Health-Information Seeking and Intention to Quit Smoking: Do Health Beliefs Have a Mediating Role?

Background: Smoking is a leading cause of preventable deaths. Smoking cessation can reduce the risk of smoking-associated disease and death. But smoking cessation involves behaviour change. Existing research indicates that health-information seeking and health-promoting behaviours can be positively associated. However, in the context of smoking, the relationship between seeking health information and intending to quit smoking remains only partially understood. Aim: This study aimed to examine the relationship between seeking health information and intending to quit smoking and to determine whether this relationship is mediated by health beliefs. Methods: We used data from the fourth cycle of the US National Cancer Institute’s Health Information National Trends Survey (HINTS). Logistic regression was used to assess the independent variable (ie, health-information seeking) and dependent variable (ie, intention to quit smoking) as mediated by health belief. Results: Our findings suggest that smokers who seek health information have a 2.67 times higher odds of intending to quit smoking than smokers who do not seek health information. However, health beliefs do not have an intervening effect between seeking health information and intending to quit smoking. Discussion: Seeking health information is important in predicting attempts to quit smoking, regardless of the smokers’ pre-existing health beliefs. Our findings support cessation efforts that encourage smokers to seek health information. Determining optimal ways to encourage smokers to seek smoking-related information could support achieving and maintaining smoking cessation. Conclusion: Cessation programmes and policies should encourage smokers to seek health information. Additional research should further examine smokers’ motivators and cues for health-information seeking and should further probe smokers’ beliefs about the risks of smoking

Readmission Rates and Their Impact on Hospital Financial Performance: A Study of Washington Hospitals

This longitudinal study examines whether readmission rates, made transparent through Hospital Compare, affect hospital financial performance by examining 98 hospitals in the State of Washington from 2012 to 2014. Readmission rates for acute myocardial infarction (AMI), pneumonia (PN), and heart failure (HF) were examined against operating revenues per patient, operating expenses per patient, and operating margin. Using hospital-level fixed effects regression on 276 hospital year observations, the analysis indicated that a reduction in AMI readmission rates is related with increased operating revenues as expenses associated with costly treatments related with unnecessary readmissions are avoided. Additionally, reducing readmission rates is related with an increase in operating expenses. As a net effect, increased PN readmission rates may show marginal increase in operating margin because of the higher operating revenues due to readmissions. However, as readmissions continue to happen, a gradual increase in expenses due to greater use of resources may lead to decreased profitability

Improving Healthcare Quality in the United States Healthcare System: A Scientific Management Approach

The US healthcare system has been facing pressures from stakeholders to reduce costs and improve quality. The purpose of this paper is to develop a conceptual model to illustrate the approaches used in healthcare quality management (Continuous Quality Improvement/Total Quality Management, Lean, and Six Sigma) weaved into the underlying framework of scientific management theory. This paper employs scientific management theory to explain the healthcare quality tenets that influence the quality of care in our healthcare organizations. The father of scientific management, Frederick Taylor, and other key contributors collectively created scientific management principles, which are widely used for quality improvement purposes both in the engineering and the healthcare field. Healthcare quality is also discussed with examples of the application of scientific management principles. Shared themes between scientific management principles and healthcare quality tenets, as given in CQI/TQM, Six Sigma-Lean, and Donabedian Model, were developed. To understand the three pillars of quality (structure, process, outcome) in relation to the underpinnings of scientific management principles, we incorporated insights of scientific management theory into Donabedian’s healthcare quality model. It is recommended that selection of personnel play a more significant role among human resources practices in organizations; strategy formulation must include a careful assessment of organizations’ strengths and weaknesses with regard to continuous quality improvement, with organizations striving to achieve standardization to attain efficiency and reduce costs

A Qualitative Analysis of the Impact of Electronic Health Records (EHR) on Healthcare Quality and Safety: Clinicians’ Lived Experiences

Purpose: There have been mixed findings of clinicians’ perceptions of Electronic Health Record (EHR). This study aims to explore the lived experiences of clinicians, to assess the role of EHR in improving the quality and safety of healthcare. Basic Procedures: A qualitative study design was used. We collected the opinions from different groups of clinicians (physicians, hospitalists, nurse practitioners, nurses, and patient safety officers) using semi-structured interviews. Organizations represented were trauma hospitals, academic medical centers, medical clinics, home health centers, and small hospitals. Main findings: Our study found clinicians’ ambivalent assessments toward EHR, which confirms extant literature. We compared the responses by job roles and found that nurses were positive about improving efficiency with EHR while others regarded EHR as time-consuming. While many underscored the importance of EHR in avoiding medical errors by improving data accessibility, nurses had concerns regarding data accuracy. Interoperability appeared to be a concern given limited system integration. Principal conclusions: Lived experiences of clinicians further tease out the mixed views about the effectiveness of EHR and highlight the challenges in EHR implementation. Redesigning the EHR and improving its implementation process may be potential solutions to increase its effectiveness

The Association Between Organizational Characteristics and Strategic Information Systems Planning: A Study of U.S. Hospitals

Despite the potential of Strategic Information System Planning (SISP) to reduce cost and improve quality, hospitals have been slow to have strategic plans on Information Systems. Our objective was to explore which organizational characteristics influence SISP in healthcare. Data on Information Systems plans from the HIMSS analytics database was combined with organizational characteristics data from the American Hospital Association. Logistic regression analyses on a sample of 2,495 hospitals revealed that hospitals with system membership and for profit status had a greater likelihood of selecting ‘computerized medical records’ (OR=1.88, OR=6.60 respectively, p<0.05), ‘decreasing medical errors’ (OR=7.02, p<0.05), ‘resolving integration issues’ (OR=1.36, OR=0.15 respectively, p<0.05), ‘migrating towards a paperless environment (OR=1.66, OR=8.28 respectively, p<0.05), and ‘reducing the number of software vendors’ (OR=1.78, OR=0.23 respectively, p<0.05) as their Information System plans. System membership and ownership status are associated with SISP. An understanding of the hospital characteristics that may impact Strategic Information Systems Planning, managers would assist managers in making informed decisions about planning and implementing Information Systems at their hospitals

Impact of COVID-19 on Healthcare Labor Market in the United States: Lower Paid Workers Experienced Higher Vulnerability and Slower Recovery

The resilience of the healthcare industry, often considered recession-proof, is being tested by the COVID-19 induced reductions in physical mobility and restrictions on elective and non-emergent medical procedures. We assess early COVID-19 effects on the dynamics of decline and recovery in healthcare labor markets in the United States. Descriptive analyses with monthly cross-sectional data on unemployment rates, employment, labor market entry/exit, and weekly work hours among healthcare workers in each healthcare industry and occupation, using the Current Population Survey from July 2019−2020 were performed. We found that unemployment rates increased dramatically for all healthcare industries, with the strongest early impacts on dentists’ offices (41.3%), outpatient centers (10.5%), physician offices (9.5%), and home health (7.8%). Lower paid workers such as technologists/technicians (10.5%) and healthcare aides (12.6%) were hit hardest and faced persistently high unemployment, while nurses (4%), physicians/surgeons (1.4%), and pharmacists (0.7%) were spared major disruptions. Unique economic vulnerabilities faced by low-income healthcare workers may need to be addressed to avoid serious disruptions from future events similar to COVID-19

A Novel Fault-Tolerant Routing Technique for Mesh-of-Tree based Network-on-Chip Design

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Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

Trends in the Utilization of Human Papillomavirus Vaccines and the Incidence of Malignant Cervical Cancer in Women and Teenagers: A Secondary Analysis

Background: Human papillomavirus (HPV) is a sexually transmitted infection, and HPV types 16 and 18 are responsible for approximately 66% of all U.S. cervical cancer cases in women. The quadrivalent HPV vaccine was licensed in mid-2006, and it was designed to target and protect against HPV types 6, 11, 16, and 18. The aim of this study is to examine the utilization rate of the HPV vaccine, and the trends and incidence rate of malignant cervical cancer across the United States. Methods: This study utilized data from Surveillance, Epidemiology, and End Results (SEER) and the National Immunization Survey’s (NIS) teenage datasets across select years. For the SEER survey, the modification for confidence intervals by Tiwari et al., 2006, was utilized to obtain the incidence rate per 100,000, so that it could be age-adjusted for the 2000 U.S. standard population, as noted in the data provided by the U.S. Census. The dates examined started in the year 2000 and ended in 2017. For the NIS-Teen survey, the public-use data file was used, and a point estimate (%), with a 95% confidence interval, was performed to examine the trends in HPV vaccine utilization across the U.S. adolescent female population from the years 2007 to 2019. Results: This study found that the rate of diagnosis had been falling over the nearly two decades examined in this study. Implications: This study would support current efforts to encourage the utilization of HPV vaccines that are currently in the vaccination schedule rotation, and to illustrate the importance of completing all doses of the three-step series

Cash, Cash Conversion Cycle, Inventory and COVID-19

In recent years, hospital cash balances and cash conversion has been largely stable in Washington State hospitals, with the only increase coming in terms of increasing inventory. At current levels, cash is in short supply at many hospitals. While increasing inventory would appear to be a good move in light of the COVID-19 pandemic, inventory is not a single generic item. Hospital inventory is comprised of literally thousands of supplies and medications, only a few of which are critical. Hospital financial viability could be threatened by insufficient liquidity