Chenjuan Ma

Abstract

Functional disability and physical frailty (PF) are debilitating geriatric conditions. Previous studies have suggested both perceived neighborhood social cohesion (PNSC) and PF can influence functional disability and may have an interactive effect too. This cross-sectional study aims to examine the independent and combined relationships of PF and PNSC on functional disability in community-dwelling older adults in Shanghai, China. A total of 1616 older adults aged 75 years were recruited using multistage sampling. Results showed that prefrailty, frailty (using the modified frailty phenotype criteria), and low PNSC (measured by the Neighborhood Cohesion Scale) were independently associated with increased likelihood of functional disability after adjustment of covariates. To evaluate the combined relationships of PF and PNSC, participants were classified into six groups based on their levels of PF and PNSC. The probability of frail older adults with low PNSC having functional disability stood out compared with the robust older adults with high PNSC. Our findings suggest the importance of high PNSC as a protective factor of maintaining functional ability. Future longitudinal studies are needed to identify the role of PNSC in the development of functional disability among frail older adults.

Abstract

Background: Authorizing health care providers other than physicians to prescribe medicines (i.e., non-medical prescribing, NMP) has been used to improve access to healthcare in many countries. This paper aimed to identify the scope of policies facilitating NMP worldwide and investigate the relationship of such policies with a country's physician to population ratio and economic status. Methods: A hierarchical search strategy was used. First, we compiled a list of countries and territories (n = 216) based upon World Bank record. Then, we collected relevant information for each country by using country name combined with key terms in PubMed, Google, and World Health Organization (WHO) country pharmaceutical profiles. Countries’ socio-economic status and physician to population ratio were determined using data from the World Bank. Results: Legislation allowing NMP was found for 117 of 216 (54%) countries and territories. The most prevalent policy identified was that of autonomous prescribing authority (59%). Countries with low or high incomes and those with low or high physician to population ratios (<1/1000 or >3/1000) had the highest concentration of policies for NMP rights. Conclusion: Despite the varied scope of relevant policies, NMP has been implemented in countries of varied income levels and physician to population ratios. Future research is warranted to empirically examine its impact on access to care.

Abstract

Patients in home health care (HHC), a rapidly growing healthcare sector, are at high risk for infections. This study aimed to identify risk factors for infections among HHC patients using the Outcome and Assessment Information Set (OASIS) data. We used a 5% random sample of the 2013 national OASIS data. Infections were identified if records indicated that patients were hospitalized or received emergency care for one of three types of infections (respiratory, wound site, and urinary tract infection). Multivariate logistic regression models were used to identify risk factors for each individual infection type. The final analysis included 128,163 patients from 8,255 HHC agencies nationwide. Approximately 3.2% of the patients developed infections during their HHC stay that led to hospitalization or emergency care treatment. We found that associations between demographics and infection risk are specific to the type of infection. In general, a history of multiple hospitalizations in past 6 months, comorbidity, having a severe condition at HHC admission, and impaired physical functioning increased HHC patients' risk of infections. We also identified that HHC patients with caregivers who needed training in providing medical procedure or treatment are at higher risk for wound-site infections. Our findings suggest that patients with underlying medical conditions and limited physical function status are more likely to develop infection. The caregiver's lack of training in providing needed care at home also places HHC patients at high risk for infection. Education for patients and caregivers should be tailored based on their health literacy level to ensure complete understanding.

Abstract

Internationally educated nurses (IENs) are an important part of the U.S. nursing workforce. Optimizing their transition-to-practice (TTP) experiences in the United States is crucial for ensuring high-quality patient and IENs’ outcomes. The purpose of this integrative review is to analyze and synthesize the current evidence surrounding IEN TTP experiences in the United States from 2000 to 2018 to inform improvements in TTP. Eighteen studies were included. TTP was defined through IENs’ description of facilitators and barriers of the transition process and presented in seven themes. Two themes were facilitators: support from family and nursing colleagues, and perceptions of self-efficacy. The remaining five themes were barriers: (a) the stigma associated with educational preparation, (b) communication and language, (c) differences in culture, (d) differences in nursing practice, and (e) legal issues. Findings are important for improving TTP programs. Further research focusing on the outcomes of transition programs is needed to inform policymaking surrounding IEN recruitment and retention.

Abstract

Employing internationally educated nurses (IENs) to address the nursing workforce shortage is common in many countries, including the United States. This study examined the relationship between unit utilization of IENs and collaboration in U.S. hospitals. Results indicated more IENs on a unit did not significantly affect the collaboration among nurses and between nurses and physicians. The presence of IENs significantly influenced unit nursing characteristics, such as education attainment and unit tenure.

Abstract

According to the U.S. census Bureau, close to 20% of the U.S. population speaks a language other than English at home. Home health care (HHC) patients who speak English less than very well or have limited English proficiency (LEP) are at an increased risk for medication mismanagement and serious health consequences. The purpose of this study was to examine if there were differences in medication management between English-speaking patients and patients with LEP receiving HHC services. Data for this cross-sectional observation study were collected from 2010 to 2014. Medication management was measured by two items in the Centers for Medicare and Medicaid Services–mandated Outcomes Assessment Information Set (OASIS). All patients in the database who were taking medications and had a valid admission and discharge assessment from HHC were included in the analysis. Inverse probability of treatment weighting (IPTW) with a marginal structural model was used to address potential imbalances in observed patient characteristics when estimating the effect of having LEP or being an English-speaking HHC patient on changes in medication management over the course of a HHC episode. Estimates from marginal structural model with inverse probability weighting indicate that being LEP was associated with less improvement in medication management and increased likelihood of getting worse over the course of a HHC episode. This study is one of the first to demonstrate that patients with LEP experience disparities in medication management when compared to English-speaking patients in HHC.

Abstract

Objective: Hospital readmission in persons with dementia is becoming a critical safety and cost issue. The purpose of this review is to systematically assess published evidence on hospital readmissions in persons with dementia, including rate, clinical reasons, risk factors, and prevention programs. Methods: A systematic review of relevant literature was conducted. Literature were searched in PubMed, CINAHL, PsycINFO, and Embase as well as hand searching. Quality of reviewed studies were assessed independently by reviewers using quality assessment checklists. Results: Nineteen studies met the inclusion criteria and were reviewed. In persons with dementia, all-cause 30-day readmission rate was most frequently reported and ranged from 7% to 35%. Compared with those without dementia, persons with dementia had significantly higher rate of readmission. Reported risk factors of readmission varied across studies from patient sociodemographic and clinical status, history of health care utilization, to family caregivers. Reasons for readmission were rarely documented. Programs of home-based individualized care and interdisciplinary team care were used for preventing readmissions. Findings from some of the studies were limited by small sample sizes, single data source, and other methodologic flaws. Conclusions: Persons with dementia are at high risk for hospital readmission, but many of the readmissions are potentially preventable. Multiple strategies such like identifying high-risk individuals and the clinical reasons for index admission and readmission and implementing home-based individualized care by interdisciplinary team can reduce preventable hospital readmissions. Future studies should use multiple national data sources and advanced methodology to identify risk factors and clinical reasons of hospital readmissions.

Abstract

BackgroundIncreasingly, patients with limited English proficiency are accessing home health care services in the United States. Few studies have examined how language barriers influence provider role implementation or workload in the home health care setting.ObjectivesTo explore home health care professionals’ perspectives about how workload changes from managing language barriers influence quality and safety in home health care.DesignA qualitative secondary data analysis using a summative content analysis approach was used to analyze existing semi-structured interview data.SettingA large urban home health care agency located on the East Coast of the United States.ParticipantsThirty five home health care providers [31 registered nurses, 3 physical therapists, 1 occupational therapist].ResultsA total of 142 discrete incidents emerged from the analysis. Overall, home health care providers experienced distinct shifts in how they implemented their roles that added to their workload and time spent with Limited English Proficiency patients and family members. Providers were concerned about interpretation accuracy and perceived it as potentially posing risks to patient safety. Changes in work patterns, therefore, sought to maximize patient safety.ConclusionsHome health care providers decision-making about how they adapt practice when faced with a language barrier is a sequence of actions based on awareness of the patient’s language preference and if they spoke another language. Subsequent choices showed proactive behaviors to manage increased workload shaped by their perceived risk of the threats posed by the quality of interpreter services. Future research should develop quantitative models examining differences in workload when caring for limited English proficiency versus English speaking patients as well as the relationship between visit length and patient outcomes to determine optimal quality models.

Abstract

OBJECTIVE The aim of this study was to examine the impact of nurse shift patterns on nurses' collaboration with nurses and physicians in US acute care hospital units. BACKGROUND Collaboration between nurses and other healthcare providers is critical for ensuring quality patient care. Nurses perform collaboration during their shift work; thus, nurse shift patterns may influence collaboration. However, there is a dearth of empirical evidence of the relationship between nurse shift patterns and collaboration of nurses with other healthcare providers. METHODS This is a cross-sectional study using data from 957 units in 168 acute care hospitals. Measures of collaboration include nurse-nurse collaboration and nurse-physician collaboration. Measures of shift patterns included shift length and overtime. Multilevel linear regressions were conducted at the unit level, controlling unit and hospital characteristics. RESULTS Overtime (more nurses working overtime or longer overtime hours) was associated with lower collaboration at the unit level; however, shift length was not. CONCLUSIONS Working overtime may negatively influence nurses' collaboration with other healthcare providers.