Journal of Healthcare Management最新文献

{"title":"Financial and Geographic Barriers to Health Care Access in Kenya: The Quest towards Universal Health Coverage","authors":"Obiero Brian Odhiambo, K. Purity","doi":"10.36959/569/474","DOIUrl":"https://doi.org/10.36959/569/474","url":null,"abstract":"The Quest towards Abstract Background : Access to health care services without being plunged into financial hardship is a life blood of the Universal Health Coverage. Kenya’s health sector is heavily dependent on out of pocket health expenditure. This model of health financing is inequitable and leads to underutilization of the much needed health care services. Majority of Kenyans travel for longer distances to access health care services. The geographic access barrier is linked to delayed care, missed appointments, delayed medication and undue loss of life. This study examines the correlates of financial and geographic health care access barriers in the UHC implementing Counties in Kenya. Methodology : The study used a cross-sectional data collected from 249 respondents using exit interviews at the health facilities drawn from the Kenya Master Health Facility List (KMHL). A multivariate log it regression model was used to analyze the predictors of probability of failure to access health care services owing to prohibitive health care and transport costs. Results: High out-of-pocket monthly expenditure on medicine; wider proximity, higher transportation cost and a longer traveling time to a health facility increases the probability of not seeking medical treatment owing to prohibitive health care and transportation costs. These factors thus, acts as key barriers to health care access. Conclusion : Financial and geographic access barriers negatively impact on health care access. To hasten the realization of the Universal Health Coverage, prepayment models such as use of taxes and insurance should be pursued.","PeriodicalId":51633,"journal":{"name":"Journal of Healthcare Management","volume":"45 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2022-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77168481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Pennsylvania Rural Health Model: Hospitals’ Early Experiences With Global Payment for Rural Communities","authors":"D. Scanlon, M. Sciegaj, Laura J. Wolf, Jocelyn M. Vanderbrink, Bobbie L Johannes, Bethany Shaw, Kassidy Shumaker, Diane C Farley, Erin Kitt-Lewis, L. Davis","doi":"10.1097/JHM-D-20-00347","DOIUrl":"https://doi.org/10.1097/JHM-D-20-00347","url":null,"abstract":"SUMMARY Goal: In January 2019, the first cohort of rural hospitals began to operate under the Pennsylvania Rural Health Model for all-payer prospective global budget reimbursement as part of a demonstration funded by the Center for Medicare and Medicaid Innovation. Using information from primary source documents and interviews with key stakeholders, we sought to identify challenges and lessons learned throughout the design, development, and early implementation stages of the model. Methods: We relied on two qualitative research approaches: (1) review of primary source documents such as peer-reviewed publications and news accounts related to the model and (2) semistructured interviews with key staff and stakeholders, including current and former members of the Pennsylvania Department of Health, first-year applicant hospitals, technical assistance providers, and members of state and federal organizations and agencies familiar with the Pennsylvania and Maryland payment reform efforts for rural health and rural hospitals (N = 20). Principal Findings: We identified four primary attributes that innovative projects such as the model need: (1) a champion at the state and hospital level, significant cooperation across state agencies and between federal and state agencies, and support from nongovernment stakeholders; (2) ongoing engagement and education of all stakeholders, particularly related to rural health disparities, the challenges faced by rural hospitals (especially resource limitations), and the differences between rural and urban health and health service delivery; (3) realistic time lines, noting that stakeholder relationships with hospital leadership develop over many months; and (4) multistakeholder collaboration, because participating hospitals must have ongoing engagement with community members (i.e., consumers of healthcare), nonacute community partners, and other rural hospitals to foster a “rural health movement.” Applications to Practice: A successful Pennsylvania model holds promise for other states seeking to address the needs of rural populations and the hospitals that are vital to those communities. The lessons in this article can assist others in making the transition from volume to value in rural healthcare.","PeriodicalId":51633,"journal":{"name":"Journal of Healthcare Management","volume":"67 1","pages":"162 - 172"},"PeriodicalIF":1.8,"publicationDate":"2022-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48943302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Participation in Value-Based Payment Programs and U.S. Acute Care Hospital Population Health Partnerships","authors":"Larry R. Hearld, Aizhan Karabukayeva","doi":"10.1097/JHM-D-20-00338","DOIUrl":"https://doi.org/10.1097/JHM-D-20-00338","url":null,"abstract":"SUMMARY Goal: The goal of this study was to describe the prevalence and pattern of population health partnerships by hospitals and examine whether these partnerships were associated with different types of payment model programs. Methods: We conducted a cross-sectional analysis of 3,012 U.S. hospitals using data from the American Hospital Association’s Annual Survey, the Area Health Resources File, and the County Health Rankings & Roadmaps data. We ran a multivariable Poisson regression model to examine the relationship between value-based payment designs and the number of population health partnerships. Binary logistic regression models were used to assess whether participation in value-based payment design programs was associated with specific types of population health partnerships. Principal Findings: We found that two thirds or more of hospitals used more informal collaborative partnerships with local or state government, faith-based organizations, and local businesses; formal alliances were most common with health insurance companies and other healthcare providers. Accountable care organizations and bundled payment program participation were associated with greater numbers of population health partnerships, whereas hospital ownership of a health plan was not associated with significantly greater numbers of population health partnerships. Applications to Practice: Hospitals were engaged in an intermediate number of partnerships (mean = 3.5, out of 8.0 possible), with opportunities for more partnerships with specific types of organizations (faith-based organizations, health insurance companies). Our findings also suggest that certain types of payment models, particularly those that are less capital intensive and entail less extensive organizational transformation on the part of hospitals, may support hospital engagement in population health partnerships. Hospital leaders need to monitor these partnerships continually to determine if they can capitalize on opportunities to play a more prominent role in population health management in local communities.","PeriodicalId":51633,"journal":{"name":"Journal of Healthcare Management","volume":"67 1","pages":"103 - 119"},"PeriodicalIF":1.8,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45001738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physician Understanding of and Beliefs About Leadership","authors":"R. T. Collins, N. Purington, S. Roth","doi":"10.1097/JHM-D-21-00036","DOIUrl":"https://doi.org/10.1097/JHM-D-21-00036","url":null,"abstract":"SUMMARY Goal: Little is known about how physicians conceptualize leadership, what factors influence that conceptualization, and how their conceptualization may impact willingness to lead. We sought to explore how physicians conceptualize leadership. Methods: We conducted an exploratory study of data from a convenience sample of physicians across the United States using an anonymous, 54-item, online survey. We devised a novel leadership resonance score (LRS) to distinguish between leadership and management based on published definitions and prior pilot work. The activities fit on a spectrum from purely leadership actions to purely management actions, and we assigned a numeric value to each activity, allowing for quantification of a respondent’s conceptualization of leadership as either more managing or more leading. Principal Findings: There were 206 respondents (57% male; median age of 43 years [interquartile ranges, IQR: 32, 72]) who completed the survey. Respondents viewed leadership abilities to be highly important for physicians, with a median importance score of 80 (range 0–100, IQR: 50, 100). LRS indicated most physicians conflate leadership and management. Compared to other physicians, respondents assessed their own preparedness for leadership highly (median preparedness score: 70, IQR: 2, 100). Respondents’ assessment of their preparedness for leadership was associated with age (Spearman’s rho = 0.24, p < .001). LRS was not associated with preparedness for leadership (Spearman’s rho = 0.12, p = .08). “Aversion to politics” was the most common barrier to interest in leadership (45%, 93/206), with “loss of personal time” being second (30%, 62/206). Applications to Practice: Our data demonstrate physicians misunderstand the differences between leadership and management. We surmise that if an accurate conceptualization of leadership by physicians is associated with increased willingness to lead, then educational activities designed to improve physicians’ understanding of leadership could be beneficial in increasing physicians’ willingness to take on leadership positions. An increased willingness by physicians to take on leadership roles would ultimately have a positive impact not only on individual patient care, but also on the healthcare system as a whole.","PeriodicalId":51633,"journal":{"name":"Journal of Healthcare Management","volume":"67 1","pages":"120 - 136"},"PeriodicalIF":1.8,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42236548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is Skilled Nursing Facility Financial Status Related to Readmission Rate Improvement?","authors":"J. Clement, Kristin M MacDonald","doi":"10.1097/JHM-D-20-00320","DOIUrl":"https://doi.org/10.1097/JHM-D-20-00320","url":null,"abstract":"SUMMARY Goal: We examined whether higher skilled nursing facility (SNF) lagged profitability is associated with a lower 30-day all-cause all-payer risk-adjusted hospital readmission rate. Our aim was to provide insight into whether SNFs with limited financial resources are able to respond to incentives to lower their readmission rates to hospitals. Methods: We used data from 2012–2016 to estimate a fixed effects (FE) model with a time trend. Our data included financial data from the Centers for Medicare & Medicaid Services Healthcare Cost Report Information System SNF cost reports, facility characteristics including the all-cause all-payer risk-adjusted unplanned 30-day readmission rate from the LTCFocus (Long-Term Care Focus) project at Brown University, and county-level market variables from the Area Health Resource File. We also examined the relationship for a shorter time frame (2012–2015) after stratifying the sample by system membership or ownership. Principal Findings: SNFs with an increase in the lagged operating margin showed a statistically significant, small decrease (<.01 percentage point) in the risk-adjusted readmission rate. The results were robust for different time periods and model specifications. Fixed effects model estimates for SNFs in the highest quartile of percentage of Medicaid patients (≥73.9%) had a lagged operating margin coefficient that is almost four times as large as the coefficient of the FE model with all SNFs. Application to Practice: SNFs have an important role in achieving the national priority of reducing hospital readmissions. The study findings suggest that managers of SNFs should not see low profitability as an obstacle to reducing readmission rates, which is good news given the low average profitability of SNFs. Further, reductions in profitability due to penalties incurred from the recently implemented Medicare Skilled Nursing Facility Value-Based Purchasing Program may not limit SNFs’ ability to lower hospital readmission rates, at least initially. However, policymakers may need to determine whether additional resources to high Medicaid SNFs can lower readmission rates for these SNFs.","PeriodicalId":51633,"journal":{"name":"Journal of Healthcare Management","volume":"67 1","pages":"89 - 102"},"PeriodicalIF":1.8,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44005075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Telemedicine in the Midst of the COVID-19 Crisis: A Case Study in Government and Healthcare Agility","authors":"Moonesar Immanuel Azaad, Stephens Melodena, Mazrouei Kulaithem Saif Al, Henriksson Dorcus Kiwanuka, Gordeev Vladimir Sergeevich","doi":"10.36959/569/472","DOIUrl":"https://doi.org/10.36959/569/472","url":null,"abstract":"","PeriodicalId":51633,"journal":{"name":"Journal of Healthcare Management","volume":"15 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2022-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80474489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Association between Nutritional Parameters Used in Nutritional Risk Assessment (NRA) Tools in Hospitalized Malnourished COVID-19 Patients: A Systematic Review","authors":"Sadighi Sanambar, Mohseni Sana, Hosseini Sayyideh Forough, Olang Orkideh, Khatami Seyedeh Mohaddeseh, Salim Maryam Rezaii, Allard Johane, Shafiee Mohammad Ali","doi":"10.36959/569/471","DOIUrl":"https://doi.org/10.36959/569/471","url":null,"abstract":"","PeriodicalId":51633,"journal":{"name":"Journal of Healthcare Management","volume":"73 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2022-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79365036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pandemic-Related Experiences and Stress Among Children’s Hospital Staff Predict Psychosocial Risk","authors":"Damion J. Grasso, Matthew Lewin, Basia Adams, G. Lapidus","doi":"10.1097/JHM-D-21-00022","DOIUrl":"https://doi.org/10.1097/JHM-D-21-00022","url":null,"abstract":"SUMMARY Goal: COVID-19 has imposed unique challenges for healthcare workers who have faced increased risk of exposure to the virus, heightened work demands, and disruptions in work–life balance. For some healthcare workers, these challenges may have contributed to increased stress, burnout, and psychosocial impairment, including symptoms of depression and anxiety. The current study addresses a knowledge gap of associations between pandemic-related experiences and psychosocial risk among medical and nonmedical pediatric healthcare staff. Methods: A sample of 369 staff (90% female) employed at an acute care, freestanding pediatric hospital in Connecticut completed an online survey. The survey assessed specific pandemic-related experiences and perceived impact with the Epidemic-Pandemic Impacts Inventory, and depression and anxiety risk with the 2-item Patient Health Questionnaire depression screen and 2-item Generalized Anxiety Disorder screen, respectively. Enrollment and survey completion occurred over a 6-week period during the pandemic (summer 2020). Principal Findings: High rates of adverse pandemic-related experiences included workplace experiences (e.g., inadequate support, interpersonal difficulties), home life (e.g., childcare difficulties, partner conflict), and experiences reflecting social isolation and quarantine, child and adult mental health difficulties, increased alcohol or substance use, and unhealthy lifestyle behaviors. Medical relative to nonmedical staff reported significantly more adverse and fewer positive experiences, and a significantly higher perceived negative impact of workplace experiences. A positive screen for depression or anxiety was significantly predicted by cumulative adverse workplace experiences (OR = 1.15), changes in emotional/physical health (OR = 1.35), and perceived negative impact of workplace experiences (OR = 1.32). Applications to Practice: The present study joins recent reports of increased adverse experiences and psychosocial outcomes among healthcare workers during the COVID-19 pandemic. Findings underscore the need for pediatric hospitals to innovate ways to reduce burden and connect staff to mental health services during similar public health crises. Such services might include (1) assisting healthcare staff to navigate disruptions in their home and social lives as a result of new challenges faced at work, (2) adapting the hospital environment and culture to mitigate stress experienced by staff because of these challenges, and (3) bolstering mental health screening and services to address exacerbated or emerging mental health symptoms, such as depression and anxiety.","PeriodicalId":51633,"journal":{"name":"Journal of Healthcare Management","volume":"67 1","pages":"75 - 88"},"PeriodicalIF":1.8,"publicationDate":"2022-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41343745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Covid-19 in Patients with Hematological Disorders: An Italian Single Center Experience before Covid-19 Vaccination","authors":"A. Rago, T. Caravita di Toritto","doi":"10.36959/569/473","DOIUrl":"https://doi.org/10.36959/569/473","url":null,"abstract":"Background: A novel severe acute respiratory syndrome (SARS)-like coronavirus (SARS-CoV-2) has emerged as a human pathogen, causing global pandemic and resulting in over 400,000 deaths worldwide. In the literature, there are several reports in patients with cancer and COVID-19 infection. These studies demonstrated that patients with solid tumors had a higher risk of contracting SARS-CoV-2 infection, because of their systemic immunosuppressive state, caused by the malignancy and anticancer treatments, such as chemo therapy or surgery. On the contrary, very few data are available on COVID-19 outcomes in patients with hematologic diseases. Methods: We report data on 5 patients with hematological disease referred to a single medical hematology unit of a general hospital from January and October, 2020. During 2020, no vaccines were available. Results: Five patients were on active cancer therapy during the infection. Overall 5 patients developed pneumonia and all patients are alive. Conclusion: In conclusion, our study, which describes a small local experience, show how patients suffering from hematological diseases can contract covid infection and that in times of pandemic, it is important to maintain social distancing and think about a reduction in hospital visits. In this out-patient setting, it is important to reduce hospital admission as it is a potential risk factors for SARS-CoV-2 infection.","PeriodicalId":51633,"journal":{"name":"Journal of Healthcare Management","volume":"8 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74829557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Strategy Management of COVID-19 Pandemic: An Integrative Review","authors":"B. Zaadoud, EL Rhazi Karima","doi":"10.36959/569/469","DOIUrl":"https://doi.org/10.36959/569/469","url":null,"abstract":"Objective: The objective of this paper is to analyze and evaluate public policies in the fight against the COVID-19 pandemic in the world through publications and recommendations issued by countries and international organizations. Method: We have suggested a research methodology based on expert opinion on the critical factors that determine the outcomes of national pandemic policies. Based on comprehensive literature review, three independent variables were calculated: The reach of public policy pandemic interventions, the timing of public policy interventions, and the success of public policy in motivating compliance with pandemic measures (e.g. Communication, safety and security coordination). The variables that ultimately condition the current mortality and morbidity rates of COVID-19 worldwide. We have collected information from various national and international health care guidelines and publications. Results: Given the variability in growth rates of COVID-19 cases in different regions and countries, a number of criteria are proposed for the evaluation of quality improvement plans for COVID control: Potential for rapid implementation and completion; minimization of administrative and manpower burden required from stressed HCWs and healthcare institutions; effectiveness of and potential for revealing occupational risks; ability to identify inefficiencies in the management of known risks; and to monitor risks associated with transmission routes. Conclusion: The COVID pandemic experience has taught us that the expansion of health systems requires the development of health practices based on an interdisciplinary vision, with outcomes oriented towards the dynamics of actions and the management of health problems. The central role of leadership and a strong organization are paramount in managing such crises.","PeriodicalId":51633,"journal":{"name":"Journal of Healthcare Management","volume":"43 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80925086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}