Health and Medical Administration Commons^™

Super-Utilization: The New Perfect Storm Of Health Reform, Jill Diane Nault

Theses and Dissertations (ETD)

This three-essay dissertation was focused on geographic variation of super-utilization, or the disproportionately high healthcare utilization and costs attributed to a small sub-set of the inpatient population. For purposes of this research, super-utilization was operationalized as high repeat utilization (HRU) and referred to inpatient utilization and inpatient readmission expenditures attributed to beneficiaries with four or more 30-day readmissions per year. The overall purpose of the research was to identify geographic areas at increased risk for HRU. These areas corresponded to where beneficiaries live and were aligned with the geographically-bound healthcare delivery systems. Each essay employed an observational study design using …

Population Health Improvement Through Coordination Of Care, Trevey Davis

Muskie School Capstones and Dissertations

The objective of this Capstone Project is to work with the Mercy Gap in Care Coordinators (GCCs) to document the value of the care coordination at Mercy Health System. A key element of this project was to develop a workflow diagram alongside the GCC in order to track patient outcomes. Additionally, the team developed a system for documenting patient outcomes that is crucial to measuring the impact of care coordination. From the data collected there are a number of outcomes that can be measured. The number of patients who are contacted for screening is measurement of patient experience. Following initial …

Implementing A Good Catch Program In Nursing Homes, Leigh Raposo

Muskie School Capstones and Dissertations

Rationale and processes for reporting near misses and evidence-based tools were collected by a literature search, seminal works by Sidney Dekker and James Reason, and websites for the Agency for Healthcare Research and Quality (AHRQ), the Institute for Healthcare Improvement (IHI), and the Centers for Medicare and Medicaid Services (CMS). Tools, information, and strategies found in this research were evaluated for implementation in Maine nursing homes. The tools provide a communication vehicle for nursing home staff to safely report to management near misses, or mistakes that do not harm residents. To emphasize a positive approach, the project replaces the term …

The Story Of Emily, Lori L. Jennings Ms, Barb O'Neil, Kim Bossy, Denise Dodman, Jill Campbell

Patient Experience Journal

This case study describes Bluewater Health’s quest to weave the philosophy and practice of patient and family-centered care from the boardroom to the bedside by introducing Emily. Emily’s image is a composite of photographs of staff, physicians, volunteers, patients and families exemplifying that each has a role in Emily’s care. Emily represents every patient and family of the past, present, and future. Emily’s journey started with the launch of Bluewater Health‘s 2013-2015 strategic plan and moved throughout the organization as patient councils were established and the organization embedded three foundational patient and family-centered RNAO Best Practice Guidelines into daily practice …

Impact Of Logo Wear On Provider Perception Of Patient, Bill R. Gombeski Jr

Patient Experience Journal

Patient’s appearance affects provider perception of patients and subsequent provider behavior. Based on anecdotal information, it was hypothesized that wearing a health organization’s brand would result in a more positive perception of a patient by providers and subsequently a better patient experience. A study of 121 individuals with patient contact was conducted. Using photos of patients with and without a health care brand on their shirts, study subjects rated the attractiveness and willingness to engage with photos of patients. Patients with a Mayo brand and UK HealthCare brand showed some significant positive attractiveness over the same patient without the brand. …

Developing Approaches To The Collection And Use Of Evidence Of Patient Experience Below The Level Of National Surveys, Elizabeth J. Gibbons, Chris Graham, Jenny King, Kelsey Flott, Crispin Jenkinson Professor, Raymond Fitzpatrick Professor

Patient Experience Journal

National approaches to collecting patient feedback provide trust level information which although can provide a benchmark for trusts often doesn’t provide information about specific services or patients experiences of pathways of care. This more granular level of data could be more informative for local service development and improvement. This research explored the feasibility and usefulness of such approaches. A conceptual model and standard questionnaire of patient experience was developed that might work across a range of services and pathways of care. Seven trusts were recruited as collaborating sites in which the model and survey instrument was tested. These were from …

Impact Of Hospital Diagnosis-Specific Quality Measures On Patients’ Experience Of Hospital Care: Evidence From 14 States, 2009-2011, Emily M. Johnston, Kenton J. Johnston, Jaeyong Bae, Jason M. Hockenberry, Arnold Milstein, Edmund Becker

Patient Experience Journal

In order to assess consistency across quality measures for Untied States hospitals, this paper uses patient responses to the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey for three years (2009-2011) from 1,333 acute-care hospitals in fourteen states to analyze patterns in hospital-reported patient experience-of-care scores by diagnosis-specific process and outcome measures for acute myocardial infarction, heart failure, and pneumonia. We also evaluate how scores have changed over the three-year period. We find significant differences in patient experience-of-care scores for 195 out of 230 relationships between HCAHPS patient experience-of-care scores and 23 diagnosis-specific process and outcomes measures. We …

Patient Perceptions Of An Aidet And Hourly Rounding Program In A Community Hospital: Results Of A Qualitative Study, Tosha Allen, Tyne Rieck, Stacie Salsbury

Patient Experience Journal

Quantitative evidence links patient satisfaction scores to the use of communication strategies such as AIDET (Acknowledge, Introduce, Duration, Explanation, and Thank you) and Hourly Rounding. However, little is known about patient perceptions of these tools in regards to their hospital experience. Qualitative interviews were conducted with a convenience sample of 14 adult medical/surgical inpatients in one mid-sized, community hospital, following hospital discharge. The interview data was transcribed and opened coded, utilizing constant comparison to identify common themes. Themes emerged in four topical areas: (a) patient experience of hospitalization, (b) AIDET, (c) Hourly Rounding, and (d) unexpected findings. Patients placed significant …

Does She Think She’S Supported? Maternal Perceptions Of Their Experiences In The Neonatal Intensive Care Unit, Emily A. Lilo, Richard J. Shaw, Julia Corcoran, Amy Storfer-Isser, Sarah M. Horwitz

Patient Experience Journal

Parents’ involvement in the care of their infants in the neonatal intensive care unit (NICU) is critically important, leading many NICUs to implement policies and practices of family-centered care (FCC). Analyzing narrative interviews, we examined whether mothers of premature infants who participated in an intervention to help reduce anxiety, stress, and depression felt that their NICU experience reflected four key nursing behaviors previously identified as being necessary to achieving FCC. Fifty-six narratives derived from semi-structured interviews with the mothers were analyzed qualitatively and quantitatively to examine whether the women experienced emotional support, parent empowerment, welcoming environment, and parent education, as …

A Call To Excellence In Patient Experience, Geoffrey A. Silvera

Patient Experience Journal

In this address, the incoming associate editor describes his early experience with the Patient Experience Journal (PXJ) and issues a call to action to the PXJ community. In the call to action, the PXJ community is asked to build upon our collective history of scholastic and practical excellence. The combination of practical relevance and methodological rigor in our contributions will help to ensure a future in which patient experience is paramount in health service delivery conversations. In addition, gaps in the patient experience literature and emergent opportunities for theoretical and practical contributions are recommended.

Patient Experience: Driving Outcomes At The Heart Of Healthcare, Jason A. Wolf Phd

Patient Experience Journal

There is no longer a question that patient experience matters in healthcare today. It matters for those that are cared for and served and matters to all those working each and every day to provide the best in care at all touch points across the healthcare continuum. With this recognition, there too needs to be a change in mindset about patient experience itself. When addressing the topic of patient experience, the conversation is about something much broader than the “experience of care”, as identified in the triple aim. The idea of experience reflects our biggest opportunity in healthcare, where experience …

Measuring Progress To Comprehensive Public Health Systems, National Preparedness, And A Culture Of Health, Glen P. Mays

Health Management and Policy Presentations

This update describes recent progress on two national health measurement initiatives: The National Health Security Preparedness Index and the National Longitudinal Survey of Public Health Systems. These longitudinal data sources offer valuable perspectives on how health security practices and public health delivery systems are changing across the U.S.

Learning From Variation And Change: The 2016 Release Of The National Health Security Preparedness Index, Glen P. Mays

Health Management and Policy Presentations

The 2016 release of the National Health Security Preparedness Index uses an improved computational methodology and validated set of measures to more accurately track national and state progress in protecting the public from the health effects of disasters, outbreaks and other large-scale emergencies. This presentation provides a preview of the new methodology and results.

Understanding The Value Of Multi-Sector Partnerships To Improve Population Health, Glen P. Mays

Health Management and Policy Presentations

We review recent research concerning multi-sectoral partnerships aimed at improving health status on a population-wide basis, with a particular focus on implementation strategies and on health and economic impact. While still preliminary and emerging, research indicates that large health benefits are possible through collective actions that engage the medical, public health, and social sectors. Mechanisms for aligning incentives, dividing responsibilities equitably, and measuring progress regularly appear critical to success.

Measuring Comprehensive Public Health Delivery Systems And Their Contributions To Population Health, Glen P. Mays, Rick Ingram

Health Management and Policy Presentations

We review methods for measuring the structure of public health delivery systems using data from the National Longitudinal Survey of Public Health Systems. A growing body of research using these measures demonstrates how multiple sectors contribute to core public health functions, and how these functions influence community health status over time. We end with a summary of how the Comprehensive Public Health System measure will be used in monitoring the impact of the 21st Century Public Health System initiative.

User Acceptance Of Neurology Telemedicine Technology In The Emergency Department, Teresa W. Mcneil

Applied Research Projects

There is currently a significant shortage of trained neurologists in the country. In addition to the shortfall of neurologists, there is an increasing need for this specialty due to an aging population, increase in the incident of neurologic diseases and an increasing demand for healthcare (Freeman, 2013). The development of tele neurology technology has been shown to help address these problems. As with any new technology there are multiple barriers to overcome, one of those being user acceptance of the technology. A survey of users of the telemedicine product VGo was conducted at Hunt Regional Medical Center to access the …

Factors Influencing The Variation In Gms Prescribing Expenditure In Ireland, Aisling Conway Lenihan, S. Ahern, J. Cronin, N. Woods

Dept. of Management & Enterprise Publications

Background

Pharmaceutical expenditure growth is a familiar feature in many Western health systems and is a real concern for policymakers. A state funded General Medical Services (GMS) scheme in Ireland experienced an increase in prescription expenditure of 414 % between 1998 and 2012. This paper seeks to explore the rationale for this growth by investigating the composition (Anatomical Therapeutic Chemical (ATC) Group level 1 & 5) and drivers of GMS drug expenditure in Ireland in 2012.

Methods

A cross-sectional study was carried out on the Health Service Executive-Primary Care Reimbursement Service (HSE-PCRS) population prescribing database (n = 1,630,775). Three …

Aligning Delivery & Financing Systems To Advance A Culture Of Health, Glen P. Mays

Health Management and Policy Presentations

The Robert Wood Johnson Foundation's Systems for Action Research Program supports research on how best to organize, finance, and deliver the constellation of services and supports that promote health and well-being in American communities, including but extending beyond the medical care and public health sectors. This session describes work underway through the S4A program and future research priorities, building on a strong scientific foundation in the fields of health services research (HSR) and public health services & systems research (PHSSR).

Integrating Health Services & Systems: What We Know, Think We Know, And Need To Learn, Glen P. Mays

Health Management and Policy Presentations

The delivery and financing systems for medical care, public health, and social and community services pursue many common goals and serve overlapping groups of families and communities. Unfortunately, in most American communities these systems interact in complex and often poorly understood ways through fragmented funding vehicles, information flows, governance and decision-making structures, institutional relationships, implementation rules and strategies, and professional and interpersonal connections. New research approaches are required to untangle these interactions and expose novel pathways of influence that can support equitable improvements in service delivery, resource use, health impact, and wellbeing. This presentation will summarize evidence from recent studies …

Measuring Multi-Sector Contributions To Public Health Delivery Systems & Population Health, Glen P. Mays

Health Management and Policy Presentations

The National Longitudinal Survey of Public Health Systems has followed a nationally-representative cohort of U.S. communities since 1998 to measure the scope of public health activities implemented in each community and the range of organizations and sectors that contribute to each activity. With 16 years of follow-up observations, this survey allows us to study the effects of demographic, economic, and policy shocks on public health delivery systems, and estimate the health effects attributable to delivery system change.

Racial And Ethnic Disparities In Health Care: An Examination Of State Inpatient Databases In The Utilization Of And Outcomes Following Total Knee Arthroplasty, Alexis W. Lan, Wei Zhang, Yan Ma

GW Research Days 2016 - 2020

Title: Racial and Ethnic Disparities in Health Care: An Examination of State Inpatient Databases in the Utilization of and Outcomes following Total Knee Arthroplasty

Background: The U.S. population is becoming more racially and ethnically diverse yet disparities in health care still exist. One area of medical care in which racial disparities have been identified is total knee arthroplasty (TKA)¬—an efficacious and cost-effective treatment option for individuals with advanced arthritis of the knee. Previous studies have documented that racial and ethnic minorities tend to have higher rates of adverse health outcomes and face more barriers utilizing the procedure. However, these studies …

Measuring Comprehensive Public Health Delivery Systems And Their Contributions To Population Health, Glen P. Mays

Health Management and Policy Presentations

Delivery and financing systems for public health services vary widely across U.S. communities, raising questions about the comparative effectiveness and efficiency of alternative structures. We summarize recent approaches for measuring alternative system configurations and estimating their health and economic effects.

Analisis Pelayanan Kemoterapi Peserta Badan Penyelenggara Jaminan Sosial Di Rawat Singkat Anyelir Rumah Sakit Kanker “Dharmais” Dengan Metode Lean Tahun 2015, Agung Julipriohadi

Jurnal ARSI : Administrasi Rumah Sakit Indonesia

Rumah Sakit Kanker “Dharmais” (RSKD) as a cancer referral centers nationwide in Indonesia, trying to implement a culture of continuous improvement. Lean methods provide analytical approach to the problem of organizing the queue chemotherapy participant of Badan Penyelenggaran Jaminan Sosial (BPJS), particularly in Anyelir ward (One Day Care). Cross-functional Flowchart, Value Stream Mapping, Fishbone diagram, and 5 Why's were used to show the situation and identify activities that Value Added and Non-Value Added based on the patient's perspective. With the proposed improvements, Projected Value Perfomance showed increased activity efficiency up to 43,1%, save the time up to 48%, and cut …

Analisis Kebutuhan Tenaga Perawat Unit Pelayanan Intensif Berdasarkan Beban Kerja Dan Kompetensi Di Unit Pelayanan Intensif Rumah Sakit Dr Oen Solo Baru Tahun 2015, Antonny Halim Gunawan

Jurnal ARSI : Administrasi Rumah Sakit Indonesia

Nurses, as human resources for health also contribute greatly to the health services in hospitals and to provide services directly to patients. Nursing services at Intensive Care Unit has to be developed along with the technology development. Therefore, there is a need to concern the effieciency of nurses in term of quantity and competencies. This research discussed about the needs analysis nursing staff in the Intensive Care Unit of dr. Oen Solo Baru Hospital based on workload (using time and motion technique to 7 nurses then processed by Ilyas Methods) and work competencies based on Aditama 2007 and Ilyas (depth …

Penyusunan Rencana Strategis Rumah Sakit Pertamina Jaya Tahun 2017-2022, Budi Karmawan

Jurnal ARSI : Administrasi Rumah Sakit Indonesia

The focus of this study is how to develop strategic planning for hospitals, with case studies of Pertamina Jaya Hospital which is a class C private hospital. This research is qualitative research with descriptive design. The results showed that environmental factors both external as well as internal hospital put the Pertamina Jaya Hospital on the position of Growth and Build on IE Matrix and Internal Fix-It on TOWS Matrix. An alternative strategy is doing market penetration accompanied improvements in hospital weaknesses to capture opportunities. Implementation plan was drawn up in order to be in line with the achievement of Hospital …

Analisis Efektivitas Biaya Laparoskopik Herniotomy Dan Open Herniotomy Pada Pasien Hernia Inguinalis Unilateral Di Rumah Sakit Gading Pluit Jakarta Utara Tahun 2014, Dewi Saputra Tjitra

Jurnal ARSI : Administrasi Rumah Sakit Indonesia

This thesis is an economic evaluation with a cross sectional quantitative method design, observational and using comparative studies between two herniotomy techniques. The aim of this thesis is to analyze the cost effectiveness between patients with Laparoscopic Herniotomy and patients with Open Herniotomy of the inguinal hernia. This research is using Activity Based Costing with simple distribution to achieve total cost and then compared with the output, therefore cost effectiveness ratio (CER) is achieved. The CER is then compared to understand which is the lesser cost therefore is more effective. The research result shows that Open Herniotomy gives a smaller …

Faktor-Faktor Yang Berhubungan Dengan Motivasi Kerja Pegawai Tetap Di Rumah Sakit Umum Daerah Kabupaten Penajam Paser Utara Kalimantan Timur Tahun 2014, Sisvana Damayanti

Jurnal ARSI : Administrasi Rumah Sakit Indonesia

The study aims to determine the relationship between the characteristics of a permanent employee, factors satisfiers and dissatisfiers factors on employee motivation remains in District General Hospital North Penajam Paser. The study was conducted in May and June 2014 using a questionnaire with closed questions. Analyses were performed quantitative approach with a cross-sectional study design. The sample of the study was 138 from 181 people of the total population. The results of this study indicate that as many as 57,2% of respondents have less motivation to work better, and 42,8% of respondents have a good motivation to work, as well …

Analisis Faktor-Faktor Yang Berhubungan Dengan Keinginan Pindah Kerja Perawat Rumah Sakit X Balikpapan Tahun 2014, Susila Indrayani

Jurnal ARSI : Administrasi Rumah Sakit Indonesia

This is a descriptive analytical study with quantitative and qualitative design aim to descripe and analysis factors related to move out of nurses at the X hospital Balikpapan. The study collected using questionnaire to 199 nurses, followed by in-depth interviews to 5 senior management, 1 chief ward and 1 secretary of nursing committe of hospital. Career development, compensation, and communication are the mean factors related to the intention to move out, communication is the most factor influencing the intention to move out. Qualitative methode validated the important communication between the management and the nurses which is not in a good …

Pengembangan Model Instrumen Penilaian Kinerja Dokter Spesialis Obsgyn Melalui Analisis Kinerja Di Rumah Sehat Ibu Dan Anak Budi Kemuliaan, Titi Setyorini

Jurnal ARSI : Administrasi Rumah Sakit Indonesia

The purpose of this studyis to develop an instrument that appropriate to measured Obstetrician and Gynecologist performance in Budi Kemuliaan Hospital through Performance Analysis. Descriptive study with qualitative method aims to constructed a Performance Appraisal’s Instrument. A convenience Informan of Obstetrician and Gynecologists and stakeholders in Budi Kemuliaan Hospital participated in this study. This study successfully developed a valid method to constructed a Performance Appraisal’s Instrument in Budi Kemuliaan Hospital by using Nominal Group Technique Method. A performance appraisal’s instrument contains 8 (eight) specific measurable criteria for Obstetrician and Gynecologists using the JCAHO’s six competencies to evaluated Medical Doctors performance …

Hospital Discharge Planning In Medicare: Current Requirements And Proposed Changes, Sally Coberly

National Health Policy Forum

Medicare's specific minimum health and safety standards for hospitals, known as conditions of participation, include requirements for discharge planning for patients who need such services. Discharge planning is intended to ensure smooth transitions from hospital to home or other health care facility. This publication reviews the current discharge planning requirements for hospitals as well as changes included in a proposed rule published by the Centers for Medicare & Medicaid Services on November 3, 2015. Key proposed changes include an expanded definition of which patients must receive discharge planning services, a requirement that providers responsible for follow-up care receive timely …