Medical Humanities Commons^™

The Association Between Medicaid Expansion, Medicaid Disproportionate Share Payments And The Financial Performance Of Safety Net Hospitals, Jon Law

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Safety Net Hospitals (SNHs) provide necessary emergency and acute care to all individuals, regardless of their ability to pay for health care. Medicaid Expansion and Disproportionate Share (DSH) payments are two Medicaid programs that may mitigate the financial vulnerability of SNH’s. Some assert that Medicaid Expansion, as part of the Patient and Affordable Care Act (ACA), may provide financial relief for SNHs. It offers payment mechanisms for millions of uninsured individuals. DSH expenditures per capita for each state vary widely. There is some likelihood that SNHs in some states may benefit greater than others. The study was framed within the …

An Analysis Of The Impact Of The Long-Term Care Partnership Program On The Number Of Lives Covered By Long-Term Care Insurance And Medicaid Expenditures In Nursing Homes, Cheris Kline

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The growing number of people over the age of 65 in the U.S. will exacerbate already inadequate resources for long-term care, producing increased public health costs. The Long-Term Care Partnership Program (LTCPP) was proposed to save Medicaid expenditures by incentivizing the purchase of long-term care insurance. At this juncture, it is unclear if the partnership program saves the government money. This study draws from the expected utility theory and resource dependency theory to determine whether the LTCPP has increased the purchase of private long-term care insurance and reduced Medicaid expenditures in nursing homes in states that have adopted the partnership …

An Analysis Of Hospitalist Programs In Critical Access Hospitals, Robert Thomas Peterson

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AN ANALYSIS OF HOSPITALIST PROGRAMS IN CRITICAL ACCESS HOSPITALS ROBERT T. PETERSON HEALTHCARE LEADERSHIP ABSTRACT Hospitalists are physicians specially trained in the care of hospitalized patients. In critical access hospitals (CAHs), the annual cost of a physician-based hospitalist program is approximately $1M. The high cost of hospitalist programs must be offset by the hospitalists’ ability to reduce the cost of inpatient care and/or by their ability to generate additional inpatient volume and revenue. Two well-established metrics are used to measure hospitalist performance: the average inpatient length of stay (ALOS) and the average daily census (ADC). Well-performing hospitalist programs are expected …

Health Systems And Societal Level Community Benefit, Meghan Blueberry Mccarthy

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In America, the amount spent on community benefit as tax exemption justification for not-for-profit health care is approaching 100 billion dollars annually. There are multiple categories for community benefit as defined by the Internal Revenue Service (IRS). The overwhelming majority of these funds are spent on individual financial assistance rather than societal level community health investments to address social determinates of health. Societal level community benefit is defined as the total spending on community health improvement, cash & in-kind donations to community groups and community building as reported on IRS form 990 Schedule H. These three combined itemized areas of …

The Comparison Of Two Diabetes Self-Management Education Programs In The Reduction Of Patient A1c Levels, Edward Sharpless

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This dissertation was a quasi-experimental research study exploring the effectiveness of two educational teaching methods with patients with diabetes. One teaching method utilized an education framework called the Conversation Map tools, a group-based, highly interactive learning experience using colorful visual tools, activity cards and sharing of real-life experiences. The other method was a traditional, lecture-style class taught by a health educator using overhead slides and handouts.

Secondary data from a regional health system in the Western U.S. was used to test the hypothesis that participants in the Conversation Map classes would report a larger drop in A1c levels compared to …

Assessment Of Emergency Department High Utilizer Program In Public Health System Setting, Michael Malaise

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is study examined whether a case management model designed to reduce emergency department utilization among patients described as super-utilizers in a public health system could also reduce the per patient cost of those super-utilizers. The setting for this study was a large public health system in a major metropolitan area. The study focused on a low-income, urban population. Given the program’s stated desire to improve the self-efficacy of patients over time so that they could take more ownership of their own health status, this study reviewed the program within the framework of self-efficacy theory. This research predicted that the case …

Fixed And Variable Costs At Critical Access Hospitals, Jeremy J. Lyman

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Cost structures (the ratio of fixed to variable costs) vary across and within indus-tries. Hospital managers and policymakers can make better decisions when they under-stand cost structures, including marginal costs (the change in the total cost that arises when the quantity produced is increased by one unit). Although some studies have inves-tigated hospital cost structures, the results have been mixed and less than definitive, and very little attention has been given to critical access hospitals and marginal costs specifi-cally. Rural hospitals, including critical access hospitals, have increasingly experienced financial distress. Between 2005 and 2019, 159 rural hospitals closed across the …

Impact Of Ncqa Pcmh-Level On Low Income Diabetics In Louisiana, Michael G. Griffin

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While past studies have examined the relationship between safety-net provider sites that are certified as Patient Centered Medical Homes (PCMH) and quality health care outcomes, no previous studies have evaluated the relationship between NCQA PCMH certification levels at primary care sites and quality health care outcomes. NCQA is the largest national certification program for PCMH, and for 10 years was the only national program that offered a tiered level of certification based on provider level of patient engagement and deployed resources. The Donabedian Model, which focuses on structure, process, and outcomes, was used to develop the theoretical framework to address …

Impact Of Registered Nurse Staffing Ratio On Nursing Home Operating Margins And Quality Measure Star Ratings, Douglas R. Whitman

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Today’s nursing homes are under immense pressure from government regulators to improve quality while the government simultaneously tightens reimbursement rates. These two forces squeeze operating margins. The question facing nursing home operators is how to improve quality without breaking the bank. This study looks at the association of more registered nurses (RN) with quality and margins in U.S. nursing homes. This research project fills literature gaps which previously found improved nursing home quality correlates with more RNs. However, prior studies used self-reported data and typically considered only two or three quality measures. This study uses recently released electronic payroll data …

Examining The Impact Of Baldrige On Hospital Performance, Jennifer O. Strahan

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The national Baldrige program has supported performance excellence within healthcare for over twenty years, yet it has seen recent declines in the number of applications despite Baldrige award recipients claiming noteworthy improvements across operational, clinical, and financial outcomes. Previous studies have compared Baldrige hospital recipients to non-recipients, but no studies have empirically investigated the value of pursuing the Baldrige award, regardless of award recognition or not. Furthermore, it is unclear if specific categories of the Baldrige Excellence Framework (BEF) are associated with standardized industry performance outcomes. This study used propensity score matching with linear and quantile regression techniques to understand …

The Relationship Between Accreditation And Performance Among Federally Qualified Health Centers, Henry Thompson

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While past studies have examined the relationship between accreditation and hospital performance, no previous studies have evaluated the relationship between Joint Commission accreditation and Federal Qualified Health Center (FQHC) performance. Multiple regression analyses were used to evaluate the relationship between Joint Commission accreditation and variables of interest. Joint Commission accreditation was utilized as the dependent variable in the evaluation of organizational and environmental market factors, and utilized as the independent variable in the evaluation of clinical and non-clinical performance outcomes. This study applies a novel approach to determine the relationship between Joint Commission accreditation and adoption among FQHCs, and organizational …

Organizational Characteristics And Environmental Factors Associated With Hospitals Identified As Consolidation Targets, Christi Pierce

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In today’s dynamic healthcare landscape, hospitals face uncertainty and pressure from changing reimbursement schemas, intense government regulation, technological advances, consumer demand and workforce scarcity. These increased pressures have led to an acceleration of consolidation activities as hospitals position themselves to cope with a dynamic and complex external environment by maximizing resources, creating economies of scale and expanding access to care. Despite increased hospital consolidation activity, little is known about what makes a hospital attractive as a consolidation target to an acquiring hospital, particularly post-ACA. The purpose of this study was to evaluate the organizational characteristics and environmental factors associated with …

Insuring Graduation: An Analysis Of The Association Between Student Health Insurance And Graduation, John Robert Lovett

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Most college students have access to basic health services through their campus’ college health program. Unfortunately, students who lack health insurance may be limited in their access to health services beyond the acute care provided, which may manifest in a myriad of adverse outcomes; ultimately resulting in withdrawal from college without graduating. Student health insurance plans (SHIPs) are high-quality, affordable insurance plans specially designed to meet this need. This study utilized survival analysis to examine the temporal nature of college graduation behavior, as it related to student health insurance status. The results of this study show no significant relationship between …

Healthcare Cybersecurity: Building A Cyber Vulnerability Profile For U.S. Hospitals, Gemini O. Majkowski

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Digital transformation in healthcare has offered exponential advances in capabilities and efficiencies improving access, quality of care, chronic disease management, public health surveillance, and population health. However, the speed of change left security lagging, exposing cyber vulnerabilities that cost the U.S. $6.2 billion dollars annually, at an average cost of $2.2 million dollars, and 3,128 records breached per incident. Despite significant investments to close the gap on cyber vulnerabilities, cybersecurity remains a critical issue. Little research has been done to build a cyber vulnerability profile for U.S. hospitals. In this study, U.S. hospitals with reportable breach and without reportable breach …

Reported Clinical And Financial Performance Of Hospitals With Physician Ceos Compared To Those With Nonphysician Ceos, Leon Moores

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Leaders impact organizational behavior and performance, and CEOs may have greater impact via numerous proposed mechanisms. Because of this, organizations expend considerable resources recruiting and selecting CEOs and may benefit from information suggesting a positive impact on organizational performance based upon measurable CEO characteristics. Little work has been done comparing the performance of hospitals with physician CEOs versus non-physician CEOs, in spite of the ease of identification of this characteristic and extant leadership theories suggesting a relationship between technical expertise and success in leading highly technical organizations. We compared multiple measures of reported clinical and financial performance and our linear …

A Crisis In Care: Evaluating The Causes And Consequences Of Burnout Among Emergency Physicians, Michael Allyn Wiechart

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For many physicians, the growing list of mandates and the unrelenting pace of change in today’s health care have taken a toll, leading to burnout. The consequences of burnout extend well beyond the impact on the individual provider, with physician burnout linked to a decrease in patient satisfaction, an increase in preventable medical errors, and increased levels of staff turnover. Consequently, the high rates of burnout reported among U.S. physicians might be considered not only as a symptom of dysfunction in the health care delivery system but also as a factor contributing to the dysfunction. While burnout exists to a …

The Impact Of Hospital Change Of Ownership On Hospital Quality Of Care As Evidenced By Patient Satisfaction Scores And Readmission Rates, Ian Edward Mcfadden

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THE IMPACT OF HOSPITAL CHANGE OF OWNERSHIP ON HOSPITAL QUALITY OF CARE AS EVIDENCED BY PATIENT SATISFACTION SCORES AND READMISSION RATES IAN E. MCFADDEN DOCTOR OF SCIENCE IN ADMINISTRATION-HEALTH SERVICES ABSTRACT Much of the literature on current hospital consolidation activity reveals that hospitals and health systems are experiencing an inordinate amount of increased merger and acquisition activity due to the impact of healthcare reform legislation. The implementation of the Affordable Care Act of 2010 resulted in many hospital and health system providers seeking consolidation as a means to enhance resources and capital. These efforts have resulted in many hospitals changing …

The Association Between Designation As Leader In Lgbt Healthcare Equality And Hospitals' Patient Experience Scores, Rita Dileo

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ABSTRACT There are an increasing number of LGBT individuals who openly acknowledge their sexuality and are visibly part of society. Unfortunately, a stigma remains among this group and a fear of discrimination that prevents many individuals from seeking healthcare. This is a long-standing issue and further challenged by lack of culturally competent LGBT healthcare providers. Using a conceptual framework based on the Resource Dependence and Resource-Based theories, the association between designation as a 2016 Leader in LGBT Healthcare Equality and patient experience scores are evaluated. Regression analyses were performed to assess the association between market factors, organizational characteristics, HCAHPS survey …

A Study To Examine The Relationship Between Hospital Mergers And Patient Experience, Timothy William Attebery

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Since 2009, the United States has experienced another wave of hospital mergers. Consequently, health systems are getting larger and increasing their market concentration. How patients benefit from hospital consolidation remains an open issue for policy-makers, economists, health care executives, community leaders, politicians, government agencies, and others. One measure of healthcare consolidation’s impact, and its potential benefit/detriment, is how mergers affect patient experience, which, since 2007, has been measured by the standardized HCAHPS instrument. Hundreds of studies conducted over the past 50 years have found mergers trigger an internal, socially-disruptive effect in the first 12 to 24 months following the event …

Effects Of Medicaid Expansion On The Financial Performance Of Rural Hospitals, Keith Darryl Brady

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EFFECTS OF MEDICAID EXPANSION ON THE FINANCIAL PERFORMANCE OF RURAL HOSPITALS KEITH BRADY DOCTOR OF SCIENCE IN HEALTH SERVICES ADMINISTRATION ABSTRACT The purpose of this research was to examine the effects of Medicaid expansion on the financial performance of rural hospitals. The analysis compares Medicaid revenue, uncompensated care cost and operating margins between rural hospitals in states that expanded Medicaid and rural hospitals in states that did not expand Medicaid. Strategic Management Theory was used to develop a theoretical framework to address three primary hypotheses. Secondary data from the Medicare Cost Report (MCR), the Agency for Healthcare Research and Quality …

An Analysis Of The Association Between An Established Chief Experience Officer Position And Hospital Patient Experience Scores Within Three States, William Robert Breen

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Few industries operate with as much capacity to personally satisfy or disappoint, as does the U.S healthcare industry. Healthcare outcomes sought by society include wellness, safety, healing, and, ultimately, experiences. While healthcare involves complex relationships between patients, families, providers, payers, and regulators, the use of management theory can be insightful in studying and explaining the motivations and strategic decisions of healthcare managers. The healthcare industry is currently reacting to multiple stakeholders demanding improvements to the patient experience. New ways to measure patient experiences in healthcare are emerging. Some healthcare organizations are implementing new management structures, i.e., the role of Chief …

The Relationship Among Nurse-Physician Collaboration And Outcomes: Influence Of Nursing Leadership, Tiffany Lebano Cabibbo

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Background: Hospitalized patients outcomes are impacted by many professionals, with registered nurses and physicians being the most predominant. Nurses and physicians represent different autonomous professions, but their interdependent relationship effective collaboration for patients to receive high-quality and safe care. Nurse-physician collaboration is a key behavior that must be fostered by hospital leadership to meet or exceed value based outcomes (safety and quality). The purpose of this study was to examine the Chief Nursing Officer’s (CNO) perception of nurse-physician collaboration and its influence (mediating affect) on their direct reports (Nurse Directors). Furthermore, this study examining the relationship of this influence and …

Culture And Patient Safety Outcomes: Examining The Impact Of The Departmental Work Environment On Outcomes, Dawn Ahner

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This study examined the relationship between the departmental work environment and patient safety outcomes to determine if there were particular subcomponents of a department’s work environment that had a more significant impact on patient safety outcomes. The work environment was defined as the culture of an individual nursing department which consisted of the employee’s perception of engagement and patient safety culture. The research was informed by the commitment-based theory. Based on this theory, it was predicted that a team-based approach in the work environment would lead to a learning and positive environment, which would be positively associated with quality of …

Interorganizational Relationships And Hospital Adoption Of Surgical Robots, Stephen Cullen

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INTERORGANIZATIONAL RELATIONSHIPS AND HOSPITAL ADOPTION OF SURGICAL ROBOTS STEPHEN G. CULLEN EXECUTIVE DOCTORIAL PROGRAM IN HEALTHCARE LEADERSHIP ABSTRACT The study investigates the relationship between interorganizational relationships (IORs) and hospital adoption of robotic surgery in the United States over a ten-year period. As a competitive strategy for hospitals, IORs should matter in a hospital’s decision to adopt a surgical robot given associated costs and risks. While literature exists on IORs and technical innovation, there is a gap in the literature on IORs and hospital adoption of surgical robots. This study explores four types of IORs (i.e., networks, systems, contract management, and …

The Relationship Of Lean Implementation And Patient Satisfaction (Hcahps) Scores In Acute Care Hospitals, Charles V. Hagood

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THE RELATIONSHIP OF LEAN IMPLEMENTATION AND PATIENT SATISFACTION (HCAHPS) SCORES IN ACUTE CARE HOSPITALS CHARLES V. HAGOOD DOCTOR OF SCIENCE IN HEALTH SERVICES ADMINISTRATION ABSTRACT Background: The purpose of the study was to better understand the relationship of Lean implementation and patient satisfaction (HCAHPS) scores in acute care hospitals. Hospitals are under significant pressure to improve patient satisfaction, thus a number of hospitals are increasingly using Lean improvement methodologies to do so. However, the results that have been achieved are often reported as mixed at best and lack empirical proof, specifically the relationship of Lean methodologies and their impact on …

The Effect Of Cultural Competency Training Programs On Expatriate Nurses' Levels Of Cultural Competence In Saudi Arabia As Measured By The Inventory For Assessing The Process Of Cultural Competence (Iapcc-R), Naof Faiz Saleem Al-Ansary

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The study examined the relationship between cultural competence training programs and the levels of cultural competence among expatriate nurses in Saudi Arabia. Cultural competence training programs are believed to increase the awareness of expatriate nurses in Saudi Arabia in regards to issues that might arise from cultural differences between patients and healthcare providers. Healthcare professionals, and healthcare organizations, emphasize the importance of culturally competent healthcare environments in providing optimum healthcare services to individuals from different cultural backgrounds. Findings from the study suggested that participation in cultural competency training is associated to higher cultural competency scores. Additionally, age was positively associated …

A Comparative Multiyear Assessment Of Care Utilization Between Existing And Newly Enrolled Medicaid Populations Within Washington State, Preston M. Simmons

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A COMPARATIVE MULTIYEAR ASSESSMENT OF CARE UTILIZATION BETWEEN EXISTING AND NEWLY ENROLLED MEDICAID POPULATIONS WITHIN WASHINGTON STATE ABSTRACT The study looks at 2012 through June of 2016 Medicaid data from the Washington State Health Care Authority, comparing claims utilization for newly enrolled patients each calendar year to continuously enrolled members. Mean number of emergency department, hospital, and ambulatory (office) claims per Medicaid member are compared to ascertain if they are the same or different between the groups. Differences in the mean number of ambulatory care sensitive conditions (ACSC) were additionally assessed between those continuously and newly enrolled. The results of …

The Effects Of Nurse-Manager Relationships And Nurse-Physician Collaboration On Nurse Intent To Leave, Phillip John Mazzuca

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ABSTRACT Aim. The aim of this study was to determine whether two relational aspects of the nurse work environment – perceived quality of the nurse-supervisor relationship and nurse-physician collaboration – might reduce nurse intent to leave the hospital. Background. There is a documented global shortage of nurses which is a pressing issue in U.S. hospitals. The nursing shortage has been exacerbated by a high rate of voluntary nursing turnover in U.S. hospitals which is costly and has previously been found to negatively impact patient care. Factors associated with the nursing work environment have been found to be important predictors of …

Home Healthcare And Performance: Development And Application Of A Typology For Home Health Agencies, Ronique Nechelle Evans

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This three-paper dissertation sought to examine the existence of strategic groups in the home health industry, the application of Porter’s generic strategies (cost leader, differentiator, “stuck-in-the-middle” and both cost leader/differentiator) in identifying these groups, and the association of group membership with agency performance. The findings of this study will provide researchers and managers with a highlight of the current strategic makeup of the home health industry and its relationship with quality and financial performance. The results of this dissertation provide some evidence that strategic groups do exist in the home health industry and can be described along the basis of …

The Effectiveness Of Clinical Integration: The Relationship Between Evidence-Based Clinical Processes, In-Network Utilization And Clinical, Service And Efficiency Outcomes, Patrick D. Falvey

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THE EFFECTIVENESS OF CLINICAL INTEGRATION: THE RELATIONSHIP BETWEEN EVIDENCE-BASED CLINICAL PROCESSES, IN-NETWORK UTILIZATION AND CLINICAL, SERVICE AND EFFICIENCY OUTCOMES PATRICK D. FALVEY EXECUTIVE DOCTORAL PROGRAM – SCHOOL OF HEALTH PROFESSIONS ABSTRACT The evolving U.S. health care system continues to steer healthcare organizations and integrated healthcare delivery networks (IDNs) to function as population health networks and ACOs. Policymakers, payers, health care leaders and consumer groups are advocating that IDNs clinically integrate processes and structures under the assumption that they will improve the clinical outcomes for a population, reduce the health care spend, and enhance the patient experience. Relatively little research has …