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1.
Artigo em Inglês | MEDLINE | ID: mdl-35019863

RESUMO

BACKGROUND: Federally qualified health centers (FQHCs) are pivotal safety net primary care providers for the medically underserved. FQHCs have complex organizational designs, with many FQHCs providing care at multiple physical locations ("sites"). The number of sites, however, varies considerably between FQHCs, which can have important implications for differential access that may perpetuate disparities in quality of care. PURPOSE: The objective of this study is to explore the organizational and environmental antecedents of the number of sites operated by each FQHC. The findings of this study contribute to a better understanding of FQHCs' expansion that has vital implications for cost and access outcomes. METHODOLOGY/APPROACH: The study is based on data between the years 2012 and 2018. Using multivariate growth curve modeling, we analyzed the final sample, consisting of 5,482 FQHC-years. RESULTS: The level of competition, measured as the number of FQHC sites in the Primary Care Service Area (PCSA) and the number of primary care physicians per 1,000 PCSA residents, was positively associated with the number of FQHC sites. The number of patients, the level of federal grant, and the year were also positively associated with the number of FQHC sites, whereas percentage of Medicaid patients; workforce supply, measured as primary care physician assistants per 1,000 PCSA residents; Medicaid expansion; and state/local funding available for FQHCs were not. CONCLUSION: Findings of this study indicate that competition, especially between peer FQHCs, is significantly associated with FQHC expansion. PRACTICE IMPLICATIONS: This result suggests that FQHC managers and policymakers may closely monitor cost, access, and quality implications of competition and FQHC expansion.

2.
J Ambul Care Manage ; 45(1): 42-54, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34669619

RESUMO

Acute conditions are the leading cause of work restrictions and missed workdays, contributing to over $27 billion in lost productivity each year and negatively impacting workers' health and quality of life. Primary care services, specifically patient-centered medical homes (PCMHs), play an essential role in supporting timely acute illness or injury recovery for working adults. The purpose of this review is to synthesize the evidence on the relationship between PCMH implementation, care processes, and outcomes. In addition, we discuss the empirical connection between this evidence and return-to-work outcomes, as well as the need for further research.

3.
Mil Med ; 2021 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-34893857

RESUMO

INTRODUCTION: Over the last 40 years, patient-centered medical home (PCMH) has evolved as the leading primary care practice model, replacing traditional primary care models in the United States and internationally. The goal of PCMH is to improve chronic condition management. In the U.S. Army, the scope of the medical home, which encompasses various care delivery platforms, including PCMH and soldier-centered medical home (SCMH), extends beyond the management of chronic illnesses. These medical home platforms are designed to support the unique health care needs of the U.S. Army's most vital asset-the soldier. The PCMHs and SCMHs within the U.S. Army employ patient-centered care principles while incorporating nationally recognized structural attributes and care processes that work together in a complex adaptive system to improve organizational and patient outcomes. However, U.S. Army policies dictate differences in the structures of PCMHs and SCMHs. Researchers suggest that differences in medical home structures can impact how organizations operationalize care processes, leading to unwanted variance in organizational and patient outcomes. This study aimed to compare 3 care processes (access to care, primary care manager continuity, and patient-centered communication) between PCMHs and SCMHs. MATERIALS AND METHODS: This was a retrospective, cross-sectional, and correlational study. We used a subset of data from the Military Data Repository collected between January 1, 2018, and December 31, 2018. The sample included 266 medical home teams providing care for active duty soldiers. Only active duty soldiers were included in the sample. We reviewed current U.S. Army Medical Department policies to describe the structures and operational functioning of PCMHs and SCMHs. General linear mixed regressions were used to evaluate the associations between medical home type and outcome measures. The U.S. Army Medical Department Center and School Institutional Review Board approved this study. RESULTS: There was no significant difference in access to 24-hour and future appointments or soldiers' perception of access between PCMHs and SCMHs. There was no significant difference in primary care manager continuity. There was a significant difference in medical home team continuity (P < .001), with SCMHs performing better. There was no significant difference in patient-centered communication scores. Our analysis showed that while the PCMH and SCMH models were designed to improve primary care manager continuity, access to care, and communication, medical home teams within the U.S. Army are not consistently meeting the Military Health System standard of care benchmarks for these care processes. CONCLUSIONS: Our findings comparing 3 critical medical home care processes suggest that structural differences may impact continuity but not access to care or communication. There is an opportunity to further explore and improve access to appointments within 24 hours, primary care manager and medical home team continuity, perception of access to care, and the quality of patient-centered communication among soldiers. Knowledge gained from this study is essential to soldier medical readiness.

4.
Artigo em Inglês | MEDLINE | ID: mdl-34939603

RESUMO

OBJECTIVE: The purpose of this study was to examine whether certain types of leaders were associated with the degree to which local health departments (LHDs) generate and use evidence to inform their service offering. DESIGN: Pooled, cross-sectional analysis using 4 waves (2010, 2013, 2016, and 2019) of the National Profiles of Local Health Departments sponsored by the National Association of County and City Health Officials (NACCHO). Univariate analysis was used to assess the extent to which LHDs were generating and using evidence to improve the health of their local communities and whether this changed over time. Multinomial logistic regression models were used to examine the relationships between LHD leader attributes and the extent to which LHDs were generating and using evidence. PARTICIPANTS: Between 1496 and 2087 (varied by survey round) LHDs from throughout the United States. MAIN OUTCOME MEASURES: Two outcome variables pertaining to the generation of evidence: (1) how recently an LHD completed a community health assessment and (2) how recently an LHD completed a community health improvement plan. A third outcome variable reflected how extensively an LHD used the Community Guide, a compendium of evidence-based findings. RESULTS: In 2010, 25.1% and 41.4% of all LHDs had not completed a community health assessment or a community health improvement plan, respectively; by 2019, those figures declined significantly to 14.6% and 24.7%. Similarly, in 2010, 61.7% of all LHDs were not using the Community Guide; by 2019, that percentage declined significantly to 42.5%. Multivariable analysis revealed that leader experience was a more robust correlate of evidence generation and use by LHDs than leader education. CONCLUSIONS: While LHDs' generation and use of evidence have grown over the past decade, there is room for improvement. Local health department leader attributes-education and experience-highlight targeted opportunities to fill gaps in the use of evidence-based public health practices.

5.
6.
Artigo em Inglês | MEDLINE | ID: mdl-34319278

RESUMO

BACKGROUND: As large numbers of coronavirus disease 2019 (COVID-19) patients were admitted to intensive care units (ICUs) in 2020 and 2021, the United States faced a shortage of critical care providers. Intensivists are physicians specializing in providing care in the ICU. Although studies have explored the clinical and financial benefits associated with the use of intensivists, little is known about the organizational and market factors associated with a hospital administrator's strategic decision to use intensivists. PURPOSE: The aim of this study was to use the resource dependence theory to better understand the organizational and market factors associated with a hospital administrator's decision to use intensivists. METHODOLOGY: The sample consisted of the national acute care hospitals (N = 4,986) for the period 2007-2017. The dependent variable was the number of full-time equivalent intensivists staffed in hospitals. The independent variables were organizational and market-level factors. A negative binomial regression model with state and year fixed effects, clustered at the hospital level, was used to examine the relationship between the use of intensivists and organizational and market factors. RESULTS: The results from the analyses show that administrators of larger, not-for-profit hospitals that operate in competitive urban markets with relatively high levels of munificence are more likely to utilize intensivists. PRACTICE IMPLICATIONS: When significant strains are placed on ICUs like what was experienced during the COVID-19 pandemic, it is imperative that hospital administrators understand how to best staff their ICUs. With a better understanding of the organizational and market factors associated with the use of intensivists, practitioners and policymakers alike can better understand how to strategically utilize intensivists in the ICU, especially in the face of a continuing pandemic.

7.
Artigo em Inglês | MEDLINE | ID: mdl-34319281

RESUMO

BACKGROUND: The 1980s to 1990s saw many health systems in the United States enter and exit the insurance market in the form of provider-sponsored health plans (PSHPs). Reforms and value-based reimbursement methods have stimulated health care organizations to reconsider PSHP as a logical strategy. PURPOSE: The aim of this study was to examine market and organizational factors associated with PSHP ownership and motivations for engaging in PSHP after health care reforms. The resource dependence theory was used as a theoretical lens. METHODOLOGY/APPROACH: A sequential quantitative to qualitative mixed-methods design was used. The quantitative analysis examined data for 5,849 U.S. hospitals. Results were synthesized with qualitative findings from 10 semistructured interviews representing eight health systems in five states. RESULTS: Organizational and environmental characteristics were significantly associated with PSHP ownership. Hospital and payer concentration, Medicare penetration, income, unemployment rate, government, and for-profit and metro area hospitals were associated with a lower likelihood of PSHP ownership. Salaried physician arrangements, clinically integrated network membership and adoption of other risk-bearing arrangements were associated with higher odds of PSHP ownership. Interviewees described PSHP as the culmination of the journey to value-based care and as a strategy to improve patient care, compete, and diversify revenue streams. CONCLUSIONS: Both market and organizational factors are important considerations for hospitals contemplating PSHP ownership, and motivations for ownership cover a broad range of financial, competitive, strategic, and mission-based goals. PRACTICE IMPLICATIONS: Hospitals considering PSHP ownership must carefully evaluate their competitive landscapes and organizational resources to ensure optimal conditions for this strategy. PSHP ownership has high start-up costs and requires a long-term organizational commitment.

8.
J Health Organ Manag ; ahead-of-print(ahead-of-print)2021 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-34232597

RESUMO

PURPOSE: The purpose of this study was to examine the organizational context that may support learning and change readiness climates that previous research has found to be conducive to implementing evidence-based interventions. DESIGN/METHODOLOGY/APPROACH: An exploratory, mixed method evaluation that included 15 rheumatology clinics throughout the United States was performed. Quantitative data were collected using a web-based survey completed by 135 clinic members. Qualitative data were collected via semi-structured interviews with 88 clinic members. FINDINGS: In general, clinics reported strong, positive learning and change readiness climates. More complex organizations (e.g. multispecialty, academic medical centers) with rational/hierarchical cultures and members with longer tenure were associated with less supportive learning and change readiness climates. The authors' findings highlight opportunities for organizational leaders and evidence-based intervention sponsors to focus their attention and allocate resources to settings that may be most susceptible to implementation challenges. ORIGINALITY/VALUE: First, the authors address a deficit in previous research by describing both the level and strength of the learning and change readiness climates for implementing an evidence-based shared decision-making aid (SDMA) and examine how these vary as a function of the organizational context. Second, the study examines a broader set of factors to assess the organizational context (e.g. organizational culture, organizational structure, ownership) than previous research, which may be especially salient for shaping the climate in smaller specialty clinics like those we study. Third, the authors utilize a mixed methods analysis to provide greater insights into questions of how and why organizational factors such as size and structure may influence the learning and change readiness climate.


Assuntos
Reumatologia , Aprendizagem , Cultura Organizacional , Inovação Organizacional , Organizações
9.
Health Serv Manage Res ; : 9514848211028708, 2021 Jul 07.
Artigo em Inglês | MEDLINE | ID: mdl-34232827

RESUMO

Many communities are developing innovative forms of collaborative organizations such as multi-sector health care alliances (MHCAs) to address problems of misaligned incentives among providers, payers, and community stakeholders and improve health and health care. Member engagement is essential to the success of these organizations due to their dependence on volunteer members to develop and implement strategy and provide material and in-kind support for alliance efforts, yet relatively little research has examined how alliances can foster engagement. This study examined behavioral indicators of member engagement (e.g., recruitment and retention of organizational and individual members) and how they are related to two foundational dimensions of alliance functioning - alliance leadership and community centrality. Using three rounds of an internet-based survey of alliance members from 14 alliances, the study found that organizational recruitment and retention increased over time, from 26.6% to 41.5% and 56.0% to 65.2%, respectively. Recruitment of individuals increased over the study period (38.3% to 47.2%, while retention of individual members declined over the study period (61.0% to 53.2%). Alliance leadership was associated with lower levels of recruitment (both organizational and individual members) but higher levels of organizational retention (both organizational and individual members). Collectively, our findings suggest that behavioral aspects of alliances are more effective at retaining members than relatively stable characteristics such as size and positioning in the community. Contrasting relationships between recruitment and retention, however, suggest that different forms of leadership may be required to simultaneously attract new members while retaining existing ones.

10.
Am J Health Promot ; 35(7): 988-990, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-33792355

RESUMO

PURPOSE: Compare the effectiveness of two educational teaching methods for diabetic patients. DESIGN: Quasi-experimental study comparing two interventions using a pretest/post-test design. SETTING: Three clinics within a western U.S. regional health system. SUBJECTS: 818 adult diabetic participants (60.5 mean age, 52% female) attended one to four sessions between 2013-2017, and had A1c tests within 180 days of first attended session and 30 to 365 days after last attended session. INTERVENTION: A group-based, highly interactive learning experience (n = 561) and a traditional, lecture-style class (n = 257). MEASURES: Pre and post measures of A1c. ANALYSIS: Paired t-tests measured change within each group pre-post intervention. Two-sample t-tests measured mean change pre-post intervention between the two groups. Multivariable linear regression measured mean change in A1c between groups, adjusted for pre-test scores and controlling for demographic variables. RESULTS: Both interactive and traditional teaching interventions were effective at significantly reducing patient A1c levels by 1.3 (p < 0.001) and 1.0 (p < 0.001) points respectively. The between groups difference in A1c was not significant, t(512) = 1.66, p = 0.0985, but when controlling for age, pre-A1c and days post-A1c, the interactive intervention was significantly (p < 0.05) more effective reducing patient A1c levels by 0.19 points than the traditional intervention. CONCLUSION: Group-based, interactive diabetes self-management education programs may be an effective model for reducing patient A1c levels.


Assuntos
Diabetes Mellitus Tipo 2 , Autogestão , Adulto , Diabetes Mellitus Tipo 2/terapia , Feminino , Hemoglobina A Glicada/análise , Comportamentos Relacionados com a Saúde , Humanos , Masculino , Pessoa de Meia-Idade
11.
Implement Sci Commun ; 2(1): 30, 2021 Mar 11.
Artigo em Inglês | MEDLINE | ID: mdl-33706813

RESUMO

OBJECTIVE: To provide the details of the study protocol for an observational, case study design, implementation trial. METHODS: Implementing the DEcision-Aid for Lupus (IDEAL) study will put into practice a shared decision-making (SDM) strategy, using an individualized, culturally appropriate computerized decision-aid (DA) for lupus patients in 15 geographically diverse clinics in the USA. The overarching frameworks that guide this implementation study are the Consolidated Framework for Implementation Research (CFIR) and Powell's typology of implementation strategies. All 15 clinics will receive standardized capacity-building activities for lupus DA implementation in the clinic, including education, training, technical assistance, re-training, and incorporation of a clinic champion in the core team of each site. In addition, clinics will also choose among clinic-targeted activities to integrate the DA into existing work processes and/or patient-targeted activities to raise awareness and educate patients about the DA. These activities will be chosen to stimulate participant recruitment and retention activities that support the implementation of the DA at their clinic. In study aim 1, using surveys and semi-structured interviews with clinic personnel in 15 lupus clinics, we will assess stakeholder needs and identify clinic and contextual characteristics that inform the implementation strategy component selection and influence implementation effectiveness. Study aim 2 is to implement and assess the effectiveness of the IDEAL (standardized and tailored) strategy in 15 lupus clinics by examining the changes in our primary outcome of penetration, i.e., the proportion of all eligible patients in the clinic that receive the lupus DA, and secondary outcomes include DA appropriateness, acceptability, success, permanence, and feasibility. Study aim 3 is to identify ways to sustain and disseminate our lupus DA via semi-structured debriefing interviews with key clinic personnel and patients. DISCUSSION: The study will enroll at least 500 patient participants with lupus across all 15 sites and assess the effectiveness in implementing the DA in various clinic settings across the USA. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03735238 . Protocol version number: 15, date 6/8/2020.

13.
J Healthc Manag ; 66(1): 48-61, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33411486

RESUMO

EXECUTIVE SUMMARY: Financial distress is a persistent problem in U.S. hospitals, leading them to close at an alarming rate over the past two decades. Given the potential adverse effects of hospital closures on healthcare access and public health, interest is growing in understanding more about the financial health of U.S. hospitals. In this study, we set out to explore the extent to which relevant organizational and environmental factors potentially buffer financially distressed hospitals from closure, and even at the brink of closure, enable some to merge with other hospitals. We tested our hypotheses by first examining how factors such as slack resources, environmental munificence, and environmental complexity affect the likelihood of survival versus closing or merging with other organizations. We then tested how the same factors affect the likelihood of merging relative to closing for financially distressed hospitals that undergo one of these two events. We found that different types of slack resources and environmental forces impact different outcomes. In this article, we discuss the implications of our findings for hospital stakeholders.


Assuntos
Fechamento de Instituições de Saúde , Hospitais , American Hospital Association , Estados Unidos
14.
Health Serv Manage Res ; 34(3): 158-166, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33085543

RESUMO

Hospitalists, or specialists of hospital medicine, have long been practicing in Canada and Europe. However, it was not until the mid-1990s, when hospitals in the U.S. started widespread adoption of hospitalists. Since then, the number of hospitalists has grown exponentially in the U.S. from a few hundred to over 50,000 in 2016. Prior studies on hospitalists have well documented benefits hospitals gain from adopting this innovative staffing strategy. However, there is a dearth of research documenting predictors of hospitals' adoption of hospitalists. To fill this gap, this longitudinal study (2003-2015) purposes to determine organizational and market characteristics of U.S. hospitals that utilize hospitalists. Our findings indicate that private not-for-profit, system affiliated, teaching, and urban hospitals, and those located in higher per capita income markets have a higher probability of utilizing hospitalists. Additionally, large or medium, profitable hospitals, and those that treat sicker patients have a higher probability of adoption. Finally, hospitals with a high proportion of Medicaid patients have a lower probability of utilizing hospitalists. Our results suggest that hospitals with greater slack resources and those located in munificent counties are more likely to use hospitalists, while their under-resourced counterparts may experience more barriers in adopting this innovative staffing strategy.


Assuntos
Médicos Hospitalares , Canadá , Hospitais , Humanos , Estudos Longitudinais , Estados Unidos , Recursos Humanos
15.
Health Care Manage Rev ; 46(1): 1, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33235014

Assuntos
Editoração , Humanos
16.
Health Care Manage Rev ; 46(4): 266-277, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-31702707

RESUMO

BACKGROUND: Privatization is one of the strategies that public hospitals may adopt to remain competitive. Privatized hospitals may implement nurse staffing cuts as a cost-saving mechanism and to increase financial performance. A better understanding of how privatization may affect nurse staffing is important given its association with patient and organizational outcomes. PURPOSE: The aim of this study was to examine the impact of not-for-profit (NFP) and for-profit (FP) privatizations of public hospitals on nurse staffing. METHODOLOGY/APPROACH: Based on secondary data sets from the American Hospital Association Annual Survey, the Centers for Medicare & Medicaid Services Impact Files, and the Area Health Resources File, this study used a nonexperimental longitudinal design consisting of negative binomial and linear regression models with hospital level and year fixed effects. Our sample consisted of nonfederal and noncritical access, acute care, public hospitals (n = 492) followed from 1997 to 2013 (8,335 hospital-year observations). Nurse staffing was measured as full-time equivalents (FTEs) and skill mix. Privatization was defined as conversion from public to either private NFP or private FP status. RESULTS: FP privatization was associated with greater decreases in registered nurse (RN) staffing FTEs (incidence rate ratio [IRR] = 0.93, p = .004) and total nurse staffing FTEs (IRR = 0.93, p = .001), compared with NFP privatization: RN staffing FTEs (IRR = 0.95, p = .003) and total nurse staffing FTEs (IRR = 0.96, p = .007). CONCLUSION: Overall, privatization was associated with decreased RN FTEs and total nurse staffing FTEs and no changes in licensed practical nurse FTEs and RN skill mix. PRACTICE IMPLICATIONS: A close monitoring of nurse staffing level, after privatization, is encouraged to prevent potential deterioration in quality of care.


Assuntos
Enfermeiras e Enfermeiros , Privatização , Idoso , Hospitais Públicos , Humanos , Medicare , Estados Unidos , Recursos Humanos
17.
Med Care Res Rev ; 78(4): 361-370, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-31865856

RESUMO

This study assessed the impact of public hospitals' privatization on payer-mix. We used a national sample of nonfederal, acute care, public hospitals in 1997 and followed them through 2013, resulting in a cohort of 492 hospitals (8,335 hospital-year observations). Privatization to for-profit (FP) status was associated with a greater increase in Medicare payer-mix (ß = 0.13; p ≤ .001), compared with a smaller increase for privatization to not-for-profit (NFP) status (ß = 0.02; p ≤ .05). FP privatization was associated with a greater decrease in Medicaid payer-mix (ß = -0.09; p ≤ .001), compared with NFP privatization (nonsignificant). There is a larger change in payer-mix after FP privatization than after NFP privatization.


Assuntos
Medicaid , Privatização , Idoso , Estudos de Coortes , Hospitais Públicos , Humanos , Medicare , Estados Unidos
18.
J Healthc Manag ; 65(5): 330-343, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32925532

RESUMO

EXECUTIVE SUMMARY: 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.


Assuntos
Pesquisas sobre Serviços de Saúde/estatística & dados numéricos , Instituições Associadas de Saúde/organização & administração , Satisfação do Paciente/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos
20.
Health Care Manage Rev ; 45(3): 185, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32472822
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