The effects of state minimum staffing standards on staffing, quality of care, and financial performance in nursing homes

This dissertation attempts to provide a comprehensive understanding about the impacts of state minimum staffing standards and to determine unbiased estimates of the effect of staffing on quality of nursing home care. Specifically, by exploiting differences in the timing of staffing standard changes for the 50 states and the District of Columbia from 1998 to 2001, this study conducts three empirical analyses to examine (1) the total effects of staffing standards on staffing choices and on quality of care, (2) the total effect of staffing standards on financial performance, and (3) the underlying (causal) relationship between staffing and quality of care. The major findings are as follows: (1) Increases in staffing standards matter particularly for the subset of nursing homes with staffing level previously below or close to new standards, whereas the results show consistent beneficial effects for the rate of restraint use and the number of total deficiencies at all types of facilities. (2) Increases in staffing standards have significant negative impacts on total margin at nonprofit facilities with relatively low staffing. (3) When endogeneity of staffing is taken into account, the results support the persistent beneficial effects of increasing total staff hours on the onset of pressure sores, contractures, and catheter use. The analyses performed in this dissertation are particularly relevant to the era of growth in the aged population and provides important policy implications. Structural differences in nursing home behavior in response to increased staffing standards suggest that future policy should be developed by emphasizing on stragetic planning and operative management of scarce labor resources to achieve both better quality and greater efficiency. In order to achieve the benefits of mandatory staffing standards, the federal and state governments should determine the additional costs and develop a plan to adequately fund the required increases in staffing levels. The monitoring and enforcement of federal and state laws and regulations are necessary. Lastly, the findings suggest that differences in financial performance may result in differences in quality produced and vice versa. An integrative perspective which explores the relationship between quality and financial performance may be insightful in the future research

Longitudinal Analysis of Electronic Health Records on Staffing Mix in Community Health Centers

Community health centers (CHCs) have long faced clinical staffing challenges especially in rural areas of the US due to providers perceiving a lack of socioeconomic opportunities. A recent study found that CHCs are adaptable and manage to maintain productivity levels across different staffing configurations by leveraging the clinical staff available. What is unknown is how two major changes in the health care landscape—adoption of an electronic health record (EHR) system and recognition of being a patient-centered medical home (PCMH)—have impacted staffing in CHCs, which may in turn have productivity implications

Fast and Accurate Dual-Way Streaming PARAFAC2 for Irregular Tensors -- Algorithm and Application

How can we efficiently and accurately analyze an irregular tensor in a dual-way streaming setting where the sizes of two dimensions of the tensor increase over time? What types of anomalies are there in the dual-way streaming setting? An irregular tensor is a collection of matrices whose column lengths are the same while their row lengths are different. In a dual-way streaming setting, both new rows of existing matrices and new matrices arrive over time. PARAFAC2 decomposition is a crucial tool for analyzing irregular tensors. Although real-time analysis is necessary in the dual-way streaming, static PARAFAC2 decomposition methods fail to efficiently work in this setting since they perform PARAFAC2 decomposition for accumulated tensors whenever new data arrive. Existing streaming PARAFAC2 decomposition methods work in a limited setting and fail to handle new rows of matrices efficiently. In this paper, we propose Dash, an efficient and accurate PARAFAC2 decomposition method working in the dual-way streaming setting. When new data are given, Dash efficiently performs PARAFAC2 decomposition by carefully dividing the terms related to old and new data and avoiding naive computations involved with old data. Furthermore, applying a forgetting factor makes Dash follow recent movements. Extensive experiments show that Dash achieves up to 14.0x faster speed than existing PARAFAC2 decomposition methods for newly arrived data. We also provide discoveries for detecting anomalies in real-world datasets, including Subprime Mortgage Crisis and COVID-19.Comment: 12 pages, accept to The 29th ACM SIGKDD International Conference on Knowledge Discovery and Data Mining (KDD) 202

The Staffing-Outcomes Relationship in Nursing Homes: The Staffing-Outcomes Relationship

To assess longitudinally whether a change in registered nurse (RN) staffing and skill mix leads to a change in nursing home resident outcomes while controlling for the potential endogeneity of staffing

Advanced practice nursing in Latin America and the Caribbean: regulation, education and practice

Abstract Objective: to identify the current state of advanced practice nursing regulation, education and practice in Latin America and the Caribbean and the perception of nursing leaders in the region toward an advanced practice nursing role in primary health care to support Universal Access to Health and Universal Health Coverage initiatives. Method: a descriptive cross-sectional design utilizing a web-based survey of 173 nursing leaders about their perceptions of the state of nursing practice and potential development of advanced practice nursing in their countries, including definition, work environment, regulation, education, nursing practice, nursing culture, and perceived receptiveness to an expanded role in primary health care. Result: the participants were largely familiar with the advanced practice nursing role, but most were unaware of or reported no current existing legislation for the advanced practice nursing role in their countries. Participants reported the need for increased faculty preparation and promotion of curricula reforms to emphasize primary health care programs to train advanced practice nurses. The vast majority of participants believed their countries' populations could benefit from an advanced practice nursing role in primary health care. Conclusion: strong legislative support and a solid educational framework are critical to the successful development of advanced practice nursing programs and practitioners to support Universal Access to Health and Universal Health Coverage initiatives

Advanced Practice Nursing in Latin America and the Caribbean: Regulation, Education and Practice

OBJECTIVE: to identify the current state of advanced practice nursing regulation, education and practice in Latin America and the Caribbean and the perception of nursing leaders in the region toward an advanced practice nursing role in primary health care to support Universal Access to Health and Universal Health Coverage initiatives. METHOD: a descriptive cross-sectional design utilizing a web-based survey of 173 nursing leaders about their perceptions of the state of nursing practice and potential development of advanced practice nursing in their countries, including definition, work environment, regulation, education, nursing practice, nursing culture, and perceived receptiveness to an expanded role in primary health care. RESULT: the participants were largely familiar with the advanced practice nursing role, but most were unaware of or reported no current existing legislation for the advanced practice nursing role in their countries. Participants reported the need for increased faculty preparation and promotion of curricula reforms to emphasize primary health care programs to train advanced practice nurses. The vast majority of participants believed their countries\u27 populations could benefit from an advanced practice nursing role in primary health care. CONCLUSION: strong legislative support and a solid educational framework are critical to the successful development of advanced practice nursing programs and practitioners to support Universal Access to Health and Universal Health Coverage initiatives. OBJETIVO: identificar o estado atual da regulação, educação e prática do enfermeiro de prática avançada na América Latina e no Caribe e a percepção de líderes de enfermagem na região quanto ao papel da enfermagem de prática avançada na atenção primaria à saúde em apoio às iniciativas de Acesso Universal à Saúde e Cobertura Universal de Saúde. MÉTODO: o estudo descritivo transversal utilizou um survey online com 173 líderes de enfermagem questionando suas percepções sobre o estado atual da prática de enfermagem e o potencial desenvolvimento da enfermagem de prática avançada em seus países, incluindo a definição do termo, o ambiente de trabalho, a regulação, educação, prática, cultura de enfermagem e receptividade percebida de um papel mais amplo deste profissional na atenção primaria à saúde. RESULTADO: os participantes referiram estar familiarizados com o papel do enfermeiro de prática avançada, mas a maioria não sabia ou não relatou a legislação vigente para o papel da prática avançada em seus países. Os participantes relataram a necessidade de aumentar a preparação do corpo docente e promover reformas curriculares com enfase na atenção primária à saúde para formar enfermeiros de prática avançada. A grande maioria dos participantes acredita que as populações de seus países se beneficiará com o papel do enfermeiro de prática avançada na atenção primária à saúde. CONCLUSÃO: forte apoio em termos de legislação e uma estrutura educacional sólida de formação contínua são fundamentais para o êxito do desenvolvimento de programas de enfermagem de prática avançada em apoio às iniciativas de Acesso Universal à Saúde e Cobertura Universal de Saúde. OBJETIVO: identificar el estado actual de la regulación, educación y práctica de la enfermera de práctica avanzada en Latinoamérica y el Caribe y la percepción de los líderes de enfermería en la región hacia un rol de práctica avanzada de enfermería dentro de la atención primaria de salud para apoyar las iniciativas de Acceso Universal a la Salud y la Cobertura Universal de Salud. MÉTODO: un diseño transversal descriptivo que utilizó una encuesta basada en la web a 173 líderes de enfermería acerca de sus percepciones sobre el estado de la enfermería y el desarrollo potencial de la práctica avanzada de enfermería en sus países, incluyendo definición, ambiente laboral, regulación, educación, práctica de enfermería, cultura de enfermería y la receptividad percibida a un papel más amplio en atención primaria de salud. RESULTADO: los participantes estaban ampliamente familiarizados con el rol de la enfermera de práctica avanzada, pero la mayoría desconocía la legislación o reportaba no existencia actual de legislación para el rol de práctica avanzada en sus países. Los participantes reportaron la necesidad de aumentar la preparación docente y reformas curriculares para apoyar programas de atención primaria de salud para capacitar las enfermeras de práctica avanzada. La gran mayoría de los participantes creían que las poblaciones de sus países se podrían beneficiar de un rol de práctica avanzada de enfermería en atención primaria de salud. CONCLUSIÓN: un fuerte apoyo legislativo y un marco educacional sólido que continúen informándose entre sí, son críticos para el desarrollo exitoso de programas de práctica avanzada y de nurse practitioners para apoyar las iniciativas de Acceso Universal a la Salud y Cobertura Universal de Salud

Use of hospitalists and office-based primary care physicians\u27 productivity

BACKGROUND: Growth in the care of hospitalized patients by hospitalists has the potential to increase the productivity of office-based primary care physicians (PCPs) by allowing them to focus on outpatient practice. OBJECTIVE: Our aim was to examine the association between utilization of hospitalists and the productivity of office-based PCPs. DESIGN/PARTICIPANTS: The cross-sectional study was conducted using the 2008 Health Tracking Physician Survey Restricted Use File linked to the Area Resource File. We analyzed a total of 1,158 office-based PCPs representing a weighted total of 97,355 physicians. MAIN MEASURES: Utilization of hospitalists was defined as the percentage of a PCP’s hospitalized patients treated by a hospitalist. The measures of PCPs’ productivity were: (1) number of hospital visits per week, (2) number of office and outpatient clinic visits per week, and (3) direct patient care time per visit. KEY RESULTS: We found that the use of hospitalists was significantly associated with a decreased number of hospital visits. The use of hospitalists was also associated with an increased number of office visits, but this was only significant for high users. Physicians who used hospitalists for more than three-quarters of their hospitalized patients had an extra 8.8 office visits per week on average (p = 0.05), which was equivalent to a 10 % increase in productivity over the predicted mean of 87 visits for physicians who did not use hospitalists. We did not find any significant differences in direct patient care time per visit. CONCLUSIONS: Our study demonstrates that the increase in productivity for the one-third of PCPs who use hospitalists extensively may not be sufficient to offset the current loss of PCP workforce. However, our findings provide cautious optimism that if more PCPs effectively and efficiently used hospitalists, this could help mitigate a PCP shortage and improve access to primary care services