678 results match your criteria national facility-level

Impact of Insurance Expansion on Disposition for Pediatric Trauma Patients: A National Trauma Data Bank Cohort Study.

J Surg Res 2021 Jun 16;267:109-116. Epub 2021 Jun 16.

Division of General Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah.

Background: The insurance status of pediatric trauma patients is associated with access to post-discharge resources, including inpatient rehabilitation. Our goal was to understand the impact of changes in insurance coverage on access to post-acute care resources for pediatric trauma patients.

Materials And Methods: We utilized the National Trauma Data Bank from 2012 to 2016 for all pediatric trauma patients with a highest body region abbreviated injury score >2. Read More

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Association between availability of medications for opioid use disorder in specialty treatment and use of medications among patients: A state-level trends analysis.

J Subst Abuse Treat 2021 Apr 22;132:108424. Epub 2021 Apr 22.

The Pew Charitable Trusts, Washington, DC, USA.

Introduction: Access to medication for opioid use disorder (MOUD) is a recognized public health challenge to improving the health of people with opioid use disorder (OUD) in many communities. Prior studies have shown that although MOUD availability has increased over time, particularly in some states, many substance use treatment facilities still do not offer medications. The relationship between greater availability of MOUD and use of MOUD among patients in treatment programs is not well understood. Read More

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Effects of Staff Training on Nursing Home Residents' End-Of-Life Care: A Randomized Controlled Trial.

J Am Med Dir Assoc 2021 Jun 13. Epub 2021 Jun 13.

Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland; Helsinki University Hospital, Unit of Primary Health Care, Helsinki, Finland. Electronic address:

Objectives: This trial examines the effects of end-of-life training on long-term care facility (LTCF) residents' health-related quality of life (HRQoL) and use and costs of hospital services.

Design: A single-blind, cluster randomized (at facility level) controlled trial (RCT). Our training intervention included 4 small-group 4-hour educational sessions on the principles of palliative and end-of-life care (advance care planning, adverse effects of hospitalizations, symptom management, communication, supporting proxies, challenging situations). Read More

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Where are US outpatient mental health facilities that serve children with autism spectrum disorder? A national snapshot of geographic disparities.

Autism 2021 Jun 12:13623613211024046. Epub 2021 Jun 12.

Harvard Medical School, USA.

Lay Abstract: There has been a rise in the observed prevalence of autism spectrum disorder among children. Existing studies show the share of counties with a treatment facility that offers care for children with autism spectrum disorder. However, no estimates exist of the share of US outpatient mental health treatment facilities that provide services for children with autism spectrum disorder. Read More

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The impact of additional payments on functional decline among long-term care health facility residents in Japan.

Age Ageing 2021 Jun 11. Epub 2021 Jun 11.

Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, University of Tokyo, Tokyo City, Japan.

Background: Additional payment approach has been one of the most important incentives in long-term care (LTC) systems for the past 20 years in Japan.

Objective: To estimate the effect of additional payments on functional decline in long-term care health facility (LTCHF) residents of Japan.

Design: A 24-month retrospective cohort study. Read More

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Profiles of institutional departments affect operative outcomes of eight gastroenterological procedures.

Ann Gastroenterol Surg 2021 May 20;5(3):304-313. Epub 2021 Feb 20.

The Japanese Society of Gastroenterological Surgery Tokyo Japan.

Aim: We evaluated the association of profiles of institutional departments with operative outcomes of eight major gastroenterological procedures.

Methods: We administered a 15-item online survey to 2634 institutional departments in 2016 to investigate the association of questionnaire responses with operative mortality for the procedures. The proportions of conditions met were listed according to institutional volume and classified according to annual operative cases in 1464 departments. Read More

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Appointment wait time data for primary & specialty care in veterans health administration facilities vs. community medical centers.

Data Brief 2021 Jun 14;36:107134. Epub 2021 May 14.

Partnered Evidence-Based Policy Resource Center, VA Boston Healthcare System, Bldg. 9, 150 S. Huntington Ave., Boston, MA 02130, United States.

The datasets summarized in this article include more than 38 million appointment wait times that U.S. military veterans experienced when seeking medical care since January 2014. Read More

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Laboratory-identified vancomycin-resistant enterococci bacteremia incidence: A standardized infection ratio prediction model.

Infect Control Hosp Epidemiol 2021 Jun 4:1-5. Epub 2021 Jun 4.

Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.

Background: We analyzed 2017 healthcare facility-onset (HO) vancomycin-resistant Enterococcus (VRE) bacteremia data to identify hospital-level factors that were significant predictors of HO-VRE using the Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN) multidrug-resistant organism and Clostridioides difficile reporting module. A risk-adjusted model that can be used to calculate the number of predicted HO-VRE bacteremia events in a facility was developed, thus enabling the calculation of VRE standardized infection ratios (SIRs).

Methods: Acute-care hospitals reporting at least 1 month of 2017 VRE bacteremia data were included in the analysis. Read More

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Safer primary healthcare facilities are needed to protect healthcare workers and maintain essential services: lessons learned from a multicountry COVID-19 emergency response initiative.

BMJ Glob Health 2021 06;6(6)

Prevent Epidemics, Resolve to Save Lives, an Initiative of Vital Strategies, New York, New York, USA

Healthcare workers (HCWs) are at increased risk of infection from SARS-CoV-2 and other disease pathogens, which take a disproportionate toll on HCWs, with substantial cost to health systems. Improved infection prevention and control (IPC) programmes can protect HCWs, especially in resource-limited settings where the health workforce is scarcest, and ensure patient safety and continuity of essential health services. In response to the COVID-19 pandemic, we collaborated with ministries of health and development partners to implement an emergency initiative for HCWs at the primary health facility level in 22 African countries. Read More

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Community Discharge Among Post-Acute Nursing Home Residents: An Association With Patient Safety Culture?

J Am Med Dir Assoc 2021 May 21. Epub 2021 May 21.

Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.

Objectives: We examined whether better patient safety culture (PSC) in skilled nursing facilities was associated with higher likelihood of successful community discharge for post-acute care residents.

Design: Cross-sectional study.

Setting And Participants: Medicare beneficiaries who were newly admitted for post-acute care (N = 53,929) to skilled nursing facilities participating in PSC survey (N = 818). Read More

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Structural barriers for retention of HIV/AIDS patients after initiating antiretroviral therapy in outpatient clinics of Vietnam.

AIDS Care 2021 May 21:1-8. Epub 2021 May 21.

Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.

Little evidence is available about structural factors associated with the retention in care for people living with HIV/AIDS (PLWH) in Vietnam. This retrospective longitudinal study was conducted among PLWH initiating antiretroviral therapy (ART) in 62 ART clinics from 15 provinces, to estimate retention rates and identify specific related structural factors. Facility-related factors such as location, duration of HIV service implantation, level of healthcare facility, frequency of drugs dispensed, integration of HIV care were examined. Read More

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Geographic variation in influenza vaccination among U.S. nursing home residents: A national study.

J Am Geriatr Soc 2021 May 20. Epub 2021 May 20.

Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA.

Objectives: Estimates of influenza vaccine use are not available at the county level for U.S. nursing home (NH) residents but are critically necessary to guide the implementation of quality improvement programs aimed at increasing vaccination. Read More

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Health system influences on the implementation of tuberculosis infection prevention and control at health facilities in low-income and middle-income countries: a scoping review.

BMJ Glob Health 2021 05;6(5)

Institute for Global Health and Development, School of Health Sciences, Queen Margaret University, Edinburgh, UK.

Background: Tuberculosis infection prevention and control (TB-IPC) measures are consistently reported to be poorly implemented globally. TB-IPC guidelines provide limited recognition of the complexities of implementing TB-IPC within routine health systems, particularly those facing substantive resource constraints. This scoping review maps documented system influences on TB-IPC implementation in health facilities of low/middle-income countries (LMICs). Read More

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Effect of Medicaid Expansion on Receipt of Definitive Treatment and Time to Treatment Initiation by Racial and Ethnic Minorities and at Minority-Serving Hospitals: A Patient-Level and Facility-Level Analysis of Breast, Colon, Lung, and Prostate Cancer.

JCO Oncol Pract 2021 May;17(5):e654-e665

Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.

Purpose: We sought to investigate the association between Medicaid expansion under the Affordable Care Act and access to stage-appropriate definitive treatment for breast, colon, non-small-cell lung, and prostate cancer for underserved racial and ethnic minorities and at minority-serving hospitals (MSHs).

Methods: We conducted a retrospective, difference-in-differences study including minority patients with nonmetastatic breast, colon, non-small-cell lung, and prostate cancer and patients treated at MSHs between the age of 40 and 64, with tumors at stages eligible for definitive treatment from the National Cancer Database. We not only defined non-Hispanic Black and Hispanic cancer patients as racial and ethnic minorities but also report findings for non-Hispanic Black cancer patients separately. Read More

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Where Are the Newly Diagnosed HIV Positives in Kenya? Time to Consider Geo-Spatially Guided Targeting at a Finer Scale to Reach the "First 90".

Front Public Health 2021 23;9:503555. Epub 2021 Apr 23.

Centre for International Health, University of Bergen, Bergen, Norway.

The UNAIDS 90-90-90 Fast-Track targets provide a framework for assessing coverage of HIV testing services (HTS) and awareness of HIV status - the "first 90." In Kenya, the bulk of HIV testing targets are aligned to the five highest HIV-burden counties. However, we do not know if most of the new HIV diagnoses are in these five highest-burden counties or elsewhere. Read More

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Differences in Sociodemographic Disparities Between Patients Undergoing Surgery for Advanced Colorectal or Ovarian Cancer.

Ann Surg Oncol 2021 May 6. Epub 2021 May 6.

Department of Surgery, University of Chicago, Chicago, IL, USA.

Background: Cytoreductive surgery (CRS) for ovarian cancer with peritoneal metastases (OPM) is an established treatment, yet access-related racial and socioeconomic disparities are well documented. CRS for colorectal cancer with peritoneal metastases (CRPM) is garnering more widespread acceptance, and it is unknown what disparities exist with regards to access.

Methods: This retrospective cross-sectional multicenter study analyzed medical records from the National Cancer Database from 2010 to 2015. Read More

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Associations of facility-level antibiotic use and hospital-onset infection in US acute-care hospitals, 2012-2018.

Infect Control Hosp Epidemiol 2021 May 7:1-3. Epub 2021 May 7.

Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia.

Previously reported associations between hospital-level antibiotic use and hospital-onset Clostridioides difficile infection (HO-CDI) were reexamined using 2012-2018 data from a new cohort of US acute-care hospitals. This analysis revealed significant positive associations between total, third-generation, and fourth-generation cephalosporin, fluoroquinolone, carbapenem, and piperacillin-tazobactam use and HO-CDI rates, confirming previous findings. Read More

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Variability and Costs of Low-Value Preoperative Testing for Cataract Surgery Within the Veterans Health Administration.

JAMA Netw Open 2021 May 3;4(5):e217470. Epub 2021 May 3.

Center for Innovation to Implementation, VA Palo Alto Healthcare System, Palo Alto, California.

Importance: The Choosing Wisely guidelines indicate that preoperative testing is often unnecessary and wasteful for patients undergoing cataract operations. However, little is known about the impact of these widely disseminated guidelines within the US Veterans Health Administration (VHA) system.

Objective: To examine the extent, variability, associated factors, and costs of low-value tests (LVTs) prior to cataract operations in the VHA. Read More

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Paying for performance to improve the delivery of health interventions in low- and middle-income countries.

Cochrane Database Syst Rev 2021 05 5;5:CD007899. Epub 2021 May 5.

Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK.

Background: There is growing interest in paying for performance (P4P) as a means to align the incentives of healthcare providers with public health goals. Rigorous evidence on the effectiveness of these strategies in improving health care and health in low- and middle-income countries (LMICs) is lacking; this is an update of the 2012 review on this topic.

Objectives: To assess the effects of paying for performance on the provision of health care and health outcomes in low- and middle-income countries. Read More

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Drug-related problems in Ethiopian public healthcare settings: Systematic review and meta-analysis.

SAGE Open Med 2021 16;9:20503121211009728. Epub 2021 Apr 16.

Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.

Identification and prevention of drug-related problems have become the central role of patient-centered pharmacy practitioners. After the initiation of patient-oriented pharmacy service, many studies evaluating magnitude of drug-related problems at facility level in Ethiopia have been conducted, though the extent of the problem at a national level remains unknown. Hence, this systematic review and meta-analysis is undertaken with the aim of quantifying the prevalence of drug-related problems in Ethiopian public healthcare settings using Cipolle/Strand classification system. Read More

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Contraceptive counseling experiences among women attending HIV care and treatment centers: A national survey in Kenya.

Contraception 2021 Apr 22. Epub 2021 Apr 22.

Department of Child, Family, and Population Health Nursing and Department of Global Health, University of Washington, Seattle, WA, United States. Electronic address:

Objectives: To characterize contraceptive counseling experiences among women living with HIV (WLWH) receiving HIV care in Kenya.

Study Design: Sexually active, WLWH aged 15 to 49 years were purposively sampled from 109 high-volume HIV Care and Treatment Centers in Kenya between June and September 2016. Cross-sectional surveys were administered to enroll women on a tablet using Open Data Kit. Read More

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Implementation outcomes of national decentralization of integrated outpatient services for severe non-communicable diseases to district hospitals in Rwanda.

Trop Med Int Health 2021 Apr 23. Epub 2021 Apr 23.

Rwanda Biomedical Center, Rwanda Ministry of Health, Kigali, Rwanda.

Objectives: Effective coverage of non-communicable disease (NCD) care in sub-Saharan Africa remains low, with the majority of services still largely restricted to central referral centres. Between 2015 and 2017, the Rwandan Ministry of Health implemented a strategy to decentralise outpatient care for severe chronic NCDs, including type 1 diabetes, heart failure and severe hypertension, to rural first-level hospitals. This study describes the facility-level implementation outcomes of this strategy. Read More

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Moving away from the "unit cost". Predicting country-specific average cost curves of VMMC services accounting for variations in service delivery platforms in sub-Saharan Africa.

PLoS One 2021 22;16(4):e0249076. Epub 2021 Apr 22.

University of California Berkeley, Berkeley, CA, United States of America.

Background: One critical element to optimize funding decisions involves the cost and efficiency implications of implementing alternative program components and configurations. Program planners, policy makers and funders alike are in need of relevant, strategic data and analyses to help them plan and implement effective and efficient programs. Contrary to widely accepted conceptions in both policy and academic arenas, average costs per service (so-called "unit costs") vary considerably across implementation settings and facilities. Read More

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Assessment of the core and support functions of the integrated disease surveillance and response system in Zanzibar, Tanzania.

BMC Public Health 2021 04 17;21(1):748. Epub 2021 Apr 17.

Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.

Background: Disease surveillance is a cornerstone of outbreak detection and control. Evaluation of a disease surveillance system is important to ensure its performance over time. The aim of this study was to assess the performance of the core and support functions of the Zanzibar integrated disease surveillance and response (IDSR) system to determine its capacity for early detection of and response to infectious disease outbreaks. Read More

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The Governance and Implementation of the National Action Plan on Antimicrobial Resistance in Tanzania: A Qualitative Study.

Antibiotics (Basel) 2021 Mar 9;10(3). Epub 2021 Mar 9.

Muhimbili University of Health and Allied Sciences, Dar es Salaam 65001, Tanzania.

Tanzania launched its first National Action Plan (NAP) on antimicrobial resistance (AMR) in 2017 to reduce the burden of AMR in the country and contribute to the global response. We aimed to analyze the implementation of the NAP on AMR in Tanzania using the governance framework. In-depth interviews were conducted with human and animal health practitioners and national-level policy actors. Read More

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Early retention among pregnant women on 'Option B + ' in urban and rural Zimbabwe.

AIDS Res Ther 2021 04 1;18(1):10. Epub 2021 Apr 1.

National AIDS Council, Harare, Zimbabwe.

Background: In 2013, the World Health Organisation (WHO) recommended Option B+ as a strategy to prevent mother-to-child transmission (PMTCT) of HIV. In option B+ , lifelong antiretroviral therapy (ART) is offered to all HIV positive pregnant and breastfeeding women to reduce MTCT rate to less than or equal to 5%. Its success depends on retaining women on ART during pregnancy, delivery and breast-feeding period. Read More

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Association of Treatment Facility Characteristics With Overall Survival After Mohs Micrographic Surgery for T1a-T2a Invasive Melanoma.

JAMA Dermatol 2021 May;157(5):531-539

Department of Dermatology, Yale School of Medicine, New Haven, Connecticut.

Importance: Early-stage melanoma, among the most common cancers in the US, is typically treated with wide local excision. However, recent advances in immunohistochemistry have led to an increasing number of these cases being excised via Mohs micrographic surgery (MMS). Although studies of resections for other cancers have reported that facility-level factors are associated with patient outcomes, it is not yet established how these factors may affect outcomes for patients treated with Mohs micrographic surgery. Read More

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Political economy analysis of the performance-based financing programme in Afghanistan.

Glob Health Res Policy 2021 03 10;6(1). Epub 2021 Mar 10.

London School of Hygiene and Tropical Medicine, Faculty of Public Health and Policy, Department of Global Health and Development, London, UK.

Background: Performance-based financing (PBF) has attracted considerable attention in recent years in low and middle-income countries. Afghanistan's Ministry of Public Health (MoPH) implemented a PBF programme between 2010 and 2015 to strengthen the utilisation of maternal and child health services in primary health facilities. This study aimed to examine the political economy factors influencing the adoption, design and implementation of the PBF programme in Afghanistan. Read More

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Racial disparity in end-of-life hospitalizations among nursing home residents with dementia.

J Am Geriatr Soc 2021 Mar 22. Epub 2021 Mar 22.

Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.

Objective: Explore within and across nursing home (NH) racial disparities in end-of-life (EOL) hospitalizations for residents with Alzheimer's disease or related dementia (ADRD), and examine whether severe cognitive impairment influences these relationships.

Design: Observational study merging, at the individual level, C2014-2017 national-level Minimum Data Set (MDS), Medicare Beneficiary Summary Files (MBSF), and Medicare Provider Analysis and Review (MedPAR). Nursing Home Compare (NHC) was also used. Read More

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Cost of scaling-up comprehensive primary health care in India: Implications for universal health coverage.

Health Policy Plan 2021 May;36(4):407-417

Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India.

India has announced the ambitious program to transform the current primary healthcare facilities to health and wellness centres (HWCs) for provision of comprehensive primary health care (CPHC). We undertook this study to assess the cost of this scale-up to inform decisions on budgetary allocation, as well as to set the norms for capitation-based payments. The scale-up cost was assessed from both a financial and an economic perspective. Read More

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