Hospital executives are under continual pressure to control spending and improve quality. While prior studies have focused on the relationship between overall hospital spending and quality, the relationship between spending on specific services and quality has received minimal attention. The literature thus provides executives limited guidance regarding how they should allocate scarce resources. Using Medicare claims and cost report data, we examined the association between hospital spending for specific services and 30-day readmission rates for heart failure, pneumonia, and acute myocardial infarction. We found that occupational therapy is the only spending category where additional spending has a statistically significant association with lower readmission rates for all three medical conditions. One possible explanation is that occupational therapy places a unique and immediate focus on patients' functional and social needs, which can be important drivers of readmission if left unaddressed.

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Objective: The purpose of the study was to identify factors associated with depressive symptoms in community-dwelling older adults receiving prescription opioids for chronic pain.Design: This was a cross-sectional research design. A survey was used to gather demographic information, pain severity, health status, and factors associated with depressive symptoms.Setting: Eleven outpatient clinics affiliated with the Baltimore Veterans Affairs Medical Center and the University of Maryland Medical System were included.Participants: One hundred sixty-three older adults receiving opioid medications for chronic pain were recruited.Outcome measures: Depressive symptoms were assessed via the Center for Epidemiologic Studies Depression Scale-10 (CESD-10).Results: Univariate, bivariate, and ordinary least square (OLS) regression analyses were conducted to identify frequencies and to address the research questions. Nearly 40 percent of the elderly opioid therapy patients had depressive symptoms on the CESD-10. Bivariate analysis revealed that higher levels of pain severity were related to higher levels of depressive symptoms. OLS regression analysis revealed four risk factors significantly associated with higher depressive symptoms: higher pain severity, lower levels of functional status, lower levels of spirituality, and lower levels of social support. Age, gender, living alone, and perception of health status were not significantly associated with depressive symptoms.Conclusions: Depression is an underdiagnosed, treatable pain comorbidity that should be evaluated in older patients receiving opioid therapy. Undertreated depression in chronic pain patients receiving opioid medications may explain suboptimal improvement in pain and functional status despite increasing opioid dosage.

High pain intensity scores may indicate undertreatment of pain or may represent a rationalization to justify opioid medication use. Higher levels of depressive symptoms have been noted in the chronic pain population and may contribute to misuse of opioid medications for psychic effects. Less physically disabled persons are more likely to misuse opioid medications or older person receiving multiple medications may wish to avoid potential adverse drug effects. While there was an association between lower levels of disability and higher risk for opioid medication misuse, a causal relationship could not be determined.

Objective: Determine the industries with the highest proportion of accepted COVID-19 related workers’ compensation (WC) claims. Methods: Study included 21,336 WC claims (1898 COVID-19 and 19,438 other claims) that were filed between January 1, 2020 and August 31, 2020 from 11 states in the Midwest United States. Result: The overwhelming proportion of all COVID-19 related WC claims submitted and accepted were from healthcare workers (83.77%). Healthcare was the only industrial classification that was at significantly higher COVID-19 WC claim submission risk (odds ratio [OR]: 4.00; 95% confidence intervals [CI]: 2.77 to 5.79) controlling for type of employment, sex, age, and presumption of COVID-19 work-relatedness. Within healthcare employment, WC claims submitted by workers in medical laboratories had the highest risk (crude rate ratio of 8.78). Conclusion: Healthcare employment is associated with an increased risk of developing COVID-19 infections and submitting a workers’ compensation claim.