Improving Hospital Patient Safety Through Teamwork: The Use of TeamSTEPPS in CAHs (Policy Brief #21)

This brief, one in a series identifying and assessing evidence-based patient safety and quality improvement interventions appropriate for use by state Flex Programs and CAHs, reviews teamwork and team training which have become a standard, evidence-based intervention in small and larger hospitals alike. The focus is on TeamSTEPPS, a training program developed and disseminated by the Department of Defense and the Agency for Healthcare Research and Quality. Key Findings: State Flex programs and CAHs have successfully adapted and used TeamSTEPPS to improve patient safety through team training. The evidence indicates that team training increases communications and reduces error. The success of TeamSTEPPS depends on having appropriate expectations and identifying and cultivating internal champions. Building a patient safety infrastructure helps sustain teamwork

First Assessment of Mountains on Northwestern Ellesmere Island, Nunavut, as Potential Astronomical Observing Sites

Ellesmere Island, at the most northerly tip of Canada, possesses the highest mountain peaks within 10 degrees of the pole. The highest is 2616 m, with many summits over 1000 m, high enough to place them above a stable low-elevation thermal inversion that persists through winter darkness. Our group has studied four mountains along the northwestern coast which have the additional benefit of smooth onshore airflow from the ice-locked Arctic Ocean. We deployed small robotic site testing stations at three sites, the highest of which is over 1600 m and within 8 degrees of the pole. Basic weather and sky clarity data for over three years beginning in 2006 are presented here, and compared with available nearby sea-level data and one manned mid-elevation site. Our results point to coastal mountain sites experiencing good weather: low median wind speed, high clear-sky fraction and the expectation of excellent seeing. Some practical aspects of access to these remote locations and operation and maintenance of equipment there are also discussed.Comment: 21 pages, 2 tables, 15 figures; accepted for publication in PAS

Thermal Phase Variations of WASP-12b: Defying Predictions

[Abridged] We report Warm Spitzer full-orbit phase observations of WASP-12b at 3.6 and 4.5 micron. We are able to measure the transit depths, eclipse depths, thermal and ellipsoidal phase variations at both wavelengths. The large amplitude phase variations, combined with the planet's previously-measured day-side spectral energy distribution, is indicative of non-zero Bond albedo and very poor day-night heat redistribution. The transit depths in the mid-infrared indicate that the atmospheric opacity is greater at 3.6 than at 4.5 micron, in disagreement with model predictions, irrespective of C/O ratio. The secondary eclipse depths are consistent with previous studies. We do not detect ellipsoidal variations at 3.6 micron, but our parameter uncertainties -estimated via prayer-bead Monte Carlo- keep this non-detection consistent with model predictions. At 4.5 micron, on the other hand, we detect ellipsoidal variations that are much stronger than predicted. If interpreted as a geometric effect due to the planet's elongated shape, these variations imply a 3:2 ratio for the planet's longest:shortest axes and a relatively bright day-night terminator. If we instead presume that the 4.5 micron ellipsoidal variations are due to uncorrected systematic noise and we fix the amplitude of the variations to zero, the best fit 4.5 micron transit depth becomes commensurate with the 3.6 micron depth, within the uncertainties. The relative transit depths are then consistent with a Solar composition and short scale height at the terminator. Assuming zero ellipsoidal variations also yields a much deeper 4.5 micron eclipse depth, consistent with a Solar composition and modest temperature inversion. We suggest future observations that could distinguish between these two scenarios.Comment: 19 pages, 10 figures, ApJ in press. Improved discussion of gravity brightenin

Community Impact and Benefit Activities of Critical Access, Other Rural, and Urban Hospitals, 2017

Non-profit and publicly-owned hospitals, including Critical Access Hospitals (CAHs), have obligations to address the health needs of their communities. Non-profit hospitals are required to report their community benefit activities to the Internal Revenue Service using Form 990, Schedule H. Community benefit activities include programs and services that provide treatment and/or promote health in response to identified community needs. Publicly-owned hospitals are also held accountable to the needs of their communities through the oversight of their governing boards and local governments. To monitor the community impact and benefit activities of CAHs and to understand whether and how their community impact and benefit profiles differ from those of other hospitals, we compared CAHs to other rural and urban hospitals using a set of indicators developed by the FMT. This report enables State Flex Programs and CAH administrators to compare the community impact and benefit profiles of CAHs nationally (Tables 1 and 2) to the performance of CAHs in their state (see links to state-specific tables on page 5). Table 1 provides data for select measures of community impact and benefit, including the provision of essential health care services that are typically difficult to access in rural communities. Table 2 provides data on hospital charity care, bad debt, and uncompensated care activities. The Flex Monitoring Team also produces state-specific reports with more detailed results

Sociodemographic and Health Status Characteristics of Maine\u27s Newly Eligible Medicaid Beneficiaries [Data Brief]

This data brief identifies key characteristics of groups who will gain access through MaineCare expansion. Researchers Croll and Ziller at the University of Southern Maine, along with Leonardson of the Maine Health Access Foundation present a statistical analysis of uninsured non-elderly adults age 18 – 64 with no children and lower incomes, the population newly eligible for MaineCare through expansion. Drawing from five years of data from Maine’s Behavioral Risk Factor Surveillance System, the report addresses sociodemographic characteristics, health status, and access to care. The survey indicates that those who are likely eligible for expanded MaineCare coverage are twice as likely as other nonelderly adults to be aged 55-64, and are more likely to be unmarried and live in small or isolated regions of North and Downeast Maine. Only 11% of these individuals have a bachelor’s degree or higher. Thirty-three percent of these adults have not seen a doctor in the last year due to cost, and 20% have not received a routine checkup in five or more years. Overall, the newly eligible adults are more than three times as likely to self-report their health as fair or poor. The report also notes that this group is more likely than others to face issues with depression, obesity, smoking, and other chronic diseases. However, they are no more or less likely than other nonelderly adults to struggle with substance use disorders

On the detection of Lorentzian profiles in a power spectrum: A Bayesian approach using ignorance priors

Aims. Deriving accurate frequencies, amplitudes, and mode lifetimes from stochastically driven pulsation is challenging, more so, if one demands that realistic error estimates be given for all model fitting parameters. As has been shown by other authors, the traditional method of fitting Lorentzian profiles to the power spectrum of time-resolved photometric or spectroscopic data via the Maximum Likelihood Estimation (MLE) procedure delivers good approximations for these quantities. We, however, show that a conservative Bayesian approach allows one to treat the detection of modes with minimal assumptions (i.e., about the existence and identity of the modes). Methods. We derive a conservative Bayesian treatment for the probability of Lorentzian profiles being present in a power spectrum and describe an efficient implementation that evaluates the probability density distribution of parameters by using a Markov-Chain Monte Carlo (MCMC) technique. Results. Potentially superior to "best-fit" procedure like MLE, which only provides formal uncertainties, our method samples and approximates the actual probability distributions for all parameters involved. Moreover, it avoids shortcomings that make the MLE treatment susceptible to the built-in assumptions of a model that is fitted to the data. This is especially relevant when analyzing solar-type pulsation in stars other than the Sun where the observations are of lower quality and can be over-interpreted. As an example, we apply our technique to CoRoT observations of the solar-type pulsator HD 49933.Comment: 12 pages, 11 figures, accepted for publication in Astronomy and Astrophysic

Demonstrating Cerebral Vascular Networks: A Comparison of Methods for the Teaching Laboratory

One challenge of neuroscience educators is to make accessible to students as many aspects of brain structure and function as possible. The anatomy and function of the cerebrovasculature is among many topics of neuroscience that are underrepresented in undergraduate neuroscience education. Recognizing this deficit, we evaluated methods to produce archival tissue specimens of the cerebrovasculature and the “neurovascular unit” for instruction and demonstration in the teaching lab. An additional goal of this project was to identify the costs of each method as well as to determine which method(s) could be adapted into lab exercises, where students participate in the tissue preparation, staining, etc. In the present report, we detail several methods for demonstrating the cerebrovasculature and suggest that including this material can be a valuable addition to more traditional anatomy/physiology demonstrations and exercises

Adoption and Use of Electronic Health Records by Rural Health Clinics: Results of a National Survey [Working Paper]

Rural Health Clinics (RHCs) are a vital source of primary care services with more than 4,000 clinics serving rural communities. Relatively little is known about the extent to which RHCs have adopted and are using electronic health records (EHRs) to support clinical services. Because EHR adoption is an essential element for inclusion in accountable care organizations, patient centered medical homes, and health plan provider networks offered on state and national health insurance marketplaces, EHR implementation will be increasingly important to RHCs if they are to remain competitive participants in the evolving healthcare market. Key Findings: Nearly 72 percent of Rural Health Clinics (RHCs) have an operational electronic health record (EHR), with 63 percent indicating use by 90 percent or more of their staff. Slightly over 17 percent of RHCs without an EHR plan to implement one within six months, and 27 percent plan to do so within seven to twelve months. Common barriers to EHR implementation include acquisition and maintenance costs (72 percent), lack of capital (51 percent), and concerns about productivity and income loss during implementation (45 percent). RHCs continue to lag on some meaningful use measures, but perform well on measures related to clinical care and patient management. With Regional Extension Centers facing the loss of federal funding it is important to identify additional resources to assist RHCs in maximizing EHR adoption and use

Rural Health Clinic Readiness for Patient-Centered Medical Home Recognition: Preparing for the Evolving Healthcare Marketplace [Working Paper]

The patient-centered medical home (PCMH) model reaffirms traditional primary care values including continuity of care, connection with an identified personal clinician, provision of same day- and after-hours access, and positions providers to participate in accountable care and other financing and delivery system models. However, little is known about the readiness of the over 4,000 Rural Health Clinics (RHCs) to meet the PCMH Recognition standards established by the National Council for Quality Assurance (NCQA). The authors present findings from a survey of RHCs that examined their capacity to meet the NCQA PCMH requirements, and discuss the implications of the findings for efforts to support RHC capacity development. Key Findings: Based on their performance on the “must pass” elements and related key factors, Rural Health Clinics (RHCs) are likely to have difficulties gaining National Center for Quality Assurance’s (NCQA) Patient-Centered Medical Home (PCMH) Recognition. RHCs perform best on standards related to recording demographic information and managing clinical activities, particularly for those using an electronic health record. RHCs perform less well on improving access to and continuity of services, supporting patient self-management skills and shared decision-making, implementing continuous quality improvement systems, and building practice teams. RHCs are likely to need substantial technical assistance targeting clinical and operational performance to gain NCQA PCMH Recognition