M. Tanios, David A. Haberman, J. Bouchard, Michael S. Motherwell, J. Patel
: The increasing complexity of healthcare delivery in the United States and the financial challenges of meeting the escalating costs pose significant pressures on physicians, healthcare providers, and their teams. These various demands put physicians at high-risk for extreme mental fatigue, which affects their occupational performance and their patient’s well-being, and the healthcare delivery systems in general. Moreover, burned-out doctors are at risk exiting healthcare altogether leading to reduction patients’ access and continuity of care. In this paper, we performed a selective review of the literature related to health care associated burnout and utilize double-loop learning to offer opinions and selected solutions for physicians and healthcare organizations for interventions to minimize burnout and reverse its occurrence in the workplace and at home. Moreover, this paper will analyze the significant contributors to burnout, such as a lack of proper understanding, diversity and workplace factors, absence of organizational support systems, and health record-related burdens associated with 21st century medicine. For these reasons, the authors recommend a multifaceted approach that includes flexible scheduling, mental health education, and support systems. Other intervention areas include home-work balance, organizational interventions, and financial remedies for rewarding performance - by altering incentivization schedules. The approach considers a single and double-loop approach for medical establishments and their respective infrastructures
{"title":"Analyses of burn-out among medical professionals and suggested solutions—a narrative review","authors":"M. Tanios, David A. Haberman, J. Bouchard, Michael S. Motherwell, J. Patel","doi":"10.21037/jhmhp-20-153","DOIUrl":"https://doi.org/10.21037/jhmhp-20-153","url":null,"abstract":": The increasing complexity of healthcare delivery in the United States and the financial challenges of meeting the escalating costs pose significant pressures on physicians, healthcare providers, and their teams. These various demands put physicians at high-risk for extreme mental fatigue, which affects their occupational performance and their patient’s well-being, and the healthcare delivery systems in general. Moreover, burned-out doctors are at risk exiting healthcare altogether leading to reduction patients’ access and continuity of care. In this paper, we performed a selective review of the literature related to health care associated burnout and utilize double-loop learning to offer opinions and selected solutions for physicians and healthcare organizations for interventions to minimize burnout and reverse its occurrence in the workplace and at home. Moreover, this paper will analyze the significant contributors to burnout, such as a lack of proper understanding, diversity and workplace factors, absence of organizational support systems, and health record-related burdens associated with 21st century medicine. For these reasons, the authors recommend a multifaceted approach that includes flexible scheduling, mental health education, and support systems. Other intervention areas include home-work balance, organizational interventions, and financial remedies for rewarding performance - by altering incentivization schedules. The approach considers a single and double-loop approach for medical establishments and their respective infrastructures","PeriodicalId":92075,"journal":{"name":"Journal of hospital management and health policy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42877027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: In recent years, nonprofit hospitals have faced new and, in some cases, inconsistent policies and regulatory requirements for providing community benefits. While numerous studies have examined hospitals’ spending on community benefits under different regulatory requirements, little research has been published describing what happens “behind the curtain”. Methods: We undertook a pilot qualitative research study to better understand how hospitals are operationalizing community benefit programs in the presence of changing guidelines and regulatory requirements. We focused on hospitals in Massachusetts where in 2018, the Attorney General promulgated updated community benefit guidelines. We obtained data through semi-structured interviews with hospital community benefit administrators (CBAs) who, as the middle-managers and critical implementers for these programs, provide a particularly important lens from which to gain a better understanding of nonprofit hospital community benefit efforts. Results: Our findings, while in a small population, show that CBAs embrace changes to community benefit guidelines, including a new focus on the social determinants of health, but worry about their ability to meet increasing expectations. Conclusions: Larger sample sizes and more geographic diversity is needed to make generalized conclusions about nonprofit hospital community benefit activities. However, from this small study, implications for policy makers include the need to better articulate the expectations for nonprofit hospitals in regard to community benefits, explore how community benefits compete with or complement population health efforts such as Medicaid ACOs, and consider more explicit oversight and enforcement.
{"title":"Hospitals and community benefit requirements: perspectives of community benefit administrators in Massachusetts","authors":"G. Cramer, J. McGuire, Simone R. Singh, G. Young","doi":"10.21037/jhmhp-21-44","DOIUrl":"https://doi.org/10.21037/jhmhp-21-44","url":null,"abstract":"Background: In recent years, nonprofit hospitals have faced new and, in some cases, inconsistent policies and regulatory requirements for providing community benefits. While numerous studies have examined hospitals’ spending on community benefits under different regulatory requirements, little research has been published describing what happens “behind the curtain”. Methods: We undertook a pilot qualitative research study to better understand how hospitals are operationalizing community benefit programs in the presence of changing guidelines and regulatory requirements. We focused on hospitals in Massachusetts where in 2018, the Attorney General promulgated updated community benefit guidelines. We obtained data through semi-structured interviews with hospital community benefit administrators (CBAs) who, as the middle-managers and critical implementers for these programs, provide a particularly important lens from which to gain a better understanding of nonprofit hospital community benefit efforts. Results: Our findings, while in a small population, show that CBAs embrace changes to community benefit guidelines, including a new focus on the social determinants of health, but worry about their ability to meet increasing expectations. Conclusions: Larger sample sizes and more geographic diversity is needed to make generalized conclusions about nonprofit hospital community benefit activities. However, from this small study, implications for policy makers include the need to better articulate the expectations for nonprofit hospitals in regard to community benefits, explore how community benefits compete with or complement population health efforts such as Medicaid ACOs, and consider more explicit oversight and enforcement.","PeriodicalId":92075,"journal":{"name":"Journal of hospital management and health policy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47107402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dae-Hyun Kim, S. O’Connor, Jessica H. Williams, William Opoku-Agyeman, D. Chu, Seong Won Choi
Health literacy is defined as “the degree to which an individual has the capacity to obtain, communicate, process, and understand basic health information and services needed to make appropriate decisions for the betterment of his or her health” (1). At least half of American adults may not understand the complex medical communications used in the delivery of care, leading to negative consequences on care quality, disparities, and costs (2). Inadequate health literacy levels have been associated with numerous health issues such as worse overall health (3), increased rate of obesity (4), and increased use of Original Article
{"title":"The effect of gastrointestinal patients’ health literacy levels on gastrointestinal patients’ health outcomes","authors":"Dae-Hyun Kim, S. O’Connor, Jessica H. Williams, William Opoku-Agyeman, D. Chu, Seong Won Choi","doi":"10.21037/JHMHP-20-134","DOIUrl":"https://doi.org/10.21037/JHMHP-20-134","url":null,"abstract":"Health literacy is defined as “the degree to which an individual has the capacity to obtain, communicate, process, and understand basic health information and services needed to make appropriate decisions for the betterment of his or her health” (1). At least half of American adults may not understand the complex medical communications used in the delivery of care, leading to negative consequences on care quality, disparities, and costs (2). Inadequate health literacy levels have been associated with numerous health issues such as worse overall health (3), increased rate of obesity (4), and increased use of Original Article","PeriodicalId":92075,"journal":{"name":"Journal of hospital management and health policy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43528525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
: Interprofessional Education (IPE) plays an important role in the acquisition of an attitude for Collaborative Practice (CP) in undergraduate students. IPE offers a possible way to improve collaboration and patient care. While effective IPE programs have been shown to have a number of positive benefits, it is argued that there is only limited evidence of success in measuring the long-term effects of IPE on health care practice and collaboration. The primary aim of this project was to examine the efficacy of IPE at Gunma University. This case is unique in that the provision of IPE for undergraduate students of both medicine and health sciences has fostered the attitudes toward meaningful collaboration. Then there are only two institutions in the world, which specialize in this IPE at Gunma University as well as University of Malawi, as the WHO Collaborating Centre. Gunma University has implemented a comprehensive IPE program, including lecture-style subjects for first-year students and a training-style subject for third-year students since 1997. As an aftermath of IPE intervention, there is realization of IPE may be professional identity and concrete knowledge for patient safety, especially for communication and leadership, commonly in pre-qualified IPE intervention. Then we strongly suggested that there is a need for in-service IPE in order to sustain attitude and provide a useful CP, which results in good clinical outcome.
{"title":"Evaluation of the effectiveness of Interprofessional Education at Gunma University as the WHO Collaborating Centre: case series","authors":"Takatoshi Makino, Bumsuk Lee, Hiroki Matsui, Ena Sato, Naoto Noguchi, Akinori Kama, Hiromitsu Shinozaki, Hideomi Watanabe","doi":"10.21037/jhmhp-21-40","DOIUrl":"https://doi.org/10.21037/jhmhp-21-40","url":null,"abstract":": Interprofessional Education (IPE) plays an important role in the acquisition of an attitude for Collaborative Practice (CP) in undergraduate students. IPE offers a possible way to improve collaboration and patient care. While effective IPE programs have been shown to have a number of positive benefits, it is argued that there is only limited evidence of success in measuring the long-term effects of IPE on health care practice and collaboration. The primary aim of this project was to examine the efficacy of IPE at Gunma University. This case is unique in that the provision of IPE for undergraduate students of both medicine and health sciences has fostered the attitudes toward meaningful collaboration. Then there are only two institutions in the world, which specialize in this IPE at Gunma University as well as University of Malawi, as the WHO Collaborating Centre. Gunma University has implemented a comprehensive IPE program, including lecture-style subjects for first-year students and a training-style subject for third-year students since 1997. As an aftermath of IPE intervention, there is realization of IPE may be professional identity and concrete knowledge for patient safety, especially for communication and leadership, commonly in pre-qualified IPE intervention. Then we strongly suggested that there is a need for in-service IPE in order to sustain attitude and provide a useful CP, which results in good clinical outcome.","PeriodicalId":92075,"journal":{"name":"Journal of hospital management and health policy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44039674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Brimioulle, Prathibha Nanoo, Darren Yap, A. Hunt
Background: Telephone consultations have been shown previously to be effective and safe in general practice and in specialties for specific conditions such as human immunodeficiency virus (HIV), inflammatory bowel disease (IBD) and epilepsy. They include certain advantages such as gain of time, but these must be balanced against potential disadvantages in terms of efficacy and patient satisfaction. Until recently, there was no information available on the adequacy of telephone consultations in ear, nose, and throat (ENT). Methods: The study design was a cross-sectional observational study in the context of a service improvement project in a single ENT department during the COVID-19 pandemic. Telephone consultations by three ENT doctors were studied over a 3-week period. Total consultation time, including administrative tasks, and telephone call time were calculated and compared to pre-COVID consultation times. Clinician-assessed adequacy of the consultation was determined. Results: Ninety-six consultations were included; 65 were deemed adequate whereas 31 were inadequate due to the lack of examination. Telephone consultations took an average of 16 minutes, of which 9 minutes were spent on the telephone call, compared to an average of 20 minutes for face to face consultations. Conclusions: Telephone consultations were quicker than face to face consultations by 20% and were an appropriate alternative in two-thirds of cases. This suggests that routine practice would benefit from the addition of telephone consultation with selected patients, based on clinical presentation and patient preference.
{"title":"The efficacy of telephone consultations in ENT","authors":"M. Brimioulle, Prathibha Nanoo, Darren Yap, A. Hunt","doi":"10.21037/jhmhp-21-4","DOIUrl":"https://doi.org/10.21037/jhmhp-21-4","url":null,"abstract":"Background: Telephone consultations have been shown previously to be effective and safe in general practice and in specialties for specific conditions such as human immunodeficiency virus (HIV), inflammatory bowel disease (IBD) and epilepsy. They include certain advantages such as gain of time, but these must be balanced against potential disadvantages in terms of efficacy and patient satisfaction. Until recently, there was no information available on the adequacy of telephone consultations in ear, nose, and throat (ENT). Methods: The study design was a cross-sectional observational study in the context of a service improvement project in a single ENT department during the COVID-19 pandemic. Telephone consultations by three ENT doctors were studied over a 3-week period. Total consultation time, including administrative tasks, and telephone call time were calculated and compared to pre-COVID consultation times. Clinician-assessed adequacy of the consultation was determined. Results: Ninety-six consultations were included; 65 were deemed adequate whereas 31 were inadequate due to the lack of examination. Telephone consultations took an average of 16 minutes, of which 9 minutes were spent on the telephone call, compared to an average of 20 minutes for face to face consultations. Conclusions: Telephone consultations were quicker than face to face consultations by 20% and were an appropriate alternative in two-thirds of cases. This suggests that routine practice would benefit from the addition of telephone consultation with selected patients, based on clinical presentation and patient preference.","PeriodicalId":92075,"journal":{"name":"Journal of hospital management and health policy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43714397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The developed world’s population is aging, due to trends of increased life expectancies and decreased fertility rates. Like many Asian countries, Singapore is facing a key demographic challenge with its rapidly aging society, driven by rising life expectancies and declining fertility rates. Lower fertility rates and increased longevity mean that the number of seniors is expected to double to over 900,000, or 1 in 4 Singaporeans by the year 2030 (1). One of the nation’s solutions to this social problem is the long-term care support scheme for older persons, including housework and physical activity support community care centre facilities such as the senior day care centres helps community-dwelling elderly to manage disability, frailty, and multi-morbidity (2). We ground this paper in senior day care centres, where community-based facilities provide case management and a variety of day care activities to cater for a range of elders with differing levels of needs. In contrast to primary care hospital settings, which are mostly focused on acute and short term treatments, the primary objectives of senior day care centres are to improve the quality of life of seniors and delay institutionalization (3,4). There are, therefore, important contextual distinctions that can have implications on how Lean should be adapted to aid in the Original Article
{"title":"Adapting Lean for process redesign in senior day care services","authors":"H. Tay","doi":"10.21037/JHMHP-21-2","DOIUrl":"https://doi.org/10.21037/JHMHP-21-2","url":null,"abstract":"The developed world’s population is aging, due to trends of increased life expectancies and decreased fertility rates. Like many Asian countries, Singapore is facing a key demographic challenge with its rapidly aging society, driven by rising life expectancies and declining fertility rates. Lower fertility rates and increased longevity mean that the number of seniors is expected to double to over 900,000, or 1 in 4 Singaporeans by the year 2030 (1). One of the nation’s solutions to this social problem is the long-term care support scheme for older persons, including housework and physical activity support community care centre facilities such as the senior day care centres helps community-dwelling elderly to manage disability, frailty, and multi-morbidity (2). We ground this paper in senior day care centres, where community-based facilities provide case management and a variety of day care activities to cater for a range of elders with differing levels of needs. In contrast to primary care hospital settings, which are mostly focused on acute and short term treatments, the primary objectives of senior day care centres are to improve the quality of life of seniors and delay institutionalization (3,4). There are, therefore, important contextual distinctions that can have implications on how Lean should be adapted to aid in the Original Article","PeriodicalId":92075,"journal":{"name":"Journal of hospital management and health policy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46891685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Zo Ramamonjiarivelo, F. Zengul, J. Epane, Larry R. Hearld, Luceta McRoy, R. Weech-Maldonado
Background: Public hospitals hold a key role in providing health care services especially to individuals without health insurance, those who are partially covered by health insurance, and low income population. However, some of these hospitals have converted to private status. The objective of this study was to assess the effect of the ownership conversion of public hospitals into private status on the provision of high-technology health services. Methods: This study used a non-experimental longitudinal design based on merged secondary data from the American Hospital Association annual survey, the Area Health Resources File, and the Local Area Unemployment Statistics [1997–2013]. The dependent variable “high-technology health services” was measured using Saidin index. There were 492 non-federal acute care public hospitals (n=8,335 hospital-year observations) in our sample, of which 104 (21%) converted to private status (75 converted to private not-for-profit and 29 converted to for-profit hospitals). The independent variable “privatization” referred to ownership conversion from public to either private not-for-profit or private for-profit status. We ran two fixed-effects linear regressions to measure the impact of privatization on high-technology services offering. Results: Our key findings suggested that privatization was associated with a decrease in Saidin index ( β =−0.74; P=0.016; 95% CI: −1.34 to −1.38). For-profit privatization was associated with a greater decrease in Saidin index ( β =−1.29; P=0.024; 95% CI: −2.41 to −0.17), compared with an insignificant decrease for not-for-profit privatization ( β =−0.56; P=0.106; 95% CI: −1.25 to 0.12). Conclusions: Given the excessive cost of high-technology health services and the change in the hospitals’ mission after privatization, privatized hospitals tend to reduce the number of high-technology health services they provide.
{"title":"Does the provision of high-technology health services change after the privatization of public hospitals?","authors":"Zo Ramamonjiarivelo, F. Zengul, J. Epane, Larry R. Hearld, Luceta McRoy, R. Weech-Maldonado","doi":"10.21037/JHMHP-20-111","DOIUrl":"https://doi.org/10.21037/JHMHP-20-111","url":null,"abstract":"Background: Public hospitals hold a key role in providing health care services especially to individuals without health insurance, those who are partially covered by health insurance, and low income population. However, some of these hospitals have converted to private status. The objective of this study was to assess the effect of the ownership conversion of public hospitals into private status on the provision of high-technology health services. Methods: This study used a non-experimental longitudinal design based on merged secondary data from the American Hospital Association annual survey, the Area Health Resources File, and the Local Area Unemployment Statistics [1997–2013]. The dependent variable “high-technology health services” was measured using Saidin index. There were 492 non-federal acute care public hospitals (n=8,335 hospital-year observations) in our sample, of which 104 (21%) converted to private status (75 converted to private not-for-profit and 29 converted to for-profit hospitals). The independent variable “privatization” referred to ownership conversion from public to either private not-for-profit or private for-profit status. We ran two fixed-effects linear regressions to measure the impact of privatization on high-technology services offering. Results: Our key findings suggested that privatization was associated with a decrease in Saidin index ( β =−0.74; P=0.016; 95% CI: −1.34 to −1.38). For-profit privatization was associated with a greater decrease in Saidin index ( β =−1.29; P=0.024; 95% CI: −2.41 to −0.17), compared with an insignificant decrease for not-for-profit privatization ( β =−0.56; P=0.106; 95% CI: −1.25 to 0.12). Conclusions: Given the excessive cost of high-technology health services and the change in the hospitals’ mission after privatization, privatized hospitals tend to reduce the number of high-technology health services they provide.","PeriodicalId":92075,"journal":{"name":"Journal of hospital management and health policy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42936433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The COVID-19 pandemic has intensified the need for crisis preparedness among public health systems worldwide. Securing both human and financial resources to improve standards of health care remains a global priority (1-4). Yet, efforts to improve preparedness lack the necessary frameworks to develop and sustain improvements in health care systems’ processes and outcomes (5,6). The sudden and far-reaching impact of the COVID-19 pandemic has prompted scientists to develop frameworks that aim to adequately prepare hospitals and other health service delivery systems for surges in demand for care. A report on the operational readiness of nations on several indicators of preparedness found that only 57% of 182 countries had the functional capacity to execute crucial emergency-related activities (7). Elements of health care systems that have been implicated in low levels of preparedness have varied, ranging from supply chain failures, workforce shortages, organizational readiness for change, and resource constraints, among others (8,9). The COVID-19 pandemic has certainly impacted these elements. With decades of organizational research on the adoption and implementation of innovative practices, system and organizational scientists are poised to help health care organizations respond to the need for technical, financial, and cultural resources to effectively address public health crises (10-12). In this special issue, we embarked on an exploration of health care systems’ capacity to respond to increasing public health challenges, to meet the global imperative for more efficient and effective crisis preparedness infrastructure. This special issue on “organizational approaches to implement rapid change in hospitals to respond to public health emergencies” presents conceptual and empirical papers on various approaches that hospitals and other health care organizations could implement to counteract current (e.g., the COVID-19 pandemic), ongoing (e.g., HIV, opioid overdose) and emerging epidemics that will impact global health. The purpose of this special issue is to advance Systems, as well as Organizations and Implementation Sciences by developing and testing frameworks that lead to a highly responsive and effective public health system. These interdisciplinary sciences organizational learning in hospitals’ response to crisis management with regard to COVID-19 (15). Focusing on the practice of disaster management and crisis-driven changes, the authors review published case studies that reveal which components of change were most effective in preparing hospitals to respond to patients care challenges during the COVID-19 pandemic. The authors focus on efforts to help professionals and policy makers developed robust responses across different countries in the world. Their findings inform a framework for optimal patient care response, including the use of big data systems. The last paper in the series is written by Drs. Choflet, Packard, and Stashower, who also
{"title":"Organizational approaches to implement rapid change in hospitals to respond to public health emergencies","authors":"E. Guerrero, J. Frimpong","doi":"10.21037/jhmhp-2021-05","DOIUrl":"https://doi.org/10.21037/jhmhp-2021-05","url":null,"abstract":"The COVID-19 pandemic has intensified the need for crisis preparedness among public health systems worldwide. Securing both human and financial resources to improve standards of health care remains a global priority (1-4). Yet, efforts to improve preparedness lack the necessary frameworks to develop and sustain improvements in health care systems’ processes and outcomes (5,6). The sudden and far-reaching impact of the COVID-19 pandemic has prompted scientists to develop frameworks that aim to adequately prepare hospitals and other health service delivery systems for surges in demand for care. A report on the operational readiness of nations on several indicators of preparedness found that only 57% of 182 countries had the functional capacity to execute crucial emergency-related activities (7). Elements of health care systems that have been implicated in low levels of preparedness have varied, ranging from supply chain failures, workforce shortages, organizational readiness for change, and resource constraints, among others (8,9). The COVID-19 pandemic has certainly impacted these elements. With decades of organizational research on the adoption and implementation of innovative practices, system and organizational scientists are poised to help health care organizations respond to the need for technical, financial, and cultural resources to effectively address public health crises (10-12). In this special issue, we embarked on an exploration of health care systems’ capacity to respond to increasing public health challenges, to meet the global imperative for more efficient and effective crisis preparedness infrastructure. This special issue on “organizational approaches to implement rapid change in hospitals to respond to public health emergencies” presents conceptual and empirical papers on various approaches that hospitals and other health care organizations could implement to counteract current (e.g., the COVID-19 pandemic), ongoing (e.g., HIV, opioid overdose) and emerging epidemics that will impact global health. The purpose of this special issue is to advance Systems, as well as Organizations and Implementation Sciences by developing and testing frameworks that lead to a highly responsive and effective public health system. These interdisciplinary sciences organizational learning in hospitals’ response to crisis management with regard to COVID-19 (15). Focusing on the practice of disaster management and crisis-driven changes, the authors review published case studies that reveal which components of change were most effective in preparing hospitals to respond to patients care challenges during the COVID-19 pandemic. The authors focus on efforts to help professionals and policy makers developed robust responses across different countries in the world. Their findings inform a framework for optimal patient care response, including the use of big data systems. The last paper in the series is written by Drs. Choflet, Packard, and Stashower, who also","PeriodicalId":92075,"journal":{"name":"Journal of hospital management and health policy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42516522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ganisher K. Davlyatov, J. Lord, A. Ghiasi, R. Weech-Maldonado
Weech-Maldonado; Background: Nursing homes operating in resource-constrained environments typically have lower professional staffing and worse quality. Electronic health records (EHRs) have been utilized as an effective tool to improve the quality of care in nursing homes. This study examines the association between EHR use and the quality of care in high Medicaid nursing homes. Methods: The study used primary and secondary data from Brown University’s Long-Term Care Focus, Nursing Home Compare, Area Health Resource File, and Medicare Cost Reports for the years 2017–2018. The primary survey data was collected through a national mailer to Directors of Nursing (DONs) in high-Medicaid nursing homes. The dependent variable, nursing home quality, was conceptualized using Nursing Home Compare Five-Star Quality Rating System where the higher score represents better quality (1 to 5). The independent variable, EHR score, was a composite measure developed from 23 items. Ordered logistic regression was used to model the relationship between the average EHR score and the quality star rating in high-Medicaid nursing homes. Results: There was a significant positive relationship between the average EHR score and the five-star quality rating. For a one unit increase in the average EHR score, the odds of being in a higher star rating category increases by 50%. Additional factors, such as, being a not-for-profit, having higher occupancy rate, and being located in a higher per capita income county were significantly associated with higher quality. Conclusions: We found that EHR use in high-Medicaid nursing homes was positively associated with improvements in quality. This finding provides additional support to the promising role of EHR in improving quality of care among resource-constrained nursing homes. These under-resourced nursing homes face challenges as it relates to quality, the adoption and use of EHRs may facilitate improvements in quality of care.
{"title":"Association between electronic health record use and quality of care in high Medicaid nursing homes","authors":"Ganisher K. Davlyatov, J. Lord, A. Ghiasi, R. Weech-Maldonado","doi":"10.21037/JHMHP-20-64","DOIUrl":"https://doi.org/10.21037/JHMHP-20-64","url":null,"abstract":"Weech-Maldonado; Background: Nursing homes operating in resource-constrained environments typically have lower professional staffing and worse quality. Electronic health records (EHRs) have been utilized as an effective tool to improve the quality of care in nursing homes. This study examines the association between EHR use and the quality of care in high Medicaid nursing homes. Methods: The study used primary and secondary data from Brown University’s Long-Term Care Focus, Nursing Home Compare, Area Health Resource File, and Medicare Cost Reports for the years 2017–2018. The primary survey data was collected through a national mailer to Directors of Nursing (DONs) in high-Medicaid nursing homes. The dependent variable, nursing home quality, was conceptualized using Nursing Home Compare Five-Star Quality Rating System where the higher score represents better quality (1 to 5). The independent variable, EHR score, was a composite measure developed from 23 items. Ordered logistic regression was used to model the relationship between the average EHR score and the quality star rating in high-Medicaid nursing homes. Results: There was a significant positive relationship between the average EHR score and the five-star quality rating. For a one unit increase in the average EHR score, the odds of being in a higher star rating category increases by 50%. Additional factors, such as, being a not-for-profit, having higher occupancy rate, and being located in a higher per capita income county were significantly associated with higher quality. Conclusions: We found that EHR use in high-Medicaid nursing homes was positively associated with improvements in quality. This finding provides additional support to the promising role of EHR in improving quality of care among resource-constrained nursing homes. These under-resourced nursing homes face challenges as it relates to quality, the adoption and use of EHRs may facilitate improvements in quality of care.","PeriodicalId":92075,"journal":{"name":"Journal of hospital management and health policy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48006276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Precision medicine aims to integrate an individual’s unique features from clinical phenotypes and biological information obtained from imaging to laboratory tests and health records, to arrive at a tailored diagnostic or therapeutic solution. The premise that precision medicine will reduce disease-related health and financial burden is theoretically sound, but its realisation in clinical practice is still nascent. In contrast to conventional medicine, developing precision medicine solutions is highly data-intensive and to accelerate this effort there are initiatives to collect vast amounts of clinical and biomedical data. Over the last decade, artificial intelligence (AI), which includes machine learning (ML), has demonstrated unparalleled success in pattern recognition from big data in a range of domains from shopping recommendation to image classification. It is not surprising that ML is being considered as the critical technology that can transform big data from biobanks and electronic health records (EHRs) into clinically applicable precision medicine tools at the bedside. Distillation of high-dimensional data across clinical, biological, patient-generated and environmental domains using ML and translating garnered insights into clinical practice requires not only extant algorithms but also additional development of newer methods and tools. In this review, we provide a broad overview of the prospects and potential for AI in precision medicine and discuss some of the challenges and evolving solutions that are revolutionising healthcare.
{"title":"Artificial intelligence in healthcare—the road to precision medicine","authors":"Tran Quoc Bao Tran, Clea du Toit, S. Padmanabhan","doi":"10.21037/JHMHP-20-132","DOIUrl":"https://doi.org/10.21037/JHMHP-20-132","url":null,"abstract":"Precision medicine aims to integrate an individual’s unique features from clinical phenotypes and biological information obtained from imaging to laboratory tests and health records, to arrive at a tailored diagnostic or therapeutic solution. The premise that precision medicine will reduce disease-related health and financial burden is theoretically sound, but its realisation in clinical practice is still nascent. In contrast to conventional medicine, developing precision medicine solutions is highly data-intensive and to accelerate this effort there are initiatives to collect vast amounts of clinical and biomedical data. Over the last decade, artificial intelligence (AI), which includes machine learning (ML), has demonstrated unparalleled success in pattern recognition from big data in a range of domains from shopping recommendation to image classification. It is not surprising that ML is being considered as the critical technology that can transform big data from biobanks and electronic health records (EHRs) into clinically applicable precision medicine tools at the bedside. Distillation of high-dimensional data across clinical, biological, patient-generated and environmental domains using ML and translating garnered insights into clinical practice requires not only extant algorithms but also additional development of newer methods and tools. In this review, we provide a broad overview of the prospects and potential for AI in precision medicine and discuss some of the challenges and evolving solutions that are revolutionising healthcare.","PeriodicalId":92075,"journal":{"name":"Journal of hospital management and health policy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46126376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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