<p> The rate of hospitals merging has increased significantly over the last few years. The number of hospital mergers between 2003 and 2009 averaged 55 per year, while mergers for 2010 and 2011 were 72 and 90, respectfully. This research moved beyond anecdotal reports and by using publicly reported data to not only evaluate the financial success of mergers, but also to look at other factors such as size, ownership, geography, environment (urban vs. rural), and market competitiveness to assess impacts on financial outcomes of mergers. This study examined the effect of joining a hospital system based on financial performance. Further, it assessed the relationship of specific organizational and environmental characteristics to determine if these characteristics had any effect on the success of the mergers. </p><p> Resource Dependence Theory (RDT) served as the theoretical framework for this study. Based on RDT precepts, two main hypotheses were studied including (1) Hospitals that join a health system have better financial performance after joining a health system than those that do not join a health system, and (2) For hospitals that have joined a health system, certain organizational and environmental characteristics will have greater influence on financial performance. Data from American Hospital Association, Centers for Medicare and Medicaid, and Area Health Resource File were collected, combined, and analyzed to address the research questions. </p><p> The results demonstrated that hospital operating margins significantly improved after joining a health system. Findings also suggested (at the 90% confidence interval) that hospitals located in rural areas had improved results following the second year of the merger. However, this study found no empirical support for the expectations that operating expenses would improve or that organizational characteristics (i.e., ownership and adjusted patient days), or environmental characteristics (i.e., percentage of people living in poverty, competitiveness) had a statistically significant effect on the success of a merger. </p><p> As hospitals continue to seek ways to remain competitive and to continually serve their mission to care for the members of their communities, this study can serve as a basis for assessing the effect of system membership on financial performance. The results of this study should not be used as the only basis for making merger decisions as the sample size and time period studied were too narrow to reach overarching conclusions. Keywords: mergers, acquisitions, resource dependence theory, affiliations</p>

<p> Racial disparity continues to be a struggle in America. The main purpose of this project was to determine whether there is a relationship between race and the acquisition of health insurance in adult residents of California who are younger than 65 years old. Through secondary data gathering, analysis of an existing racial disparity in health care insurance acquisition was accomplished. The results of the project indicate that a relationship exists between race and health insurance acquisition, thereby promoting an opportunity to determine hindering factors and discuss recommendations that can help to alleviate them. Multiple factors that influence the acquisition of health insurance among residents in California have been cited. Some of these factors such as affordability and immigration status are more relevant in the Latino racial group compared to the others. The awareness of this relationship promotes implications towards a legislative focus on the underserved populations and a development of action plans and public policies that can aid in acquisition of health insurance for all.</p>

<p> Medical errors cost the United States&rsquo; healthcare system approximately $19.1 billion annually. A failure to communicate or speak up is said to be a contributing factor. The purpose of this quantitative correlational study was to examine the relationship between managerial responsiveness, managerial approachability, and prosocial voice among acute-care registered nurses (RNs) from a Greater Northwest facility. The participants were 108 acute-care RNs. Instrumentation included the Supervisor as a Voice Manager developed by Saunders, Sheppard, Knight, and Roth (1992) to measure managerial responsiveness and managerial approachability. Prosocial voice was measured using Van Dyne and LePine&rsquo;s (1998) Prosocial Voice Scale. The relationship between managerial approachability and prosocial voice was positively correlated (<i>p</i> = .001). A positive relationship (<i>p</i> = 0.001) between the linear combination gender, education, years of experience within current acute-care facility, managerial responsiveness and managerial approachability and the RN&rsquo;s use of prosocial voice was found and accounted for 20.0% of the variance in the prosocial voice score. An unexpected serendipitous finding occurred when applying a backward elimination regression to three variables: managerial approachability, managerial responsiveness, and prosocial voice. RNs use of prosocial voice was positively correlated with the RN&rsquo;s level in the organization (<i>p</i> =.01), the RN&rsquo;s perception of managerial approachability (<i>p</i> = .001) while negatively correlated with the RN&rsquo;s perception of managerial responsiveness score ( <i> p</i> = .05). This research adds to current prosocial voice literature and expands the research on managerial approachability and managerial responsiveness. Future research recommendations were identified.</p>

<p> <b>Objective:</b> To describe the characteristics of frequent geriatric users of Mount Sinai&rsquo; Emergency Department (ED). <b>Methods:</b> Patients aged &ge;65 yo with >1 ED visit between February-April 2012 were included. Data was analyzed for demographics, disposition, revisit frequency, primary care provider, and insurance. This study was approved by the Mount Sinai Institutional Review Board. <b>Results:</b> A total of 95 out of 1,077 were frequent geriatric ED users. These patients demonstrated a lower index visit (30%) and 72 hour (15%), a higher 3-7 day (54%), 8-30 day (40%) and >30 day (65%) admission rate, as well as 67% had a primary care provider and 68% had medical insurance. <b>Conclusions:</b> Frequent geriatric ED users are more likely to be discharged upon index and less than 72 hour ED revisit, have higher admission rates on subsequent visits, have primary care providers and are similarly insured when compared to the geriatric ED patient population.</p>

<p> This multiple case study research examines the personal strengths of Chief Executive Officers (CEOs) and how these strengths contribute to their success as they lead their personnel and manage psychiatric hospitals in their charge. The study provides an understanding of the role of personal strengths in the successful CEO and discusses each CEO&rsquo;s utilization and development of those strengths. The Clifton StrengthsFinder 2.0 as found in <i>StrengthsFinder 2.0</i> (Rath, 2007) instrument was employed in the study to provide a common language that facilitated the researcher&rsquo;s conversation with the participants. Used as a heuristic device, the results of the strengths identifier tool were not applied in any comparative analytical format but rather provided a common frame of reference for both the researcher and the participant. The experience of responding to the strengths identifier tool provided a starting point for an interview that allowed the participants to talk about their strengths, their development, and the contribution of their strengths to their success. The theme of self-awareness emerged as an important component of their success, common to all of the participants in the study. Secondary themes of courage and humility, connected to self-awareness, contributed to understanding how the participants utilized their signature strengths to engage in a successful career leading psychiatric hospitals. The participants were able to describe their capacities, strengths, and how they used their abilities in unique ways while leading their hospitals.</p>

<p> Background</p><p> Medicare&rsquo;s Value Based Purchasing program has linked outcomes and patient experience to reimbursement. Most clinicians and administrators have been amenable to linking outcomes with reimbursements; however, linking patient experience with reimbursement has been contentious. There is a concern among some clinicians and administrators that patient experience is not only difficult or impossible to accurately measure but also that it may have little or no relationship with actual quality. The goals of this study are to add to the body of knowledge surrounding the relationship between patient satisfaction and actual hospital quality and to provide useful information to healthcare administrators and policy makers regarding how specific payment, delivery and staffing models may be related to patient satisfaction and actual hospital quality.</p><p> Methods</p><p> A correlation analysis was used to test the relationship between hospital quality as measured by 30-day readmission rates and patient experience as measured by HCAHPS question #22; <i>Would you recommend this hospital to your friends and family?</i> were used as the measure of patient experience. </p><p> Regression analyses were used to measure whether the percent of net revenue from capitation, the percent of net revenue from shared risk, the number of employed physicians per bed, the number of hospitalists per bed or the presence of a medical home were predictors of hospital quality and patient experience. </p><p> Results</p><p> A statistically significant relationship was found between hospital quality and patient experience. Neither the percent of revenue from capitation or shared risk were found to be predictors of patient experience or quality, however the number of hospitalists per bed was found to be a predictor of both. The number of employed physicians per bed and the presence of an established patient centered medical home were found to the statistically significant predictors of patient experience but not quality.</p><p> Discussion</p><p> The findings from this study confirm that hospitals with higher patient experience scores have lower rates of readmission and therefore have higher levels of overall quality and along with other large studies, such as those by Isaac et al. <i>(n = 927)</i> in 2010 and Jha et al. <i> (n = 4032)</i> in 2008, supports the use of patient experience as an element of VBP.</p><p> In healthcare, we often think of clinical quality and patient experience as the results of education, training and even organizational culture. While all of these factors are important, this study reminds us that, how we structure our delivery or how our workforce is staffed may be just as important.</p><p> Conclusion</p><p> Patient experience is correlated with hospital quality and this finding; along with similar findings from other studies shows that it is a reliable and valid factor in value based purchasing. As administrators adapt to a system increasingly focused on value, strategic decision making surrounding delivery and employment models, ought to be influenced, at least in part, by studies like this.</p>

<p> Historically the relationship between Allopathic and Osteopathic physicians with Chiropractors has been strained at best. Since the Patient Protection and Affordable Care Act specifically list&rsquo;s Chiropractors as part of Accountable Care Organizations this strained relationship will not be in the best interests of patient care. Chiropractors are a small part of the health care puzzle so they will need to integrate into the larger health care arena and work alongside their Allopathic and Osteopathic counterparts. To accomplish this, the attitudes and beliefs of these Allopathic and Osteopathic Physicians were ascertained so that Chiropractors can possess the information required to transition into Accountable Care Organizations as seamlessly as possible. This study, with limitations including small sample size, determined the attitudes and beliefs of Allopathic and Osteopathic physicians towards Chiropractors and then determined the steps that they would suggest to help with Allopathic and Osteopathic collaboration with Chiropractors for future patient care. </p><p> The Survey used to ascertain the attitudes and beliefs of Allopathic and Osteopathic physicians was obtained with permission from Busse et.al. (2009). Three different research questions were analyzed using several different items from the Survey. Overall the Allopath&rsquo;s and Osteopath&rsquo;s had a negative view of Chiropractors including the attitude that Chiropractors should not be involved in Medical Homes or Accountable Care Organizations as stated in the Patient Protection and Affordable Care Act. Additionally there was no statistically significant relationship between Allopathic and Osteopathic attitudes or beliefs and their willingness to collaborate clinically with Chiropractors based on age, gender, Allopathic or Osteopathic education, years in practice, and specialty. In the written response aspect of the survey barriers to collaboration included Chiropractors anti-vaccine stance, non-evidence based treatment, and over treatment of patients. Key Words: Chiropractor, Allopath, Osteopath, Collaboration, Patient Care.</p>

Statistical Process Control (SPC) methods, developed in industrial settings, are increasingly being generalized to medical service environments. Of special interest is the control chart, a graphic and statistical procedure used to monitor and control variation. This dissertation evaluates the validity of the control chart model to improve medical quality. The research design combines descriptive and causal comparative (ex-post facto) methods to address the principal research question, How is the control chart model related to medical quality? Hospital data were used for patients diagnosed with Community Acquired Pneumonia (CAP). During the initial research phase, five medical quality "events" assumed to affect CAP medical quality indicators were pre-specified by hospital staff. The impact of each event was then evaluated using control charts constructed for CAP quality indicators. Descriptive analysis was undertaken to determine whether data violated the statistical assumptions underlying the control chart model. Then, variable and attribute control charts were constructed to determine whether special cause signals occurred in association with the pre-specified events. Alternative methods were used to calibrate charts to different conditions. Sensitivity was computed as the proportion of event-sensitive signals. The descriptive analysis of CAP indicators uncovered "messy," and somewhat complex, data structure. The CAP indicators were marginally stable showing trend, seasonal cycles, skew, sampling variation and autocorrelation. Study results need to be interpreted with the knowledge that few events were evaluated, and that the effect sizes associated with events were small. The charts applied to the CAP indicators showed limited sensitivity; for three chart-types (i.e. XmR, Xbar, and P-charts), there were more false alarms than event-associated signals. Conforming to expectation, larger sample size increased chart sensitivity. The application of Jaehn Decision Rules led to increases in both sensitivity and false alarm. Increasing subgroup frequency from month, to week samples, increased chart sensitivity, but also increased data instability and autocorrelation. Contrary to expectation, the application of hybrid charting techniques (EWMA and CUSUM) did not increase chart sensitivity. Study findings support the conclusion that control charts provide valuable insight into medical variation. However, design issues, data character, and causal logic provide conditions to the interpretation of control charts.

<p> The abstract is not available from PDF copy and paste.</p>

<p> Delay of health care negatively impacts patient satisfaction and contributes to an inefficient healthcare system by increasing the use of the emergency room for non-urgent conditions. Policymakers argue that long waits will result in delays in diagnosis and treatment, and these delays negatively affect individual health.</p><p> California is a diverse state and comprises of people from various ethnic backgrounds. Consequently, there are cultural, linguistic and various other underlying reasons which contribute towards the delay in health care.</p><p> Apart from this, California has a wide range of people, which varies in socioeconomic status and there is a large segment which delays health care due to lack of health insurance. This study focuses on analyzing the reasons behind the delay in health care among California residents and proposes remedies which can help mitigate the problem.</p>