Modeling Pathology Workload and Complexity to Manage Risks and Improve Patient Quality and Safety

Anatomic pathology (AP) laboratories provide critical diagnostic information that help determine patient treatments and outcomes, but the risks of AP operations and their impact on patient safety and quality of care remain poorly recognized and undermanaged. Hospital-based laboratories face an operational and risk management challenge because clinical work of unknown quantity and complexity arrives with little advance notice, which results in fluctuations in workload that can push operations beyond planned capacity, leading to diagnostic delays and potential errors. Modeling the dynamics of workload and complexity in AP offers the opportunity to better use available information to manage risks. We developed a stock-and-flow model of a typical AP laboratory operation and identified key exogenous inputs that drive AP work. To test the model, we generated training and validations data sets by combining data from the electronic medical records and laboratory information systems over multiple years. We demonstrate the implementation of 10-day AP work forecast generated on a daily basis, and show its performance in comparison with actual work. Although the model somewhat underpredicts work as currently implemented, it provides a framework for prospective management of resources to ensure quality during workload surges. Although full implementation requires additional model development, we show that AP workload largely depends on few and accessible clinical inputs. Recognizing that level loading of work in a hospital is not practical, predictive modeling of work can empower laboratories to triage, schedule, or mobilize resources more effectively and better manage risks that reduce the quality or timeliness of diagnostic information.     

LOCUS OF CONTROL,TRUST, AND DECISION MAKING*

A theoretical connection was proposed between certain social personality variables, namely locus of control (Internal or External) and trust (High and Low) and the formal decision-making model of Subjective Expected Utility (SEU). Rather than adopting the traditional definition of these variables as “generalized expectancies” for behavior of self and others, locus of control and trust were reconceptualized as intrapersonal tendencies to favor, prefer, or otherwise bias the subjective probabilities entering into a decision computation. S's high in external control orientation did not differ from internals overall, but external males were more risk averse under certain choice conditions (female-sex-role appropriate dilemma, probability-estimate form). Low-trust S's were also more risk averse than high-trust S's, overall. Low-trust males generated maximally risk-averse choice solutions under the choice condition of feminine role problem appropriateness and probability estimation. In general, female S's made choices that were more consistent with SEU-predicted solutions than males.     

Crossing the finish line? A review of college completion inequality in the United States by race and class

Although most students graduate from high school and enroll in college the following fall, rates of entry into higher education and completion of a bachelor's degree continue to be stratified by race and class. Because of the potential returns that accrue to individuals and society overall when students complete their 4‐year degree, these disparate trends should motivate more policy‐relevant research in this area. In this review, I show how a longitudinal perspective of the path to a BA degree helps to reconcile competing theories of college completion by race and class across disciplinary boundaries. Both human capital theory and status attainment theory largely examine college completion as the long‐term process of BA attainment, although they differ in their focal stages and mechanisms. In contrast, the theory of categorical inequality, as applied in this review, focuses on the years in higher education and describes the ways in which colleges and universities as organizations create, legitimate, and reinforce categorical distinctions in postsecondary schooling and how these processes independently shape college completion inequality. As public interest grows in holding colleges accountable for their graduation rates, more research is needed on how the formal and informal organizational policies and practices of colleges produce inequality.     

Military service and marital dissolution: a trajectory analysis

Military service adds additional challenges for married couples. Previous literature on service and marital stability is comprised of mixed results and has often ignored the timing of these effects. This timing is important as it helps disclose the nature of causality and has implications for both military and social security policies. Using a trajectory specification, I estimate the effect of military service on the likelihood of divorce during the volunteer’s period of service and the years following. Two veteran cohorts are examined, those who served during the early twenty-first century wars and those who served during the early 1980s. Among my results, the former cohort is shown to have had their divorce probability increased in the first 2 years post-service, while the opposite effect is found for the latter cohort. Unlike many previous studies of military service and marital stability, I find that effects are not overly dissimilar across racial groups.     

Personal Network Correlates and Predictors of Homelessness for Injection Drug Users in Baltimore,Maryland

Injection drug users are at high risk for homelessness and human immunodeficiency virus (HIV) infection. This study sought to examine incidence rates and the social and economic antecedents of homelessness of impoverished inner-city injection drug users. Of the 569 participants, from a nontreatment sample who participated HW prevention study, intelViewed at baseline, 324 (57%) were reintelViewed 5.2 months late!: At baseline 48% of the participants reported that they had been homeless in the past 10 years. Of the 324, 18% reported that at both intelViews they had been homeless within the prior 6 months, 12% reported homelessness at baseline but not at follow-up, and 8% reported homelessness at follow-up but not at baseline. At baseline personal social support network characteristic of size of material aid and size of sex network was found to be associated with self-reports of homelessness. Baseline reports ofpresence of mother in personal network, size of material aid network, and network density were found to be associated with reports of homelessness at follow-up. These result suggest the need for alternative approaches to addressing issues of homelessness injection drug users.