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Hoogestraat F, Wild EM, Winter V. Factors driving differences in the adoption of quality management practices among hospitals: A two-phase, sequential mixed-methods analysis. Health Care Manage Rev 2024; 49:161-175. [PMID: 38709000 DOI: 10.1097/hmr.0000000000000402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
BACKGROUND Although all hospitals aim to deliver high-quality care, there is considerable variation in their adoption of quality management (QM) practices. Organizational and environmental factors are known to drive strategic decision-making in hospitals, but their impact on the adoption of QM practices remains unclear. PURPOSE Our study aims to identify multiple organizational and environmental factors that explain variation in the adoption of QM practices among hospitals and to explore mechanisms underlying these relationships. METHODOLOGY We conducted a two-phase, sequential mixed-methods study of German acute care hospitals. The quantitative phase used between-effects regressions to identify factors explaining variation in the number of QM practices adopted by hospitals from 2015 to 2019. The qualitative phase used semistructured interviews with quality managers to gain in-depth insights. RESULTS The number of QM practices adopted by a hospital was significantly associated with factors like hospital size and the presence of an emergency department or QM steering committee. Our qualitative findings highlighted potential mechanisms such as the presence of an emergency department serving as a proxy for organizational complexity or urgency of case-mix. CONCLUSION We provide an overview of factors driving QM adoption in hospitals, extending beyond the focus on single factors in previous research. Future studies could explore additional factors highlighted by our interviewees. PRACTICE IMPLICATIONS Our results can inform interventions to strengthen QM in hospitals and guide future research on this topic.
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Alexandre PK, Monestime JP, Alexandre K. The Impact of Market Factors on Meaningful Use of Electronic Health Records Among Primary Care Providers: Evidence From Florida Using Resource Dependence Theory and Information Uncertainty Perspective. Med Care 2024; 62:256-262. [PMID: 38447010 PMCID: PMC10939787 DOI: 10.1097/mlr.0000000000001980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
BACKGROUND Using federal funds from the 2009 Health Information Technology for Economic and Clinical Health Act, the Centers for Medicare and Medicaid Services funded the 2011-2021 Medicaid electronic health record (EHR) incentive programs throughout the country. OBJECTIVE Identify the market factors associated with Meaningful Use (MU) of EHRs after primary care providers (PCPs) enrolled in the Florida-EHR incentives program through Adopting, Improving, or Upgrading (AIU) an EHR technology. RESEARCH DESIGN Retrospective cohort study using 2011-2018 program records for 8464 Medicaid providers. MAIN OUTCOME MU achievement after first-year incentives. INDEPENDENT VARIABLES The resource dependence theory and the information uncertainty perspective were used to generate key-independent variables, including the county's rurality, educational attainment, poverty, health maintenance organization penetration, and number of PCPs per capita. ANALYTICAL APPROACH All the county rates were converted into 3 dichotomous measures corresponding to high, medium, and low terciles. Descriptive and bivariate statistics were calculated. A generalized hierarchical linear model was used because MU data were clustered at the county level (level 2) and measured at the practice level (level 1). RESULTS Overall, 41.9% of Florida Medicaid providers achieved MU after receiving first-year incentives. Rurality was positively associated with MU ( P <0.001). Significant differences in MU achievements were obtained when we compared the "high" terciles with the "low" terciles for poverty rates ( P =0.002), health maintenance organization penetration rates ( P =0.02), and number of PCPs per capita ( P =0.01). These relationships were negative. CONCLUSIONS Policy makers and health care managers should not ignore the contribution of market factors in EHR adoption.
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Affiliation(s)
- Pierre K. Alexandre
- Health Administration Program, Dept of Management, College of Business, Florida Atlantic University, Boca Raton, FL 33431 USA
| | - Judith P. Monestime
- Health Administration Program, Dept of Management, College of Business, Florida Atlantic University, Boca Raton, FL 33431 USA
| | - Kessie Alexandre
- Department of Geography, University of Washington, Seattle, WA 98195-3560 USA
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Vogel J, Hollenbach J, Haering A, Augurzky B, Geissler A. The association of hospital profitability and digital maturity - An explorative study using data from the German DigitalRadar project. Health Policy 2024; 142:105012. [PMID: 38422802 DOI: 10.1016/j.healthpol.2024.105012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 01/19/2024] [Accepted: 02/02/2024] [Indexed: 03/02/2024]
Abstract
INTRODUCTION German hospitals largely rely on public investments for digitization. As these have been insufficient, hospitals had to use own profits to foster digital transformation. Thus, we assess if profitability affects digital maturity, and what other factors might be influential. METHODS We use digital maturity data from the DigitalRadar (DR) project (2021) and financial statement data from the Hospital Rating Report from 2017 to 2019 (n = 860). We run linear regressions with the DR-score (continuous variable from 0 to 100) as dependent and three-year average EBITDA margin as independent variable. Besides, we conduct subgroup analyses stratifying by chain size. RESULTS A one percentage point EBITDA margin increase is associated with a 0.359 points DR-score increase (p<0.01). This relationship holds in significance and holds or increases in magnitude for all specifications except when adding chain beds (0.212 point DR-score increase, p<0.05). Besides, chain membership and chain size are positively and significantly associated with hospitals' DR-score. EBITDA margins of the subgroups "large chains" and "Big 3″, i.e., the three largest chains, were strongly associated with the DR-score (2.685 and 3.197 points DR-score increase respectively, p<0.01). CONCLUSIONS Higher profitability is associated with higher digital maturity. Larger chains are digitally more mature, because (1) they might follow a chain-wide IT-strategy, (2) can standardize IT-architecture, and policies and (3) might cross-finance investments.
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Affiliation(s)
- Justus Vogel
- Chair of Health Economics, Policy and Management, School of Medicine, University of St. Gallen, St. Jakob-Strasse 21, CH-9000 St. Gallen, Switzerland.
| | - Johannes Hollenbach
- RWI - Leibniz-Institut für Wirtschaftsforschung e.V., Hohenzollernstr. 1-3, D-45128 Essen, Germany
| | - Alexander Haering
- RWI - Leibniz-Institut für Wirtschaftsforschung e.V., Hohenzollernstr. 1-3, D-45128 Essen, Germany
| | - Boris Augurzky
- RWI - Leibniz-Institut für Wirtschaftsforschung e.V., Hohenzollernstr. 1-3, D-45128 Essen, Germany
| | - Alexander Geissler
- Chair of Health Economics, Policy and Management, School of Medicine, University of St. Gallen, St. Jakob-Strasse 21, CH-9000 St. Gallen, Switzerland
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Gifford R, van Raak A, Govers M, Westra D. Back to the Future: What Healthcare Organizations Need to Thrive in the Face of Persistent Environmental Uncertainty. Adv Health Care Manag 2024; 22:3-27. [PMID: 38262008 DOI: 10.1108/s1474-823120240000022001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
While uncertainty has always been a feature of the healthcare environment, its pace and scope are rapidly increasing, fueled by myriad factors such as technological advancements, the threat and frequency of disruptive events, global economic developments, and increasing complexity. Contemporary healthcare organizations thus persistently face what is known as "deep uncertainty," which obscures their ability to predict outcomes of strategic action and decision-making, presenting them with novel challenges and threatening their survival. Persistent, deep uncertainty challenges us to revisit and reconsider how we think about uncertainty and the strategic actions needed by organizations to thrive under these circumstances. Simply put, how can healthcare organizations thrive in the face of deeply uncertain environments? We argue that healthcare organizations need to employ both adaptive and creative strategic approaches in order to effectively meet patients' needs and capture value in the long-term future. The chapter concludes by offering two ways organizations can build the dynamic capabilities needed to employ such approaches.
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Alexandre PK, Monestime JP, Alexandre K. The impact of county-level factors on meaningful use of electronic health records (EHRs) among primary care providers. PLoS One 2024; 19:e0295435. [PMID: 38271332 PMCID: PMC10810449 DOI: 10.1371/journal.pone.0295435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 11/21/2023] [Indexed: 01/27/2024] Open
Abstract
This study examines the impact of county-level factors on "meaningful use" (MU) of electronic health records (EHRs) for 8415 primary care providers (PCPs) that enrolled in the Florida Medicaid EHR Incentive Program through adopting, improving, or upgrading (AIU) a certified EHR technology. PCPs received incentive payments at enrollment and if they used their EHRs in meaningful ways; ways that benefit patients and providers alike they received additional payments. We conducted a retrospective cohort study of these providers over the 2011-2018 period while linking their records to other state data. We used the core constructs of the resource dependence theory (RDT), a well-established organization theory in business management, to operationalize the county-level variables. These variables were rurality, poverty, educational attainment, managed care penetration, changes in population, and number of PCPs per capita. The unit of analysis was provider-years. For practical and computational purposes, all the county variables were dichotomized. We used analysis of variance (ANOVA) to test for differences in MU attestation rates across each county variable. Odds ratios and corresponding 95% confidence intervals were derived from pooled logistic regressions using generalized estimated equations (GEE) with the binomial family and logit link functions. Clustered standard errors were used. Approximately 42% of these providers attested to MU after receiving first-year incentives. Rurality and poverty were significantly associated with MU. To some degree, managed care penetration, change in population size, and number of PCPs per capita were also associated with MU. Policy makers and healthcare managers should not ignore the contribution of county-level factors in the diffusion of EHRs among physician practices. These county-level findings provide important insights about EHR diffusion in places where traditionally underserved populations live. This county-perspective is particularly important because of the potential for health IT to enable public health monitoring and population health management that might benefit individuals beyond the patients treated by the Medicaid providers.
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Affiliation(s)
- Pierre K. Alexandre
- Health Administration Program, Department of Management, College of Business, Florida Atlantic University, Boca Raton, Florida, United States of America
| | - Judith P. Monestime
- Health Administration Program, Department of Management, College of Business, Florida Atlantic University, Boca Raton, Florida, United States of America
| | - Kessie Alexandre
- Department of Geography, University of Washington, Seattle, Washington, United States of America
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Burns A, Vest JR, Menachemi N, Mazurenko O, Salyers MP, Yeager VA. Market Factors Associated with Comprehensive Behavioral Health Crisis Care Availability: A Resource Dependence Theory Study. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2024; 61:469580241256822. [PMID: 38842194 PMCID: PMC11159547 DOI: 10.1177/00469580241256822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 05/07/2024] [Accepted: 05/07/2024] [Indexed: 06/07/2024]
Abstract
Behavioral health crisis care (BHCC) is a care delivery model for individuals experiencing acute distress related to a mental health or substance use disorder. We examined market factors associated with comprehensive BHCC availability using 2022 data on mental health treatment facilities (n = 9385) obtained from the Substance Abuse and Mental Health Services Administration. We aggregated facility-level data by county (n = 3142) and merged with county-level market factors. Logistic regression models were used to examine the adjusted associations between market factors and BHCC availability. We found that 468 (14.9%) counties had at least one mental health treatment facility offering comprehensive BHCC services. Specifically, counties with more mental health providers (Adjusted Odds Ratio = 2.26, Confidence Interval = 1.32-3.86) and metropolitan counties (AOR = 3.26, CI = 1.95-5.43) had higher odds of having a comprehensive BHCC facility. Our findings highlight the importance of developing the mental health workforce to increase BHCC availability and a need to address disparities in rural counties.
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Affiliation(s)
- Ashlyn Burns
- Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA
| | - Joshua R. Vest
- Indiana University Richard M. Fairbanks School of Public Health, Regenstrief Institute Center for Biomedical Informatics, Indianapolis, IN, USA
| | - Nir Menachemi
- Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA
| | - Olena Mazurenko
- Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA
| | | | - Valerie A. Yeager
- Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA
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Decker KL, Schwab SD, Bazzoli GJ, Chukmaitov AS, Wernz C. Impact of performance-based budgeting on quality outcomes in U.S. military health care facilities. Health Care Manage Rev 2023; 48:249-259. [PMID: 37170408 DOI: 10.1097/hmr.0000000000000372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
BACKGROUND Performance-based budgeting (PBB) is a variation of pay for performance that has been used in government hospitals but could be applicable to any integrated system. It works by increasing or decreasing funding based on preestablished performance thresholds, which incentivizes organizations to improve performance. In late 2006, the U.S. Army implemented a PBB program that tied hospital-level funding decisions to performance on key cost and quality-related metrics. PURPOSE The aim of this study was to estimate the impact of PBB on quality improvement in U.S. Army health care facilities. APPROACH This study used a retrospective difference-in-differences analysis of data from two Defense Health Agency data repositories. The merged data set encompassed administrative, demographic, and performance information about 428 military health care facilities. Facility-level performance data on quality indicators were compared between 187 Army PBB facilities and a comparison group of 241 non-PBB Navy and Air Force facilities before and after program implementation. RESULTS The Army's PBB programs had a positive impact on quality performance. Relative to comparison facilities, facilities that participated in PBB programs increased performance for over half of the indicators under investigation. Furthermore, performance was either sustained or continued to improve over 5 years for five of the six performance indicators examined long term. CONCLUSION Study findings indicate that PBB may be an effective policy mechanism for improving facility-level performance on quality indicators. PRACTICE IMPLICATIONS This study adds to the extant literature on pay for performance by examining the specific case of PBB. It demonstrates that quality performance can be influenced internally through centralized budgeting processes. Though specific to military hospitals, the findings might have applicability to other public and private sector hospitals who wish to incentivize performance internally in their organizational subunits through centralized budgeting processes.
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Dubas-Jakóbczyk K, Kocot E, Tambor M, Szetela P, Kostrzewska O, Siegrist Jr RB, Quentin W. The Association Between Hospital Financial Performance and the Quality of Care - A Scoping Literature Review. Int J Health Policy Manag 2022; 11:2816-2828. [PMID: 35988029 PMCID: PMC10105205 DOI: 10.34172/ijhpm.2022.6957] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 07/20/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Improving the quality of hospital care is an important policy objective. Hospitals operate under pressure to contain costs and might face challenges related to financial deficits. The objective of this paper was to identify and map the available evidence on the association between hospital financial performance (FP) and quality of care (Q). METHODS A scoping review was performed. Searches were conducted in 7 databases: Medline via PubMed, EMBASE, Web of Science, Scopus, EconLit, ABI/INFORM, and Business Source Complete. The search strategy combined multiple terms from 3 topics: hospital AND FP AND Q. The collected data were analysed using both quantitative and qualitative methods. RESULTS 10 503 records were screened and 151 full text papers analysed. A total of 69 papers were included (60 empirical, 2 theoretical, 5 literature reviews, and 2 dissertations). The majority of identified studies were published within the last decade (2010-2021). Most empirical studies had been conducted in the United States (55/60), used cross-sectional approaches (32/60) and applied diverse regression models with FP measures as dependent variables, thus measuring the impact of Q on hospitals FP (34/60). The comparability of the studies' results is limited due to differences in applied methods and settings. Yet, the general overview shows that in almost half of the cases the association between hospital FP and Q was positive, while no study showed a clear negative association. CONCLUSION This scoping review provides an overview of the available literature on the association between hospital FP and Q. The results highlight numerous research gaps: (1) systematic reviews and meta-analyses of existing studies with similar measures of FP and Q are unavailable, (2) further methodological/conceptual work is needed on the metrics measuring hospital FP and Q, and (3) more empirical studies should analyse the association between FP and Q in non-US healthcare settings.
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Affiliation(s)
- Katarzyna Dubas-Jakóbczyk
- Health Economics and Social Security Department, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Ewa Kocot
- Health Economics and Social Security Department, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Marzena Tambor
- Health Economics and Social Security Department, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Przemysław Szetela
- Health Economics and Social Security Department, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Olga Kostrzewska
- Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | | | - Wilm Quentin
- Department of Health Care Management, Technische Universität Berlin, Berlin, Germany
- European Observatory on Health Systems and Policies, WHO European Centre for Health Policy Eurostation (Office 07C020), Brussels, Belgium
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Yang J, Luo B, Zhao C, Zhang H. Artificial intelligence healthcare service resources adoption by medical institutions based on TOE framework. Digit Health 2022; 8:20552076221126034. [PMID: 36211801 PMCID: PMC9537501 DOI: 10.1177/20552076221126034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 08/25/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives This study used the Technology-Organization-Environment (TOE) framework to identify the factors involved in the decisions made by integrated medical and healthcare organizations to adopt artificial intelligence (AI) elderly care service resources. Method This study identified the Decision-making Trial and Evaluation Laboratory-Interpretive Structural Modeling (DEMATEL-ISM) method was used to construct a multilayer recursive structural model and to analyze the interrelationships between the levels. A MICMAC quadrant diagram was used for a cluster analysis. Results The ISM recursive structural model was divided into a total of seven layers. The bottom layer contained the four factors of High risk of data leakage (T1), Lack of awareness of the value and benefits of AI healthcare technology (T5), Lack of management leadership support (O1), and Government policies (E1). Having a low dependency but high driving force, these factors are the root causes of adoption by healthcare organizations. The topmost layer contained the most direct factors, which had a high dependency but the low driving force, influencing adoption: Competitive pressures (E2), Lack of patient trust (E5), and Lack of excellent partnerships (E7). Healthcare organizations are more concerned with technology and their environments when deciding to adopt intelligent healthcare resources. Conclusion The combination of the three methods of DEMATEL-ISM-MICMAC construction models provides new ideas for smart healthcare services for hospitals. The DEMATEL method favors the construction dimension of the micro-model, while the ISM method favors the construction dimension of the macro-model. Combining these two methods may reduce the loss of information within the system, simplify the matrix calculation workload, and improve the efficiency of operations while decomposing the complex problems into several sub-problems in a more comprehensive and detailed way. Conducting cluster analysis of the adoption determinants utilizing MICMAC quadrant diagrams may provide strong methodological guidance and decision-making recommendations for government departments, senior decision-makers in healthcare organizations, and policy-makers in associations in the senior care industry.
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Affiliation(s)
- Jinxin Yang
- School of Management, Hefei University of
Technology, Hefei, People’s Republic of China
| | - Biao Luo
- School of Management, Hefei University of
Technology, Hefei, People’s Republic of China,Biao Luo, School of Management, Hefei
University of Technology, No. 193, Tunxi Ro., Baohe Dist., Hefei, Anhui 230009,
People’s Republic of China.
| | - Chen Zhao
- School of Transportation Technology, Fujian University, Fuzhou,
People’s Republic of China
| | - Hongliang Zhang
- School of Management Science and Technology, Anhui University of
Technology, Ma’anshan, People’s Republic of China
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Schnack H, Uthoff SAK, Ansmann L. The perceived impact of physician shortages on human resource strategies in German hospitals - a resource dependency perspective. J Health Organ Manag 2022; 36:196-211. [PMID: 36098505 DOI: 10.1108/jhom-05-2021-0203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Like other European countries, Germany is facing regional physician shortages, which have several consequences on patient care. This study analyzes how hospitals perceive physician shortages and which strategies they adopt to address them. As a theoretical framework, the resource dependency theory is chosen. DESIGN/METHODOLOGY/APPROACH The authors conducted 20 semi-structured expert interviews with human resource officers, human resource directors, and executive directors from hospitals in the northwest of Germany. Hospitals of different ownership types, of varying sizes and from rural and urban locations were included in the sample. The interviews were analyzed by using qualitative content analysis. FINDINGS The interviewees reported that human resource departments in hospitals expand their recruiting activities and no longer rely on one single recruiting instrument. In addition, they try to adapt their retaining measures to physicians' needs and offer a broad range of employment benefits (e.g. childcare) to increase attractiveness. The study also reveals that interviewees from small and rural hospitals report more difficulties with attracting new staff and therefore focus on recruiting physicians from abroad. PRACTICAL IMPLICATIONS Since the staffing situation in German hospitals will not change in the short term, the study provides suggestions for hospital managers and health policy decision-makers in dealing with physician shortages. ORIGINALITY/VALUE This study uses the resource dependency theory to explain hospitals' strategies for dealing with healthcare staff shortages for the first time.
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Affiliation(s)
- Helge Schnack
- Division for Organizational Health Services Research, Department of Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Sarah Anna Katharina Uthoff
- Division for Organizational Health Services Research, Department of Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Lena Ansmann
- Division for Organizational Health Services Research, Department of Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
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Freeman K, Monestime JP. Associations between Florida counties' COVID-19 case and death rates and meaningful use among Medicaid providers: Cross-sectional ecologic study. PLOS DIGITAL HEALTH 2022; 1:e0000047. [PMID: 36812551 PMCID: PMC9931361 DOI: 10.1371/journal.pdig.0000047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 04/20/2022] [Indexed: 06/18/2023]
Abstract
Although the Health Information Technology for Economic and Clinical Health (HITECH) Act has accelerated adoption of Electronic Health Records (EHRs) among Medicaid providers, only half achieved Meaningful Use. Furthermore, Meaningful Use' impact on reporting and/or clinical outcomes remains unknown. To address this deficit, we assessed the difference between Medicaid providers who did and did not achieve Meaningful Use regarding Florida county-level cumulative COVID-19 death, case and case fatality rates (CFR), accounting for county-level demographics, socioeconomic and clinical markers, and healthcare environment. We found that cumulative incidence rates of COVID-19 deaths and CFRs were significantly different between the 5025 Medicaid providers not achieving Meaningful Use and the 3723 achieving Meaningful Use (mean 0.8334/1000 population; SD = 0.3489 vs. mean = 0.8216/1000; SD = 0.3227, respectively) (P = .01). CFRs were .01797 and .01781, respectively, P = .04. County-level characteristics independently associated with increased COVID-19 death rates and CFRs include greater concentrations of persons of African American or Black race, lower median household income, higher unemployment, and higher concentrations of those living in poverty and without health insurance (all P < .001). In accordance with other studies, social determinants of health were independently associated with clinical outcomes. Our findings also suggest that the association between Florida counties' public health outcomes and Meaningful Use achievement may have had less to do with using EHRs for reporting of clinical outcomes and more to do with using EHRs for coordination of care-a key measure of quality. The Florida Medicaid Promoting Interoperability Program which incentivized Medicaid providers towards achieving Meaningful Use, has demonstrated success regarding both rates of adoption and clinical outcomes. Because the Program ends in 2021, we support programs such as HealthyPeople 2030 Health IT which address the remaining half of Florida Medicaid providers who have not yet achieved Meaningful Use.
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Affiliation(s)
- Katherine Freeman
- Division of Biomedical Sciences, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida, United States of America
| | - Judith P. Monestime
- Health Administration Programs, Management Department, College of Business, Florida Atlantic University, Boca Raton, Florida, United States of America
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Zhu X, Tao Y, Zhu R, Wu D, Ming WK. Impact of Hospital Characteristics and Governance Structure on the Adoption of Tracking Technologies for Clinical and Supply Chain Use: Longitudinal Study of US Hospitals. J Med Internet Res 2022; 24:e33742. [PMID: 35617002 PMCID: PMC9185348 DOI: 10.2196/33742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/14/2021] [Accepted: 04/14/2022] [Indexed: 11/18/2022] Open
Abstract
Background Despite the increasing adoption rate of tracking technologies in hospitals in the United States, few empirical studies have examined the factors involved in such adoption within different use contexts (eg, clinical and supply chain use contexts). To date, no study has systematically examined how governance structures impact technology adoption in different use contexts in hospitals. Given that the hospital governance structure fundamentally governs health care workflows and operations, understanding its critical role provides a solid foundation from which to explore factors involved in the adoption of tracking technologies in hospitals. Objective This study aims to compare critical factors associated with the adoption of tracking technologies for clinical and supply chain uses and examine how governance structure types affect the adoption of tracking technologies in hospitals. Methods This study was conducted based on a comprehensive and longitudinal national census data set comprising 3623 unique hospitals across 50 states in the United States from 2012 to 2015. Using mixed effects population logistic regression models to account for the effects within and between hospitals, we captured and examined the effects of hospital characteristics, locations, and governance structure on adjustments to the innate development of tracking technology over time. Results From 2012 to 2015, we discovered that the proportion of hospitals in which tracking technologies were fully implemented for clinical use increased from 36.34% (782/2152) to 54.63% (1316/2409), and that for supply chain use increased from 28.58% (615/2152) to 41.3% (995/2409). We also discovered that adoption factors impact the clinical and supply chain use contexts differently. In the clinical use context, compared with hospitals located in urban areas, hospitals in rural areas (odds ratio [OR] 0.68, 95% CI 0.56-0.80) are less likely to fully adopt tracking technologies. In the context of supply chain use, the type of governance structure influences tracking technology adoption. Compared with hospitals not affiliated with a health system, implementation rates increased as hospitals affiliated with a more centralized health system—1.9-fold increase (OR 1.87, 95% CI 1.60-2.13) for decentralized or independent hospitals, 2.4-fold increase (OR 2.40, 95% CI 2.07-2.80) for moderately centralized health systems, and 3.1-fold increase for centralized health systems (OR 3.07, 95% CI 2.67-3.53). Conclusions As the first of such type of studies, we provided a longitudinal overview of how hospital characteristics and governance structure jointly affect adoption rates of tracking technology in both clinical and supply chain use contexts, which is essential for developing intelligent infrastructure for smart hospital systems. This study informs researchers, health care providers, and policy makers that hospital characteristics, locations, and governance structures have different impacts on the adoption of tracking technologies for clinical and supply chain use and on health resource disparities among hospitals of different sizes, locations, and governance structures.
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Affiliation(s)
- Xiao Zhu
- Department of Clinical Pharmacy and Pharmacy Administration, School of Pharmacy, Fudan University, Shanghai, China
| | - Youyou Tao
- Department of Information Systems and Business Analytics, College of Business Administration, Loyola Marymount University, Los Angeles, CA, United States
| | - Ruilin Zhu
- Management Science Department, Lancaster University Management School, Lancaster University, Lancaster, United Kingdom
| | - Dezhi Wu
- Department of Integrated Information Technology, College of Engineering and Computing, University of South Carolina, Columbia, SC, United States
| | - Wai-Kit Ming
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong, Hong Kong
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Malhan A, Manuj I, Pelton L, Pavur R. Electronic health records using a resource advantage theory perspective: an interdisciplinary literature review. RECORDS MANAGEMENT JOURNAL 2022. [DOI: 10.1108/rmj-06-2021-0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Warren Buffett asserted that the greatest issue confronting American business and the economy is rising health-care costs, which have risen to 17% of gross domestic product. Public policymakers, health-care providers and other stakeholders grapple with cost-containment and increased health-care delivery efficiencies. There exists a paucity of theory-driven research addressing how information technology vis-à-vis electronic health records (EHR) may supply a managerial mechanism for increasing bottom-line hospital performance, thereby attaining competitive advantage.
Design/methodology/approach
A systematic interdisciplinary literature review motivated by resource advantage theory (RAT) offers a conceptual foundation for analyzing the financial, informational and physical workflows that are core elements of supply chain management in a hospital.
Findings
RAT links how EHR impacts profitability, competitive advantage and macromarketing factors in hospital supply chains. The literature review provides a research synthesis of the implementation and adoption of EHR to reveal its impact on a hospital’s competitive advantage. Although legislative initiatives like the 2009 Health Information Technology for Economic and Clinical Health Act and the Affordable Care Act encourage EHR adoption, there remains a reluctance for hospitals to do so.
Originality/value
The extant literature precedes the relevant legislation, has incomplete data or focuses solely on patient outcomes.
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Patidar N, Lee KB, Weech‐Maldonado R, Bailur RP, Rao S. On the creation of free‐standing emergency departments by hospitals—Some insights. DECISION SCIENCES 2022. [DOI: 10.1111/deci.12557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Nitish Patidar
- Department of Management School of Business, Quinnipiac University Hamden Connecticut
| | - Kang Bok Lee
- Department of Systems and Technology, Raymond J. Harbert College of Business Auburn University Auburn Alabama
| | - Robert Weech‐Maldonado
- Department of Health Services Administration University of Alabama at Birmingham Birmingham Alabama
| | - Rekha Prabhu Bailur
- Assessment and Strategy Planning, Office of Academic Affairs College of Veterinary Medicine Auburn University Auburn Alabama
| | - Shashank Rao
- Supply Chain Management Department, Raymond J. Harbert College of Business Auburn Alabama
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Mukherjee SK, Olivieri DJ, Madhani SI, Bonfield CM, Mbabazi E, Arman DM, Dewan MC, Ekramullah SM. EMR adoption in Dhaka, Bangladesh: a template to index pediatric central nervous system tumor care and a review of preliminary neuro-oncologic observations. Childs Nerv Syst 2022; 38:1497-1504. [PMID: 35588333 PMCID: PMC9118804 DOI: 10.1007/s00381-022-05450-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 01/07/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE To describe the design, implementation, and adoption of a simplified electronic medical record (EMR) and its use in documenting pediatric central nervous system (CNS) tumors at a tertiary care referral hospital in South-East Asia. METHODS A novel EMR, cataloguing pediatric CNS tumors was used to collect data from August 2017 to March 2020 at National Institute of Neurosciences and Hospital (NINS&H) in Dhaka, Bangladesh. RESULTS Two hundred forty-nine pediatric patients with a CNS tumor were admitted to NINS&H. Fifty-eight percent of patients were male, and the median age was 8 years. A total of 188/249 patients (76%) underwent surgery during their index admission. Radiographic locations were known for 212/249 (85%) of cases; the most common radiographic locations were infratentorial (81/212; 38%), suprasellar (45/212; 21%), and supratentorial (29/212; 14%). A histopathological classification was reported on 156/249 (63%) of patients' cytology. The most common infratentorial pathologies were medulloblastoma (22/47; 47%) and pilocytic astrocytoma (14/47; 30%). The median time between admission and surgery was 36 days, while the median post-operation stay was 19.5 days. CONCLUSIONS The feasibility of a basic EMR platform for a busy pediatric neurosurgery department in a lower-middle income country is demonstrated, and preliminary clinical data is reviewed. A wide variety of pediatric CNS tumors were observed, spanning the spectrum of anatomic locations and histopathologic subtypes. Surgical intervention was performed for the majority of patients. Barriers to care include limited molecular diagnostics and unavailable data on adjuvant therapy. Future targets include improvement of clinical documentation in the pre-operative and post-operative period.
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Affiliation(s)
- Sudipta Kumer Mukherjee
- grid.489064.7Department of Pediatric Neurosurgery, National Institute of Neurosciences and Hospital (NINS&H), Dhaka, Bangladesh
| | - Daniel J. Olivieri
- grid.40263.330000 0004 1936 9094Warren Alpert Medical School, Brown University, Providence, RI USA
| | - Sarosh Irfan Madhani
- grid.7147.50000 0001 0633 6224Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Christopher M. Bonfield
- grid.412807.80000 0004 1936 9916Division of Pediatric Neurosurgery, Vanderbilt University Medical Center, 2200 Children’s Way 9th Floor , Nashville, TN 37232 USA
| | - Edith Mbabazi
- grid.461319.8CURE Children’s Hospital of Uganda, Mbale, Uganda
| | - D. M. Arman
- grid.489064.7Department of Pediatric Neurosurgery, National Institute of Neurosciences and Hospital (NINS&H), Dhaka, Bangladesh
| | - Michael C. Dewan
- grid.412807.80000 0004 1936 9916Division of Pediatric Neurosurgery, Vanderbilt University Medical Center, 2200 Children’s Way 9th Floor , Nashville, TN 37232 USA
| | - Sheikh Muhammad Ekramullah
- grid.489064.7Department of Pediatric Neurosurgery, National Institute of Neurosciences and Hospital (NINS&H), Dhaka, Bangladesh
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Medical Information Mining-Based Visual Artificial Intelligence Emergency Nursing Management System. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:4253606. [PMID: 34868517 PMCID: PMC8639237 DOI: 10.1155/2021/4253606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/31/2021] [Accepted: 11/03/2021] [Indexed: 11/17/2022]
Abstract
This study aims to design a set of the visual artificial intelligence system based on medical information mining for hospital emergency care management. A visual artificial intelligence emergency first aid nursing management system is designed by analyzing the needs of the emergency first aid nursing management system. The results show that system personnel allocation, comparative management, record management, query management analysis, basic setup analysis, nursing management basis, and nonfunctional requirements all need to be optimized for the emergency first aid management system. In this study, the comparative management module, log management module, and the query management module are designed, and the emergency first aid management system of different APP terminal functions in different modules is described in detail. The nursing document query business is tested, and the corresponding time of query of nursing assessment sheet, nurse shift record, nurse record, and physical sign observation sheet is 375.50 ms, 351.48 ms, 336.36 ms, and 245.57 ms, respectively. It shows that the visual artificial intelligence emergency nursing management system based on medical information mining can provide convenience for clinical work to a large extent and has potential application value in hospital emergency nursing work.
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Mandhana DM, Glowacki EM, Sun MC. Promoting Patient Portals: An Application of Social Cognitive Theory to Post-Adoption Patient Portal Use. HEALTH COMMUNICATION 2021; 36:1990-2001. [PMID: 32847409 DOI: 10.1080/10410236.2020.1811024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Many healthcare clinics encourage the use of online patient portals so that patients can have easier access to their health information, yet some patients are hesitant to interact with these portals. We used social cognitive theory to develop and test a theoretically grounded model that incorporates several (1) technological factors, (2) individual factors, and (3) social factors that influence individuals' post-adoption, active use of patient portals. Based on cross-sectional survey data from a sample of healthcare clinic patients (N = 431), we found that individuals' severity of illness predicted active use of patient portals and that trust in doctors predicted attitudes toward patient portals. Moreover, attitudes toward patient portals mediated the relationship between technology factors (i.e., perceived usefulness, ease of use, customization, and interactivity), and active use of patient portals. The paper concludes with a discussion of key findings, implications, and directions for future research.
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Affiliation(s)
- Dron M Mandhana
- Department of Communication, College of Liberal Arts and Sciences, Villanova University
| | - Elizabeth M Glowacki
- Department of Communication Studies, College of Arts, Media and Design, Northeastern University
| | - Mao-Chia Sun
- Department of Journalism, Fu Hsing Kang College, National Defense University
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Do Market Characteristics Matter? Factors Associated with Health Information Exchange. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182211976. [PMID: 34831731 PMCID: PMC8624939 DOI: 10.3390/ijerph182211976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 10/26/2021] [Accepted: 11/12/2021] [Indexed: 11/17/2022]
Abstract
This study explores factors associated with the breadth (extent) and depth (level of detail) of digital information exchange among stakeholders in health information technology (IT) systems. Annual and IT surveys of the American Hospital Association and the U.S. Census Bureau’s small-area income and poverty estimates from 2014–2016 were analyzed for associations between key factors and breadth and depth of information exchange. OLS Regression was used with a sample consisting of 10,040 year-hospital observations. We found that hospital-level variables such as size, ownership type, system affiliation, physician-hospital arrangement, and revenue model affect information exchange. We further found that market-level variables such as concentration ratio, urbanness, and median household income, although they directly affect information exchange, do not moderate the relationship between hospital-level variables and information exchange. Our study fills a gap in the previous literature arising from the lack of research on the determinants of health information exchange.
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Lalani K, Revere L, Chan W, Champagne-Langabeer T, Tektiridis J, Langabeer J. Impact of External Environmental Dimensions on Financial Performance of Major Teaching Hospitals in the U.S. Healthcare (Basel) 2021; 9:healthcare9081069. [PMID: 34442207 PMCID: PMC8394138 DOI: 10.3390/healthcare9081069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/12/2021] [Accepted: 08/17/2021] [Indexed: 11/16/2022] Open
Abstract
Teaching hospitals have a unique mission to not only deliver graduate medical education but to also provide both inpatient and ambulatory care and to conduct clinical medical research; therefore, they are under constant financial pressure, and it is important to explore what types of external environmental components affect their financial performance. This study examined if there is an association between the short-term and long-term financial performance of major teaching hospitals in the United States and the external environmental dimensions, as measured by the Resource Dependence Theory. Data for 226 major teaching hospitals spanning 46 states were analyzed. The dependent variable for short-term financial performance was days cash on hand, and dependent variable for long-term financial performance was return on assets, both an average of most recently available 4-year data (2014-2017). Utilizing linear regression model, results showed significance between outpatient revenue and days cash on hand as well as significant relationship between population of the metropolitan statistical area, unemployment rate of the metropolitan statistical area, and teaching hospital's return on assets. Additionally, system membership, type of ownership/control, and teaching intensity also showed significant association with return on assets. By comprehensively examining all major teaching hospitals in the U.S. and analyzing the association between their short-term and long-term financial performance and external environmental dimensions, based upon Resource Dependence Theory, we found that by offering diverse outpatient services and novel delivery options, administrators of teaching hospitals may be able to increase organizational liquidity.
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Affiliation(s)
- Karima Lalani
- Center for Health Systems Analytics, School of Biomedical Informatics, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX 77030, USA; (K.L.); (T.C.-L.)
| | - Lee Revere
- Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, Gainesville, FL 32610, USA;
| | - Wenyaw Chan
- School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX 77030, USA; (W.C.); (J.T.)
| | - Tiffany Champagne-Langabeer
- Center for Health Systems Analytics, School of Biomedical Informatics, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX 77030, USA; (K.L.); (T.C.-L.)
| | - Jennifer Tektiridis
- School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX 77030, USA; (W.C.); (J.T.)
| | - James Langabeer
- Center for Health Systems Analytics, School of Biomedical Informatics, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX 77030, USA; (K.L.); (T.C.-L.)
- Correspondence:
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20
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The organizational and environmental characteristics associated with hospitals' use of intensivists. Health Care Manage Rev 2021; 47:218-226. [PMID: 34319278 DOI: 10.1097/hmr.0000000000000321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND As large numbers of coronavirus disease 2019 (COVID-19) patients were admitted to intensive care units (ICUs) in 2020 and 2021, the United States faced a shortage of critical care providers. Intensivists are physicians specializing in providing care in the ICU. Although studies have explored the clinical and financial benefits associated with the use of intensivists, little is known about the organizational and market factors associated with a hospital administrator's strategic decision to use intensivists. PURPOSE The aim of this study was to use the resource dependence theory to better understand the organizational and market factors associated with a hospital administrator's decision to use intensivists. METHODOLOGY The sample consisted of the national acute care hospitals (N = 4,986) for the period 2007-2017. The dependent variable was the number of full-time equivalent intensivists staffed in hospitals. The independent variables were organizational and market-level factors. A negative binomial regression model with state and year fixed effects, clustered at the hospital level, was used to examine the relationship between the use of intensivists and organizational and market factors. RESULTS The results from the analyses show that administrators of larger, not-for-profit hospitals that operate in competitive urban markets with relatively high levels of munificence are more likely to utilize intensivists. PRACTICE IMPLICATIONS When significant strains are placed on ICUs like what was experienced during the COVID-19 pandemic, it is imperative that hospital administrators understand how to best staff their ICUs. With a better understanding of the organizational and market factors associated with the use of intensivists, practitioners and policymakers alike can better understand how to strategically utilize intensivists in the ICU, especially in the face of a continuing pandemic.
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Cho NE. The Impact of Health Information Sharing on Hospital Costs. Healthcare (Basel) 2021; 9:healthcare9070806. [PMID: 34206880 PMCID: PMC8303128 DOI: 10.3390/healthcare9070806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/23/2021] [Accepted: 06/25/2021] [Indexed: 11/21/2022] Open
Abstract
Despite substantial progress in the adoption of health information technology (IT), researchers remain uncertain as to whether IT investments benefit hospitals. This study evaluates the effect of health information sharing on the cost of care, and whether the effect varies with context. Our results suggest that information sharing using health IT, specifically the extent (breadth) and level of detail (depth) of information sharing, helps to reduce the cost of care at the hospital level. The results also show that the effects of depth of information sharing on cost savings are salient in poor and less-concentrated regions, but not in wealthier, more-concentrated areas, whereas the the effects of breadth of information sharing on cost savings are equivalent across wealth and concentration. To realize the benefits of using health IT more effectively, policy makers’ strategies for encouraging active use of health IT should be informed by market characteristics.
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Affiliation(s)
- Na-Eun Cho
- College of Business, Hongik University, Seoul 04066, Korea
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22
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Upadhyay S, Opoku-Agyeman W. Factors that Determine Comprehensive Categorical Classification of EHR Implementation Levels. Health Serv Insights 2021; 14:11786329211024788. [PMID: 34188485 PMCID: PMC8212366 DOI: 10.1177/11786329211024788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 05/21/2021] [Indexed: 11/24/2022] Open
Abstract
Electronic Health Records (EHRs) have the potential to alleviate patient safety
mistakes. Of the various levels of EHR, advanced or higher-level functionalities
of EHR are designed to improve patient safety. Certain organizational and
environmental factors may pose as barriers toward implementing all of the
functionalities, leaving certain hospitals intermediate between basic and
comprehensive levels of implementation. This study identifies a comprehensive
categorical classification that includes hospitals that have functionalities
between basic and comprehensive levels of EHR and determines the organizational
and environmental factors that may influence hospitals to implement one or more
combinations of these categories. A longitudinal panel design was used. Ordinal
logistic regression with random effects model was fitted with robust cluster
standard errors. Our sample consisted of non-federal general acute care
hospitals utilizing a panel design from 2010 to 2016 with 17 586 hospital-year
observations (or an average of 2600 hospitals per year). Larger size hospitals,
ones with higher total margin, metropolitan and urban hospitals, system
affiliated hospitals, and those in higher managed care penetration areas have
higher odds of belonging in one of the higher categories of EHR implementation.
Hospitals that can access a greater amount of human resources and financial
assets from their environments, may implement higher levels of EHR. Initial and
maintenance costs of EHR, interoperability issues, and inability to distribute
high costs of training across facilities may stymie implementation of higher EHR
functionalities. Policymaking to encourage competition among vendors may
possibly lower the implementation price for hospitals with limited
resources.
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Affiliation(s)
- Soumya Upadhyay
- School of Public Health, Department of Healthcare Administration and Policy, University of Nevada at Las Vegas, Las Vegas, NV, USA
| | - William Opoku-Agyeman
- School of Health and Applied Human Sciences, University of North Carolina at Wilmington, Wilmington, NC, USA
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Grossi A, Hoxhaj I, Gabutti I, Specchia ML, Cicchetti A, Boccia S, de Waure C. Hospital contextual factors affecting the implementation of health technologies: a systematic review. BMC Health Serv Res 2021; 21:407. [PMID: 33933068 PMCID: PMC8088675 DOI: 10.1186/s12913-021-06423-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 04/19/2021] [Indexed: 12/05/2022] Open
Abstract
Background To keep a high quality of assistance it is important for hospitals to invest in health technologies (HTs) that have the potential of improving health outcomes. Even though guidance exists on how HTs should be introduced, used and dismissed, there is a surprising gap in literature concerning the awareness of hospitals in the actual utilization of HTs. Methods We performed a systematic literature review of qualitative and quantitative studies aimed at investigating hospital contextual factors that influence the actual utilization of HTs. PubMed, Scopus, Web of Science, Econlit and Ovid Medline electronic databases were searched to retrieve articles published in English and Italian from January 2000 to January 2019. The quality of the included articles was assessed using the Critical Appraisal Skills Programme checklist for qualitative studies, Newcastle-Ottawa Scale for the cross-sectional studies and the Mixed Methods Appraisal Tool for mixed method studies. Results We included 33 articles, which were of moderate to high methodological quality. The included articles mostly addressed the contextual factors that impact the implementation of information and communication technologies (ICTs). Overall, for all HTs, the hospital contextual factors were part of four categories: hospital infrastructure, human resource management, financial resources and leadership styles. Conclusion Our systematic review reported that the contextual factors influencing the HTs utilization at hospital level are mainly explored for ICTs. Several factors should be considered when planning the implementation of a new HTs at hospital level. A potential publication bias might be present in our work, since we included articles published only in English and Italian Language, from January 2000 to January 2019. There remains a gap in the literature on the facilitators and barriers influencing the implementation and concrete utilization of medical and surgical HTs, suggesting the need for further studies for a better understanding. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06423-2.
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Affiliation(s)
- Adriano Grossi
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, 00168, Rome, Italy
| | - Ilda Hoxhaj
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, 00168, Rome, Italy.
| | - Irene Gabutti
- Graduate School of Health Economics and Management (ALTEMS), Faculty of Economics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria Lucia Specchia
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, 00168, Rome, Italy.,Clinical Governance Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Americo Cicchetti
- Graduate School of Health Economics and Management (ALTEMS), Faculty of Economics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Stefania Boccia
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1, 00168, Rome, Italy.,Department of Woman and Child Health and Public Health - Public Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Chiara de Waure
- Department of Medicine and Surgery, University of Perugia, Perugia, Italy
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Monestime JP, Freeman K, Alexandre PK. Provider participation in the Florida Medicaid Promoting Interoperability program: Practice characteristics, meaning use attestations, and incentive payments. Int J Med Inform 2021; 150:104441. [PMID: 33823463 DOI: 10.1016/j.ijmedinf.2021.104441] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 03/02/2021] [Accepted: 03/16/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The objective of this study was to quantify the rate of provider participation beyond year 1 incentive in the Florida Medicaid Promoting Interoperability (PI) program, formerly the Electronic Health Record Incentive program, and identify the provider and practice characteristics associated with Meaningful Use attestations. METHODS AND MATERIALS We conducted a retrospective cohort study using the 2011-2018 records from the PI program, Provider Participation Database. Bivariate associations between Meaningful Use and categorical and ordinal variables were tested using Chi-square and Mantel-Haenszel Chi-square, respectively, with results informing logistic regressions. Adjusted odds ratios and 95 % confidence intervals are reported. RESULTS We found that 42.56 % of Florida Medicaid providers achieved Meaningful Use after receiving first-year incentives. Logistic regression showed that pediatricians represented the largest percentage of providers who achieved Meaningful Use (65.06 %) while dentists had the lowest Meaningful Use (7.78 %). We also found that certain geographic areas and various EHR vendors were associated with higher rates of providers Meaningful Use attestation. DISCUSSION Although the PI program successfully influenced the adoption of a basic EHR system, low Meaningful Use attestations have inadvertently created a digital "advanced use" divide among providers who serve large numbers of Medicaid patients. This is concerning because advanced EHR functions are necessary precursors to address unmet socioeconomic needs to reduce health disparities. CONCLUSION Florida has distributed over $100 million to Medicaid providers who ultimately did not achieve Meaningful Use after collecting their first-year incentive. Policy interventions that can promote advanced EHR use functions are necessary to optimize technology in low-resourced practice settings where the potential benefits are greater.
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Li KJ, Al-Amin M. The interaction between high-level electronic medical record adoption and hospitalist staffing levels: A focus on value-based purchasing. Health Serv Manage Res 2021; 35:66-73. [PMID: 33726545 DOI: 10.1177/09514848211001696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study sought to understand the relationship of hospital performance with high-level electronic medical record (EMR) adoption, hospitalists staffing levels, and their potential interaction. MATERIALS AND METHODS We evaluated 2,699 non-federal, general acute hospitals using 2016 data merged from four data sources. We performed ordinal logistic regression of hospitals' total performance score (TPS) on their EMR capability and hospitalists staffing level while controlling for other market- and individual-level characteristics. RESULTS Hospitalists staffing level is shown to be positively correlated with TPS. High-level EMR adoption is associated with both short-term and long-term improvement on TPS. Large, urban, non-federal government hospitals, and academic medical centers tend to have lower TPS compared to their respective counterparts. Hospitals belonging to medium- or large-sized healthcare systems have lower TPS. Higher registered nurse (RN) staffing level is associated with higher TPS, while higher percentage of Medicare or Medicaid share of inpatient days is associated with lower TPS. DISCUSSION Although the main effects of hospitalists staffing level and EMR capability are significant, their interaction is not, suggesting that hospitalists and EMR act through separate mechanisms to help hospitals achieve better performance. When hospitals are not able to invest on both simultaneously, given financial constraints, they can still reap the full benefits from each. CONCLUSION Hospitalists staffing level and EMR capability are both positively correlated with hospitals' TPS, and they act independently to bolster hospital performance.
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Affiliation(s)
- Kate Jiayi Li
- Department of Information Systems and Operations Management, Suffolk University, Boston, MA,USA
| | - Mona Al-Amin
- Department of Healthcare Administration, Suffolk University, Boston, MA, USA
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Heath M, Porter TH, Silvera G. Hospital characteristics associated with HIPAA breaches. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2021. [DOI: 10.1080/20479700.2020.1870349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Michele Heath
- Department of Management, Cleveland State University, Cleveland, OH, USA
| | - Tracy H. Porter
- Department of Management, Cleveland State University, Cleveland, OH, USA
| | - Geoffrey Silvera
- Department of Political Science, Auburn University, Auburn, AL, USA
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Rosko M, Al-Amin M, Tavakoli M. Efficiency and profitability in US not-for-profit hospitals. INTERNATIONAL JOURNAL OF HEALTH ECONOMICS AND MANAGEMENT 2020; 20:359-379. [PMID: 32816192 PMCID: PMC7439627 DOI: 10.1007/s10754-020-09284-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 08/07/2020] [Indexed: 06/11/2023]
Abstract
This article examines the relationship between hospital profitability and efficiency. A cross-section of 1317 U.S. metropolitan, acute care, not-for-profit hospitals for the year 2015 was employed. We use a frontier method, stochastic frontier analysis, to estimate hospital efficiency. Total margin and operating margin were used as profit variables in OLS regressions that were corrected for heteroskedacity. In addition to estimated efficiency, control variables for internal and external correlates of profitability were included in the regression models. We found that more efficient hospitals were also more profitable. The results show a positive relationship between profitability and size, concentration of output, occupancy rate and membership in a multi-hospital system. An inverse relationship was found between profits and academic medical centers, average length of stay, location in a Medicaid expansion state, Medicaid and Medicare share of admissions, and unemployment rate. The results of a Hausman test indicates that efficiency is exogenous in the profit equations. The findings suggest that not-for-profit hospitals will be responsive to incentives for increasing efficiency and use market power to increase surplus to pursue their objectives.
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Affiliation(s)
- Michael Rosko
- Graduate Program in Health Care Management, School of Business Administration, Widener University, One University Place, Chester, PA, 19013, USA.
| | - Mona Al-Amin
- Department of Healthcare Administration, Sawyer Business School, Suffolk University, 120 Tremont Street, Room 5603, Boston, MA, 02108, USA
| | - Manouchehr Tavakoli
- School of Management, University of St. Andrews, St. Andrews, KY16 9RJ, Scotland, UK
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Steinhauser S, Doblinger C, Hüsig S. The Relative Role of Digital Complementary Assets and Regulation in Discontinuous Telemedicine Innovation in European Hospitals. J MANAGE INFORM SYST 2020. [DOI: 10.1080/07421222.2020.1831778] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Stefanie Steinhauser
- Department of Innovation and Technology Management, University of Regensburg, Regensburg, Germany
| | - Claudia Doblinger
- Campus Straubing for Biotechnology and Sustainability and School of Management, Technical University of Munich, Straubing, Germany
| | - Stefan Hüsig
- Department of Innovation Research and Technology Management, Chemnitz University of Technology, Chemnitz, Germany
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Epane JP, Weech-Maldonado R, Hearld LR, Sen B, O'Connor SJ, McRoy L. Hospitalists, two decades later: Which US hospitals utilize them? Health Serv Manage Res 2020; 34:158-166. [PMID: 33085543 DOI: 10.1177/0951484820962295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Hospitalists, or specialists of hospital medicine, have long been practicing in Canada and Europe. However, it was not until the mid-1990s, when hospitals in the U.S. started widespread adoption of hospitalists. Since then, the number of hospitalists has grown exponentially in the U.S. from a few hundred to over 50,000 in 2016. Prior studies on hospitalists have well documented benefits hospitals gain from adopting this innovative staffing strategy. However, there is a dearth of research documenting predictors of hospitals' adoption of hospitalists. To fill this gap, this longitudinal study (2003-2015) purposes to determine organizational and market characteristics of U.S. hospitals that utilize hospitalists. Our findings indicate that private not-for-profit, system affiliated, teaching, and urban hospitals, and those located in higher per capita income markets have a higher probability of utilizing hospitalists. Additionally, large or medium, profitable hospitals, and those that treat sicker patients have a higher probability of adoption. Finally, hospitals with a high proportion of Medicaid patients have a lower probability of utilizing hospitalists. Our results suggest that hospitals with greater slack resources and those located in munificent counties are more likely to use hospitalists, while their under-resourced counterparts may experience more barriers in adopting this innovative staffing strategy.
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Affiliation(s)
- Josue Patien Epane
- Department of Health Care Administration and Policy, School of Public Health, University of Nevada Las Vegas, Las Vegas, USA
| | - Robert Weech-Maldonado
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, USA
| | - Larry R Hearld
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, USA
| | - Bisakha Sen
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, USA
| | - Stephen J O'Connor
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, USA
| | - Luceta McRoy
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, USA
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Shin DY, Weech-Maldonado R, Chang J. The Impact of Market Conditions on RN Staffing in Hospitals: Using Resource Dependence Theory and Information Uncertainty Perspective. Risk Manag Healthc Policy 2020; 13:2103-2114. [PMID: 33116990 PMCID: PMC7568637 DOI: 10.2147/rmhp.s274529] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 09/26/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose Due to a limited number of studies with generalizable findings on the relationships between market conditions and RN staffing levels in hospitals, this study examined such relationships employing a longitudinal design with a representative national sample. Materials and Methods We used longitudinal panel datasets from 2006 to 2010, drawn from various datasets including the American Hospital Association Annual Survey Database and the Area Health Resource File. A random-effects linear regression model was used to measure the influence of market conditions on RN staffing levels. Results The results of this study showed that market conditions were significantly associated with RN staffing levels in hospitals. First, an increase in per capita income and being located in urban rather than rural areas were associated with a greater number of RNs per 1,000 inpatient days and a higher ratio of RNs to LPNs and nursing aides. In addition, an increase in the number of physician specialists was associated with an increase in the number of RNs per 1,000 inpatient days. Second, an increase in Medicare HMO penetration in the environment was related to an increase in the RNs to LPNs and nursing aides ratio. Lastly, an increase in market competition was associated with an increase in the number RNs per 1,000 inpatient days and the ratio of RNs to LPNs and nursing aides. Conclusion The findings of this study suggest that staffing decision makers in hospitals should consider how to best align their RN staffing levels with their operating environment. In addition, health policy makers may improve the levels the RN supply in communities that needs more RNs by modulating external environmental forces (eg, specialist resources) that influence RN staffing levels in hospitals.
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Affiliation(s)
- Dong Yeong Shin
- Department of Public Health Sciences, New Mexico State University, Las Cruces, NM, USA
| | - Robert Weech-Maldonado
- Department of Health Services Administration, University of Alabama, Birmingham, AL, USA
| | - Jongwha Chang
- Department of Pharmaceutical Sciences., University of Texas, El Paso, TX, USA
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Scott IA, Sullivan C, Staib A. Going digital: a checklist in preparing for hospital-wide electronic medical record implementation and digital transformation. AUST HEALTH REV 2020; 43:302-313. [PMID: 29792259 DOI: 10.1071/ah17153] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 01/29/2018] [Indexed: 11/23/2022]
Abstract
Objective In an era of rapid digitisation of Australian hospitals, practical guidance is needed in how to successfully implement electronic medical records (EMRs) as both a technical innovation and a major transformative change in clinical care. The aim of the present study was to develop a checklist that clearly and comprehensively defines the steps that best prepare hospitals for EMR implementation and digital transformation. Methods The checklist was developed using a formal methodological framework comprised of: literature reviews of relevant issues; an interactive workshop involving a multidisciplinary group of digital leads from Queensland hospitals; a draft document based on literature and workshop proceedings; and a review and feedback from senior clinical leads. Results The final checklist comprised 19 questions, 13 related to EMR implementation and six to digital transformation. Questions related to the former included organisational considerations (leadership, governance, change leaders, implementation plan), technical considerations (vendor choice, information technology and project management teams, system and hardware alignment with clinician workflows, interoperability with legacy systems) and training (user training, post-go-live contingency plans, roll-out sequence, staff support at point of care). Questions related to digital transformation included cultural considerations (clinically focused vision statement and communication strategy, readiness for change surveys), management of digital disruption syndromes and plans for further improvement in patient care (post-go-live optimisation of digital system, quality and benefit evaluation, ongoing digital innovation). Conclusion This evidence-based, field-tested checklist provides guidance to hospitals planning EMR implementation and separates readiness for EMR from readiness for digital transformation. What is known about the topic? Many hospitals throughout Australia have implemented, or are planning to implement, hospital wide electronic medical records (EMRs) with varying degrees of functionality. Few hospitals have implemented a complete end-to-end digital system with the ability to bring about major transformation in clinical care. Although the many challenges in implementing EMRs have been well documented, they have not been incorporated into an evidence-based, field-tested checklist that can practically assist hospitals in preparing for EMR implementation as both a technical innovation and a vehicle for major digital transformation of care. What does this paper add? This paper outlines a 19-question checklist that was developed using a formal methodological framework comprising literature review of relevant issues, proceedings from an interactive workshop involving a multidisciplinary group of digital leads from hospitals throughout Queensland, including three hospitals undertaking EMR implementation and one hospital with complete end-to-end EMR, and review of a draft checklist by senior clinical leads within a statewide digital healthcare improvement network. The checklist distinguishes between issues pertaining to EMR as a technical innovation and EMR as a vehicle for digital transformation of patient care. What are the implications for practitioners? Successful implementation of a hospital-wide EMR requires senior managers, clinical leads, information technology teams and project management teams to fully address key operational and strategic issues. Using an issues checklist may help prevent any one issue being inadvertently overlooked or underemphasised in the planning and implementation stages, and ensure the EMR is fully adopted and optimally used by clinician users in an ongoing digital transformation of care.
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Affiliation(s)
- Ian A Scott
- Princess Alexandra Hospital, 199 Ipswich Road, Brisbane, Qld 4102, Australia
| | - Clair Sullivan
- Princess Alexandra Hospital, 199 Ipswich Road, Brisbane, Qld 4102, Australia
| | - Andrew Staib
- Princess Alexandra Hospital, 199 Ipswich Road, Brisbane, Qld 4102, Australia
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Dhagarra D, Goswami M, Kumar G. Impact of Trust and Privacy Concerns on Technology Acceptance in Healthcare: An Indian Perspective. Int J Med Inform 2020; 141:104164. [PMID: 32593847 PMCID: PMC7212948 DOI: 10.1016/j.ijmedinf.2020.104164] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/25/2020] [Accepted: 04/29/2020] [Indexed: 12/17/2022]
Abstract
This paper augments the technology acceptance model (TAM) by empirically investigating the influence of behavioral traits (privacy concerns and trust) and cognitive beliefs (perceived usefulness and perceived ease of use) on patients' behavioral intention to accept technology in healthcare service delivery. Despite increased emphasis on healthcare service delivery, there has been limited studies as to how various behavioral constructs are related to adoption of new technology in healthcare sector. To this end, and to develop meaningful insights, a conceptual model integrating behavioral constructs with constructs related to technology acceptance model is devised. The aim here is essentially to understand relationships that predict patients' acceptance of technology in healthcare services. The devised model is tested on responses obtained from survey of 416 patients availing healthcare service at various primary health centers in New Delhi, India. Structural equation modeling (SEM) is employed to conceptualize the model and validate nine hypotheses entailing key constructs. The results indicate that perceived usefulness, perceived ease of use, trust and privacy concern are direct predictors of patients' behavior to accept technology in availing healthcare services. In summary, this research provides an empirical contribution to the literature on effect of trust and privacy concerns on acceptance of technology in healthcare.
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Affiliation(s)
| | - Mohit Goswami
- Operations Management Group, Indian Institute of Management Raipur, India
| | - Gopal Kumar
- Operations Management Group, Indian Institute of Management Raipur, India
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STEINHAUSER STEFANIE. ENABLING THE UTILIZATION OF POTENTIALLY DISRUPTIVE DIGITAL INNOVATIONS BY INCUMBENTS: THE IMPACT OF CONTEXTUAL, ORGANISATIONAL, AND INDIVIDUAL FACTORS IN REGULATED CONTEXTS. INTERNATIONAL JOURNAL OF INNOVATION MANAGEMENT 2020. [DOI: 10.1142/s1363919621500158] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Incumbents’ inertia in the face of disruptive innovations has been emphasised in prior literature. The relevance of inertia is particularly topical in the context of digital transformation. However, incumbents may be able to invest in disruptive digital innovations appropriately if they possess the motivation and ability to do so. In this paper, I use three streams of research in order to investigate contextual, organisational, and individual antecedents of incumbents’ motivation and ability to adopt and use potentially disruptive digital innovations in health care: institutional theory, the resource-based view, and technology acceptance literature. I employ factor analyses and logistic regressions to test the impact on the adoption and usage of telemedicine applications using a dataset of 9,196 European general practitioners. I examine B2B as well as B2C applications in order to determine the effect of the antecedents on different business models. My findings suggest that only isomorphic pressure, complementary assets, and perceived output quality significantly influence both adoption and usage as well as B2B and B2C business models in the same way. Formal institutions and individual factors yield ambiguous results. These findings provide important implications for the understanding of incumbents’ response to potentially disruptive digital innovations in regulated contexts.
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Affiliation(s)
- STEFANIE STEINHAUSER
- Department of Innovation and Technology Management, University of Regensburg, 93040 Regensburg, Germany
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34
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Factors associated with the provision of inpatient care in hospices. Health Care Manage Rev 2020; 46:E61-E67. [PMID: 32366747 DOI: 10.1097/hmr.0000000000000282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hospices provide end-of-life care to patients who have complex health care needs and whose symptoms are difficult to control. Understanding why some hospices offer inpatient hospice care to patients could bring more evidence for policy makers and researchers to focus on the role of inpatient care in hospice. PURPOSE The purpose of this study was to examine market and organizational factors that are associated with the provision of hospice inpatient care. METHODOLOGY This study used a retrospective, longitudinal design (2009-2013). The study sample was drawn from three data resources: the Area Health Resources Files, the Provider of Services files, and Hospice Cost Reports from Centers for Medicare & Medicaid Services. The sample size was 2,391 hospices or 10,999 hospice observations over 5 years. A generalized linear mixed-effects model was used to examine the association between market and organizational factors and hospice inpatient services offering. RESULTS On average, 94.59% of hospices offer inpatient services to patients. Proportion of adults who were over 65 years old (OR = 1.12) and Medicare-managed care penetration (OR = 1.02) were positively associated with the provision of hospice inpatient services. The number of hospitals with hospice program was negatively related to hospice inpatient services offering (OR = .95). Other factors such as nursing skill mix, volunteer dependence, and census region were also associated with inpatient services offering. PRACTICE IMPLICATIONS The age demand of hospice care and Medicare-managed care penetration are related to hospice inpatient services offering. Hospices located in the market with more competition from hospitals that offer hospice program are less likely to offer inpatient care.
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Hu X, Qu H, Houser SH, Chen H, Zhou J, Yu M. Hospital Characteristics Associated with Certified EHR Adoption among US Psychiatric Hospitals. Risk Manag Healthc Policy 2020; 13:295-301. [PMID: 32308512 PMCID: PMC7135123 DOI: 10.2147/rmhp.s241553] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 03/14/2020] [Indexed: 11/23/2022] Open
Abstract
Objective The aim of this study was to explore the relationship between hospital characteristics and certified electronic health record (EHR) adoption in psychiatric hospitals in the US. Methods Data were drawn from the American Hospital Association Annual Survey Database and the Centers for Medicare and Medicaid Services Hospital Compare data sets in 2016. Binary logistic regression analysis and χ2 tests were performed to examine the relationship between certified EHR adoption and hospital characteristics. Results Of 1,059 psychiatric hospitals in the US, 502 (47.4%) have adopted certified EHR technology. Large hospitals (OR 2.29, 95% CI 1.52–3.44; p<0.001), not-for-profit hospitals (OR 1.74, 95% CI 1.22–2.49; p=0.008), and hospitals participating in a network (OR 1.78, 95% CI 1.34–2.37; p<0.001) were more likely to adopt certified EHRs. Hospitals in the northeast were less likely to implement certified EHRs compared to other regions. However, there was no significant association found between EHR utilization and system affiliation, urban location, teaching status, or participation of health-maintenance organizations and preferred provider organizations. Conclusion The study results suggested variations in EHR adoption according to hospital location, size, ownership, and network participation. This study fills a gap in previous work on certified EHR adoption that focused exclusively on general hospitals, but overlooked psychiatric hospitals. Future policies designed to influence the implementation of certified EHRs should take into consideration how hospital size, ownership, and network-affiliation status affect certified EHR adoption among psychiatric hospitals.
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Affiliation(s)
- Xuejun Hu
- Department of Health Services Administration, Air Force Medical University, Xi'an, People's Republic of China.,Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Haiyan Qu
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Shannon H Houser
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Huoliang Chen
- Department of Health Services Administration, Air Force Medical University, Xi'an, People's Republic of China
| | - Jinming Zhou
- Department of Health Services Administration, Air Force Medical University, Xi'an, People's Republic of China
| | - Min Yu
- Department of Health Services Administration, Academy of Military Medical Sciences, Beijing, People's Republic of China
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Li D, Chao J, Kong J, Cao G, Lv M, Zhang M. The efficiency analysis and spatial implications of health information technology: A regional exploratory study in China. Health Informatics J 2019; 26:1700-1713. [PMID: 31793803 DOI: 10.1177/1460458219889794] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The new adoption of healthcare information technology is costly, and effects on healthcare performance can be questionable. This nationwide study in China investigated the efficient performance of healthcare information technology and examined its spatial correlation. Panel data were extracted from the Annual Investigation Report on Hospital Information in China and the China Health Statistics Yearbook for 2007 through 2015 (279 observations). Stochastic frontier analysis was employed to estimate the technical efficiency of healthcare information technology performance and related factors at the regional level. Healthcare information technology performance was positively associated with electronic medical records, total input, and cost of inpatient stay, while picture archiving and communication systems and net assets were negatively related. Local Indicators of Spatial Association showed that there existed significant spatial autocorrelation. Governmental policies would best make distinctions among different forms of healthcare information technology, especially between electronic medical records and picture archiving and communication systems. Policies should be formulated to improve healthcare information technology adoption and reduce regional differences.
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Affiliation(s)
| | | | | | - Gui Cao
- Renmin University of China, China
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How Does Electronic Health Information Exchange Affect Hospital Performance Efficiency? The Effects of Breadth and Depth of Information Sharing. J Healthc Manag 2019; 63:212-228. [PMID: 29734283 DOI: 10.1097/jhm-d-16-00041] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
EXECUTIVE SUMMARY This research was motivated by the large investment in health information technology (IT) by hospitals and the inconsistent findings related to the effects of health IT adoption on hospital performance. Building on resource orchestration theory and the information systems literature, the authors developed a research model to investigate how the configuration strategies for sharing information under health IT systems affect hospital efficiency. The hypotheses were tested using data from the 2010 annual and IT surveys of the American Hospital Association, Centers for Medicare & Medicaid Services case mix index, and U.S. Census Bureau's small-area income and poverty estimates. The study revealed that in health IT systems, the breadth (extent) and depth (level of detail) of digital information sharing among stakeholders each has a curvilinear relationship with hospital efficiency. In addition, breadth and depth reinforce each other's positive effects and attenuate each other's negative effects, and their balance has a positive effect on hospital efficiency. The results of this research have the potential to enrich the literature on the value of adopting health IT systems as well as in providing practitioner guidelines for meaningful use.
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Cooley A. Predictors of online accountability practices in US hospitals: An exploratory investigation. Int J Health Plann Manage 2019; 35:e178-e195. [PMID: 31721296 DOI: 10.1002/hpm.2958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 10/28/2019] [Accepted: 10/29/2019] [Indexed: 11/07/2022] Open
Abstract
The purpose of this research paper is to explore variations in online accountability practices in US hospitals and determine the factors that are associated with higher levels of online accountability practices. This project employed a quantitative content analysis of 240 US hospital websites. Additionally, secondary data were obtained from the American Hospital Association and the American Hospital Directory. The results show that the external environment somewhat impacted hospitals' online accountability practices, with hospital volume (measured through the number of annual admissions) as an unquestionable predictor. Another key finding is that some of the governance forms impacted online accountability practices. Particularly, hospitals with private ownership structures tended to disclose less accountability information in an online environment, compared with their public and nonprofit counterparts. The financial situation of hospitals did not have any significant impact on overall online accountability practices but was influencing performance disclosure practices. Online accountability studies have not been conducted in a health care setting. This research theoretically relates online accountability practices to organizational characteristics (such as size, volume, financial performance, system affiliation, ownership, and rurality). Knowledge of the online accountability landscape might benefit future policy decisions on accountability models.
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Affiliation(s)
- Asya Cooley
- School of Media and Strategic Communications, Oklahoma State University, Stillwater, Oklahoma, USA
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Gao F, Sunyaev A. Context matters: A review of the determinant factors in the decision to adopt cloud computing in healthcare. INTERNATIONAL JOURNAL OF INFORMATION MANAGEMENT 2019. [DOI: 10.1016/j.ijinfomgt.2019.02.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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40
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Variation in electronic health record adoption in European public hospitals: a configurational analysis of key functionalities. HEALTH AND TECHNOLOGY 2019. [DOI: 10.1007/s12553-019-00311-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Greenwood BN, Ganju KK, Angst CM. How Does the Implementation of Enterprise Information Systems Affect a Professional’s Mobility? An Empirical Study. INFORMATION SYSTEMS RESEARCH 2019. [DOI: 10.1287/isre.2018.0817] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Brad N. Greenwood
- Information and Decision Sciences, Carlson School of Management, University of Minnesota, Minneapolis, Minnesota 55455
| | - Kartik K. Ganju
- Desautels Faculty of Management, McGill University, Montréal, Quebec H3A 1G5, Canada
| | - Corey M. Angst
- Information Technology, Analytics, and Operations, Mendoza College of Business, University of Notre Dame, Notre Dame, Indiana 46556
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Explaining variations in hospitals' use of strategic human resource management: How environmental and organizational factors matter. Health Care Manage Rev 2019; 46:2-11. [PMID: 30908315 DOI: 10.1097/hmr.0000000000000242] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Against the background of increasing workforce-related challenges such as staff shortages, strategic human resource management (SHRM) has gained importance in hospitals. Although the positive implications of SHRM for hospital performance are well known and commonly accepted in research and practice, hospitals still vary in its use. However, the sources of variations in hospitals' use of SHRM are largely unknown. PURPOSE Various organizational and environmental factors were used in this study to explain the variations in hospitals' use of SHRM for physicians and nurses. METHODOLOGY Data were obtained from a hospital survey (n = 172) on topics related to human resource management in hospitals and linked to different secondary data sets. We apply multiple linear regression modeling to investigate the association between organizational and environmental characteristics and hospitals' use of SHRM for nurses and physicians. FINDINGS Our results suggest that organizational factors such as private for-profit and nonprofit ownership (compared to public ownership), academic teaching status, and the strategic involvement of the human resource administration are positively associated with hospitals' use of SHRM. None of the environmental factors investigated in this study was significantly related to hospitals' use of SHRM. PRACTICAL IMPLICATIONS The study results increase our understanding of variations in hospitals' use of SHRM. Although organizational characteristics were found to explain variations in SHRM, environmental factors seem unrelated with hospitals' use of SHRM. Our results inform both hospital managers and policy makers about possible approaches to enhance SHRM use in hospitals. Furthermore, profound knowledge about factors associated with SHRM will help to enhance our understanding of anticipating changes in hospitals' use of SHRM through organizational- and environmental-oriented interventions.
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Tarcan GY, Yalcin Balcik P, Sapaz B. Systematic evaluation of the websites: Hospital-based practice. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2019. [DOI: 10.1080/20479700.2018.1564445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Gamze Yorgancioglu Tarcan
- Department of Health Management, Faculty of Economics and Administrative Science, Hacettepe University, Beytepe, Turkey
| | - Pinar Yalcin Balcik
- Department of Health Management, Faculty of Economics and Administrative Science, Hacettepe University, Beytepe, Turkey
| | - Bulent Sapaz
- Department of Health Management, Faculty of Economics and Administrative Science, Hacettepe University, Beytepe, Turkey
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CEO Turnover Among U.S. Acute Care Hospitals, 2006-2015: Variations by Type of Geographic Area. J Healthc Manag 2019; 64:28-42. [PMID: 30608482 DOI: 10.1097/jhm-d-18-00019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
EXECUTIVE SUMMARY Recent reports have documented rising rates of CEO turnover. This phenomenon can have negative implications for hospitals and their surrounding communities, particularly in under-resourced rural communities. Ostensibly, components of the Affordable Care Act have addressed some of these resource challenges and may have helped to slow the CEO turnover trend in rural areas. We examined this possibility with a longitudinal analysis of U.S. acute care hospitals over an extended period (2006-2015) to examine whether patterns of CEO change differed for hospitals in different types of geographic areas (e.g., rural vs. urban). The rates revealed by our analysis seem to be problematic, with nearly one-quarter of all U.S. hospitals experiencing a change in CEO every 3 to 4 years, on average. Moreover, while the likelihood of a CEO change increased significantly over time for hospitals in nearly all types of geographic areas, it was nearly twice as large for frontier hospitals in areas with fewer than 2,500 residents compared to urban and rural hospitals. Our study suggests that the stability of hospital CEO leadership has declined over the past decade, particularly for vulnerable frontier hospitals, and highlights the need for recruitment and retention strategies to address this challenge.
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45
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Vest JR, Simon K. Hospitals' adoption of intra-system information exchange is negatively associated with inter-system information exchange. J Am Med Inform Assoc 2018; 25:1189-1196. [PMID: 29860502 DOI: 10.1093/jamia/ocy058] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 05/22/2018] [Indexed: 11/13/2022] Open
Abstract
Introduction U.S. policy on interoperable HIT has focused on increasing inter-system (ie, between different organizations) health information exchange. However, interoperable HIT also supports the movement of information within the same organization (ie, intra-system exchange). Methods We examined the relationship between hospitals' intra- and inter-system information exchange capabilities among health system hospitals included in the 2010-2014 American Hospital Association's Annual Health Information Technology Survey. We described the factors associated with hospitals that adopted more intra-system than inter-system exchange capability, and explored the extent of new capability adoption among hospitals that reported neither intra- or inter-system information capabilities at baseline. Results The prevalence of exchange increased over time, but the adoption of inter-system information exchange was slower; when hospitals adopt information exchange, adoption of intra-system exchange was more common. On average during our study period, hospitals could share 4.6 types of information by intra-system exchange, but only 2.7 types of information by inter-system exchange. Controlling for other factors, hospitals exchanged more types of information in an intra-system manner than inter-system when the number of different inpatient EHR vendors in use in health system is larger. Conclusion Consistent with the U.S. goals for more widely accessible patient information, hospitals' ability to share information has increased over time. However, hospitals are prioritizing within-organizational information exchange over exchange between different organizations. If increasing inter-system exchanges is a desired goal, current market incentives and government policies may be insufficient to overcome hospitals' motivations for pursuing an intra-system-information-exchange-first strategy.
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Affiliation(s)
- Joshua R Vest
- Indiana University Richard M. Fairbanks School of Public Health, Department of Health Policy & Management, Indianapolis, Indiana, USA.,Regenstrief Institute, Indianapolis, Indiana, USA
| | - Kosali Simon
- Indiana University School of Public & Environmental Affairs
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Pao HW, Lee CY, Chung PH, Wu HL. Hiring decisions on certified manpower. JOURNAL OF ADVANCES IN MANAGEMENT RESEARCH 2018. [DOI: 10.1108/jamr-05-2017-0070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The industry-wide adoption of a novel practice is often considered to be an institutional change. Although research on institutionalization has been accumulating, how and why embedded actors in the field become motivated to embrace change that remains sidelined. Viewing the introduction of a new human resource management practice, the recruitment of non-compulsory certified manpower, which is still in its infancy in the service sector of Taiwan, as a new institution, the purpose of this paper is to identify the distinct motives behind firms’ hiring decisions, and examine the extent to which such hiring decisions are contingent on institutional conditions and firm attributes.
Design/methodology/approach
The data used to test the hypotheses were drawn from a survey on service firms in Taiwan in the second half of 2011. Hypotheses were examined through moderated hierarchical regression analyses in a sample of 254 Taiwanese service firms across major sectors.
Findings
Integrating the resource dependency and social contagion views, the study contends that resource scarcity drives, or legitimacy enables, service firms to deviate from traditional hiring patterns and instead adopt new preferences toward certified manpower. The study not only shows that social factors should be incorporated into the diffusion of a new HR recruitment practice in the service sector, which is traditionally based upon economic considerations, but also sheds light on the context-dependent nature of the process of institutional innovation.
Originality/value
This study is an attempt not only to test a dual-theoretical model on the extent to which a service firm’s new hiring pattern is influenced by two distinct types of motivation, but also to evidence how an institutional innovation, in terms of the regime of service manpower certification, takes root and spreads in the field. The managerially discretional account of the resource dependence theory needs to be reconciled with social contagion theory, which highlights the influence of collective actions and so provides a better understanding of the diffusion of new HR recruitment practices in the service industry.
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Ellis Hilts K, Xia J, Yeager VA, Ferdinand AO, Menachemi N. Market characteristics associated with community health assessments by local health departments. Public Health 2018; 162:118-125. [PMID: 30029173 DOI: 10.1016/j.puhe.2018.05.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 05/18/2018] [Accepted: 05/30/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES Community health assessments (CHAs) have been promoted as a strategy for population health. This study uses the resource dependence theory (RDT) to examine how external market characteristics are associated with CHAs conducted by local health departments (LHDs) and subsequent partnering with hospitals for CHAs in the United States. STUDY DESIGN The RDT was used to guide the conceptualization of the market in the context of local public health. RDT emphasizes that organizations are not in control of all the resources they need and, to some extent, must rely on the external environment to provide those necessary resources. Binary measures were used to examine whether LHDs conducted CHAs and whether they did so in partnership with a local hospital. Independent variables were identified to measure the RDT constructs of munificence (resource availability in the environment), complexity (level of heterogeneity), and dynamism (level of environmental turbulence). METHODS Bivariate (Chi-squared and t-tests) and multivariate (logistic regression) cross-sectional analyses were conducted using secondary data from the National Association of County and City Health Officials 2013 Profile Survey, the 2013 County Health Rankings data set, and the Health Resources and Services Administration's Area Health Resource File. RESULTS Two of three variables measuring munificence were positively associated with having conducted a CHA; one variable was also related to doing so in conjunction with a local hospital. One measure of market complexity was negatively associated with having conducted a CHA. No measure of dynamism was related to the dependent variables. CONCLUSIONS Study results provide partial support for the use of RDT in understanding the relationship between market factors and LHDs' activities around CHAs. Local hospitals as partners and other market factors should be considered by LHDs when conducting CHAs. Findings from this work will be of interest to public health practitioners, policy-makers, and researchers interested in public health and population health improvement.
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Affiliation(s)
- K Ellis Hilts
- Indiana University Richard M. Fairbanks School of Public Health at IUPUI, USA.
| | - J Xia
- Indiana University Richard M. Fairbanks School of Public Health at IUPUI, USA
| | - V A Yeager
- Indiana University Richard M. Fairbanks School of Public Health at IUPUI, USA
| | | | - N Menachemi
- Indiana University Richard M. Fairbanks School of Public Health at IUPUI, USA
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The relationship between the external environment and physician e-mail communication: The mediating role of health information technology availability. Health Care Manage Rev 2018; 42:122-131. [PMID: 26587999 DOI: 10.1097/hmr.0000000000000095] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Physician e-mail communication, with patients and other providers, is one of the cornerstones of effective care coordination but varies significantly across physicians. A physician's external environment may contribute to such variations by enabling or constraining a physician's ability to adopt innovations such as health information technology (HIT) that can be used to support e-mail communication. PURPOSE The aim of the study was to examine whether the relationship of the external environment and physician e-mail communication with patients and other providers is mediated by the practice's HIT availability. METHODOLOGY The data were obtained from the Health Tracking Physician Survey (2008) and the Area Resource File (2008). Cross-sectional multivariable subgroup path analysis was used to investigate the mediating role of HIT availability across 2,850 U.S. physicians. FINDINGS Solo physicians' perceptions about malpractice were associated with 0.97 lower odds (p < .05) of e-mail communication with patients and other providers, as compared to group and hospital practices, even when mediated by HIT availability. Subgroup analyses indicated that different types of practices are responsive to the different dimensions of the external environment. Specifically, solo practitioners were more responsive to the availability of resources in their environment, with per capita income associated with lower likelihood of physician e-mail communication (OR = 0.99, p < .01). In contrast, physicians working in the group practices were more responsive to the complexity of their environment, with a physician's perception of practicing in environments with higher malpractice risks associated with greater information technology availability, which in turn was associated with a greater likelihood of communicating via e-mail with patients (OR = 1.02, p < .05) and other physicians (OR = 1.03, p < .001). PRACTICAL APPLICATIONS The association between physician e-mail communication and the external environment is mediated by the practice's HIT availability. Efforts to improve physician e-mail communication and HIT adoption may need to reflect the varied perceptions of different types of practices.
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Asagbra OE, Burke D, Liang H. Why hospitals adopt patient engagement functionalities at different speeds? A moderated trend analysis. Int J Med Inform 2017; 111:123-130. [PMID: 29425623 DOI: 10.1016/j.ijmedinf.2017.12.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 12/19/2017] [Accepted: 12/27/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To investigate acute care hospitals' adoption speed of patient engagement health information technology (HIT) functionalities from 2008 to 2013 and how this speed is contingent on environmental factors and hospital characteristics. METHODS Data on non-government acute care hospitals located in the United States was obtained from merging three databases: the American Hospital Association's (AHA) annual survey information technology supplement, AHA annual survey, and the Area Health Resource File (AHRF). The variables obtained from these datasets were the amount of annually adopted patient engagement HIT functionalities and environmental and organizational characteristics. Environmental factors included were uncertainty, munificence, and complexity. Hospital characteristics included size, system membership, ownership, and teaching status. RESULTS A regression analysis of 4176 hospital-year observations revealed a positive trend in the adoption of HIT functionalities for patient engagement (β= 1.109, p < 0.05). Moreover, the study showed that large, system-affiliated, not-for-profit, teaching hospitals adopt patient engagement HIT functionalities at a faster speed than their counterparts. Environmental munificence and uncertainty were also associated with an accelerating speed of adoption. Environmental complexity however did not show a significant impact on the speed of adoption. DISCUSSION From 2008 to 2013, there was a significant acceleration in the speed of adopting patient engagement HIT functionalities. Further efforts should be made to ensure proper adoption and consistent use by patients in order to reap the benefits of these IT investments. CONCLUSION Hospitals adopted at least one HIT functionality for patient engagement per year. The adoption speed varied across hospitals, depending on both environmental and organizational factors.
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Affiliation(s)
- O Elijah Asagbra
- Department of Health Services and Information Management, College of Allied Health Sciences, East Carolina University,4340P Health Sciences Building, Greenville, NC, USA
| | - Darrell Burke
- Department of Health Services Administration, School of Health Professions, SHP Building 590G, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Huigang Liang
- Department of Management Information Systems, College of Business, East Carolina University, 303 Slay Hall, Greenville, NC, USA.
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Gardner JW, Boyer KK, Ward PT. Achieving Time-Sensitive Organizational Performance Through Mindful Use of Technologies and Routines. ORGANIZATION SCIENCE 2017. [DOI: 10.1287/orsc.2017.1159] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- John W. Gardner
- Marriott School of Business, Brigham Young University, Provo, Utah 84602
| | - Kenneth K. Boyer
- Max M. Fisher College of Business, The Ohio State University, Columbus, Ohio 43210
| | - Peter T. Ward
- Max M. Fisher College of Business, The Ohio State University, Columbus, Ohio 43210
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