Felecia A. Lee

Kansas Physician Assistants’ Attitudes and Beliefs Regarding Spirituality and Religiosity in Patient Care

Research indicates patients want to discuss spirituality/religious (S/R) beliefs with their healthcare provider. This was a cross-sectional study of Kansas physician assistants (PA) regarding S/R in patient care. Surveys included questions about personal S/R beliefs and attitudes about S/R in patient care. Self-reported religious respondents agreed (92%) they should be aware of patient S/R; 82% agreed they should address it. Agreement with incorporating S/R increased significantly based on patient acuity. This research indicates Kansas PAs’ personal S/R beliefs influence their attitudes toward awareness and addressing patient S/R.

Trauma performance improvement and patient safety committee: fostering an effective team.

Trauma programs that are verified by the American College of Surgeons are required to have a multidisciplinary committee that examines trauma-related patient care operations. To facilitate a potentially large number of issues relevant to patient care, the Trauma Performance Improvement and Patient Safety Committee can apply team principles to promote success. A literature review concerning effective teams was conducted. Eleven principles were identified as essential for developing an effective committee that can properly respond to and resolve performance issues in complex trauma care. This article describes and applies these 11 principles to the Trauma Performance Improvement and Patient Safety Committee.

The effect of methodology in determining disparities in in-hospital mortality of trauma patients based on payer source.

A retrospective registry review of adult patients admitted to a Level I trauma center sought to determine whether results regarding in-hospital mortality associated with payer source vary on the basis of methodology. Patients were categorized into 4 literature-derived definitions (Definition 1: insured and uninsured; Definition 2: commercially insured, publicly insured, and uninsured; Definition 3: commercially insured, Medicaid, Medicare, and uninsured; and Definition 4: commercially insured, Medicaid, and uninsured). In-hospital mortality differences were found in Definitions 2 and 3, and when reclassifying dual-eligible Medicare/Medicaid into socioeconomic and age indicators. Variations in methodology culminated in results that could be interpreted with differing conclusions.

Youth empowerment implementation project evaluation results: A program designed to improve the health and well-being of low-income African-American adolescents

ABSTRACT Adolescent obesity is a major health issue facing today’s youth. This may be the first generation to have a lower life expectancy than their parents. The Youth Empowerment Implementation Project’s (YEIP) goal was to increase fruit and vegetable intake, lower junk food consumption, and increase physical activity among low-income African-American youth living in the Midwest. Thirty middle school aged youth participated in an evidenced-based program (i.e., Botvin’s Life Skills Training) and were engaged in health education and physical activities. The results from baseline to follow-up demonstrated a reduction in junk food intake for participants and an increase in fruit and vegetable intake but not for physical activity. The health behaviors of participants improved for three out of four indicators following the intervention. Limitations, future research, and implications for future programs are also discussed.

The Impact of Payer Source on Trauma Outcomes in a Pediatric Population

OBJECTIVES Determine if there were differences in conclusions drawn regarding disparities in trauma outcomes based on literature-derived payer source definitions in a pediatric population. PATIENTS AND METHODS Retrospective registry review of admitted pediatric trauma patients (≤17 years of age) at a level II pediatric trauma facility. Eligible patients were categorized into 3 payer source definitions: definition 1: commercially insured, Medicaid, uninsured; definition 2: insured, uninsured; definition 3: commercially insured, underinsured. Logistic regression was used to determine the influence of payer source on outcomes. RESULTS Payer source was not significant in definition 1, 2, or 3 for intensive care unit length of stay (LOS), hospital LOS, medical consults, or mortality. For hospital disposition, payer source was significant in definition 1, the uninsured were 90% less likely than commercially insured to be discharged to continued care. In definition 2, the uninsured were 88% less likely than insured to be discharged to continued care. In definition 3, the underinsured were 57% less likely than commercially insured to be discharged to continued care. CONCLUSIONS Differences between the literature-derived definitions were not observed and therefore conclusions drawn did not differ across definitions. The investigation demonstrated payer source was not associated with in-hospital outcomes (intensive care unit LOS, hospital LOS, medical consults, and mortality), but was with posthospital outcomes. Findings warrant future examinations on the categorization of payer source in pediatric patients and hospital disposition to gain a greater understanding of disparities related to payer source in pediatric trauma, specifically in terms of posthospital care.

Association of Injury Factors, Not Body Mass Index, With Hospital Resource Usage in Trauma Patients

BACKGROUND Allocating resources appropriately requires knowing whether obese patients use more resources during a hospital stay than nonobese patients. OBJECTIVES To determine if trauma patients with different body mass indexes differed in use of resources measured as a multifaceted outcome variable. METHODS A trauma registry was used for a retrospective study of adult patients admitted to a midwestern level I trauma center. Patients were stratified into 3 groups: nonobese (normal weight, overweight), obese, and morbidly obese. Three canonical correlation analyses were used to determine the relationship between patient/injury characteristics and hospital resource usage. RESULTS In a sample of 9771 patients, 71.2% were non-obese, 23.8% obese, and 5.0% morbidly obese. For patient/injury characteristics, Injury Severity Score and physiological complications were significant variables for all 3 groups. Scores on the Glasgow Coma Scale were significant for nonobese patients only. For resource usage, intensive care unit length of stay and procedures were significant variables for all 3 groups. CONCLUSIONS Associations between body mass index and outcomes have been noted when assessed as independent variables. However, when resource usage was assessed as a multifaceted outcome variable, injury factors (higher Injury Severity Score, lower scores on the Glasgow Coma Scale, more physiological complications) were associated with resource usage (increased length of stay in the intensive care unit and increased number of procedures). These findings provide clinicians a new perspective for evaluating the complex relationship between patient/injury characteristics and hospital resource usage.

Assessing the Relationship Between BMI and Resource Utilization in a Pediatric Trauma Population

In 2000, 15.5% of children surpassed the BMI for age at the 95th percentile; in 2010, this percentage increased to 16.9%.1,2 Children with higher BMIs are at an increased risk for developing cardiovascular, endocrine, and mental disorders3 and may suffer more from diseases such as asthma and obstructive sleep apnea.4–7 Even more concerning is that approximately one-half of obese school-aged children become obese adults who are then at risk for diseases associated with adulthood obesity.8–10 The cost of treating adult obesity and its related comorbidities is significant, with estimates approaching

Patient satisfaction with surgeons in a trauma population: testing a structural equation model using perceptions of interpersonal and technical care.

94 billion per year in 2002.11 Data related to health care utilization for overweight children are limited; 1 estimate suggests that obesity-associated inpatient hospitalization costs have risen threefold, from

Payer Source Associated with Disparities in Procedural, but Not Surgical, Care in a Trauma Population.

35 million in 1979–1981 to

A Survey Assessing Kansas Physician Assistants' Attitudes/Beliefs and Current Practices Regarding Implementation of Fall Prevention Strategies in Older Adults

127 million in 1997–1999.12 Trauma is the leading cause of morbidity and mortality for pediatric patients,13 typically requiring extensive resources and expensive hospital-based health care.14 Multiple studies have reviewed the association between obesity and trauma outcomes (eg, ICU and hospital length of stay [LOS], mortality), with varied results.15–20 Single institutional studies have concluded that obese patients experiencing traumatic injuries have a higher incidence of complications,15 increased risk for ventilator support,20 and longer hospitalizations15,20 for comparable injury severity scores (ISS) than those with normal BMIs.15 In contrast, other studies have determined that there are no differences in total ventilation days or PICU LOS18 and found no association with mortality15,19 after adjusting for ISS17 in obese pediatric patients. Because hospital resources are finite, current health care economics demand optimal patient care at the lowest cost; appropriate utilization is therefore crucial. For the purposes of hospital planning and management, patient populations …