Care Patterns and Outcomes for Hospitalized Patients with Diabetes in Nevada

This study demonstrates substantial differences between Nevada and the national average in patterns of hospital based care in patients with type 2 diabetes. Diabetic patients in Nevada are more likely to be hospitalized through the emergency department, and more likely to be admitted for a condition related to diabetes. Moreover, in Nevada, Medicaid and uninsured patients with diabetes are more likely to experience adverse outcomes then their privately insured counterparts. These differences may be primarily reflective of variances in access to ambulatory care, care seeking behavior, and availability of health services and facilities. Policies promoting expansion of health care benefits to include coverage for people at risk for type 2 diabetes and strengthening the ambulatory care services network, and system in the state, is necessary to reduce discrepancies in patterns of hospitalization and improve outcomes

Adverse Maternal Outcomes in Nevada: Does Asthma Matter?

Objective. Asthma is a common clinical complication of pregnancy and women with asthma are at greater risk of having complications. This study compared adverse maternal outcomes between women with asthma and women without asthma in Nevada. Methods. A total of 64,664 hospital discharges of delivery were abstracted from the Nevada 2003-2004 hospital discharges and thirteen adverse maternal outcomes were examined. Logistic regression was applied to compare the maternal outcomes between women with and without asthma. Results. Women with asthma were more likely to have pre-eclampsia (OR [CI] 1.73 [1.13, 2.65]), transient hypertension of pregnancy (OR [CI] 1.76 [1.11, 2.78]), pregnancy-induced hypertension (OR [CI] 1.89 [1.42, 2.53]), gestational diabetes (OR [CI] 1.89 [1.32, 2.72]), infection of the amniotic cavity (OR [CI] 2.15 [1.29, 3.58]), and cesarean section (OR [CI] 1.87 [1.56, 2.23] ). Conclusion. Women with asthma experienced a greater risk of having adverse maternal outcomes. Community-based education programs, as well as, services offered in traditional healthcare settings should be supported to educate pregnant women about the potential risk factors and the relationship between asthma and maternal outcomes

Limited Contribution of Health Behaviours to Expanding Income-Related Chronic Disease Disparities Based on a Nationwide Cross-Sectional Study in China

This study estimated the association of income and prevalence of cardiovascular diseases (CVD) and hypertension, and then quantified the contribution of health behaviors to the association in China. Using the 2013 survey of the China Health and Retirement Longitudinal Study (CHARLS), a logit model was applied to examine income-related health disparities in relation to CVD and hypertension. A four-step regression method was then constructed to measure the role of health behaviors in income-related health disparities. Using indirect effects, mediation by health behaviors was examined. Income-related health disparities in chronic diseases were found to exist in China. Specifically, individuals in the high-income group had a 14% (OR = 0.86; 95% CI 0.73–1.02) and 14% (OR = 0.86; 95% CI 0.76–0.97) lower odds of suffering from CVD and hypertension than those in the low-income group. However, limited evidence shows this association was mediated by health behaviors. The Heaviness of Smoking Index (HSI), heavy drinking, irregular eating, and nap time did not significantly mediate the association of income and prevalence of CVD and hypertension. To curb the rising prevalence of CVD and hypertension in China, policies should focus on the low-income subpopulation. However, healthy behaviors interventions targeting smoking, heavy drinking, unhealthy napping and irregular eating habits among low-income people may be ineffective in reduction of income-related disparities in prevalence of CVD and hypertension

The Long-term Coercive Effect of State Community Benefit Laws on Hospital Community Health Orientation

This study is an examination of the long-term coercive effect of state community benefit laws (CB Laws) on the provision of community health activities in U.S. acute care hospitals. The sample included all the not-for-profit and investor owned acute care hospitals for which 1994 and 2006 AHA Annual Survey data were available. A panel design was used to longitudinally examine the effect that state CB Laws had on hospital community health orientation activities and the provision of health promotion services, after controlling for the influence of other organizational and environmental variables that might affect these activities and services. The authors found that both CB Law state and non CB Law state hospitals increased their number of orientation activities and promotion services from 1994 to 2006. However, there was no significant difference in the gains in these activities and services between these two groups of hospitals. These results suggest that other environmental and organizational factors may mediate the effect of the state CB Laws over time

Adverse Maternal Outcomes for Women with Different Health Insurance Statuses in Nevada

Objective. Nevada women with unfavorable health insurance status may face greater barriers than women in the rest of the nation, since the development of healthcare infrastructure in Nevada is running behind population growth. This study examines the relationship between health insurance status and adverse maternal outcomes in Nevada. Methods. Hospital discharge information of 33,149 women aged 13 or older who delivered in 2004 was abstracted from the 2004 State Inpatient Data for Nevada. A total of 13 measures of complications associated with pregnancy were identified, including preterm labor, hypertensive disorders of pregnancy, gestational diabetes, ante-partum hemorrhage, membrane disorders, cesarean section, prolonged labor, postpartum hemorrhage, and fetal death. Multiple logistic regression was applied for data analysis. Results. As compared to women covered by private insurance, women with Medicaid were more likely to have abruptio placenta (OR [95% confidence interval (CI)] 1.67 [1.24, 2.26]), prolonged labor (OR [CI] 1.16 [1.03, 1.31]), and fetal death (OR [CI] 1.59 [1.11, 2.27]). Uninsured women had a higher risk of having prolonged labor (OR [CI] 1.20 [1.01, 1.42]) and fetal death (OR [CI] 1.70 [1.05, 2.74]), but had a lower risk of experiencing pre-eclampsia (OR [CI] 0.72 [0.53, 0.98]), pregnancy-induced hypertension (OR [CI] 0.70 [0.56, 0.88]), gestational diabetes (OR [CI] 0.75 [0.57, 0.98]), and a cesarean section (OR [CI] 0.69 [0.62, 0.77]). Conclusion. Policies promoting prenatal care and case management programs for female Medicaid recipients can help to reduce the risk of maternal complications. Joint efforts by policy makers, public health advocates, social support groups, and health care practitioners to offer integrated programs to help both Medicaid and uninsured women are likely to succeed in improving maternal outcomes

Financial Position and Adoption of Electronic Health Records: A Retrospective Longitudinal Study

AIM: Financial barriers are a major factor of slow electronic health record (EHR) adoption among US hospitals. All existing literature focuses on relationships between current or short-term financial position and EHR adoption. This study examines relationship between financial position in previous years and the current level of EHR adoption. METHODS: Retrospective longitudinal data were extracted from (1) the 2009 American Hospital Association (AHA) EHR implementation survey; (2) the 2002 and 2006 Centers for Medicare & Medicaid Cost Reports; and (3) the 2002 and 2006 AHA Annual Survey containing organizational and operational data. The final sample was 2,701 acute care hospitals in the United States. General ordinal logistic regression was used for data analysis with a three-level dependent variable to measure adoption, five independent variables to measure financial position, and 11 control variables to measure structure and environment. RESULTS: For 2006, higher total margin was significantly and positively associated with EHR adoption, but higher asset turnover was significantly and negatively associated with EHR adoption. For 2002, higher total margin was significantly and positively associated with EHR adoption, but higher asset turnover and higher equity multiplier were both significantly and negatively associated with EHR adoption. In addition, lower net days revenue in accounts receivable was significantly and positively associated with EHR adoption. For both the 2002 and 2006 control variables, human resource intensity and bed size were significant and positively related to adoption, and percentage Medicare patients and investor ownership were significant and negatively related to adoption. CONCLUSIONS: Financial position does relate to EHR adoption in mid-term and long-term planning

The Economic Impact of the Nevada Clean Indoor Air Act in Clark County, Nevada – Preliminary Findings

Objective. The primary purpose of this exploratory study was to quantitatively evaluate the economic impact of the Nevada Clean Indoor Air Act (NCIAA) on businesses in Clark County. Methods. The goal of this research was to assess economic indicators over a ten year period utilizing measurable data points, including restaurant and drinking establishment employment rates, taxable sales, openings and closings, as well as slot gaming revenues. This ten year time period consisted of a seven year span prior to the enactment of the NCIAA, and three years post enactment. Researchers conceived this study as a means to independently evaluate and address the potential economic impact of a smoke-free law in a region dependent upon tourism and gaming. Results. Economic indicators did in fact decrease after the NCIAA was enforced but most of the declining trends began prior to the passage of the smoke-free act and are consistent with downward trends in other, non-NCIAA affected segments of our economy. Conclusion. The overall findings of this study are consistent with similar non-tobacco industry supported economic studies showing little or no statistically significant downward economic trends after passage of smoke-free legislation

Does Exam-targeted Training Help Village Doctors Pass the Certified (Assistant) Physician Exam and Improve Their Practical Skills? A Cross-sectional Analysis of Village Doctors\u27 Perspectives in Changzhou in Eastern China

Background Quality of health care needs to be improved in rural China. The Chinese government, based on the 1999 Law on Physicians, started implementing the Rural Doctor Practice Regulation in 2004 to increase the percentage of certified physicians among village doctors. Special exam-targeted training for rural doctors therefore was launched as a national initiative. This study examined these rural doctors’ perceptions of whether that training helps them pass the exam and whether it improves their skills. Methods Three counties were selected from the 4 counties in Changzhou City in eastern China, and 844 village doctors were surveyed by a questionnaire in July 2012. Chi-square test and Fisher exact test were used to identify differences of attitudes about the exam and training between the rural doctors and certified (assistant) doctors. Longitudinal annual statistics (1980–2014) of village doctors were further analyzed. Results Eight hundred and forty-four village doctors were asked to participate, and 837 (99.17%) responded. Only 14.93% of the respondents had received physician (assistant) certification. Only 49.45% of the village doctors thought that the areas tested by the certification exam were closely related to the healthcare needs of rural populations. The majority (86.19%) felt that the training program was “very helpful” or “helpful” for preparing for the exam. More than half the village doctors (61.46%) attended the “weekly school”. The village doctors considered the most effective method of learning was “continuous training (40.36%)” . The majority of the rural doctors (89.91%) said they would be willing to participate in the training and 96.87% stated that they could afford to pay up to 2000 yuan for it. Conclusions The majority of village doctors in Changzhou City perceived that neither the certification exam nor the training for it are closely related to the actual healthcare needs of rural residents. Policies and programs should focus on providing exam-preparation training for selected rural doctors, reducing training expenditures, and utilizing web-based methods. The training focused on rural practice should be provided to all village doctors, even certified physicians. The government should also adjust the local licensing requirements to attract and recruit new village doctors

Levels of Adoption of Electronic Health Records and Patient Safety: Effectiveness and Efficiency

Patient safety, including hospital acquired infections has become one of the major concerns in healthcare delivery in recent years Electronic health records are becoming an integral aspect of the health care delivery Health policies have been looking to improve quality / patient safety and efficiency of healthcare through the adoption of electronic health record (EHR) systems Can EHR adoption improve patient safety? Can EHR adoption reduce cost? H1: Patients treated at hospitals with a higher level of EHR adoption are less likely to incur poorer patient safety indicators H2: Patients treated at hospitals with a higher level of EHR adoption are more likely to incur lower costs for their respective patient safety indicator

Trends and Associated Factors of Use of Opioid, Heroin, and Cannabis Among Patients for Emergency Department Visits in Nevada: 2009–2017

To examine trends and contributing factors of opioid, heroin, and cannabis-associated emergency department (ED) visits in Nevada. The 2009 to 2017 Nevada State ED database (n = 7,950,554 ED visits) were used. Use of opioid, heroin, and cannabis, respectively, was identified by the International Classification of Diseases, 9th & 10th Revisions. Three multivariable models, one for each of the 3 dependent variables, were conducted. Independent variables included year, insurance status, race/ethnicity, use of other substance, and mental health conditions. The number of individuals with opioid, heroin, cannabis-associated ED visits increased 3%, 10%, and 23% annually from 2009 to 2015, particularly among 21 to 29 age group, females, and African Americans. Use of other substance (odds ratio [OR] = 3.91; 95% confidence interval [CI] = 3.84, 3.99; reference - no use of other substance), mental health conditions (OR = 2.48; 95% CI = 2.43, 2.53; reference – without mental health conditions), Medicaid (OR = 1.41; 95% CI = 1.38, 1.44; reference – non-Medicaid), Medicare (OR = 1.44; 95% CI = 1.39, 1.49; reference – non-Medicare) and uninsured patients (OR = 1.52; 95% CI = 1.49, 1.56; reference - insured) were predictors of all three substance-associated ED visits. With a steady increase in trends of opioid, heroin, and cannabis-associated ED visits in recent years, the main contributing factors include patient sociodemographic factors, mental health conditions, and use of other substances