Evaluating the Usability of Union Web Sites in the United States: A Case Study

Union membership has undergone a dramatic decline and some have hailed the internet as a means for unions to reverse their membership declines. This study examines the usability of union websites. The content of union websites has been analyzed, but the usefulness of that content, and the overall usability of the websites, has not been assessed. In order for unions to fully utilize the internet and realize the potential benefits of cyberspace usage, they must provide websites that users find easy to use and that provide useful content. This study employs Hassan and Li\u27s (2005) benchmarking approach in order to evaluate usability and content usefulness of union websites. Hassan and Li\u27s (2005) framework assesses screen appearance, media use, interactivity, accessibility, navigation, consistency, and content usefulness. This framework was applied to the websites of four U.S. unions: a craft union, a service sector union, a manufacturing sector union, and a public sector union. The results indicated that some unions may be missing up to one-third of the criteria deemed important by experts in the area of usability

Effect of policy and practice changes on oral anticoagulation use in North Carolina

Despite a long history of proven effectiveness, oral anticoagulation therapy (OAT) has been underused in medical practice so the full potential for stroke risk reduction has yet to be realized in everyday clinical settings. Several policy changes intended to improve care quality and change care delivery were recently established, but the effect of these policy changes on OAT use is unknown. The overall objective of this proposal is to estimate the effect of policy and practice changes on OAT use in real world clinical settings. This work: investigates the impact of The Joint Commission's National Patient Safety Goals on the initiation of OAT in eligible AF patients (Aim 1); evaluates the effect of geographic, physician, facility and patient factors on OAT initiation and time to discontinuation for eligible AF patients (Aim 2); and investigates the effect of patient-centered medical homes (PCMH) on OAT initiation (Aim 3). The overall hypothesis of the work is that both National Patient Safety Goals and PCMHs are associated with increased use of OAT, but only PCMHs are associated with greater time to OAT discontinuation. Claims data from the North Carolina State Health Plan are used to create cohorts of incident AF before and after policy changes. Difference in difference regression modeling is utilized to evaluate OAT initiation upon hospital discharge in the cohorts before and after The Joint Commission policy changes. A survival analysis approach is employed using Cox proportional hazard regressions to evaluate time to OAT discontinuation before and after these policy changes. A difference in difference modeling approach is used to compare OAT initiation by PCMH exposure status. This research is significant in several respects: 1) it examines an understudied area of health policy governing health care delivery safety and quality in a population with documented underuse of appropriate therapy; 2) it identifies and differentiates specific populations who have benefitted from policy and practice changes enabling targeted future interventions for maximum effect; and 3) it evaluates an innovation in the health care delivery model for primary care, the PCMH, by providing evidence of its impact on guideline adherence in receiving OAT.Doctor of Philosoph

Trends in Emergent Hernia Repair in the United States

IMPORTANCE: Abdominal wall hernia is one of the most common conditions encountered by general surgeons. Rising rates of abdominal wall hernia repair have been described; however, population-based evidence concerning incidence rates of emergent hernia repair and changes with time are unknown. OBJECTIVE: To examine trends in rates of emergent abdominal hernia repair within the United States for inguinal, femoral, ventral, and umbilical hernias from January 1, 2001, to December 31, 2010. DESIGN, SETTING, AND PARTICIPANTS: A retrospective analysis of adults with emergent hernia repair using National Center for Health Statistics data, a nationally representative sample of inpatient hospitalizations in the United States that occurred from January 1, 2001, to December 31, 2010. All emergent hernia repairs were identified during the study period. MAIN OUTCOMES AND MEASURES: Incidence rates per 100,000 person-years, age, and sex adjusted to the 2010 US census population estimates were calculated for selected subcategories of emergent hernia repairs and time trends were evaluated. RESULTS: An estimated 2.3 million inpatient abdominal hernia repairs were performed from 2001 to 2010; of which an estimated 567,000 were performed emergently. A general increase in the rate of total emergent hernias was observed from 16.0 to 19.2 emergent hernia repairs per 100,000 person-years in 2001 and 2010, respectively. In 2010, emergent hernia rates were highest among adults 65 years and older, with 71.3 and 42.0 emergent hernia repairs per 100,000 person-years for men and women, respectively. As expected, femoral hernia rates were higher among women while emergent inguinal hernia rates were higher among men. Rates of emergent incisional hernia repair were high but relatively stable among older women, with 24.9 and 23.5 per 100,000 person-years in 2001 and 2010, respectively. However, rates of emergent incisional hernia repair among older men rose significantly, with 7.8 to 32.0 per 100,000 person-years from 2001 to 2010, respectively. CONCLUSIONS AND RELEVANCE: These increasing rates of emergent incisional hernia repair are troublesome owing to the significantly increased risk morbidity and mortality associated with emergent hernia repair. While this increased mortality risk is multifactorial, it is likely associated with older age and the accompanying serious comorbidities

Extent and reasons for nonadherence to antihypertensive, cholesterol, and diabetes medications: the association with depressive symptom burden in a sample of American veterans

ObjectivePersons with depressive symptoms generally have higher rates of medication nonadherence than persons without depressive symptoms. However, little is known about whether this association differs by comorbid medical condition or whether reasons for nonadherence differ by depressive symptoms or comorbid medical condition.MethodsSelf-reported extent of nonadherence, reasons for nonadherence, and depressive symptoms among 1,026 veterans prescribed medications for hypertension, dyslipidemia, and/or type 2 diabetes were assessed.ResultsIn multivariable logistic regression adjusted for clinical and demographic factors, the odds of nonadherence were higher among participants with high depressive symptom burden for dyslipidemia (n=848; odds ratio [OR]: 1.42, P=0.03) but not hypertension (n=916; OR: 1.24, P=0.15), or type 2 diabetes (n=447; OR: 1.15, P=0.51). Among participants reporting nonadherence to antihypertensive and antilipemic medications, those with greater depressive symptom burden had greater odds of endorsing medication nonadherence reasons related to negative expectations and excessive economic burden. Neither extent of nonadherence nor reasons for nonadherence differed by depressive symptom burden among patients with diabetes.ConclusionThese findings suggest that clinicians may consider tailoring interventions to improve adherence to antihypertensive and antilipemic medications to specific medication concerns of participants with depressive symptoms

Do primary care medical homes facilitate care transitions after psychiatric discharge for patients with multiple chronic conditions?

Primary-care-based medical homes may facilitate care transitions for persons with multiple chronic conditions (MCC) including serious mental illness. The purpose of this manuscript is to assess outpatient follow-up rates with primary care and mental health providers following psychiatric discharge by medical home enrollment and medical complexity

Do Medical Homes Offer Improved Diabetes Care for Medicaid Enrollees with Co-occurring Schizophrenia?

To determine whether Medicaid recipients with co-occurring diabetes and schizophrenia that are medical-home-enrolled are more likely to receive guideline-concordant diabetes care than those who are not medical-home-enrolled, controlling for confounders

A non-experimental study of oral anticoagulation therapy initiation before and after national patient safety goals

ObjectivesThe Joint Commission revised its National Patient Safety Goals (NPSGs) to include oral anticoagulation therapy (OAT) in 2008. We sought to examine the effect of including OAT in The Joint Commission's NPSGs on historically low rates of OAT initiation for individuals with incident atrial fibrillation (AF).SettingSoutheastern state in the USA.ParticipantsNorth Carolina State Health Plan claims data from 944 500 individuals enrolled between 1 January 2006 and 31 December 2010, supplemented with data from the Area Resource File and Online Survey, Certification and Reporting data network. We evaluated OAT initiation before and after the 2008 NPSGs revisions in a retrospective cohort new user design with an AF intervention group and two control groups: a positive control—patients estimated to be at very high risk of thromboembolism (mechanical heart valve and pulmonary embolism); and a negative control—patients with very low perceived risk of thromboembolism (paroxysmal AF). We developed multivariable models using a difference-in-difference parameterisation. Effects were estimated with generalised estimating equations.Primary outcome measureOAT initiation, a binary outcome defined as having a prescription drug claim for warfarin within 30 days of the index claim.ResultsOAT initiation was low (26.8%) for eligible individuals with incident AF in 2006–2008 but increased after NPSGs implementation (31.7%, p=0.022). OAT initiation was high but decreased in the positive control group (67.5% vs 62.0%, p=0.003). Multivariate analysis resulted in a relative 11% (95% CI (4% to 18%), p<0.01) increase in OAT initiation for incident AF patients.ConclusionsWe document a substantial increase in guideline concordant OAT initiation in incident AF after the establishment of NPSGs, suggesting that regulatory healthcare agency initiatives can influence clinical practice

Resource Use Trajectories for Aged Medicare Beneficiaries with Complex Coronary Conditions

To use coronary revascularization choice to illustrate the application of a method simulating a treatment's effect on subsequent resource use

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

SummaryBackground Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatoryactions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19.Methods In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospitalwith COVID-19 in the UK. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients wererandomly allocated to either usual standard of care alone or usual standard of care plus azithromycin 500 mg once perday by mouth or intravenously for 10 days or until discharge (or allocation to one of the other RECOVERY treatmentgroups). Patients were assigned via web-based simple (unstratified) randomisation with allocation concealment andwere twice as likely to be randomly assigned to usual care than to any of the active treatment groups. Participants andlocal study staff were not masked to the allocated treatment, but all others involved in the trial were masked to theoutcome data during the trial. The primary outcome was 28-day all-cause mortality, assessed in the intention-to-treatpopulation. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936.Findings Between April 7 and Nov 27, 2020, of 16 442 patients enrolled in the RECOVERY trial, 9433 (57%) wereeligible and 7763 were included in the assessment of azithromycin. The mean age of these study participants was65·3 years (SD 15·7) and approximately a third were women (2944 [38%] of 7763). 2582 patients were randomlyallocated to receive azithromycin and 5181 patients were randomly allocated to usual care alone. Overall,561 (22%) patients allocated to azithromycin and 1162 (22%) patients allocated to usual care died within 28 days(rate ratio 0·97, 95% CI 0·87–1·07; p=0·50). No significant difference was seen in duration of hospital stay (median10 days [IQR 5 to >28] vs 11 days [5 to >28]) or the proportion of patients discharged from hospital alive within 28 days(rate ratio 1·04, 95% CI 0·98–1·10; p=0·19). Among those not on invasive mechanical ventilation at baseline, nosignificant difference was seen in the proportion meeting the composite endpoint of invasive mechanical ventilationor death (risk ratio 0·95, 95% CI 0·87–1·03; p=0·24).Interpretation In patients admitted to hospital with COVID-19, azithromycin did not improve survival or otherprespecified clinical outcomes. Azithromycin use in patients admitted to hospital with COVID-19 should be restrictedto patients in whom there is a clear antimicrobial indication

Differences between Work-related Ethics and Non-work Ethics, and the Effects of Religiosity

The purpose of this study was to determine if differences exist in individuals\u27 perceptions of ethics in the work context compared to non-work contexts, and to assess the effects of religiosity, from a traditional Christian perspective, on work- related ethical beliefs as well as non-work beliefs. We found that ethical beliefs are associated with religiosity and our results also indicated that there are differences in people\u27s ethical beliefs concerning work contexts versus non-work contexts. Additionally, while much of the empirical research on business ethics uses student samples, we obtained our results using a sample of employed individuals