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Improvements in nursing home safety climate could lead to enhanced resident safety. Yet safety climate has been little studied in the nursing home setting, and existing safety climate instruments have significant limitations. To investigate safety climate in Veterans Health Affairs nursing homes (Community Living Centers [CLCs]), this study had two objectives: (a) to develop a resident safety climate instrument for use in CLCs and (b) to assess this instrument's psychometric properties by administering it in a sample of CLCs. Using a standard conceptual framework, the CLC Employee Survey of Attitudes about Resident Safety was developed with the aid of an expert panel and multiple rounds of cognitive interviews. It was subsequently pilot tested in a sample of CLC employees. After refinement based on the pilot results, it was administered in a sample of five CLCs, where it was found to have adequate reliability and validity.

Ensuring equitable access to quality health care historically has focused on gaps in care, where patients fail to receive the high-value care that will benefit them, something termed unde­ruse. But providing high-quality health care sometimes requires reducing low-value care that delivers no benefit or where known harms outweigh expected benefits. These situations represent health care overuse. The process involved in reducing low-value care is known as de-implementation. In this article, we argue that de-implementation is critical for advanc­ing equity for several reasons. First, medical overuse is associated with patient race, ethnic­ity, and socioeconomic status. In some cases, the result is even double jeopardy, where racial and ethnic minorities are at higher risk of both overuse and underuse. In these cases, more tra­ditional efforts focused exclusively on underuse ignore half of the problem. Second, overuse of preventive care and screening is often greater for more socioeconomically advantaged pa­tients. Within insured populations, this means more socioeconomically disadvantaged pa­tients subsidize overuse. Finally, racial and eth­nic minorities may have different experiences of overuse than Whites in the United States. This may make efforts to de-implement over­use particularly fraught. We therefore provide several actions for closing current research gaps, including: adding subgroup analyses in studies of medical overuse; specifying and measuring potential mechanisms related to equity (eg, double jeopardy vs thermostat models of over­use); and testing de-implementation strategies that may mitigate bias.Ethn Dis. 2019;29(Suppl 1):93-96; doi:10.18865/ed.29.S1.93.

In 2008, the Centers for Medicare & Medicaid Services introduced a new policy to adjust payment to hospitals for health care-associated infections (HAIs) not present on admission. Interviews with 36 hospital infection preventionists across the United States explored the perspectives of these key stakeholders on the potential unintended consequences of the current policy. Responses were analyzed using an iterative coding process where themes were developed from the data. Participants' descriptions of unintended impacts of the policy centered around three themes. Results suggest the policy has focused more attention on targeted HAIs and has affected hospital staff; relatively fewer systems changes have ensued. Some consequences of the policy, such as infection preventionists having less time to devote to HAIs other than those in the policy or having less time to implement prevention activities, may have undesirable effects on HAI rates if hospitals do not recognize and react to potential time and resource gaps.

Improving safety climate could enhance patient safety, yet little evidence exists regarding the relationship between hospital characteristics and safety climate. This study assessed the relationship between hospitals' organizational culture and safety climate in Veterans Health Administration (VA) hospitals nationally. Data were collected from a sample of employees in a stratified random sample of 30 VA hospitals over a 6-month period (response rate = 50%; n = 4,625). The Patient Safety Climate in Healthcare Organizations (PSCHO) and the Zammuto and Krakower surveys were used to measure safety climate and organizational culture, respectively. Higher levels of safety climate were significantly associated with higher levels of group and entrepreneurial cultures, while lower levels of safety climate were associated with higher levels of hierarchical culture. Hospitals could use these results to design specific interventions aimed at improving safety climate.