<p> Managed care through a series of comprehensive health care services is a trend in today&rsquo;s healthcare; and it includes specialized services that can provide plenty of opportunities to many healthcare organizations. Private Medical Service of San Diego currently does not have the necessary medical equipment to provide a comprehensive pain management and the ability to retain availability and flexibility to grow at its own pace and convenience. The new business plan is to acquire fluoroscopic equipment that will be staged in-house to equip its interdisciplinary pain management program. This will help increase the efficacy and safety of the pain management procedures as well as a potential for good profit.</p>

This study investigated the phenomenon of hospital leadership in a free-standing psychiatric hospital attached to a private, non-profit medical center. This phenomenon was studied primarily because little is known about leadership in hospitals. Therefore, the question: What is hospital leadership? was addressed. Secondary issues pertaining to external, internal, and personal aspects of hospital leadership were also addressed. They included developing understanding of: (a) How environmental constraints might affect the practice of hospital leadership; (b) how the practice of hospital leadership might vary internally; and (c) how the values and beliefs of hospital leaders might affect the practice of hospital leadership. / Hospital leadership was considered to be a form of cultural expression; therefore, ethnography was chosen as the method of research. Moreover, ethnography was chosen because it encourages development of grounded concepts and theory; outcomes expected to inform the practice of hospital leadership. / Research proceeded in three stages--entry and orientation, data gathering, and ethnography preparation--and used observation, interviewing, and secondary sources of information to generate data. Data were recorded as fieldnotes, and were analyzed continuously according to Spradley's (1980) Developmental Research Sequence Method. Data were presented as follows: Narrative descriptions of key domains, critical events, and emergent themes; ranked frequency tables for guided interview responses; taxonomies for other domains; and topological and schematic diagrams to summarize the cultural scene and concluding thesis. / This thesis suggests leadership is essentially a process of implementing a mission through the attainment of goals. It involves two major components: Values and power. Values are necessary to establish the mission; power is necessary to overcome goal constraints. Outcomes provide measures of goal attainment and quality of leadership. Feedback provides information on constraints, clarifying where power should be directed. Goals may be modified in the process. / Implications include: Successful leadership requires (a) there be a clear mission, implicitly shared by members of an organization; (b) that a leader have sufficient power to overcome constraints; and (c) that a leader be able to benefit from feedback. Future research possibilities suggested by these implications were discussed. / Source: Dissertation Abstracts International, Volume: 48-12, Section: B, page: 3526. / Thesis (Ph.D.)--The Florida State University, 1987.

<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> 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>

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>

<p> The purpose of the study was to determine whether there were associations between hospital costs and hospital size, hospital location, hospital ownership type, and Group Purchasing Organization (GPO) participation. The 2008 American Hospital Association annual survey responses were used as the instrument for a retrospective secondary study. Analyzing results from the various tests employed in this study showed there was a statistically significant association between hospital costs and hospital size. There were statistically significant differences between the means when comparing cost with hospital location and ownership type. There was not an association between hospital costs and GPO participation, likely as a result of the unadjusted cost metric used. Further research using a time series approach would help determine the true association of GPO participation. Expanding the criteria to identify whether the hospitals participate in a regional alliance may also return different results relative to cost and GPO participation.</p>

<p> The purpose of this study is to investigate the relationship and pattern of Computerized Physician Order Entry (CPOE) implementation among various ambulatory care settings. With the increasing focus on cost reduction and improved efficiency of the healthcare industry, successful CPOE implementation would benefit many providers. The research entails an analysis of practice setting characteristics that may provide insight to the future of CPOE full adoption. Through secondary data analysis on the responses collected from the Electronic Medical Records Supplemental Survey (within the 2009 National Ambulatory Medical Care Survey), four hypotheses are tested in this study: (a) use of CPOE will be greater in primary practices as opposed to specialists, (b) use of CPOE will be greater amongst group practices and less in solo practices, (c) private practice setting types will have greater implementation patterns of CPOE compared to other setting types, and (d) practices with greater private insurance reimbursements will have greater CPOE utilization. All four hypotheses were tested using a chi-square analysis in order to better examine the relationship between utilization patterns of CPOE and medical care practice characteristics. Although results showed that there are significant associations between CPOE use and practice specialty, type, setting, and type of major payer, there is still a strong lack of adoption in the ambulatory care setting as a whole. The study provides some insight into what types of practices may have lucrative qualities in the future, however the data is reflective of a time when many changes are expected to effect the industry. Not every medical practice has adopted or successfully implemented the first stages of CPOE, however the benefits and the future of healthcare show that many practices will soon be on their way in order to stay profitable.</p>

<p> The abstract is not available for copy and paster.</p>