Background: Diabetes is a common and serious chronic condition. If not well-managed, significant multi-system complications often arise, resulting in increased health care utilization and poor health outcomes. There is considerable evidence that people with diagnosed diabetes are not receiving recommended care. A comprehensive program aimed at improving adherence to recommended care can improve patient outcomes and result in cost-savings. The key aim of this study was to determine whether the long-term receipt of appropriate clinical procedures by patients with type 2 diabetes was associated with higher medical care costs. Methodology: A cohort of 20,288 diagnosed type 2 diabetes patients was identified using physician and hospital records. An analytic file was created by linking information on patient characteristics with utilization of physician and acute care services during a five-year period (1996 to 2001). Adherence to recommended clinical procedures for the assessment of blood glucose, blood pressure and cholesterol levels, as well as retinopathy and nephropathy, were measured during this same five-year period. Subjects were assigned to both a categorical (low, medium and high) and a binary (low and high) adherence group. Physician and acute care resource use was converted to constant 2000 Canadian dollars. Multivariate logistic regression was used to assess the relationship between patient characteristics, including adherence as a categorical variable, and utilization of physician and acute care services. Results: Long-term adherence was suboptimal, with patients receiving just 53% of recommended procedures. Adherence to recommended procedures, however, improved during the five year period. Patient characteristics associated with poor adherence include being male, younger, low socio-economic status, having no diabetes-specific complicating conditions and living in certain geographic areas. Patients with high long-term adherence (receiving 73% of recommended clinical procedures) were 59% more likely to use a high level of physician resources but 22% less likely to use a high level of acute care resources. On the other hand, patients with low adherence (receiving 31% of procedures) were 28% less likely to use a high level of physician resources but 17% more likely to use a high level of acute care resources. The utilization difference related to adherence was particularly noticeable in older adults with higher levels of morbidity. Elderly patients in this low adherence group were more likely to be hospitalized (64.3% vs. 55.8% over the five-year period) and, when they were hospitalized, tended to stay in hospital for longer periods of time (11.9 vs. 6.7 days) than patients in the high adherence group. Conclusion: Improving long-term adherence may result in the avoidance of $4 in acute care costs for every additional $1 in physician costs. If all patients moved into the high adherence category, as much as $3.1 million in annual costs might be avoided across the study sample. If this analysis is applied to all adults with diagnosed diabetes in the province of British Columbia, the annual costs avoided could reach the level of $34.4 million. Systemic changes are required in the provision of primary care to promote long-term adherence to recommended diabetes care.

Congenital anomalies (CAs) are the leading cause of infant mortality and one of the leading causes of death for young children in developed countries. As significant improvements have been seen world-wide in controlling childhood infectious disease and issues related to poor nutrition, CAs are now making a proportionally bigger impact on the health of the worlds children. In addition to the impact of CA status on the individual child and ones family, prevalence of CAs has a significant impact on the population, as children with birth defects can cost the system a great deal of money in the provision of specialized health and education services.<p>When conducting surveillance of five selected CAs between 1990 and 1999, Saskatchewan Health found significant regional differences in the prevalence of these CAs. The purpose of this study is to ascertain whether or not there is a regional difference in all types of CAs, to assess whether or not any regional disparities also exist in the use of health care services by children with and without CAs and to determine what factors influence childrens use of health care services in the study population.<p>This study follows a birth cohort of 17,414 children (9169 cases and 8245 controls) born between January 1, 1994 to December 31, 1998 until their 5th birthday, death or emigration out of Saskatchewan. Through graphical analysis, it was revealed that while an overall regional difference does not exist in the prevalence of CAs in Saskatchewan, there are regional differences in the prevalence of 13 of the 22 specific categories of conditions studied. One-way ANOVAs showed that children with CAs have higher numbers of physician visits (p<0.001) and hospitalizations (p<0.001), and longer lengths of stay in hospital (p<0.001) than children without CAs. Regional differences were found for all outcome variables for the total population, and for children with and without CAs. The outcome with the most substantial differences between children with and without CAs was length of stay, which may indicate differential access to outpatient services throughout the province. Finally, using Andersons theoretical framework of factors that influence the use of health care services (need characteristics, predisposing characteristics and enabling characteristics) three negative binomial models were built to examine childrens use of health care services using variables from each category. <p>This study found significant regional differences for all outcome measures studied, and found that region of residence was a significant predictor of childrens use of health care services even after accounting for a variety of other maternal and child factors.

Background¡G With the carrying on the step of the society and the changing of the health care insurance system, the medical behavior has changed. The health care organization should not only focus on professional field, but also looking for operating forever. Objective¡G 1.To understand the recent condition of health care organizational ethics in others counties by paper research. 2.To develop the questionary of health care organizational ethics. 3.To understand the recent condition of health care organizational ethics in Taiwan by questionary, and compare the importance and feasibility. Methods¡G The target of this questionary includes clinicians, nurses, the staff of medical laboratory and pharmacist, administrators and others. The location of the questionary includes medical center, territorial hospitals, regional hospitals and primary hospitals. The program SPSS 13.0 will be used for descriptive statistics, factor analysis¡Arelability test and t test in this research. Result and Conclusion¡G There was significant difference in the interviewee¡¦s consideration between importance and feasibility of health care organizational ethics survey, whatever in every aspect or item. Classify all interviewee by different level of hospital but same position, or same level of hospital but different positions, there was also significant difference in the interviewee¡¦s consideration of importance or feasibility by different level of hospital or positions, except nurses.

Patients view about health care service delivery is a neglected subject in many developing countries. Patients are viewed as passive beneficiary of health care service without a voice. However, the views and opinions of patient on perception of service quality and satisfaction of health care service can assist management and policy makers in the design, implementation and evaluation of services which in turn assist to better improve and deliver qualitative health care service to the populace. This study was aimed at assessing patient perception of service quality and satisfaction with health services received at Olabisi Onabanjo university teaching hospital, Sagamu, Nigeria. A cross-sectional study was carried out at the outpatient clinics of the hospital during the study period. A total of 349 patients were interviewed using a pretested questionnaire to collect information on several dimensions of perceived quality and patient satisfaction. The data collected was analysed using SPSS statistical software. Factor analysis and multiple regressions were used to develop an 18-item scale having good reliability and validity identify. Four important dimensions of quality and satisfaction including doctor’s behavior and communication, supportive staff behavior, health infrastructure and waiting time were described. A total of 290 (83.1%) patients were satisfied with the overall service received at the hospital. The level of satisfaction was statistically significantly associated with female sex and employment status. Patient who were satisfied with the service significantly had a shorter waiting time than those not satisfied. Also patients who were satisfied with service had a longer consultation time compared with those not satisfied. In conclusion patient perception of quality and satisfaction are associated with the four important dimensions of quality. Long waiting time negatively affected satisfaction. If this is improved upon it will lead to increase patient satisfaction of health care service delivery / WHO liaison office No 10 Osborne road ikoyi Lagos, Nigeria +2348036591678; +2347090486687 +23414620493

<p> The rate of hospitals merging has increased significantly over the last few years. The number of hospital mergers between 2003 and 2009 averaged 55 per year, while mergers for 2010 and 2011 were 72 and 90, respectfully. This research moved beyond anecdotal reports and by using publicly reported data to not only evaluate the financial success of mergers, but also to look at other factors such as size, ownership, geography, environment (urban vs. rural), and market competitiveness to assess impacts on financial outcomes of mergers. This study examined the effect of joining a hospital system based on financial performance. Further, it assessed the relationship of specific organizational and environmental characteristics to determine if these characteristics had any effect on the success of the mergers. </p><p> Resource Dependence Theory (RDT) served as the theoretical framework for this study. Based on RDT precepts, two main hypotheses were studied including (1) Hospitals that join a health system have better financial performance after joining a health system than those that do not join a health system, and (2) For hospitals that have joined a health system, certain organizational and environmental characteristics will have greater influence on financial performance. Data from American Hospital Association, Centers for Medicare and Medicaid, and Area Health Resource File were collected, combined, and analyzed to address the research questions. </p><p> The results demonstrated that hospital operating margins significantly improved after joining a health system. Findings also suggested (at the 90% confidence interval) that hospitals located in rural areas had improved results following the second year of the merger. However, this study found no empirical support for the expectations that operating expenses would improve or that organizational characteristics (i.e., ownership and adjusted patient days), or environmental characteristics (i.e., percentage of people living in poverty, competitiveness) had a statistically significant effect on the success of a merger. </p><p> As hospitals continue to seek ways to remain competitive and to continually serve their mission to care for the members of their communities, this study can serve as a basis for assessing the effect of system membership on financial performance. The results of this study should not be used as the only basis for making merger decisions as the sample size and time period studied were too narrow to reach overarching conclusions. Keywords: mergers, acquisitions, resource dependence theory, affiliations</p>

<p> Racial disparity continues to be a struggle in America. The main purpose of this project was to determine whether there is a relationship between race and the acquisition of health insurance in adult residents of California who are younger than 65 years old. Through secondary data gathering, analysis of an existing racial disparity in health care insurance acquisition was accomplished. The results of the project indicate that a relationship exists between race and health insurance acquisition, thereby promoting an opportunity to determine hindering factors and discuss recommendations that can help to alleviate them. Multiple factors that influence the acquisition of health insurance among residents in California have been cited. Some of these factors such as affordability and immigration status are more relevant in the Latino racial group compared to the others. The awareness of this relationship promotes implications towards a legislative focus on the underserved populations and a development of action plans and public policies that can aid in acquisition of health insurance for all.</p>

<p> Medical errors cost the United States&rsquo; healthcare system approximately $19.1 billion annually. A failure to communicate or speak up is said to be a contributing factor. The purpose of this quantitative correlational study was to examine the relationship between managerial responsiveness, managerial approachability, and prosocial voice among acute-care registered nurses (RNs) from a Greater Northwest facility. The participants were 108 acute-care RNs. Instrumentation included the Supervisor as a Voice Manager developed by Saunders, Sheppard, Knight, and Roth (1992) to measure managerial responsiveness and managerial approachability. Prosocial voice was measured using Van Dyne and LePine&rsquo;s (1998) Prosocial Voice Scale. The relationship between managerial approachability and prosocial voice was positively correlated (<i>p</i> = .001). A positive relationship (<i>p</i> = 0.001) between the linear combination gender, education, years of experience within current acute-care facility, managerial responsiveness and managerial approachability and the RN&rsquo;s use of prosocial voice was found and accounted for 20.0% of the variance in the prosocial voice score. An unexpected serendipitous finding occurred when applying a backward elimination regression to three variables: managerial approachability, managerial responsiveness, and prosocial voice. RNs use of prosocial voice was positively correlated with the RN&rsquo;s level in the organization (<i>p</i> =.01), the RN&rsquo;s perception of managerial approachability (<i>p</i> = .001) while negatively correlated with the RN&rsquo;s perception of managerial responsiveness score ( <i> p</i> = .05). This research adds to current prosocial voice literature and expands the research on managerial approachability and managerial responsiveness. Future research recommendations were identified.</p>

<p> <b>Objective:</b> To describe the characteristics of frequent geriatric users of Mount Sinai&rsquo; Emergency Department (ED). <b>Methods:</b> Patients aged &ge;65 yo with >1 ED visit between February-April 2012 were included. Data was analyzed for demographics, disposition, revisit frequency, primary care provider, and insurance. This study was approved by the Mount Sinai Institutional Review Board. <b>Results:</b> A total of 95 out of 1,077 were frequent geriatric ED users. These patients demonstrated a lower index visit (30%) and 72 hour (15%), a higher 3-7 day (54%), 8-30 day (40%) and >30 day (65%) admission rate, as well as 67% had a primary care provider and 68% had medical insurance. <b>Conclusions:</b> Frequent geriatric ED users are more likely to be discharged upon index and less than 72 hour ED revisit, have higher admission rates on subsequent visits, have primary care providers and are similarly insured when compared to the geriatric ED patient population.</p>

<p> This multiple case study research examines the personal strengths of Chief Executive Officers (CEOs) and how these strengths contribute to their success as they lead their personnel and manage psychiatric hospitals in their charge. The study provides an understanding of the role of personal strengths in the successful CEO and discusses each CEO&rsquo;s utilization and development of those strengths. The Clifton StrengthsFinder 2.0 as found in <i>StrengthsFinder 2.0</i> (Rath, 2007) instrument was employed in the study to provide a common language that facilitated the researcher&rsquo;s conversation with the participants. Used as a heuristic device, the results of the strengths identifier tool were not applied in any comparative analytical format but rather provided a common frame of reference for both the researcher and the participant. The experience of responding to the strengths identifier tool provided a starting point for an interview that allowed the participants to talk about their strengths, their development, and the contribution of their strengths to their success. The theme of self-awareness emerged as an important component of their success, common to all of the participants in the study. Secondary themes of courage and humility, connected to self-awareness, contributed to understanding how the participants utilized their signature strengths to engage in a successful career leading psychiatric hospitals. The participants were able to describe their capacities, strengths, and how they used their abilities in unique ways while leading their hospitals.</p>

<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>