Journal of hospital management and health policy最新文献

{"title":"Optimizing the complexities of unforeseen risk in healthcare with innovation and technology: a proposed framework","authors":"Asfandyar Khan, Aimen Farooq, Sarfraz Ahmad, Jane M. Fraser","doi":"10.21037/JHMHP-21-3","DOIUrl":"https://doi.org/10.21037/JHMHP-21-3","url":null,"abstract":"Today, healthcare must be willing to take risks while advancing clinical transformation, starting from research to innovations, patient care technicians to physicians, management thinking lean to maximizing inventory flow, building a supply chain of healthcare workers to allowing engineering strategies, and building community facilities to establishing remote reusable facilities. In recent months, the ongoing pandemic (COVID-19) has changed everyone’s perspective globally. The United States healthcare system is linked with financial needs. The stakeholders must understand the growth and possibility of the unforeseen new medical risks, including how to challenge the dataset used for decision making, increasing the required acceptance level for the verification and validation of growing medical risk models, because healthcare is a stochastic system, forecasting always changes and so does the final decision of investing the cost. The global fear brought on by the ongoing pandemic is playing a major role in the economic and social consequences. Experts recommend that physicians must be willing to take over the key roles and lead these strategies, but at the same time better integration of engineering fields can play a huge role in helping physicians to understand the strategies. It is very important to help them craft a solution that healthcare workers can stick to. In this article, we propose three key frameworks (viz., health surveillance, workforce, and modular facilities) that would be helpful in creating a balance within the healthcare industry daily operation which is the paramount need of the “new normal” and sustainability. © Journal of Hospital Management and Health Policy. All rights reserved.","PeriodicalId":92075,"journal":{"name":"Journal of hospital management and health policy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44317512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient preferences for health information technologies: a systematic review","authors":"N. Crossnohere, Brent Weiss, Sarah Hyman, J. Bridges","doi":"10.21037/JHMHP-20-105","DOIUrl":"https://doi.org/10.21037/JHMHP-20-105","url":null,"abstract":"Background: Advances in patient-facing health information technology (HIT) promise to improve health care delivery and patient outcomes. Low utilization of HIT suggests that the preferences of patients may not be adequately guiding the development of these technologies. This systematic review offers an assessment of published evidence regarding patient preferences for HIT. Methods: Articles addressing preferences for HIT from patient and other end-user groups published up through 2020 were identified from PubMed, Web of Science, Scopus and via hand searching. Articles that used quantitative stated-preference methods to explore preferences for HIT were eligible for inclusion. Studies that explored attitudes towards HIT without eliciting trade-offs were excluded. Critical appraisal of study quality was conducted using the PREFS checklist and quality criteria identified by the US Food and Drug Administration including heterogeneity analysis and patient engagement in study design. We conducted thematic analysis of the main preference findings from each study to synthesize patient and enduser preferences for HIT. The review was not registered and authors received no funding to conduct the review. Results: The search yielded 7,299 unique articles, 59 of which were ultimately included in the review. Studies explored preferences for telemedicine (n=30), patient portals (n=12), mHealth (n=9) or multiple HITs (n=8). Preference elicitation methods included direct elicitation (n=26), discrete-choice experiments (n=13), conjoint analysis (n=6), contingent valuation (n=5), and ranking exercises (n=9). Studies had a mean PREFS score of 3.51 out of 5. Forty-two studies conducted preference heterogeneity analysis and only 20 included patients in study design. Thematic meta-analysis indicated that patients prefer HIT that is convenient and lower cost, but does not sacrifice quality, and preferences varied by demographic features such as age as well as depending on the type of health information being communicated. Conclusions: Patient and end-users have distinct preferences for the use of HIT in their medical care. It is timely that researchers and healthcare administrators consider these preferences for HIT given its rapid uptake amidst the COVID-19 pandemic. Although this literature demonstrates that patients can be engaged as participants in preference studies to identify meaningful aspects of HIT, the field was limited in its inclusion of patients in the design of such studies. Future development of HIT should be guided by high-quality preference research that integrates patients in all stages in the design and implementation of HIT. © Journal of Hospital Management and Health Policy. All rights reserved.","PeriodicalId":92075,"journal":{"name":"Journal of hospital management and health policy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42263296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence in healthcare—the road to precision medicine","authors":"Tran Quoc Bao Tran, Clea du Toit, S. Padmanabhan","doi":"10.21037/JHMHP-20-132","DOIUrl":"https://doi.org/10.21037/JHMHP-20-132","url":null,"abstract":"Precision medicine aims to integrate an individual’s unique features from clinical phenotypes and biological information obtained from imaging to laboratory tests and health records, to arrive at a tailored diagnostic or therapeutic solution. The premise that precision medicine will reduce disease-related health and financial burden is theoretically sound, but its realisation in clinical practice is still nascent. In contrast to conventional medicine, developing precision medicine solutions is highly data-intensive and to accelerate this effort there are initiatives to collect vast amounts of clinical and biomedical data. Over the last decade, artificial intelligence (AI), which includes machine learning (ML), has demonstrated unparalleled success in pattern recognition from big data in a range of domains from shopping recommendation to image classification. It is not surprising that ML is being considered as the critical technology that can transform big data from biobanks and electronic health records (EHRs) into clinically applicable precision medicine tools at the bedside. Distillation of high-dimensional data across clinical, biological, patient-generated and environmental domains using ML and translating garnered insights into clinical practice requires not only extant algorithms but also additional development of newer methods and tools. In this review, we provide a broad overview of the prospects and potential for AI in precision medicine and discuss some of the challenges and evolving solutions that are revolutionising healthcare.","PeriodicalId":92075,"journal":{"name":"Journal of hospital management and health policy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46126376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High hospital volume is associated with more consistent long-term mortality rates","authors":"M. Curry, A. Lipitz-Snyderman, D. Rubin, Diane G. Li, Elaine Duck, M. Radzyner, P. Bach","doi":"10.21037/JHMHP-20-118","DOIUrl":"https://doi.org/10.21037/JHMHP-20-118","url":null,"abstract":"Long-term survival following cancer treatment is a widely accepted metric used to evaluate the quality of cancer care and varies between hospitals (1-3). Long-term survival takes years to evaluate, and these metrics reflect care quality from many years prior. Long-term survival has unknown applicability as a quality measure to evaluate current performance. It is important to determine if the structural lag in measurement limits the value of long-term survival measures meaningless as a tool for assessing current hospital performance. The study assesses the stability of hospitals’ performance over time based on its cancer patients’ fouryear survival. We hypothesized that hospitals’ four-year mortality ratio would be consistent over time, implying that patients could use such information when deciding where to get care. Additionally, since decades of research have demonstrated a relationship between higher surgical volume and better outcomes for hospitals, we set out to explore consistency by hospital volume (1,4).","PeriodicalId":92075,"journal":{"name":"Journal of hospital management and health policy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43223679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between hospital accrediting agencies and hospital outcomes of care in the United States","authors":"Mark Kato, D. Zikos","doi":"10.21037/jhmhp-21-24","DOIUrl":"https://doi.org/10.21037/jhmhp-21-24","url":null,"abstract":"Improving outcomes, reducing harm, and decreasing costs in care have been at the forefront of healthcare leaders’ minds for decades. The focus on quality came to a head in 1999 after the release of “To Err is Human” asserting that 44,000 to 98,000 people die each year attributing to billions in hospital cots due to errors resulting from poor processes (1). Hospital practices and processes are evaluated Original Article","PeriodicalId":92075,"journal":{"name":"Journal of hospital management and health policy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43391634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hospital satisfaction does not predict functional outcome one year after total shoulder arthroplasty","authors":"Robert D. Wojahn, J. M. Atencio, Julianne A. Sefko, L. Galatz, J. Keener, K. Yamaguchi, A. Chamberlain","doi":"10.21037/JHMHP-20-51","DOIUrl":"https://doi.org/10.21037/JHMHP-20-51","url":null,"abstract":"Background: Healthcare is shifting to value-based payment models. Two percent of Medicare reimbursements are currently linked to value measures including the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) hospital satisfaction survey. The purpose of this study was to determine if HCAHPS survey results are correlated with validated legacy outcome measures after total shoulder arthroplasty. Methods: A prospective observational study was conducted in 84 patients undergoing elective total shoulder arthroplasty. Baseline 12-item Short-Form Health Survey (SF-12), American Shoulder and Elbow Surgeons (ASES), and Western Ontario Osteoarthritis of the Shoulder Index (WOOS) questionnaires were completed at the time of enrollment. ASES and WOOS scores were collected at 3-months and 1-year post-operatively. Patients were contacted to complete the HCAHPS survey postoperatively. HCAHPS results and baseline functional scores were evaluated for an association with improvements in legacy outcome measures after surgery. Results: HCAHPS scores were higher among males than females (P=0.04). Age, SF-12 physical component scores, SF-12 mental component scores, and pre-operative symptom severity were not associated with HCAHPS results. HCAHPS scores were not correlated with ASES (r=0.09, P=0.44) or WOOS scores (r=−0.17, P=0.13) at one year after surgery. HCAHPS was also not correlated with the absolute improvement in ASES (r=−0.02, P=0.85) or WOOS scores (r=−0.08, P=0.48) from pre- to one year post-operatively. Conclusions: The HCAHPS score, a measure of satisfaction and a determinant of Medicare quality-based reimbursement, showed no correlation with functional outcome measures at one year after total shoulder arthroplasty. Thus, HCAHPS patient satisfaction survey may not be aligned with functional outcomes valued by patients. Further consideration is warranted regarding the assessment of quality, and in turn reimbursements, with survey results.","PeriodicalId":92075,"journal":{"name":"Journal of hospital management and health policy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43715446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations between patient experience and clinical outcomes at a level I trauma center: a cross-sectional survey-based study","authors":"Andrew Oberle, Dajun Tian, K. Hayes, Steven W. Howard, V. Moran","doi":"10.21037/jhmhp-21-65","DOIUrl":"https://doi.org/10.21037/jhmhp-21-65","url":null,"abstract":"Background: Helping survivors of traumatic injuries achieve optimal recovery is a crucial global health issue. Traumatic injuries present major implications for the health of patients, care systems, and world economies. Focusing on the improvement of structures and processes that influence hospitalized trauma patient experience is a potentially important way to improve outcomes and health-related finances. The purpose of this study is to determine if there are associations between patient experience and clinical outcomes for hospitalized trauma patients. Methods: The study used a cross-sectional design. Primary data was collected in March and April 2020. Potential participants were 95 trauma patients who received care for traumatic injuries at a United States urban Level I trauma center from November 2018 to January 2020 and consented to be contacted for future research. Phone surveys were used to collect quantitative and qualitative data on participants’ patient experiences and health outcomes related to their hospitalization. Additional health outcomes were collected from participants’ electronic health records. General linear and Poisson regressions were used to analyze associations between experience and outcomes. Differences between injury severity groups were analyzed using chi-square and t-tests. Results: Thirty participants completed the phone survey, a response rate of 31.6%. Positive nurse communication was associated with a significantly lower risk of hospital-acquired complications compared to negative nurse communication (−33%; 95% CI, −61% to −5.5%). Patients with severe injuries had a lower risk of 30-day readmissions when reporting positive nurse communication (−56% decrease; 95% CI, −88% to −23%), positive doctor communication (−50%; 95% CI, −81% to −19%), and positive overall hospital rating (−56%; 95% CI, −99% to −13%) when compared to severely injured patients who reported negative nurse and doctor communication and overall rating. Conclusions: This study shows that aspects of patient experience, especially those related to communication with providers, are significantly associated with clinical outcomes for acute trauma patients, with potential implications for Continuous Quality Improvement and value-based reimbursement. Additional research would confirm if these associations exist for larger samples and patients treated for traumatic injuries in non-urban settings.","PeriodicalId":92075,"journal":{"name":"Journal of hospital management and health policy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41980985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Examination of the relationship between physician shortages and compensation rates in primary care versus other specialties","authors":"A. Michaels, L. Clack","doi":"10.21037/JHMHP-20-154","DOIUrl":"https://doi.org/10.21037/JHMHP-20-154","url":null,"abstract":"Background: It is projected that the United States will experience a shortage of 21,100 to 55,200 full-time equivalent primary care physicians by the year 2032. The shortage has been sparked by the passage of the Patient Protection and Affordable Care Act and has continued to grow due to the United States’ aging population, population health initiatives, and physician workload. While primary care physicians are responsible for more than half of all physician office visits in the United States, primary care physicians make up approximately 28% of the workforce. Recently, research has cited compensation as the primary reason for the shortage of primary care physicians. Primary care physicians have historically made less than physicians who specialize in other disciplines. Over the last 10 years, primary care physician compensation has increased. However, the shortage also continues to increase. The purpose of this research is to determine the relationship between primary care physician demand and compensation, and to compare that relationship with other specialties. Methods: Physician supply and demand data were collected utilizing the Association of American Medical Colleges (AAMC) reports, The Complexities of Physician Supply and Demand . Compensation data was collected utilizing Modern Healthcare’s Physician Compensation database. Results: When analyzing physician compensation with the employment cost index, primary care physician compensation was 1% higher than projected with inflation. Despite earning more than projected, it was determined that demand has little to no impact on primary care physician compensation. Conclusions: With more physicians moving towards employment with hospitals and hospital systems, there is an increased need for human resources initiatives. Hospital and hospital systems’ human resources departments should develop initiatives that increase pay for primary care physicians such as the standardization of compensation regardless of specialty within a healthcare organization.","PeriodicalId":92075,"journal":{"name":"Journal of hospital management and health policy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45204288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Revitalizing the Italian NHS: remarks on the 2021–2026 national recovery plan (next generation EU)","authors":"E. Vendramini, F. Lega","doi":"10.21037/jhmhp-21-78","DOIUrl":"https://doi.org/10.21037/jhmhp-21-78","url":null,"abstract":"The first cases of coronavirus disease (COVID-19) were recorded in China in late 2019. By February 2020 the disease had begun to spread to other Asian countries and then throughout Europe, where Italy was the first country to be hit by the pandemic. Overall, the country’s national health service is reputed to provide quality health services. Indeed, nearly all Italian residents are registered with the NHS, which covers most of the medical costs in hospitals and physician consultations (OECD 2019), and hospitals are described as providing high-quality treatment for patients requiring acute care. As Morciano and Caredda (1) state, “Italian prevention services are largely public and free at point of delivery. Immunisation and screening programmes represent priorities in the public health area, although with differences in services between regions”. Yet there remain wider issues that hinder NHS performance. Italy has a decentralized healthcare system organized by region and a weak governance structure that generates inequalities, with poor national coordination between the country’s 20 regions (2). There is also the problem that the pandemic response plan appeared to be outdated when the crisis emerged (The Guardian, 13 August 2020 https://www.theguardian.com/world/2020/ aug/13/italy-pandemic-plan-was-old-and-inadequatecovid-report-finds). The infection rate rose rapidly after the first recorded case of COVID-19 (23 February 2020), with nearly 3,000 new infections and 100 deaths occurring in less than two weeks. The Italian government issued a Decree of the President of the Council of Ministers (DPCM) announcing a national lockdown shortly thereafter (11 March through 3 May 2020), followed suit by other European countries over the subsequent weeks. The pandemic had gone global, escaping the control of many countries. And it continues to spread by variants. Presently, the number of COVID-19 cases has begun to increase again in Italy, and localized lockdowns were issued between October 2020 and the first half of 2021. While the situation had stabilized during the second half of 2021, the emergence of the new omicron variant aroused renewed alarm in early 2022. The pandemic has created numerous challenges for the Italian NHS. The national recovery plan will need to address several, among which the following are of particular importance.","PeriodicalId":92075,"journal":{"name":"Journal of hospital management and health policy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44906412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Design, implementation and impact of a new physician role to address capacity challenges at a large academic medical center","authors":"K. Safavi, M. Bravard, Brian J. Yun, W. Levine, P. Dunn","doi":"10.21037/jhmhp-21-48","DOIUrl":"https://doi.org/10.21037/jhmhp-21-48","url":null,"abstract":"Background: Hospitals are experiencing significant strain on inpatient capacity leading to delays in care that threaten their ability to provide safe, high-quality services. We implemented an institutional role called the capacity physician to aid in patient access, progress of care, and discharge at a large academic medical center with significant capacity challenges. Methods: From September 2019 through January 2020, we performed a prospective observational study of the volume of consultations and related challenges, actions, and impact of the capacity physician. Data regarding consultations were collected via survey of physicians in the role. A member of the study team categorized challenges, actions, and impact on capacity based upon common themes. Results: Overall there were 155 consultations from 14 different departments and locations within the hospital. General medicine and surgery accounted for most consultations at 51.6%. Common reasons for consultation were critical capacity levels in the emergency department (ED) (44, 28.4%), communication/ coordination gaps across clinical services (37, 23.9%), and critical capacity levels in the general care wards (29, 18.7%). The most common action taken by the capacity physician was to prioritize a patient and help coordinate their care across services (54, 34.8%). The impact on capacity of consultations included reduction in length of stay (LOS) (78, 50.3%), facilitation of access for hospital transfers (46, 29.7%), and reduction in waiting times for hospital beds (31, 20.0%). Conclusions: The capacity physician was successfully implemented and utilized at a large academic hospital. This role represents a novel approach to addressing the significant quality and safety challenges caused by capacity strain and crowding.","PeriodicalId":92075,"journal":{"name":"Journal of hospital management and health policy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49148349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}