Publications

Abstract

BACKGROUND: There is limited collaboration between hospitals and primary care despite parallel efforts to improve postdischarge care transitions. OBJECTIVE: To understand what primary care leaders perceived as barriers and facilitators to collaboration with hospitals. METHODS: Qualitative study with in-depth, semistructured interviews of 22 primary care leaders in 2012 from California safety-net clinics. RESULTS: Major barriers to collaboration included lack of institutional financial incentives for collaboration, competing priorities (e.g., regulatory requirements, strained clinic capacity, financial strain) and mismatched expectations about role and capacity of primary care to improve care transitions. Facilitators included relationship building through interpersonal networking and improving communication and information transfer via electronic health record (EHR) implementation. CONCLUSIONS: Efforts to improve care transitions should focus on aligning financial incentives, standardizing regulations around EHR interoperability and data sharing, and enhancing opportunities for interpersonal networking.

Abstract

OBJECTIVE: The aim of this study was to explore the relationship between Magnet Recognition® and nurse-reported quality of care. BACKGROUND: Magnet® hospitals are recognized for nursing excellence and quality patient outcomes; however, few studies have explored contributing factors for these superior outcomes. METHODS: This was a secondary analysis of linked nurse survey data, hospital administrative data, and a listing of American Nurses Credentialing Center Magnet hospitals. Multivariate regressions were modeled before and after propensity score matching to assess the relationship between Magnet status and quality of care. A mediation model assessed the indirect effect of the professional practice environment on quality of care. RESULTS: Nurse-reported quality of care was significantly associated with Magnet Recognition after matching. The professional practice environment mediates the relationship between Magnet status and quality of care. CONCLUSION: A prominent feature of Magnet hospitals, a professional practice environment that is supportive of nursing, plays a role in explaining why Magnet hospitals have better nurse-reported quality of care.

Abstract

Mobile health (mHealth) technology presents opportunities to enhance chronic illness management, which is especially relevant for persons living with HIV (PLWH). Since mHealth technology comprises evolving and adaptable hardware and software, it provides many challenging design problems. To address this challenge, our methods were guided by the Information System Research (ISR) framework. This paper focuses on the Design Cycle of the ISR framework in which we used user-centered distributed information design methods and participatory action research methods to inform the design of a mobile application (app) for PLWH. In the first design session, participants (N=5) identified features that are optimal for meeting the treatment and management needs of PLWH. In the second design session, participants (N=6) were presented with findings from the first design session and pictures of existing apps. Findings from the Design Cycle will be evaluated with usability inspection methods. Using a systematic approach has the potential to improve mHealth functionality and use and subsequent impact.

Abstract

Objective. To examine the screening practices of family practitioners (FPs) and pediatricians for type 2 diabetes (T2D) in adolescents. Design. Cross-sectional study. Setting and participants. The researchers randomly sampled 700 pediatricians and 700 FPs who participated in direct patient care using the American Medical Association Physician Masterfile using a mail survey. Exclusion criteria included providers who were residents, hospital staff, retirees, or employed by federally owned medical facilities, certified with a subspecialty, or over age 70. Main outcome measures. Providers were given a hypothetical case of an obese, female, teenaged patient with concurrent associated risk factors for T2D (family history of T2D, minority race, signs of insulin resistance) and asked what initial screening tests they would order. Respondents were then informed of the updated American Diabetes Association (ADA) guidelines that added hemoglobin A1c as a screening test to diagnose diabetes. The survey then asked if knowing this change in recommendation has changed or will change their screening practices in adolescents. Main results. 1400 surveys were mailed. After 2 were excluded due to mailing issues, 52% of providers provided responses. Of these, 129 providers reported that they did not care for adolescents (age 10-17), resulting in 604 providers in the final sample, 398 pediatricians and 335 FPs. The vast majority (92%) said they would screen the hypothetical case for diabetes, with most initially ordering a fasting test (fasting plasma glucose or 2-hour glucose tolerance test) (63%) or A1c test (58%). Of the 58% who planned to order HbA1c, only 35% ordered it in combination with a fasting test. HbA1c was significantly more likely to be ordered by pediatricians than by FPs (P = 0.001). After being presented with the new guidelines, 84% said then would now order HbA1c, a 27% increase. Conclusion. In response to information about the new guidelines, providers were more likely to order A1c as part of initial testing. Due to the lower test performance in children and increased cost of the test, the use of HbA1c without fasting tests may result in missed diagnosis of T2D in adolescents as well as increased health care costs.

Abstract

This project used the interRAI based, community health assessment (CHA) to develop a model for identifying current elder drivers whose driving behavior should be reviewed. The assessments were completed by independent housing sites in COLLAGE, a non-profit, national senior housing consortium. Secondary analysis of data drawn from older adults in COLLAGE sites in the United States was conducted using a baseline assessment with 8042 subjects and an annual follow-up assessment with 3840 subjects. Logistic regression was used to develop a Driving Review Index (DRI) based on the most useful items from among the many measures available in the CHA assessment. Thirteen items were identified by the logistic regression to predict drivers whose driving behavior was questioned by others. In particular, three variables reference compromised decision-making abilities: general daily decisions, a recent decline in ability to make daily decisions, and ability to manage medications. Two additional measures assess cognitive status: short-term memory problem and a diagnosis of non-Alzheimers dementia. Functional measures reflect restrictions and general frailty, including receiving help in transportation, use of a locomotion appliance, having an unsteady gait, fatigue, and not going out on most days. The final three clinical measures reflect compromised vision, little interest or pleasure in things normally enjoyed, and diarrhea. The DRI focuses the review process on drivers with multiple cognitive and functional problems, including a significant segment of potentially troubled drivers who had not yet been publicly identified by others. There is a need for simple and quickly identified screening tools to identify those older adults whose driving should be reviewed. The DRI, based on the interRAI CHA, fills this void. Assessment at the individual level needs to be part of the backdrop of science as society seeks to target policy to identify high risk drivers instead of simply age-based testing.

Abstract

The literature supports that organizations that create working conditions with positive practice environments improve nurses' job satisfaction and reduce turnover in hospital settings (Havens & Johnston, 2004; International Council of Nurses [ICN], 2007). Positive practice environments promote quality nursing care and better patient outcomes. However, in South America, there are no instruments to measure the nursing practice environment in a hospital setting. The purpose of this research was to examine the validity and reliability of a Spanish translation of the Practice Environment Scale of the Nursing Work Index (PES-NWI; Lake, 2002) in the Colombian clinical context. An instrument validation study using expert panel review, content validity indexing techniques, and a factor analysis of survey responses from 144 nurses was used. The scale-level content validity evaluation achieved high levels of acceptability, with values above 0.90. Construct validity results suggest that the instrument consists of 5 factors as prescribed by original instrument. The overall internal consistency value was a Cronbach's alpha level of 0.89. This is the first instrument to measure the work environment of nursing practice in South America, now validated in the Colombian context.

Abstract

Clinical nurse leader (CNL) practice, by definition, requires individuals to make career transitions. CNLs must adjust to their new work role and responsibilities and doing so also entails individual adjustment. Prior work has not examined the role of individual-level factors in effective CNL role transition. This study contributes to CNL implementation efforts by developing understanding of personal and contextual factors that explain variation in individuals' levels of self-confidence with performing the key functions of the CNL role. Data were gathered using a cross-sectional survey from a national sample of registered nurses (RNs) certified as CNLs. Respondents' perceptions of their confidence in performing CNL role competencies were measured with the Clinical Nurse Leader Self-Efficacy Scale (CNLSES; Gilmartin MJ, Nokes, K. (in press). The Clinical Nurse Leader Self Efficacy Scale: Results of a pilot study. Nursing Economic$). The CNLSES is a 35-item state-specific self-efficacy scale with established measurement properties that assesses nurses' perceptions of their ability to function effectively as a CNL. Demographic data were also collected. Data were analyzed using a general linear regression model. One hundred forty-seven certified CNLs participated in the survey. Results indicate that respondents vary in their confidence with performing the nine role competencies associated with CNL practice. Results from regression analyses also show that respondents' confidence in their abilities to carry out the core functions associated with the CNL role varied significantly across geographic region, organizational type, and by CNL graduate program model. The results of this study show important differences in CNLs' levels of self-confidence with the core competencies of their role. As a result, it may be important to develop targeted career transition interventions to gain the full benefit of CNL practice.

Abstract

Preoperative breast pain in women with breast cancer may result from a number of causes. Previous work from our team found that breast pain occurred in 28.2% of women (n = 398) who were about to undergo breast cancer surgery. The occurrence of preoperative breast pain was associated with a number of demographic and clinical characteristics, as well as variation in two cytokine genes. Given that ion channels regulate excitability of sensory neurons, we hypothesized that variations in potassium channel genes would be associated with preoperative breast pain in these patients. Therefore, in this study, we evaluated for associations between single-nucleotide polymorphisms and inferred haplotypes among 10 potassium channel genes and the occurrence of preoperative breast pain in patients scheduled to undergo breast cancer surgery. Multivariable logistic regression analyses were used to identify those genetic variations that were associated with the occurrence of preoperative breast pain while controlling for age and genomic estimates of and self-reported race/ethnicity. Variations in four potassium channel genes: (1) potassium voltage-gated channel, delayed rectifier, subfamily S, member 1 (KCNS1); (2) potassium inwardly rectifying channel, subfamily J, member 3 (KCNJ3); (3) KCNJ6; and (4) potassium channel, subfamily K, member 9 (KCNK9) were associated with the occurrence of breast pain. Findings from this study warrant replication in an independent sample of women who report breast pain following one or more breast biopsies.

Abstract

Objective: Sexual violence is a significant public health issue on college campuses. Much of the research to date has focused on sexual violence victimization with less data on perpetration of sexual violence. This analysis describes sexual violence victimization and perpetration experiences in a sample of college students. Methods: We sought to recruit college students attending three universities in the United States. A crosssectional survey design was used to contact students through e-mail or voluntary gatherings. Each participant completed a questionnaire focused on experiences of sexual violence. Results: Atotal of 1,978 students consented to participate in the studywith 1,829 completing the questions related to victimization experiences and 1,479 completing the questions related to perpetration experiences. Thirty-eight percent (n = 700) of the sample (men and women) reported sexual violence victimization. Victimization among women and men was 42.6% and 28.7%, respectively. Almost 6%(n = 100) of the sample reported sexual violence perpetration.Men reported a higher rate of perpetration, 14.5% (n = 60), compared to women, 3.8% (n = 40). Conclusion: This study provides data on both victimization and perpetration experiences of college students. Both college men and women reported experiences of being victimized as well as perpetrating sexual violence. Understanding victimization and perpetration on college campuses will increase awareness, thus piercing the silence, of unwanted sexual experiences and help move college campuses toward a response.

Abstract

Purpose – Human resource management (HRM) practices are implemented to improve outcomes, such as reducing turnover, absenteeism, and improving performance. Using social exchange theory (SET), the purpose of this paper is to examine one HRM practice that has received less attention by researchers: employer-sponsored childcare assistance programs.Design/methodology/approach – Study 1 – a field study compared three groups of hospital employees’ (n=148) attitudes and behaviors using MANCOVA/ANOVA over two time periods. Study 2 – using a field study, on-site and voucher childcare assistance programs were evaluated in terms of the cost to the organization and the relationship to attitudinal variables.Findings – Study 1 – results indicated that employee performance was higher and absenteeism lower for employees using the on-site childcare center than employees using an off-site center or with no children. Although the attitudinal results did not align with hypotheses, they were not inconsistent with SET. Study 2 – results indicate that childcare assistance programs may be a beneficial HRM practice for organizations to implement.Research limitations/implications – One limitation of Study 1 is the small sample size. Future research should continue to examine how employee benefits like childcare programs affect employees, as well as examine how such benefits differentially employees who value and do not value the benefits. In Study 2, although the authors randomly selected the sample of on-site and voucher programs, the health care facilities self-selected themselves to participate in the program and selected the type of childcare program, a potential source of bias. Future research should examine childcare assistance programs and their impact on work-family balance and strain-based conflict in awider variety of samples.Practical implications – Implications for research and practice: Both studies offer researchers a “next step” in the evaluation of childcare assistance research. Additionally, these studies are of practical value to administrators/researchers in organizations who may be considering vouchers or on-site programs as they relate such programs to organizational outcomes.Originality/value – The first study is one of the few studies on this topic to use a field design with two time points and with multiple behaviors and attitudes. The second study provides a descriptive comparison of two types of childcare assistance programs, a comparison made by few studies to date.

Abstract

Research has shown that hospitals with better nurse staffing and work environments have better nurse outcomes—less burnout, job dissatisfaction, and intention to leave the job. Many studies, however, have not accounted for wage effects, which may confound findings. By using a secondary analysis with cross-sectional administrative data and a four-state survey of nurses, we investigated how wage, work environment, and staffing were associated with nurse outcomes. Logistic regression models, with and without wage, were used to estimate the effects of work environment and staffing on burnout, job dissatisfaction, and intent to leave. We discovered that wage was associated with job dissatisfaction and intent to leave but had little influence on burnout, while work environment and average patient-to-nurse ratio still have considerable effects on nurse outcomes. Wage is important for good nurse outcomes, but it does not diminish the significant influence of work environment and staffing on nurse outcomes.

Abstract

Registered nurse turnover is an important indicator of the nurse job market. Despite its wide use as a measure for health-care system analysis, there is a lack of consistency in the definition of turnover. Some definitions include any nurse leaving an organization; others may include involuntary and voluntary leaving. These inconsistent definitions also result in various turnover rates. The RN Work Project is a 10-year panel study of new nurses. Data were collected from the new nurses, rather than from a specific organization. About 17.5% of new nurses leave their first job within 1 year of starting their jobs. Consistent and accurate measurement of turnover is an important step in addressing organizational work environments and policies about the nursing workforce.

Abstract

Background: Sexual assault is a major public health problem disproportionately affecting women on college and university campuses. As sexual assault is often unreported, survivorsmay not have the access to resources and services that are helpful in healing. Campus-based women's centers provide a comfortable place and resource to address women's issues on campus. Individuals who work in these centers have open communication channels with students and a role in the administrative structure that may provide a unique understanding of survivors, the student environment, and the institutional context regarding sexual assault. Objective: The purpose of this study was to understand the perceptions of campus-based women's center staff on college and university campuses, specifically regarding campus-based responses to sexual assault. Methods: Participants responded electronically to six open-ended survey questions. Data were analyzed using a qualitative content analysis approach to identify key themes present within the data. Results: Key concepts identified included respect, trust, confidentiality, trained professionals, and comprehensive and consistent response. Conclusions:The findings provide an early description of the perceptions of staff in campus-based women's centers related to prevention, reporting, and response to sexual violence on campuses and can be used to inform campus policies and practices as well as forensic and college-based nursing practice.

Abstract

HIV testing in emergency departments (EDs) remains underutilized. The authors evaluated a computer tool to facilitate rapid HIV testing in an urban ED. Randomly assigned nonacute adult ED patients were randomly assigned to a computer tool (CARE) and rapid HIV testing before a standard visit (n = 258) or to a standard visit (n = 259) with chart access. The authors assessed intervention acceptability and compared noted HIV risks. Participants were 56% nonWhite and 58% male; median age was 37 years. In the CARE arm, nearly all (251/258) of the patients completed the session and received HIV results; four declined to consent to the test. HIV risks were reported by 54% of users; one participant was confirmed HIV-positive, and two were confirmed false-positive (seroprevalence 0.4%, 95% CI [0.01, 2.2]). Half (55%) of the patients preferred computerized rather than face-to-face counseling for future HIV testing. In the standard arm, one HIV test and two referrals for testing occurred. Computer-facilitated HIV testing appears acceptable to ED patients. Future research should assess cost-effectiveness compared with staff-delivered approaches.

Abstract

According to rigorous guidelines of instrument development, a 17-item chronic carriers of hepatitis B virus-related stigma scale (HBV-SS) in college students, including 4 domains (labeling, stereotype, separating, discrimination), was developed with data from 717 college students in China. Cronbach's alpha coefficient of HBV-SS was .85. Four common factors were extracted in accordance with the conceptual model. Students with HBsAg positive/ever-positive (vs. negative), with HBsAg ever-positive (vs. never positive/did not know), and students who had any family member, friend, or acquaintance as a chronic carrier of HBV (vs. had not/did not know) had significantly lower scores. Research has shown that the scale is reliable, valid, and sensitive and is recommended for application of HBV-SS to assist public health practice.

Abstract

Objective: The purpose of this study was to examine the relationship between typically measured prenatal screening biomarkers and early-preterm birth in euploid pregnancies. Study Design: The study included 345 early-preterm cases (<30 weeks of gestation) and 1725 control subjects who were drawn from a population-based sample of California pregnancies who had both first- and second-trimester screening results. Logistic regression analyses were used to compare patterns of biomarkers in cases and control subjects and to develop predictive models. Replicability of the biomarker early-preterm relationships that was revealed by the models was evaluated by examination of the frequency and associated adjusted relative risks (RRs) for early-preterm birth and for preterm birth in general (<37 weeks of gestation) in pregnancies with identified abnormal markers compared with pregnancies without these markers in a subsequent independent California cohort of screened pregnancies (n = 76,588). Results: The final model for early-preterm birth included first-trimester pregnancy-associated plasma protein A in the ≤5th percentile, second-trimester alpha-fetoprotein in the ≥95th percentile, and second-trimester inhibin in the ≥95th percentile (odds ratios, 2.3-3.6). In general, pregnancies in the subsequent cohort with a biomarker pattern that were found to be associated with early-preterm delivery in the first sample were at an increased risk for early-preterm birth and preterm birth in general (<37 weeks of gestation; adjusted RR, 1.6-27.4). Pregnancies with ≥2 biomarker abnormalities were at particularly increased risk (adjusted RR, 3.6-27.4). Conclusion: When considered across cohorts and in combination, abnormalities in routinely collected biomarkers reveal predictable risks for early-preterm birth.