The HITECH Act aimed to leverage Electronic Health Records (EHRs) to improve efficiency, quality, and patient safety. Patient safety and EHR use have been understudied, making it difficult to determine if EHRs improve patient safety. The objective of this study was to determine the impact of EHRs and attesting to Meaningful Use (MU) on Patient Safety Indicators (PSIs). A multivariate regression analysis was performed using a generalized linear model method to examine the impact of EHR use on PSIs. Fully implemented EHRs not attesting to MU had a positive impact on three PSIs, and hospitals that attested to MU had a positive impact on two. Attesting to MU or having a fully implemented EHR were not drivers of PSI-90 composite score, suggesting that hospitals may not see significant differences in patient safety with the use of EHR systems as hospitals move towards pay-for-performance models. Policy and practice may want to focus on defining metrics and PSIs that are highly preventable to avoid penalizing hospitals through reimbursement, and work toward adopting advanced analytics to better leverage EHR data. These findings will assist hospital leaders to find strategies to better leverage EHRs, rather than relying on achieving benchmarks of MU objectives.

This report is the primary outcome from Part I of the project “Towards a new Nordic textile commitment - Collection, sorting, reuse and recycling” initiated by the Nordic Waste Group (NAG). The report for Part 2 will be published in December 2014.This report summarizes the work carried out in 2013. The four subreports will be the basis for the work to be performed in 2014 with the aim of creating a Voluntary Commitment and a Code of Conduct. The reports for 2013 are: • Mapping of current actors in the collection, sorting, reuse and recycling of used textiles and the management of textile wastes • Literature review of the traceability of global textile flows. • Definition and documentation of operational and best practice standards in the collection, sorting, reuse and recycling of used textiles and management of textile wastes. • Comparison with waste management of other waste streams. The report is part of the Nordic Prime Ministers’ overall green growth initiative: “The Nordic Region – leading in green growth.” Read more in the web magazine “Green Growth the Nordic Way” at www.nordicway.org or at www.norden.org/greengrowt

The proposed strategy for increased reuse and recycling of textiles provides a starting point for the work towards a more sustainable textile and fashion sector in the Nordic region. It is focused on the increased collection, sorting, reuse and recycling in the region and thereby provides one part of the sustainability puzzle in the sector. The proposed strategy includes incentives, policy measures and measures needed on local, regional, national and Nordic levels to ensure successful implementation. The report is part of the Nordic Prime Ministers' overall green growth initiative: “The Nordic Region – leading in green growth” - read more in the web magazine “Green Growth the Nordic Way” at www.nordicway.org or at www.norden.org/greengrowt

Introduction Effective collaboration between public health and the health care system is essential for connecting medical and community health-related resources and improving population health. We investigated the linkages between local health departments and primary care clinics in Nebraska. Methods We conducted a mixed-method study by using semistructured in-person and telephone interviews and surveys in 2017 and 2018 with directors of 19 Nebraska local health departments. Interviews and surveys assessed activities and programs that health departments implemented or planned with clinics in their jurisdictions. Barriers, benefits, and opportunities for building the linkages were identified. Results Strong linkages existed between local health departments and primary care clinics. Linkages focused on the control and prevention of chronic diseases and on traditional public health programs, including screening for cancer and other chronic diseases, vaccinations, worksite wellness programs, home visits, clinic and medication assistance referrals, health message development, electronic health records data analyses, staff education, and improvements in policies and procedures. The most frequently reported barrier was funding, and the most frequently reported benefit was patient behavior change. The opportunity most frequently reported was chronic disease health coaching. Conclusion Extensive linkages exist between Nebraska local health departments and the health care systems in their areas. Additional funding, effective workforce management, community needs assessments, and program evaluation can support joint initiatives to address community health priorities.

Context: Federal and state policy makers have debated the evolving concept of community benefit and the extent to which nonprofit hospitals are providing benefits to the community in exchange for the tax benefits they receive. Objective: This study compares community benefits spending by nonprofit hospitals in Nebraska and other selected states in both 2012 and 2015. Expenditures are also examined by rural, regional, and urban hospitals within Nebraska. Methods: Community benefit expenditure data were taken from Community Benefit Insight and consolidated into the categories of direct patient care, community health improvement initiatives, and health professions education and research. Results: When community benefit expenditures were compared across 11 states, Nebraska had the highest percentage of expenditures for community health improvement initiatives in both 2012 and 2015. Although community benefit expenditures for the 44 nonprofit hospitals within Nebraska increased from 2012 to 2015, they remained flat as a share of total hospital expenditures. In 2015, 63% of community benefit expenditures were allocated to direct patient care, which represented a 7.3% decrease from 2012. This decline led to greater spending on community health improvement initiatives (3.1%) and health professions education and research (4.2%). Rural, regional, and urban hospitals spent more proportionately on community health improvement initiatives in 2015 than in 2012. Conclusions: The shift in community benefit expenditures from direct patient care to community health improvement initiatives and health professions education and research suggests that hospitals are investing in programs with broader community-wide benefits. Nebraska allocates a significantly larger share of its community benefits spending to community health improvement activities than other Great Plains and Midwestern states. Nebraska is in the process of implementing Medicaid expansion, which may shift future community benefits spending decisions.