Health and Medical Administration Commons^™

Getting To Zero Preventable Falls: An Exploratory Study, Kate Lim

Theses and Dissertations

Objective: The objective of this study is to examine relations between patient safety culture and processes of care, specifically, how patient safety culture influences the prevention of patient falls. The purpose of this inquiry is to identify the barriers and facilitators that can advance an inpatient rehabilitation facility to become a high reliability organization and advance interdisciplinary teamwork.

Method: A qualitative phenomenological approach was conducted and an interpretive phenomenological analysis explored the experiences of frontline staff with regard to patient safety culture and fall prevention. The study utilized semi-structured interviews with 24 frontline staff from three inpatient rehabilitation hospitals. Participants …

Inpatient Utilization Of Computed Tomography: The Influence Of Market, Hospital, And Patient Characteristics, Michael Hanshew

Theses and Dissertations

The use of computed tomography (CT) in the care of patients has grown dramatically since its introduction over 30 years ago. The vast majority of the utilization research has focused on factors associated with the variable use in the outpatient and emergency department settings. This has left much of the inpatient use and variation understudied. This study has multiple aims. The first is to characterize the inpatient variation across multiple states and markets. The second is to evaluate the relationship between inpatient CT use and commercial payers across these areas. The third is to develop a model to evaluate the …

Speech Recognition Technology: Improving Speed And Accuracy Of Emergency Medical Services Documentation To Protect Patients, Tan T. Tran

UROP Posters

Because hospital errors, such as mistakes in documentation, cause one sixth of the deaths each year in the United States, the accuracy of health records in the emergency medical services (EMS) must be improved. One possible solution is to incorporate speech recognition (SR) software into current tools used by EMS first responders. The purpose of this research was to determine if SR software could increase the efficiency and accuracy of EMS documentation to improve the safety for patients of EMS. An initial review of the literature on the performance of current SR software demonstrated that this software was not 99% …

Reducing Sepsis Mortality: A Cloud-Based Alert Approach, Janet A. Zink

Theses and Dissertations

The aim of this study is to examine the impact of a cloud-based CDS alerting system for SIRS, a precursor to sepsis, and sepsis itself, on adult patient and process outcomes at VCU Health System. The two main hypotheses are: 1) the implementation of cloud-based SIRS and sepsis alerts will lead to lower sepsis-related mortality and lower average length of stay, and 2) the implementation of cloud-based SIRS and sepsis alerts will lead to more frequent ordering of the Sepsis PowerPlan and more recording of sepsis diagnoses. To measure these outcomes, a pre-post study was conducted. A pre-implementation group diagnosed …

A Comparison Of Quality Indicators Between Medicare Accountable Care Organizations And Health Maintenance Organizations Using Publicly Available Data, William W. Campbell Iii

Theses and Dissertations

The purpose of this study is to explore differences in quality between Medicare Accountable Care Organizations (ACO) and Health Maintenance Organizations (HMO). Three outcomes measures reported by these plans use different methodologies but possess enough alignment to permit comparison: percent of diabetic patients with last HbA1c > 9.0%, colon cancer screening rate and ER visits per 1,000. These outcomes are the dependent variables (DV). A secondary purpose is to explore differences in quality based on the size of the beneficiary population served, using the same measures.

As the Medicare program faces threats to its solvency in coming decades, with 10,000 baby …

Assessing Efficiency Of Public Health And Medical Care Provision In Oecd Countries After A Decade Of Reform, Yasar A. Ozcan, Jaya Khushalani

Health Administration Publications

The objective of this study was to examine the change in efficiency of health care systems of 34 OECD countries between 2000 and 2012, a period marked by significant health reform in most OECD countries. This paper uses a novel Dynamic Network Data Envelopment Analysis (DNDEA) model to analyze the efficiency of the public health system and the medical care system of these OECD countries independently along with assessing the efficiency of their overall health system. This helps understand the relative priorities for improving the overall health system. The data for this study was obtained from the OECD Health Facts …

Determinants Of Hospital Administrators' Choice Of Anesthesia Practice Model, Maribeth L. Massie

Theses and Dissertations

Hospital administrators are being held accountable by patients, insurers, and other stakeholders in evaluating their overall hospital performance to reduce costs and improve efficiency. With the move to alternative payment models and value-based purchasing, hospital administrators must understand the economic viability and value that their specialty services bring to their facility.

The purpose of this study was to identify the determinants New England acute care hospital administrators’ utilize in making the choice of anesthesia practice model for their facility.

A quantitative, exploratory study of factors hospital administrators use when choosing an anesthesia practice model utilizing a non-experimental, correlational research design …

Racial And Ethnic Differences In Receipt Of Immediate Breast Reconstruction Surgery: Do Hospital Characteristics Matter?, Jaya Shankar Khushalani

Theses and Dissertations

Immediate Breast Reconstruction Surgery (IBRS) is associated with better quality of life among women who undergo a mastectomy. Despite insurance coverage for IBRS, utilization of IBRS remains low. Data from publicly available sources for 2010-2012 are used to examine the association between hospital characteristics receipt of IBRS by patients. Minority-serving status, low bed size, for-profit ownership, non-teaching status, high competition, low density of plastic surgeons in the market and non-metropolitan location are associated with lower likelihood of receipt of IBRS.

Racial and ethnic minorities are less likely to receive IBRS. A mixed effects logistic regression model with interactions between Black/Hispanic …

Can Plan Recommendations Improve The Coverage Decisions Of Vulnerable Populations In Health Insurance Marketplaces?, Andrew J. Barnes, Yaniv Hanoch, Thomas Rice

Health Administration Publications

Objective

The Affordable Care Act’s marketplaces present an important opportunity for expanding coverage but consumers face enormous challenges in navigating through enrollment and re-enrollment. We tested the effectiveness of a behaviorally informed policy tool—plan recommendations—in improving marketplace decisions.

Study Setting

Data were gathered from a community sample of 656 lower-income, minority, rural residents of Virginia.

Study Design

We conducted an incentive-compatible, computer-based experiment using a hypothetical marketplace like the one consumers face in the federally-facilitated marketplaces, and examined their decision quality. Participants were randomly assigned to a control condition or three types of plan recommendations: social normative, physician, and government. …

Accountable Care Organizations And Transaction Cost Economics, Stephen S. Farnsworth Mick, Patrick D. Shay

Health Administration Publications

Using a Transaction Cost Economics (TCE) approach, this paper explores which organizational forms Accountable Care Organizations (ACOs) may take. A critical question about form is the amount of vertical integration that an ACO may have, a topic central to TCE. We posit that contextual factors outside and inside an ACO will produce variable transaction costs (the non-production costs of care) such that the decision to integrate vertically will derive from a comparison of these external versus internal costs, assuming reasonably rational management abilities. External costs include those arising from environmental uncertainty and complexity, small numbers bargaining, asset specificity, frequency of …

A Comparison Of A Multistate Inpatient Ehr Database To The Hcup Nationwide Inpatient Sample, Jonathan P. Deshazo, Mark A. Hoffman

Health Administration Publications

Background

The growing availability of electronic health records (EHRs) in the US could provide researchers with a more detailed and clinically relevant alternative to using claims-based data.

Methods

In this study we compared a very large EHR database (Health Facts©) to a well-established population estimate (Nationwide Inpatient Sample). Weighted comparisons were made using t-value and relative difference over diagnoses and procedures for the year 2010.

Results

The two databases have a similar distribution pattern across all data elements, with 24 of 50 data elements being statistically similar between the two data sources. In general, differences that were found are consistent …

A Comparison Of A Multistate Inpatient Ehr Database To The Hcup Nationwide Inpatient Sample, Jonathan P. Deshazo, Mark A. Hoffman

Health Administration Publications

Background

The growing availability of electronic health records (EHRs) in the US could provide researchers with a more detailed and clinically relevant alternative to using claims-based data.

Methods

In this study we compared a very large EHR database (Health Facts©) to a well-established population estimate (Nationwide Inpatient Sample). Weighted comparisons were made using t-value and relative difference over diagnoses and procedures for the year 2010.

Results

The two databases have a similar distribution pattern across all data elements, with 24 of 50 data elements being statistically similar between the two data sources. In general, differences that were found are consistent …

Procalcitonin Identifies Cell Injury, Not Bacterial Infection, In Acute Liver Failure, Jody A. Rule, Linda S. Hynan, Nahid Attar, Corron Sanders, William J. Korzun, William M. Lee, Acute Liver Failure Study Group

Health Administration Publications

Background

Because acute liver failure (ALF) patients share many clinical features with severe sepsis and septic shock, identifying bacterial infection clinically in ALF patients is challenging. Procalcitonin (PCT) has proven to be a useful marker in detecting bacterial infection. We sought to determine whether PCT discriminated between presence and absence of infection in patients with ALF.

Method

Retrospective analysis of data and samples of 115 ALF patients from the United States Acute Liver Failure Study Group randomly selected from 1863 patients were classified for disease severity and ALF etiology. Twenty uninfected chronic liver disease (CLD) subjects served as controls.

Results …

Measuring The Impact Of Recognized Patient-Centered Medical Homes (Pcmh), Rick Moore

Theses and Dissertations

This dissertation proposal seeks to understand if the increasingnumbers (density) of recognized PCMH practices incommunities affect avoidable hospitalizations related toambulatory care sensitive conditions (ACSC), as measured bythe AHRQ Composite Prevention Quality Indicators (PQI). Theresearch has two purposes: 1. Establish constructs and hypotheses to measurethe effect of the increasing numbers of NCQA-Recognized PCMH practices in communities(counties). 2. Using an outcomes-based measurement approach,investigate the relationship between growingdensities of NCQA-Recognized PCMH practicedoctors among all primary care doctors (PCD) ina community and the associated impact on theutilization of inpatient care, specifically related toACSCs, as measured by the AHRQ CompositePQIs.

The research is quasi-experimental in …

Changes In Malaria Prevention And Incidence Due To Political Restructuring Of Mozambique And South Africa, Nirmala K. Shivakumar

UROP Posters

The UN’s current Millennium Development Goal puts pressure on many countries to decrease malaria incidence by 2015, including Mozambique and South Africa. While Mozambique and South Africa have continually worked to decrease malaria incidence for the last five decades, neither country can claim elimination of disease by UN standards. This study analyzes the changes in political structure and the simultaneous changes in the malaria prevention programs of Mozambique and South Africa after the end of their respective civil wars in 1992 and 1994. This study analyzed public health, historical, and social science journal articles. This study examined political power distribution, …

Barriers And Disparities In Emergency Medical Services 911 Calls For Stroke Symptoms In The United States Adult Population: 2009 Brfss Survey, Munseok Seo, Charles Begley, James R. Langabeer, Jami L. Dellifraine

Health Administration Publications

Introduction: This study examines barriers and disparities in the intentions of American citizens, when dealing with stroke symptoms, to call 911. This study hypothesizes that low socioeconomic populations are less likely to call 911 in response to stroke recognition. Methods: The study is a cross-sectional design analyzing data from the Centers for Disease Control’s 2009 Behavioral Risk Factor Surveillance Survey, collected through a telephone-based survey from 18 states and the District of Columbia. The study identified the 5 most evident stroke-warning symptoms based on those given by the American Stroke Association. We conducted appropriate weighting procedures to account for the …

Nursing Home Organizational Characteristics And Utilization Of Cancer-Related Medical Services, Chun-Chieh Lin

Theses and Dissertations

Cancer is the second leading cause of death in the U.S and is more common among the elderly. Since frailty and other age related conditions put the elderly at risk for nursing home care, nursing homes may be the site of care and death for many elderly cancer patients. However, there is a large gap in knowledge concerning cancer treatment of elderly nursing home residents. Since residents rely heavily on their nursing facilities, nursing homes might influence them in their treatment decisions. After controlling for resident and nursing home market characteristics, this study applies Andersen’s Behavioral Model to examine whether …

The Impact Of A Coordinated Care Program On Uninsured, Chronically Ill Patients, Jennifer Neimeyer

Theses and Dissertations

This study explored how being enrolled in a program that both coordinates patient care and provides a medical home changes health care utilization for uninsured patients, more specifically those persons with chronic conditions, through the use of the Chronic Care Model and Andersen and Aday’s Behavioral Model for Access to Health Care. Uninsured patients typically seek out care in a fragmented manner, which may lead to ineffective and inefficient care, especially for conditions that may require ongoing treatment and monitoring such as chronic conditions. The methodology used to examine the relationship between the interaction of enrollment and chronic condition status …

The Impact Of Medicaid Disproportionate Share Hospital Payment On The Provision Of Hospital Uncompensated Care And Quality Of Care, Hui-Min Hsieh

Theses and Dissertations

Medicaid Disproportionate Share Hospital (DSH) payment is one of the major funds supporting health care providers as they treat low-income patients. However, Medicaid DSH payments have been targeted for major budget cuts in many health policy reforms. This study examines the association between the changes in Medicaid DSH payments resulting from the BBA policy changes and hospital outcomes, in terms of hospital provision of uncompensated care and quality of care. Economic theory of non-profit hospital behavior is used as a conceptual framework, and longitudinal data for California short-term, non-federal general acute care hospitals for 1996-2003 are examined. California was especially …

A Longitudinal Examination Of How Hospital Provision Of Home Health Services Changed After The Implementation Of The Balanced Budget Act Of 1997: Does Ownership Matter?, Tiang-Hong Chou

Theses and Dissertations

By using a natural experiment approach and longitudinal national hospital data, this study sheds light on the objective functions of hospitals with different ownership forms by comparing their relative reductions in HH provision after the implementation of the BBA. The empirical findings reveal that for-profit hospitals behave differently as compared to public and private nonprofit hospitals, due to their different operational objectives. While the response of for-profit hospitals is consistent with the profit-maximizer model, both public and private nonprofit ownership types behave consistently in accordance with the model of two-good producers whose objective is to maximize market outputs for meeting …

Determinants Of Nursing Home Performance: Examining The Relationship Between Quality And Efficiency, Nailya Delellis

Theses and Dissertations

Determinants of nursing home performance: examining the relationship between quality and efficiency By Nailya O. DeLellis, MPH, Ph.D. A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy at Virginia Commonwealth University. Virginia Commonwealth University, 2010 Director: Dr. Yasar Ozcan, Professor, Department of Health Administration To assess the relationship between quality of care and efficiency of nursing homes this study used 10% random sample of non-hospital based nursing homes of size 20-360 beds and occupancy rate of 5-100% in OSCAR database 2008 (n=1430). Data Envelopment Analysis was used to calculate efficiency score and Structural …

The Effect Of Pediatric Hospital Specialization On Patient Safety And Effectiveness Of Care, James Mitchell Harris Ii

Theses and Dissertations

Provider specialization is an area of interest in health care as patients, payers and policy makers are now demanding better performance and demonstrated proof of the benefits of specialization. While previously ignored in the specialization debate, now even the hospitals focusing on pediatric care (i.e. children's hospitals) are experiencing pressure to demonstrate their value. The current study attempts to answer the questions: do hospitals specializing in pediatric care provide better quality pediatric inpatient care; and do they do so for differing types of patient outcomes and across different levels of care complexity? Contingency Theory is used to develop and assess …

Factors Associated With The Provision Of Coronary Heart Disease Preventive Careservices, Patricia Carcaise-Edinboro

Theses and Dissertations

The Anderson and Aday access framework (1974) is utilized to investigate the association of individual and community level, predisposing, socio-demographic, and enabling factors, on potential and realized access to coronary heart disease (CHD) preventive care. The cross-sectional study is based on a sample of adults age 18-85 from the Medical Expenditure Panel Survey (MEPS) who were identified with CHD risk or who had a CHD diagnosis.Variables from the MEPS and the Area Resource File (ARF) are used to test logistic regression models for dependent variables measuring primary and secondary CHD preventive care services. The primary preventive care measures include blood …

Factors Associated With Hospital Commitment To Provide Child/Adolescent Psychiatric Services, Lea Anne Gardner

Theses and Dissertations

General acute care hospitals play a particularly important role in the delivery of children's mental health given the extant lack of alternatives to long term hospitals for patients requiring a restrictive treatment environment (Glied and Cuellar, 2003). This cross-sectional study identifies environmental and organizational factors associated with general acute care and children's hospitals in the United States that provide hospital-based child/adolescent psychiatric services and the number of services. Two macro-level theories, Resource Dependence Theory and Institutional Theory were used to identify environmental and organizational factors. A nationwide sample of hospitals was drawn from the 2003 AHA annual survey. Data from …

An Evaluation Of Hospital Capital Investment After The Balanced Budget Act, Tae Hyun Kim

Theses and Dissertations

Capital investments in the latest medical equipment and the replacement of aging facilities are important hospital decisions because they may have a significant influence on operating efficiencies and quality of care. However, hospitals experienced a minimal growth rate in capital expenditures which contributed to the aging of the hospital industry's asset base during the late 1990's and early 2000's. One of the underlying reasons behind this lack of growth might be the financial stresses that hospitals were facing after the Balanced Budget Act (BBA) of 1997, which significantly reducedMedicare reimbursement and had an adverse impact on the financial viability of …

Determinants Of Care Seeking For Persons With Low Back And Neck Pain Treated By Physicians, Chiropractors Or Physical Therapists, Julia Chevan

Theses and Dissertations

Low back and neck pain are frequent reasons for adults to seek healthcare. Three types of practitioners are commonly used in the United States: physicians, chiropractors and physical therapists. In this study, Andersen's "Behavioral Model of Health Services Utilization" is used to examine care seeking and provider selection. Estimates of back and neck pain prevalence in the United States are presented as well as care seeking rates and care consumption estimates for patients who used the three providers of interest. Multivariate regression analyses are presented that model the variables that most influence care seeking and provider selection.Cases with the conditions …

Electronic Medical Records In Acute Care Hospitals: Correlates, Efficiency, And Quality, Abby Jo Swanson

Theses and Dissertations

The purpose of this dissertation is to examine the organizational and environmental correlates of hospital EMR use and to examine the relationship between hospital EMR use and performance. Using a theoretical framework that combines resource dependence theory with Donabedian's structure, process, outcome model, a conceptual model is created. To test the hypotheses of this model, logistic regression and Data Envelopment Analysis (DEA) are used. The data included in this analysis come from the AHA, HIMSS, CMS, ARF, and HQA. In the analysis of hospitals correlates of EMR use, three hypotheses were supported, and one was partially supported. Hospital system affiliation, …

The Determinants Of Hospital Adoption And Expansion Of Bariatric Procedures: A Resource Dependence Perspective, Wenquiang Tian

Theses and Dissertations

New medical technologies have been viewed as the primary cause of rising health are expenditures by health policy researchers in the United States. Since the mid 1990s, with the prevalence of obesity among Americans, the utilization of bariatric surgery, a medical innovation, has increased rapidly among U.S. hospitals. Generally, current literature only states that the volume of bariatric procedures is increasing dramatically.Very limited studies have been conducted to investigate the growth of bariatric procedures.The objective of this study is (1) to provide a detailed description about the adoption and utilization of bariatric procedure in hospitals in 11 states, and (2) …

Information Technology Outsourcing In U.S. Hospital Systems, Mark L. Diana

Theses and Dissertations

The purpose of this study was to determine the factors associated with outsourcing of information systems (IS), and if there is a difference in IS sourcing based on the strategic value of the outsourced functions. The theoretical framework is based upon a synthesis of strategic management theory (SMT) and transaction cost economics (TCE) as they apply to vertical integration in the health care sector; therefore, IS sourcing behavior was conceptualized as a case of vertical integration. The conceptual model proposed that sourcing behavior would be determined by asset specificity, uncertainty, the interaction of asset specificity and uncertainty, bargaining power, corporate …

A Determination Of The Association Of Competition And Regulation With Hospital Strategic Orientation, Kathleen B. Heatwole

Theses and Dissertations

This research study examines the influence of two major forces, competition and regulation, on the strategic orientation of hospitals. This is a particularly relevant subject, as the effectiveness of competition versus the effectiveness of regulation in the health care market has been called one of the Bellwether issues in health care policy, and the most controversial and far reaching philosophical battle facing the health care industry. Even after three decades of research and debate, there is still no consensus on how the hospital industry responds to either a competitive environment or a regulated environment. There continues to be significant variation …