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Assessment of the Prevalence and Impact of Social Determinants of Health in Successful Newly Licensed Registered Nurses While in School
Get PDFAbstract:Background: The impacts of social determinants of health (SDOH) have been found to adversely affect the current and long-term health status of people. In fact, all people are affected in some way by SDOH but the degree in which these determinants become barriers differs depending on the individual situation. This impact has yet to be assessed in how these barriers affect the ability of nursing students in their successful completion of nursing school. Those studies that have been analyzed in the literature with regards to health and college students are mostly assessing the impact of lifestyle choices such as binge drinking or smoking on health status.
Purpose: The focus and purpose of this study is to assess the challenges presented by SDOH in nursing students and the effect they have on a student nurses’ perception of their overall health status.
Design: This study used data from the 2019 California Newly Licensed RN Employment survey conducted by Health Impact California and disseminated from the California Board of Registered Nursing. The survey gathered data from 12,249 newly licensed nurses in the state of California. The response rate was 24.3% and 162 nurses did not meet inclusion criteria, resulting in a sample of 2,873 nurses.
Methods: The dependent variable used in this study was the perceived overall health status as rated by the respondents. This variable was created as an ordinal variable in a Likert-like scale and was measured as: poor, quite poor, fair, quite good and very good. The independent variables used were also created Likert-like in design to capture a range of answers. The independent variables used were housing security, food security, trouble with clothing, utilities, child care, adult dependent care, medicine/healthcare, transportation, depression, stress, family economic status, and bias/discrimination. Descriptive analyses were conduct by the Health Impact team. Multivariate Ordinal logistic regressions were conducted using STATA 16.1 to find which SDOH had affected the nurse’s perceptions of overall health. Analyses were completed on overall health status initially with only the independent variables and then again with race/ethnicity as a moderating variable. Using race/ethnicity as a moderating variable was done in order to find out what, if any race/ethnicity, faced challenges with social determinants that are more pronounced.
Results: It was found that of those who were accepted into the survey, 721 out of 2,873 of these nurses reported having some challenges related to SDOH (25.09%). The most common problem observed was the impact of depression on nurses perceived overall health. Depression was significant on every level of overall health, with and without race/ethnicity as a moderating variable. Other findings in the survey included the impacts of housing security, bias, and who was mostly affected based on race/ethnicity.
Conclusion: While SDOH occur in everyone’s life, not all experience them in the same way. The effects of social determinants of health such as unstable housing, family socio-economic status and mental health barriers, have shown through this analysis to affect an individual’s perception of their overall health status. With all of the information gathered, it is imperative to remember that these are successful nurses in California and further research must be conducted to better understand the challenges nursing students face outside of the classroo
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Pay-for-Performance to Improve the Value of Surgical Care: State of the Science and Empirical Evidence
Get PDFBackgroundSurgical care comprises 30% of hospital admissions and half of overall hospital costs. Surgical complications, in particular, increase hospital costs by approximately $20,000 per admission and extend hospital stays by 9.7 days. How to improve surgical care quality and reduce costs has attracted much attention from payers and policymakers. Pay-for-performance (P4P) schemes, along with other efforts, have emerged as a key tool for improving quality at reduced cost by linking payment to performance measures.ObjectivesThe overarching aim of this dissertation is to investigate the impact of P4P programs on improving the value of care for surgical patients. To address critical gaps in the literature, three primary aims are: (1) to identify the optimal payment design that maximizes the impact of P4P programs, (2) to evaluate the effectiveness of a mandated national P4P program launched by the Centers for Medicare and Medicaid Services, and (3) to assess the potential negative consequences of P4P programs on patient outcomes. MethodsTo address Aim 1, a systematic review was conducted using five databases to understand how much variation in surgical outcomes is attributable to the design of P4P programs. Studies were selected for review based on PRISMA guidelines, and the quality of individual studies was evaluated based on the STROBE checklist. To address Aim 2, an empirical study employing a propensity score weighted difference-in-differences design was performed to evaluate the impact of P4P programs on quality and cost outcomes of surgical care. To address Aim 3, another empirical analysis, building on the same statistical design as Aim 2, was performed to investigate the unintended consequences of P4P.Results and ImplicationsThe systematic review highlighted large variation in outcomes associated with payment designs of P4P programs. The evidence regarding preferred payment designs was inconclusive due to mixed results and studies lacking rigorous designs. Future studies are needed to draw stronger inferences about the best P4P payment design.The first empirical study found that the incidence of surgical site infection, length of stay, and hospital costs decreased following the implementation of a mandated national P4P policy. Policymakers may therefore consider these findings when considering the continuation and expansion of this P4P program, and other payers may also consider implementing a similar policy. Building on this analysis, the second empirical analysis found that patients treated in low-income-serving hospitals had worsened surgical quality outcomes following the P4P policy. This highlighted the importance of monitoring for potential unintended consequences of P4P programs and indicated that solutions to addressing the quality chasm in surgical outcomes need to be developed if equity in outcomes, while improving care for all surgical patients, is to be achieved. ConclusionsP4P may be a promising strategy if designed carefully. This dissertation indicates that the increasing popularity of P4P programs could be a window of opportunity for providers, hospitals, and payers to align quality of care with expenditures through incentives. Monitoring for potential unintended consequences, especially for populations at risk, and strategies to counteract these unintended consequences are recommended components of all P4P programs
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Home Health Nursing: Workforce Trends, Utilization Patterns, and Implications for Policy Reform
Get PDFHome health provides clinical care to a population comprised largely of aging and homebound adults. To be reimbursed by Medicare it must be delivered in an episodic, intermittent fashion when acute needs arise. The demand for home health services is projected to grow exponentially in the coming years. Home health nurses, who deliver much of the care, have shown signs of workforce instability characterized by diminishing workforce presence and high rates of turnover and workplace vacancy rates. Gaining a better understanding of home health nurse workforce issues is vital to ensure that there is a capacity to meet growing need for services and to design a home health system that better meets the needs of its patients. A series of secondary analyses of large, nationally representative datasets were conducted to explore the scope and nature of nurse turnover and work-related challenges, including turnover from home health workplaces, the broader home health sector, and utilization of nursing and non-nursing home health services. We found that home health nurses were more likely to leave the home health setting compared to hospital nurses leaving the hospital setting and were more likely to leave their workplaces farther along in their careers than nurses in hospital settings. Long hours were predictive of workplace turnover for home health nurses. Few nurses from other sectors were likely to enter home health as new employment. We also found a tendency for chronically ill and functionally impaired patients to require home healthcare repeatedly and by diverse care teams comprised of nurses and other professionals like physical therapists and care aides. Taken together, our results suggest a need to attract and retain newer-career nurses to home health, to explore modifiable time-consuming work tasks, highlight dangers of contemporary payment systems that disincentivize multidisciplinary care, and ultimately question the fittingness of the intermittent, episodic care system. Our use of national data suggest that these issues transcend specific locales and may therefore be amenable to reform from federal bodies like Medicare, which plays a large role in the regulation and reimbursement of home healthcare
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Get PDFWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Get PDFWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
koamabayili/VECTRON-author-checklist: VECTRON author checklist
No full textWe have done our best to complete the author checklist relating to the use of animals in the hut study. Note that the objective for the hut study was to evaluate the IRS treatment applications for residual efficacy against Anopheles mosquitoes, including the local An. coluzzii mosquito population. Cows were only used to attract mosquitoes into the huts and no tests were carried out directly on the cows. The author checklist is intended for use with studies where experiments are carried out on animals, which is why we have had such difficulty in completing this for the hut study, as many of the questions do not relate to how the cows were used
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