Characteristics of hospitals providing preventive services: does delivery system integration make a difference?

OBJECTIVE

As health care organizations consolidate into integrated delivery systems, increased delivery of preventive services is expected. The study objective was to evaluate the impact of hospitals' participation in multiorganizational arrangements and managed care on their delivery of preventive services.

METHOD

The study is a secondary data analysis of data in the American Hospital Association 1993 Annual Survey of Hospitals Data Base. Two primary prevention variables (health promotion services to patients and to community members), and one secondary prevention variable (screening mammography) were included. Hospital characteristics included ownership, bed-size, and integration-participation in a multiorganizational arrangement and having managed care (HMO and PPO) contracts.

RESULT

The 5,387 general medical and surgical hospitals responding to the 1993 survey were included in the analysis. Proportions of hospitals reporting delivery of health promotion services to patients, and to community members, and screening mammography services were respectively 90%, 83%, and 88%. Hospitals reporting participation in multiorganizational arrangements were more likely to report delivery of preventive services after adjusting for bed-size. The bed-adjusted odds ratios for providing health promotion services to inpatients, and to members of the community, and screening mammography services in hospitals with managed care contracts versus those without managed care contracts were respectively: 2.72 (95% CI: 1.65, 2.50), 2.03 (1.63, 2.53), and 1.51 (1.26, 1.81).

CONCLUSION

Preliminary findings from this secondary data analysis support the expectation that current changes in the health care delivery system may expand the delivery of preventive services.

Strategic performance measurement systems: next step after dashboards

This article has summarized work being done at the leading edge of strategic performance measurement. Initiatives that today seem ivory-towerish tomorrow may represent the mainstream. Compared with the organizations profiled here, other health systems may be smaller, be less automated, or lack expertise in statistics and graphic presentation. Such differences should not prevent any hospital, medical group, HMO, or integrated delivery system from embracing in its own way the essential aspects of strategic performance measurement: Developing--as the cornerstone for measurement--a clear mission, vision, and strategy based on the organization's core values, core competencies, and customer expectations. Developing high-level performance measures of the organization's current performance and progress toward its strategic vision. Cascading measures throughout the entire organization, from the governing board and senior management down to operating clinical and administrative units. Expanding measures beyond internal operations to include measures of community or population health, systemwide measures along the continuum of care, and environmental scanning of key external trends. Using measurement actively throughout the organization to drive strategic planning and continuous improvement. Such efforts are not an "add-on" to busy board and executive agendas; they are an integral part of them. When measures on performance reports are reflective of organizational reality--like the speed and compass gauges on a jetliner's instrument panel--knowledgeable leaders will use them with ease. Even such complex constructs as spider diagrams, says Dr. Berman, are putty in a board's hands when the measures are pertinent and directors are educated about them. "They're useful decision-making tools because they're easy for our board members and managers to understand," he sums up. "They provide a snapshot of our organization."

Not your father's HMO

It's new. It's improved. And it's coming to medicare beneficiaries everywhere. It's the next generation of managed care, and it will happen even if Congress does nothing to reshape the medicare program this year.

Proving the link between outcomes and resource utilization

Medical practice profiling is a popular way of helping to reduce variation in resource utilization among providers in managed care organizations. Usually, these programs take into account severity of illness, patient demographics, and so forth, but rarely are clinical practice patterns linked with outcome. The authors offer information about an information system-based program that attempts to do just that.

Designing the future: physician poll rates the trends

A recent interactive electronic poll of 160 physicians attending an educational conference at ACPE's Future Forum reveals some opinions physicians have about the transition of medicine into the 21st century. Emerging issues include capitation, quality, law, and how to manage integrated delivery systems. Overall, respondents are concerned about remaining solvent is a capitated managed care environment.