Health and Medical Administration Commons^™

Hospital Characteristics Associated With Hospital Acquired Condition (Hac) Reduction Program Payment Penalties Across Program Years, Emily D. Cochran

Theses and Dissertations

Objective: The primary objective of this study was to examine the relationship between hospital structural characteristics and penalization status (penalized or not penalized) in any given hospital acquired condition (HAC) Reduction Program year, FY 2015 through 2018. Structural characteristics included hospital type, case mix index, average daily census, bed size, ownership, disproportionate share percentage, location, and American Nurses Credentialing Center Magnet status. The secondary objective of the study was to determine whether a hospital's penalization status across one or more HAC Reduction Program years is related to quality performance (Total HAC Score) in subsequent years. These objectives were achieved through …

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 …

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 …

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 …

Examining Regionalization Efforts To Develop Lessons Learned And Consideration For Department Of Defense Medical Facilities, Erik B. Schuh

Theses and Dissertations

The increase in competition locally and globally has forced companies to become more efficient. One way for companies to gain efficiency is by regionalizing their facilities by either consolidating or collocating to a particular location. A comprehensive literature review addressed the advantages and disadvantages organizations have used in the past when regionalizing. This insight was used on a case study looking at military hospitals in the National Capital Region. The case study was used to find potential cost savings for three surgical procedures by consolidating each procedure to the lowest cost hospital. Future years were then forecasted to find cost …

Do Healthcare Professionals With High Weight Biases Provide Different Quality Of Care To Obese Compared To Normal Weight Patients?, Justine Leigh Seymour

Theses and Dissertations

Though weight bias has been acknowledged in the health field, it is less understood if and how weight bias affects quality of care. The purpose of this study was to determine if weight bias exhibited by healthcare professionals (HCPs) impacts quality of healthcare provided to obese individuals. HCPs (n=220; 88% female, 87% nurses) in the Midwest region of the United States were recruited to complete an online survey. Participants completed the Attitude Towards Obese Persons scale (ATOP) to assess weight bias and responded to hypothetical patient scenarios to evaluate quality of care. A median split was calculated for ATOP scores …

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 …

Understanding Conceptualizations And Structural Environment For Improving Pre-Pregnancy Planning For Adolescent Girls And Young Women In Harare, Zimbabwe, Chiwoneso Beverley Tinago

Theses and Dissertations

Zimbabwe has a high maternal mortality with adolescent girls and young women facing disproportionately high risk of maternal morbidity and mortality. Current approaches to reducing maternal mortality in Zimbabwe focus on the pregnancy period with antenatal care, obstetric care, and micronutrient supplementation during pregnancy. Although important, these approaches are not reaching a large number of women and may benefit from integration with pre-pregnancy approaches. The importance of pre-pregnancy interventions to promote young women’s health has been emphasized, yet many young women in developing countries like Zimbabwe do not have access to pre-pregnancy care because little is understood about the concept …

Practice Characteristics That Matter In The Provision Of Health Education Services By Primary Care Physicians, George Paul Newby Jr.

Theses and Dissertations

The onset of chronic disease is occurring earlier and more often in the lives of adult citizens of the United States. The literature has effectively demonstrated the efficacy that physician provision of health education services offers their patients and the positive effects it has for lowering risk factors for chronic disease. The literature has described the complexities physicians encounter in providing these services. The literature is not as plentiful in defining and describing the characteristics of physician practice that are associated with increased health education provision.

This study is an analysis of the factors that are associated with provision of …

A Prescription For Better Health: The Role Of On-Line Research In Doctor-Nurse-Patient Communication, Julie Anne Maio

Theses and Dissertations

As more technological media are made available to health consumers, patients take to the Internet to research ailments, side effects, and pressing health matters. Patients widely use this information to feel empowered and in control of their health. Yet, many sources perpetuate false information, or are deemed untrustworthy by healthcare professionals (HCPs). This dissonance can create a lack of collaborative communication between patients and the healthcare team. As such, the present study examined perceived credibility of online sources (.org websites, .com websites, forums, social media, etc.), patient intent to disclose online information, patient empowerment, HCPs communication styles, HCP-patient partnerships and …

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 …

Urgent Aeromedical Evacuation Network Capacity Planning, Scott C. Finkbeiner

Theses and Dissertations

Aeromedical Evacuation (AE) has been steadily utilized during Operation Iraqi Freedom and Operation Enduring Freedom. AE is a global enterprise. The current structure of AE is facing changes as forces scale down from operations in Iraq and Afghanistan. AE will, however, continue to be important in its domestic use in the continental USA (CONUS). Current practice is to pull aircraft (e.g. C-17, C-130 or KC-135) from their normal operations to meet Urgent and Priority patient needs when local alternatives are infeasible. An alternative to the current system would be having a centralized "bed-down" location for AE operations that would house …

A Primary Care Workload Production Model For Estimating Relative Value Unit Output, Rachel G. Murphy

Theses and Dissertations

Health care costs have grown to unsustainable levels nationally and within the Department of Defense. Military health care costs have historically been difficult to isolate, causing budget cuts to be the vehicle for cost control. Maximum efficiency, therefore, is the goal in order to show improvement. With the Air Force’s new preventive health plan, they aim to drive a long-term posture for cost reduction through prevention. This research effort aimed to develop a tool to assist in future efforts to understand and improve efficiency in workload output, and whether a relationship exists between patient workload demand and the per-encounter variables …

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 …

A Delphi Study Assessing Long-Term Access To Electronic Medical Records (Emr), Byron D. Nicholson

Theses and Dissertations

This research effort addressed the issue of long-term access to electronic medical records as technological generations become obsolete, thereby preventing the access to patient health information. Using the Delphi methodology, experts with experience in electronic medical records and applicable systems provided insight based on their years of hands-on experience managing and/or using records and these systems. The end result of this research was a collection of ideas that medical institutions and medical informaticians must consider to ensure that patients and hospitals do not lose long-term access to electronic medical records as electronic medical records and technology continually evolves. Results of …

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 …

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 …

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 …

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, …

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 …

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 …

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 …

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 …