Jayani Jayawardhana

Loneliness as a Public Health Issue: The Impact of Loneliness on Health Care Utilization Among Older Adults

OBJECTIVES We aimed to determine whether loneliness is associated with higher health care utilization among older adults in the United States. METHODS We used panel data from the Health and Retirement Study (2008 and 2012) to examine the long-term impact of loneliness on health care use. The sample was limited to community-dwelling persons in the United States aged 60 years and older. We used negative binomial regression models to determine the impact of loneliness on physician visits and hospitalizations. RESULTS Under 2 definitions of loneliness, we found that a sizable proportion of those aged 60 years and older in the United States reported loneliness. Regression results showed that chronic loneliness (those lonely both in 2008 and 4 years later) was significantly and positively associated with physician visits (β = 0.075, SE = 0.034). Loneliness was not significantly associated with hospitalizations. CONCLUSIONS Loneliness is a significant public health concern among elders. In addition to easing a potential source of suffering, the identification and targeting of interventions for lonely elders may significantly decrease physician visits and health care costs.

Is there a business case for magnet hospitals? Estimates of the cost and revenue implications of becoming a magnet.

Background:Although Magnet hospitals (MHs) are known for their better nursing care environments, little is known about whether MHs achieve this at a higher (lower) cost of health care or whether a superior nursing environment yields higher net patient revenue versus non-MHs over an extended period of time. Objective:To examine how achieving Magnet status is related to subsequent inpatient costs and revenues controlling for other hospital characteristics. Data and Methods:Data from the American Hospital Association Annual Survey, Hospital Cost Reporting Information System reports collected by Centers for Medicare & Medicaid Services, and Magnet status of hospitals from American Nurses Credentialing Center from 1998 to 2006 were combined and used for the analysis. Descriptive statistics, propensity score matching, fixed-effect, and instrumental variable methods were used to analyze the data. Results:Regression analyses revealed that MH status is positively and significantly associated with both inpatient costs and net inpatient revenues for both urban hospitals and all hospitals. MH status was associated with an increase of 2.46% in the inpatient costs and 3.89% in net inpatient revenue for all hospitals, and 2.1% and 3.2% for urban hospitals. Conclusions:Although it is costly for hospitals to attain Magnet status, the cost of becoming a MH may be offset by higher net inpatient income. On average, MHs receive an adjusted net increase in inpatient income of

Money Matters: Cost-Effectiveness of Juvenile Drug Court with and without Evidence-Based Treatments

104.22–

Adoption of national quality forum safe practices by Magnet® hospitals.

127.05 per discharge after becoming a Magnet which translates to an additional

Master Settlement Agreement (MSA) spending and tobacco control efforts.

1,229,770–

Diagnostic Imaging Services in Magnet and Non-Magnet Hospitals: Trends in Utilization and Costs

1,263,926 in income per year.

Pain as a Risk Factor for Loneliness Among Older Adults

The 12-month cost-effectiveness of juvenile drug court and evidence-based treatments within court were compared with traditional Family Court for 128 substance-abusing/dependent juvenile offenders participating in a 4-condition randomized trial. Intervention conditions included Family Court with community services (FC), Drug Court with community services (DC), Drug Court with Multisystemic Therapy (DC/MST), and Drug Court with MST enhanced with a contingency management program (DC/MST/CM). Average cost-effectiveness ratios for substance use and criminal behavior outcomes revealed that economic efficiency in achieving outcomes generally improved from FC to DC, with the addition of evidence-based treatments improving efficiency in obtaining substance use outcomes.

Health Insurance Enrollment and Availability of Medications for Substance Use Disorders

BACKGROUND : Magnet hospitals (MHs) are known for their high retention rates of nurses and positive work environment, yet little is known about whether MHs also have higher levels of safe practice adoption rates compared with non-Magnet hospitals (NMHs). METHODS : In this study, we investigate adoption of National Quality Forum (NQF) Safe Practices in 34 regions during 2004 to 2006 that were part of the Leapfrog Group initiative to improve quality of hospital care. We conducted a secondary data analysis by combining multiple data sets from the American Hospital Association Annual Survey, Healthcare Cost Reports Information System, and Leapfrog Group Annual Hospital Survey. A composite safe practice score (CSPS) was constructed from the Leapfrog annual survey and ranged from 0 (no adoption) to 1,000 (complete adoption) of the 30 NQF Safe Practices. A descriptive analysis and a regression with Heckman correction to control for selection bias were used to determine the effect of Magnet status and other hospital and market characteristics on differences in CSPS over the 3-year period. RESULTS : There were 140 MHs and 1,320 NMHs reporting data for the CSPS. In 2004, MHs had a mean CSPS of 865 versus 774 for NMHs (P < .001). By 2006, NMHs improved their CSPS from 774 to 872 (98 points), whereas MHs improved their CSPS from 865 to 925 (60 points, P < .001). Regression analysis showed a positive and significant effect of Magnet status of hospitals on the adoption rates of NQF Safe Practices as measured by the CSPS. Our results also indicated that smaller hospitals (in bed size), hospitals with larger share of Medicare patients, higher nurse intensity levels (mean hours of nursing care per day), and higher levels of competition among hospitals in Leapfrog rollout regions were associated with higher CSPS. CONCLUSION : Magnet hospitals in the urban areas of 34 Leapfrog rollout regions were more likely to have higher adoption rates of NQF Safe Practices in comparison to NMHs in the same demographic areas during the time frame of the study, but other hospitals nearly closed the gap by 2006.Background: Magnet® hospitals (MHs) are known for their high retention rates of nurses and positive work environment, yet little is known about whether MHs also have higher levels of safe practice adoption rates compared with non-Magnet hospitals (NMHs). Methods: In this study, we investigate adoption of National Quality Forum (NQF) Safe Practices in 34 regions during 2004 to 2006 that were part of the Leapfrog Group initiative to improve quality of hospital care. We conducted a secondary data analysis by combining multiple data sets from the American Hospital Association Annual Survey, Healthcare Cost Reports Information System, and Leapfrog Group Annual Hospital Survey. A composite safe practice score (CSPS) was constructed from the Leapfrog annual survey and ranged from 0 (no adoption) to 1,000 (complete adoption) of the 30 NQF Safe Practices. A descriptive analysis and a regression with Heckman correction to control for selection bias were used to determine the effect of Magnet status and other hospital and market characteristics on differences in CSPS over the 3-year period. Results: There were 140 MHs and 1,320 NMHs reporting data for the CSPS. In 2004, MHs had a mean CSPS of 865 versus 774 for NMHs (P < .001). By 2006, NMHs improved their CSPS from 774 to 872 (98 points), whereas MHs improved their CSPS from 865 to 925 (60 points, P < .001). Regression analysis showed a positive and significant effect of Magnet status of hospitals on the adoption rates of NQF Safe Practices as measured by the CSPS. Our results also indicated that smaller hospitals (in bed size), hospitals with larger share of Medicare patients, higher nurse intensity levels (mean hours of nursing care per day), and higher levels of competition among hospitals in Leapfrog rollout regions were associated with higher CSPS. Conclusion: Magnet hospitals in the urban areas of 34 Leapfrog rollout regions were more likely to have higher adoption rates of NQF Safe Practices in comparison to NMHs in the same demographic areas during the time frame of the study, but other hospitals nearly closed the gap by 2006.

Risk Factors for Loneliness in Elderly Adults

We investigate whether the distributions to the states from the Tobacco Master Settlement Agreement (MSA) in 1998 is associated with stronger tobacco control efforts. We use state level data from 50 states and the District of Columbia from four time periods post MSA (1999, 2002, 2004, and 2006) for the analysis. Using fixed effect regression models, we estimate the relationship between MSA disbursements and a new aggregate measure of strength of state tobacco control known as the Strength of Tobacco Control (SoTC) Index. Results show an increase of

Opioids in Georgia Medicaid: gender and insurance disparities in utilization and potential inappropriate prescribing practices

1 in the annual per capita MSA disbursement to a state is associated with a decrease of −0.316 in the SoTC mean value, indicating higher MSA payments were associated with weaker tobacco control measures within states. In order to achieve the initial objectives of the MSA payments, policy makers should focus on utilizing MSA payments strictly on tobacco control activities across states.