<p> The Patient Protection and Affordable Care Act, commonly known as the Affordable Care Act or the ACA, introduced legislation that mandated all large employers to offer health insurance to their employees or a monetary penalty will be assessed. The mandate inherently impacted employers with older workers. This paper analyzed how California employers viewed their older workers specific to the ACA through qualitative interviews. Sample size of ten (<i>N </i>=10) participants in the study: eight employers and two professionals managing health insurance plans. Themes emerged from participant employers who viewed their older workers as valuable and like family, while the age of the older workers did not influence the participant employers during the decision making process to offer a health plan in light of the ACA's mandate. </p>

Length of hospital stay was analyzed in Ile-de-France, for 1147 patients with drug poisoning, diabetes mellitus, head trauma, varicoses veins, urinary calculus, gall-stone disease, or myocardial infarction. The explanatory variables (socio-demographic, hospital, and clinical characteristics) were different from one diagnosis to another; the percentage of variance explained laid between 13% and 26%, depending on the specific diagnosis. Results confirm that length of stay is more than a managerial indicator; it also contains clinical-epidemiological information. Results from multiple linear regression, logistic regression, and Cox model were compared for diabetes mellitus and myocardial infarction. From a managerial point of view, logistic regression provided operational information, whereas results from multiple linear regression, as an explanatory method, were disappointing. Cox model was less interesting since there is not censoring data in this study population. The use of administrative data for research is discussed.

Thesis (Ph.D.)--Indiana University, Dept. of Economics, 2006. / "Title from dissertation home page (viewed July 16, 2007)." Source: Dissertation Abstracts International, Volume: 67-10, Section: A, page: 3907. Adviser: Pravin Trivedi.

<p> The purpose of this case study was to explore the perceptions and experiences of hospital emergency preparedness coordinators of preparing for and responding to incidents. Stakeholder and protection motivation theories provided the theoretical framework for the study. The nonprobability sampling technique of purposive sample was used to identify 10 hospital preparedness coordinators employed at acute care hospitals with emergency departments located in Connecticut and Massachusetts. A field-tested researcher developed 20-question interview questionnaire guided data collection. This qualitative case study answers the questions: What are hospital emergency preparedness coordinators perspectives of hospital preparedness? How do hospital emergency preparedness coordinators prepare for a hospital incident? How do hospital emergency preparedness coordinators respond to a hospital incident? What factors do hospital emergency preparedness coordinators believe best prepares a hospital for incidents? Ranked in order of replication, the researcher identified three themes using first and second cycle coding techniques with pattern coding: (a) planning, (b) training, and (c) communication. Control and motivation emerged as subthemes. Results of the study provide detail rich data for hospital emergency preparedness coordinators, and provide insight and information for stakeholders from all types of private and public organizations to improve hospital emergency preparedness programs. </p>

<p> Designed as a qualitative multiple-case evaluation, this study assessed the nature of policy congruence in health care organizations by evaluating the relationship of policy implementation strategies in these organizations with policy objectives contained in legislative enactments. The Program of All-Inclusive Care for the Elderly (PACE) was the conduit for this study, and research emphasis focused on how PACE programs attempt to implement policy objectives engrossed in the Patient Protection and Affordable Care Act of 2010 (ACA), even when not specifically required to do so. The problem identified has been that questions of policy consistency with the ACA continue to permeate the discussions surrounding PACE, and its utility as an alternative elder care initiative as contrasted against those concepts promoted in the ACA. The purpose of this research project was to advance theory and the application of theory in policy analysis. No review of PACE had been conducted through a theoretical perspective, and the theories of public choice and new institutionalism served as the theoretical framework which guided this study. Phone interviews of twelve PACE managers were conducted to ascertain organizational response to policies promoted in the ACA. Observational research was conducted at three PACE locations where high levels of policy congruence with the ACA were detected. This was complemented with public record document review which served to triangulate the research project. The study&rsquo;s key finding is that uncertainty in markets where PACE is located has led most PACE programs to reflect characteristics of mimetic isomorphism. Furthermore, the ACA can be seen as subtly coercive in that regard, whereby PACE managers migrate PACE towards policies promoted in the ACA, and attempt to attain institutional legitimacy through mimetic behavior, which leads to more homogenous health care organizations. This study confirms the utility of public choice theory and new institutional theory in the investigation of public policy, and organizational strategies associated with public policy implementation. Evaluating PACE through public choice and new institutional theory expands the understanding of these theories, and their applicability and utility in evaluating the linkage between the policy theory, promulgation, and implementation processes, and thus, consequent effective governance strategies.</p>

<p> It has been estimated that by 2020 nearly one-third of all Americans (almost 160 million people) will have at least one chronic disease to manage and the cost of health care will consume over 20 percent of the GDP. The Obama Administration responded to this pending crisis by passing the Patient Protection and Affordable Care Act (PPACA) in 2010. This major legislation aims to instill patient-centered, accountable care into the health care delivery system. Specifically, the United States government is on a mission to reduce the utilization of expensive inpatient care, while increasing access to primary care for all Americans, thereby lowering the total cost of health care.</p><p> Primary care practices organized around the principles of the patient-centered medical home (PCMH) can better manage their patients, especially their patients with chronic conditions; and become accountable for their care. In 2008, the National Committee for Quality Assurance (NCQA) released practice-level recognition standards based on the seven Joint Principles of the PCMH, to aid doctors seeking to transform their practices into effective patient-centered delivery systems.</p><p> The results of several published studies have touted the successes (e.g., reduced emergency department visits, reduced hospitalizations) of the PCMH model at individual practice sites. These localized successes demonstrated that the principle tenets of the PCMH model&mdash;care coordination, team-based care, population management&mdash;helped lower utilization of more expensive health care services within the specific practice settings evaluated. However, there has been no study to determine if these core tenets are having a broader impact on the health care delivery system within a community.</p><p> One hypothesized outcome of a health care system centered on the PCMH care model is better care coordination and more effective, whole-person care management across the continuum of health care; resulting in a more efficient system that can prevent avoidable hospitalizations.</p><p> This dissertation proposal seeks to understand if the increasing numbers (density) of recognized PCMH practices in communities affect avoidable hospitalizations related to ambulatory care sensitive conditions (ACSC), as measured by the AHRQ Composite Prevention Quality Indicators (PQI). The research has two purposes: </p><p> 1. Establish constructs and hypotheses to measure the effect of the increasing numbers of NCQA-Recognized PCMH practices in communities (counties).</p><p> 2. Using an outcomes-based measurement approach, investigate the relationship between growing densities of NCQA-Recognized PCMH practice doctors among all primary care doctors (PCD) in a community and the associated impact on the utilization of inpatient care, specifically related to ACSCs, as measured by the AHRQ Composite PQIs.</p><p> The research is quasi-experimental in design and is based on a retrospective (2008&ndash;2011) analysis of existing data from the NCQA PCMH program, the AHRQ Composite PQI and the Centers for Medicare &amp; Medicaid Services (CMS) National Provider Identification (NPI) databases. Analysis will link NCQA-Recognized PCMH practices (independent variable), AHRQ Risk Adjusted Composite PQIs (dependent variable), and the CMS NPI (total PCDs) on Federal Information Processing Standard (FIPS) identifiers across 114 state and county-level geographical areas in Vermont and North Carolina. The research will inform the following hypotheses:</p><p> 1. Does the research literature support the measurement construct proposed in this study?</p><p> 2. Communities with concentrations of recognized PCMH practices among primary care practices will have lower risk-adjusted avoidable hospital admission rates.</p><p> 3. The use of technology and care coordination will have a greater predictive correlation on risk-adjusted avoidable hospital admission rates than other PCMH capabilities.</p>

<p> The healthcare environment, specifically hospitals, face a turbulent environment and external forces that present difficult challenges to leaders. Hospital leaders are required to do more with less and navigate to ensure a profitable bottom line and high ratings of patient satisfaction. However, viewing solutions, such as developing a new force of leaders, to navigate through such a hostile environment may not be the only answer. This study seeks not to understand the leader solely, but is focused on the leadership process and the effect followers create due to their behaviors and attributes that influence leaders. </p><p> The study draws from the scholarship of positive organizational behavior particularly that of its positive construct of Psychological Capital and followership theories. In order to understand the follower&rsquo;s influence on the leader, the study uses quantitative methods to analyze the Psychological Capital Questionnaire and the Multifactor Leadership Questionnaire instruments to identify a relationship between followers Psychological Capital and the followers&rsquo; rating of leadership behavior inclusive of transformational and transactional leadership and laissez-faire. </p><p> The results of the study concluded that there is a positive relationship between Psychological Capital and the leadership dimensions scales from the Multifactor Leadership Questionnaire as both rated by the follower, but no statistical correlation significance. There was a significant correlation in regards to follower demographics and leaders behavior as rated by the follower. </p>

<p>Objectives: First, to identify the core Electronic Health Records (EHR) functionalities available to physicians who work in private and public health care facilities in Trinidad and Tobago and the extent to which physicians are using each function. Second, to understand the rate of adoption of Electronic Health Records in private and public hospitals/clinics, and finally, to identify the barriers to adoption of Electronic Health Records in private and public hospitals/clinics in Trinidad and Tobago. Background: The two largest public hospitals in Trinidad and Tobago, Port of Spain General Hospital and San Fernando General Hospital, utilized paper medical records. In Trinidad and Tobago, there is little known about the EHR functions available and being used, adoption rates, and barriers to adoption of EHR in the private and public sectors. Method: Electronic Health Records (n = 130) questionnaires were sent to number of health care practices in the private and public facilities in the five regions of Trinidad and Tobago, in order to understand availability and use of EHR, adoption rates, and barriers to the use of EHR. Results: The most commonly available function for the private and public physicians was Health Information and Data with respective scores of 58% and 29%. Sixty-three percent of the private physicians who adopted EHR reported using the Result Management and Order Management functions. The public physicians who had adopted EHR reported they were not utilizing the Decision Support, Result Management, and Order Management functions. There was no statistical difference between private and public physicians for the available and used functions. A total of 53 private and 19 public physicians responded to the survey (55% response rate). Thirteen (25%) private physicians reported adopting EHR and 2(11%) public physician reported adoption of EHR. Private and public physicians cited start-up cost and technical limitations of systems as the barriers to their practices' adoption of EHR. Conclusion: Findings showed the same availability and use of core functionalities, as well as adoption rate among the private and public facilities, and slightly fewer barriers in the private practices. A larger sample is merited to understand if there is any statistically significant difference between the two groups.

<p> Continuing population growth and increased urbanization within disaster-prone areas have led to greater numbers of mass casualties and economic losses caused by natural or human-made disasters. Efficient decision-making processes are crucial in all phases of a disaster life cycle, from mitigation and preparedness to response and recovery. The overarching goal of this dissertation is to contribute to region-wide disaster operation management capabilities by creating a set of tools to facilitate fast, life-saving decision-making. The dissertation begins with initial first responders&rsquo; assignments to affected structures and spans health care and infrastructure preparation and response. In mass casualty incident (MCI) circumstances in particular, situations are complicated, networks are often large, and conditions are transient and time-dependent. Thus, models developed in this thesis evaluate and update decisions based on available information at each point in time to the system. </p><p> The functioning of various response networks, whether in the disaster scene or at the health care facilities, is conceptualized mathematically. Each model can be viewed as a type of queueing network in which MCI victims are customers and responders or health care facilities are servers. Each queueing network is employed to: (1) test developed protocols, acting as queueing system operational policies to support disaster response, (2) assess tactics developed otherwise, or (3) optimize regional resiliency of the health care system given its dependence on set of interdependent supporting lifelines in disasters through preparedness and response actions. Resource-constrained patient flow models of hospitals are presented for routine and emergency operations for the purpose of the study. Using queueing network conceptualizations, discrete event simulation and simulation-based optimization techniques are developed to propose and evaluate protocols that guide responses and for assessing performance and resilience of these systems.</p><p>

<p> The purpose of this study was to examine the utilization of emergency department services by homeless adults in Pomona, California achieved through quantitative cross-sectional research. The results revealed that many homeless adults frequent the emergency department for mental health reasons and those homeless adults with physical ailments required longer lengths of stay and extensive discharge planning. Most participants had insurance coverage, but many appeared to lack social or primary care resources in the community, leading to frequent emergency department usage. This study may be beneficial to individuals, communities, and professionals to better understand the healthcare experiences of homeless individuals. The tangible and nontangible barriers to healthcare, as well as outside social resources affect the general public health through risks of contagious diseases and the rise in emergency department overcrowding. </p><p>