis that personalized 3D-printed frames could improve N95 FFRs quantitative fit test pass rates and test scores in health care workers (HCWs). HCWs were recruited at a tertiary hospital in Adelaide, Australia (ACTRN 12622000388718). A mobile iPhone camera + app was used to produce 3D scans of volunteers’ faces, which were then imported into a software program to produce personalized virtual scaffolds suited to each user’s face and their unique anatomical features. These virtual scaffolds were printed on a commercially available 3D printer, producing plastic (and then silicone-coated, biocompatible) frames that can be fitted inside existing hospital supply N95 FFR. The primary endpoint was improved pass rates on quantitative fit testing, comparing participants wearing an N95 FFR alone (control 1) with participants wearing the frame + N95 FFR (intervention 1). The secondary endpoint was the fit factor (FF) in these groups, and R-COMFI respirator comfort and tolerability survey scores. N = 66 HCWs were recruited. The use of intervention 1 increased overall fit test pass rates to 62/66 (93.8%), compared to 27/66 (40.9%) for controls. (OR for pFF pass 20.89 (95%CI: 6.77, 64.48, p < 0.001.) Average FF increased, with the use of intervention 1–179.0 (95%CI: 164.3,193.7), compared to 85.2 (95%CI: 70.4,100.0) with control 1. Pass rates and FF were improved with intervention 1 compared to control 1 for all stages of the fit-test: bending, talking, side-to-side, and up-down motion. (p < 0.001 all stages). Tolerability and comfort of the frame were evaluated with the validated R-COMFI respirator comfort score, showing improvement with the frame compared to N95 FFR alone (p = 0.006). Personalized 3D-printed face frames decrease leakage, improve fit testing pass rates and FF, and provide improved comfort compared to the N95 FFR alone. Personalized 3D-printed face frames represent a rapidly scalable new technology to decrease FFR leakage in HCW and potentially the wider population.

Analysis of Hospital Operating Margins and Provision of Safety Net Services

Safety net hospitals (SNH) provide many community services. The cost of providing these services is unknown. To determine what safety net criteria are associated with differences in hospital operating margin. This cross-sectional study of US acute care hospitals from 2017 to 2019 included eligible hospitals identified from US Centers for Medicare & Medicaid Services Cost Reports. Five domains of SNH: undercompensated care measured using the Disproportionate Share Hospital index, uncompensated care, essential community services, neighborhood disadvantage, and sole community hospital and critical access hospital status. Each was categorized as a quintile or binary response. Covariates included hospital ownership, size, teaching status, census region, urbanicity, and wage index. Operating margin and its association with each safety net criterion was determined using linear regression adjusting for all safety net criteria and covariates. A total of 4219 hospitals were analyzed, of which 3329 hospitals (78.9%) satisfied at least 1 safety net criterion; 23 hospitals (0.5%) met 4 or all 5 criteria. Among safety net criteria, the highest quintile of undercompensated care (-6.2 percentage point difference compared with lowest quintile; 95% CI, -8.2 to -4.2 percentage points), uncompensated care (-3.4 percentage points; 95% CI, -5.1 to -1.6 percentage points), and neighborhood disadvantage (-3.9 percentage points; 95% CI, -5.7 to -2.1 percentage points) were each associated with a lower operating margin. No association with operating margin was found between critical access or sole community hospital status (0.9 percentage points; 95% CI, -0.8 to 2.7 percentage points) or the highest vs lowest quintile of essential services (0.8 percentage points; 95% CI, -1.2 to 2.7 percentage points). Among essential services, burn, inpatient psychiatry, and primary care services were associated with lower operating margin, while others were either not associated or showed positive association. Fall-off in operating margin by level of uncompensated care was most severe in the highest percentiles of uncompensated care, with the most marked declines among those with the lowest operating margin. In this cross-sectional study of SNH, hospitals in the highest quintiles of undercompensated care, uncompensated care, and neighborhood disadvantage were more financially vulnerable than those not in the top quintile, especially when they met numerous of these criteria. Ensuring targeting of financial support to these hospitals could improve their financial stability.

Supply chain planning of vaccine and pharmaceutical clusters under uncertainty: The case of COVID-19

As an abrupt epidemic occurs, healthcare systems are shocked by the surge in the number of susceptible patients' demands, and decision-makers mostly rely on their frame of reference for urgent decision-making. Many reports have declared the COVID-19 impediments to trading and global economic growth. This study aims to provide a mathematical model to support pharmaceutical supply chain planning during the COVID-19 epidemic. Additionally, it aims to offer new insights into hospital supply chain problems by unifying cold and non-cold chains and considering a wide range of pharmaceuticals and vaccines. This approach is unprecedented and includes an analysis of various pharmaceutical features such as temperature, shelf life, priority, and clustering. To propose a model for planning the pharmaceutical supply chains, a mixed-integer linear programming (MILP) model is used for a four-echelon supply chain design. This model aims to minimize the costs involved in the pharmaceutical supply chain by maintaining an acceptable service level. Also, this paper considers uncertainty as an intrinsic part of the problem and addresses it through the wait-and-see method. Furthermore, an unexplored unsupervised learning method in the realm of supply chain planning has been used to cluster the pharmaceuticals and the vaccines and its merits and drawbacks are proposed. A case of Tehran hospitals with real data has been used to show the model's capabilities, as well. Based on the obtained results, the proposed approach is able to reach the optimum service level in the COVID conditions while maintaining a reduced cost. The experiment illustrates that the hospitals' adjacency and emergency orders alleviated the service level significantly. The proposed MILP model has proven to be efficient in providing a practical intuition for decision-makers. The clustering technique reduced the size of the problem and the time required to solve the model considerably.

HealthDote: A blockchain-based model for continuous health monitoring using interplanetary file system

The Healthcare industry demands increased privacy and security to protect confidential patient information and comply with regulations. Both these features can be incorporated into the existing systems using Blockchain technology. The only challenge faced here is the ease of users, but this can be quickly resolved by integrating the Internet of Things (IoT) and blockchain. IoT-based devices overcome limited computing capacity for personal intelligent health devices. Cloud-assisted IoT devices also require limited storage capacity for devices like wearable sensors. However, it must be considered that this system still has drawbacks, leading to its inefficiency. These problems include Data Privacy and Data sharing. This paper proposes an Interplanetary File System (IPFS) based solution to these problems. Here, the users continually upload the health data collected by IoT devices and add them to blockchain transactions that the other user nodes, such as physicians, pharmacists, insurance companies, hospital authorities, etc., can access. This system ensures the well-being of the users by monitoring the data gathered every 5 min and daily. It also facilitates the alarm feature in an emergency, making it reliable. The user receives daily notifications regarding his lifestyle, and the family members receive the notifications on his behalf if there are some chances of an emergency. The authorized doctors are also notified immediately in case an emergency is detected. Apart from this feature, the user can get consultations from doctors, prescriptions from the pharmacist, funds from insurance authorities, and hospital supplies, all through the transaction on the six blockchains of HealthDote using the cryptocurrency DoteCoins, which are designed specifically for this system.

Microbial profile and antibiotic resistance pattern of water supply in a tertiary care hospital of Uttarakhand.

In healthcare settings, hospital water and water-related devices can act as a reservoir for waterborne infections. Potable water, sinks, faucet aerators, showers, tub immersion, toilets, dialysis water, water baths, eyewash stations, and dental-unit water stations have all been linked to nosocomial outbreaks. This study aimed to determine the microbial profile and pattern of antibiotic resistance in the water supply of a tertiary care hospital in Uttarakhand. This is a 1-year prospective study which was carried out by the Department of Microbiology and Immunology at Sri Mahant Indersh Hospital (SMIH), Dehradun. A total of 154 water samples were collected from the AC outlets, ventilators in the Intensive care unit (ICUs), Operation theatre (OTs), and High dependency unit (HDUs), scrub stations, pantry, and blood bank, patient's bathroom, private ward, septic ward, labour room, transplant unit, laboratory, scope rinse water, the dialysis unit and tank throughout the hospital, including tap water (pre and post flush [25%]), tap swabs (24%), drinking water (9%), AC outlets (13%), and other areas (3%). 30 of the 154 (19.5%) water samples tested were culture-positive. The most contaminated water samples were tap swabs (27%, n = 8/30). A total of nine organisms were isolated, of which the most predominant was Pseudomonas aeruginosa (40%; 12/30), followed by Legionella pneumophila (13%; 4/30), Acinetobacter baumanii (10%; 3/30), Klebsiella pneumoniae (10%; 3/30), Escherichia coli (7%; 2/30), Enterococcus faecalis (7%; 2/30), Aspergillus flavus (7%; 2/30), Stenotrophomonas (3%; 1/30), and Fusarium spp. (3%; 1/30). Gram-negative bacilli and non-lactose fermenting (GNB and NLF) showed a high rate of contamination, 53.3% (n = 16/30). P. aeruginosa showed resistance to gentamicin and amikacin (42%), imipenem (50%), levofloxacin (58%), and colistin (25%), while Acinetobacter baumanii showed resistance to gentamicin and amikacin (67%), minocycline (63%), and levofloxacin, imipenem and colistin (33%). The study's findings show that a variety of microorganisms are contaminating hospital water supplies and can be a source of hospital-acquired infections. A suitable and robust surveillance program for hospital water supplies, as well as strict adherence to infection control practices, is strongly advised.

Sustainable Hospital Supply Chain Management through Hospital Infrastructure Development

Sustainability in Hospital Supply Chain Management (HSCM) is a critical consideration in the modern healthcare industry, given the growing concern for environmental conservation and resource optimization. Hospital Infrastructure Development (HID) is one of the key elements that can significantly contribute to sustainable HSCM. This article discusses the role of HID in enhancing the sustainability of HSCM and the various strategies that can be implemented.

Improving hospital material supply chain performance by integrating decision problems: A literature review and future research directions

Logistics costs are the second largest cost for hospitals, so effectively managing the hospital material supply chain provides significant opportunities for improvement. In order to optimise supply chain performance, strategic, tactical and operational decisions (e.g. location, inventory, routing) of the different echelons should be made in an integrated way. Large efficiency improvements and cost reductions are possible through the application of holistic supply chain management, while at the same time maintaining a high quality of care. In addition, real-life features that distinguish the hospital supply chain from other contexts should be included in the decision-making process (e.g. patient safety, perishability, stochasticity). In this paper, an extensive literature review on integrated decision making in hospital supply chains is conducted. The focus is on quantitative research papers dealing with the integration and optimisation of two or more hospital material supply chain decisions as a way to improve operational performance and reduce logistics costs. This paper is the first to provide a comprehensive and structured overview of the existing literature on integrated decision making within the entire hospital supply chain. Existing literature is classified based on both general and real-life problem characteristics that distinguish the healthcare setting from other industries. The insights can direct and facilitate future research on this topic, enhance the applicability of existing supply chain management techniques to a real-life hospital supply chain and, consequently, improve hospital supply chain performance.

A changing supply chain for a changing health care system: Barriers and facilitators of implementing enterprise resource planning.

No studies have examined how health care mergers and acquisitions affected the hospital supply chain and its employees since the passing of the Patient Protection and Affordable Care Act. To describe the barriers and facilitators of digital transformation in a hospital supply chain from the employee perspective. We conducted two rounds of interviews, one year apart, with supply chain employees at an urban academic health system preparing to adopt an enterprise resource planning (ERP) software (N = 11 in Round I and N = 8 in Round II). Two researchers coded transcripts for themes using NVivo 11. We identified the following barriers to technology integration: silos between supply chain groups (e.g. Purchasing, Information Management, Strategic Sourcing), between employees and management, and resulting from prior mergers; focus on short-term problems and fear of change; and lack of transparent communication about upcoming changes. Facilitators of technology integration included motivation to work in supply chain; long-term vision that allowed tolerance of change and positive outlook; and transparent communication. Desire for shared leadership among employees emerged as a major theme, indicating the need for active involvement of employees during transition to new integrative technology.

A Holistic View on the Adoption and Cost-Effectiveness of Technology-Driven Supply Chain Management Practices in Healthcare

Healthcare supply chains are complex systems facing challenges in delivering high-quality care while maintaining cost-effectiveness. Research on inventory management and control, the heart of the healthcare supply system, has demonstrated that these targets can be reached by managing inventories efficiently while aiming at desired service levels. Although this can be enabled by adopting various supply chain management practices, the healthcare sector appears to lag compared to other industries. Seeking to investigate these aspects, this study draws on operations management literature, identifies and categorizes technology-driven supply chain management practices that are applied in hospital operations, develops a holistic conceptual framework delineating the key factors influencing their adoption in healthcare facilities, and examines their aggregated impact on financial performance. The research model is tested using structural equation modeling with survey data collected from Greek public hospitals. The study results indicate that technological readiness, organizational readiness, perceived benefits, and hospital size significantly influence the adoption of these practices in hospital supply chains. Moreover, they show a statistically significant association between the supply chain management practices applied and improved hospital cost performance, suggesting greater urgency for hospitals to exploit them fully. Theoretical and practical implications of the findings are discussed.

Hospital Supply Chain Management: Cross-Disciplinarity Opportunities in the Post-Pandemic Era and Research Agenda

Hospital Supply Chain Management: Cross-Disciplinarity Opportunities in the Post-Pandemic Era and Research Agenda

Opinions Related to the Potential Application of Artificial Intelligence (AI) by the Responsible in Charge of the Administrative Management Related to the Logistics and Supply Chain of Medical Stock in Health Centers in North of Chile

The research evaluated the opinion of those in charge of the administrative management of the logistics and supply chain of medical and pharmaceutical stocks of health care centers in the north of Chile and a potential improvement of their operations through the use of artificial intelligence (AI). The identification of the problem arose from the empirical analysis, where serious deficiencies in the manual handling and management of the stock of medicines and hospital supplies were evidenced. This deficiency does not allow a timely response to the demand of the logistics and supply chain, causing stock ruptures in health centers. Based on this finding, we asked ourselves how AI was observed as the most efficient tool to solve this difficulty. The results were obtained through surveys of personnel in charge of hospital and pharmacy supplies. The questions focused on the level of training, seniority in positions related to the problem, knowledge of regulations, degree of innovation in the procedures used in logistics and supply chain and procurement. However, a very striking fact was related to the importance of the use of AI, where, very surprisingly, 64.7% considered that it would not help to reduce human errors generated in the areas analyzed.

Senior Services in US Hospitals and Readmission Risk or Mortality Among Medicare Beneficiaries Since the Affordable Care Act.

Background: The Senior Care Services Scale (SCSS) describes hospital provision of older adult services before the passage of the Affordable Care Act. Objectives: Since act passage, (1) update SCSS service groups; and (2) investigate hospital SCSS scores' relationship to readmission or mortality among Medicare beneficiaries. Methods: Retrospective cohort analysis of older adults ≥65years (n = 1,416,669), admitted to 2570 US acute-care hospitals from 2014 to 2015. Outcomes: Hospital readmission, or death, within 30 and 90days of discharge. Results: The updated SCSS had three service groups: Inpatient Specialty Care, Post-Acute Community Care, and Home Care and Hospice. Older adults admitted to high Inpatient-Specialty-Care-scoring hospitals had lower risk of death within 30days (RR .94, 95% CI .91-.98), and 90days (RR .94, 95% CI .91-.97). There was no significant association between Home-Care-and-Hospice and Post-Acute-Community-Care scores and study outcomes. Conclusion: Greater provision of hospital-level senior services may be associated with mortality reduction among Medicare beneficiaries.

Rationalizing the Use of COVID-19 Questionable Efficacy Drugs in a Low Middle-income Country: A Hospital Tocilizumab Committee Experience.

Only corticosteroids have confirmed mortality benefits in coronavirus disease of 2019 (COVID-19). Rational use of costlier drugs with questionable benefits poses a great concern to hospital pharmacies in low middle-income countriesAim: The present study aimed to assess the rational utilization of hospital supply tocilizumab and understand its clinical benefits in hospitalized COVID-19 pneumonia patientsMethods: The Hospital Tocilizumab Committee (HTC) decision support system framework was developed to make patients eligible or ineligible for tocilizumab procurement from the hospital pharmacy. A total of 33 consecutive patients receiving tocilizumab were analyzed retrospectively in the 3-month study period. The records of the inpatient stay of the patients were observed for pulse, blood pressure, respiratory rate (RR), oxygen saturation (SpO2), fraction of inspired oxygen (FiO2) laboratory work-up, hospital stay duration, and mortality benefit, if any. Patients were analyzed as "died," "survived," and "composite" subgroupsResults: The study observed death as a final outcome in 48% of patients. The study observed a significant effect of tocilizumab on C-reactive protein (CRP) (p = 0.02) and ferritin (p = 0.018) levels on a 10-day follow-up when all patients were analyzed together. Rising and declining trends of RR and FiO2 were observed among the "died" (RR, p = 0.02; FiO2, p = 0.03) and survived (RR, p = 0.03; FiO2, p = 0.05) subgroups. The second dose of tocilizumab was received by 88% of survivors as against 50% of patients who died (p = 0.04)Conclusion: Hospital Tocilizumab Committee (HTC) was successfully established to continue the assessment of the costlier drug with uncertain treatment benefits. A repeat dose of tocilizumab may provide a mortality benefit in Asian Indians.

Digitalization of the Healthcare Supply Chain through the Adoption of Enterprise Resource Planning (ERP) Systems in Hospitals: An Empirical Study on Influencing Factors and Cost Performance

Rising healthcare costs force healthcare organizations worldwide to reconsider their business strategies. Hospital managers are tasked with lowering operating costs while upholding the high quality of care, two goals perceived as contradictory by many healthcare professionals. Attempting to contribute towards reaching these goals, the study explores the digitalization of the healthcare supply chain through the adoption of enterprise resource planning (ERP) systems and its impact on hospital supply chain costs. Established technology adoption theories are synthesized to develop a research model that investigates the adoption of hospital ERP systems and its impact on supply chain cost performance. The framework is validated via structural equation modeling (SEM) with data collected from 107 Greek public hospitals. The results indicate that technological and organizational readiness, hospital size, governmental policies, and perceived benefits have a significant influence on the extent of ERP systems adoption. They also demonstrate a statistically significant association between the use of ERP systems and hospital supply chain costs. The present study highlights the influencing factors of ERP systems adoption in hospitals and provides empirical evidence on the resulting cost benefits., This implies greater urgency for hospitals to digitalize their supply chain by implementing and fully exploiting the ERP systems’ functionality in order to reach their goal of delivering quality care at a lower cost.

Association of Medicaid expansion and 1115 waivers for substance use disorders with hospital provision of opioid use disorder services: a cross sectional study

IntroductionOpioid-related hospitalizations have risen dramatically, placing hospitals at the frontlines of the opioid epidemic. Medicaid expansion and 1115 waivers for substance use disorders (SUDs) are two key policies aimed at expanding access to care, including opioid use disorder (OUD) services. Yet, little is known about the relationship between these policies and the availability of hospital based OUD programs. The aim of this study is to determine whether state Medicaid expansion and adoption of 1115 waivers for SUDs are associated with hospital provision of OUD programs.MethodsWe conducted a cross-sectional study of a random sample of hospitals (n = 457) from the American Hospital Association’s 2015 American Hospital Directory, compiled with the most recent publicly available community health needs assessment (2015–2018).ResultsControlling for hospital characteristics, overdose burden, and socio-demographic characteristics, both Medicaid policies were associated with hospital adoption of several OUD programs. Hospitals in Medicaid expansion states had significantly higher odds of implementing any program related to SUDs (OR: 1.740; 95% CI: 1.032–2.934) as well as some specific activities such as programs for OUD treatment (OR: 1.955; 95% CI: 1.245–3.070) and efforts to address social determinants of health (OR: 6.787; 95% CI: 1.308–35.20). State 1115 waivers for SUDs were not significantly associated with any hospital-based SUD activities.ConclusionsMedicaid expansion was associated with several hospital programs for addressing OUD. The differential availability of hospital-based OUD programs may indicate an added layer of disadvantage for low-income patients with SUD living in non-expansion states.

Experiences of Child and Adolescent Psychiatric Patients Boarding in the Emergency Department from Staff Perspectives: Patient Journey Mapping.

Over the past decade, healthcare providers nationwide have contended with a growing boarding crisis as pediatric patients await psychiatric treatment in emergency departments (EDs). COVID-19 has exacerbated this urgent youth mental health crisis, driving EDs to act as crisis units. Journey mapping is a robust methodology with which to examine strengths and challenges in patient care workflows such as boarding and emergency psychiatric care.Psychiatric, emergency medicine, and hospitalist providers serving patients boarding at a northeastern children's hospital participated in semi-structured qualitative interviews. Investigators conducted directed content analysis with an inductive approach to identify facilitators, barriers, and persistent needs of boarding patients, which were summarized in a patient journey map. Findings were presented to participants for feedback and further refinement.Quantitative data showed a three-fold increase in the number of patients who boarded over the past three years and a 60% increase in the average time spent boarding in the ED. Emergent qualitative data indicated three stages in the boarding process: Initial Evaluation, Admitted to Board, and Discharge. Data highlighted positive and negative factors affecting patient safety, availability of beds in pediatric hospital and psychiatric inpatient settings, high patient-provider ratios that limited staffing support, and roadblocks in care coordination and disposition planning.Patient journey mapping provided insight into providers' experiences serving patients boarding for psychiatric reasons. Findings described bright points and pain points at each stage of the boarding process with implications for psychiatric care and systemic changes to reduce boarding volume and length of stay.

Charitable activities of Kyiv eparchy monasteries and convents in the second half of the 19th century – the early 20th century

The article deals with charitable activities of Kyiv eparchy monasteries and convents during the second half of the 19th century and the early 20th century. It shows that charitable activities of the Orthodox church reached its peak in the post-reform period. The charitable activities within the specified time frame lay in the provision of schools, hospitals, orphanages, almshouses, and hotels for the poor and pilgrims. Kyiv eparchy monasteries and convents a) distributed alms, organized free lunches, provided material and medical assistance, b) handled education issues by establishing parish schools, c) supported almshouses by aiding sick people, lonely elderly people, people with special needs, and the mentally ill. At the beginning of World War I, Kyiv eparchy monasteries and convents became actively involved in the provision of assistance to the population, as well as the establishment and maintenance of shelters for children (orphans) of fallen soldiers. Such children were provided with proper care and timely medical assistance. Charitable institutions at the premises of Kyiv eparchy monasteries and convents operated at the expense of funds received from their economic activities, as well as donations from private individuals. Kyiv eparchy monasteries and convents comprised the greatest number of hospitals and almshouses of all those operating in the territory of the then Kyiv Governorate.

Uncertainty in Hospital Supplies—A Cardinal Error (a): Decision-Making as a Crisis Unfolds

Uncertainty in Hospital Supplies—A Cardinal Error (a): Decision-Making as a Crisis Unfolds

The Adequacy of Hospital Response to COVID-19 Pandemic amongst Surgical Institutions in South-Eastern Nigeria.

The novel corona virus (COVID-19) was first diagnosed in Wuhan, China in December 2019. The healthcare specifically, departments of surgery in Southeastern Nigeria, are making modifications to cope and plan for the pandemic. To evaluate how well surgical institutions in Southeastern Nigeria are prepared for the anticipated influx of Covid-19 patients, existing patients and to determine the adequacy of hospital provision of essential supplies and awareness creation. A cross-sectional online study of two hundred and one (201) surgery resident doctors in surgical institutions in South-eastern Nigeria was conducted. Questionnaires were designed and distributed using online platforms. The data obtained was analyzed using the Statistical Package for the Social Sciences (SPSS). Significance was set at P < 0.05. Consent was obtained from all respondents. A total of 201 surgery resident doctors filled and submitted their questionnaires, response rate of 71.5%, out of which 50.1% agreed that hospital response to Covid-19 pandemic was inadequate, 78.3% agreed that the Personal Protective Equipment (PPEs) provided by hospitals were inadequate while about 53.8% agreed that the hospital workforce was poor and inadequate and incapable of adapting to the unstable workforce during the pandemic. About 46.2% agreed that the hospitals were conducting an adequate creation of awareness with regards to the pandemic while 25% agreed that the hospital compliance with the CDC (Center for disease control) preventive protocols/guidelines in surgical institutions were adequate.There was a statistically significant association (P = 0.019 (< 0.05); X2= 5.517) between hospital type and provision of adequate Personal protective equipment for surgical procedures. Only 19% of the government hospital employees felt that adequate amount of PPEs were provided compared to 41% of private hospital employees. The results from this study show that the hospital response to Covid-19 pandemic and awareness creation amongst surgical institutions in Southeastern Nigeria are inadequate. The government should equip the health sector by providing the necessary amenities to adequately combat the challenges of surgical practice in the Covid-19 pandemic.

Disability and in-hospital breastfeeding practices and supports in Ontario, Canada: a population-based study

Breastfeeding provides infants with nutrients required for optimal growth and development. We aimed to examine breastfeeding practices and supports that promote exclusive breastfeeding during the birth hospital stay among birthing parents with physical disabilities, sensory disabilities, intellectual or developmental disabilities, and multiple disabilities compared with those without a disability. This population-based cohort study was done in Ontario, Canada. We accessed and analysed health administrative data from ICES and the Better Outcomes Registry & Network. We included all birthing parents aged 15-49 years who had a singleton livebirth between April 1, 2012, and March 31, 2018. The study outcomes were breastfeeding practices and supports that promoted exclusive breastfeeding during the birth hospital stay, conceptualised based on WHO-UNICEF Baby Friendly Hospital Initiative guidelines. Individuals with a physical disability, sensory disability, intellectual or developmental disability, or two or more (multiple) disabilities, identified using diagnostic algorithms, were compared with individuals without disabilities on the opportunity to initiate breastfeeding, in-hospital breastfeeding, exclusive breastfeeding at hospital discharge, skin-to-skin contact, and provision of breastfeeding assistance. Relative risks (RRs) were estimated using modified Poisson regression. Our cohort included 634 111 birthing parents, of whom 54 476 (8·6%) had a physical disability, 19 227 (3·0%) had a sensory disability, 1048 (0·2%) had an intellectual or developmental disability, 4050 (0·6%) had multiple disabilities, and 555 310 (87·6%) had no disability. Individuals with intellectual or developmental disabilities were less likely than those without a disability to have an opportunity to initiate breastfeeding (adjusted RR 0·82, 95% CI 0·76-0·88), any in-hospital breastfeeding (0·85, 0·81-0·88), exclusive breastfeeding at hospital discharge (0·73, 0·67-0·79), skin-to-skin contact (0·90, 0·87-0·94), and breastfeeding assistance (0·85, 0·79-0·91). Those with multiple disabilities were less likely to have an opportunity to initiate breastfeeding (0·93, 0·91-0·96), any in-hospital breastfeeding (0·93, 0·92-0·95), exclusive breastfeeding at hospital discharge (0·90, 0·87-0·93), skin-to-skin contact (0·93, 0·91-0·95), and breastfeeding assistance (0·95, 0·92-0·98). Differences for individuals with a physical or sensory disability only were mostly non-significant. Our findings show disparities in breastfeeding outcomes between individuals without a disability and individuals with intellectual or developmental disabilities or multiple disabilities, but not individuals with physical or sensory disabilities. There is a need for further research on the factors that contribute to breastfeeding intentions, practices, and supports in people with intellectual or developmental disabilities and multiple disabilities, especially factors that affect breastfeeding decision making. National Institutes of Health and the Canada Research Chairs Program.