A cohort study on protocol-based nurse-led out-patient management of post-chemotherapy low-risk febrile neutropenia.

Purpose: International guidelines adopt risk stratification approach to manage patients with low-risk febrile neutropenia patients. We developed this out-patient program using shared-care model with professional input and patient empowerment, so as to reduce patients' psychological burden from hospitalization and to improve the cost-effectiveness of management.

Method: This is a prospective cohort study to compare the efficacy and safeness of the out-patient program when compared with traditional in-patient care.

Insurance Financing Increased For Mental Health Conditions But Not For Substance Use Disorders, 1986-2014.

This study updates previous estimates of US spending on mental health and substance use disorders through 2014. The results reveal that the long-term trend of greater insurance financing of mental health care continued in recent years. The share of total mental health treatment expenditures financed by private insurance, Medicare, and Medicaid increased from 44 percent in 1986 to 68 percent in 2014.

Engaging Frontline Staff in Performance Improvement: The American Organization of Nurse Executives Implementation of Transforming Care at the Bedside Collaborative.

Background: Process improvement stresses the importance of engaging frontline staff in implementing new processes and methods. Yet questions remain on how to incorporate these activities into the workday of hospital staff or how to create and maintain its commitment. In a 15-month American Organization of Nurse Executives collaborative involving frontline medical/surgical staff from 67 hospitals, Transforming Care at the Bedside (TCAB) was evaluated to assess whether participating units successfully implemented recommended change processes, engaged staff, implemented innovations, and generated support from hospital leadership and staff.

Spending on mental and substance use disorders projected to grow more slowly than all health spending through 2020.

Spending on mental and substance use disorders will likely grow more slowly than all health spending through 2020. We project that spending on mental and substance use disorders, as a share of all health spending, will fall from 7.4 percent in 2009 ($172 billion out of $2.

When medicare cuts hospital prices, seniors use less inpatient care.

The Affordable Care Act permanently slows the growth in Medicare hospital prices. To better understand the effects of those price cuts, we used data from ten states for the period 1995-2009 to examine the market-level relationship between Medicare prices and hospital utilization among the elderly. Regression analyses indicate that a 10 percent reduction in the Medicare price was associated with a 4.

The surge in urgent care centers: emergency department alternative or costly convenience?

As the U.S. health care system grapples with strained hospital emergency department (ED) capacity in some areas, primary care clinician shortages and rising health care costs, urgent care centers have emerged as an alterna­tive care setting that may help improve access and contain costs.

Emergency preparedness and community coalitions: opportunities and challenges.

Being prepared for a natural disaster, infectious disease outbreak or other emergency where many injured or ill people need medical care while maintaining ongoing operations is a significant challenge for local health systems. Emergency preparedness requires coordination of diverse entities at the local, regional and national levels. Given the diversity of stakeholders, fragmentation of local health care systems and limited resources, developing and sustaining broad community coalitions focused on emergency preparedness is difficult.

Small employers and self-insured health benefits: too small to succeed?

Over the past decade, large employers increasingly have bypassed traditional health insurance for their workers, opting instead to assume the financial risk of enrollees' medical care through self-insurance. Because self-insurance arrangements may offer advantages--such as lower costs, exemption from most state insurance regulation and greater flexibility in benefit design--they are especially attractive to large firms with enough employees to spread risk adequately to avoid the financial fallout from potentially catastrophic medical costs of some employees. Recently, with rising health care costs and changing market dynamics, more small firms--100 or fewer workers--are interested in self-insuring health benefits, according to a new qualitative study from the Center for Studying Health System Change (HSC).

The growing power of some providers to win steep payment increases from insurers suggests policy remedies may be needed.

In the constant attention paid to what drives health care costs, only recently has scrutiny been applied to the power that some health care providers, particularly dominant hospital systems, wield to negotiate higher payment rates from insurers. Interviews in twelve US communities indicated that so-called must-have hospital systems and large physician groups--providers that health plans must include in their networks so that they are attractive to employers and consumers--can exert considerable market power to obtain steep payment rates from insurers. Other factors, such as offering an important, unique service or access in a particular geographic area, can contribute to provider leverage as well.

The influence of integrated electronic medical records and computerized nursing notes on nurses' time spent in documentation.

We investigated nurses' time spent in documentation as it relates to the use of electronic charting. A cross-sectional analysis was completed using time and motion data collected during a nursing process improvement initiative for 105 units in 55 hospitals. Ordinary least squares regression with a cluster adjustment revealed very little difference in time spent in documentation with or without the use of electronic medical records or computerized nursing notes.

Nurse manager perceptions of the impact of process improvements by nurses.

Approaches in assessment of process improvements by nurses are a timely issue, given a growing focus on changes in care delivery. Nineteen semistructured phone interviews with nurse managers whose units participated in a process improvement intervention were completed. The most prominent among assessment strategies was observation.

The relationship between the volume and type of transforming care at the bedside innovations and changes in nurse vitality.

Through an initiative called Transforming Care at the Bedside (TCAB), the Robert Wood Johnson Foundation and the Institute for Healthcare Improvement have created an innovative bottom-up framework for redesigning the work environment on medical-surgical units. The specific purpose of this study, conducted by the University of California Los Angeles/RAND evaluation team, was to examine the number of innovations tested and the association of the volume of tests made and changes in a summary measurement of self-reported vitality at the 13 participating hospitals. The findings of this evaluation yielded several important implications for nurse leaders.

Spreading nursing unit innovation in large hospital systems.

Healthcare administrators increasingly face the challenge of how to spread innovation throughout their organizations. The authors present the results of an evaluation of the efforts of 3 major hospital systems to internally disseminate nursing unit change among medical-surgical units. The findings show that all 3 organizations carefully planned, coordinated, and implemented a spread process; none left dissemination to chance.