1
|
Gupta S, Zengul FD, Blackburn J, Hearld LR, Jablonski R, Sen B, Weech-Maldonado R. Hospital-based skilled nursing facility survival: Organizational and market-level predictors. Health Care Manage Rev 2024; 49:254-262. [PMID: 39102338 DOI: 10.1097/hmr.0000000000000411] [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: 08/07/2024]
Abstract
BACKGROUND Rising health care costs and consequent increases in Medicare reimbursements have led to many payment reforms over the years. Implementation of the prospective payment system (PPS) for hospitals in 1983 incentivized hospitals to either purchase skilled nursing facilities (SNFs) or utilize their excess capacity to establish one within the hospital. With PPS reimbursement being applied to SNFs in 1998, prior monetary incentives for hospitals to own an SNF disappeared. However, despite the reduction in numbers, many hospitals continued to operate their hospital-based skilled nursing facilities (HBSNFs). PURPOSE This study examines the organizational and market-level factors associated with the survival of HBSNFs using the population ecology of organizations framework. METHODOLOGY Using American Hospital Association survey data, event histories of all U.S. acute care hospitals with an open HBSNF in 1998 were plotted to examine if a hospital closed its HBSNF during a 22-year period (1998-2020). The primary independent variables included hospital size, ownership, total margin, market competition, and Medicare Advantage penetration. The independent and control variables were lagged by 1 year. Cox regressions were conducted to estimate the hazard ratios capturing the risk of HBSNF closure. RESULTS The results showed that HBSNFs located in large, not-for-profit hospitals and those operating in less competitive markets had greater odds of surviving. PRACTICE IMPLICATIONS The HBSNF administrators of small, for-profit hospitals and those operating in highly competitive markets could utilize the findings of this study to judiciously allocate slack resources to their HBSNFs to keep those open given the current emphasis on continuity of care by regulatory bodies.
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
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.
Collapse
|
4
|
Abstract
PURPOSE The purpose of this article was to investigate the organizational and market-level variables associated with sustained superior hospital performance on Value-Based Purchasing total performance scores (TPS). METHODOLOGY TPS for 2014 through 2017 was obtained from the Centers for Medicare & Medicaid Services Hospital Compare website. Market-level data were from the 2017 Area Health Resource File, and hospital-level data were from the 2014 American Hospital Association Annual Survey database. We specified a logistic regression model to identify significant predictors of hospitals with sustained superior performance on TPS, that is, "sustainers." PRINCIPAL FINDINGS Only 8.4% of hospitals were classified as sustainers. Hospitals located in rural markets with a high Medicare Advantage penetration had a higher likelihood of being classified as sustainers. High RN staffing levels, lower Medicare share of inpatient days, not-for-profit ownership, and small size were all significant organizational predictors of sustained superior performance. CONCLUSIONS Both modifiable characteristics, such as nurse staffing levels, and nonmodifiable characteristics, such as rural markets and small hospital size, are associated with the likelihood of hospitals sustaining superior performance over time. PRACTICE IMPLICATIONS Managers need to carefully examine their staffing levels as they pursue interventions to sustain high TPS overtime. Moreover, factors such as Medicare share of inpatient days and size need to be considered when understanding barriers to sustained performance on Value-Based Purchasing domains.
Collapse
|
5
|
Opoku-Agyeman W, Weech-Maldonado R, Upadhyay S, Patidar N, Opoku-Agyeman C. Environmental and Organizational Factors Associated with Hospital Use of GPO Services. Hosp Top 2020; 98:89-102. [PMID: 32715977 DOI: 10.1080/00185868.2020.1787804] [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: 10/23/2022]
Abstract
Given the potential benefits of Group Purchasing Organizations in cost-containment efforts for hospitals on supplies and purchased services, an important question that remains unanswered is what conditions support or hinder the utilization of GPOs by hospitals. Therefore, this study explores the relationship between GPO use by hospitals and their market and organizational characteristics. Data on hospital GPO utilization and other organizational characteristics were combined with secondary hospital market characteristics. Panel logistic regression with random effects and state and year fixed effects analysis was used to examine the relationship between hospitals' utilization of GPO services and hospitals' organizational and market characteristics. Overall, the majority of hospitals utilized the services of GPOs. Specifically, the number of hospitals utilizing the services of GPOs increased slightly from 3290 (72.2%) in 2004 to 3337 (74.4%) in 2013. In regression analyses, hospitals utilizing the services of GPOs operated in an external environment with mixed levels of munificence, more dynamism, and less competition. Specifically, hospitals operating in a less munificent environment are more likely to utilize the services of GPOs. The study findings provide organizational decision-makers and policymakers' insights into how certain market and organizational factors influence hospital strategy choice, in this case, the use of GPOs.
Collapse
Affiliation(s)
- William Opoku-Agyeman
- School of Health and Applied Human Sciences University of North Carolina Wilmington, Wilmington, North Carolina, USA
| | - Robert Weech-Maldonado
- Department of Health Service Administration, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Soumya Upadhyay
- Department of Healthcare Administration and Policy, School of Public Health, University of Nevada at Las Vegas, Las Vegas, Nevada, USA
| | - Nitish Patidar
- School of Business, Quinnipiac University, Hamden, Connecticut, USA
| | - Chris Opoku-Agyeman
- Department of Public Administration, The University of Akron, Cleveland, Ohio, USA
| |
Collapse
|
6
|
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.
Collapse
|
7
|
Tarver WL, Menachemi N. Environmental market factors associated with electronic health record adoption among cancer hospitals. Health Care Manage Rev 2019; 43:303-314. [PMID: 28225447 DOI: 10.1097/hmr.0000000000000149] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Although recent literature has explored the relationship between various environmental market characteristics and the adoption of electronic health records (EHRs) among general, acute care hospitals, no such research currently exists for specialty hospitals, including those providing cancer care. PURPOSE The aim of the study was to examine the relationship between market characteristics and the adoption of EHRs among Commission on Cancer (CoC)-accredited hospitals. METHODS/APPROACH Secondary data on EHR adoption combined with hospital and environmental market characteristics were analyzed using logistic regression. Using the resource dependence theory, we examined how measures of munificence, complexity, and dynamism are related to the adoption of EHRs among CoC-accredited hospitals and, separately, hospitals not CoC-accredited. FINDINGS In a sample of 2,670 hospitals, 141 (0.05%) were academic-based CoC-accredited hospitals and 562 (21%) were community-based CoC-accredited hospitals. Measures of munificence such as cancer incidence rates (OR = 0.99, CI [0.99, 1.00], p = .020) and percentage population aged 65+ (OR = 0.99, CI [0.99, 1.00], p = .001) were negatively associated with basic EHR adoption, whereas urban location was positively associated with comprehensive EHR adoption (OR = 3.07, CI [0.89, 10.61], p = .076) for community-based CoC-accredited hospitals. Measures of complexity such as hospitals in areas with less competition were less likely to adopt a basic EHR (OR = 0.33, CI [0.19, 0.96], p = .005), whereas Medicare Managed Care penetration was positively associated with comprehensive EHR adoption (OR = 1.02, CI [1.00, 1.05], p = .070) among community-based CoC-accredited hospitals. Lastly, dynamism, measured as population change, was negatively associated with the adoption of comprehensive EHRs (OR = 0.99, CI [0.99, 1.00], p = .070) among academic-based CoC-accredited hospitals. PRACTICE IMPLICATIONS A greater understanding of the environment's relationship to health information technology adoption in cancer hospitals will help stakeholders in these institutions make informed strategic decisions about information technology investments guided by their facilities' respective environmental factors. The results of this study may also be useful to hospital chief information officers and chief executive officers seeking to either improve their quality of care or achieve and maintain accreditation in providing cancer care.
Collapse
Affiliation(s)
- Will L Tarver
- Will L. Tarver, DrPH, MLIS, is Postdoctoral Fellow, Training in Research for Behavioral Oncology and Cancer Control Program, Indiana University, and Postdoctoral Fellow, Center for Health Services Research, Regenstrief Institute, Indianapolis, Indiana. E-mail: . Nir Menachemi, PhD, MPH, is Professor and Chair, Health Policy and Management, Fairbanks School of Public Health, Indiana University, and Affiliated Scientist, Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana
| | | |
Collapse
|
8
|
Hansen KE, Hyer K, Holup AA, Smith KM, Small BJ. Analyses of Complaints, Investigations of Allegations, and Deficiency Citations in United States Nursing Homes. Med Care Res Rev 2017; 76:736-757. [DOI: 10.1177/1077558717744863] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Quality of care in nursing homes has been evaluated from varying perspectives, but few studies analyze complaints made to surveyors. This study analyzed complaints, investigations, and citations for nursing homes nationwide. Using the complaint and survey data sets, analyses match nursing home complaints with findings of investigations conducted. Results showed the average complaint rate was 13.3 complaints per 100 residents and that 43.2% of complaint allegations were substantiated, with complaints about care and services provided being the most prevalent. Variability was noted among the Centers for Medicare and Medicaid Services regions and, on average, 47.5% of facilities had five or more complaints in a given year. While additional research could evaluate the effect of complaint investigations on nursing home quality, results indicated that complaints and subsequent investigations provide further information regarding quality for residents. Results also suggest improvements in the training for surveyors and more consistency across Centers for Medicare and Medicaid Services survey regions.
Collapse
|
9
|
Contextual factors associated with hospitals’ decision to operate freestanding emergency departments. Health Care Manage Rev 2017; 42:269-279. [DOI: 10.1097/hmr.0000000000000113] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
10
|
Ramamonjiarivelo Z, Weech-Maldonado R, Hearld L, Menachemi N, Epané JP, O'Connor S. Public hospitals in financial distress: Is privatization a strategic choice? Health Care Manage Rev 2016; 40:337-47. [PMID: 25029510 DOI: 10.1097/hmr.0000000000000032] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND As safety net providers, public hospitals operate in more challenging environments than private hospitals. Such environments put public hospitals at greater risk of financial distress, which may result in privatization and deterioration of the safety net. PURPOSE The purpose of this study was to investigate whether financial distress is associated with privatization among public hospitals. METHODOLOGY/APPROACH We used panel data merged from the American Hospital Association Annual Survey, Medicare Cost Reports, Area Resource File, and Local Area Unemployment Statistics. Our study population consisted of all U.S. nonfederal acute care public hospitals in 1997 tracked through 2009, resulting in 6,426 hospital-year observations. The dependent variable "privatization" was defined as conversion from public status to either private not-for-profit or private for-profit status. The main independent variable, "financial distress," was based on the Altman Z-score methodology. Control variables included market and organizational factors. Two random-effects logistic regression models with state and year fixed-effects were constructed. The independent and control variables were lagged by 1 year and 2 years for Models 1 and 2, respectively. FINDINGS Public hospitals in financial distress had greater odds of being privatized than public hospitals not in financial distress: (OR = 4.53, p < .001) for Model 1 and (OR = 3.05, p = .001) for Model 2. PRACTICE IMPLICATIONS Privatization eases access to resources and may provide financial relief to government entities from the burden of continuously funding a hospital operating at a loss, which in turn may help keep the hospital open and preserve access to care for the community. Privatizing a financially distressed public hospital may be a better strategic alternative than closure. The Altman Z-score could be used as a managerial tool to monitor hospitals' financial condition and take corrective actions.
Collapse
Affiliation(s)
- Zo Ramamonjiarivelo
- Zo Ramamonjiarivelo, PhD, MBA, is Assistant Professor, Department of Health Administration, Governors State University, University Park, Illinois. . Robert Weech-Maldonado, PhD, MBA, is Professor and L.R. Jordan Endowed Chair of Health Administration, Department of Health Services Administration, University of Alabama at Birmingham. Larry Hearld, PhD, MSA, MBA, is Assistant Professor, Department of Health Services Administration, University of Alabama at Birmingham. Nir Menachemi, PhD, MPH, is Professor and Doctoral Program Director, Department of Health Care Organization and Policy, University of Alabama at Birmingham. Josué Patien Epané, PhD, MBA, is Assistant Professor, Department of Health Care Administration and Policy, University of Nevada, Las Vegas. Stephen O'Connor, PhD, MBA, MPA, FACHE, is Professor, Department of Health Services Administration, University of Alabama at Birmingham
| | | | | | | | | | | |
Collapse
|
11
|
Environmental factors associated with physician's engagement in communication activities. Health Care Manage Rev 2015; 40:79-89. [PMID: 24398619 DOI: 10.1097/hmr.0000000000000003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Communication between patients and providers is a crucial component of effective care coordination and is associated with a number of desired patient and provider outcomes. Despite these benefits, physician-patient and physician-physician communication occurs infrequently. PURPOSE The purpose of this study was to examine the relationship between a medical practice's external environment and physician engagement in communication activities. METHODOLOGY/APPROACH This was a cross-sectional examination of 4,299 U.S. physicians' self-reported engagement in communication activities. Communication was operationalized as physician's time spent on communication with patients and other providers during a typical work day. The explanatory variables were measures of environmental complexity, dynamism, and munificence. Data sources were the Health Tracking Physician Survey, the Area Resource File database, and the Dartmouth Atlas. Binary logistic regression was used to estimate the association between the environmental factors and physician engagement in communication activities. FINDINGS Several environmental factors, including per capita income (odds ratio range, 1.17-1.38), urban location (odds ratio range, 1.08-1.45), fluctuations in Health Maintenance Organization penetration (odds ratio range, 3.47-13.22), poverty (odds ratio range, 0.80-0.97) and population rates (odds ratio range, 1.01-1.02), and the presence of a malpractice crisis (odds ratio range, 0.22-0.43), were significantly associated with communication. PRACTICE IMPLICATIONS Certain aspects of a physician's external environment are associated with different modes of communication with different recipients (patients and providers). This knowledge can be used by health care managers and policy makers who strive to improve communication between different stakeholders within the health care system (e.g., patient and providers).
Collapse
|
12
|
Environmental factors and quality improvement in county and local health departments. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2014; 19:240-9. [PMID: 23348521 DOI: 10.1097/phh.0b013e31825f74b2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE On the basis of resource dependency theory and the uncertainty principle, this study examines the relationship between the local public health market environment and the use of quality improvement (QI) strategies in local health departments. DESIGN This cross-sectional study uses secondary data from the 2008 National Association of County & City Health Officials profile study, the Health Resources and Services Administration's Area Resource File, and the County Health Rankings 2010 data set. SETTING AND PARTICIPANTS US local health departments. MAIN OUTCOME MEASURES Seven binary dependent variables that represented the use of QI processes or QI training within local health departments were used. Eight independent variables were identified and operationalized to measure the constructs of munificence, dynamism, and complexity for the local public health market environment. Bivariate and multivariate regression analyses were used. RESULTS Two of the 3 munificence variables were positively associated with QI, as predicted. These included percentage of zip codes with healthy food outlets (β = +.016, P < .05) and the number of primary care physicians per capita (β = +1.327, P < .05). Two of the 3 measures of complexity were, as predicted, negatively associated with indicators of QI. These included smoking prevalence (β = -.118, P < .05) and obesity rates (β = -.081, P < .10). With respect to dynamism, 1 variable (change in population size over a 5-year period) was unexpectedly, positively related to QI (β = +.118, P < .10 and β = +0.235, P < .05). CONCLUSIONS Overall findings provide moderate support for the use of resource dependency theory and the uncertainty perspective to understand the influence of the external environment on QI within the local public health setting. Future research should examine other ways of operationalizing these environmental constructs to examine the relationship between the environment and other elements of public health practice.
Collapse
|
13
|
Using resource dependency theory to measure the environment in health care organizational studies. Health Care Manage Rev 2014; 39:50-65. [DOI: 10.1097/hmr.0b013e3182826624] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
14
|
Abstract
BACKGROUND Previous studies identified individual or practice factors that influence practice-based physicians' electronic medical record (EMR) adoption. Less is known about the market factors that influence physicians' EMR adoption. PURPOSE The aim of this study was to explore the relationship between environmental market characteristics and physicians' EMR adoption. METHODS The Health Tracking Physician Survey 2008 and Area Resource File (2008) were combined and analyzed. Binary logistic regression was used to examine the relationship between three dimensions of the market environment (munificence, dynamism, and complexity) and EMR adoption controlling for several physician and practice characteristics. RESULTS In a nationally representative sample of 4,720 physicians, measures of market dynamism including increases in unemployment, odds ratio (OR) = 0.95, 95% confidence interval (CI) [0.91, 0.99], or poverty rates, OR = 0.93, 95% CI [0.89, 0.96], were negatively associated with EMR adoption. Health maintenance organization penetration, OR = 3.01, 95% CI [1.49, 6.05], another measure of dynamism, was positively associated with EMR adoption. Physicians practicing in areas with a malpractice crisis, OR = 0.82, 95% CI [0.71, 0.94], representing environmental complexity, had lower EMR adoption rates. PRACTICE IMPLICATIONS Understanding how market factors relate to practice-based physicians' EMR adoption can assist policymakers to better target limited resources as they work to realize the national goal of universal EMR adoption and meaningful use.
Collapse
|
15
|
Abstract
BACKGROUND : Previous studies have provided theoretical and empirical evidence that environmental forces influence hospital strategy. PURPOSES : Rooted in resource dependence theory and the information uncertainty perspective, this study examined the relationship between environmental market characteristics and hospitals' selection of a health information technology (HIT) management strategy. METHODOLOGY/APPROACH : A cross-sectional design is used to analyze secondary data from the American Hospital Association Annual Survey, the Healthcare Information and Management Systems Society Analytics Database, and the Area Resource File. Univariate and multinomial logistic regression analyses are used. FINDINGS : Overall, 3,221 hospitals were studied, of which 60.9% pursed a single-vendor HIT management strategy, 28.9% pursued a best-of-suite strategy, and 10.2% used a best-of-breed strategy. Multivariate analyses controlling for hospital characteristics found that measures of environmental factors representing munificence, dynamism, and/or complexity were systematically associated with various hospital HIT management strategy use. Specifically, the number of generalist physicians per capita was positively associated with the single-vendor strategy (B = -5.64, p = .10). Hospitals in urban markets were more likely to pursue the best-of-suite strategy (B = 0.622, p < .001). Dynamism, measured as the number of managed care contracts for a given hospital, was negatively associated with the single-vendor strategy (B = 0.004, p = .049). Lastly, complexity, measured as market competition, was positively associated with the best-of-breed strategy (B = 0.623, p = .042). PRACTICE IMPLICATIONS : By and large, environmental factors are associated with hospital HIT management strategies in mostly theoretically supported ways. Hospital leaders and policy makers interested in influencing the adoption of hospital HIT should consider how market conditions influence HIT management decisions as part of programs to promote meaningful use.
Collapse
|
16
|
The Impact of Special Focus Facility Nursing Homes on Market Quality. THE GERONTOLOGIST 2010; 50:519-30. [DOI: 10.1093/geront/gnq006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
17
|
Tyler DA, Jung HY, Feng Z, Mor V. Prevalence of nursing assistant training and certification programs within nursing homes, 1997-2007. THE GERONTOLOGIST 2010; 50:550-5. [PMID: 20185520 DOI: 10.1093/geront/gnq014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE The purpose of this study was to describe how the prevalence of nurse aide training and competency evaluation programs (NATCEPs) provided in the nursing home (NH) setting changed between 1997 and 2007, to explore the environmental factors that may be influencing the prevalence of these programs, and to examine how the changing prevalence of NH-based NATCEPs may be affecting those considering certified nursing assistant (CNA) work. METHODS We used the Online Survey Certification and Reporting (OSCAR) data to generate descriptive statistics for 3 groups of NHs from 1997 to 2007: NHs that never provided an NATCEP, those that provided the program throughout the study period, and those that provided the program intermittently. We gathered information on states' policies regarding CNA training by telephone and Internet. Data from the National Nursing Assistant Survey were also utilized to describe where CNAs are receiving their training and what proportion of costs they are paying. RESULTS Prevalence of NH-based programs dropped throughout the study period. It is likely that most CNAs are now receiving their preemployment training outside the NH setting and paying a greater share of their training costs. IMPLICATIONS The shifting of CNA training to venues other than NHs raises important questions about the quality of training and states' ability to monitor training programs. In addition, CNAs receiving training outside NHs pay a greater share of their training costs, possibly creating a disincentive to enter the field.
Collapse
Affiliation(s)
- Denise A Tyler
- Department of Community Health, Center for Gerontology and Health Care Research, Brown University, Providence, Rhode Island 02912, USA.
| | | | | | | |
Collapse
|