Cost containment measures instituted in the early 1980s are responsible for moving the health care industry to a more competitive composition. As a result of placing hospitals in a more cost conscious environment, they will no longer be able to finance uncompensated care through cross-subsidization. In three separate empirical studies, this dissertation investigates issues concerning the consequences procompetitive actions may have on the provision of hospital care to the poor. / In the first study, Certificate of Need (CON) regulation is likened to regulation allocated on a public interest standard. To test this analogy, probit analysis is used to isolate the objectives of CON regulators as reflected in their decisions regarding hospital investment applications. The results reveal some tendency for regulators to favor hospitals providing relatively large amounts of uncompensated care. This suggests that the benefits of CON protection are used to reward hospitals for providing uncompensated care. / The second study examines efficiency among hospitals providing different levels of uncompensated care. If the few hospitals providing the majority of uncompensated care are relatively inefficient, a more competitive market may force them to change their mode of operation, be bought out, or even close down. Estimates of a multiproduct cost function indicate that hospitals providing relatively large amounts of uncompensated care are less efficient on average. Thus, competition in the health care industry will not only affect the financing of indigent care, but also the providers. / The third study offers a more accurate depiction of those who generate uncompensated care and the hospitals that provide it. Previous studies have relied on characteristics of the uninsured population to make inferences about those who generate uncompensated care. A unique survey from Florida includes patient characteristics along with the amount of uncompensated care generated. Estimates from a type-two tobit model indicate that many of the conclusions derived from studies of the uninsured also hold true for the indigent. Of particular interest is the result that many of the indigent are employed but uninsured. Thus, policies aimed at the employed uninsured are likely to be effective at alleviating the problem of uncompensated care. / Source: Dissertation Abstracts International, Volume: 50-03, Section: A, page: 0742. / Major Professor: Gary Michael Fournier. / Thesis (Ph.D.)--The Florida State University, 1989.

This dissertation investigates the effects of market forces and government regulation on the innovation decision of firms. Using Florida data on the adoption of high technology equipment in hospitals I analyzed the effects of market share, concentration, ownership including teaching status, cost and revenue, background demand such as population and income of the relevant market. / In addition, the effects of regulatory changes such as Prospective Payment System (PPS) and Certificate of Need (CON) deregulation were investigated using dynamic Weibull regression model. The Model shows the impact of explanatory variables on the likelihood of innovation and changes in the marginal probability of adoption flowing through time. / The result of estimation shows that leading firms in more competitive markets adopt earlier than others. Teaching status of a hospital, which offers technological advantage, encourages it to innovate earlier than others. The behavioral change of regulating agency rather than official deregulation appeared to affect innovation decision of firms. It is hoped that this study will better clarify the relative importance of the key variables as well as the usefulness of dynamic econometric modelling approaches so that policy makers may obtain clearer intuition about how hospitals approach major adoptions, and what factors to consider in shaping innovation policies. / Source: Dissertation Abstracts International, Volume: 52-03, Section: A, page: 1013. / Major Professor: Gary M. Fournier. / Thesis (Ph.D.)--The Florida State University, 1991.

<p> <b>Purpose:</b> The purpose of this DNP quality improvement project was to increase primary care provider knowledge about indications for adolescent depression screening. </p><p> <b>Background:</b> Approximately 13.3% of adolescents experienced depression in the past year. In Oklahoma alone, rates are increasing, with depression totaling 60% of all mental health illness among adolescents. Primary care providers see approximately 75% of adolescents; however, mental health conditions are missed 84% of the time. Current clinical guidelines recommend screening for adolescent depression during wellness visits or when risk factors are present. </p><p> <b>Methods:</b> The providers of interest were nurse practitioners, physicians, and physician assistants providing primary care to children between the ages of 12 and 17 in a private pediatric practice group consisting of three clinics. The Model for Improvement guided the process of developing, implementing, and evaluating an educational intervention through use of a pre-test/post-test quantitative design. An email invited participants to complete an anonymous pre-test survey to evaluate knowledge and beliefs surrounding adolescent depression, then view an educational presentation on adolescent depression and screening guidelines, then complete a post-survey to evaluate any changes in knowledge and intention to screen. Results were shared with clinic representatives to help refine the education for future testing cycles and other clinic sites. </p><p> <b>Results:</b> Data collection took place over one week. Five providers completed both the pre-test and post-test surveys. Provider knowledge scores significantly increased 29% after participating in the education and self-reported knowledge on screening increased. </p><p> <b>Conclusions:</b> DNP quality improvement projects like this help develop strategies to increase best practices, leading to improved patient outcomes. Nurse-led improvement programs like this contribute to healthcare literature and the advancement of the nursing profession by developing patient-centered interventions applicable to a wide variety of providers. Results may be used to develop strategies to increase and align provider practices with best standards to help promote early identification and treatment of adolescents with depression. </p><p>

No description available.

<p> Continuous changes within the health care industry and continuing medical education regulations within the United States (US) provide opportunities for Accreditation Council for Continuing Medical Education (ACCME) accredited providers to enhance the continuing medical education provided to the physicians. Blended CME, Inc.&rsquo;s sole purpose is to allow accredited providers an opportunity to enhance physician knowledge, competence, and performance in order to narrow professional practice gaps and to produce measurable improvement in patient outcomes. This business plan shows how Blended CME intends to provide quality consulting services to accredited providers, while at the same time being a profitable organization. Blended CME utilizes a rigorous educational planning process that draws on the experience of multi-disciplinary experts in physician education, practice-based learning, and system-based practice.</p>

<p> Aging Well Day Care Center is a start-up company designed to offer an affordable alternative care for seniors living alone. The services offered will be equally beneficial for families caring for their aging parents. Recent legislation has emphasized the importance of developing daycare centers to handle the rapidly growing population of elder Americans that relies upon the federal insurance programs to help manage their long-lasting medical conditions which can be treated but not cured. The objective of this business plan is to illustrate the need for adult day care services within this region and that adequate resource are available to build and maintain a financially solvent organization.</p>

In this thesis we discuss three models that are used to estimate vehicle busy probabilities when call service time depends on call location and the serving vehicle. The first model requires an assumption that each vehicle operates independently of the other vehicles. The second model approximately corrects for the independence assumption. The third model also approximately corrects for the independence assumption, however it assumes that all vehicles have an equal busy probability. We evaluate model bias by comparing the estimates from each model with estimates from a simulation model. We use extremely long runs to ensure that the simulation is both accurate and precise. Our results suggest that the model using the independence assumption performs poorly as the system utilization increases. The correction models, however, perform well over a wide range of system sizes and utilizations. (Abstract shortened with permission of author.)

<p>An important factor in the rise of health care costs is the structure and performance of health care markets. This is an area in which policy can be particularly effective. Health care markets are characterized by complex interactions between consumers, physicians, insurers, facilities, and government agencies. Physicians, insurers, and facilities operate under a mix of objectives and governance structures. The many varieties of objectives, and governance structures can be broadly categorized as for-profit, not-for-profit, and governmental. </p><p> In the three chapters that follow I construct a theoretical framework to analyze hospital behavior and use a 30 year panel of data on Californian hospitals to assess the validity of the models and to identify the impact of governance structure on behavior. Chapter II addresses firm objectives. I find that firms have a continuum of weighting allocations, with for-profit firms placing greater weight on profit, government firms placing greater weight on social objectives, and not-for-profit firms locating in a middle ground. All three types of governance structures display overlap in their objectives. </p><p> In Chapter III, I identify patterns in hospital entry and exit. Like most manufacturing industries, entering hospitals are significantly smaller than incumbent hospitals and exiting hospitals are significantly smaller than surviving hospitals. The patterns of entry and exit for hospitals vary systematically with both governance structure and geographic diversification. </p><p> In Chapter IV, I develop a model of hospital entry that explains heterogeneous entry size and firm survival. I find entry size to be a relatively important factor in firm survival. In general entering on a larger scale increases the probability of survival. Despite this fact many firms enter relatively small. The model that I develop resolves small entry as a rational choice for uncertain firms. </p>

<p> <b>Introduction:</b> Human biospecimens such as surgical tissue and blood are essential for some types of biomedical research because they contain genetic material (genes contained in living organisms). Because of their genetic content, biospecimens are able to add great value to fields of study such as genomics, molecular biology and biological chemistry. Increasing knowledge in these fields holds promise for improving healthcare for individual patients (precision medicine), as well as the broader healthcare community. These genetic materials obtained from patient donors are procured, stored and dispersed through a complex operation called biobanking. Biobanking systems are involved with two primary functions, 1) procure sufficient quantities of human biospecimens allowing researchers the materials required to answer scientific questions, and 2) capture relevant corresponding clinical and phenotypic information for eventual correlation with scientific results. This capture and manipulation of corresponding information (e.g. clinical, pathological, and environmental) are where the value of the biospecimens are maximized for research purposes. The complexity of biobanking requires informatics to integrate the biospecimen-related information with corresponding clinical and phenotypic data. In designing biobanking systems, informatics must be considered as they play a vital role in managing the samples and data in a timely fashion as well as reducing the costs associated with biobanking. </p><p> <b>Background:</b> Biobanks are resources that play a key role in the procurement, processing, storage and dispersal of human biospecimens. Collections of human tissue have been a common place in hospitals and specialist clinics since the nineteenth century when preservation techniques were introduced. Governance concerning these human biobanks has evolved and is set by institutional, regional, national and international policy. They can be public (e.g. non-profit, academic, governmental), private (e.g. for-profit or pharmaceutical industry) or public-private partnerships. Regardless of the governance level or specific research focus of the biobank, the next generation of biobanking resources will require interdisciplinary collaborations and integrated informatics approaches to accelerate the procurement and use of the research biospecimens. </p><p> <b>Methods:</b> A literature search was conducted to explore biobanking informatics configurations and architecture to determine the context and extent of the software applications utilized in current biobanking systems. There were a substantial number of publications describing informatics architecture and their export of data to a Virtual Data Warehouse or Centralized Research Data Repository. However, there was a lack of published literature specifically describing use of an enterprise-wide electronic health record (EHR) in the initial three upstream workflows (i.e. clinical, pathology and biobank) involved with most institutional biobanking systems. Patient data generated/utilized in these three workflows are manually double-entered into separate information applications as there is no direct data exchange/export between EHR and the Laboratory Information System (LIS) or the Biorepository Information Management System (BIMS) specifically to assist with biobank procurement. Therefore, an EHR integrated-access informatics model was designed that would maximize benefits created by the EHRs capabilities in the upstream workflows of an institutional biobanking system. The approach described in the thesis was designed and documented using a model driven UML tool and incorporates an EHR integrated-access approach along with inter-departmental workflow processes. Interoperability gaps were identified that could take advantage of institutional EHR software existing at most large academic healthcare institutions or teaching hospitals. This model synergistically integrates the EHR, LIS and BIMS to maximize information exchange during the upstream biospecimen procurement workflow. This informatics model for institutional biobanking is based on the premise that commercial software applications are already implemented at most large academic healthcare facilities and they can be utilized within their biobanking systems. </p><p> <b>Conclusion:</b> This EHR integrated-access model would enhance sharing of key research data between three software applications (EHR, LIS, BIMS) that are available at most large academic medical centers that perform research biobanking. The informatics model would promote data exchange between processes of three primary biobanking steps in the clinic, pathology department and biobank improving efficiency and increasing biospecimen procurement. Large healthcare facilities who have EHR, LIS and BIMS applications available could utilize this EHR integrated-access model as a first-step in improving their biobanking informatics workflow to increase high-quality biospecimen collections. New methodologies that improve the success of biobanks can eventually lead to institutional biobanking systems playing a major role in a path to personalized medicine.</p>

<p> Quality citizen participation in processes of policy development is crucial to a democracy interested in equity of voice for all its citizens. Citizens with less political power, however, are often absent from policy development for a variety of reasons, despite legislative and advocacy efforts for inclusion. In policy development processes, community representatives are a mechanism for traditionally marginalized or disadvantaged citizens to have a voice; yet the question remains how to effectively utilize that voice. This question stems from research demonstrating an increase in quantity citizen participation but not in quality citizen participation, which is more interested in the process of policy development as opposed to a final product. To understand quality citizen participation, a critical ethnography guided by a socio-ecological perspective allowing for the investigation of contextual as well as individual factors impacting policy development processes was conducted to assist in advancing knowledge about the best practices necessary to facilitate quality citizen participation in policy development. The policy development process explored in this qualitative study was the context provided by three CHCs in a Midwestern state. Information was gathered about these three CHC boards from multiple sources to best represent the context surrounding participation on the boards and that participation experience from the perspective of board members. The data analyzed included: descriptive statistics of seven counties which comprised the patient community of the three CHCs participating in the study, descriptive statistics of the patient communities of those three CHCs, interviews with national and state policy experts, the clinic directors and board chairs of the three CHCs and interviews with 16 board members of the three CHCs. Analysis of these data identified individual, relational, organizational, community and public policy level factors which impacted the participation of board members of three CHCs. For example, the education and background experiences of board members (individual) as well as relationships between board members and the management teams of the clinics (relational) facilitated the quality of their participation on the boards. Contextual knowledge of economic, political, and cultural factors were discovered for each of the three clinics, and proved important to understanding the quality of participation of board members. </p><p> Social work educators and practitioners will benefit from the advancement of knowledge about what factors facilitate the quality of citizen participation in policy development processes. The results of this study suggest that practitioners interested in empowering consumers to have a role in the provision of services need to understand what facilitates the quality of citizen participation to ensure that consumers have a legitimate voice in policy development and implementation processes. The results of this study also inform our understanding of citizen participation in multiple policy development processes. For example, because legislators will benefit when barriers to the quality of citizen participation are identified, educators teaching social work students about macro practice will have concrete lessons to draw from; practitioners who work with non-elected members of boards will benefit from barrier identification allowing them to assist in the empowerment of future board members engaged in policy development on a wide variety of boards; and finally actual board members, especially those representing traditionally disadvantaged or marginalized communities, will benefit from knowledge gleaned from similar experiences, and educators teaching social work students about the benefits of advocacy and empowerment could assist to make their participation more effective.</p>