The purpose of this study is to evaluate financial and clinical data of patients within a selected DRG. The data obtained from such analysis will be used to design a system whereby clinical pharmacists may improve the hospital's reimbursement potential. Based upon Upton's proposed plan, this study is designed to evaluate all DRGs in a community hospital in an attempt to focus on those DRGs which represent the greatest financial pressure to the pharmacy department and, therefore, to the institution. Clinical and financial data of patients within the expensive DRG, will be collected from their medical and financial records for subsequent statistical analysis with special consideration to pharmacy charges. The ultimate objective of this study, though, is to provide a list of measures or parameters that may affect the patient's hospital charges. Using these parameters, the clinical pharmacists will be able to intensify their monitoring of patients with high pharmacy charges in an attempt to reduce their impact on patients' charges. This study was designed to review and analyze DRGs at St. Joseph's Hospital, in Stockton, Californias. The main objective was to determine the relationship between clinical and financial data for patients within a DRG. The second objective was to identify patient-specific information that may reflect high pharmacy charges and the need for clinical pharmacy intervention. The third objective was to propose criteria that may predict which patients need to be monitored in an attempt to control pharmacy charges within a selected DRG category.

This dissertation investigates how healthcare provider networks are formed and their effects on patient health outcomes. The first chapter explores three types of hospital networks that are intended to improve coordination of patient care across different hospitals: integrated delivery systems, accountable care organizations, and electronic health records. Using 2007-2017 Healthcare Information and Management Systems Society IT data and Medicare data on accountable care organizations and hospital quality, I document several interesting patterns regarding the formation and potential effects of these networks in the United States. I find correlations consistent with assortative matching where higher quality hospitals match with higher quality groups, which may be inefficient if there are peer effects that mean higher quality groups could have more substantial influence on lower quality hospitals that have more room to improve. I show that accountable care organizations appear to be strategic about the network formation process, omitting hospitals that are natural members. They may do so for anticompetitive reasons–ordinary least square regressions find that accountable care organization market concentration is negatively correlated with hospital quality. These regressions additionally point to the need for caution in advocating for a unified electronic health record, as hospital quality is positively correlated with regional electronic health record market concentration–which is related to coordination abilities–but negatively correlated with national concentration–which is related to competition. The second chapter takes inspiration from the descriptive results of the first chapter and establishes a causal effect of electronic health record networks at the patient level. I hypothesize that systematic, reliable transfer of patient medical history can improve clinical decisions and thus health outcomes, especially during medical emergencies. Thus, I identify patients who had emergency cardiovascular episodes in 2007-2014 Medicare claims and use a difference-in-differences strategy to estimate the causal effect of their primary care and emergency hospitals being in the same electronic health record network. I find that electronic health record compatibility decreases the mortality rate but increases the rate of other bad health outcomes by approximately the same amount, suggesting that compatibility makes it easier for patients to survive given poor health but does not overall improve health otherwise. This result highlights the importance of analyzing the effects of healthcare treatments on both the rates of mortality and negative outcomes in survivors. Only looking at the rate of negative outcomes in survivors, electronic health record compatibility would have appeared to be a harmful treatment, while it was actually reducing mortality. The third chapter moves from hospital networks, which have only one type of agent, to look at physician-insurer networks, represented by a two-sided many-to-many matching market. I use Healthgrades and National Committee for Quality Assurance consumer ratings data to collect physician and insurance plan characteristics, respectively. Descriptive statistics indicate that higher quality physicians are in more insurance networks, while higher quality plans tend to be more restricted in the numbers of physicians they accept. There is a mild correlation between physician and plan quality, but there are many possible explanations for it. To test if it is due to assortative matching and to better understand how physicians and insurers decide with whom to contract, I estimate a structural many-to-many matching model using the matching maximum score estimator. Data quality and quantity appear to be obstacles in obtaining precise estimates, so I leave further exploration of this topic to future research.

A reading of recent studies in preventative health care behavior recalls the proverb about the blind men and the elephant: each man is able to describe the part of the animal he is closest to, but none can see, and so none can put their diverse and often contradictory opinions together to come up with an accurate description of the whole elephant. Similarly, in preventative health care studies, each researcher or research group is able to observe the preventative health care utilization patterns of specific populations at particular times, but the conclusions reached are often based on less than complete knowledge. This is especially true of the research into what makes low income people use preventative services in certain ways.

The purpose of this study is to investigate in what ways cultural value differences between Alaskan Native clients and non-Native health professionals affect the communicating of "wellness" concepts. Specifically, this study focuses on possible difference in the cultural value orientation of "Man's Relationship to Health."

Urgent Care Centers (UCCs) are a recent innovation in the American system of health care delivery. The number of UCCs has increased significantly in recent years. Many researchers point out that the rapid growth of UCCs is expected to escalate during the next few decades. This growth will create more competition among providers of these facilities in the health care market, and the competition could lead to an uneven distribution of UCCs within cities. While health officials and planners are interested in attracting more patients by expanding UCC services, they are often unfamiliar with the factors that go into site selection decisions. Understanding the factors influencing UCC location is crucial to explaining why UCCs cluster in certain urban areas, while other areas are under-served. It is also important for providers who want to enhance accessibility of special population segments to UCC locations. This study uses the Portland metropolitan area as a case study. Due to the lack of access to providers' propriety data, the specific problem targeted here uses publicly available data as a proxy for providers' data to determine the factors influencing UCC location. The essence of this research is to show how these factors explain and predict existing locations of UCCs and to find out how well this publicly available data explains UCC providers' locational behavior. Most of the data for this study is provided by Metro of Portland. Other data are collected utilizing surveys and data from different public agencies and published reports. Logit analysis is used to find out which factors explain existing UCC location. The empirical findings of this research substantiate the existence of a strong relationship between the location of UCCs and land use factors. This study highlights the complexity and importance of understanding the factors influencing the location of UCCs. It rejects prior arguments that UCC location is influenced by some demographic and socioeconomic factors, while it introduces land use factors as the major determinants of UCC location. However, this study concluded that land use factors influence considered a rare phenomena that should be carried out for future research and that demographic factors may still have an indirect effect on UCC location.

No description available.

The purpose of this study was to explore and describe the perceptions of registered nurses about patient-friendly health services rendered within an ambulatory care setting in the King Abdulaziz Medical City, Riyadh (KAMC-R), Kingdom of Saudi Arabia. A qualitative, explorative, descriptive and contextual design was used. Fifteen registered nurses (one male and 14 female) voluntarily participated in this study. The data collection process comprised of semi-structured individual interviews with the participants to explore what they perceived to be patient-friendly health services. The obtained data were analysed using Van Mannen’s thematic analysis method. The emerging empirical data identified four themes, three categories and nine subcategories; a literature control was incorporated to validate the findings. The study findings revealed that the participants identified cultural differences as a quintessential obstacle in rendering patient-friendly health services in the study context. Professional yet patient-friendly communication proved to be a challenge as did ambulatory care flow. This had the potential to compromise patient-friendly health services. Meeting the patients’ needs was acknowledged. However, the needs, goals and values of patientfriendly healthcare services were perceived differently by the patients on the one hand and the registered nurses on the other and this affected the process of interaction and delivery of patient-friendly care. Despite the fact that the registered nurses daily experienced ongoing challenges which compromised patient-friendly health services, they were aware and committed to deliver patient-friendly health services. The process of scientific inquiry concluded with the limitations of the study and recommendations were made based on the findings. / Health Studies / M.A. (Heath Studies)

The purpose of this study was to explore and describe the perceptions of registered nurses about patient-friendly health services rendered within an ambulatory care setting in the King Abdulaziz Medical City, Riyadh (KAMC-R), Kingdom of Saudi Arabia. A qualitative, explorative, descriptive and contextual design was used. Fifteen registered nurses (one male and 14 female) voluntarily participated in this study. The data collection process comprised of semi-structured individual interviews with the participants to explore what they perceived to be patient-friendly health services. The obtained data were analysed using Van Mannen’s thematic analysis method. The emerging empirical data identified four themes, three categories and nine subcategories; a literature control was incorporated to validate the findings. The study findings revealed that the participants identified cultural differences as a quintessential obstacle in rendering patient-friendly health services in the study context. Professional yet patient-friendly communication proved to be a challenge as did ambulatory care flow. This had the potential to compromise patient-friendly health services. Meeting the patients’ needs was acknowledged. However, the needs, goals and values of patientfriendly healthcare services were perceived differently by the patients on the one hand and the registered nurses on the other and this affected the process of interaction and delivery of patient-friendly care. Despite the fact that the registered nurses daily experienced ongoing challenges which compromised patient-friendly health services, they were aware and committed to deliver patient-friendly health services. The process of scientific inquiry concluded with the limitations of the study and recommendations were made based on the findings. / Health Studies / M. A. (Heath Studies)

Chile has experienced great success in terms of economic growth in the last decades. This growing economy brings changes in the Chilean health care system. Its health care system was primarily funded by state sources until 1981, when a major reform was introduced that established new rules for the health insurance market. Since then, Chile has a public-private mixed health care system, both in financing and delivery of services. Citizens can choose for coverage between the Public National Health Insurance and the Private Health Insurance system. However, these systems have a common funding source coming from the mandatory contribution of employees, equivalent to 7% of their taxable income with an approximate limit of US$2,800 dollars. One of the more important Chilean health reforms towards the establishment of social guarantees was effective on July 2005, when the Regime of Explicit Health Guarantees, also known as Plan AUGE became effective. Plan AUGE is a health program that benefits all Chileans without discrimination of age, gender, economic status, health care, or place of residence. This plan includes the 69 diseases with higher impact on Chilean population in its different stages, but with feasibility of effective treatments. Changes in the health care system and its last reform brought questions about their impact on the distribution of health care services throughout country. Is Chile moving towards a better and more equitable health care system? The main purpose of this thesis is to investigate equity in health system finance and health care utilization as well as to explore alternative measurement of access to health care in Chile. The first two manuscripts examine equity issues in Chile. The purpose of the first one is to assess equity in health system finance in Chile, accounting for all finance sources. While equity in health system finance has been well studied in OECD countries, there are still few published empirical studies on Latin American health care systems, where there tends to be a wider gap in income-wealth distribution among states. This gap may increase the financial burden for people in the lower spectrum of income groups, which is the main concern in the first manuscript. It will focus on identifying policy variables that may contribute to more equitable distribution of the financial burden in health care. The equity principle we adopt for this study is the ability to pay principle. Based on this, we explore factors that contribute to inequities in the health care system finance and issues about who bears the heavier burden of out-of pocket (OOP) payment, progressivity of OOP payment, and the redistributive effect of OOP payment for health care as a source of finance in the Chilean health care system. Our analysis is based on data from the National Socioeconomic Survey (CASEN), and the 2006 National Survey on Satisfaction and OOP payments. Results from this study provide comprehensive understanding of the financial burden of health care in Chile. This study identified evidence of inequity, in spite of the progressivity of the health care system. Furthermore, our assessment of equity in health system finance identified relevant policy variables such as education, insurance system, and method of payment that should be taken into consideration in the ongoing debates and research in improving the Chilean system. Such findings will also benefit other Latin American countries that are concerned about equity in health system finance. The purpose of the second manuscript was to assess equity in health care utilization in Chile. Secondary data analyses from the National Socioeconomic Survey (CASEN) were performed to estimate the impact of different factors including AUGE in the utilization of health care services. We used a two-part model for the analysis of frequency of health care use in the country. Four other separate two-part models were also specified to estimate the frequency of use of preventive services, general practitioner services, specialty care and emergency care. An assessment of horizontal equity was also included. Results suggest the presence of pro-rich inequities in the use of medical care. The estimation of the two-part model found key factors affecting utilization of health care services such as education and the implementation of the AUGE program. These findings provide timely evidence to policy-makers to understand the current distribution and equity of health care utilization, and to strengthen availability of health services accordingly. The third manuscript was motivated by the previous findings. Its purpose was to explore an alternative measurement for health care access. The majority of studies nowadays use a single proxy to estimate access: the use of health care services. However, we saw many limitations on this approach since it only considers people that are already using the system and ignores those that are not. The final manuscript proposed a model to estimate access to health care services based on communitarian claims. The model identified barriers to health care access as well as the preferences of the community for priority settings. / Graduation date: 2012

Project (B.S.)--James Madison University, 2009. / Includes bibliographical references.