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Access to health specialists is difficult for many individuals in rural communities. Telemedicine, health care service delivered remotely through telecommunications, is one potential solution, but its use varies across regions, potentially associated with the availability of high-speed internet (broadband) access. The Federal Communications Commission (FCC) and Congress have emphasized the need to increase broadband access in rural communities, in part to facilitate the use of telemedicine, and the FCC’s Connect America Fund has set aside billions of dollars to subsidize broadband expansion. Our objective was to examine whether broadband availability in local communities is associated with telemedicine use. (Wilcock et al, 7/29)

In 2010, prompted by compelling evidence that demonstrated better patient outcomes in hospitals with higher percentages of nurses with a bachelor of science in nursing (BSN), the Institute of Medicine recommended that 80 percent of the nurse workforce be qualified at that level or higher by 2020. Using data from the American Heart Association’s Get With the Guidelines–Resuscitation registry (for 2013–18), RN4CAST-US hospital nurse surveys (2015–16), and the American Hospital Association (2015), we found that each 10-percentage-point increase in the hospital share of nurses with a BSN was associated with 24 percent greater odds of surviving to discharge with good cerebral performance among patients who experienced in-hospital cardiac arrest. Lower patient-to-nurse ratios on general medical and surgical units were also associated with significantly greater odds of surviving with good cerebral performance. These findings contribute to the growing body of evidence that supports policies to increase access to baccalaureate-level education and improve hospital nurse staffing. (Harrison et al, 7/1)

Among people with three consecutive years of coverage from a large employer, just 1.3 percent of enrollees accounted for 19.5 percent of overall health spending in 2017, finds a new �鶹Ů�� analysis. These “people with persistently high spending” – people in the top five percent of spending in each of the three years from 2015 to 2017 – had average health spending of $87,870 in 2017. That compared to average per person spending of $5,870 among all large group enrollees during that period. (7/24)

Infants ≤28 days of age with fever are frequently hospitalized while undergoing infectious evaluation. We assessed differences in rates of serious bacterial infection (SBI; bacteremia, bacterial meningitis, urinary tract infection) and invasive bacterial infection (IBI; bacteremia, bacterial meningitis) among the following neonates: (1) febrile at presentation (FP), (2) afebrile with history of fever without subsequent fever during hospitalization, and (3) afebrile with history of fever with subsequent fever during hospitalization. (Ramgopal et al, 8/1)

In this qualitative study of data collected from interviews with 158 key stakeholders at 9 Get With The Guidelines–Resuscitation hospitals, distinct differences were found in the organizational structure and function of rapid response teams. Top-performing hospitals feature rapid response teams with dedicated staff without competing responsibilities, serve as a resource for bedside nurses in surveillance of at-risk patients, collaborate with nurses during and after a rapid response, and can be activated by a member of the care team without fear of reprisal. (Dukes et al, 7/29)