Impaq International (United States)

To improve local air quality policies, healthcare facilities can serve as models for holistic management, concurrently addressing both indoor and ambient air quality.

Food insecurity, or the lack of access to an adequate supply of nutritious food, is associated with poor health outcomes including diabetes, heart disease, and depression. Food insecurity research has grown in the past two decades and has spurred efforts in the US health care system to "screen and intervene" for patient food insecurity. Using nationally representative data from the period 2013-18, this study is the first to our knowledge to investigate the prevalence of food insecurity for the health care workforce, an industry that ranges from low-skill, low-wage hourly jobs to highly specialized salaried positions. We found that relative to health diagnosing and treating practitioners, the odds of being food insecure were 5.1 times higher for health care support workers and 2.5 times higher for health technologists and technicians. The health care industry is the largest and fastest-growing US employer, and it is vital that leaders and policy makers address food insecurity among the health care workforce.

Abstract. Social-distancing to combat the COVID-19 pandemic has led to widespread reductions in air pollutant emissions. Quantifying these changes requires a business as usual counterfactual that accounts for the synoptic and seasonal variability of air pollutants. We use a machine learning algorithm driven by information from the NASA GEOS-CF model to assess changes in nitrogen dioxide (NO2) and ozone (O3) at 5756 observation sites in 46 countries from January through June 2020. Reductions in NO2 correlate with timing and intensity of COVID-19 restrictions, ranging from 60 % in severely affected cities (e.g., Wuhan, Milan) to little change (e.g., Rio de Janeiro, Taipei). On average, NO2 concentrations were 18 % lower than business as usual from February 2020 onward. China experienced the earliest and steepest decline, but concentrations since April have mostly recovered and remained within 5 % to the business as usual estimate. NO2 reductions in Europe and the US have been more gradual with a halting recovery starting in late March. We estimate that the global NOx (NO + NO2) emission reduction during the first 6 months of 2020 amounted to 2.9 TgN, equivalent to 5.1 % of the annual anthropogenic total. The response of surface O3 is complicated by competing influences of non-linear atmospheric chemistry. While surface O3 increased by up to 50 % in some locations, we find the overall net impact on daily average O3 between February–June 2020 to be small. However, our analysis indicates a flattening of the O3 diurnal cycle with an increase in night time ozone due to reduced titration and a decrease in daytime ozone, reflecting a reduction in photochemical production. The O3 response is dependent on season, time scale, and environment, with declines in surface O3 forecasted if NOx emission reductions continue.

Toxic workplaces have detrimental effects on worker performance. Workplace ostracism is a painful experience and for some, a toxic social stressor. This chapter integrates theoretically grounded findings addressing the implications of workplace ostracism on performance-related outcomes, including effort, job performance, creativity/innovation, and job withdrawal behaviors. For example, some people experiencing high rates of ostracism not only have difficulty persisting at their work tasks and performing their assigned roles, but they also decrease their effort on work tasks. Other individuals cope with ostracism by increasing prosocial behaviors, which reveals the complexity of the ostracism-performance relationship. Similarly, those experiencing ostracism sometimes demonstrate greater creativity and at other times demonstrate decreased creativity. Various boundary conditions, including environmental factors (e.g., social support, culture) and personal factors (e.g., self-esteem), appear to influence when or how workplace ostracism relates to these performance-related outcomes. Furthermore, boundary conditions notwithstanding, people experiencing workplace ostracism have a greater tendency to withdraw from their organizations and report higher intention to leave than those who do not experience workplace ostracism. In the case of withdrawal, certain types of social support and personality often intensify the relationship between ostracism and withdrawal, rather than mitigate it. The chapter concludes with recommendations for future research.

ObjectiveTo estimate the impact of the major components of the ACA (Medicaid expansion, subsidized Marketplace plans, and insurance market reforms) on health care access and self‐assessed health during the first 2 years of the Trump administration (2017 and 2018).Data SourceThe 2011‐2018 waves of the Behavioral Risk Factor Surveillance System (BRFSS), with the sample restricted to nonelderly adults. The BRFSS is a commonly used data source in the ACA literature due to its large number of questions related to access and self‐assessed health. In addition, it is large enough to precisely estimate the effects of state policy interventions, with over 300 000 observations per year.DesignWe estimate difference‐in‐difference‐in‐differences (DDD) models to separately identify the effects of the private and Medicaid expansion portions of the ACA using an identification strategy initially developed in Courtemanche et al (2017). The differences come from: (a) time, (b) state Medicaid expansion status, and (c) local area pre‐2014 uninsured rates. We examine ten outcome variables, including four measures of access and six measures of self‐assessed health. We also examine differences by income and race/ethnicity.Principal FindingsDespite changes in ACA administration and the political debate surrounding the ACA during 2017 and 2018, including these fourth and fifth years of postreform data suggests continued gains in coverage. In addition, the improvements in reported excellent health that emerged with a lag after ACA implementation continued during 2017 and 2018.ConclusionsWhile gains in access and self‐assessed health continued in the first 2 years of the Trump administration, the ongoing debate at both the federal and state level surrounding the future of the ACA suggests the need to continue monitoring how the law impacts these and many other important outcomes over time.

This report evaluates hospital blood use trends during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, and identifies factors associated with the need for transfusion and risk of death in patients with coronavirus 2019 (COVID-19). Overall hospital blood use and medical records of adult patients with COVID-19 were extracted for two institutions. Multivariate logistic regression models were conducted to estimate associations between the outcomes transfusion and mortality and patient factors. Daily blood use decreased compared to pre-COVID-19 levels; the effect was more significant for platelets (29% and 34%) compared to red blood cells (25% and 20%) at the two institutions, respectively. Surgical and oncologic services had a decrease in average daily use of platelets of 52% and 30%, and red blood cells of 39% and 25%, respectively. A total of 128 patients with COVID-19 were hospitalized, and 13 (10%) received at least one transfusion due to anemia secondary to chronic illness (n = 7), recent surgery (n = 3), and extracorporeal membrane oxygenation (n = 3). Lower baseline platelet count and admission to the intensive care unit were associated with increased risk of transfusion. The blood group distribution in patients with COVID-19 was 37% group O, 40% group A, 18% group B, and 5% group AB. Non-type O was not associated with increased risk of mortality. The response to the SARS-CoV-2 pandemic included changes in routine hospital operations that allowed for the provision of a sufficient level of care for patients with and without COVID-19. Although blood type may play a role in COVID-19 susceptibility, it did not seem to be associated with patient mortality.

IntroductionEfforts to improve teamwork in health care have received considerable attention. The current systematic review was conducted to identify recent studies that implemented practices to improve teamwork and were associated with positive improvements on the job.MethodsElectronic searches of 2 databases (i.e., CINAHL and MEDLINE) were conducted to identify relevant articles published between 2008 and 2018.ResultsTwenty articles were selected for inclusion in this review. The studies most often used quasiexperimental designs and interventions were applied in a variety of hospital settings including labor and delivery, operating rooms, and emergency departments. Across studies, measures assessing teamwork skills on the job were most often collected and showed sustained improvements up to 12 months. Moreover, evidence of improved clinical processes (e.g., compliance with guidelines and efficiency) and increased patient safety (e.g., reduction in adverse events) was found in both studies of team training interventions, as well as in those that introduced performance support tools (e.g., checklist).ConclusionsThe results of the current review are consistent with previous research and add to the evidence base on the practices to improve teamwork within hospital settings. Although efforts to improve teamwork have spread to other health care settings such as office-based care, published studies are lagging behind.

Although there are many pharmacologic alternatives to opioids, it is unclear whether the structure of Medicare Part D formularies discourages use of the alternatives. To quantify the coverage of opioid alternatives and prevalence of prior authorization, step therapy, quantity limits, and tier placement for these drugs, and test whether these formulary exclusions and restrictions are associated with increased opioid prescribing to older adults at the county level. County fixed-effect models were estimated using a panel of counties across the 50 US states and the District of Columbia over calendar years 2015 and 2016. Data analysis was conducted from July 1 to September 23, 2019. The sample included 2721 counties in 2015 and 2671 counties in 2016 with sufficient data on Medicare Part D formulary design and opioid prescribing. County-level opioid prescribing rate (number of opioid claims divided by the number of overall claims) and counts of excluded opioid alternatives and opioid alternatives with prior authorization, step therapy, quantity limits, and high-tier placements. A total of 30 nonopioid analgesics were examined across 28 997 Medicare plans in 2015 and 30 390 plans in 2016. Medicare plans did not cover a mean of 7% of these drugs (interquartile range, 10%; lower to upper limit, 0%-23%). Among covered nonopioids, prior authorization and step therapy were uncommon, with fewer than 5% affected by prior authorization and 0% by step therapy. However, 13% of covered nonopioids had quantity limits (interquartile range, 10%; lower to upper limit, 0%-31%) and 22% were in high-cost tiers (interquartile range, 38%; lower to upper limit, 0%-50%). Increases in the number of nonopioids excluded on Medicare plans in a county were associated with increased opioid prescribing (effect size relative to mean, 2.2%-3.7%; P = .004). Conversely, increases in the number of opioids not covered on Medicare plans in a county was found to be associated with decreased opioid prescribing (effect size relative to mean, 0.8%-1.5%; P = .02). None of the utilization management strategies (prior authorization, step therapy, and quantity limits) examined or high-cost tier placements of nonopioids were associated with increased opioid prescribing. Lack of Medicare coverage for pharmacologic alternatives to opioids may be associated with increased opioid prescribing.

The purpose of this paper is to estimate the impact of the major components of the ACA (Medicaid expansion, subsidized Marketplace plans, and insurance market reforms) on disparities in insurance coverage after four years. We use data from the 2011-2017 waves of the American Community Survey (ACS), with the sample restricted to nonelderly adults. Our methods feature a difference-in-difference-in-differences model, developed in the recent ACA literature, which separately identifies the effects of the nationwide and Medicaid expansion portions of the law. The differences in this model come from time, state Medicaid expansion status, and local area pre-ACA uninsured rate. We stratify our sample separately by income, race/ethnicity, marital status, age, gender, and geography in order to examine access disparities. After four years, we find that the fully implemented ACA eliminated 44 percent of the coverage gap across income groups, with the Medicaid expansion accounting for this entire reduction. The ACA also reduced coverage disparities across racial groups by 26.7 percent, across marital status by 45 percent, and across age groups by 44 percent, with these changes being partly attributable to both the Medicaid expansion and nationwide components of the law.