Many children in the United States have access to firearms in their homes, and the consequences c... more Many children in the United States have access to firearms in their homes, and the consequences can be tragic. Recent headlines tell a sad and increasingly familiar story: "Boy charged with attempted murder in shooting of 14-year-old girl," "Boy, 4, shot by 6-year-old," "Just a routine school shooting...." Public health agencies, organizations representing children, and groups representing firearm owners offer consistent guidelines about how to store firearms to make them inaccessible to children: unload them, lock them up, and store them separately from ammunition. However, a RAND analysis of data regarding firearm ownership and storage patterns found that of the families in the United States with children and firearms, fewer than half store their firearms unloaded, locked, and away from ammunition. Using nationally representative data from a large interview survey by the National Center for Health Statistics (NCHS), RAND researchers examined the prevalence of firearms in U.S. homes with children under 18 years old and learned how those firearms are stored.
Examined how attachment relationships, cognitive attributes and sociodemographic characteristics ... more Examined how attachment relationships, cognitive attributes and sociodemographic characteristics function as protective and risk factors across a range of specific violent behaviors. The study analyzed data from the National Longitudinal Study of Adolescent Health (Wave 1; 18,924 Ss aged 12-18 yrs). A multistage sample design was used to represent the US population of 7th-12th graders. The results indicate the importance of attachment to family and school as protectivc factors against a range of violent behaviors in adolescence. While an intact family structure appears as a protective factor against violence, the data supports the idea that the meaning attached to a particular family structure is more important than the structure itself. Adolescents reporting attendance at a religious service with a parent reported lower levels of involvement in all forms of violent behavior. Given the fundamental importance of attachment, these results support the importance of providing all childr...
While the need to provide appropriate mental health services to children in foster care is well r... more While the need to provide appropriate mental health services to children in foster care is well recognized, there is little information on administrative barriers to assuring that such services are provided. This article presents results from a national survey of mental health agencies to profile their awareness of currently available practice standards, the roles these standards play in guiding practice of mental health agencies, common reimbursement strategies in use for mental health services, and collaborations between mental health and child welfare agencies that enhance children’s access to appropriate mental health care. Implications and recommendations for mental health policymakers are discussed.
We evaluated interrelationships and associations among mortality rates, drug costs, total cost of... more We evaluated interrelationships and associations among mortality rates, drug costs, total cost of care, and length of stay in United States hospitals. Relationships between these variables and the presence of clinical pharmacy services and pharmacy staffing also were explored. A database was constructed from the 1992 American Hospital Association's Abridged Guide to the Health Care Field, the 1992 National Clinical Pharmacy Services database, and 1992 Health Care Finance Administration mortality data. A severity of illness-adjusted multiple regression analysis was employed to determine relationships and associations. Study populations ranged from 934-1029 hospitals (all hospitals for which variables could be matched). The only pharmacy variable associated with positive outcomes with all four health care outcome measures was the number of clinical pharmacists/occupied bed. That figure tended to have the greatest association (slope) with reductions in mortality rate, drug costs, and length of stay. As clinical pharmacist staffing levels increased from the tenth percentile (0.34/100 occupied beds) to the ninetieth percentile (3.23/100 occupied beds), hospital deaths declined from 113/1000 to 64/1000 admissions (43% decline). This resulted in a reduction of 395 deaths/hospital/year when clinical pharmacist staffing went from the tenth to the ninetieth percentile. This translated into a reduction of 1.09 deaths/day/hospital having clinical pharmacy staffing between these staffing levels, or 320 dollars of pharmacist salary cost/death averted. Three hospital pharmacy variables were associated with reduced length of stay in 1024 hospitals: drug protocol management (slope -1.30, p=0.008), pharmacist participation on medical rounds (slope -1.71, p<0.001), and number of clinical pharmacists/occupied bed (slope -26.59, p<0.001). As drug costs/occupied bed/year increased, severity of illness-adjusted mortality rates decreased (slope -38609852, R(2) 8.2%, p<0.0001). As the total cost of care/occupied bed/year increased, those same mortality rates decreased (slope -5846720642, R(2) 14.9%, p<0.0001). Seventeen clinical pharmacy services were associated with improvements in the four variables.
We evaluated hospital demographics (census regions, size, teaching affiliation, hospital ownershi... more We evaluated hospital demographics (census regions, size, teaching affiliation, hospital ownership, hospital pharmacy director's degree, pharmacist location within the hospital) and clinical pharmacist staffing/occupied bed in United States hospitals. A database was constructed from the 1992 American Hospital Association's Abridged Guide to the Health Care Field and the 1992 National Clinical Pharmacy Services database. Simple statistical tests and multiple regression analysis were employed. The study population consisted of 1391 hospitals that reported information on clinical pharmacist staffing. The mean number of clinical pharmacists/100 occupied beds was 0.51 +/- 0.18. Factors associated with increased clinical pharmacist staffing were west north central region (slope = 0.0029439, p = 0.002), Pacific region (slope = 0.0032089, p = 0.004), affiliation with pharmacy teaching hospitals (slope = 0.0025330, p = 0.0001), teaching hospitals (slope = 0.0028122, p = 0.001), federal government ownership (slope = 0.0029697, p = 0.012), directors with Pharm.D. degrees (slope = 0.0335020, p = 0.002), directors with M.S. Pharmacy degrees (slope = 0.0028622, p = 0.003), pharmacists in a decentralized location (slope = 0.0035393, p = 0.0001), and pharmacy technician staffing (slope = 0.0517713, p = 0.0001). Statistically significant associations between demographic variables and decreased clinical pharmacist staffing/occupied bed were mid-Atlantic region (slope = -0.0028237, p = 0.002), small size (slope = -0.0028894, p = 0.001), pharmacy directors with B.S. degrees (slope = -0.0019271, p = 0.023), and pharmacy administrator staffing (slope = -0.0184513, p = 0.042). The R2 for this multiple regression analysis was 28.31% and adjusted R2 was 24.83%. Increased pharmacy technician staffing had the greatest association (slope = 0.0517713) with increased clinical pharmacist staffing. Significant differences were observed between clinical pharmacist staffing and hospital demographic factors. It appears that one of the most effective ways to increase clinical pharmacist staffing is to increase pharmacy technician staffing (slope). These findings will help future researchers determine specific reasons why some types of hospitals have higher and some lower levels of clinical pharmacist staffing.
This study evaluated hospital demographics, staffing, pharmacy variables, health care outcomes me... more This study evaluated hospital demographics, staffing, pharmacy variables, health care outcomes measures (severity of illness-adjusted mortality rates, drug costs, total cost of care, and length of stay) and medication errors. A database was constructed from the 1992 American Hospital Association's Abridged Guide to the Health Care Field, the 1992 National Clinical Pharmacy Services database, and 1992 mortality data from the Health Care Financing Administration. Simple statistical tests and a severity of illness-adjusted multiple regression analysis were employed. The study population consisted of 1116 hospitals that reported information on medication errors and 913 hospitals that reported information on medication errors that adversely affected patient care outcomes. We evaluated factors associated with the 430,586 medication errors and 17,338 medication errors that adversely affected patient care outcomes. Medication errors occurred in 5.07% of the patients admitted each year to these hospitals. Each hospital experienced a medication error every 22.7 hours (every 19.73 admissions). Medication errors that adversely affected patient care outcomes occurred in 0.25% of all patients admitted to these hospitals/year. Each hospital experienced a medication error that adversely affected patient care outcomes every 19.23 days (or every 401 admissions). The following factors were associated with increased medication errors/occupied bed/year: lack of pharmacy teaching affiliation (slope = 0.8875, p=0.0416), centralized pharmacists (slope = 1.0942, p=0.0001), number of registered nurses/occupied bed (slope = 1.624, p=0.032), number of registered pharmacists/occupied bed (slope = 25.0573, p=0.0001), hospital mortality rate (slope = 2.8017, p=0.0192), and total cost of care/occupied bed/year (slope = 0.01432, p=0.0091). Factors associated with decreased medication errors were location in the Mid-Atlantic census region (slope = -1.5182, p=0.03), affiliation with a pharmacy teaching program (slope = -1.0252, p=0.0349), decentralized pharmacists (slope = -0.9843, p=0.0037), and number of medical residents/occupied bed (slope = -1.478, p=0.0014). There was a 45% decrease in medication errors (1.81-fold decrease) in hospitals that had decentralized pharmacists, compared with hospitals that had centralized pharmacists. In addition, there was a 94% decrease in medication errors that adversely affected patient care outcomes (16.88-fold decrease) in hospitals that had decentralized pharmacists compared with hospitals that had only centralized pharmacists. Based on previous field studies and our findings in 1116 hospitals, it appears that one of the most effective ways to prevent or reduce medication errors is to decentralize pharmacists to patient care areas. The results of this study should help hospitals reduce the number of medication errors that occur each year.
The direct relationships and associations among clinical pharmacy services, pharmacist staffing, ... more The direct relationships and associations among clinical pharmacy services, pharmacist staffing, and medication errors in United States hospitals were evaluated. A database was constructed from the 1992 National Clinical Pharmacy Services database. Both simple and multiple regression analyses were employed to determine relationships and associations. A total of 429,827 medication errors were evaluated from 1081 hospitals (study population). Medication errors occurred in 5.22% of patients admitted to these hospitals each year. Hospitals experienced a medication error every 22.04 hours (every 19.13 admissions). These findings suggest that at minimum, 90,895 patients annually were harmed by medication errors in our nation's general medical-surgical hospitals. Factors associated with increased medication errors/occupied bed/year were drug-use evaluation (slope = 0.0023476, p=0.006), increased staffing of hospital pharmacy administrators/occupied bed (slope = 29.1972932, p<0.001), and increased staffing of dispensing pharmacists/occupied bed (slope = 19.3784148, p<0.001). Factors associated with decreased medication errors/occupied bed/year were presence of a drug information service (slope = -0.1279301, p<0.001), pharmacist-provided adverse drug reaction management (slope = -0.3409332, p<0.001), pharmacist-provided drug protocol management (slope = -0.3981472, p=0.013), pharmacist participation on medical rounds (slope = -0.6974303, p<0.001), pharmacist-provided admission histories (slope = -1.6021493, p<0.001), and increased staffing of clinical pharmacists/occupied bed (slope = -9.5483813, p<0.001). As staffing increased for clinical pharmacists/occupied bed from the 10th percentile to the 90th percentile, medication errors decreased from 700.98 +/- 601.42 to 245.09 +/- 197.38/hospital/year, a decrease of 286%. Specific increases or decreases in yearly medication errors associated with these clinical pharmacy services in the 1081 study hospitals were drug-use evaluation (21,372 more medication errors), drug information services (26,738 fewer medication errors), adverse drug reaction management (44,803 fewer medication errors), drug protocol management (90,019 fewer medication errors), medical round participation (42,859 fewer medication errors), and medication admission histories (17,638 fewer medication errors). Overall, clinical pharmacy services and hospital pharmacy staffing variables were associated with medication error rates. The results of this study should help hospitals reduce the number of medication errors that occur each year.
Many children in the United States have access to firearms in their homes, and the consequences c... more Many children in the United States have access to firearms in their homes, and the consequences can be tragic. Recent headlines tell a sad and increasingly familiar story: "Boy charged with attempted murder in shooting of 14-year-old girl," "Boy, 4, shot by 6-year-old," "Just a routine school shooting...." Public health agencies, organizations representing children, and groups representing firearm owners offer consistent guidelines about how to store firearms to make them inaccessible to children: unload them, lock them up, and store them separately from ammunition. However, a RAND analysis of data regarding firearm ownership and storage patterns found that of the families in the United States with children and firearms, fewer than half store their firearms unloaded, locked, and away from ammunition. Using nationally representative data from a large interview survey by the National Center for Health Statistics (NCHS), RAND researchers examined the prevalence of firearms in U.S. homes with children under 18 years old and learned how those firearms are stored.
Examined how attachment relationships, cognitive attributes and sociodemographic characteristics ... more Examined how attachment relationships, cognitive attributes and sociodemographic characteristics function as protective and risk factors across a range of specific violent behaviors. The study analyzed data from the National Longitudinal Study of Adolescent Health (Wave 1; 18,924 Ss aged 12-18 yrs). A multistage sample design was used to represent the US population of 7th-12th graders. The results indicate the importance of attachment to family and school as protectivc factors against a range of violent behaviors in adolescence. While an intact family structure appears as a protective factor against violence, the data supports the idea that the meaning attached to a particular family structure is more important than the structure itself. Adolescents reporting attendance at a religious service with a parent reported lower levels of involvement in all forms of violent behavior. Given the fundamental importance of attachment, these results support the importance of providing all childr...
While the need to provide appropriate mental health services to children in foster care is well r... more While the need to provide appropriate mental health services to children in foster care is well recognized, there is little information on administrative barriers to assuring that such services are provided. This article presents results from a national survey of mental health agencies to profile their awareness of currently available practice standards, the roles these standards play in guiding practice of mental health agencies, common reimbursement strategies in use for mental health services, and collaborations between mental health and child welfare agencies that enhance children’s access to appropriate mental health care. Implications and recommendations for mental health policymakers are discussed.
We evaluated interrelationships and associations among mortality rates, drug costs, total cost of... more We evaluated interrelationships and associations among mortality rates, drug costs, total cost of care, and length of stay in United States hospitals. Relationships between these variables and the presence of clinical pharmacy services and pharmacy staffing also were explored. A database was constructed from the 1992 American Hospital Association's Abridged Guide to the Health Care Field, the 1992 National Clinical Pharmacy Services database, and 1992 Health Care Finance Administration mortality data. A severity of illness-adjusted multiple regression analysis was employed to determine relationships and associations. Study populations ranged from 934-1029 hospitals (all hospitals for which variables could be matched). The only pharmacy variable associated with positive outcomes with all four health care outcome measures was the number of clinical pharmacists/occupied bed. That figure tended to have the greatest association (slope) with reductions in mortality rate, drug costs, and length of stay. As clinical pharmacist staffing levels increased from the tenth percentile (0.34/100 occupied beds) to the ninetieth percentile (3.23/100 occupied beds), hospital deaths declined from 113/1000 to 64/1000 admissions (43% decline). This resulted in a reduction of 395 deaths/hospital/year when clinical pharmacist staffing went from the tenth to the ninetieth percentile. This translated into a reduction of 1.09 deaths/day/hospital having clinical pharmacy staffing between these staffing levels, or 320 dollars of pharmacist salary cost/death averted. Three hospital pharmacy variables were associated with reduced length of stay in 1024 hospitals: drug protocol management (slope -1.30, p=0.008), pharmacist participation on medical rounds (slope -1.71, p<0.001), and number of clinical pharmacists/occupied bed (slope -26.59, p<0.001). As drug costs/occupied bed/year increased, severity of illness-adjusted mortality rates decreased (slope -38609852, R(2) 8.2%, p<0.0001). As the total cost of care/occupied bed/year increased, those same mortality rates decreased (slope -5846720642, R(2) 14.9%, p<0.0001). Seventeen clinical pharmacy services were associated with improvements in the four variables.
We evaluated hospital demographics (census regions, size, teaching affiliation, hospital ownershi... more We evaluated hospital demographics (census regions, size, teaching affiliation, hospital ownership, hospital pharmacy director's degree, pharmacist location within the hospital) and clinical pharmacist staffing/occupied bed in United States hospitals. A database was constructed from the 1992 American Hospital Association's Abridged Guide to the Health Care Field and the 1992 National Clinical Pharmacy Services database. Simple statistical tests and multiple regression analysis were employed. The study population consisted of 1391 hospitals that reported information on clinical pharmacist staffing. The mean number of clinical pharmacists/100 occupied beds was 0.51 +/- 0.18. Factors associated with increased clinical pharmacist staffing were west north central region (slope = 0.0029439, p = 0.002), Pacific region (slope = 0.0032089, p = 0.004), affiliation with pharmacy teaching hospitals (slope = 0.0025330, p = 0.0001), teaching hospitals (slope = 0.0028122, p = 0.001), federal government ownership (slope = 0.0029697, p = 0.012), directors with Pharm.D. degrees (slope = 0.0335020, p = 0.002), directors with M.S. Pharmacy degrees (slope = 0.0028622, p = 0.003), pharmacists in a decentralized location (slope = 0.0035393, p = 0.0001), and pharmacy technician staffing (slope = 0.0517713, p = 0.0001). Statistically significant associations between demographic variables and decreased clinical pharmacist staffing/occupied bed were mid-Atlantic region (slope = -0.0028237, p = 0.002), small size (slope = -0.0028894, p = 0.001), pharmacy directors with B.S. degrees (slope = -0.0019271, p = 0.023), and pharmacy administrator staffing (slope = -0.0184513, p = 0.042). The R2 for this multiple regression analysis was 28.31% and adjusted R2 was 24.83%. Increased pharmacy technician staffing had the greatest association (slope = 0.0517713) with increased clinical pharmacist staffing. Significant differences were observed between clinical pharmacist staffing and hospital demographic factors. It appears that one of the most effective ways to increase clinical pharmacist staffing is to increase pharmacy technician staffing (slope). These findings will help future researchers determine specific reasons why some types of hospitals have higher and some lower levels of clinical pharmacist staffing.
This study evaluated hospital demographics, staffing, pharmacy variables, health care outcomes me... more This study evaluated hospital demographics, staffing, pharmacy variables, health care outcomes measures (severity of illness-adjusted mortality rates, drug costs, total cost of care, and length of stay) and medication errors. A database was constructed from the 1992 American Hospital Association's Abridged Guide to the Health Care Field, the 1992 National Clinical Pharmacy Services database, and 1992 mortality data from the Health Care Financing Administration. Simple statistical tests and a severity of illness-adjusted multiple regression analysis were employed. The study population consisted of 1116 hospitals that reported information on medication errors and 913 hospitals that reported information on medication errors that adversely affected patient care outcomes. We evaluated factors associated with the 430,586 medication errors and 17,338 medication errors that adversely affected patient care outcomes. Medication errors occurred in 5.07% of the patients admitted each year to these hospitals. Each hospital experienced a medication error every 22.7 hours (every 19.73 admissions). Medication errors that adversely affected patient care outcomes occurred in 0.25% of all patients admitted to these hospitals/year. Each hospital experienced a medication error that adversely affected patient care outcomes every 19.23 days (or every 401 admissions). The following factors were associated with increased medication errors/occupied bed/year: lack of pharmacy teaching affiliation (slope = 0.8875, p=0.0416), centralized pharmacists (slope = 1.0942, p=0.0001), number of registered nurses/occupied bed (slope = 1.624, p=0.032), number of registered pharmacists/occupied bed (slope = 25.0573, p=0.0001), hospital mortality rate (slope = 2.8017, p=0.0192), and total cost of care/occupied bed/year (slope = 0.01432, p=0.0091). Factors associated with decreased medication errors were location in the Mid-Atlantic census region (slope = -1.5182, p=0.03), affiliation with a pharmacy teaching program (slope = -1.0252, p=0.0349), decentralized pharmacists (slope = -0.9843, p=0.0037), and number of medical residents/occupied bed (slope = -1.478, p=0.0014). There was a 45% decrease in medication errors (1.81-fold decrease) in hospitals that had decentralized pharmacists, compared with hospitals that had centralized pharmacists. In addition, there was a 94% decrease in medication errors that adversely affected patient care outcomes (16.88-fold decrease) in hospitals that had decentralized pharmacists compared with hospitals that had only centralized pharmacists. Based on previous field studies and our findings in 1116 hospitals, it appears that one of the most effective ways to prevent or reduce medication errors is to decentralize pharmacists to patient care areas. The results of this study should help hospitals reduce the number of medication errors that occur each year.
The direct relationships and associations among clinical pharmacy services, pharmacist staffing, ... more The direct relationships and associations among clinical pharmacy services, pharmacist staffing, and medication errors in United States hospitals were evaluated. A database was constructed from the 1992 National Clinical Pharmacy Services database. Both simple and multiple regression analyses were employed to determine relationships and associations. A total of 429,827 medication errors were evaluated from 1081 hospitals (study population). Medication errors occurred in 5.22% of patients admitted to these hospitals each year. Hospitals experienced a medication error every 22.04 hours (every 19.13 admissions). These findings suggest that at minimum, 90,895 patients annually were harmed by medication errors in our nation's general medical-surgical hospitals. Factors associated with increased medication errors/occupied bed/year were drug-use evaluation (slope = 0.0023476, p=0.006), increased staffing of hospital pharmacy administrators/occupied bed (slope = 29.1972932, p<0.001), and increased staffing of dispensing pharmacists/occupied bed (slope = 19.3784148, p<0.001). Factors associated with decreased medication errors/occupied bed/year were presence of a drug information service (slope = -0.1279301, p<0.001), pharmacist-provided adverse drug reaction management (slope = -0.3409332, p<0.001), pharmacist-provided drug protocol management (slope = -0.3981472, p=0.013), pharmacist participation on medical rounds (slope = -0.6974303, p<0.001), pharmacist-provided admission histories (slope = -1.6021493, p<0.001), and increased staffing of clinical pharmacists/occupied bed (slope = -9.5483813, p<0.001). As staffing increased for clinical pharmacists/occupied bed from the 10th percentile to the 90th percentile, medication errors decreased from 700.98 +/- 601.42 to 245.09 +/- 197.38/hospital/year, a decrease of 286%. Specific increases or decreases in yearly medication errors associated with these clinical pharmacy services in the 1081 study hospitals were drug-use evaluation (21,372 more medication errors), drug information services (26,738 fewer medication errors), adverse drug reaction management (44,803 fewer medication errors), drug protocol management (90,019 fewer medication errors), medical round participation (42,859 fewer medication errors), and medication admission histories (17,638 fewer medication errors). Overall, clinical pharmacy services and hospital pharmacy staffing variables were associated with medication error rates. The results of this study should help hospitals reduce the number of medication errors that occur each year.
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