Health Services Management Research最新文献

Using observational data and variation in hospital admissions across days of the week, we examined the association between ED boarding time and development of delirium within 72 hours of admission among patients aged 65+ years admitted to an inpatient neurology ward. We exploited a natural experiment created by potentially exogenous variation in boarding time across days of the week because of competition for the neurology floor beds. Using proportional hazard models adjusting for socio-demographic and clinical characteristics in a propensity score, we examined the time to delirium onset among 858 patients: 2/3 were admitted for stroke, with the remaining admitted for another acute neurologic event. Among all patients, 81.2% had at least one delirium risk factor in addition to age. All eligible patients received delirium prevention protocols upon admission to the floor and received at least one delirium screening event. While the clinical and social-demographic characteristics of admitted patients were comparable across days of the week, patients with ED arrival on Sunday or Tuesday were more likely to have had delayed floor admission (waiting time greater than 13 hours) and delirium (adjusted HR = 1.54, 95%CI:1.37-1.75). Delayed initiation of delirium prevention protocol appeared to be associated with greater risk of delirium within the initial 72 hours of a hospital admission.

Socio-economic and racial/ethnic disparities in healthcare quality have been the point of huge discussion and debate. There is currently a public debate over healthcare legislation in the United States to eliminate the disparities in healthcare. We reviewed the literature and critically examined standard socio-economic and racial/ethnic measurement approaches. As a result of the literature review, we identified and discussed the limitations in existing quality assessment for identifying and addressing these disparities. The aim of this research was to investigate the difference between health outcomes based on patients' ability to pay and ethnic status during a single emergency admission. We conducted a multifactorial analysis using the 11-year admissions data from a single hospital to test the bias in short-term health outcomes for length of stay and death rate, based on 'payment type' and 'race', for emergency hospital admissions. Inconclusive findings for racial bias in outcomes may be influenced by different insurance and demographic profiles by race. As a result, we found that the Self-Pay (no insurance) category has the shortest statistically significant length of stay. While the differences between Medicare, Private and Government are not significant, Self-Pay was significantly shorter. That 'Whites' have more Medicare (older) patients than 'Blacks' might possibly lead to a longer length of stay and higher death rate for the group.

Transitional care management (TCM) is a novel strategy for reducing costs and improving clinical outcomes after hospitalization but remains under-utilized. An economic analysis was performed on a hospital-based transition of care clinic (TCC) open to all patients regardless of payor status. TCC reduced re-hospitalization and emergency department (ED) utilization at six-month follow up. A cost-consequence analysis based on real world data found the TCC intervention to be cost effective relative to usual care. Hospital managers should consider adoption of TCC to improve patient care and reduce costs.

Medical tourism is an expanding phenomenon. Scientific studies address the changes and challenges of the present and future trend. However, no research considers the study of bibliometric variables and area of business, management and accounting. This bibliometric analysis discovered the following elements: (1) The main articles are based on guest services, management, leadership principles applied, hotel services associated with healthcare, marketing variables and elements that guide the choice in medical tourism; (2) The main authors do not deal with tourism but are involved in various ways in the national health system of the countries of origin or in WHO; (3)cost-efficiency and analytical accounting linked to medical tourism structures and destination choices are not yet developed topics.

Although there has been a tremendous change in the way diseases are diagnosed and treated, the ways in which health care delivery has been managed has seen very little change.Several academic studies have arisen in the area of service design, but an amalgamation of this research, especially in the area of healthcare services is not available. The aim of this systematic review is to evaluate the published research on service design in healthcare and accordingly identify the gaps and scope of future research. After analyzing the articles and reviewing the Service design in healthcare literature, the following are our main contributions: (i) clarification of the service design concept and the developments that appears in the literature review of service design in the healthcare sector; (ii) classification of the service design tools and techniques that are most commonly used in the healthcare sector; (iii) demonstration of the service design as the preponderant construct that is used as a tool and technique to improve quality and efficiency in the healthcare service.The resultant systematic review reveals a change in the type of research carried out, the service design tools used and a shift towards service design from using the co-design tool to other methods. The paper highlights the gaps in the very limited amount of empirical work in the non-clinical healthcare space and accordingly a model is recommended.

Objective: This study sought to understand the relationship of hospital performance with high-level electronic medical record (EMR) adoption, hospitalists staffing levels, and their potential interaction.

Materials and methods: We evaluated 2,699 non-federal, general acute hospitals using 2016 data merged from four data sources. We performed ordinal logistic regression of hospitals' total performance score (TPS) on their EMR capability and hospitalists staffing level while controlling for other market- and individual-level characteristics.

Results: Hospitalists staffing level is shown to be positively correlated with TPS. High-level EMR adoption is associated with both short-term and long-term improvement on TPS. Large, urban, non-federal government hospitals, and academic medical centers tend to have lower TPS compared to their respective counterparts. Hospitals belonging to medium- or large-sized healthcare systems have lower TPS. Higher registered nurse (RN) staffing level is associated with higher TPS, while higher percentage of Medicare or Medicaid share of inpatient days is associated with lower TPS.

Discussion: Although the main effects of hospitalists staffing level and EMR capability are significant, their interaction is not, suggesting that hospitalists and EMR act through separate mechanisms to help hospitals achieve better performance. When hospitals are not able to invest on both simultaneously, given financial constraints, they can still reap the full benefits from each.

Conclusion: Hospitalists staffing level and EMR capability are both positively correlated with hospitals' TPS, and they act independently to bolster hospital performance.

The objective of this study was to evaluate the mobbing perception levels of health workers, who were mobbed and to determine whether the socio-demographic characteristics of the employees made a significant difference in the perception of mobbing. Within the scope of the study, the mobbing perception levels of 516 healthcare personnel were evaluated by using relational screening model. In order to collect data, socio-demographic data form and Leymann Psychological Terrorist Scale developed by Heinz Leymann were used. As a result of the study, 70.0% of the participants who were exposed to mobbing reported that they were exposed to mobbing behaviors by their managers. The Leymann Psychological Terrorism Scale was found to be 1.49. Mobbing behaviors that affect self-disclosure and communication possibilities is the most common bullying behavior that the participants were exposed (x̄: 1.73). As a result, the data suggested that company policies rather than demographic characteristics of individuals are effective in the exposure to mobbing behaviors. It is thought that the cultural structures of the societies and the individuals' knowledge about which behaviors can be evaluated as mobbing have an effect on the mobbing perception levels of the individuals. Accepting mobbing behaviors as a normal situation in hierarchical structure or interpersonal relationships is one of the important problems in prevention. For this reason, one of the most important steps in the prevention of mobbing is to ensure that both managers and employees are informed about mobbing.

Objective: The measurement of patient safety climate within hospitals, and specifically in operating rooms is a basic tool for the development of the patient's safety policy. There are no validated Spanish versions of instruments to measure safety climate. The objective of this research was to validate the Spanish version of the Hospital Survey on Patient Safety (HSOPS®), with the addition of a module for surgical units, to evaluate the patient safety climate in operating rooms.

Methods: Survey validation study. The Hospital Survey on Patient Safety (HSOPS®) was applied to health workers from 6 acute general hospitals, from Medellín (Colombia), with surgical procedures greater than 300 per month, 18 items were added considered specific for Operating Rooms. For construct validation, an exploratory factor analysis (EFA) was used, utilizing principal components as the extraction method. Reliability was evaluated with Cronbach's α.

Results: A 10 dimensions model was obtained with EFA, most of the dimensions of the original questionnaire were conserved, although the factorial structure was not reproduced. Two new dimensions emerged from the added items. The Cronbach's α ranged between 0.66 and 0.87. Conclusions: We found the HSOPS questionnaire is valid and reliable for measuring patient safety climate in Spanish speaking Latin American countries. Two additional dimensions are proposed for Operating Rooms.

Over the last decade, second victim phenomenon (SVP) has been identified as a serious issue for healthcare workers (HCWs). Results from a 2018 survey of Canadian HCWs demonstrated that the majority of those who responded had experienced SVP and indicated that there was a lack of support in the workplace. The overall objectives of this paper are to a) heighten the awareness about SVP and its impact on HCWs and 2) to recommend an organizational/systems approach to support HCWs as second victims. This will be accomplished by first defining SVP and its relationship to patient safety. We will apply a health geography framework which incorporates the concepts of location, place, human interaction, movement and region to demonstrate the variability across care settings and the need for a systems approach to support HCWs. A human geography approaches to SVP would allow policymakers, leadership teams and managers within a health care setting to uniquely tailor their support systems to their individual contexts, which in turn will create a workplace culture of safety that builds on the organization's unique qualities.

Behavioral health influences patient health outcomes and healthcare utilization rates. Hospitals are promising settings for appropriate identification, treatment, and referral of behavioral health issues and may affect hospital admission rates and healthcare costs. Implementation frameworks are designed to aid successful adoption and scaling of health innovations. One type - process models - present staged frameworks for rolling out an innovation into routine practice. Process models are appealing for their pragmatism but are criticized for oversimplifying the complexity of implementation. This review investigates the empirical evidence for process models' utility in hospitals, chosen for their uniquely complex structures, by determining whether their use impacts implementation outcomes. Using systematic search and selection criteria across six databases, ten peer-reviewed studies were identified. Each applied a process model for implementing behavioral health innovations within hospital systems. Studies were coded by type of stage framework and reported implementation outcomes. Studies reported mostly favorable or mixed outcomes. No one framework prevailed in use nor evidence. Due to the paucity of published literature and reported data, there is limited evidence that process model application propels implementation outcomes in hospital settings. Furthering the science requires creating and utilizing systematic guidelines to employ process models, measure and report implementation stage transition, and measure and report implementation outcomes. Management and practitioners can include such data collection in standard process evaluations of hospital implementation and scale-up activities, or adopt complexity-informed approaches that lack the simplicity of process models but may be more realistic for complex settings.