PubMed Health⌕ Search

Biomedical subjects

G L Glandon

Publications and source records attributed to G L Glandon.

At least 19 recordsLinked to original sources
PubMed1995

An analysis of the adoption of managerial innovation: cost accounting systems in hospitals.

The adoption of new medical technologies has received significant attention in the hospital industry, in part, because of its observed relation to hospital cost increases. However, few comprehensive studies exist regarding the adoption of non-medical technologies in the hospital setting. This paper develops and tests a model of the adoption of a managerial innovation, new to the hospital industry, that of cost accounting systems based upon standard costs. The conceptual model hypothesizes that four organizational context factors (size, complexity, ownership and slack resources) and two environmental factors (payor mix and interorganizational dependency) influence hospital adoption of cost accounting systems. Based on responses to a mail survey of hospitals in the Chicago area and AHA annual survey information for 1986, a sample of 92 hospitals was analyzed. Greater hospital size, complexity, slack resources, and interorganizational dependency all were associated with adoption. Payor mix had no significant influence and the hospital ownership variables had a mixed influence. The logistic regression model was significant overall and explained over 15% of the variance in the adoption decision.

Accounting↗
PubMed1995

Improving hospital performance: issues in assessing the impact of TQM activities.

Despite numerous published reports of the need for TQM activities in health care organizations and their widespread diffusion within the health care industry, whether they make a difference remains an unresolved issue. In this article, we discuss the major reasons why the impacts of TQM should be assessed, what needs to be measured during assessment activities, and significant methodological issues that can confound the evaluation of TQM effects. An audit framework is described that can be used to depict the types of effects that TQM may have on the performance of health care organizations. Assessment guidelines are offered that will hopefully benefit the future efforts of institutional managers and health services researchers in their attempts to determine whether TQM activities do in fact make a significant difference.

Cost-Benefit Analysis↗
PubMed1995

Economic and quality of life outcomes: managed care perspectives.

A variety of economic factors have created a growing demand for health care reform and the rapid expansion of managed care plans. Absence of a clear, commonly accepted definition of managed care constitutes one of the major difficulties in constructing a useful dialogue about managed care and its likely effects. This paper defines basic managed care models and outlines for each the degree of financial risk and reward to the provider and of internal (vs external) control of care. This transfer of risk to the provider is a key aspect of managed care and brings with it an increase in the physician's freedom to choose appropriate care for patients. The potential impact of managed care on quality of life measures is also discussed.

Health Care Reform↗
PubMed1992

Elderly health beliefs, attitudes, and maintenance.

BACKGROUND: Why older persons engage in varying amounts of health maintenance activity is becoming both an increasingly important policy issue and a topic of interest to health services researchers. Such activity may help the elderly to delay the onset of the health-related problems associated with aging, maintain if not improve their functional abilities, and perhaps improve their quality of life. METHODS: Using a conceptual model largely based upon the health belief model, this study sought to examine predictors of variability of health maintenance activity among older persons. The project included cross-sectional data drawn from the first phase of a multiyear panel study of elderly community residents. RESULTS: Results of ordinary least-squares and logistic regression analyses of seven types of health maintenance activity suggest that health beliefs are an important consideration but that other variables, namely, type of insurance plan and select sociodemographic factors, also had significant impacts. Another consistent finding was that each of the types of health maintenance activity was associated with different types of predictor variables. CONCLUSION: These findings suggest that in order for levels of health maintenance activity to be increased, intervention programs need to be targeted toward specific types of health beliefs and need to take into account the importance of social differences.

Age Factors↗
PubMed1992

Information dissemination and the cesarean birth rate. The Illinois experience.

A study was initiated to investigate the impact of information dissemination in Illinois upon the projected rise in the cesarean birth rate over the period from 1986 through 1988. The total cesarean birth rate in Illinois had not changed significantly during this period, whereas the rate of vaginal births after cesarean sections (VBAC) increased by 58.4% (p < .001). Information dissemination may have contributed to stemming an increase in the cesarean birth rate in Illinois while promoting VBAC deliveries.

Adolescent↗
PubMed1992

An analysis of physician utilization by elderly persons: systematic differences between self-report and archival information.

Elderly persons may over- or underreport their utilization of services, and systematic variance in this discrepancy may bias research findings. Therefore, this study analyzed the discrepancy between archival and self-report measures of physician utilization and examined the association of that discrepancy with health status and sociodemographic variables. Each older person underreported physician utilization by a net of .35 visits, but the total discrepancy was nearly two visits per person, or 65 percent of the number of self-reported visits. The multivariate findings indicate that underreports of utilization are smaller for those elderly persons with lower health status (as measured by disease history) and larger for those with higher levels of utilization. Those in poor health tend to overreport physician visits, and those with greater levels of utilization tend to have greater proportional reporting error. Self-reported measures of physician utilization should be considered in the context of the net error and the systematic nature of that error.

Activities of Daily Living↗
PubMed1992

Total quality management in a health care organization: how are employees affected?

Since the late 1980s, health care managers have exhibited a rapidly growing interest in large-scale total quality management (TQM) programs. This quasi-experimental study examines the effects of one such TQM program on employee job satisfaction, perceptions of organizational climate, and general opinions concerning the work situation. Two years after the TQM program had been introduced, responses of participants and nonparticipants were compared. Participants in the program exhibited a higher level of job satisfaction and more favorable opinions regarding both the organization and their work.

Academic Medical Centers↗
PubMed1991

A panel study of life stress, social support, and the health services utilization of older persons.

Interest in the health care needs and medical care utilization patterns of older persons has steadily increased in recent years. The major goal of this study was to examine the extent to which specific factors moderate the relationship between life stress exposure and subsequent health services utilization. Two groups of older persons (health maintenance organization members and fee-for-service clients) participating in a multiyear panel study comprised the study sample. Time-ordered, multivariate analyses of links among life stress exposure, moderating variables, and subsequent health services utilization indicate that the process may not be direct or simple to explain. There was no indication in this study that social support had any direct moderating effects on the time-ordered relationship between life stress exposure and the utilization of medical care services. However, the interaction of high life stress exposure and low social support was consistently linked to increased rates of health services utilization.

Adaptation, Psychological↗
PubMed1991

The cesarean birth rate: influence of hospital teaching status.

Knowledge of how cesarean birth rates vary by hospital characteristics may aid in understanding and perhaps modifying some of the structural and process components of newborn delivery services to decrease the necessity of birth by cesarean procedure. To examine the influence of select hospital characteristics, data on hospital newborn deliveries in Illinois for 1986 among women 10-50 years of age inclusive (N = 130,249) were obtained from computerized hospital discharge abstract files. Characteristics of the hospitals were obtained from the annual American Hospital Association survey. Adjusting for mother's age at delivery; presence of pregnancy, labor, and delivery complications; expected primary payer; and size of hospital, women delivering in hospitals with teaching status were less likely (odds ratio = 0.76, p less than .001, 95 percent CL: 0.73, 0.79) to have a primary cesarean birth than women delivering in hospitals without this designation. A significantly lower cesarean birth rate in teaching hospitals was also observed in women of all age groups, in Medicaid and non-Medicaid women, and for most categories of delivery complications. These data suggest the need to identify the programmatic, technologic, and manpower functions associated with hospital teaching status that could decrease the likelihood of a primary cesarean delivery. The study also suggests that changes aimed at the manner of diagnosis, monitoring, and/or management of pregnancy/delivery complications may reduce the cesarean birth rate because of large differences in the primary cesarean birth rate found between teaching and other hospitals for most categories of newborn delivery complications.

Adolescent↗
PubMed1988

Using ratios to measure hospital financial performance: can the process be simplified?

Evaluation of a hospital's financial condition is often contingent upon the analysis of financial ratios. This study of 114 Illinois hospitals sought to simplify the financial assessment process by exploring the empirical dimensions that underlie 25 financial ratios. Results of a factor analytic solution suggest that there are five underlying factors which account for approximately 77% of the total variance. Uses of summative scaled measures in health services financial management and research are discussed.

Accounting↗
PubMed1988

Managerial innovation in the hospital: an analysis of the diffusion of hospital cost-accounting systems.

Currently much interest is focused on the uses of cost-accounting systems within the hospital industry. Proponents frequently contend that such systems will help hospitals successfully adapt to new methods of financial reimbursement because they are essential to a number of major management functions, including competitive bidding, cost management, pricing, and profitability assessment. This article reports the results of a study conducted to examine the extent to which hospitals in a major market are actually beginning to use standard cost-accounting systems and identify factors that either aid or hinder the diffusion of these methods. Chief financial officers from 94 hospitals (83 percent response rate) participated in the study during the summer of 1986 where less than half of the hospitals (43 percent) had recently purchased a cost-accounting system. Detailed information about the interface of cost-accounting systems with other application systems and their specific management uses is reported.

Accounting↗
PubMed1988

Issues in nursing labor costs allocation.

Prospective payment has created a desire for improved internal operating efficiency by nurse executives and hospital administrators. Identifying nursing costs is one step in obtaining those efficiencies. Improved nursing cost allocation methods have been developed but these systems are costly to implement. Finding a low cost alternative to such systems would be valuable. The authors present direct comparisons of conventional daily and acuity based nursing labor costs allocation systems. Consistent with the findings of others, they demonstrate substantial differences between these methods. There is a high correlation of nursing labor costs with the patient's ancillary costs. However, the correlation is not sufficiently strong to use as a proxy for nursing costs. Consequently, nurse executives should strive to implement nursing cost allocation systems.

Ancillary Services, Hospital↗
PubMed1987

An analytical review of hospital financial performance measures.

Hospital administrators must have timely, valid, and interpretable financial information that allows them to make operational decisions in response to the threats of the changing health care environment. Aggregate indexes that reflect dimensions of hospital financial performance and simplify the information in financial ratios are needed to aid in decision making. This article reviews the development and use of hospital financial performance measures and lays the groundwork for research into deriving a multidimensional measure.

Decision Support Systems, Management↗
PubMed1986

Redefining the hospital-physician relationship under prospective payment.

In response to the rapid increases in the costs of health care in the 1970s and early 1980s, the Medicare prospective payment system (PPS) now places hospitals at financial risk for services provided to their Medicare patients. Although hospital boards and administrators can pursue a variety of steps to reduce the cost of care, the hospital must ultimately rely on its medical staff for fundamental change. This paper describes the incentive conflicts that face hospitals and physicians as a result of PPS and identifies a series of options with which hospitals and their medical staff members can resolve the conflict.

Cost Control↗