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Matthew A Davis - One of the best experts on this subject based on the ideXlab platform.
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long term Healthcare Provider availability following large scale hurricanes a difference in differences study
PLOS ONE, 2020Co-Authors: Sue Anne Bell, Katarzyna Klasa, Theodore J Iwashyna, Edward C Norton, Matthew A DavisAbstract:Background Hurricanes Katrina and Sandy were two of the most significant disasters of the 21st century that critically impacted communities and the health of their residents. Despite the assumption that disasters affect access to Healthcare, to our knowledge prior studies have not rigorously examined availability of Healthcare Providers following disasters. Objective The objective of this study was to examine availability of Healthcare Providers following large-scale hurricanes. Methods Using historical data on Healthcare Providers from the National Plan and Provider Enumeration System and county-level population characteristics, we conducted a quasi-experimental study to examine the effect of large-scale hurricanes on Healthcare Provider availability in the short-term and long-term. We separately examined availability of primary care physicians, medical specialists, surgeons, and nurse practitioners. A difference-in-differences analysis was used to control for time variant factors comparing county-level health care Provider availability in affected and unaffected counties the year before Hurricanes Katrina and Sandy, to five years after each storm. Results Counties affected by Hurricane Katrina compared to unaffected locales experienced a decrease of 3.59 primary care physicians per 10,000 population (95% CI: -6.5, -0.7), medical specialists (decrease of 5.9 Providers per 10,000 (95% CI: -11.3, -0.5)), and surgeons (decrease of 2.1 (95% CI: -3.8, -0.37)). However, availability of nurse practitioners did not change appreciably. Counties affected by Hurricane Sandy exhibited less pronounced changes. Changes in availability of primary care physicians, nurse practitioners, medical specialists, and surgeons were not statistically significant. Conclusion Large-scale hurricanes appear to affect availability of Healthcare Providers for up to several years following impact of the storm. Effects vary depending on the characteristics of the community. Primary care physicians and medical specialists availability was the most impacted, potentially having long-term implications for population health in the context of disaster recovery.
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The Effect of Healthcare Provider Availability on Spine Spending
Journal of General Internal Medicine, 2020Co-Authors: Benjamin A. Y. Cher, Olga Yakusheva, Haiyin Liu, Julie P. W. Bynum, Matthew A DavisAbstract:Background Spine conditions are costly and a major cause of disability. A growing body of evidence suggests that Healthcare utilization and spending are driven by Provider availability, which varies geographically and is a topic of Healthcare policy debate. Objective To estimate the effect of Provider availability on spine spending. Design Retrospective cohort study using relocation as a natural experiment. Participants Fee-for-service Medicare beneficiaries over age 65 who relocated to a new hospital referral region between 2010 and 2014. Main Measures We used generalized linear models to evaluate how changes in per-beneficiary availability of three types of Healthcare Providers (primary care physicians, spine surgeons, and chiropractors) affected annual per-beneficiary spine spending. We evaluated increases and decreases in Provider availability separately. To account for the relative sizes of the Provider workforces, we also calculated estimates of the effects of changes in national workforce size on changes in national spine spending. Key Results The association between Provider availability and spending was generally stronger among beneficiaries who experienced a decrease (versus an increase) in availability. Of the three Provider groups, spine surgeon availability was most strongly associated with spending. Among beneficiaries who experienced a decrease in availability, a decrease in one spine surgeon per 10,000 beneficiaries was associated with a decrease of $36.97 (95% CI: $12.51, $61.42) in annual spending per beneficiary, versus a decrease of $1.41 (95% CI: $0.73, $2.09) for a decrease in primary care physician availability. However, changes in the national workforce size of primary care physicians were associated with the largest changes in national spine spending. Conclusions Provider availability affects individual spine spending, with substantial changes observed at the national level. The effect depends on Provider type and whether availability increases or decreases. Policymakers should consider how changes in the size of the physician workforce affect Healthcare spending.
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the effect of Healthcare Provider availability on spine spending
Journal of General Internal Medicine, 2020Co-Authors: Benjamin A. Y. Cher, Olga Yakusheva, Haiyin Liu, Julie Bynum, Matthew A DavisAbstract:Spine conditions are costly and a major cause of disability. A growing body of evidence suggests that Healthcare utilization and spending are driven by Provider availability, which varies geographically and is a topic of Healthcare policy debate. To estimate the effect of Provider availability on spine spending. Retrospective cohort study using relocation as a natural experiment. Fee-for-service Medicare beneficiaries over age 65 who relocated to a new hospital referral region between 2010 and 2014. We used generalized linear models to evaluate how changes in per-beneficiary availability of three types of Healthcare Providers (primary care physicians, spine surgeons, and chiropractors) affected annual per-beneficiary spine spending. We evaluated increases and decreases in Provider availability separately. To account for the relative sizes of the Provider workforces, we also calculated estimates of the effects of changes in national workforce size on changes in national spine spending. The association between Provider availability and spending was generally stronger among beneficiaries who experienced a decrease (versus an increase) in availability. Of the three Provider groups, spine surgeon availability was most strongly associated with spending. Among beneficiaries who experienced a decrease in availability, a decrease in one spine surgeon per 10,000 beneficiaries was associated with a decrease of $36.97 (95% CI: $12.51, $61.42) in annual spending per beneficiary, versus a decrease of $1.41 (95% CI: $0.73, $2.09) for a decrease in primary care physician availability. However, changes in the national workforce size of primary care physicians were associated with the largest changes in national spine spending. Provider availability affects individual spine spending, with substantial changes observed at the national level. The effect depends on Provider type and whether availability increases or decreases. Policymakers should consider how changes in the size of the physician workforce affect Healthcare spending.
Benjamin A. Y. Cher - One of the best experts on this subject based on the ideXlab platform.
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The Effect of Healthcare Provider Availability on Spine Spending
Journal of General Internal Medicine, 2020Co-Authors: Benjamin A. Y. Cher, Olga Yakusheva, Haiyin Liu, Julie P. W. Bynum, Matthew A DavisAbstract:Background Spine conditions are costly and a major cause of disability. A growing body of evidence suggests that Healthcare utilization and spending are driven by Provider availability, which varies geographically and is a topic of Healthcare policy debate. Objective To estimate the effect of Provider availability on spine spending. Design Retrospective cohort study using relocation as a natural experiment. Participants Fee-for-service Medicare beneficiaries over age 65 who relocated to a new hospital referral region between 2010 and 2014. Main Measures We used generalized linear models to evaluate how changes in per-beneficiary availability of three types of Healthcare Providers (primary care physicians, spine surgeons, and chiropractors) affected annual per-beneficiary spine spending. We evaluated increases and decreases in Provider availability separately. To account for the relative sizes of the Provider workforces, we also calculated estimates of the effects of changes in national workforce size on changes in national spine spending. Key Results The association between Provider availability and spending was generally stronger among beneficiaries who experienced a decrease (versus an increase) in availability. Of the three Provider groups, spine surgeon availability was most strongly associated with spending. Among beneficiaries who experienced a decrease in availability, a decrease in one spine surgeon per 10,000 beneficiaries was associated with a decrease of $36.97 (95% CI: $12.51, $61.42) in annual spending per beneficiary, versus a decrease of $1.41 (95% CI: $0.73, $2.09) for a decrease in primary care physician availability. However, changes in the national workforce size of primary care physicians were associated with the largest changes in national spine spending. Conclusions Provider availability affects individual spine spending, with substantial changes observed at the national level. The effect depends on Provider type and whether availability increases or decreases. Policymakers should consider how changes in the size of the physician workforce affect Healthcare spending.
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the effect of Healthcare Provider availability on spine spending
Journal of General Internal Medicine, 2020Co-Authors: Benjamin A. Y. Cher, Olga Yakusheva, Haiyin Liu, Julie Bynum, Matthew A DavisAbstract:Spine conditions are costly and a major cause of disability. A growing body of evidence suggests that Healthcare utilization and spending are driven by Provider availability, which varies geographically and is a topic of Healthcare policy debate. To estimate the effect of Provider availability on spine spending. Retrospective cohort study using relocation as a natural experiment. Fee-for-service Medicare beneficiaries over age 65 who relocated to a new hospital referral region between 2010 and 2014. We used generalized linear models to evaluate how changes in per-beneficiary availability of three types of Healthcare Providers (primary care physicians, spine surgeons, and chiropractors) affected annual per-beneficiary spine spending. We evaluated increases and decreases in Provider availability separately. To account for the relative sizes of the Provider workforces, we also calculated estimates of the effects of changes in national workforce size on changes in national spine spending. The association between Provider availability and spending was generally stronger among beneficiaries who experienced a decrease (versus an increase) in availability. Of the three Provider groups, spine surgeon availability was most strongly associated with spending. Among beneficiaries who experienced a decrease in availability, a decrease in one spine surgeon per 10,000 beneficiaries was associated with a decrease of $36.97 (95% CI: $12.51, $61.42) in annual spending per beneficiary, versus a decrease of $1.41 (95% CI: $0.73, $2.09) for a decrease in primary care physician availability. However, changes in the national workforce size of primary care physicians were associated with the largest changes in national spine spending. Provider availability affects individual spine spending, with substantial changes observed at the national level. The effect depends on Provider type and whether availability increases or decreases. Policymakers should consider how changes in the size of the physician workforce affect Healthcare spending.
Olga Yakusheva - One of the best experts on this subject based on the ideXlab platform.
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The Effect of Healthcare Provider Availability on Spine Spending
Journal of General Internal Medicine, 2020Co-Authors: Benjamin A. Y. Cher, Olga Yakusheva, Haiyin Liu, Julie P. W. Bynum, Matthew A DavisAbstract:Background Spine conditions are costly and a major cause of disability. A growing body of evidence suggests that Healthcare utilization and spending are driven by Provider availability, which varies geographically and is a topic of Healthcare policy debate. Objective To estimate the effect of Provider availability on spine spending. Design Retrospective cohort study using relocation as a natural experiment. Participants Fee-for-service Medicare beneficiaries over age 65 who relocated to a new hospital referral region between 2010 and 2014. Main Measures We used generalized linear models to evaluate how changes in per-beneficiary availability of three types of Healthcare Providers (primary care physicians, spine surgeons, and chiropractors) affected annual per-beneficiary spine spending. We evaluated increases and decreases in Provider availability separately. To account for the relative sizes of the Provider workforces, we also calculated estimates of the effects of changes in national workforce size on changes in national spine spending. Key Results The association between Provider availability and spending was generally stronger among beneficiaries who experienced a decrease (versus an increase) in availability. Of the three Provider groups, spine surgeon availability was most strongly associated with spending. Among beneficiaries who experienced a decrease in availability, a decrease in one spine surgeon per 10,000 beneficiaries was associated with a decrease of $36.97 (95% CI: $12.51, $61.42) in annual spending per beneficiary, versus a decrease of $1.41 (95% CI: $0.73, $2.09) for a decrease in primary care physician availability. However, changes in the national workforce size of primary care physicians were associated with the largest changes in national spine spending. Conclusions Provider availability affects individual spine spending, with substantial changes observed at the national level. The effect depends on Provider type and whether availability increases or decreases. Policymakers should consider how changes in the size of the physician workforce affect Healthcare spending.
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the effect of Healthcare Provider availability on spine spending
Journal of General Internal Medicine, 2020Co-Authors: Benjamin A. Y. Cher, Olga Yakusheva, Haiyin Liu, Julie Bynum, Matthew A DavisAbstract:Spine conditions are costly and a major cause of disability. A growing body of evidence suggests that Healthcare utilization and spending are driven by Provider availability, which varies geographically and is a topic of Healthcare policy debate. To estimate the effect of Provider availability on spine spending. Retrospective cohort study using relocation as a natural experiment. Fee-for-service Medicare beneficiaries over age 65 who relocated to a new hospital referral region between 2010 and 2014. We used generalized linear models to evaluate how changes in per-beneficiary availability of three types of Healthcare Providers (primary care physicians, spine surgeons, and chiropractors) affected annual per-beneficiary spine spending. We evaluated increases and decreases in Provider availability separately. To account for the relative sizes of the Provider workforces, we also calculated estimates of the effects of changes in national workforce size on changes in national spine spending. The association between Provider availability and spending was generally stronger among beneficiaries who experienced a decrease (versus an increase) in availability. Of the three Provider groups, spine surgeon availability was most strongly associated with spending. Among beneficiaries who experienced a decrease in availability, a decrease in one spine surgeon per 10,000 beneficiaries was associated with a decrease of $36.97 (95% CI: $12.51, $61.42) in annual spending per beneficiary, versus a decrease of $1.41 (95% CI: $0.73, $2.09) for a decrease in primary care physician availability. However, changes in the national workforce size of primary care physicians were associated with the largest changes in national spine spending. Provider availability affects individual spine spending, with substantial changes observed at the national level. The effect depends on Provider type and whether availability increases or decreases. Policymakers should consider how changes in the size of the physician workforce affect Healthcare spending.
Haiyin Liu - One of the best experts on this subject based on the ideXlab platform.
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The Effect of Healthcare Provider Availability on Spine Spending
Journal of General Internal Medicine, 2020Co-Authors: Benjamin A. Y. Cher, Olga Yakusheva, Haiyin Liu, Julie P. W. Bynum, Matthew A DavisAbstract:Background Spine conditions are costly and a major cause of disability. A growing body of evidence suggests that Healthcare utilization and spending are driven by Provider availability, which varies geographically and is a topic of Healthcare policy debate. Objective To estimate the effect of Provider availability on spine spending. Design Retrospective cohort study using relocation as a natural experiment. Participants Fee-for-service Medicare beneficiaries over age 65 who relocated to a new hospital referral region between 2010 and 2014. Main Measures We used generalized linear models to evaluate how changes in per-beneficiary availability of three types of Healthcare Providers (primary care physicians, spine surgeons, and chiropractors) affected annual per-beneficiary spine spending. We evaluated increases and decreases in Provider availability separately. To account for the relative sizes of the Provider workforces, we also calculated estimates of the effects of changes in national workforce size on changes in national spine spending. Key Results The association between Provider availability and spending was generally stronger among beneficiaries who experienced a decrease (versus an increase) in availability. Of the three Provider groups, spine surgeon availability was most strongly associated with spending. Among beneficiaries who experienced a decrease in availability, a decrease in one spine surgeon per 10,000 beneficiaries was associated with a decrease of $36.97 (95% CI: $12.51, $61.42) in annual spending per beneficiary, versus a decrease of $1.41 (95% CI: $0.73, $2.09) for a decrease in primary care physician availability. However, changes in the national workforce size of primary care physicians were associated with the largest changes in national spine spending. Conclusions Provider availability affects individual spine spending, with substantial changes observed at the national level. The effect depends on Provider type and whether availability increases or decreases. Policymakers should consider how changes in the size of the physician workforce affect Healthcare spending.
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the effect of Healthcare Provider availability on spine spending
Journal of General Internal Medicine, 2020Co-Authors: Benjamin A. Y. Cher, Olga Yakusheva, Haiyin Liu, Julie Bynum, Matthew A DavisAbstract:Spine conditions are costly and a major cause of disability. A growing body of evidence suggests that Healthcare utilization and spending are driven by Provider availability, which varies geographically and is a topic of Healthcare policy debate. To estimate the effect of Provider availability on spine spending. Retrospective cohort study using relocation as a natural experiment. Fee-for-service Medicare beneficiaries over age 65 who relocated to a new hospital referral region between 2010 and 2014. We used generalized linear models to evaluate how changes in per-beneficiary availability of three types of Healthcare Providers (primary care physicians, spine surgeons, and chiropractors) affected annual per-beneficiary spine spending. We evaluated increases and decreases in Provider availability separately. To account for the relative sizes of the Provider workforces, we also calculated estimates of the effects of changes in national workforce size on changes in national spine spending. The association between Provider availability and spending was generally stronger among beneficiaries who experienced a decrease (versus an increase) in availability. Of the three Provider groups, spine surgeon availability was most strongly associated with spending. Among beneficiaries who experienced a decrease in availability, a decrease in one spine surgeon per 10,000 beneficiaries was associated with a decrease of $36.97 (95% CI: $12.51, $61.42) in annual spending per beneficiary, versus a decrease of $1.41 (95% CI: $0.73, $2.09) for a decrease in primary care physician availability. However, changes in the national workforce size of primary care physicians were associated with the largest changes in national spine spending. Provider availability affects individual spine spending, with substantial changes observed at the national level. The effect depends on Provider type and whether availability increases or decreases. Policymakers should consider how changes in the size of the physician workforce affect Healthcare spending.
David J Weber - One of the best experts on this subject based on the ideXlab platform.
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the antimicrobial scrub contamination and transmission ascot trial a three arm blinded randomized controlled trial with crossover design to determine the efficacy of antimicrobial impregnated scrubs in preventing Healthcare Provider contamination
Infection Control and Hospital Epidemiology, 2017Co-Authors: Deverick J Anderson, Rachel M Addison, Yuliya Lokhnygina, Bobby Warren, Batu K Sharmakuinkel, Laura J Rojas, Susan D Rudin, Sarah S Lewis, Rebekah W Moehring, David J WeberAbstract:OBJECTIVE To determine whether antimicrobial-impregnated textiles decrease the acquisition of pathogens by Healthcare Provider (HCP) clothing. DESIGN We completed a 3-arm randomized controlled trial to test the efficacy of 2 types of antimicrobial-impregnated clothing compared to standard HCP clothing. Cultures were obtained from each nurse participant, the Healthcare environment, and patients during each shift. The primary outcome was the change in total contamination on nurse scrubs, measured as the sum of colony-forming units (CFU) of bacteria. PARTICIPANTS AND SETTING Nurses working in medical and surgical ICUs in a 936-bed tertiary-care hospital. INTERVENTION Nurse subjects wore standard cotton-polyester surgical scrubs (control), scrubs that contained a complex element compound with a silver-alloy embedded in its fibers (Scrub 1), or scrubs impregnated with an organosilane-based quaternary ammonium and a hydrophobic fluoroacrylate copolymer emulsion (Scrub 2). Nurse participants were blinded to scrub type and randomly participated in all 3 arms during 3 consecutive 12-hour shifts in the intensive care unit. RESULTS In total, 40 nurses were enrolled and completed 3 shifts. Analyses of 2,919 cultures from the environment and 2,185 from HCP clothing showed that scrub type was not associated with a change in HCP clothing contamination (P=.70). Mean difference estimates were 0.118 for the Scrub 1 arm (95% confidence interval [CI], -0.206 to 0.441; P=.48) and 0.009 for the Scrub 2 rm (95% CI, -0.323 to 0.342; P=.96) compared to the control. HCP became newly contaminated with important pathogens during 19 of the 120 shifts (16%). CONCLUSIONS Antimicrobial-impregnated scrubs were not effective at reducing HCP contamination. However, the environment is an important source of HCP clothing contamination. TRIAL REGISTRATION Clinicaltrials.gov Identifier: NCT 02645214 Infect Control Hosp Epidemiol 2017;38:1147-1154.
