The United States is experiencing another wave of hospital mergers. Whether patients benefit from these mergers, however, remains an open issue for many interested stakeholders. One measure of the ...potential benefit of hospital mergers is how they affect patient experience. This study used a quasi-experimental design to examine the relationship between hospital mergers and four different Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) ratings (i.e., overall, physician communication, nurse communication, and staff responsiveness). The study findings showed an association between hospitals that experienced a merger and slower growth in HCAHPS scores for two of the four HCAHPS domains (overall and nurse communication) when compared to matching hospitals that did not merge. Findings from this study can guide and inform hospital administrators, health system boards, state and federal government regulators and policymakers, and others across the spectrum of healthcare stakeholders.
Abstract
High-quality nursing home (NH) care has long been a challenge within the United States. For decades, policymakers at the state and federal levels have adopted and implemented regulations to ...target critical components of NH care outcomes. Simultaneously, our delivery system continues to change the role of NHs in patient care. For example, more acute patients are cared for in NHs, and the Center for Medicare and Medicaid Services (CMS) has implemented value payment programs targeting NH settings. As a part of these growing pressures from the broader healthcare delivery system, the culture-change movement has emerged among NHs over the past two decades, prompting NHs to embody more person-centered care as well as promote settings which resemble someone's home, as opposed to institutionalized healthcare settings.
Researchers have linked culture change to high-quality outcomes and the ability to adapt and respond to the ever-changing pressures brought on by changes in our regulatory and delivery system. Making enduring culture change within organizations has long been a challenge and focus in NHs. Despite research suggesting that culture-change initiatives that promote greater resident-centered care are associated with several desirable patient outcomes, their adoption and implementation by NHs are resource intensive, and research has shown that NHs with high percentages of low-income residents are especially challenged to adopt these initiatives.
This chapter takes a novel approach to examine factors that impact the adoption of culture-change initiatives by assessing knowledge management and the role of knowledge management activities in promoting the adoption of innovative care delivery models among under-resourced NHs throughout the United States. Using primary data from a survey of NH administrators, we conducted logistic regression models to assess the relationship between knowledge management and the adoption of a culture-change initiative as well as whether these relationships were moderated by leadership and staffing stability. Our study found that NHs were more likely to adopt a culture-change initiative when they had more robust knowledge management activities. Moreover, knowledge management activities were particularly effective at promoting adoption in NHs that struggle with leadership and nursing staff instability. Our findings support the notion that knowledge management activities can help NHs acquire and mobilize informational resources to support the adoption of care delivery innovations, thus highlighting opportunities to more effectively target efforts to stimulate the adoption and spread of these initiatives.
As large numbers of coronavirus disease 2019 (COVID-19) patients were admitted to intensive care units (ICUs) in 2020 and 2021, the United States faced a shortage of critical care providers. ...Intensivists are physicians specializing in providing care in the ICU. Although studies have explored the clinical and financial benefits associated with the use of intensivists, little is known about the organizational and market factors associated with a hospital administrator's strategic decision to use intensivists.
The aim of this study was to use the resource dependence theory to better understand the organizational and market factors associated with a hospital administrator's decision to use intensivists.
The sample consisted of the national acute care hospitals (N = 4,986) for the period 2007-2017. The dependent variable was the number of full-time equivalent intensivists staffed in hospitals. The independent variables were organizational and market-level factors. A negative binomial regression model with state and year fixed effects, clustered at the hospital level, was used to examine the relationship between the use of intensivists and organizational and market factors.
The results from the analyses show that administrators of larger, not-for-profit hospitals that operate in competitive urban markets with relatively high levels of munificence are more likely to utilize intensivists.
When significant strains are placed on ICUs like what was experienced during the COVID-19 pandemic, it is imperative that hospital administrators understand how to best staff their ICUs. With a better understanding of the organizational and market factors associated with the use of intensivists, practitioners and policymakers alike can better understand how to strategically utilize intensivists in the ICU, especially in the face of a continuing pandemic.
Cultural competency has been proposed as an organizational strategy to address racial/ethnic disparities in the healthcare system; disparities are a long-standing policy challenge whose relevance is ...only increasing with the increasing population diversity of the US and across the world. Using an integrative conceptual framework based on the resource dependency and institutional theories, we examine the relationship between organizational and market factors and hospitals' degree of cultural competency. Our sample consists of 119 hospitals located in the state of California (US) and is constructed using the following datasets for the year 2006: Cultural Competency Assessment Tool of Hospitals (CCATH) Survey, California's Office of Statewide Health Planning & Development's Hospital Inpatient Discharges and Annual Hospital Financial Data, American Hospital Association's Annual Survey, and the Area Resource File. The dependent variable consists of the degree of hospital cultural competency, as assessed by the CCATH overall score. Organizational variables include ownership status, teaching hospital, payer mix, size, system membership, financial performance, and the proportion of inpatient racial/ethnic minorities. Market characteristics included hospital competition, the proportion of racial/ethnic minorities in the area, metropolitan area, and per capita income. Regression analyses were conducted to assess the relationship between the CCATH overall score and organizational and market variables. Our results show that hospitals which are not-for-profit, serve a more diverse inpatient population, and are located in more competitive and affluent markets exhibit a higher degree of cultural competency. Our results underscore the importance of both institutional and competitive market pressures in guiding hospital behavior. For instance, while not-for-profit may adopt innovative/progressive policies like cultural competency simply as a function of their organizational goals, linking cultural competency with organizational performance may be essential to attract more profit driven hospitals.
► Use of resource dependence and institutional theories to examine factors associated with hospital cultural competency in the US. ► Cultural Competency Assessment Tool for Hospitals (CCATH) applied as a measure of organizational cultural competency. ► Not-for-profit hospitals and those that serve a more diverse patient population show a higher degree of cultural competency. ► Hospitals that are located in more competitive and affluent markets show a higher degree of cultural competency. ► Our results underscore the importance of both institutional and competitive market pressures in guiding hospital behavior.
Community orientation refers to hospitals' efforts to assess and meet the health needs of the local population. Variations in the number of community orientation-related activities offered by ...hospitals may be attributed to differences in organizational and environmental characteristics. Therefore, hospitals have to strategically respond to these internal and external constraints to improve community health. Understanding the facilitators and barriers of hospital community orientation is important to health care managers facing pressure from the external environment to meet the expectations of the community as well as Affordable Care Act guidelines.
The purpose of this study was to examine the organizational and environmental factors that promote or impede hospital community orientation.
A multivariate regression with random effects was conducted using data from the American Hospital Association Annual Survey from 2007 to 2010 and county level data from the Area Health Resource Files.
Not-for-profit, system-affiliated, network-affiliated, and larger hospitals have a higher degree of community orientation. In addition, the percentage of the county residents under the age of 65 years with health insurance and hospitals in states with certificate-of-need laws were also positively related to the degree of community orientation. During the study period, it appears that organizational factors mattered more in determining the degree of community orientation.
Overall, a better understanding of the factors that influence community orientation can assist hospital administrators and policymakers in stimulating the hospital's role in improving population health and its responsiveness to community health needs. These efforts may occur by building interorganizational relationships or by incentivizing those hospitals that are least likely to be community oriented.
This study examined the association between interdepartmental transfers and the perceptions of care received by adult patients who were admitted and discharged from a 300-bed, not-for-profit ...community tertiary hospital in the Midwest. Transfers of patient care are daily and frequent hospital processes. However, limited attention has focused on the effect that intrahospital transfers of care have on the patient experience. Understanding this relationship is important, since value-based purchasing models directly tie patient experience measures into hospital reimbursements. The key finding of this study indicates that as patients’ transfers increase, their perceptions of care decrease. Therefore, by reducing the frequency of interdepartmental transfers, patient satisfaction may increase. This research provides clinicians and administrators a better understanding of the relationship between a frequent and a daily hospital process (ie, interdepartmental transfers) and its influence on patients’ perceptions of their experience.
Highlights • Patients use internet search for medication risk information as well as consulting with their providers and family/friends. • Patient race, age and gender are factors related to ...medication risk information seeking behavior. • Minorities and older patients are more likely to rely on their physician for medication risk information than on the internet. • Men are more likely to rely on their pharmacist for medication risk information than on the internet, compared to women.
Increased interest in the patient-centered medical home (PCMH) among policy makers and practitioners has resulted in a growth of research on the factors that influence its adoption and ...implementation, yet this research often fails to capture the multidimensional nature of the PCMH and the longitudinal nature of the implementation process. This study documented physician practices’ PCMH capacity across 12 different domains (e.g., extended access, specialist referral, use of patient registry) over a 3-year period (2008-2010). Linear growth models indicated that participation through different types of physician organizations and practice size were associated with different baseline levels of capacity and changes in capacity over time; however, the association varied as a function of the different PCMH dimensions. Differences in PCMH capacity across the 12 domains and time suggest that more attention should be paid to the longitudinal nature of PCMH implementation and the differential challenges associated with its component parts.
The study compares racial differences in access to highly active antiretroviral therapy (HAART) for human immunodeficiency virus (HIV) patients under Medicaid managed care and Medicaid ...fee-for-service (FFS). This study uses the HIV Cost and Services Utilization Study (HCSUS) data set. The analysis includes Black and White Medicaid enrollees with HIV/AIDS in 1996. Logistic regression is used to estimate the models with exposure to HAART as the dependent variable. This study suggests that Black enrollees still face barriers in access to care, even after Medicaid has assured financial access. Disparities in access to HIV/AIDS treatment exist under both Medicaid FFS and Medicaid managed care.
This article examines the effect of parents' Medicaid status on the use of preventive health services by young children. Using data from the 1996 Medical Expenditure Panel Survey (MEPS), we analyzed ...a logit model for receipt of any well-child visits (WCVs) that compared three groups of low-income children. The three groups, defined by the joint insurance status of children and their parents, involved Medicaid pairs (both the child and the parent had Medicaid throughout the year), mixed pairs (the child had Medicaid and the parent was uninsured), and uninsured pairs (both child and parent were uninsured). Medicaid coverage for children was positively associated with receipt of any WCVs. However, the utilization effect of Medicaid coverage for children was significantly larger when the parent was also on Medicaid instead of being uninsured. Considering uninsured children with uninsured parents in 1996, enrolling only the children in Medicaid would have increased the percentage with WCVs from 29 to 43 percent according to simulations with the logit model. If the parents were enrolled in Medicaid as well, the percentage of children with any WCVs would have increased to 67 percent.
PDF
