Managerial process improvement: a lean approach to eliminating medication delivery.

PURPOSE: Statistical evidence shows that medication errors are a major cause of injuries that concerns all health care oganizations. Despite all the efforts to improve the quality of care, the lack of understanding and inability of management to design a robust system that will strategically target those factors is a major cause of distress. The paper aims to discuss these issues. DESIGN/METHODOLOGY/APPROACH: Achieving optimum organizational performance requires two key variables; work process factors and human performance factors. The approach is that healthcare administrators must take in account both variables in designing a strategy to reduce medication errors. However, strategies that will combat such phenomena require that managers and administrators understand the key factors that are causing medication delivery errors. FINDINGS: The authors recommend that healthcare organizations implement the Toyota Production System (TPS) combined with human performance improvement (HPI) methodologies to eliminate medication delivery errors in hospitals. ORIGINALITY/VALUE: Despite all the efforts to improve the quality of care, there continues to be a lack of understanding and the ability of management to design a robust system that will strategically target those factors associated with medication errors. This paper proposes a solution to an ambiguous workflow process using the TPS combined with the HPI system.

Health information technology capacity at federally qualified health centers: a mechanism for improving quality of care.

BACKGROUND: The adoption of health information technology has been recommended as a viable mechanism for improving quality of care and patient health outcomes. However, the capacity of health information technology (i.e., availability and use of multiple and advanced functionalities), particularly in federally qualified health centers (FQHCs) on improving quality of care is not well understood. We examined associations between health information technology (HIT) capacity at FQHCs and quality of care, measured by the receipt of discharge summary, frequency of patients receiving reminders/notifications for preventive care/follow-up care, and timely appointment for specialty care. METHODS: The analyses used 2009 data from the National Survey of Federally Qualified Health Centers. The study included 776 of the FQHCs that participated in the survey. We examined the extent of HIT use and tested the hypothesis that level of HIT capacity is associated with quality of care. Multivariable logistic regressions, reporting unadjusted and adjusted odds ratios, were used to examine whether 'FQHCs' HIT capacity' is associated with the outcome measures. RESULTS: The results showed a positive association between health information technology capacity and quality of care. FQHCs with higher HIT capacity were significantly more likely to have improved quality of care, measured by the receipt of discharge summaries (OR=1.43; CI=1.01, 2.40), the use of a patient notification system for preventive and follow-up care (OR=1.74; CI=1.23, 2.45), and timely appointment for specialty care (OR=1.77; CI=1.24, 2.53). CONCLUSIONS: Our findings highlight the promise of HIT in improving quality of care, particularly for vulnerable populations who seek care at FQHCs. The results also show that FQHCs may not be maximizing the benefits of HIT. Efforts to implement HIT must include strategies that facilitate the implementation of comprehensive and advanced functionalities, as well as promote meaningful use of these systems. Further examination of the role of health information systems in clinical decision-making and improvements in patient outcomes are needed to better understand the benefits of HIT in improving overall quality of care.

The importance of examining movements within the US health care system: sequential logit modeling.

BACKGROUND: Utilization of specialty care may not be a discrete, isolated behavior but rather, a behavior of sequential movements within the health care system. Although patients may often visit their primary care physician and receive a referral before utilizing specialty care, prior studies have underestimated the importance of accounting for these sequential movements. METHODS: The sample included 6,772 adults aged 18 years and older who participated in the 2001 Survey on Disparities in Quality of Care, sponsored by the Commonwealth Fund. A sequential logit model was used to account for movement in all stages of utilization: use of any health services (i.e., first stage), having a perceived need for specialty care (i.e., second stage), and utilization of specialty care (i.e., third stage). In the sequential logit model, all stages are nested within the previous stage. RESULTS: Gender, race/ethnicity, education and poor health had significant explanatory effects with regard to use of any health services and having a perceived need for specialty care, however racial/ethnic, gender, and educational disparities were not present in utilization of specialty care. After controlling for use of any health services and having a perceived need for specialty care, inability to pay for specialty care via income (AOR = 1.334, CI = 1.10 to 1.62) or health insurance (unstable insurance: AOR = 0.26, CI = 0.14 to 0.48; no insurance: AOR = 0.12, CI = 0.07 to 0.20) were significant barriers to utilization of specialty care. CONCLUSIONS: Use of a sequential logit model to examine utilization of specialty care resulted in a detailed representation of utilization behaviors and patient characteristics that impact these behaviors at all stages within the health care system. After controlling for sequential movements within the health care system, the biggest barrier to utilizing specialty care is the inability to pay, while racial, gender, and educational disparities diminish to non-significance. Findings from this study represent how Americans use the health care system and more precisely reveals the disparities and inequalities in the U.S. health care system.

Policy challenges in US health care system reform.

Once again, efforts are being made to overhaul the US health care system. Democrats and Republicans have conflicting views on how to repair this ailing system. However, this is not a new phenomenon. Reformers have long struggled to form a universal health care system only to find themselves in conflict with groups whose financial stake is threatened as well as numerous labor associations who are concerned about a loss of power. This struggle is also caused by differences in ideologies. This article surveys social movements for national health insurance (NHI) that occurred in the United States and will examine features that prevented NHI policy formation.

The economic value of investing in regenerative medicine.

This article discusses the science of regenerative medicine and presents evidence that investments towards the development of this technology will reduce total health care output. Use of regenerative medicine will also be an important factor in eliminating chronic diseases such as diabetes, heart disease, and Parkinson's disease. Investment in regenerative medicine is a sound strategy for several reasons: human suffering will be reduced, if not eliminated; and the economy will be stimulated by creating employment opportunities, generating additional income and tax revenues, increasing worker productivity, creating new conglomerates, and reducing insurance costs. This article discusses some of the latest advances in regenerative medicine as well as the progress that has been made in the development of new stem cell therapies.

Confronting the challenges of long-term health care crisis in the United States.

This article examines the factors that comprise long-term health care and the impact that the aging population will have in dramatically increasing the costs of long-term health care in the United States if current health policies are not amended. It further analyzes the reasons that will cause the health care expenditures to expand. It also discusses the economic challenges and the impact that absent reform can have on state and federal budgets, ultimately affecting the national economy. Aside from that, this article presents numerous options that communities across the nation can embark on to reduce health care costs and it briefly glances at the proposed legislation called America's Affordable Health Choices Act of 2009 that was submitted by the House Committee on Ways and Means and in summary discusses the key features of the bill.

Treatment disparities in medication prescribing for Alzheimer's: disease among ethnic groups.

OBJECTIVES: The purpose of this explanatory study was to determine whether medication prescribing for Alzheimer's disease (AD) differs by racial and ethnic group membership. The following research question was examined in this study: Are there prescribing pattern differences for AD among racial and ethnic groups? Additional beneficiary characteristic variables examined included: diabetes, memory loss, psychological disorder, age category, and gender. METHODS: This research project employed a time series study design to analyze three years of a national secondary dataset to examine Medicare beneficiaries with Alzheimer's disease (AD). Specific medications were identified as the standard of care treatment regimen for severe and mild to moderate AD (Aricept and Exelon, respectively). RESULTS: Descriptive statistics for medications for the AD group were obtained. Total prescribed medications for the AD group was analyzed for treatment differences for the study variables race, age category, gender, psychological disorder, diabetes, and memory loss. An association was found for all three years between treatment (Aricept) and the following variables: diabetes, memory loss, and psychological disorder. DISCUSSION: Treatment type trends indicated that Aricept use for both blacks and whites has decreased. High frequency of antiseizure medications were found, which could indicate their use as mood enhancers. Study findings indicate that patients on AD treatment were not also taking mood enhancers. Diabetic patients were found to be on Aricept and Exelon and mood altering medications. Hormones were present among the medications; since the sample was over 65 (post menopausal), could indicate use of hormone therapy as a treatment option for this sample despite standard treatment recommendations.

Strategic information technology alliances for effective health-care supply chain management.

To gain and sustain competitive advantage, health-care providers have to continuously review and renovate their operational and information technology (IT) strategies through collaborative and cooperative endeavour with their supply chain channel members. This paper explores new ways of enhancing a health-care organization's responsiveness to changes and increasing its competitiveness through implementing strategic information technology alliances among channel members in a health-care supply chain network. An overview of issues and problems (e.g. bullwhip effect, negative externalities and free-riding phenomenon in multichannel supply chains) presented in the health-care supply chains is first delineated. This paper further goes over the issues of health-care supply chain coordination and integration for strategic IT alliances, followed by the discussion of the spillover effect of IT investments. A number of viable IT practices (such as information sharing and Internet-enabled supply chain portal) for effective health-care supply chain collaboration and coordination are then examined in this research. Finally, the paper discusses how strategic IT alliances can help improve the effectiveness of health-care supply chain management.

Does increasing cigarette excise tax improve people's health? The cases of heart attacks and stroke.

INTRODUCTION: Recently, public health advocates have fervently supported an increase in the cigarette excise tax as a means of reducing smoking. Likewise, political leaders have heavily relied on the cigarette excise tax as a means of encouraging a reduction in the overall rates of cigarette use. However, little is known about whether the cigarette excise tax is a valid tool for reducing the negative effects of smoking on public health. Our objective is to examine whether increasing the cigarette excise tax will reduce the morbidity rates of heart attack and stroke, which have consistently been among the major causes of death and disability in the United States. METHODS: We used the static and dynamic panel-data model to explore the impact of the US regional cigarette excise tax on morbidity rates of heart attack and stroke. These rates of heart attack and stroke are estimated based on the 1970-2000 National Hospital Discharge Survey (NHDS). RESULTS: Study results show that the causal relationship between cigarette excise tax and morbidity rates of heart attack and stroke is unclear. However, the morbidity rates of non-smoking-related hypertension and high cholesterol-related diseases are positively correlated with the morbidity rates of heart attack and stroke. CONCLUSIONS: We did not find clear empirical evidence to support the hypothesis that raising the cigarette excise tax effects a reduction the morbidities of heart attack and stroke. Therefore, use of the cigarette excise tax may not be an effective means to improve the health of the US population.

A strategic approach of E-health initiatives.

The Internet is transforming the US economy. Though it continues to lag behind other industries, healthcare has begun to incorporate this technology on a wider scale to reduce costs and more effectively address quality and patient-choice issues. This article presents the background of the US healthcare system, examines the application of e-health, advocates for the integration of e-health components and discusses the roles of major stakeholders in e-health as the basis for the strategic planning, initiation and implementation of integrated e-health systems. Strategic planning provides the opportunity for an insightful view and consideration of the impacts, expectations and responses of e-health stakeholders while implementing integrated e-health solutions for access to more cost-effective and better patient care delivery.

Health care competition, strategic mission, and patient satisfaction: research model and propositions.

PURPOSE: In all industries, competition among businesses has long been encouraged as a mechanism to increase value for patients. In other words, competition ensures the provision of better products and services to satisfy the needs of customers This paper aims to develop a model that can be used to empirically investigate a number of complex issues and relationships associated with competition in the health care industry. DESIGN/METHODOLOGY/APPROACH: A literature review was conducted. A total of 50 items of literature related to the subject were reviewed. Various perspectives of competition, the nature of service quality, health system costs, and patient satisfaction in health care are examined. FINDINGS: A model of the relationship among these variables is developed. The model depicts patient satisfaction as an outcome measure directly dependent on competition. Quality of care and health care systems costs, while also directly dependent on the strategic mission and goals, are considered as determinants of customer satisfaction as well. The model is discussed in the light of propositions for empirical research. PRACTICAL IMPLICATIONS: Empirical studies based on the model proposed in this paper should help identify areas with significant impact on patient satisfaction while maintaining high quality of service at lower costs in a competitive environment. ORIGINALITY/VALUE: The authors develop a research model which included propositions to examine the complex issues of competition in the health care industry.

Effects of maternal and provider characteristics on up-to-date immunization status of children aged 19 to 35 months.

OBJECTIVES: We examined the effects of maternal and provider characteristics on the up-to-date immunization status of children. METHODS: We used data from the 2003 National Immunization Survey to determine variations in children's up-to-date status in the 4:3:1:3 immunization series. RESULTS: Low maternal educational levels and low socioeconomic status were associated with high 4:3:1:3 series completion rates. Also, completion rates were high in Hispanic and non-Hispanic Black families with low income-to-poverty ratios. CONCLUSIONS: We found that children of less educated mothers and children in Hispanic and non-Hispanic Black families with low income-to-poverty ratios were more likely to have completed the 4:3:1:3 series. Although the reasons for these results need further exploration in other data sets, possible factors are Hispanics' positive cultural attitudes regarding the needs and importance of young children and provision of information on immunizations to low-income minority mothers who access government-subsidized health care programs.

Comparison of health behaviors among single- and multiple-member households.

OBJECTIVE: To assess the differences in health behavior between multiple-member and single-member households by gender. METHODS: Face-to-face household survey interviews were conducted. The relationship between health behaviors and living arrangement was assessed by adjusting for SES. RESULTS: Women living alone exercised more and ate less food high in fat. More highly educated men were less likely to exercise 5 or more times a week than high school or less educated men. CONCLUSIONS: By analyzing local data, a profile can be established to develop and implement appropriate public health programs aimed at these various target communities for effective intervention and healthy change in the community.

The effects of location and race on the performance of cardiac procedures.

This study assessed the impact of patient and facility characteristics on patient outcomes for coronary artery disease. The sample data studied and analyzed (i.e., hospital financial and administrative data) were from patients discharged in 2004, from hospitals in Florida with principal diagnoses codes indicating diseases of the circulatory system. Patient outcomes were measured as principal procedure codes for patients who received coronary arteriography, percutaneous transluminal coronary angioplasty, and coronary artery bypass graft surgeries. Chi-square analysis indicated that both patient location (chi 2 = 225.9038, p < .0001) and race (chi 2 = 312.1335, p < .0001) were associated with the receipt of cardiovascular procedures.

A research model of health-care competition and customer satisfaction.

In all industries, competition among businesses has long been encouraged as a mechanism to increase value for customers. In other words, competition ensures the provision of better products and services to satisfy the needs of customers. Various perspectives of competition, the nature of service quality, health-care system costs and customer satisfaction in health care are examined. A model of the relationship among these variables is developed. The model depicts customer satisfaction as an outcome measure directly dependent on competition. Quality of care and health-care system costs, while also directly dependent on competition, are considered as determinants of customer satisfaction as well. The model is discussed in the light of propositions for empirical research.

Managing and analysing a large health-care system database for predicting in-hospital mortality among acute myocardial infarction patients.

There is increasing interest in the identification of predictors of risk for in-hospital mortality due to acute myocardial infarction (AMI). This study identified significant predictors of in-hospital mortality among AMI patients using a patient level clinical database. The study population consisted of 4167 cases admitted between October 1999 and April 2001 with a principal diagnosis of AMI to 36 hospitals in three US states. Of the 182 available variables in the clinical data set, 30 variables were used as candidate predictors, and 19 showed significant univariate association with AMI in-hospital mortality. By applying multiple logistic regression and stepwise selection, a final prediction model for AMI in-hospital mortality was developed. Variables included in the final model were age, arrived from cardiac rehabilitation centre, cardiopulmonary resuscitation (CPR) on arrival, Killip class, AMI with co-morbid conditions, AMI with complications, percutaneous transluminal coronary angioplasty (PTCA) performed, beta-blockers given, angiotensin-converting enzyme (ACE) inhibitors given, Plavix given. A 10-variable in-hospital mortality prediction model for AMI patients, which includes both risk factors and beneficial treatment procedures, was developed. chi(2) goodness of fit test suggested a good fit for the model.

High blood pressure in school children: prevalence and risk factors.

BACKGROUND: The purpose of this study was to determine the prevalence of high blood pressure (HBP) and associated risk factors in school children 8 to 13 years of age. METHODS: Elementary school children (n = 1,066) were examined. Associations between HBP, body mass index (BMI), gender, ethnicity, and acanthosis nigricans (AN) were investigated using a school based cross-sectional study. Blood pressure was measured and the 95th percentile was used to determine HBP. Comparisons between children with and without HBP were utilized. The crude and multiple logistic regression adjusted odds ratios were used as measures of association. RESULTS: Females, Hispanics, overweight children, and children with AN had an increased likelihood of HBP. Overweight children (BMI > or = 85th percentile) and those with AN were at least twice as likely to present with HBP after controlling for confounding factors. CONCLUSION: Twenty one percent of school children had HBP, especially the prevalence was higher among the overweight and Hispanic group. The association identified here can be used as independent markers for increased likelihood of HBP in children.

Socioeconomic determinants of planned methadone treatment.

OBJECTIVES: To examine socioeconomic characteristics associated with planned methadone maintenance treatment (MMT). METHODS: We performed multiple logistic regressions using data from the 1998 Treatment Episode Data Set, which tracks admissions for substance abuse treatment. RESULTS: MMT was more prevalent among heroin users than nonheroin users. Among heroin users, females, Hispanics, Southerners, the employed, and those who are not homeless or in jail are more likely to be planned to receive MMT. Among nonheroin users, females were less likely to be planned for MMT. CONCLUSIONS: Greater effort may be necessary to extend MMT to vulnerable populations.

Health Insurance Portability and Accountability Act: blessing or curse?

The health care industry has undergone dramatic changes over the past decade. Advances in technologies are being implemented, making the health care industry more complex. In response to increasing administrative costs, the inability to control the collection and distribution of an individual's health information, and the rising costs of health care, the Health Insurance Portability and Accountability Act (HIPAA) was passed as part of the Social Security Act in 1996 to address the emerging complexities of the industry. Over the past years, the health care system has focused efforts on compliance with HIPAA regulations. HIPAA compliance can improve efficiency, reduce costs, and protect the privacy of personal medical information; however, some health care providers and other health care entities have experienced various setbacks in efforts to comply with HIPAA. Health care providers may be reluctant to comply with HIPAA regulations because the rules are complex and result in short-term increases in administrative costs. Nevertheless, long-term HIPAA compliance could allow the health care system to improve its effectiveness and efficiency in health care delivery.

Prescription drug spending: contribution to health care spending and cost containment strategies.

Prescription drug costs have been the focus of much research in the health care economy, within managed care organizations, and hospital systems. Pharmacy costs are drivers of general health care spending, premium increases, and to a lesser extent, hospital spending. Factors contributing to increased prescription spending include increased prescription use, replacement of older, cheaper drugs with new and more expensive ones, and the costly prices of retail prescription drugs. In this article, we review the cost of prescription drugs as they relate to general health care costs and the costs associated with operating a hospital organization. We also address what is currently being done to control the cost of prescription drugs in the hospital setting.