Hospital & health services administration最新文献

This study used a block multiple regression analysis to examine the impacts of different factors on the degree of rurality of physician assistants' (PAs') practice location and compared the power of each block of factors in predicting rurality. Differences in the models for PAs in primary care specialties and for PAs as a whole were also explored. The findings suggest that policies should provide support to PA students in primary care specialties and to rural-oriented PA education/training programs. Efforts to facilitate PA recruitment and retention should include, among other things, increasing practice responsibility/autonomy, broadening acceptance of PA prescriptive authority, and providing equitable reimbursement for nonphysician care of Medicare and Medicaid beneficiaries.

This article examines a demonstration program to develop skills and experience for middle managers at a mid-sized urban hospital. Many of the middle managers selected for the program lacked formal management training or management experience prior to their present position. Elements of the program are summarized and first year accomplishments examined. Issues associated with continuation and replication of the program are discussed so that other hospitals may benefit from the lessons learned during development and implementation.

Quality improvement in healthcare organizations requires effective measurement of patient satisfaction. This paper describes a methodology that identifies dimensions of care most closely associated with overall perceptions of quality. A patient satisfaction survey was mailed to 2,055 discharged patients of 13 home health agencies. Patients were asked to evaluate service dimensions of home health relating to scheduling, nursing care, home health aide services, and discharge arrangements. Overall satisfaction with quality of services was used as the dependent variable in two discriminant analysis equations. Eleven dimensions discriminated between "excellent" and "good" quality, and seven dimensions discriminated between "satisfactory" and "unsatisfactory" quality. Using discriminant analysis, items most closely associated with quality indeces can be identified and used in CQI initiatives.

The organizational and operational characteristics of 140 private Florida hospitals with sustained high profitability and sustained low profitability were compared using pretax operating margin (PTOM) and pretax return on assets (PROA) measures. Approximately 15 to 20 percent of hospitals were defined as PTOM or PROA high-profit or low-profit for the years 1990, 1991, and 1992. The PTOM or PROA high-profit groups had a lower adjusted average length of stay and debt utilization, and a higher labor yield, occupancy rate, and percent with high hospital accreditation ratings (p < .05). In addition, the PROA high-profit group had a higher case-mix index and Medicare mix (p < .05). Characteristics that were different for high-profit and low-profit groups were within the scope of management.

Over the years, congressional legislation toward healthcare reform has evolved, moving toward channeling indigent populations into managed care plans. Health Maintenance Organizations (HMOs) will have to respond to increased competition caused by this shift enrollment as each entity attempts to funnel these patients into its own provider network. It is likely that some HMOs may bid too low when contracting for patients, putting these organizations at risk for financial insolvency. This paper discusses the impact of Medicaid waivers on HMO administrators. HMO executives need to develop a strategy for monitoring the financial integrity and contractual performance of new and existing HMOs in light of changes taking place with respect to healthcare reform. The transition to managed care and the shift in enrollment pose many challenges for directors of HMOs as will be discussed by analyzing lessons learned from Medicaid managed care plans in Arizona and Oregon.

Patient satisfaction is a significant issue for emergency departments. The special nature of the emergency encounter calls for a sound understanding of the factors that influence patient satisfaction. This study uses a national sample of emergency departments to identify specific elements that increase the likelihood of patients recommending the facility. We find that demographic variables such as age and sex do not significantly influence the decision to recommend. Nursing/staff items, physician issues, and waiting time are the key factors that drive satisfaction with emergency departments.

Recently hospitals have increased their use of external labor sources, contracting many traditional functions such as pharmacy and emergency to outside labor providers. Use of external labor sources often means that traditional human resource functions such as screening, hiring, and training are performed by the external labor provider, potentially reducing the value of the HR function. Using financial and staffing data gathered by the California Statewide Health Planning and Development Office during the period 1976 to 1989, this study explores the relationship between the size of HR functions and the utilization of contingent labor.

Strategies associated with ownership or management of a range of health service facilities, service sharing, and other coordination activities are important to the viability of many rural hospitals. This article articulates a set of linkage strategies employed by rural hospitals. Such strategies and their environmental and organizational correlates are assessed in a sample of 46 rural Pennsylvania hospitals.

Major changes are occurring in the health care workforce and organization of work. Such changes include, for example, a shift in workforce composition from specialists to generalists in medical care, as well as a shift from autonomous work performance to work performed in teams. This article provides a survey of such major changes. It identifies patterns of change and examines their causes. Further, we raise questions about the implications of these changes for practice and research in the health care field.

Recent policy initiatives attempt to link the tax treatment of nonprofit hospitals more closely with the provision of social benefits. A key issue in defining these benefits is the treatment of "community benefit" programs and services. While their costs are often unreimbursed, these programs differ from traditional charity care in terms of the populations whom they benefit and the motivation for their provision. Community benefit programs are typically targeted to the general population, rather than the poor or other underserved groups, and often serve a marketing function.