Occupational stress, Type A behavior, and physical well being.

In the context of a person-environment fit framework, organizational level and the Type A behavior pattern of managers were found to moderate the stressor, satisfaction, and physiology associations. For nurses, Type A behavior pattern was a much more significant moderator of the person-environment fit than were the nurses' specialty work activities.     

The effects of age,gender, and crash types on drivers’ injury-related health care costs

There are many studies that evaluate the effects of age, gender, and crash types on crash related injury severity. However, few studies investigate the effects of those crash factors on the crash related health care costs for drivers that are transported to hospital. The purpose of this study is to examine the relationships between drivers’ age, gender, and the crash types, as well as other crash characteristics (e.g., not wearing a seatbelt, weather condition, and fatigued driving), on the crash related health care costs. The South Carolina Crash Outcome Data Evaluation System (SC CODES) from 2005 to 2007 was used to construct six separate hierarchical linear regression models based on drivers’ age and gender. The results suggest that older drivers have higher health care costs than younger drivers and male drivers tend to have higher health care costs than female drivers in the same age group. Overall, single vehicle crashes had the highest health care costs for all drivers. For males older than 64-years old sideswipe crashes are as costly as single vehicle crashes. In general, not wearing a seatbelt, airbag deployment, and speeding were found to be associated with higher health care costs. Distraction-related crashes are more likely to be associated with lower health care costs in most cases. Furthermore this study highlights the value of considering drivers in subgroups, as some factors have different effects on health care costs in different driver groups. Developing an understanding of longer term outcomes of crashes and their characteristics can lead to improvements in vehicle technology, educational materials, and interventions to reduce crash-related health care costs.     

Using Bayesian networks to analyze occupational stress caused by work demands: Preventing stress through social support

Occupational stress is a major health hazard and a serious challenge to the effective operation of any company and represents a major problem for both individuals and organizations. Previous researches have shown that high demands (e.g. workload, emotional) combined with low resources (e.g. support, control, rewards) are associated with adverse health (e.g. psychological, physical) and organizational impacts (e.g. reduced job satisfaction, sickness absence). The objective of the present work is to create a model to analyze how social support reduces the occupational stress caused by work demands.     

Professional values,technology and future health care: The view of health care professionals in The Netherlands

Perceptions and values of care professionals are critical in successfully implementing technology in health care. The aim of this study was threefold: (1) to explore the main values of health care professionals, (2) to investigate the perceived influence of the technologies regarding these values, and (3) the accumulated views of care professionals with respect to the use of technology in the future. In total, 51 professionals were interviewed. Interpretative phenomenological analysis was applied. All care professionals highly valued being able to satisfy the needs of their care recipients. Mutual inter-collegial respect and appreciation of supervisors was also highly cherished. The opportunity to work in a careful manner was another important value. Conditions for the successful implementation of technology involved reliability of the technology at hand, training with team members in the practical use of new technology, and the availability of a help desk. Views regarding the future of health care were mainly related to financial cut backs and with a lower availability of staff. Interestingly, no spontaneous thoughts about the role of new technology were part of these views. It can be concluded that professionals need support in relating technological solutions to care recipients' needs. The role of health care organisations, including technological expertise, can be crucial here.     

Conference report. Measuring and improving the quality of care in health plans.

BACKGROUND: More than 200 health care policymakers and researchers, clinicians, quality professionals, and other representatives of managed care organizations, government, and academia, attended the fifth annual Building Bridges conference, "The Health Care Puzzle: Using Research to Bridge the Gap Between Perception and Reality," in Chicago, April 11-13, 1999. Sponsored by the American Association of Health Plans and the Agency for Health Care Policy and Research--and now, the Centers for Disease Control and Prevention--these annual conferences are intended to promote research in measuring the quality and effectiveness of the services health plans provide. Selected plenary sessions from the conference are represented in this report. KEYNOTE ADDRESS: "Three worthy objectives" for managed care-harmonize practice guidelines, develop evidence-based copays or price structure for drugs, and demystify medical necessity--were discussed. PLENARY: A POPULATION HEALTH PERSPECTIVE: Population-based care is designed to identify effective clinical and service interventions and ensure their efficient delivery, identify ineffective interventions and minimize their use, and monitor outcomes and change practice if outcomes are suboptimal. Yet certain questions need to be asked about how to put this strategy in place, especially Why should any individual or potential patient be willing to be treated in a population-based delivery system? THE FINANCIAL AND SCIENTIFIC EVIDENCE BEHIND PREVENTION: The concepts of scientific evidence and financial evidence for prevention were reviewed and applied in scenarios of the effectiveness and cost-effectiveness of selected preventive care services. Education efforts are needed to promote the use of effective interventions and encourage questioning of interventions with unproven or less important effectiveness and poor cost-effectiveness.     

Integrating baseline health status data collection into the process of care.

BACKGROUND: Health status data are an increasingly important component of outcomes assessment and can be used to facilitate quality assessment and improvement efforts. An enormous challenge to the use of health status data among hospitalized patients, however, is collecting baseline data at the time of treatment, an essential component for risk-adjusting subsequent outcomes. The Mid America Heart Institute of Saint Luke's Hospital (Kansas City, Mo), attempted to integrate the collection of health status assessments within the process of performing coronary revascularization. THE DATA COLLECTION STRATEGY: The data collection strategy was developed for each admission portalelective outpatients (admissions for same-day procedures), inpatients, and emergent cases. Health status data were collected on all patients with coronary artery disease who were receiving a percutaneous coronary intervention or coronary artery bypass graft with no disruption to physician scheduling or nursing staff. RESULTS: In general, patients were agreeable to completing the health status survey. Despite initial efforts to educate the hospital staff about the goal and purpose of health status assessment, staff members who were unaware of the uses of these data seemed to minimize their value. Providing examples of how to use these data relative to the staff member's specific occupational role facilitated buy-in for this project. EPILOGUE: After the pilot study, which lasted until June 1999, data were continually collected for 18 months, through August 2000, even with the cessation of external grant funding for this project. Baseline data collection finally stopped, primarily because of a failure to accommodate data collection into the routine flow of patient care by existing nursing staff.     

The impact of staffing and the organization of work on patient outcomes and health care workers in health care organizations

BACKGROUND: Numerous reports in the popular press express concern about the restructuring or lowering of staffing levels in health care organizations and the impact on the quality of patient care. Overtime and other extended shifts also represent work stresses for health care workers. This article reviews the research literature on the relationships among staffing, organization of work, and patient outcomes, and it discusses research findings on the relationship between staffing and the health of health care workers. RESEARCH ON STAFFING, ORGANIZATION, AND PATIENT OUTCOMES/STAFF WELL-BEING: Safe staffing level requirements have been identified for nursing homes, but only in extremely limited cases for hospitals, home care, or other health settings. There is little information about the impact of staffing levels and the organization of work on health personnel or on patient outcomes. There is almost no information about staffing and patient outcomes in home health and ambulatory care. Much of the research on staffing and quality has been discipline specific; future research should reflect the interdisciplinary nature of health care delivery rather than the impact of a particular occupation. RESEARCH USE: Research is conducted to increase the scientific base per se and to inform decision making. Who should decide staffing levels and the organization of work? Professionals, employers/owners, the government, and consumers all have significant interest in staffing levels and the organization of care. Improving health care quality requires research about the critical staffing and organization of work variables. This requires obtaining appropriate data, conducting the research, and widely disseminating the findings.     

Substance use and social,health and safety-related factors among fatally injured drivers

Objective

The aim of this study was to examine different socio-demographic, health and safety-related factors, and psychoactive substance use among fatally injured drivers in road traffic accidents in Finland during 2006–2008.

Methods

An accident information register maintained by the Traffic Safety Committee of Insurance Companies (VALT) of the Finnish Motor Insurers’ Centre was used as basic data, and the basic data were complemented with further toxicological analytical information retrieved from autopsy reports from the Department of Forensic Medicine, Helsinki University. The data included all the drivers (n = 556) who were driving a motor vehicle and who died in a road traffic accident in Finland during 2006–2008.

Results

Of all the 556 fatally injured drivers 43% (n = 238) had psychoactive substance findings. 51% (n = 121) of substance positive drivers had a finding for alcohol only, the rest had a finding for one or more illicit/medicinal drugs impairing driving ability, and possibly also alcohol. Fatally injured drivers with alcohol findings were significantly younger (mean age 34 years) than sober drivers (mean age 44 years) or drivers with findings for drugs (mean age 45 years). Socio-demographic background did not differ substantially among drunken/drugged and sober drivers, although drivers with alcohol findings had a slightly lower education and socioeconomic position. Previous substance abuse problems were highly prevalent among drivers with substance findings and mental or both mental and physical health problems were more common among drivers with drug findings. The non-use of safety equipment and driving at a high speed were more common among fatally injured drivers with substance findings.

Conclusions

Substance abuse and mental health problems, as well as reckless driving behavior were more pronounced among fatally injured drivers with substance findings when compared to sober drivers. Thus, prevention and early intervention concerning substance abuse, mental health problems and DUI are essential. Improved traffic safety cannot be achieved by means of traffic policy only, but integration with other policies, such as health and social policy should be strengthened.     

Making health care quality reports easier to use.

BACKGROUND: Although there is evidence that consumers want comparative quality information, most studies indicate that consumers make limited use of the data in decision making. The reasons for the limited use appear to be the complexity of the information and the difficulty of processing and using the amount of information in reports. The purpose of this investigation was to determine whether there are approaches to reporting comparative information that make it easier for consumers to comprehend the information. Further, the degree to which consumers who have a low level of skill can accurately use that information when it is presented in a format that is easier to use was examined. METHODS: The study used an experimental design to examine how different presentation approaches affect the use of information. Participants were randomly assigned to different conditions and were asked to review information and complete a decision task related to using comparative information and making health plan selections. Two separate convenience samples were used in the study: an elderly Medicare sample (N = 253), and a nonelderly sample (N = 239). RESULTS: The findings indicate that there are data presentation approaches that help consumers who have lower skills use information more accurately. Some of these presentation strategies (for example, relative stars) improve comprehension among the lower skilled, and other strategies (for example, evaluative labels) appear to aid those in the midrange of comprehension skill. CONCLUSIONS: Using these approaches in reporting would likely increase the use of the comparative information and increase the efficacy of reporting efforts.     

Length of hospitalization--an indicator of social costs of disabilities from traffic injuries

The social costs of disabilities are not generally included in estimates of the costs of traffic accidents, primarily because of measurement problems. This paper examines the disability consequences of traffic injuries in New Zealand and applies social cost values to them. A strong correlation is found to exist between the disability consequence of accidents and the average length of stay in hospital. Information on the latter is commonly available and therefore provides a basis for estimating disability costs. An interesting finding of the analysis is that less than 16% of traffic injury types, represented by the 3-digit ICD classification, account for more than 80% of the total social cost of disability. The implications for countermeasure policy are identified.     

Vulnerability to flooding: health and social dimensions

This paper presents research results on the impacts that floods can have on the people affected, thus complementing the existing data on the monetary losses liable to occur in flood events. Both datasets should be used when deciding on investment in flood defence measures. We report on research on the vulnerability of flood-affected communities to adverse health effects, and the development of an index of community vulnerability based on extensive focus-group research and secondary-source census data.     

Contact with AIDS patients as a source of work-related distress: effects of organizational and social support.

In this study, we hypothesized that a nurse's exposure to acquired immunodeficiency syndrome (AIDS) patients as part of the work role is positively associated with distress as indexed by negative mood at work. Given this expected relation, we sought to identify factors that might reduce the negative effects of caring for AIDS patients on nurses. We predicted that both organizational and social support would moderate the relationship between extent of exposure and negative mood, with the relationship being strongest when support is low and weakest when support is high. The results of tests among a sample of 256 nurses supported all the hypotheses. We discuss implications of this study and directions for future research.     

The economic burden of injury: Health care and productivity costs of injuries in the Netherlands

BackgroundDetailed information on health care costs and productivity costs for the whole spectrum of injuries is lacking. We measured the total costs of injuries by external-cause, injury groupings, age and sex.MethodInjury patients visiting an Emergency Department in the Netherlands were included. Health service use and work absenteeism were estimated with national database data and a prospective follow-up study. Health care costs (direct costs) and productivity costs (indirect costs) were determined using the incidence-based Dutch Cost of Injury Model.ResultsTotal costs of injuries were €3.5 billion annually (€210/capita and €4300/patient); €2.0 billion healthcare costs and €1.5 billion productivity costs. Home and leisure injury subcategory falls caused 41% of total costs. Traffic injury was prominent in the 15–54 age group, mainly due to bicycle injuries. Sports injuries, in special football/soccer injuries, resulted in high costs in the 15–24 age group. Although costs per patient were comparable between males and females, health care costs were higher in females, whereas males have more than twice as high productivity costs. Health care costs were highest for hip fractures (€20,000/patient). Extremity fractures had high costs due to high incidences and high productivity costs per patient.ConclusionOur detailed cost model identified known risk groups, such as elderly females with hip fractures resulting from falls, as well as less obvious important high risk groups, such as young children falling from furniture, young males who sustained football/soccer injuries and bicycle injuries among all ages. This information is essential to assess additional priority areas for prevention.     

Estimation of the social costs of home injury: a comparison with estimates for road injury

Home injury is thought to constitute a major health burden in most developed countries. However, efforts to address this burden have been hampered by reluctance from outside agencies to interfere with the home environment of individuals, even if it benefits the occupant's safety. This paper outlines cost–benefit evaluation methods established in the transport safety domain applied to home safety to estimate the social cost of unintentional home injury in New Zealand. Estimates of costs imposed on society by home injury can provide an important motivator for initiating research and programmes to reduce home injury risk. Data sources used included mortality data, hospitalisation data and data on minor injuries that required medical treatment, but not hospital admission. We estimated that unintentional home injuries in New Zealand impose an annual social cost of about $NZ 13 billion (about $US 9 billion), which is about 3.5 times the annual social cost of road injury. These estimates provide a rational evidence base for decisions on housing-focused safety regulation or interventions that always carry some cost, and therefore need to be weighed against the benefits of injuries potentially prevented.