Health and Medical Administration Commons^™

What Cost Hospital Quality: Performance Uncertainty Under Market Reform, Ronald L. Fisher

Theses and Dissertations

Healthcare is an organizational field that has undergone profound change in the last few decades, an era characterized by market reform. Healthcare production has revealed both economic and quality problems in past eras, and reporting on these problems can be seen to have contributed to pressures for social reform. Yet, the move toward more market-oriented governance structures and design solutions also reflects a wider isomorphic institutional tendency for organizing social order.The conceptual frame work of this study takes a pessimistic stance on whether the market reform has achieved the intended goals with respect to advancing organizational quality performance. The framework …

Hospitals' Decision To Vertically Integrate Skilled Nursing Units Before And After The Balanced Budget Act, Betty C. Lucente

Theses and Dissertations

The decision to vertically integrate services and deliver care has both management and policy concerns for healthcare in the United States. The change in reimbursement, which was enacted with the Balanced Budget Act of 1997, influenced the availability of post acute services for acute hospital inpatients. Prior to this change, post acute services were reimbursed based on cost similar to the pre DRG era of Medicare reimbursement. The change in payment had the potential to make discharging patients more difficult resulting in a prolonged length of stay without additional payment and at increased costs for hospitals. As a result of …

Influence Of Organizational, Operational, Financial Andenvironmental Factors On Hospitals' Adoption Of Computerized Physician Order Entry Systems For Improving Patient Safety: A Resource Dependence Approach, Imre Solti

Theses and Dissertations

This study examines specific organizational, operational, financial and environmental characteristics to identify factors that are associated with increased likelihood of hospitals' CPOE adoption decision in six rollout regions of the Leapfrog initiatives.Resource dependence theory provides theoretical basis for the study. The study is retrospective observational in design. Individual hospitals are the unit of analysis. The Leapfrog Group's 2002-survey collection serves the primary data source. Univariate statistical methods along with bivariate and ordinal logistic regression models are used to analyze the data. The models provided support for multiple hypotheses for both the adoption and early adoption decisions of study hospitals. The …

Variations In Quality Outcomes Among Hospitals In Different Types Of Health Systems, Askar S. Chukmaitov

Theses and Dissertations

Although prior research has found differences in costs and financial performance across different types of hospital systems, there has been no systematic study of variations in patient quality of care or safety indicators across different systems. Our study examines whether five main types of health systems - centralized (CHS), centralized physician/insurance (CPIHS), moderately centralized (MCHS), decentralized (DHS), and independent (IHS) - as well as other hospital characteristics are associated with differences in quality of patient care. Data were assembled for 6 years (1995 - 2000) from multiple sources. We used 4 AHRQ risk adjusted inpatient quality indicators (IQIs) and 5 …

A National Survey Of The Arrangements Managed-Care Plans Make With Physicians, Marsha R. Gold , Sc.D., Robert Hurley , Ph.D., Timothy Lake , M.P.P., Todd Ensor, Robert Berenson , M.D.

Health Administration Publications

Abstract

Background. Despite the growth of managed care in the United States, there is little information about the arrangements managed-care plans make with physicians.

Methods. In 1994 we surveyed by telephone 138 managed-care plans that were selected from 20 metropolitan areas nationwide. Of the 108 plans that responded, 29 were group-model or staff-model health maintenance organizations (HMOs), 50 were network or independentpractice–association (IPA) HMOs, and 29 were preferred-provider organizations (PPOs).

Results. Respondents from all three types of plan said they emphasized careful selection of physicians, although the group or staff HMOs tended to have more demanding requirements, …

A Causal Model Of Hospital Volume, Structure And Process Indicators, And Surgical Outcomes, Myra Boles

Theses and Dissertations

This research developed and tested a conceptual model to explain why higher volumes of certain surgical procedures lead to better patient outcomes. The model incorporated hospital structural characteristics and process of care indicators to explain the volume-outcome relationship. The volume-outcome relationship was further examined longitudinally to determine stability over time and to substantiate the causality implied by the conceptual model.

A sample (n=1752) of acute-care, general hospitals was selected from hospitals that performed, in 1990, at least one surgical procedure on Medicare patients of the following: reduction of hip fracture, cholecystectomy, hip replacement, carotid endarterectomy, and pacemaker insertion. For the …

Transmission Of Human Immunodeficiency Virus Type 1 From A Seronegative Organ And Tissue Donor, R.J. Simonds , M.D., Scott D. Holmberg M.D., M.P.H., Richard L. Hurwitz , M.D., Theresa R. Coleman , B.A., Scott Bottenfield , R.N., Lois J. Conley , M.T., M.P.H., Sherry H. Kohlenberg , M.H.A., Kenneth G. Castro , M.D., Beverley A. Dahan , B.A., Charles A. Schable , M.S., Mark A. Rayfield , Ph.D., Martha F. Rogers , M.D.

Health Administration Publications

Abstract

BACKGROUND

Since 1985, donors of organs or tissues for transplantation in the United States have been screened for human immunodeficiency virus type 1 (HIV-1), and more than 60,000 organs and 1 million tissues have been transplanted. We describe a case of transmission of HIV-1 by transplantation of organs and tissues procured between the time the donor became infected and the appearance of antibodies. The donor was a 22-year-old man who died 32 hours after a gunshot wound; he had no known risk factors for HIV-1 infection and was seronegative.

METHODS

We reviewed the processing and distribution of all the …

Modeling The Determinants Of Hospital Mortality, Abdolmohsin S. Al-Haider

Theses and Dissertations

This study examined hospital characteristics that affected the differential in hospital mortality, while controlling for the effect of community attributes. Analytical models for the determinants of hospital mortality were formulated and validated through an empirical examination of 243 hospitals that had higher or lower mortality rates than expected for Medicare beneficiaries. The dependent variable for this study was death rates for 1984 Medicare patients in united states hospitals released in 1986 by the Health Care Financing Administration.

Structural equation models that portray the causal relation between organizational constructs and hospital mortality rate were formulated. This causal model was empirically validated. …