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Combining Resource, Structure and Institutional Environment: A Configurational Approach to the Mode Selection of the Integrated Healthcare in County. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16162975. [PMID: 31430889 PMCID: PMC6719034 DOI: 10.3390/ijerph16162975] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 08/09/2019] [Accepted: 08/15/2019] [Indexed: 11/16/2022]
Abstract
Integrated healthcare has received considerable attention and has developed into the highly important health policy known as Integrated Healthcare in County (IHC) against the background of the Grading Diagnosis and Treatment System (GDTS) in rural China. However, the causal conditions under which different integrated health-care modes might be selected are poorly understood, particularly in the context of China's authoritarian regime. This study aims to identify these causal conditions, and how they shape the mode selection mechanism for Integrated Healthcare in County (IHC). A theoretical framework consisting of resource heterogeneity, governance structure, and institutional normalization was proposed, and a sample of fifteen IHCs was selected, with data for each IHC being collected from news reports, work reports, government documents and field research for Fuzzy-sets Qualitative Comparative Analysis (fsQCA). This study firstly pointed out that strong governmental control and centralization are necessary conditions for the administration-oriented organization mode (MOA). Additionally, this research found three critical configured paths in the selection of organizational modes. Specifically, we found that the combination of low resource heterogeneity, weak governmental control, centralization, and normalization was sufficient to explain the selection path of the insurance-driven organization mode (MOI); the combination of low resource heterogeneity, strong governmental control, centralization, and normalization was sufficient for selecting MOA; and the combination of weak governmental control, weak centralization, and weak normalization was sufficient for selecting the contractual organization mode (MOC). Our study highlighted the necessity and feasibility of constructing different IHC modes separately and promoting their development gradually, as a result of the complex relationships among the causal conditions described above, thus helping to optimize the distribution of health resources and integrate the healthcare system.
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Klassen A, Miller A, Anderson N, Shen J, Schiariti V, O'Donnell M. Performance measurement and improvement frameworks in health, education and social services systems: a systematic review. Int J Qual Health Care 2009; 22:44-69. [PMID: 19951964 DOI: 10.1093/intqhc/mzp057] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To perform a systematic review, supplemented by a targeted grey literature scan, for performance measurement and improvement frameworks within and across the health, education and social service systems. The intended outcome was the creation of a foundation of evidence to inform the development of cross-sectoral quality improvement frameworks. DATA SOURCES MEDLINE, CINAHL, PsycINFO, ERIC, EMBASE, Social Services Abstracts, Social Work Abstracts and Education Index Full Text were searched up to April/May 2007. In addition, 26 governmental and 27 organizational websites were searched. STUDY SELECTION English language material with a publication date of 1986 or more recent that described a health, education or social services multidimensional framework for performance measurement and improvement. Data extraction The framework name; administrative sector; level of application; setting; population of interest; categories of quality described within the framework; country of application; and citations to other performance measurement and improvement frameworks were extracted from each article. RESULTS In total, 111 frameworks were identified. Most frameworks (n = 97) were developed in or for the health sector. A concept sorting exercise identified 16 quality concepts applicable across many settings, sectors and levels of application. CONCLUSION This systematic review of quality domains will be relevant and useful to those who are developing and using performance measurement and improvement frameworks for adult and child populations within or across the health, social service or education sectors.
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Affiliation(s)
- Anne Klassen
- Department of Pediatrics, McMaster University, HSC 3A, 1200 Main St W, Hamilton, ON, Canada L8N 3Z5.
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Jaana M, Ward MM, Paré G, Sicotte C. Antecedents of Clinical Information Technology Sophistication in Hospitals. Health Care Manage Rev 2006; 31:289-99. [PMID: 17077703 DOI: 10.1097/00004010-200610000-00004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Grounded in the resource-based theory and the innovation diffusion theory, this article develops and tests a research model for assessing the antecedents of hospital innovativeness with regard to clinical information technology (IT) applications. A cross-sectional survey was conducted in a sample of U.S. hospitals (n = 74) to assess three dimensions of clinical IT sophistication. Secondary data were used to measure the antecedents, namely, four groups of organizational capacity variables. Bivariate and regression analyses were conducted to identify significant associations. A significant percentage (45-61%) of the variance in clinical IT sophistication was explained, mostly by leadership and knowledge sharing capacities. In particular, IT tenure and technical knowledge resources were significantly related to clinical IT sophistication. Surprisingly, managerial tenure and hospital's belonging to a network showed significant negative associations with two dimensions of the clinical IT sophistication construct. To address the challenges they face, hospitals should consider encouraging career development for current individuals in charge of IT activities, and attracting professionals with an IT background who have the knowledge and ability to trigger new ideas and favor the adoption and use of clinical IT applications in these settings.
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Affiliation(s)
- Mirou Jaana
- Canada Research Chair in Information Technology in Health Care, HEC Montreal, Canada and Department of Health Management and Policy, American University of Beirut, Lebanon.
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Stuart B, Fennell M, Sun R, Campbell SE. Financial Consequences of Rural Hospital Long-Term Care Strategies. Health Care Manage Rev 2006; 31:145-55. [PMID: 16648694 DOI: 10.1097/00004010-200604000-00008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Data for 540 rural hospitals from 1982 to 1997 were analyzed to determine whether adoption of long-term-care (LTC) strategies improved hospital financial performance. Adoption of external and internal LTC strategies (other than swing-beds) was generally, but not unambiguously, associated with higher profits, increased occupancy, and/or lower costs.
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Affiliation(s)
- Bruce Stuart
- University of Maryland School of Pharmacy, Baltimore, USA
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Abstract
This study analyzed financial and non-financial performance of a national sample of ninety-six community health centers participating in networks funded through the DHHS' Integrated Services Development Initiative.
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Affiliation(s)
- Judith Ortiz
- Department of Health Professions, University of Central Florida, Orlando, USA
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Abstract
Based on observations of the government's vital role in enhancing rural health care accessibility, in this article, we analyze solutions implemented by Quebec's public health system by highlighting the limitations in incentives used to remedy the dearth of rural medical resources and the consequent interest in ameliorating health care accessibility through service integration. The current challenge lies in fostering cooperation between health care institutions not subject to market incentives and integrating private practice physicians into the public system. To this end, regulatory agencies in public systems use four main leverage mechanisms: formal power, economic power, influence, and commitment, as illustrated in an experiment conducted in rural Quebec.
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Affiliation(s)
- Nassera Touati
- Centre de recherche, Hôpital Charles-Lemoyne, Quebec, Canada
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Stewart MK, Redford R“B, Poe K, Veach D, Hines R, Beachler M. The Arkansas River Valley Rural Health Cooperative: Building a Three-pronged Approach to Improved Health and Health Care. J Rural Health 2003. [DOI: 10.1111/j.1748-0361.2003.tb00655.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Mpofu D, Lockinger L, Bidwell J, McDuffie HH. Evaluation of a respiratory health program for farmers and their families. J Occup Environ Med 2002; 44:1064-74. [PMID: 12448358 DOI: 10.1097/00043764-200211000-00013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Occupational exposures to organic dusts, gases, welding fumes and agricultural chemicals result in farmers' increased risk of respiratory health problems compared to other workers. The Respiratory Health Program for Saskatchewan farmers addresses the difficulties of delivering an occupational health program to a sparsely distributed population on the Prairies. We summarized their pulmonary function and respiratory health by spirometry and questionnaire respectively. The necessity of the program was demonstrated by the frequency of lower than predicted pulmonary function tests and referrals to family physicians (1996 through 1999). Age, years in farming, usual cough, wheezing on most days and nights, bringing up phlegm from the chest, breathlessness, and cigarette smoking were associated significantly with pulmonary function results. We evaluated the Respiratory Health Program (1994 through 2000) with respect to acceptability, accessibility, appropriateness, continuity, effectiveness, efficiency, and risk/safety by using questionnaires and evaluations by farm families.
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Affiliation(s)
- Debbie Mpofu
- Saskatchewan Institute on Prevention of Handicaps
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Moscovice I, Stensland J. Rural hospitals: trends, challenges, and a future research and policy analysis agenda. J Rural Health 2002; 18 Suppl:197-210. [PMID: 12061514 DOI: 10.1111/j.1748-0361.2002.tb00931.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Previous reviews of the status of rural hospitals conclude that rural hospitals play a major role in ensuring the provision of health services in rural areas, are an essential part of the social and economic identity of rural communities, have had mixed success in their ability to respond to environmental threats, and are very sensitive to public policies due, in part, to their small size. The evolving hospital paradigm in the United States and a turbulent economic and health care environment have created an uncertain future for the rural hospital. Hospitals are being forced to shift their emphasis from filling acute inpatient care beds to providing a more diversified set of services through linkages with other institutions and provider groups. This presents challenges for rural hospitals, which often serve as the foundation for health care delivery in rural communities yet struggle to overcome the effects of troubled local economies, shortages of health professionals, and public policy inequities. This article reviews key trends and challenges facing rural hospitals from the perspective of their structure and organization, financial sustainability, quality of care provided, and strategic linkages with other entities. It concludes with the presentation of a research and policy analysis agenda that addresses the feasibility of the role of the rural hospital as the hub or coordinator of the rural health care delivery system, the fiscal viability of the rural hospital in the post-Balanced Budget Act period, strategies for measuring and improving the quality of care provided by rural hospitals, and the structure and value of horizontal and vertical linkages of rural hospitals.
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Affiliation(s)
- Ira Moscovice
- Division of Health Services Research and Policy, University of Minnesota, Minneapolis 55455, USA.
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Saleh SS, Vaughn T, Rohrer JE. Rural hospitals and the adoption of managed care strategies. J Rural Health 2002; 17:210-9. [PMID: 11765885 DOI: 10.1111/j.1748-0361.2001.tb00958.x] [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: 11/28/2022]
Abstract
This research examined the performance of rural hospitals engaged in different levels of managed care activities and identified factors related to performance and competition that affected rural hospitals' likelihood of pursuing managed care as a strategy. The sample studied consisted of 139 rural hospitals in Iowa and Nebraska. Results showed that a relatively high percentage of hospitals were engaged in managed care activities, mainly through contractual arrangements. The study found that high competition in the marketplace increased the likelihood of hospitals pursuing managed care strategies, while high demand markets had a negative association with the likelihood of pursuing a managed care strategy. No significant relationship was detected between poor performance and pursuing a managed care strategy.
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Affiliation(s)
- S S Saleh
- State University of New York at Albany, School of Public Health, Department of Health Policy, Management and Behavior, Rensselaer 12144, USA
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11
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Abstract
This article describes why rural residents migrate or travel outside their local market area for specialty physician care. Data were collected through a random mail survey of persons residing in Iowa's rural counties. The results imply that migration for specialty care is not simply a function of a low perceived availability of local specialty physicians. Managers of rural and urban health care systems may need to rethink the extent to which specialty physician services should be distributed across rural markets.
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Affiliation(s)
- T F Borders
- School of Medicine, Texas Tech University HSC, Lubbock, Texas, USA.
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Nauenberg E, Brewer CS. Surveying hospital network structure in New York State: how are they structured? Health Care Manage Rev 2001; 25:67-79. [PMID: 10937338 DOI: 10.1097/00004010-200007000-00008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We determine the most common network structures in New York state. The taxonomy employed uses three structural dimensions: integration, complexity, and risk-sharing between organizations. Based on a survey conducted in 1996, the most common type of network (26.4 percent) had medium levels of integration, medium or high levels of complexity, and some risk-sharing. Also common were networks with low levels of integration, low levels of complexity, and no risk-sharing (22.1 percent).
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Affiliation(s)
- E Nauenberg
- Department of Social and Preventive Medicine, School of Medicine and Biomedical Sciences, State University of New York at Buffalo, USA
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Sinclair D. Health care reform: the effect of a vertically integrated health system on emergency medicine. CAN J EMERG MED 2000; 2:154-5. [PMID: 17621392 DOI: 10.1017/s1481803500004851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Nauenberg E, Brewer CS, Basu K, Bliss MK, Osborne JW. Network structure and hospital financial performance in New York State: 1991-1995. Med Care Res Rev 1999; 56:415-39. [PMID: 10589202 DOI: 10.1177/107755879905600402] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
As networks have proliferated, questions have arisen regarding which structure is optimal. To obtain an answer from the hospital perspective, the authors conducted a survey of New York State hospitals to determine how network integration, complexity, and financial risk sharing relate to measures of financial performance during the period of 1991-1995. Of the 64 hospitals indicating a network affiliation by 1995, 67.2 percent listed some network risk-sharing activity. The least integrated networks were associated with the smallest improvements in throughput, and the most complex were associated with the largest negative changes in operating margins. During the first 2 years of network membership, hospitals joining risk-sharing networks experienced operating margin gains averaging 12 percentage points higher than hospitals joining networks without risk sharing; however, this difference dissipated in later years. Networks with higher levels of integration, lower levels of complexity, and which involve some risk-sharing between affiliates are most likely to experience improved hospital financial performance during the network's initial years.
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Affiliation(s)
- E Nauenberg
- State University of New York at Buffalo, USA
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Abstract
The pressures for closer alignment between physicians and hospitals in both rural and urban areas are increasing. This study empirically specifies independent dimensions of physician and clinical integration and compares the extent to which such activities are practiced between rural and urban hospitals and among rural hospitals in different organizational and market contexts. Results suggest that both rural and urban hospitals practice physician integration, although each emphasizes different types of strategies. Second, urban hospitals engage in clinical integration with greater frequency than their rural counterparts. Finally, physician integration approaches in rural hospitals are more common among larger rural hospitals, those proximate to urban facilities, those with system affiliations, and those not under public control.
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Affiliation(s)
- J A Alexander
- University of Michigan, Health Management and Policy, School of Public Health, Ann Arbor 48109, USA
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Wakefield DS, Tracy R. Adjusting measures of physician availability to reflect importation of physician services into rural areas. J Rural Health 1999; 12:39-44. [PMID: 10157082 DOI: 10.1111/j.1748-0361.1996.tb00771.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Recent changes in the organization and delivery of physician services in rural areas suggest the need to update how physician availability is viewed and measured. The objective of this study was to empirically examine the effect of rural hospitals contracting with outside physicians for part or all of their emergency room coverage, and the use of urban specialists to staff outpatient clinics, on measures used to assess physician availability. Based on data from one rural state, the findings demonstrate the importance of adjusting for the importation of physician services into rural areas.
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Affiliation(s)
- D S Wakefield
- Graduate Program in Hospital and Health Administration, University of Iowa, Iowa City 52242, USA
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Trinh HQ, Begun JW. Strategic adaptation of US rural hospitals during an era of limited financial resources: a longitudinal study, 1983 to 1993. Health Care Manag Sci 1999; 2:43-52. [PMID: 10916601 DOI: 10.1023/a:1019063123037] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This research investigated the competing effects of environmental and organizational pressures on rural hospitals' revenue-enhancing and cost-containment strategies from 1993 to 1993. In general, organizational pressures (multihospital system membership and non-government control) exerted more influence than environmental ones. Also, strategies generally were sustained over time and were particularly interdependent with hospitals' maintenance of staffed beds. Strategies did respond to environmental pressures, however, with revenue enhancement associated with local market competition and munificence, and cost containment associated with pressures from Medicare reimbursement.
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Affiliation(s)
- H Q Trinh
- Health Information Administration, University of Wisconsin-Milwaukee 53201, USA
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Trinh HQ. Are Rural Hospitals "Strategic"? Health Care Manage Rev 1999. [DOI: 10.1097/00004010-199907000-00005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Casey MM, Wellever A, Moscovice I. Rural health network development: public policy issues and state initiatives. JOURNAL OF HEALTH POLITICS, POLICY AND LAW 1997; 22:23-47. [PMID: 9057120 DOI: 10.1215/03616878-22-1-23] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Rural health networks are a potential way for rural health care systems to improve access to care, reduce costs, and enhance quality of care. Networks provide a means for rural providers to contract with managed care organizations, develop their own managed care entities, share resources, and structure practice opportunities to support recruitment and retention of rural physicians and other health care professionals. The results of early network development initiatives indicate a need for state officials and others interested in encouraging network development to agree on common rural health network definitions, to identify clearly the goals of network development programs, and to document and analyze program outcomes. Future network development efforts need to be much more comprehensive if they are to have a significant impact on rural health care. This article analyzes public policy issues related to integrated rural health network development, discusses current efforts to encourage network development in rural areas, and suggests actions that states may take if they desire to support rural health network development. These actions include adopting a formal rural health network definition, providing networks with alternatives to certain regulatory requirements, and providing incentives such as matching grants, loans, or technical assistance. Without public sector support for networks, managed care options may continue to be unavailable in many less densely populated rural areas of the country, and locally controlled rural health networks are unlikely to develop as an alternative to the dominant pattern of managed care expansion by large urban entities. Implementation of Medicare reform legislation could provide significant incentives for the development of rural health networks, depending on the reimbursement provisions, financial solvency standards, and antitrust exemptions for provider-sponsored networks in the final legislation and federal regulations.
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