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Nursing Students' Subjective Happiness: A Social Network Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111612. [PMID: 34770124 PMCID: PMC8583011 DOI: 10.3390/ijerph182111612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/02/2021] [Accepted: 11/02/2021] [Indexed: 11/16/2022]
Abstract
Improving nursing students’ subjective happiness is germane for efficiency in the nursing profession. This study examined the subjective happiness of nursing students by applying social network analysis (SNA) and developing a strategy to improve the subjective happiness of nursing. The study adopted a cross sectional survey to measure subjective happiness and social network of 222 nursing students. The results revealed that the centralization index, which is a measure of intragroup interactions from the perspective of an entire network, was higher in the senior year compared with the junior year. Additionally, the indegree, outdegree, and centrality of the social network of students with a high level of subjective happiness were all found to be high. This result suggests that subjective happiness is not just an individual’s psychological perception, but can also be expressed more deeply depending on the subject’s social relationships. Based on the study’s results, to strengthen self-efficacy and resilience, it is necessary to utilize strategies that activate group dynamics, such as team activities, to improve subjective happiness. The findings can serve as basic data for future research focused on improving nursing students’ subjective happiness by consolidating team-learning social networks through a standardized program approach within a curriculum or extracurricular programs.
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Fos EB, Thompson ME, Elnitsky CA, Platonova EA. Community Benefit Spending Among North Carolina's Tax-Exempt Hospitals After Performing Community Health Needs Assessments. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2020; 25:E1-E8. [PMID: 31136519 DOI: 10.1097/phh.0000000000000921] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
CONTEXT As of March 23, 2012, the Internal Revenue Service (IRS) requires tax-exempt hospitals to conduct Community Health Needs Assessment (CHNA) every 3 years to incentivize hospitals to provide programs responsive to the health needs of their communities. OBJECTIVE To examine the distribution and variation in community benefit spending among North Carolina's tax-exempt hospitals 2 years after completing their first IRS-mandated CHNA. DESIGN Cross-sectional study using secondary analysis of published community benefit reports. Community benefit was categorized on the basis of North Carolina Hospital Association's community benefit reporting guidelines. Multiple regression analysis using generalized linear model was used to examine the variation in community benefit spending among study hospitals considering differences in hospital-level and community characteristics. SETTING Fifty-three private, nonprofit hospitals across North Carolina. MAIN OUTCOME MEASURE Dollar expenditures as a percentage of operating expenses of the 2 categories of community benefit spending: patient care financial assistance and community health programs. RESULTS Study hospitals' aggregate community benefit spending was $2.6 billion, 85% of which was in the form of patient care financial assistance, with only 0.7% of total spending allocated to community-building activities such as affordable housing, economic development, and environmental improvements. On average, the study hospitals' community benefit spending was equivalent to 14.6% of operating expenses. Hospitals with 300 or more beds provided significantly higher investments in community health programs as a percentage of their operating expenses than hospitals with 101 to 299 beds (P = .03) or hospitals with 100 or fewer beds (P = .04). Access to care was not associated with patient care financial assistance (P = .81) or community health programs expenditures (P = .94). CONCLUSIONS The study hospitals direct most of their community benefit expenditures to patient care financial assistance (individual welfare) rather than population health improvement initiatives, with virtually no investments in community-building activities that address socioeconomic determinants of health.
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Affiliation(s)
- Elmer B Fos
- Department of Public Health Sciences (Drs Fos, Thompson, and Platonova) and School of Nursing (Dr Elnitsky), University of North Carolina at Charlotte, Charlotte, North Carolina
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Rigoli F, Mascarenhas S, Alves D, Canelas T, Duarte G. Tracking pregnant women displacements in Sao Paulo, Brazil: a complex systems approach to regionalization through the emergence of patterns. BMC Med 2019; 17:184. [PMID: 31570106 PMCID: PMC6771099 DOI: 10.1186/s12916-019-1416-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 08/06/2019] [Accepted: 08/23/2019] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The healthcare system can be understood as the dynamic result of the interaction of hospitals, patients, providers, and government configuring a complex network of reciprocal influences. In order to better understand such a complex system, the analysis must include characteristics that are feasible to be studied in order to redesign its functioning. The analysis of the emergent patterns of pregnant women flows crossing municipal borders for birth-related hospitalizations in a region of São Paulo, Brazil, allowed to examine the functionality of the regional division in the state using a complex systems approach and to propose answers to the dilemma of concentration vs. distribution of maternal care regional services in the context of the Brazilian Unified Health System (SUS). METHODS Cross-sectional research of the areas of influence of hospitals using spatial interaction methods, recording the points of origin and destination of the patients and exploring the emergent patterns of displacement. RESULTS The resulting functional region is broader than the limits established in the legal provisions, verifying that 85% of patients move to hospitals with high technology to perform normal deliveries and cesarean sections. The region has high independence rates and behaves as a "service exporter." Patients going to centrally located hospitals travel twice as long as patients who receive care in other municipalities even when the patients' conditions do not demand technologically sophisticated services. The effects of regulation and the agents' preferences reinforce the tendency to refer patients to centrally located hospitals. CONCLUSIONS Displacement of patients during delivery may affect indicators of maternal and perinatal health. The emergent pattern of movements allowed examining the contradiction between wider deployments of services versus concentration of highly specialized resources in a few places. The study shows the potential of this type of analysis applied to other type of patients' flows, such as cancer or specialized surgery, as tools to guide the regionalization of the Brazilian Health System.
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Affiliation(s)
- Felix Rigoli
- School for International Training, São Paulo, Brazil.
| | - Sergio Mascarenhas
- Institute of Physics, University of Sao Paulo, Sao Carlos Campus, Brazil
| | - Domingos Alves
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Tiago Canelas
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Geraldo Duarte
- Department of Gynecology and Obstetrics of Ribeirão Preto Medical School, University of Sao Paulo, Sao Carlos Campus, Brazil
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Thomsen JM. An Investigation of the Critical Events and Influential Factors to the Evolution of the U.S. Man and the Biosphere Program. ENVIRONMENTAL MANAGEMENT 2018; 61:545-562. [PMID: 29353305 DOI: 10.1007/s00267-017-0988-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 12/29/2017] [Indexed: 06/07/2023]
Abstract
The UNESCO Man and the Biosphere program has operated for 45 years as an international program that started in the 1970s to conserve biotic communities and provide areas for research, education, and training. The program later evolved in the 1990s to address social and environmental issues in a sustainable manner across a landscape. This program was one of the first efforts that recognized the importance of working beyond park and protected area boundaries and the need to sustain livelihoods as much as the resources. In the MAB program's infancy, the United States (U.S.) was a major advocate and leader with more than 45 biosphere reserves, most of them established in or around 1976. Yet, many political, economic, and other external factors influenced the U.S. MAB involvement in subsequent years. Consequently, the U.S. has remained largely inactive in the international MAB network for the past fifteen years until a recent push to revive the program under the leadership of the State Department and the National Park Service. Through in-depth research on two longterm U.S. biosphere reserves, this paper provides a description of the key events impacting the U.S. MAB program over the past several decades and discusses the influential role of politics, a public image, and the perceptions of international designations. Through the lessons presented in this paper, recommendations are provided to support the revival of the MAB program in the U.S.
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Affiliation(s)
- Jennifer M Thomsen
- Department of Society and Conservation, University of Montana, 32 Campus Drive, Missoula, MT, 59812, USA.
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Kitts JA, Lomi A, Mascia D, Pallotti F, Quintane E. Investigating the Temporal Dynamics of Interorganizational Exchange: Patient Transfers among Italian Hospitals. AJS; AMERICAN JOURNAL OF SOCIOLOGY 2017; 123:850-910. [PMID: 34305150 PMCID: PMC8302044 DOI: 10.1086/693704] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Previous research on interaction behavior among organizations (resource exchange, collaboration, communication) has typically aggregated those behaviors over time as a network of organizational relationships. The authors instead study structural-temporal patterns in organizational exchange, focusing on the dynamics of reciprocation. Applying this lens to a community of Italian hospitals during 2003-7, the authors observe two mechanisms of interorganizational reciprocation: organizational embedding and resource dependence. The authors show how these two mechanisms operate on distinct time horizons: dependence applies to contemporaneous exchange structures, whereas embedding develops through longer-term historical patterns. They also show how these processes operate differently in competitive and non-competitive contexts, operationalized in terms of market differentiation and geographic space. In noncompetitive contexts, the authors observe both logics of reciprocation, dependence in the short term and embedding over the long term, developing into population-level generalized exchange. In competitive contexts, they find no reciprocation and instead observe the microfoundations of status hierarchies.
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Westra D, Angeli F, Carree M, Ruwaard D. Coopetition in health care: A multi-level analysis of its individual and organizational determinants. Soc Sci Med 2017; 186:43-51. [PMID: 28582655 DOI: 10.1016/j.socscimed.2017.05.051] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 05/18/2017] [Accepted: 05/25/2017] [Indexed: 10/19/2022]
Abstract
Cooperative inter-organizational relations are salient to healthcare delivery. However, they do not match with the pro-competitive healthcare reforms implemented in several countries. Healthcare organizations thus need to balance competition and cooperation in a situation of 'coopetition'. In this paper we study the individual and organizational determinants of coopetition versus those of cooperation in the price-competitive specialized care sector of the Netherlands. We use shared medical specialists as a proxy of collaboration between healthcare organizations. Based on a sample of 15,431 medical specialists and 371 specialized care organizations from March 2016, one logistic multi-level model is used to predict medical specialists' likelihood to be shared and another to predict their likelihood to be shared to a competitor. We find that different organizations share different specialists to competitors and non-competitors. Cooperation and coopetition are hence distinct organizational strategies in health care. Cooperation manifests through spin-off formation. Coopetition occurs most among organizations in the price-competitive market segment but in alternative geographical markets. Hence, coopetition in health care does not appear to be particularly anti-competitive. However, healthcare organizations seem reluctant to share their most specialized human resources, limiting the knowledge-sharing effects of this type of relation. Therefore, it remains unclear whether coopetition in health care is beneficial to patients.
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Affiliation(s)
- Daan Westra
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Duboisdomein 30, 6229 GT Maastricht, The Netherlands.
| | - Federica Angeli
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Duboisdomein 30, 6229 GT Maastricht, The Netherlands; Department of Organization Studies, School of Social and Behavioural Sciences, Tilburg University, Warandelaan 2, 5038 AB Tilburg, The Netherlands.
| | - Martin Carree
- Department of Organisation and Strategy, School of Business and Economics, Maastricht University, Tongersestraat 53, 6211 LM, Maastricht, The Netherlands.
| | - Dirk Ruwaard
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Duboisdomein 30, 6229 GT Maastricht, The Netherlands.
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Multiplex Competition, Collaboration, and Funding Networks Among Health and Social Organizations: Toward Organization-based HIV Interventions for Young Men Who Have Sex With Men. Med Care 2017; 55:102-110. [PMID: 27676400 DOI: 10.1097/mlr.0000000000000595] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Young men who have sex with men (YMSM) have the highest rates of human immunodeficiency virus (HIV) infection in the United States. Decades into the HIV epidemic, the relationships that YMSM-serving health and social organizations have with one another has not been studied in depth. OBJECTIVES The aim of this study was to examine the competition, collaboration, and funding source structures of multiplex organization networks and the mechanisms that promote fruitful relationships among these organizations. RESEARCH DESIGN The study data collection method was a survey of health and social organizations from 2013-2014 in 2 cities, Chicago, IL and Houston, TX. SUBJECTS Study participants were representatives from 138 health and social organizations. MEASURES Responses to survey questions were used to reconstruct competition, collaboration, and combined competition-collaboration networks. RESULTS While taking into consideration the collaborative relationships among organizations, we provide statistical evidence that organizations of similar type, similar social media use patterns, comparable patterns of funding, and similar network contexts tended to compete with one another. This competition was less likely to be accompanied by any sort of collaboration if the organizations shared common funding sources. CONCLUSIONS Competition that excludes potential collaboration may be detrimental to mobilizing the collective efforts that serve local YMSM communities. System-level interventions may provide promising approaches to scaling-up HIV prevention and treatment efforts so as to encourage organizations to form partnerships with otherwise competing providers.
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Pallotti F, Tubaro P, Lomi A. How Far do Network Effects Spill Over? Evidence from an Empirical Study of Performance Differentials in Interorganizational Networks. EUROPEAN MANAGEMENT REVIEW 2015. [DOI: 10.1111/emre.12052] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Francesca Pallotti
- Department of International Business and Economics; University of Greenwich; London UK
- University of Lugano; Switzerland
| | - Paola Tubaro
- Department of International Business and Economics; University of Greenwich; London UK
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Housman M, Al-Amin M. Dynamics of ambulatory surgery centers and hospitals market entry. Health Serv Manage Res 2013; 26:54-64. [PMID: 25595002 DOI: 10.1177/0951484813502007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In this article, we investigate the diversity of healthcare delivery organizations by comparing the market determinants of hospitals entry rates with those of ambulatory surgery centers (ASCs). Unlike hospitals, ASCs is one of the growing populations of specialized healthcare delivery organizations. There are reasons to believe that firm entry patterns differ within growing organizational populations since these markets are characterized by different levels of organizational legitimacy, technological uncertainty, and information asymmetry. We compare the entry patterns of firms in a mature population of hospitals to those of firms within a growing population of ASCs. By using patient-level datasets from the state of Florida, we break down our explanatory variables by facility type (ASC vs. hospital) and utilize negative binomial regression models to evaluate the impact of niche density on ASC and hospital entry. Our results indicate that ASCs entry rates is higher in markets with overlapping ASCs while hospitals entry rates are less in markets with overlapping hospitals and ASCs. These results are consistent with the notion that firms in growing populations tend to seek out crowded markets as they compete to occupy the most desirable market segments while firms in mature populations such as general hospitals avoid direct competition.
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Affiliation(s)
- Michael Housman
- Healthcare Management Department, University of Pennsylvania, USA
| | - Mona Al-Amin
- Department of Healthcare Administration, Sawyer School of Business, Suffolk University, USA
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Mascia D, Di Vincenzo F, Cicchetti A. Dynamic analysis of interhospital collaboration and competition: empirical evidence from an Italian regional health system. Health Policy 2012; 105:273-81. [PMID: 22406110 DOI: 10.1016/j.healthpol.2012.02.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Revised: 02/08/2012] [Accepted: 02/15/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Policymakers stimulate competition in universalistic health-care systems while encouraging the formation of service provision networks among hospital organizations. This article addresses a gap in the extant literature by empirically analyzing simultaneous collaboration and competition between hospitals within the Italian National Health Service, where important procompetition reforms have been implemented. PURPOSE To explore how rising competition between hospitals relates to their propensity to collaborate with other local providers. METHODS Longitudinal data on interhospital collaboration and competition collected in an Italian region from 2003 to 2007 are analyzed. Social network analysis techniques are applied to study the structure and dynamics of interhospital collaboration. Negative binomial regressions are employed to explore how interhospital competition relates to the collaborative network over time. RESULTS Competition among providers does not hinder interhospital collaboration. Collaboration is primarily local, with resource complementarity and differentials in the volume of activity and hospital performance explaining the propensity to collaborate. CONCLUSIONS Formation of collaborative networks among hospitals is not hampered by reforms aimed at fostering market forces. Because procompetition reforms elicit peculiar forms of managed competition in universalistic health systems, studies are needed to clarify whether the positive association between interhospital competition and collaboration can be generalized to other health-care settings.
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Affiliation(s)
- Daniele Mascia
- Catholic University of the Sacred Heart, Department of Public Health, Largo F. Vito 1, 00168 Rome, Italy.
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Understanding hospital performance: the role of network ties and patterns of competition. Health Care Manage Rev 2012; 36:327-37. [PMID: 21697719 DOI: 10.1097/hmr.0b013e31821fa519] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND To improve efficiency and quality, a number of policies have recently been implemented to increase competition and cooperation within the health systems of many countries. We theorize how hospital performance, measured as productivity, is contingent upon network embeddedness, the extent to which a hospital is involved in a network of interconnected interorganizational relationships. PURPOSE The aim of this study was to explore the effects on hospital productivity resulting from both collaborative network ties and competitive relationships between providers. METHODOLOGY We used panel data collected between 2003 and 2007 from 35 hospitals in Abruzzo, one of the most populated regions of central Italy. We used secondary data of hospital activities regarding both clinical and administrative aspects. For each year, we examined the intensity of interhospital competition and the unique position each provider has within a larger network of relationships with other hospitals. Other idiosyncratic organizational characteristics were examined as well. FINDINGS Our results show that hospital productivity is negatively related to the degree of competition that a hospital faces and positively related to the degree with which hospitals establish collaborative relationships. We also found that the negative impact on hospital productivity due to competition was lessened when hospitals were more likely to create cooperative network ties. PRACTICE IMPLICATIONS Because interhospital collaboration and competition are related to hospital productivity, they should constitute a core element in the strategic planning of a hospital's operation. Health administrators should implement policies that favor collaborative network ties at the regional level and mitigate interorganizational rivalries when establishing collaborative relationships with local competitors.
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Frosini F, Dixon A, Robertson1 R. Competition in the NHS: A Provider Perspective. J Health Serv Res Policy 2012; 17 Suppl 1:16-22. [DOI: 10.1258/jhsrp.2011.010194] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objective To analyse how competition is experienced and characterized by NHS and independent sector acute care providers in the English National Health Service (NHS). Methods Semi-structured interviews with 49 senior staff in 15 NHS trusts and independent sector providers between November 2008 and April 2009, in England. Results The market was predominantly defined based on geographical proximity. Competition was mainly on the periphery of catchment areas but markets were differentiated based on the scope and type of services. Niche providers, specialist hospitals and tertiary centres did not directly compete with district general hospital-type providers. Competitors were increasingly primary and community care providers, while there was little perceived threat from the private sector. There were many examples of how different providers (both NHS and independent sector) were co-operating and collaborating. Patients and general practitioners (GPs) appeared to be loyal to local providers. Conclusion The providers' view of the market and the relevance of historical relationships and loyalties suggest fine grained variations in competition which is consistent with a relational rather than structural approach to competition. Also the evidence on embeddedness of relationships implies that collaboration might be a strong lever for quality improvement locally. Finally, some of the agreements found might be deemed in breach of the rules of competition but they may well be in the interests of patients and taxpayers, with implications for regulation in publicly funded health care systems.
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Affiliation(s)
- Francesca Frosini
- The King's Fund, London, UK; 1The Commonwealth Fund, New York, NY, USA
| | - Anna Dixon
- The King's Fund, London, UK; 1The Commonwealth Fund, New York, NY, USA
| | - Ruth Robertson1
- The King's Fund, London, UK; 1The Commonwealth Fund, New York, NY, USA
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From network ties to network structures: Exponential Random Graph Models of interorganizational relations. ACTA ACUST UNITED AC 2011. [DOI: 10.1007/s11135-011-9619-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Parchman ML, Scoglio CM, Schumm P. Understanding the implementation of evidence-based care: a structural network approach. Implement Sci 2011; 6:14. [PMID: 21349194 PMCID: PMC3056826 DOI: 10.1186/1748-5908-6-14] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Accepted: 02/24/2011] [Indexed: 11/15/2022] Open
Abstract
Background Recent study of complex networks has yielded many new insights into phenomenon such as social networks, the internet, and sexually transmitted infections. The purpose of this analysis is to examine the properties of a network created by the 'co-care' of patients within one region of the Veterans Health Affairs. Methods Data were obtained for all outpatient visits from 1 October 2006 to 30 September 2008 within one large Veterans Integrated Service Network. Types of physician within each clinic were nodes connected by shared patients, with a weighted link representing the number of shared patients between each connected pair. Network metrics calculated included edge weights, node degree, node strength, node coreness, and node betweenness. Log-log plots were used to examine the distribution of these metrics. Sizes of k-core networks were also computed under multiple conditions of node removal. Results There were 4,310,465 encounters by 266,710 shared patients between 722 provider types (nodes) across 41 stations or clinics resulting in 34,390 edges. The number of other nodes to which primary care provider nodes have a connection (172.7) is 42% greater than that of general surgeons and two and one-half times as high as cardiology. The log-log plot of the edge weight distribution appears to be linear in nature, revealing a 'scale-free' characteristic of the network, while the distributions of node degree and node strength are less so. The analysis of the k-core network sizes under increasing removal of primary care nodes shows that about 10 most connected primary care nodes play a critical role in keeping the k-core networks connected, because their removal disintegrates the highest k-core network. Conclusions Delivery of healthcare in a large healthcare system such as that of the US Department of Veterans Affairs (VA) can be represented as a complex network. This network consists of highly connected provider nodes that serve as 'hubs' within the network, and demonstrates some 'scale-free' properties. By using currently available tools to explore its topology, we can explore how the underlying connectivity of such a system affects the behavior of providers, and perhaps leverage that understanding to improve quality and outcomes of care.
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Affiliation(s)
- Michael L Parchman
- Family & Community Medicine Department, 7703 Floyd Curl Drive, University of Texas Health Science Center, San Antonio, Texas, 78229-3884, USA.
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Porell FW, Liu K, Brungo DP. Agency and market area factors affecting home health agency supply changes. Health Serv Res 2006; 41:1847-75. [PMID: 16987305 PMCID: PMC1955289 DOI: 10.1111/j.1475-6773.2006.00561.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To use the natural experiment created by the Medicare interim payment system (IPS) to study supply change behavior of home health agencies (HHAs) in local market areas. DATA SOURCES One hundred percent Medicare home health claims for 1996 and 1999, linked with Medicare Provider of Service and Denominator files, and the Area Resource File. STUDY DESIGN Medicare home health care (HHC) claims data were used to distinguish HHAs that changed the local market supply of Medicare HHC by their market exit or by significant expansion or contraction of their geographic service area between 1996 and 1999 from other HHAs. Multinomial logit models were estimated to analyze how characteristics of agencies and the market areas in which they served were associated with these different agency-level supply changes. PRINCIPAL FINDINGS Changes in local HHA supply stemming from geographic service area expansions and contractions rivaled those owing to agency closures and market entries. Agencies at greater risk of closure and service area contraction tended to be smaller, newer, freestanding agencies, operating with more visit-intensive practice styles in markets with more competitor agencies. Except for having much less visit-intensive practice styles, similar attributes characterized agencies that increased local supply through service area expansion. CONCLUSIONS Supply changes by HHAs largely reflected rational market responses by agencies to significant changes in financial incentives associated with the Medicare IPS. Recently certified agencies were among the most dynamic providers. Supply changes were more likely among agencies operating in more competitive market environments.
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Affiliation(s)
- Frank W Porell
- Gerontology Department, McCormack Graduate School of Policy Studies, University of Massachusetts-Boston, 100 Morrissey Boulevard, Boston, MA 02125-3393, USA
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Dexter F, Wachtel RE, Sohn MW, Ledolter J, Dexter EU, Macario A. Quantifying Effect of a Hospital’s Caseload for a Surgical Specialty on That of Another Hospital Using Multi-Attribute Market Segments. Health Care Manag Sci 2005; 8:121-31. [PMID: 15952609 DOI: 10.1007/s10729-005-0395-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Inpatient and outpatient data were used to create market segments consisting of hierarchical combinations of surgical procedure, then type of payer, and then location of patients' residences. The competitive effect of one hospital's caseload for a given surgical specialty on the caseload of another hospital was determined from the numbers of patients in each segment. Earlier methods for estimating surgical competition that ignored market segments over-estimated the competitive effects of one hospital on another. Thus, results differed from those obtained previously for all types of hospital admissions. When actual market segments with homogeneous groups of patients are used, competitive effects of hospitals in the same market area are far less than expected.
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Affiliation(s)
- Franklin Dexter
- Division of Management Consulting, Department of Anesthesia, University of Iowa, Iowa City, Iowa, USA.
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Abstract
OBJECTIVE To identify comprehensive pediatric hospitals on the basis of publicly available data. STUDY DESIGN We developed identification criteria for comprehensive pediatric hospitals, then evaluated the number of hospitals meeting these selection criteria. Criteria for a comprehensive pediatric hospital included pediatric residency accreditation, pediatric inpatient volume, and diversity of pediatric disorders at each hospital. New York State hospital administrative discharge data were analyzed for patients 0 to 14 years of age, excluding neonatal diagnoses. RESULTS Infants and children (n = 125,588) with 375 different diagnosis-related groups were discharged from 230 hospitals in 2000. Through the use of higher selective criteria (educational accreditation plus both high volume and diversity in the top decile), 11 comprehensive pediatric hospitals were identified. These hospitals serve populations of 1.7 +/- 0.3 million (mean +/- SD) each, with 8 referral regions throughout the state, collectively providing care for 29% of all pediatric statewide hospitalizations. CONCLUSIONS Comprehensive pediatric hospitals serve the population of New York widely and evenly. The ability to identify pediatric hospitals will permit evaluation of the relative quality of care and suggest appropriate regulatory interventions to improve pediatric hospital utilization.
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Affiliation(s)
- Robert K Kanter
- Department of Pediatrics, Upstate Medical University, Syracuse, NY 13210, USA.
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Abstract
Antitrust litigation involving hospitals is common. This paper describes recent developments and underlying issues in antitrust law with respect to hospital-hospital relations, hospital-physician relations, and hospital-payer relations. A key unanswered question in each of these areas is how government regulation and public purchasing affect competitive markets for hospital services.
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