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 …

The Effect Of A Self-Care Education Program On A Military Medical Beneficiary Population, Christopher S. Svehlak

Theses and Dissertations

Previous research in the area of self-care has focused on medical beneficiaries in a wide range of settings, but the current or former members of the United States Armed Services have largely been ignored. This research concentrates on designing, implementing, and reporting on a study of the impact of a self-care education program on a military beneficiary population. Specifically, retired and active-duty households, whose medical records are maintained by the Wright-Patterson Air Force Base Medical Center, were systematically randomly sampled and invited to participate in the study. Those households who responded were given their choice of a self-care book, and …

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 …

Staffing Sources Of Usaf Medical Center Systems Offices: A Study Of Their Relation To Information Systems Quality, William K. Dorr, Shelley D. Christia

Theses and Dissertations

This study measured the relationship between Medical Systems Office staffing source (i.e., military medical, military communications/computer, civilian government, and contractor personnel) and quality of automated information services provided at CONUS USAF medical centers. A literature search determined that information system quality is best measured on eight dimensions: performance, features, reliability, conformance, durability, serviceability, aesthetics, and perceived quality. The CIO at each medical center was surveyed to determine the level of system conformance to Air Force standards and to gather data on each MSO staff. Users at the medical centers were also surveyed in order to measure performance, features, reliability, serviceability, …

A Comparative Study Of Dod And Civilian Hospital Inventory Management Systems, Karen A. Lemay

Theses and Dissertations

The purpose of this thesis was to determine if one method of inventory management would standardize procedures and minimize costs for Department of Defense and civilian hospitals. This was accomplished by conducting a comparative analysis of inventory management systems, used at Wright-Patterson Medical Center, Wright-Patterson Air Force Base, Dayton, Ohio; Kettering Medical Center, Kettering, Ohio; and Evans US Army Community Hospital, Ft. Carson, Colorado. The literature review examined various inventory management methods used for both general and hospital specific inventories. The thesis concluded that, although different automated systems were used at the three hospitals studied, the basis of each inventory …

An Expert System Advisor For Medical Evaluation Boards, Jerry S. G. Harrington

Theses and Dissertations

Expert system technology has proven itself to be able to improve productivity and decision making in a variety of fields of endeavor. The purpose of this study was to determine if an expert system for medical evaluation boards (MEBs) could improve upon the processing of medical evaluation board cases. Research was conducted to develop an expert system and measure the capabilities of the system, both in terms of accuracy and timeliness of case completion of the medical evaluation administrators/clerks who were assisted by the system. The research methodology involved a three - phase approach. The objective of phase one was …

Heuristics For Hospital Inventory Management, Thomas G. Hibson

Theses and Dissertations

This study investigated the reasoning strategies used by hospital logistics management experts and was conducted at the Wright-Patterson AFB (WPAFB) Medical Center. An expert system was developed to verify the captured strategies. The particular area of interest of this study was the reasoning strategies involved in the reconciliation of the Monthly Stock Status Report within the Medical Logistics Branch. A literature review revealed there were few guidelines as to when and what action to pursue when reconciling the Monthly Stock Status Report. Though there were no references in the literature on expert systems that dealt with this particular report, there …

Executive Information Systems For Usaf Hospital Administrators: A Feasibility Assessment, Alan R. Constantian

Theses and Dissertations

This thesis investigated the feasibility of implementing an executive information system (EIS) for hospital administrators at CONUS-based USAF inpatient medical facilities. A literature search determined that successful system implementation would require that such an EIS be found technically, economically, operationally, and motivationally feasible. Failure to meet any of these feasibility factors would jeopardize successful implementation. Surveys were mailed to each of the administrators and medical systems officers of CONUS- based USAF inpatient medical facilities in order to gather data on these feasibility issues. Approximately eighty percent of the survey population of 66 in each group responded to the survey. There …

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. …

Socioeconomic And Medicare Status Differences Between Elderly Church Service And Lds Private Pay Hospital Patients, Edward L. Soper

Theses and Dissertations

The purpose of this study was to determine the kind and degree of differences that existed in the socioeconomic status and access to financial resources of elderly members of the Church of Jesus Christ of Latter-day Saints, and to determine if differences existed between Church Service and private pay elderly hospital patients in economic status, type of housing, housing costs, marital status, sex, number and degree of access to children, savings and other assets.

Certain elderly members of the LDS Church were found to be significantly deficient economically because of inadequate income, low lifetime earnings and high medical expenses. Findings …