Biomedical subjects
Publications and source records attributed to S M Shortell.
Formal program evaluation is an important resource for health care decision making. It is necessary in situations where traditional organizational evaluative capabilities an no longer meet the requirements of the job at hand.
Using data from the 1973 American Hospital Association national survey of hospital medical staff organization, six factors of medical staff organization structure are examined in relation to each other and to hospital ownership, size, teaching status, geographic region and size of Standard Metropolitan Statistical Area (SMSA). The six factors include 1) Resource Capability; 2) Generalist Physician Contractual Orientation; 3) Communication and Control; 4) Local Staff Orientation; 5) Physician Participation in Decision Making; and 6) Hospital-Based Contractual Orientation. Several relatively distinct patterns emerged related to hospital ownership, size, teaching activity and region of the country, as well as interrelationships among the factors themselves. Differences between smaller and larger hospitals clearly emerged as well as a distinctive pattern for for-profit hospitals. All of the factors are subject to manipulation through administrative and/or public policy interventions and the findings suggest dimensions for future investigation of important policy issues related to the medical staff's role in cost containment, utilization, quality assurance and technology adoption.
This article examines the relationships among hospital structural characteristics, individual physician characteristics, medical staff organization characteristics and quality of care for two conditions: acute myocardial infarction and appendicitis. Using data obtained from the Commission on Professional and Hospital Activities (CPHA), approximately 50,000 acute myocardial infarction cases and 8,183 appendectomy cases collected from 96 hospitals in the East North Central Region of the country (Illinois, Indiana, Michigan, Ohio and Wisconsin) were examined. These data were merged with medical staff organization and related data on hospital characteristics obtained from the American Hospital Association. The results indicate that such medical staff organization factors as involvement of the medical staff president with the hospital governing board, overall physician participation in hospital decision making, frequency of medical staff committee meetings and percentage of active staff physicians on contract are positively associated with higher quality-of-care outcomes, independent of the effects of hospital and physician characteristics. Further, the medical staff organization factors appear to be somewhat more strongly associated with higher quality-of-care outcomes than the hospital and physician characteristics. For acute myocardial infarction, higher volume of patients treated per family practitioner and internist and presence of a coronary care unit were also associated with better outcomes. Given the restricted number of conditions studied, the geographically limited sample and the fact that specific variables were not consistently related to quality of care for both conditions, the results area viewed as preliminary. However, they are consistent with and extend other developing findings in this area. They also suggest that more attention needs to be given to the organization of the hospital medical staff and its articulation with the overall hospital decision-making structure and process in attempts to improve outcomes of hospitalization.
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Mental health services were included in comprehensive benefits available with no out-of-pocket expenses to enrollees in the Seattle Prepaid Health Care Project. This study was designed to examine the characteristics of users as compared to nonusers of mental health services and to examine the possibility of lower use of somatic health services attributable to the availability of mental health services. Two enrollee groups were studied: one group included enrollees with at least one mental health service (MH-U) and the other included those with some somatic utilization but without mental health utilization (MH-NU). Results indicated that mental health users were different from nonusers based on sociodemographic, health status, and prior utilization measures. Further, the mental health utilizers consumed more somatic services than other enrollees, even controlling for background variables. The visit and admission rates for the MH-U group were 2.4 times that of the MH-NU group, and total inpatient and outpatient costs were three times as high. On all three comparisons, approximately 60 per cent of the difference was accounted for by mental health utilization and by differences in sociodemographic and health status characteristics. The remaining 40 per cent could not be explained, but there is a suggestion that the higher utilization occurred for conditions where medical care is discretionary.
Many federally financed programs have been launched to improve the access of the poor to medical care, under the assumption that this will improve their health. The effectiveness of these programs, however, has generally been measured by increased utilization rather than by improved health. The few studies which have considered health status have shown small or negative effects. Here, data are presented from a project which provided fully prepaid care to near poor families through existing sources in the community. A group of 748 enrollees was found to report worse health on four of five health indicators after one year of enrollment in the program; further, they appeared sicker on all five measures than a group without free medical care. It is suggested: 1) that the impact of health programs on the health of a population is a complex and poorly understood issue; and 2) that increasing access to health care may not be an effective way to improve health.
This paper examines the rates and patterns of referral of four family physicians in an underserved rural area of Washington State. The majority of referrals made by the family physicians were for management of a particular problem outside the scope of practice of the physician. The referral rates ranged from 1.8 to 3.2 percent of all patient visits and were comparable with those previously reported. A National Health Service Corps physician had the highest rate of referral and a foreign medical graduate had the lowest rate of referral. These results may be explained by practice building incentives as well as the ability to establish ties with the referral network.
Based on organization theory and the work of Roemer and Friedman, seven dimensions of hospital medical staff organization structure are proposed and examined. The data are based on a 1973 nationwide survey of hospital medical staffs conducted by the American Hospital Association. Factor analysis yielded six relatively independent dimensions supporting a multidimensional view of medical staff organization structure. The six dimensions include 1) Resource Capability, 2) Generalist Physician Contractual Orientation, 3) Communication/Control, 4) Local Staff Orientation, 5) Participation in Decision Making, and 6) Hospital-Based Physician Contractual Orientation. It is suggested that these dimensions can be used to develop an empirical typology of hospital medical staff organization structure and to investigate the relationship between medical staff organization and public policy issues related to cost containment and quality assurance.
A causal model of health services which includes patient and provider variables, perceived access to care, utilization of services, continuity of care, technical quality of the care process, technical quality of the care outcome, and patient satisfaction is applied to a group of diabetic patients enrolled in the Seattle Prepaid Health Care Project. The enrollees received comprehensive health services at zero out-of-pocket cost from either a prepaid group practice plan or an independent practice plan. Surveys were periodically conducted to determine health status, satisfaction, and demographic characteristics of the enrollees; utilization of services was monitored throughout the experiment. The causal model is operationalized through the use of path analysis. Significant relationships (p less than or equal to .10) were established between satisfaction and perceived access to care, family size, sex, and professional qualifications of the provider; between outcome of care and health status, female education, and physician performance; between physician performance and professional qualifications; between continuity of care and health status and female education; between utilization and perceived access, specialty of provider, and provider system; and between access to care and provider system. The policy implications of the results are discussed.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
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Explore the source record for details and available documents.