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PubMed1989

The impact of corporate structures on physician inclusion and participation.

This study examines the impact of corporate arrangements on the hospital-physician relationship. Specifically, it investigates the effects of for-profit ownership and membership in a multihospital system on physician inclusion (salaried employment, hospital-based practice) and participation (involvement in governance and management). Contrary to common perceptions and several hypotheses drawn from the literature, corporate arrangements are associated with low physician inclusion and high participation. There is no indication that corporatization of healthcare restricts the physician's freedom of movement or decision-making role. It is instead argued that health care corporations do just the opposite in order to please physicians, promote physician welfare, and to gain legitimacy.

Data Collection↗
PubMed1991

The relationship of hospital characteristics and the results of peer review in six large states.

To determine which characteristics of hospitals may be related to a higher quality of care, the association of hospital characteristics with the outcomes of medical record review by state Peer Review Organizations (PROs) was studied. The two data sources were: 1) the AHA 1986 Annual Survey of Hospitals and 2) reviews completed between July 1987 through June 1988 from six large PROs. For each hospital the percentage of cases that failed physician review (the confirmed problem rate) was computed. Hospital characteristics evaluated included financial status, ownership, medical training, technological sophistication, and size. The following characteristics were significantly associated with a lower confirmed problem rate: a higher occupancy rate, greater payroll expenses per bed, a higher proportion of physicians who were board-certified specialists, greater technological sophistication, a higher number of beds, a higher proportion of nurses who were registered, and membership in the Council of Teaching Hospitals. Public hospitals had higher problems rates than private not-for-profit hospitals. All characteristics significantly related to higher confirmed problem rates were also related to higher adjusted mortality rates in a previous study of 3,100 U.S. hospitals. The results suggest that hospital resources, including financial status, training of medical personnel, and availability of sophisticated equipment, are related to the quality of care provided by the hospital.

Bed Occupancy↗
PubMed1994

The relationship of provider organizational status and erythropoietin dosing in end stage renal disease patients.

Controversy exists as to whether provider organizational characteristics such as profit status and setting are associated with the content of medical care or efficiency with which care is rendered. Following FDA approval of human recombinant erythropoietin (EPO) for use in clinical practice, Medicare approved coverage for beneficiaries in its end stage renal disease program and established a fixed payment per dose. Because cost of EPO administration varied positively with dose, providers could realize larger profit with prescription of smaller doses. We used Medicare claims data to assess EPO use by renal dialysis providers one year after FDA approval (June 1990) as a function of provider ownership (for-profit, not-for-profit, government agency) and setting (hospital-based, free-standing). Mean dose of EPO was 236 units greater (P = 0.0001) for not-for-profit freestanding facilities, 593 units greater (P = 0.0001) for government facilities, and 555 units greater for not-for-profit hospitals (P = 0.0001) than among for-profit freestanding providers. With fixed payment per dose of EPO, for-profit, freestanding providers prescribed EPO more often and administered smaller doses than not-for-profit or government providers, behavior that is consistent with profit maximization.

Ambulatory Care Facilities↗
PubMed1996

Differentiation and specialization in the California hospital industry 1983 to 1988.

This article examines changes in the service mix of California hospitals as part of their response to shifts in the system of reimbursement between 1983 and 1988. The Hospital Discharge Data Set and the Annual Hospital Disclosure Report produced by California Office of Statewide Health Planning and Development were used in this study. Characteristics of inpatient hospital services in California before and after the introduction of new reimbursement mechanisms (including the Medicare Prospective Payment System [PPS] and the growth of selective contracting plans) were compared. The factors that influence two measures of hospital service mix, one focusing on specialization and the other on differentiation, were studied. The factors included hospital characteristics and changes in hospital reimbursement. Variables describing a hospital's service mix and the level in its market were constructed from data in the annual discharge abstracts. Data pertaining to average hospital costs and reimbursements under the Medicare PPS were drawn from a file containing a 20% sample of hospital stay records for the year of PPS. Other hospital data, such as ownership and bed size, were taken from the California Annual Disclosure Report data set. The results indicate that completion among hospitals tended to increase differentiation whereas higher financial PPS pressure is associated with increased specialization. Hospitals tend to adopt some high visibility services offered by their competitors while filling market niches selectively overall. It also appears that the cost savings expected for specialization may prevail only for narrowly defined services. Study of subsequent data sets should show whether the cost containment strategies used by the hospitals to achieve these results have been maintained over a period of sustained financial pressure.

California↗
PubMed1996

The performance of Hospital Corporation of America and Healthtrust hospitals after leveraged buyouts.

The authors examine performance changes after two leveraged buyouts (LBOs) in the hospital industry, one an employee stock ownership plan (ESOP) and the other a managed buyout (MBO). The findings show that hospitals owned by HCA, the MBO firm, and Health Trust, the ESOP firm, did not increase revenues, decrease operating expenses, or improve profitability after the LBOs, relative to other hospitals in their local markets. Nor were the numbers or salaries of employees at these facilities decreased. Although performance incentives associated with LBOs did not change performance at the hospital level, incentives to meet debt payments did result in corporate changes. More specifically, the LBOs led to corporate downsizing through the sale of hospitals and subsidiaries.

Capital Expenditures↗
PubMed1999

Grading the graders: how hospitals in California and New York perceive and interpret their report cards.

BACKGROUND: Concerns about quality of care are increasing as hospitals struggle to lower costs. Hospital report cards are controversial, but little is known about their impact. OBJECTIVES: To determine whether recent hospital report cards are viewed more favorably than pioneering federal efforts; whether a report based on clinical data is viewed more favorably than one based on administrative data; and whether attitudes toward report cards are related to hospital characteristics. DESIGN: Mailed survey of chief executives at 374 California hospitals and 31 New York hospitals listed in report cards on myocardial infarction and coronary bypass mortality. SUBJECTS: Two-hundred-and-seventy-four hospitals in California (73.3% response) and 27 in New York (87.1% response). California hospitals were categorized on ownership, size, occupancy, risk-adjusted mortality, teaching status, patient volume, and surgical capability. MEASURES: Number of hospital units that received or discussed the report card, ratings of its quality, perceptions of its usefulness, and knowledge of its methods. RESULTS: In both states, report cards were widely disseminated within hospitals. The mean quality rating was higher (P = 0.0074) in New York than in California; New York respondents appeared to be more knowledgeable about key methods. One or more hospital characteristics was associated with each outcome measure. Leaders at high-mortality hospitals were especially critical and did not find the report useful, despite limited understanding of its methods. CONCLUSIONS: Recent hospital report cards were rated better than pioneering federal efforts. A report based on clinical data was rated better, understood better, and disseminated more often to key staff than one that was based on administrative data. Barriers to constructive use of outcomes data persist, especially at high mortality hospitals.

Attitude of Health Personnel↗
PubMed2000

Influence of facility characteristics on use of antipsychotic medications in nursing homes.

OBJECTIVES: This study investigated the effect of facility and resident characteristics on the use of antipsychotic medications in the long-term care setting. RESEARCH DESIGN: This research used data available from the On-Line Survey and Certification of Automated Records (OSCAR) for all Medicare/Medicaid-certified nursing homes in the contiguous United States in 1997. The data consisted of 14,631 facilities. MEASURES: A multiple linear regression model was used to determine the effects of selected facility and resident characteristics on antipsychotic drug use while simultaneously controlling for the effects of resident characteristics and stratifying by ownership type. beta-Coefficients provided measures of effect and represented the per-unit change in the prevalence of antipsychotic use corresponding to the per-unit change in each independent variable. RESULTS: In for-profit facilities, both the presence of special care units and mental health professionals were associated with increased antipsychotic use (beta = 1.70, SE = 0.23; beta = 0.24, SE = 0.17, respectively), while other facility factors such as increasing size, being part of a chain, and higher occupancy rate were associated with decreased antipsychotic drug use. In the nonprofit environment, facility characteristics (eg, increasing occupancy rate, certified nurses' aides per 100 beds) were associated with decreasing antipsychotic use. Increasing percentages of residents covered by Medicare, those with dementia, and residents with mental retardation (beta = 0.05, SE = 0.01; beta = 0.03, SE = 0.01; beta = 0.08, SE = 0.08, respectively) were predictive of increased drug use. CONCLUSIONS: Facility and resident characteristics are associated with use of antipsychotic medications, although the extent to which these factors explain variability in use of anti-psychotics may vary on the basis of the underlying financial incentives of the institution.

Antipsychotic Agents↗
PubMed2001

Hospital conversion foundations. Issues in creation, operation, and evaluation.

A major healthcare transformation in the United States is the conversion of nonprofit hospitals to for-profit entities, and the creation of hospital conversion foundations for the nonprofit charitable assets, which now exceeds $9 billion. Because less than 21% of the 525 hospitals converting from nonprofit to for-profit ownership have established a hospital conversion foundation, the public's monetary losses are considerable. This article examines some of the key legal and organizational issues related to hospital conversion foundations including factors related to establishing fair value of the converting hospital, foundation mission, use of conversion revenue, governance, and evaluation.

Foundations↗
PubMed2003

Support for smoking cessation interventions in physician organizations: results from a national study.

OBJECTIVES: To document the extent to which physician organizations, defined as medical groups and independent practice associations, are providing support for smoking cessation interventions and to identify external incentives and organizational characteristics associated with this support. METHODS: This research uses data from the National Study of Physician Organizations and the Management of Chronic Illness, conducted by the University of California at Berkeley, to document the extent to which physician organizations provide support for smoking cessation interventions. Of 1587 physician organizations nationally with 20 or more physicians, 1104 participated, for a response rate of 70%. RESULTS: Overall, 70% of physician organizations offered some support for smoking cessation interventions. Specifically, 17% require physicians to provide interventions, 15% evaluate interventions, 39% of physician organizations offer smoking health promotion programs, 25% provide nicotine replacement therapy starter kits, and materials are provided on pharmacotherapy (39%), counseling (37%), and self-help (58%). Factors positively associated with organizational support include income or public recognition for quality measures, financial incentives to promote smoking cessation interventions, requirements to report HEDIS (Health Plan Employer Data and Information Set) scores, awareness of the 1996 Clinical Practice Guideline on Smoking Cessation, being a medical group, organizational size, percentage of primary care physicians, and hospital/HMO ownership of the organization. CONCLUSION: Physician organizations are providing support for smoking cessation interventions, yet the level of support might be improved with more extensive use of external incentives. Financial incentives targeted specifically at promoting smoking cessation interventions need to be explored further. Additionally, emphasis on quality measures should continue, including an expansion of HEDIS smoking cessation measures.

Group Practice↗
PubMed2003

A survey of gun collection and use among three groups of veteran patients admitted to veterans affairs hospital treatment programs.

BACKGROUND: An important risk factor for suicide is psychiatric illness, but only a limited amount of work has been directed at assessing the use of firearms and other weapons by select psychiatric populations at high risk for violent acts. METHOD: Patients with combat-related posttraumatic stress disorder (PTSD), patients with schizophrenia, and patients undergoing rehabilitation for substance abuse were asked to complete a weapons-use survey and measures of psychopathology. RESULTS: The PTSD patients surveyed related owning more than four times as many firearms as other subjects and reported significantly higher levels of potentially dangerous firearm-related behaviors than the other psychiatric subjects surveyed. CONCLUSION: High levels of aggression, impulsive and dangerous weapon use, and ready weapon availability may be significant factors in gun-related violence in the PTSD patient population. Additional prospective research is needed to determine whether gun ownership or certain types of weapon use in this population is associated with future acts of violence.

Adult↗
PubMed2006

Firearm-related personal and clinical characteristics of US medical students.

BACKGROUND: Firearm injuries are the second leading cause of fatal injury in the US, and several medical specialty societies encourage patient counseling about firearm injury prevention. Because personal choices. influence physicians' willingness to counsel, it would be valuable to know how frequently guns are kept in the homes of physicians-in-training, as well as their perceptions and current rates of counseling about firearm injury prevention. METHODS: At a nationally representative sample of 16 medical schools, we surveyed the class of 2003 at freshman orientation, entrance to wards, and during senior year. RESULTS: A total of 2,316 students provided data (response rate = 80.3%). Among freshmen, 16% reported living in a home with a firearm, 13% did so at entry to wards, as did 14% of seniors (14% overall, women = 9%, men = 19%). Only 34% of seniors reported counseling their patients more often than "never/rarely" about firearm possession and storage. CONCLUSIONS: US medical students reported substantially lower rates of household gun ownership than the general population, but their participation in firearm-related counseling is also low.

Adult↗
PubMed1998

Southampton University Hospitals NHS Trust: our approach to performance management.

Southampton University Hospitals Trust has developed a performance management strategy which is improving service quality, overcoming interdepartmental blockages and delivering significant savings with greater departmental ownership and commitment. The strategy also offers a solution to the age-old problem of if and when to market test by doing this only when it is apparent the inhouse team cannot deliver the required level of performance. This is achieved by agreeing the initiating key targets to reach or improve on high levels of performance using a variety of techniques including benchmarking, value management and external technical advice.

Cost Control↗
PubMed1996

A journey from bureaucracy to enterprise.

Uses the Business Development Consultancy as a case study to demonstrate how a training and development function responded to the working for patient reforms in the NHS. Offers an example of how change can be managed effectively when moving from a bureaucratic to enterprise culture. Emphasizes dealing with the human side (including the casualties of the change) and obtaining ownership of the change and focuses on how the mind set needs to shift. Highlights that change is more than implementation of a new organizational structure or set of rules. Reinforces that change is continuous and requires continual monitoring and review. Ends by stating that change from bureaucracy to enterprise may be difficult but can be achieved successfully.

Health Services Research↗
PubMed1997

The conundrum of patient records.

Examines issues and concerns surrounding the management of patient information in the form of health records, such as accessibility, privacy, security, confidentiality, ownership and eventual disposal. Discusses the effects of health reform on the management of patient information, especially regionalization in Saskatchewan, and advances in technology. Concludes that it is incumbent on health-care professionals to show leadership and set guidelines since technology will outstrip legislation.

Confidentiality↗
PubMed2004

Accountability framework for managing stakeholders of health programs.

Understanding the incentives of stakeholders and employing effective management practices with various stakeholder groups is essential for program sustainability. This paper offers a conceptual model that depicts four different types of stakeholder interests that are relevant to health service organizations. The study identified the major stakeholders of telehealth programs, compared the influence of stakeholders by organizational ownership and investigated the practices used to manage these stakeholders. Quantitative and qualitative analyses demonstrated empirical support for the stakeholder model. The paper suggests that the model can be used as a stakeholder management tool in healthcare organizations and offers an assessment of the utility of the stakeholder framework in organizational research

Health Services Administration↗
PubMed2000

Hospitals sponsored by the Roman Catholic Church: separate, equal, and distinct?

For centuries, the Catholic Church has been a major social actor in the provision of health services, particularly health care delivered in hospitals. Through a confluence of powerful environmental forces at the beginning of the twenty-first century, the future of Catholic health care is threatened. Although Catholic hospitals are a separate case of private, nonprofit hospitals, they have experienced environmental pressures to become isomorphic with other hospital ownership types and, on some dimensions, they are equal. To keep pace with the changing demands of religion and the social role of the hospital, Catholic hospitals continue to redefine themselves. To justify a distinct and legitimate social role, more research should be conducted to develop and measure indicators of Catholic identity.

Catholicism↗
PubMed2004

Do dogs resemble their owners?

We examined whether the frequent casual reports of people resembling their pets are accurate by having observers attempt to match dogs with their owners. We further explored whether any ability of observers to make such matches is due to people selecting dogs who resemble them, in which case the resemblance should be greater for predictable purebreds than for nonpurebreds, or is due to convergence, in which case the resemblance should grow with duration of ownership. Forty-five dogs and their owners were photographed separately, and judges were shown one owner, that owner's dog, and one other dog, with the task of picking out the true match. The results were consistent with a selection account: Observers were able to match only purebred dogs with their owners, and there was no relation between the ability to pair a person with his or her pet and the time they had cohabited. The ability to match people and pets did not seem to rely on any simple trait matching (e.g., size or hairiness). The results suggest that when people pick a pet, they seek one that, at some level, resembles them, and when they get a purebred, they get what they want.

Adult↗
PubMed1994

Illuminating dissertation supervision through reflection.

This paper describes a small research study designed to explore the role of the dissertation supervisor and to examine the potential of using reflection as a tool for learning and for enhancing professional educational practice. The authors met to discuss and reflect upon the processes of supervision and the role of the supervisor throughout the period of supervising three dissertation students. Each author maintained individual reflective written accounts of supervisory meetings with students. These accounts and the transcribed tape-recordings of the group meetings provided two sets of data which were analysed using qualitative techniques. From the data analysis the authors were able to identify various phases in dissertation supervision--partnership; setting the learning contract; signposting; ownership of the dissertation; letting go; the rush at the end; maintaining the balance--and also contextual issues of humanness; time; and energy, which were needed to sustain the supervisory processes. The role of the dissertation supervisor was illuminated and the potential of using reflection as a tool for developing professional educational practice was realized. The importance of constructive support while engaged in processes of reflection cannot be underestimated.

Academic Dissertations as Topic↗