Enhancing Discharge Transitions at Gifford Health Care

Enhancing Discharge Transitions at Gifford Health Care Megan L. O’Brien, MS, FNP-BC, APRN Purpose. During transitions of hospital discharge, errors and lack of education pose risks to patients resulting in dissatisfaction with hospital care, poorly attended follow-up appointments, and readmissions. Discharge planning that encompasses patient centered, multidisciplinary principles have been proven to reduce health care costs while increasing satisfaction among patients and staff. At Gifford Health Care in Randolph, Vermont, hospital readmission rates were below the national average of 15.9%, but the patient satisfaction scores were lower than state and national averages. To improve discharge transitions, this project utilized the Boston University evidenced-based ReEngineered Discharge (ProjectRED) principles to develop three aims: 1) increase patient preparedness for self-management, 2) timely access to follow-up appointments, and 3) support the transition of care from discharge until primary care appointment. Methods. This project set three objectives 1) improve the discharge instructions provided to patients and families at discharge, 2) access to follow-up appointments within 5 days of discharge, 3) enhance the transition period from discharge to follow-up appointment by creating a process for a structured telephone call with documentation. Process measures regarding follow-up appointments and phone calls were evaluated by random sampling chart audit. Outcome measures were evaluated using the Hospital Consumer Assessment of Healthcare Provider and Systems (HCAHPS) survey to evaluate satisfaction scores. Implementation involved multi-disciplinary meetings involving staff, administration, technical support, pharmacy, quality team, and care management to revise the discharge order set and develop an electronic form for phone call documentation. Results. This project yielded improved overall hospital rating (5.3%), earlier access to follow up (by 2 days), and reduced readmissions (1%). Despite these positive trends, a decrease in follow- up appointment attendance (3%) and lack of consistent follow-up phone calls was noted ( Conclusions. Improving discharge systems has been demonstrated to improve patient care and satisfaction. ProjectRED was originally developed in large, urban, tertiary care facilities. This project has demonstrated that similar outcomes can be achieved on a smaller scale by using a multidisciplinary team to implement selected evidenced based components. Data generated from this project can be used as a foundation to partner with the primary care teams to improve the follow up appointment process, and use the responses from the discharge follow-up phone call to develop further quality improvement projects around the discharge process. Future areas of work may include replication at additional smaller institutions. Keywords. ProjectRED, discharge, transitions, patient satisfaction, readmission

Effect of Enterprise Risk Management (ERM) on Sustainability and Survival of Banks in Nigeria

Beyond question, risk management is the surviving engine to which enterprises are built upon for sound organizational sustainability. Thus, this study assessed enterprise risk management and its effect on sustainability and survival of deposit money banks in Nigeria. The study utilized Survey research design, a non probability judgment sample of 111 participants extracted from 16 deposit money banks in JOS north local government of plateau state responded to a re-validated 5 points Likert scale questionnaire. Data were analyzed using quantitative techniques and multiple regression analysis with aid of SPSSv23 to test the hypotheses. The result found significant relationship between ERM and bank sustainability and survival indicators. To this effect, the study recommended that for a better opportunity to remain relevant and financially successful it is imperative for deposit money banks to readjust their strategic financial plans; increase their income diversification base to combat adverse impacts of risks and uncertainty in business transactions; more so, to keep up with global trends, banks should not underestimate the role sound administration and financial management play in reducing attendant cost and forestalling future financial crisis

Contributions of natural and human factors to increases in vegetation productivity in China

Increasing trends in vegetation productivity have been identified for the last three decades for many regions in the northern hemisphere including China. Multiple natural and human factors are possibly responsible for the increases in vegetation productivity, while their relative contributions remain unclear. Here we analyzed the long-term trends in vegetation productivity in China using the satellite-derived normalized difference vegetation index (NDVI) and assessed the relationships of NDVI with a suite of natural (air temperature, precipitation, photosynthetically active radiation (PAR), atmospheric carbon dioxide (CO2) concentrations, and nitrogen (N) deposition) and human (afforestation and improved agricultural management practices) factors. Overall, China exhibited an increasing trend in vegetation productivity with an increase of 2.7%. At the provincial scale, eleven provinces exhibited significant increases in vegetation productivity, and the majority of these provinces are located within the northern half of the country. At the national scale, annual air temperature was most closely related to NDVI and explained 36.8% of the variance in NDVI, followed by afforestation (25.5%) and crop yield (15.8%). Altogether, temperature, total forest plantation area, and crop yield explained 78.1% of the variance in vegetation productivity at the national scale, while precipitation, PAR, atmospheric CO2 concentrations, and N deposition made no significant contribution to the increases in vegetation productivity. At the provincial scale, each factor explained a part of the variance in NDVI for some provinces, and the increases in NDVI for many provinces could be attributed to the combined effects of multiple factors. Crop yield and PAR were correlated with NDVI for more provinces than were other factors, indicating that both elevated crop yield resulting from improved agricultural management practices and increasing diffuse radiation were more important than other factors in increasing vegetation productivity at the provincial scale. The relative effects of the natural and human factors on vegetation productivity varied with spatial scale. The true contributions of multiple factors can be obscured by the correlation among these variables, and it is essential to examine the contribution of each factor while controlling for other factors. Future changes in climate and human activities will likely have larger influences on vegetation productivity in China

Cities, traffic, and CO2: A multidecadal assessment of trends, drivers, and scaling relationships

Emissions of CO2 from road vehicles were 1.57 billion metric tons in 2012, accounting for 28% of US fossil fuel CO2 emissions, but the spatial distributions of these emissions are highly uncertain. We develop a new emissions inventory, the Database of Road Transportation Emissions (DARTE), which estimates CO2 emitted by US road transport at a resolution of 1 km annually for 1980-2012. DARTE reveals that urban areas are responsible for 80% of on-road emissions growth since 1980 and for 63% of total 2012 emissions. We observe nonlinearities between CO2 emissions and population density at broad spatial/temporal scales, with total on-road CO2 increasing nonlinearly with population density, rapidly up to 1,650 persons per square kilometer and slowly thereafter. Per capita emissions decline as density rises, but at markedly varying rates depending on existing densities. We make use of DARTE's bottom-up construction to highlight the biases associated with the common practice of using population as a linear proxy for disaggregating national- or state-scale emissions. Comparing DARTE with existing downscaled inventories, we find biases of 100% or more in the spatial distribution of urban and rural emissions, largely driven by mismatches between inventory downscaling proxies and the actual spatial patterns of vehicle activity at urban scales. Given cities' dual importance as sources of CO2 and an emerging nexus of climate mitigation initiatives, high-resolution estimates such as DARTE are critical both for accurately quantifying surface carbon fluxes and for verifying the effectiveness of emissions mitigation efforts at urban scales.https://doi.org/10.1073/pnas.1421723112Published versio

Attitude of students towards peers with disabilities: The effect of including students from an education support centre in an inclusive middle school setting

This research examines the attitudes of middle school students towards their peers with disabilities. The opportunity for students with disabilities to participate in inclusive education in Western Australia has increased steadily in recent years. The impact of inclusion on stakeholders within the education arena is, therefore, an important area of research. As part of this increased demand for inclusive education a trial inclusion program was set-up at a middle school in regional Western Australian. The target group for this study was all Year 8 (N = 199) students at that school. The attitude of the Year 8 students towards students with disabilities was measured using the Peer Attitudes Toward the Handicapped Scale (PATHS), (Bagley & Greene, 1981). The PATHS questionnaire was administered at the beginning and end of Semester 1 in 2003. Teacher perspectives of student attitude were also assessed via a focus group discussion after the second PATHS administration. Analysis of variance of the pre-test data showed the frequency of participant\u27s prior classroom contact with students with a disability to have a significant impact on acceptance. Gender differences at the pre-test stage also proved to be significantly different in several measures. Although a repeated measures analysis showed no statistically significant change after one semester of the trial inclusion program, data trends and the focus group discussion indicated an increased acceptance of students with disabilities by their mainstream peers. The implications of these results and recommendations for future research are discussed

Annual Report of the White House Task Force on the Middle Class

[Excerpt] The White House Task Force on the Middle Class, chaired by Vice President Joe Biden, was created by President Obama a little more than one year ago, shortly after the Administration took office. The mission of the Task Force, as stated in the Executive Order that created it, is to work with our member agencies and councils to ensure that the economic challenges facing the American middle class, challenges that predate the recession that was deepening as the Task Force was formed, always remain front and center in the work of the Administration. Over the past year, this has been our singular focus. Of course, in the context of the deepest recession since the Great Depression, the Administration’s first priority for the middle class has been restoring job growth by stabilizing an economy that was in freefall. This economic contraction has dealt a serious blow to middle-class families, with staggering losses to their jobs, their savings, and the value of their homes. The Vice President, in his role as the Administration’s chief overseer of the Recovery Act, has played a critical role in this central part of our economic agenda. And of course, the President’s health care reform agenda targets one of the most important—and too often most precarious—aspects of middle-class life. But at the same time, the Task Force has worked to address some of the longer term challenges facing the middle class: balancing work and family responsibilities, college access and affordability, and retirement security. And while restarting the engine of job creation is the Administration’s highest priority, the Task Force is working to ensure that the jobs that are created as the economy begins to recover are good jobs. This report details our activities in pursuing policy solutions to these challenges over the past year. The report also highlights some of the key Administration initiatives supported by the Task Force, many of which are part of the President’s Fiscal Year 2011 Budget

Satellite evidence for significant biophysical consequences of the “Grain for Green” Program on the Loess Plateau in China

Afforestation has been implemented worldwide as regional and national policies to address environmental problems and to improve ecosystem services. China\u27s central government launched the “Grain for Green” Program (GGP) in 1999 to increase forest cover and to control soil erosion by converting agricultural lands on steep slopes to forests and grasslands. Here a variety of satellite data products from the Moderate Resolution Imaging Spectroradiometer were used to assess the biophysical consequences of the GGP for the Loess Plateau, the pilot region of the program. The average tree cover of the plateau substantially increased because of the GGP, with a relative increase of 41.0%. The GGP led to significant increases in enhanced vegetation index (EVI), leaf area index, and the fraction of photosynthetically active radiation absorbed by canopies. The increase in forest productivity as approximated by EVI was not driven by elevated air temperature, changing precipitation, or rising atmospheric carbon dioxide concentrations. Moreover, the afforestation significantly reduced surface albedo, leading to a positive radiative forcing and a warming effect on the climate. The GGP also led to a significant decline in daytime land surface temperature and exerted a cooling effect on the climate. The GGP therefore has significant biophysical consequences by altering carbon cycling, hydrologic processes, and surface energy exchange and has significant feedbacks to the regional climate. The net radiative forcing on the climate depends on the offsetting of the negative forcing from carbon sequestration and higher evapotranspiration and the positive forcing from lower albedo