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RESULTS Based on the AHI, 411 participants (48%) had OSA, of whom 92 (11% of total sample) and 26 (3%) had moderate and severe OSA, respectively. In the multivariate analysis, participants with severe OSA had thinner RNFL superotemporally than those without OSA or with mild OSA. (P less then 0.001 and P=0.001, respectively). Additionally, superotemporal RNFL was inversely associated with AHI (P=0.004) and sleep time with oxygen saturation level less then 90% (P=0.005). There was no association between OSA measures and BMO-MRW. CONCLUSIONS Our findings do not provide strong evidence of a link between measures of OSA and the optic disc. However, the association between increased OSA severity and thinner superotemporal RNFL has been reported consistently in previous studies and thus warrants further evaluation.We linked the Medicare Provider Utilization and Payment Data for Home Health and the Home Health Compare data for the year 2016 to identify home healthcare agency (HHA) characteristics associated with acute care hospitalization (ACH) or emergency department (ED) use. The study cohort consisted of 9,800 HHAs. Beta regression was used to examine the association between average age, race/ethnic composition, number of skilled nursing visits, number of therapy visits, percentage of dual eligible patients, HHA ownership, HHA location, Medicare tenure, proportion of patients with a diagnosis of schizophrenia, stroke, diabetes, depression, chronic obstructive pulmonary disease (COPD), heart failure, cancer and Alzheimer disease, and ACH or ED use. After controlling for HHA-level characteristics, variations in HHAs' ACH and unplanned ED visits were found. For-profit HHAs were significantly less likely to have patients with ACH. (Odds ratio = -0.05, p = 0.020), HHAs in the Midwest, South, and West had lower odds of ACH. HHAs that serve more than 50% Black patients had significantly decreased odds (β = -0.16, p less then 0.001) of ACH. A 1-unit increase in the proportion of patients with a diagnosis of schizophrenia, COPD, stroke, heart failure, and Alzheimer disease was associated with increased odds of hospitalization. For each unit increase in the number of skilled nursing visits, the odds of ACH increased by 0.02 (p = 0.001). For-profit and nonprofit HHAs had a significant decrease in the odds of unplanned ED visits (p less then 0.05). An increase in the proportion of patients with COPD was associated with increased odds of unplanned ED visits (p less then 0.001). HHA characteristics are associated with hospitalization and ED use without hospitalization. These characteristics point to variation in quality of care measured by ACH and ED use.The purpose of this study was to describe self-reported outcomes and perceptions of community-dwelling older adults who participated in a 6-month prevention-focused home care physical therapy program entitled Home-based Older Persons Upstreaming Prevention Physical Therapy (HOP-UP-PT). Selleckchem GSK269962A A 17-question telephone survey was offered 1 to 3 months after program completion to HOP-UP-PT participants who completed a minimum of three visits. Self-reported fall outcomes, healthcare utilization outcomes, perceptions of interventions, and financial perceptions were descriptively analyzed. There were 18 survey respondents (9 male, 9 female, mean age = 79 years). No falls were reported by 15 respondents and 3 reported 1 to 2 falls without injury. Seventeen participants reported no hospitalizations, one reported only overnight emergency room observation, and no participants reported requiring physical therapy. Participants reported benefits of activity trackers (18/18), fall-prevention exercises (17/18), and electronic blood pressure monitor use (13/18). Despite reported benefits, participants indicated an inability/unwillingness to privately pay for the program with fixed incomes identified as the rationale for this response. Future considerations for third-party reimbursement warrants examination given older adults may have limitations in disposable income. The findings of this study suggest efficacy of HOP-UP-PT may translate to participant satisfaction and positive health and behavior changes after participation.Patients with chronic obstructive pulmonary disease (COPD) who are rehospitalized following hospitalization for an exacerbation of COPD are at higher risk of mortality and poor health outcomes. Approximately 20% of patients who are discharged from the hospital following an exacerbation of COPD are readmitted within 30 days. At a home healthcare agency in southeastern United States, 36.4% of patients admitted to the agency with a primary or secondary diagnosis of COPD between August 2018 and January 2019 were rehospitalized within 30 days of admission. A quality improvement project was conducted between January 2019 and July 2019. This project involved implementation of a COPD self-management care plan packet provided by home healthcare nurses to patients with a primary or secondary diagnosis of COPD. The 30-day rehospitalizations for patients with COPD decreased from 36.4% preintervention to 15.4% postintervention. The number of patients receiving timely follow-up with their provider increased from 79% preintervention to 88% postintervention, and COPD medication reconciliation at admission improved from 79% preintervention to 84% postintervention. The generalizability of these results is limited due to a small sample size and inconsistencies in intervention implementation.Pediatric Home Service (PHS) in Roseville, Minnesota, has provided home care for children with medical complexity for over 30 years. This article describes the PHS program for educating and training home care nurses (HCNs). Since the inception of the company, advanced training for family and professional caregivers of ventilator-dependent children has been an important focus. The current program for HCN has three components and incorporates simulation and in-home training. Standardizing educational requirements and competencies for pediatric HCNs across nursing agencies has the potential to improve outcomes for children with medical complexity receiving home healthcare services.As the population of ventilator-dependent children with tracheostomies grows, there are increasing demands to shift the care of technology-dependent children from hospital to home. Home care nurses are an integral part in the continuum of care for these children and their families after hospital discharge. Home care nurses help to facilitate a safe transition from the hospital and allow families and children to thrive in their home and community. The purpose of this article is to describe best practices in caring for children with tracheostomies and invasive home mechanical ventilation. Hypothetical case studies are presented.This quality improvement initiative was aimed at reducing low-value Positron emission tomography-computed tomography (PET-CT) studies performed on hospital inpatients. Requests for PET-CT with a predetermined low-value indication triggered a requirement for the ordering provider to call the Nuclear Medicine radiologist to discuss the case for approval of the testing. A retrospective review of inpatient PET-CT approximately 2 years immediately before and after the implementation revealed a 20.6% decrease in scans for low-value indications after the intervention, from 0.397 to 0.315 studies per day (p less then .05; CI -0.158 to -0.005). The overall daily rate of PET-CT was reduced by 23%. Of the 12 low-value indications, 7 had reduced volumes (aggregate 43 fewer scans), 1 was unchanged, and 4 showed an increase in volumes (aggregate of 10 additional scans). Several common indications for inpatient PET-CT that were not targeted for reduction by this intervention also demonstrated large decreases in volumes during the intervention.There is increasing evidence of the role of non-patient-level factors on discharge against medical advice (DAMA), but limited quantitative information regarding the extent of their impact. This study quantifies the contribution of discharge-level and hospital-level factors to the variation in DAMA. We grouped variables from the 2014 National Inpatient Sample data and ran incremental mixed-effects logit models with grouping at the level of the discharge, the hospital, and the census region. We obtained the intraclass correlation coefficients (ICCs), and evaluated the incremental change in ICC. The final sample included 2,687,430 discharges. 12.8% of the identified variation in the probability of DAMA was associated with the hospital, and 1.2% of the variation was associated with the census division in which the hospital was located. The final, fully-adjusted model had 7.3% of variation in DAMA associated with the hospital-level, with the greatest percentage reductions because of the addition of patient demographics. Even after adjusting for measured patient-level characteristics, there was a contribution of non-patient-level factors to DAMA outcomes. The findings identify a role for a multi-level approach to addressing DAMA.BACKGROUND Nationally, there is an expectation that residents and fellows participate in quality improvement (QI), preferably interprofessionally. Hospitals and educators invest time and resources in projects, but little is known about success rates or what fosters success. PURPOSE To understand what proportion of trainee QI projects were successful and whether there were predictors of success. METHODS We examined resident and fellow QI projects in an integrated healthcare system that supports diverse training programs in multiple hospitals over 2 years. All projects were reviewed to determine whether they represented actual QI. Projects determined as QI were considered completed or successful based on QI project sponsor self-report. Multiple characteristics were compared between successful and unsuccessful projects. RESULTS Trainees submitted 258 proposals, of which 106 (41.1%) represented actual QI. Non-QI projects predominantly represented needs assessments or retrospective data analyses. Seventy-six percent (81/106) of study sponsors completed surveys about their projects. Less than 25% of projects (59/258) represented actual QI and were successful. Project category was predictive of success, specifically those aimed at preventive care or education. CONCLUSION Less than a quarter of trainee QI projects represent successful QI. IMPLICATIONS Hospitals and training programs should identify interventions to improve trainee QI experience.Lean has gained recognition in healthcare as a quality improvement tool. The purpose of this research was to examine the extent to which quality improvement projects in healthcare adhered to Lean's eight-step process. We analyzed 605 publications identified through a systematic literature review following PRISMA guidelines. Each publication was coded using a structured coding sheet. The most frequent type of publication reported empirical research (48.6%) and most of these (80.3%) shared the results of the Lean projects. Of the 237 publications reporting Lean projects, more than half (71.3%) used an experimental, one-site, pre/postdesign. The impact of the project was most often measured using a single metric (59.1%) that was operational (e.g., waiting time). Although most Lean project publications reported the use of tools to "break down the problem" (84.4%, Step 2) and "see countermeasures through" (70.0%, Step 6), fewer than half described using tools associated with each of the other steps. Projects completed an average of 2.