Associations of Primary Care Provider Burnout with Quality Improvement, Patient Experience Measurement, Clinic Culture, and Job Satisfaction.

Background: Burnout among providers negatively impacts patient care experiences and safety. Providers at Federally Qualified Health Centers (FQHC) are at high risk for burnout due to high patient volumes; inadequate staffing; and balancing the demands of patients, families, and team members.

Objective: Examine associations of provider burnout with their perspectives on quality improvement (QI), patient experience measurement, clinic culture, and job satisfaction.

Associations of pediatric nurse burnout with involvement in quality improvement.

Purpose: Burnout among nurses negatively impacts patient care experiences and safety. Inpatient pediatric nurses are high-risk for burnout due to high patient volumes, inadequate staffing, and needing to balance the demands of patients, families and team members. We examined the associations of inpatient pediatric nurse burnout with their perspectives on the importance of quality at the hospital, patient experience measurement, quality improvement (QI), unit culture, and staffing.

Usefulness of Child HCAHPS Survey Data for Improving Inpatient Pediatric Care Experiences.

Objectives: Quality improvement (QI) requires data, indicators, and national benchmarks. Knowledge about the usefulness of Child Hospital Consumer Assessment of Healthcare Providers and Systems (Child HCAHPS) data are lacking. We examined quality leader and frontline staff perceptions about patient experience measurement and use of Child HCAHPS data for QI.

Robust estimation of the causal effect of time-varying neighborhood factors on health outcomes.

The fundamental difficulty of establishing causal relationships between an exposure and an outcome in observational data involves disentangling causality from confounding factors. This problem underlies much of neighborhoods research, which abounds with studies that consider associations between neighborhood characteristics and health outcomes in longitudinal data. Such analyses are confounded by selection issues; individuals with above average health outcomes (or associated characteristics) may self-select into advantaged neighborhoods.

Engagement in HIV Prevention Advocacy Associated with Increased Consistent Condom Use Among HIV Clients in Uganda.

We examined whether engagement in prevention advocacy among HIV clients is associated with their own condom use and HIV care adherence. Longitudinal data merged from three studies in Uganda produced a sample of 1,882 participants who were administered assessments at baseline and months 6 and 12. The measure of prevention advocacy was the mean of two Likert scale items assessing encouragement of others to (1) use condoms, and (2) get HIV tested.

Do improvements in substance use and mental health symptoms during treatment translate to long-term outcomes in the opposite domain?

Providers who treat adolescents with co-occurring substance use and mental health issues may prioritize treatment of one set of symptoms believing that improvements in one domain will result in improvements of the other. However, limited empirical data for adolescents provide evidence of such "spillover effects." Using data from 2900 youth in an outpatient treatment, we examined whether during-treatment changes in substance use or mental health symptoms predicted 12-month outcomes in the analogous and opposite domains.

Changes in condom use during the first year of HIV treatment in Uganda and the relationship to depression.

Purpose: We examined the effect of antiretroviral therapy (ART), and the predictive role of depression, on condom use with primary partners.

Methods: Data from three studies in Uganda were combined into a sample of 750 patients with a primary sex partner, with 502 starting ART and 248 entering HIV care, and followed for 12 months. Random-effects logistic regression models were used to examine the impact of ART, and the influence of baseline level and change in depression, on condom use with primary partners.

An intervention to improve program implementation: findings from a two-year cluster randomized trial of Assets-Getting To Outcomes.

Background: Studies have shown that communities have not always been able to implement evidence-based prevention programs with quality and achieve outcomes demonstrated by prevention science. Implementation support interventions are needed to bridge this gap between science and practice. The purpose of this article is to present two-year outcomes from an evaluation of the Assets Getting To Outcomes (AGTO) intervention in 12 Maine communities engaged in promoting Developmental Assets, a positive youth development approach to prevention.

A tutorial on propensity score estimation for multiple treatments using generalized boosted models.

The use of propensity scores to control for pretreatment imbalances on observed variables in non-randomized or observational studies examining the causal effects of treatments or interventions has become widespread over the past decade. For settings with two conditions of interest such as a treatment and a control, inverse probability of treatment weighted estimation with propensity scores estimated via boosted models has been shown in simulation studies to yield causal effect estimates with desirable properties. There are tools (e.

The relationship between urban sprawl and coronary heart disease in women.

Studies have reported relationships between urban sprawl, physical activity, and obesity, but - to date - no studies have considered the relationship between sprawl and coronary heart disease (CHD) endpoints. In this analysis, we use longitudinal data on post-menopausal women from the Women's Health Initiative (WHI) Clinical Trial to analyze the relationship between metropolitan statistical area (MSA)-level urban compactness (the opposite of sprawl) and CHD endpoints including death, any CHD event, and myocardial infarction. Models control for individual and neighborhood socio-demographic characteristics.

Understanding variations in Medicare Consumer Assessment of Health Care Providers and Systems scores: California as an example.

Objective: To understand reasons why California has lower Consumer Assessment of Healthcare Providers and Systems (CAHPS) scores than the rest of the country, including differing patterns of CAHPS scores between Medicare Advantage (MA) and fee-for-service, effects of additional demographic characteristics of beneficiaries, and variation across MA plans within California.

Study Design/data Collection: Using 2008 CAHPS survey data for fee-for-service Medicare beneficiaries and MA members, we compared mean case mix adjusted Medicare CAHPS scores for California and the remainder of the nation.

Principal Findings: California fee-for-service Medicare had lower scores than non-California fee-for-service on 11 of 14 CAHPS measures; California MA had lower scores only for physician services measures and higher scores for other measures.

Long-term effect of community-based treatment: evidence from the Adolescent Outcomes Project.

A growing literature on adolescent drug treatment interventions demonstrates the efficacy of "research therapies," but few rigorous studies examine the effectiveness of community-based treatments that are more commonly available to and utilized by youths and their families, the criminal justice system and other referring agencies. Even less is known about the long-term effects of these community-based treatments. This study evaluates the effects 72-102 months after intake to a widely disseminated community-based treatment model, residential therapeutic community treatment, using data from RAND's Adolescent Outcomes Project.