Source: Diane L. Elliot, Kerry S. Kuehl, International Association of Fire Chiefs (IAFC) and the United States, Fire Administration (USFA), Oregon Health & Science University, June 2007
From the summary:
This new report, The Effects of Sleep Deprivation on Fire Fighters and EMS Responders, along with its accompanying computer-based educational program, presents background information on normal sleep physiology and the health and performance effects of sleep deprivation. Countermeasures for sleep deprivation are reviewed, which relate to identifying those particularly susceptible to risks of sleep deprivation, individual mitigating strategies and work-related issues. The project was supported by a cooperative agreement between the IAFC and the United States Fire Administration (USFA), with assistance from the faculty of Oregon Health & Science University.
Source: Christine T. Kovner,Carol S. Brewer, Susan Fairchild, Shakthi Poornima, Hongsoo Kim, Maja Djukic, American Journal of Nursing, Vol. 107 no. 9, September 1, 2007
From a summary:
In this article, researchers presented findings from the first wave of a three-year panel study on the work experience of newly licensed nurses. A randomly selected sample of 3,266 newly licensed RNs from 60 sites across the country participated in the study. RNs completed a multipage survey that addressed several aspects of their current employment.
Source: PricewaterhouseCoopers’ Health Research Institute, 2007
Many nurses and physicians are among the baby boomers who will start to retire in the next three to five years. The federal government is predicting that by 2020, nurse and physician retirements will contribute to a shortage of approximately 24,000 doctors and nearly 1 million nurses. While hospital leaders voice much of the concern over possible shortages, the implications extend throughout the labor-intensive, trillion-dollar United States health system. It’s expensive to educate new nurses and doctors. Taxpayer-funded Medicare spends $8 billion a year for residence training of physicians alone.
While the U.S. has more physicians and nurses today than ever before, they are not distributed or deployed efficiently. Shortage projections tend to be built around today’s often dysfunctional system, which makes them problematic. However, while future shortages are certainly worrisome, the bigger issue for health industry leaders today lies in orchestrating care in an increasingly complex and converging healthcare labor market.
Source: Rutgers College of Nursing, Press Release, August 15, 2007
From press release:
(NEWARK, N.J., Aug. 14, 2007) – Rutgers College of Nursing faculty member Linda Flynn is conducting a study to explore the effects of nurse staffing, work environment and safety technology on the frequency of non-intercepted medication errors in 17 New Jersey hospitals.
Funded by a two-year $308,254 grant from the Robert Wood Johnson Foundation, the study’s focus is to determine the best practices for reducing non-intercepted medication errors.
Source: PricewaterhouseCoopers’ Health Research Institute, 2007
It is impossible to improve what cannot be measured or to measure what hasn’t been defined. Take, for example, the topic of healthcare quality. Everyone wants quality, but everyone’s keeping score differently. This conundrum was described in some detail in The Quality Conundrum, a book developed and distributed in 2007 by PricewaterhouseCoopers’ Health Research Institute (HRI). It explores practical approaches to improving the quality of patient care from the perspective of patients, physicians, payers, and employers.
One of these approaches is pay-for-performance (P4P), which attempts to define, measure, and reward quality. This represents a radical departure from traditional payment methods, which pay providers the same regardless of differences in quality. P4P has gained traction, largely because the Centers for Medicare and Medicaid Services (CMS) has told hospitals and physicians that future increases in payment will be linked to improvements in clinical performance. Commercial health plans are also responding to employers’ demands for quality improvement by developing “scorecards” that use quality metrics to grade care provided by hospitals and physicians. By tying providers’ scores to financial payments, non-financial rewards, and public reporting, both private and public payers intend to incent improvements in quality of care and outcomes.
The most mature P4P programs are more than 10 years old. However, among payers interviewed for this report, P4P programs are still evolving. As they’ve blossomed, providers have faced a host of new and varied reporting requirements-what some call a “virtual soup of different metrics.” This has caused some to question the value of P4P and whether the results are worth the administrative burden.
Pay-for-Performance: Will the Latest Payment Trend Improve Care?
Source: Meredith B. Rosenthal, R. Adams Dudley, JAMA: Journal of the American Medical Association, Vol. 297 No. 7, February 21, 2007 (subscription required)
Source: Council 31, American Federation of State, County and Municipal Employees (AFSCME), July 2007
From press release:
Council 31 of the American Federation of State, County and Municipal Employees (AFSCME) have issued a new report documenting low wage levels that keep patient-support staff art Resurrection Health Care hospitals mired in poverty and unable to support their families. Resurrection Health Care (RHC) is the second largest non-profit hospital system in the Chicago metropolitan area. It encompasses eight hospitals, as well as nursing homes, home health services, and outpatient clinics.
Entitled Coming Up Short: Resurrection Health Care’s Distorted Pay Priorities, the report depicts a starkly skewed pay structure in which the compensation of RHC hospital executives significantly exceeds national norms while the meager wages of patient-support staff (housekeepers, laundry and food service workers) fall far short of self-sufficiency standards in the Chicago area.
Source: Farr A. Curlin, MD, Lydia S. Dugdale, MD, John D. Lantos, MD, and Marshall H. Chin, MD, MPH, Annals of Family Medicine, Vol. 5 no. 4, July/August 2007
Religious traditions call their members to care for the poor and marginalized, yet no study has examined whether physicians’ religious characteristics are associated with practice among the underserved. This study examines whether physicians’ self-reported religious characteristics and sense of calling in their work are associated with practice among the underserved. This study entailed a cross-sectional survey by mail of a stratified random sample of 2,000 practicing US physicians from all specialties.
Source: Elisabeth D. Root, Jacqueline B. Amoozegar, Shulamit Bernard, Agency for Healthcare Research and Quality, AHRQ Publication No. 07-0029-1, May 2007
From the overview:
To date, most health care preparedness planning efforts have been focused on hospital and first responder preparedness. Nevertheless, the elderly are particularly vulnerable to bioterrorism and other public health emergencies due to their complex physical, medical, and psychological needs. The potential role and question of preparedness on the part of nursing homes has emerged in local and national preparedness discussions. However, little is known about the extent to which nursing homes have planned for and/or been incorporated into regional planning efforts
To address this issue, a series of focus groups was conducted to collect information about disaster- and bioterrorism-related planning activities among nursing homes in five States—North Carolina, Oregon, Pennsylvania, Washington, and Utah—and southern California. The aims of the focus groups were to:
• Determine if nursing home administrators have prepared and trained staff on disaster plans, including bioterrorism response.
• Assess the special needs of the elderly population in nursing home settings during a public health emergency.
• Determine if nursing homes are able to accommodate patient flows from acute care hospitals or provide other resources.
• Assess the impact of State regulations on the ability of nursing homes to offer support and/or surge capacity.
Findings from this report can provide important insight into current nursing home preparedness activities as well as the potential role of nursing homes in larger local or regional preparedness efforts and the special needs of the nursing home population.
See also: Emergency Preparedness Atlas — U.S. Nursing Home and Hospital Facilities
The Agency for Healthcare Research and Quality (AHRQ) sponsored preparation of this atlas to support local/regional planning and response efforts in the event of a bioterrorism or other public health emergency. In the atlas, case studies in six areas illustrate the location of nursing homes relative to population and various emergency preparedness regions. There are also maps of the location of hospitals and nursing homes in all 50 States and the District of Columbia.
Download in sections (PDFs)
Source: John E Lyncheski, Nursing Homes: Long Term Care Management, Vol. 56 no. 7, July 2007
Misunderstood or misapplied provisions of the Department of Labor’s regulations can have explosive consequences. The Department of Labor has long-term care in its sights for nonexempt employee overtime infractions.
Source: Congressional Budget Office Background Paper, Pub. No. 2761, July 2007
Rising costs in Medicare, Medicaid, and other federal health-related programs represent the central long-term fiscal challenge facing the nation. The Congressional Budget Office (CBO) is therefore increasingly focusing on analyzing the causes of those rising costs and potential policy responses.
Medicare’s spending under the fee-for-service portion of the program depends on the rates that Medicare pays to medical providers and the volume of services that medical providers supply to beneficiaries. The Congress has periodically limited growth in Medicare’s payments to providers to reduce spending. The effect on Medicare’s spending of changes in Medicare’s payment rates depends on whether and to what extent the volume of services adjusts in response.
In this background paper, CBO examines changes in the volume of services provided by skilled nursing facilities (SNFs) in response to changes in Medicare’s payment rates for SNFs. As with other CBO background papers, it is designed to make the agency’s analyses more transparent by explaining CBO’s methods and assumptions. In keeping with CBO’s mandate to provide objective, nonpartisan analysis, this paper makes no recommendations.