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Biomedical subjects

J S Zinn

Publications and source records attributed to J S Zinn.

27 records · Page 2Linked to original sources
PubMed1994

Medicare-certified home health services: national and regional supply in the 1980s.

The number of Medicare-certified home health agencies nearly doubled from 1980 to 1990. Using Health Care Financing Administration data, this study documented national and regional patterns of entry and exist by Medicare home health providers from 1980 to 1990. Nationally, agency origination rates accelerated during the early 1980s and then dropped abruptly in the second half of the decade. The proprietary sector, accounting for approximately 42% of agencies in existence during the period of the study, exhibited the greatest volatility. Regional differences are also evident. Both expansion and contraction in Medicare home health services appear to be a response to the incentives of legislation implemented during this period.

Certification↗
PubMed1994

Selecting international markets: lessons from for-profit hospitals.

As growth potential in the U.S. market declines and regulatory constraints increase, providers of health-related services may look increasingly to international opportunities as a way to supplement the lost domestic market. In this article, critical factors bearing on the decision to compete in international markets are identified. Existing theories of multinational competition are expanded to provide a framework for analyzing international competition. Applied in the context of the proprietary hospital industry, the critical factors governing both the selection of foreign markets and mode of entry are proposed to be host country receptivity and market growth potential.

Australia↗
PubMed1994

Strategic groups, performance, and strategic response in the nursing home industry.

OBJECTIVE: This study examines the effect of strategic group membership on nursing home performance and strategic behavior. DATA SOURCES AND STUDY SETTING: Data from the 1987 Medicare and Medicaid Automated Certification Survey were combined with data from the 1987 and 1989 Pennsylvania Long Term Care Facility Questionnaire. The sample consisted of 383 Pennsylvania nursing homes. STUDY DESIGN: Cluster analysis was used to place the 383 nursing homes into strategic groups on the basis of variables measuring scope and resource deployment. Performance was measured by indicators of the quality of nursing home care (rates of pressure ulcers, catheterization, and restraint usage) and efficiency in services provision. Changes in Medicare participation after passage of the 1988 Medicare Catastrophic Coverage Act (MCCA) measured strategic behavior. MANOVA and Turkey HSD post hoc means tests determined if significant differences were associated with strategic group membership. FINDINGS: Cluster analysis produced an optimal seven-group solution. Differences in group means were significant for the clustering, performance, and conduct variables (p < .0001). Strategic groups characterized by facilities providing a continuum of care services had the best patient care outcomes. The most efficient groups were characterized by facilities with high Medicare census. While all strategic groups increased Medicare census following passage of the MCCA, those dominated by for-profits had the greatest increases. CONCLUSIONS: Our analysis demonstrates that strategic orientation influences nursing home response to regulatory initiatives, a factor that should be recognized in policy formation directed at nursing home reform.

Analysis of Variance↗
PubMed1993

The influence of nurse wage differentials on nursing home staffing and resident care decisions.

This study examines the extent to which nursing homes adjust staffing and care practices relative to local market conditions. Weighted two-stage least squares regression results suggest that facilities employ more nonprofessional nursing staff in markets in which professional nurse wages are higher. RN staffing levels are higher in markets with a higher percentage of self-pay nursing home residents and a lower percentage of for-profit nursing homes. Controlling for resident characteristics, the use of labor-saving practices is higher in markets with higher average nursing home wages, suggesting that there are economic incentives to hire fewer nursing personnel.

Efficiency, Organizational↗
PubMed1993

Variations in the outcomes of care provided in Pennsylvania nursing homes. Facility and environmental correlates.

This research study utilizes indicators from federal and state surveys to evaluate variation in outcomes in 438 Medicare certified skilled nursing care facilities in Pennsylvania. First, a standardization function adjusting for patient characteristics known to influence outcomes was developed and estimated. The relationships between organizational and environmental characteristics and the chosen outcome indicators (i.e., differences between the actual and expected rate of mortality, pressure ulcers, urethral catheterization and physical restraints) were then analyzed by weighted least squares regression. Results suggest considerable interfacility variation in rates for these outcome indicators. A portion of this variation is significantly attributable to resident characteristics (P < or = 0.05). However, variation in outcomes in Pennsylvania facilities is also associated with facility characteristics (e.g., size and for-profit status), and environmental characteristics (e.g., per capita income and bed supply). Implications for nursing home management and policy are considered.

Aged↗
PubMed1993

The use of standardized indicators as quality improvement tools: an application in Pennsylvania nursing homes.

The Institute of Medicine recommends the use of key quality indicators (resident outcomes that suggest the presence of good or bad care) as tools for interfacility comparison of the quality of care provided in nursing homes. In the spirit of this recommendation, the Health Care Financing Administration released selected results from its Medicare and Medicaid Annual Certification Survey to guide consumers in purchasing nursing home services. However, because this information is published without adjustment for resident characteristics that can influence the outcomes of nursing home care, its utility for policy-makers or consumers interested in variation in nursing home quality is limited. This research study utilizes federal and state survey data to evaluate variations in mortality, pressure ulcers, urethral catheterization, and physical restraint use in 438 Medicare-certified skilled nursing care facilities in Pennsylvania. A standardization function adjusting for resident characteristics known to influence outcomes is developed and estimated by ordinary least squares regression. Results suggest considerable variation in rates for these indicators across Pennsylvania nursing home facilities. Alternative uses for risk-adjusted key quality indicators as tools for improving nursing home quality and assisting potential consumers of nursing home care in making better informed choices are considered.

Aged↗
PubMedDate not supplied

Managerial implications of corporate board involvement and perceived market competition for quality improvement in nursing homes.

This study examines the relationships among corporate board involvement, total quality management (TQM) adoption, perceived market competition, and the perceived effect of quality improvement (QI) activities for a sample of nursing homes in Pennsylvania. The findings of this study have several implications for healthcare managers interested in maximizing the effectiveness of QI efforts. Board involvement in quality improvement was an important predictor of QI outcomes in the areas of finance, resident care, and human resources. However, TQM adoption had a positive effect on human resources outcomes only. These findings suggest that board involvement in any organized form of QI may be more important than the adoption of a formal TQM program in the nursing home industry. TQM's emphasis on employee empowerment may account for its positive influence on human resources. Perceived competition was associated with better financial outcomes. Low-cost leadership can be a key to survival in more competitive markets, requiring a focus on efficiency and productivity issues in QI efforts. By focusing on process improvement, the facilities may achieve cost reductions that can result in an improved financial position. Facilities perceived to be in more competitive environments were also more likely to adopt TQM. This is consistent with the assertion by resource-dependence theorists that organizations facing competition for resources must be responsive to the needs of resource-providing constituencies.

Centers for Medicare and Medicaid Services, U.S.↗