In 2011, Medicare patients represented the largest share of total readmissions and health costs when compared to all other patient categories. Because patient-centered care drives the use of health services, the U.S. Patient Protection and Affordable Care Act outlined improving the patient experience to reduce readmission rates; however, the relationship between patient experience and readmissions is not well understood. Grounded in systems theory, the purpose of this correlational study was to determine if the relationship between patient experience and readmission rates in Medicare Shared Savings Program accountable care organizations. Data from the Consumer Assessment of Healthcare Providers and Systems survey were gathered from the Centers for Medicare and Medicaid datasets to analyze patient experience measurements and readmission rates, while accounting for variation among Medicare service regions, number of assigned beneficiaries, and performance year. Using multiple linear regression to analyze the data, the model was used to predict Medicare's all-condition readmission rate (per 1000), R-²= .242, F (13, 634) 15.59, p < .001. The research question was answered partially; variation in the patient experience domain did not support all hypotheses. Because the Medicare population represents the fastest growing patient population within the U.S. health care system, continuous evaluation of policy and performance provides an evidence-based analysis to health administrators and providers who have pivotal roles in the creation of positive social change. Findings may be used to improve quality and service while reducing costs, which contributes to the sustainability of the U.S. Medicare program and its beneficiary population.

Workplace violence (WPV) is ranked as one of the leading causes of occupational injury in the United States and is common in health settings. Nurses have the highest rate of violent victimization reported in the U.S., thus presenting a significant issue for healthcare leaders. Various researchers focus on prevalence rates of WPV among nurses discussing types of violence, location, and the setting where the WPV occurred. Less information exists regarding time taken off work and factors associated with WPV among nurses versus nursing assistants (NAs). This information is important due to the impact on safe work environments for nursing employees. The research questions for the study examined the prevalence of WPV and time taken off work among nurses compared to NAs. The study employed a retrospective secondary analysis of data collected by the Bureau of Labor Statistics, from 2011 to 2014, of nurses and NAs in the State of Texas. Multivariate analysis, partial correlation statistical test, and partition of the sum of squares (ANOVA) determined that NAs experienced more incidents of WPV and spent more time away from work due to injuries than nurses. The study was limited because the data did not provide clear indications of environmental factors that led to the injuries, nor did data related to the culture of the working environments and injuries exist. A recommendation for future research is evaluation of the impact of WPV on productivity, patient safety, and quality of care when nurses continue to work or return to work after experiencing WPV. Results of the study reveal the differences in injuries between the two groups and factors impacting the injuries. This information is important for social change as healthcare leaders evaluate opportunities to create a safe working environment for their staff and provide additional resources for nurses to prevent WPV incidents.

The use of computed tomography (CT) in the care of patients has grown dramatically since its introduction over 30 years ago. The vast majority of the utilization research has focused on factors associated with the variable use in the outpatient and emergency department settings. This has left much of the inpatient use and variation understudied. This study has multiple aims. The first is to characterize the inpatient variation across multiple states and markets. The second is to evaluate the relationship between inpatient CT use and commercial payers across these areas. The third is to develop a model to evaluate the relationship between inpatient CT use and the characteristics of markets, hospitals, and patients. The study uses a four-state convenience sample of cross-sectional data for hospitals. It included non-Federal, acute care hospitals that reported the performance of inpatient CT exams during 2015 (N=181). The literature review was used to justify the inclusion of variables in the study. The descriptive analyses were used to justify the appropriateness of the variables and methodology for testing. A comparison of means demonstrated the significant differences for inpatient utilization between states. A univariate general linear model demonstrated a negative relationship with a hospital’s proportion of commercially insured patients and the inpatient utilization rate. An ordinary least squares multivariate linear regression was used to test for variable significance within each of three constructs: markets, hospitals, and patients. The results indicated that inpatient CT rates were positively associated with higher level of insurer concentration (market), positively associated with system centralization (hospitals), and negatively associated with a hospital’s increasing proportion of minority patient discharges (patients). The study serves an important function in identifying varying patterns of CT utilization across the full spectrum of inpatients across multiple states, regardless of payer. It also creates new knowledge about how the characteristics of these markets, hospitals, and patients are related to inpatient use. It also provides implications for administrators, researchers, and policy makers. The additional knowledge and understanding provided by this research have the potential to lead to improvements in the appropriate and equitable use of inpatient CT exams.

Hospital readmissions within 30 days of discharge result in significant multimillion-€dollar penalties to thousands of Medicare-€eligible hospitals throughout the United States and are indicators of suboptimal patient healthcare leading to less than ideal health outcomes for previously hospitalized patients. The purpose of this correlation study was to examine the relationship between medication reconciliation, nursing workforce competency, timely and effective care, and Medicare-€eligible hospital 30-€day readmission rates. The sample of 269 hospitals came from the population of Medicare-€eligible hospitals throughout the United States. Complexity theory and the general model of readmission were theoretical frameworks grounding this study. Secondary data were from publicly available governmental databases. The reporting of the F statistic resulted in rejection of the null hypothesis in this study, based on evidence of the existence of a significant correlation between the variables. Findings shows a statistically significant relationship between nursing workforce competency, timely and effective care, and Medicare-€eligible hospital 30-€day readmission rates. Medication reconciliation, as measured in this study, was not a significant predictor of 30-€day readmission rates. Implications of this study for positive social change include an understanding of factors related to hospital 30-€day readmission rates to help leaders take action to enhance patient care, reduce inpatient care expenses, and decrease Medicare-€imposed hospital penalties.

Some owners of small to medium-sized managed care businesses lack strategies to address the effects of healthcare regulations on their businesses. The purpose of this multiple case study was to identify strategies that owners of small to medium-sized managed care businesses used to address the financial effects of healthcare regulations on their businesses. The conceptual framework for this study was profit maximization and adaptation in changing contexts. Data were gathered from company documents, observations, and semistructured interviews with 5 home healthcare business owners in Los Angeles County, California. Data were coded to identify themes from the narrative segments. Key themes that emerged from the data analysis include home health strategic management, application of business strategies, healthcare reform, and strategic business processes. The implications of this study for social change include the potential to catalyze economic, intellectual, and social developments that improve community health and wellness programs and related activities in home health.

Failure to collect reimbursement because of changing regulations negatively impacts hospital profitability. A multiple case study approach was used to explore the successful strategies billing managers employed to collect reimbursement for all legitimate Medicare claims. The target population for this study included 5 hospital billing managers from 3 organizations in the Northern New Jersey region. The complexity theory was used as a framework for assessing changing Medicare regulations and how the managers adapted to them. The data collection process for this study involved gathering data from participant interviews, documentation from the organizations of the participants, and government documented regulations and manuals. The logical and sequential order of data analysis for this study embraced Yin's 5-steps data analysis that includes compiling data, disassembling data, reassembling data, interpreting the data, and concluding. The successful strategies billing managers used that emerged as themes were remaining up to date with Medicare changing compliance regulations; enhancing communication with staff, multiple departments, and Medicare; and adopting a robust billing system and other systems that compliment billing. The implications of this study for social change include the potential to ensure access to patient care for benefiting families and communities through the sharing of successful strategies for Medicare claims.

By the end of 2015, Medicare-eligible physicians at primary care practices (PCP) who do not use an electronic health record (EHR) system will incur stiff penalties if they fail to meet the deadline for using EHRs. Yet, less than 30% of rural primary clinics have fully functional EHR systems. The purpose of this phenomenology study was to explore rural primary care physicians and physician assistants' experiences regarding overcoming barriers to implementing EHRs. Complex adaptive systems formed the conceptual framework for this study. Data were collected through face-to-face interviews with a purposeful sample of 21 physicians and physician assistants across 2 rural PCPs in the southeastern region of Missouri. Participant perceptions were elicited regarding overcoming barriers to implementing EHRs under the American Recovery and Reinvestment Act, Health Information Technology for Economic and Clinical Health, and the Patient Protection and Affordable Care Act legislation. Interview questions were transcribed and processed through qualitative software to discern themes of how rural PCP physicians and physician assistants might overcome barriers to implementing electronic health records. Through the exploration of the narrative segments, 4 emergent themes were common among the participants: (a) limited finances to support EHRs, (b) health information exchange issues, (c) lack of business education, and (d) lack of transformation at rural medical practices. The implications for positive social change include the potential implementation of EHRs particularly in physician practices in rural communities, which could provide cost-efficient health care services for those communities and a more sustainable future at primary care practices.

Organizational leaders face challenges related to implementing ethical standards, which influence performance, organization sustainability, and culture. The purpose of this single case study was to explore ethics strategies that health care business leaders used to improve employees' ethical conduct. Data were collected through face-to-face, semistructured interviews with a purposive sample of 7 business leaders of a health care organization located in central Georgia and a review of organization documents. The conceptual framework was Brady's Janus-headed model of ethical theory. Using a priori coding during the data analysis process provided 3 thematic categories: policy strategies for the improvement of employee ethical conduct, ethics strategies used to address employee unethical conduct, and strategies to overcome barriers of strategy implementation. Themes that emerged from the data were accountability and responsibility, leadership development, escalating behaviors, and adapting to change. The findings from this study might contribute to social change by providing information about ethical strategies leaders used to improve employee ethical conduct, which can be used to influence individuals' livelihood, stakeholders' comfort level, and the well-being of the community.

The healthcare industry, and more specifically the nursing home sector, is changing operations and services due to a healthcare mandates and enactment of the 2010 Affordable Care Act. Such changes are termed quality assurance performance improvements (QAPI), to receive government subsidies and indemnification compensations. The purpose of this single case study was to explore effective strategies implemented by 4 healthcare leaders to comply with QAPI regulations. Total quality management theory was the conceptual framework used in this study. Data were collected through semistructured, open-ended, face-to-face interviews with 4 participants who serve in a management capacity at an organization located in northwest Missouri. Member checking was used to strengthen the credibility and trustworthiness of the interpretation of the participants' responses. The emergent themes from the study were (a) quality planning using systematic and strategic approaches, (b) quality control using business instruments and tools to measure performance and progress, (c) quality assurance through internal and external systematic analysis, and (d) quality improvements using an integrated systems approach. The implications for positive social change include the potential optimization of care provided to consumers in nursing homes by identifying best practices and strategies healthcare and business professionals have used to modify their business processes and operations.

Hospital-acquired conditions cause harm to patients and increase mortality. In addition to lowering the quality of patient care, hospital-acquired conditions also negatively affect financial performance, which makes them a business problem for hospital administrators. The purpose of this single case study, which was grounded in the theory of high reliability, was to explore strategies used to reduce the number of hospital-acquired conditions. The sample consisted of 13 senior leaders of a large academic medical center in the southeastern United States, who shared successful strategies used to reduce hospital-acquired conditions. Data collection took place through semistructured interviews and a review of plans and reports that showed rates of hospital-acquired conditions from 2014 to 2017. Data analysis involved using Yin's 5-step process as well as coding interview text and data from documents and then grouping related words to develop themes. Themes that emerged from this study included leadership style, communication practices, and trust. A key finding was the importance of positive and trusting leadership behaviors by senior leaders planning to reduce hospital-acquired conditions. Another key finding was the confirmation that hospital administrators can and should prioritize quality and financial improvement simultaneously. The implications of this study for positive social change include the potential to reduce health care costs and save patients' lives by reducing the number of hospital-acquired conditions.