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1	The Effect of Pediatric Hospital Specialization on Patient Safety and Effectiveness of Care Harris, James Mitchell, II 01 January 2007 (has links) Provider specialization is an area of interest in health care as patients, payers and policy makers are now demanding better performance and demonstrated proof of the benefits of specialization. While previously ignored in the specialization debate, now even the hospitals focusing on pediatric care (i.e. children's hospitals) are experiencing pressure to demonstrate their value. The current study attempts to answer the questions: do hospitals specializing in pediatric care provide better quality pediatric inpatient care; and do they do so for differing types of patient outcomes and across different levels of care complexity? Contingency Theory is used to develop and assess a theoretical framework to see if pediatric hospital specialization is associated with improved outcomes for pediatric inpatient care. The theory suggests that not all ways of organizing are equally effective, and that organizational performance is maximized when there is alignment between organizational structure (specialization) and external contingencies (care complexity). A sample of 1,317 U.S. hospitals was included in the study. Data from two sources - the 2003 Healthcare Cost and Utilization Project (HCUP) Kids' Inpatient Database (KID) and the American Hospital Association's (AHA) Annual Survey Database for fiscal year 2003 - was used in a factor analysis to generate a measure of hospital pediatric specialization. The results of the factor analysis were then used in regression models to examine the effect hospital pediatric specialization had on patient safety and effectiveness of care at multiple levels of care complexity. Results suggest that there are two dimensions of hospital pediatric specialization - a pediatric focused element and a complex pediatric care element - and that these dimensions appear to have opposing influences on measures of inpatient care quality. Focusing primarily on the treatment of pediatric patients seems to improve the level of care provided, but specializing in the care of complex pediatric conditions has a small but significant association with higher patient safety event rates and longer than expected lengths of stay. childrens hospital organizational performance Contingency Theory patient safety pediatric care medical specialization Health and Medical Administration Medicine and Health Sciences
2	Disease and the city Hartmann, Gunnar 21 October 2015 (has links) Während die Krankheit einen pathologischen Zustand des Körpers beschreibt, ist der Raum der Krankheit ein spatiotemporaler Zustand, welcher Krankheit ermöglicht. Historisch gesehen blühten Krankheiten in urbaner Umgebung auf – in jener städtischen Umgebung, in der große Konzentrationen von Körpern und Mengen von Materialströmen vorkamen. Das heißt, verschiedene urbane Bedingungen können für den Ausbruch von Epidemien verantwortlich gemacht werden. Ganz gleich, auf welchem Maßstab wir diese Räume der Krankheit betreten (auf der Größenordnung eines überkontinentalen Handelsweges, einer Stadt, oder eines Gebäudes), der physische Raum stellt lediglich einen potenziellen Risikofaktor dar. Erst der Fluss von physischen, chemischen und biologischen Bestandteilen konditioniert den Raum für Krankheiten. Folglich ist jede Krankheit als räumlicher Arbeitsablauf zu begreifen und somit architektonisch und operativ beschreibbar. Auf diesem Schauplatz von Krankheit und Stadt wurde der Raum in Form von räumlichen Maßnahmen notwendigerweise bis zum Äußersten ausgereizt. Raum engt ein, behandelt, erschließt und kultiviert Krankheiten – und ist selbst Gegenstand von Medikation. Im Kontext dieser Forschung dient das Krankenhaus als Hauptvertreter der städtischen Architektur. Das Krankenhaus der Charité in Berlin wird hier im Rahmen einer Fallstudie untersucht, ihre 300-jährige Geschichte definiert den Zeitrahmen dieser Forschung. Diese Arbeit ist der Versuch, die Geschichte des Krankenhauses der klinischen Medizin zu erweitern; deshalb werden erstens unterschiedliche Räume von Krankheiten und deren Einfluss auf die Stadt rekonstruiert, zweitens verschiedene räumliche Maßnahmen, welche die Stadt historisch gegen Krankheiten implementierte, im Vergleich zum Krankenhaus kontextualisiert und drittens die einhergehenden Veränderungen des Krankenhauses im Anbetracht zunehmender klinischer Spezialisierung analysiert. / While disease describes a body’s pathological state, space of disease is the spatio-temporal condition that allows disease to come into existence. Conceptually speaking, a space of disease both preconditions a disease and holds it in place for a certain time. Historically, disease has flourished in urban environments that rely on large concentrations of bodies and a vast amount of material flows; that is, various urban conditions can be held responsible for the outbreak of epidemics. No matter on what scale we enter these particular spaces of disease (on the scale of a cross-continental trade route, a city, or a building), physical space represents only a potential risk factor, requiring the flow of physical, chemical, and biological components through it to precondition that space for disease. Hence, each disease should be viewed as a spatial flow, which can be described architecturally and operatively. In this arena of disease and the city, the spatial measures that have evolved in response to disease have by necessity pushed space to its limits—space confines, treats, accesses, and cultivates disease, and is itself subject to medication. In the context of this research, the hospital serves as the primary representative of the architecture of the city. While the hospital of the Charité in Berlin is the subject of this case study (and its three-hundred-year history defines the time frame of this research), the attempt here is to expand upon the history of the hospital of clinical medicine by framing various spaces of disease and their impact upon the city; by positioning the hospital within the context of the diverse spatial measures that the city historically has implemented against disease; and by analyzing the hospital’s move toward greater clinical specialization. Stadt Krankheit Räume der Krankheit Krankenhaus der klinischen Medizin medizinische Spezialisierung City Disease Spaces of Disease Hospital of Clinical Medicine Medical Specialization 700 Künste, Bildende Kunst allgemein 01 Wissenschaft und Kultur allgemein MS 6020 MS 6280 ZH 6350 ddc:700
3	Disruptive Transformations in Health Care: Technological Innovation and the Acute Care General Hospital Lucas, D. Pulane 24 April 2013 (has links) Advances in medical technology have altered the need for certain types of surgery to be performed in traditional inpatient hospital settings. Less invasive surgical procedures allow a growing number of medical treatments to take place on an outpatient basis. Hospitals face growing competition from ambulatory surgery centers (ASCs). The competitive threats posed by ASCs are important, given that inpatient surgery has been the cornerstone of hospital services for over a century. Additional research is needed to understand how surgical volume shifts between and within acute care general hospitals (ACGHs) and ASCs. This study investigates how medical technology within the hospital industry is changing medical services delivery. The main purposes of this study are to (1) test Clayton M. Christensen’s theory of disruptive innovation in health care, and (2) examine the effects of disruptive innovation on appendectomy, cholecystectomy, and bariatric surgery (ACBS) utilization. Disruptive innovation theory contends that advanced technology combined with innovative business models—located outside of traditional product markets or delivery systems—will produce simplified, quality products and services at lower costs with broader accessibility. Consequently, new markets will emerge, and conventional industry leaders will experience a loss of market share to “non-traditional” new entrants into the marketplace. The underlying assumption of this work is that ASCs (innovative business models) have adopted laparoscopy (innovative technology) and their unification has initiated disruptive innovation within the hospital industry. The disruptive effects have spawned shifts in surgical volumes from open to laparoscopic procedures, from inpatient to ambulatory settings, and from hospitals to ASCs. The research hypothesizes that: (1) there will be larger increases in the percentage of laparoscopic ACBS performed than open ACBS procedures; (2) ambulatory ACBS will experience larger percent increases than inpatient ACBS procedures; and (3) ASCs will experience larger percent increases than ACGHs. The study tracks the utilization of open, laparoscopic, inpatient and ambulatory ACBS. The research questions that guide the inquiry are: 1. How has ACBS utilization changed over this time? 2. Do ACGHs and ASCs differ in the utilization of ACBS? 3. How do states differ in the utilization of ACBS? 4. Do study findings support disruptive innovation theory in the hospital industry? The quantitative study employs a panel design using hospital discharge data from 2004 and 2009. The unit of analysis is the facility. The sampling frame is comprised of ACGHs and ASCs in Florida and Wisconsin. The study employs exploratory and confirmatory data analysis. This work finds that disruptive innovation theory is an effective model for assessing the hospital industry. The model provides a useful framework for analyzing the interplay between ACGHs and ASCs. While study findings did not support the stated hypotheses, the impact of government interventions into the competitive marketplace supports the claims of disruptive innovation theory. Regulations that intervened in the hospital industry facilitated interactions between ASCs and ACGHs, reducing the number of ASCs performing ACBS and altering the trajectory of ACBS volume by shifting surgeries from ASCs to ACGHs. Disruptive Disruptive Innovation Theory Disruptive Transformations Disruptive Innovation Innovation Technology Technological Innovation Medical Innovation Medical Technology Medical Advancement Laparoscopy Laparoscopic Surgery open surgery appendectomy cholecystectomy bariatric surgery weight loss surgery appendectomies cholecystectomies inpatient outpatient ambulatory ambulatory surgery ambulatory surgery center acute care general hospital hospital acute care hospital general hospital health care healthcare hospital industry health care industry Clayton Christensen Clayton M Christensen Michael Porter Harvard Business School Virginia Commonwealth University CMS Health policy public policy public administration organizational theory organization theory Population Ecology Theory Competitive Strategy policy analysis John Kimberly Organization Size Structural Inertia liability of smallness health spending health care cost specialty medical facility open system niche width dynamic outpatient department technology shift surgical setting surgical setting shift medical facility shift substitution threat health system system level analysis Ecological Approach hospital trends ambulatory surgery trends reimbursement rate Medicare CMS coverage decision P J DiMaggio DiMaggio and Powell w w Powell Hannan and Freeman M T Hannan Organizational change minimally invasive surgery less invasive surgery Prospective Payment System Outpatient Prospective Payment System entreprenuerial physician health care organization health care management Roice Luke Carl Ameringer new technology surgical utilization elective surgery Medicare Payment Advisory Commission MedPAC coverage decision trends in surgery abdominal surgery surgical variation physician-owned physician ownership physician autonomy outpatient clinic utilization trends unnecessary surgery Pfeffer Salancik technology diffusion redefining health care interdisciplinary research health care delivery panel design diffusion of hospital technology state variation regional variation local health care market government intervention medical facility health care capacity focused factory advances in health care physician organization relationship hospital competition medical specialization hospital expansion medical arms race integrated care integrated health system J E Wennberg health care transformation reimbursement scheme surgical volume Florida Wisconsin policy making health policy analysis competitive dynamics center of excellence intervening factor service line competition service-line competition surgical reimbursement innovative business model innovative technology environmental influence established firm new market entrant patient safety sophisticated technology Harvard Divinity School Social and Behavioral Sciences

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