<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.

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<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>

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