Biomedical subjects

Gary J Young

Publications and source records attributed to Gary J Young.

12 recordsLinked to original sources

PubMed2006

Provider attitudes toward pay-for-performance programs: development and validation of a measurement instrument.

OBJECTIVE: To develop an instrument for assessing physician attitudes toward quality incentive programs, and to assess its reliability and validity. DATA SOURCES: Study involved primary data collection. A 40-item paper and pencil survey of primary care physicians in Rochester, New York, and Massachusetts was conducted between May 2004 and December 2004. Seven-hundred and ninety-eight completed questionnaires were received, representing a response rate of 32 percent (798/2,497). STUDY DESIGN: Based on an extensive review of the literature and discussions with experts in the field, we developed a conceptual framework representing the features of pay-for-performance (P4P) programs hypothesized to affect physician behavior in that context. A draft questionnaire was developed based on that conceptual model and pilot tested in three groups of physicians. The questionnaire was modified based on the physician feedback, and the revised version was distributed to 2,497 primary care physicians affiliated with two of the seven sites participating in Rewarding Results, a national evaluation of quality target and financial incentive programs. DATA COLLECTION: Respondents were randomly divided into a derivation and a validation sample. Exploratory factor analysis was applied to the responses of the derivation sample. Those results were used to create scales in the validation sample, and these were then subjected to multitrait analysis (MTA). One scale representing physicians' perception of the impact of P4P on their clinical practice was regressed on the other scales as a test of construct validity. PRINCIPAL FINDINGS: Seven constructs were identified and demonstrated substantial convergent and discriminant validity in the MTA: awareness and understanding, clinical relevance, cooperation, unintended consequences, control, financial salience, and impact. Internal consistency reliabilities (Cronbach's alpha coefficients) ranged from 0.50 to 0.80. A statistically significant 25 percent of the variation in perceived impact was accounted for by physician perceptions of the other six characteristics of P4P programs. CONCLUSIONS: It is possible to identify and measure the key salient features of P4P programs using a valid and reliable 26-item survey. This instrument may now be used in further studies to better understand the impact of P4P programs on physician behavior.

Attitude of Health Personnel↗

PubMed2006

Psychiatrists' self-reported adherence to evidence-based prescribing practices in the treatment of schizophrenia.

OBJECTIVE: This study sought to identify relationships between psychiatrists' characteristics and their self-reported adherence to evidence-based recommendations regarding antipsychotic use in the treatment of schizophrenia. METHODS: Surveys were sent to 1,757 psychiatrists affiliated with the Veterans Health Administration. Respondents (N=696) reported their own adherence to two recommended prescribing practices for using antipsychotics. RESULTS: Several psychiatrists' characteristics were associated with greater adherence, including midcareer status, male sex, a caseload with a larger proportion of patients with schizophrenia, and use of current information from scientific literature or from drug company detailing. CONCLUSIONS: This study identified several characteristics of psychiatrists that may affect their adherence to evidence-based prescribing practices for patients with schizophrenia.

Antipsychotic Agents↗

PubMed2006

Incentive implementation in physician practices: A qualitative study of practice executive perspectives on pay for performance.

Pay-for-performance (P4P) programs offer health care providers financial incentives to achieve predefined quality targets. Practice executives sit at a key nexus point for determining how P4P programs are implemented in physician practices. Using a qualitative interview design, this article examines the role practice executives play in the implementation of P4P programs and how their perspectives and decisions can influence the success of these programs. The authors identified five key findings related to practice executives' views on P4P: quality incentives are better than utilization incentives, quality incentives are bonus rewards, quality incentives are agents for change, providers do not feel they have control over attaining quality targets, and the ways in which quality is measured are problematic. The authors discuss five different ways in which practice executives distribute rewards to physicians. These findings may help payers more effectively design and implement financial rewards for quality.

Attitude of Health Personnel↗

PubMed2005

The effect of network arrangements on hospital pricing behavior.

The Department of Justice (DOJ) and the Federal Trade Commission (FTC) have taken a recent interest in collaborations among hospitals that do not entail common ownership, despite the lack of scientific evidence regarding effects of these hospital "networks" on market competition. This paper explores the relationship between hospital networks and pricing behavior in California during a period of dynamic increase in hospital network activity there. Using Herfindahl-Hirschman Indexes (HHI) market definitions based on patient origin and accounting for network relationships, we find a positive network effect on hospital pricing. However, this result appears to be generated primarily by system-owned hospitals that form networks to provide particular services jointly.

Hospital Costs↗

PubMed2005

Health plan liability and ERISA: the expanding scope of state legislation.

The federal Employee Retirement Income Security Act of 1974 (ERISA) supersedes state laws as they relate to employer-based health care plans. Thus, cases brought under ERISA are heard in federal courts. We examined the intent, scope, and impact of recent laws passed in 10 states attempting to expand the legal rights of health plan enrollees to sue their plans. In June 2004, the US Supreme Court ruled that state-law causes of action brought under the Texas Health Care Liability Act involving coverage decisions by Aetna Health Inc and CIGNA Health Care of Texas were preempted by ERISA. The full implications of this decision are not evident at present.

Compensation and Redress↗

PubMed2004

Teamwork culture and patient satisfaction in hospitals.

BACKGROUND: A growing line of research indicates a positive relationship between a healthcare organization's culture and various performance measures. In these studies, a key cultural characteristic is the emphasis placed on teamwork. None of the studies, however, have examined teamwork culture relative to patient satisfaction, which is now 1 of the most widely used performance measures for healthcare organizations. OBJECTIVES: This study investigated the relationship between teamwork culture of hospitals and patient reports of their satisfaction with the care they received. METHODS: The study setting was the Veterans Health Administration (VHA), Department of Veterans Affairs. The study sample consisted of 125 VHA hospitals for which independent and valid sources of data for culture and patient satisfaction were obtained. Each hospital's culture was assessed relative to 4 dimensions: teamwork, entrepreneurial, bureaucratic, and rational. Patient satisfaction data were available for both inpatient and outpatient settings. RESULTS: Results from multivariate regression analyses indicated a significant and positive relation between teamwork culture and patient satisfaction for inpatient care, and a significant and negative relation between bureaucratic culture and patient satisfaction for inpatient care. Additional analyses revealed an almost 1 standard deviation difference in patient satisfaction scores between hospitals in the top third and bottom third of the distribution for the teamwork culture measure. CONCLUSION: Study results suggest that hospitals and possibly other healthcare organizations should strive to develop a culture emphasizing teamwork and deemphasizing those aspects of bureaucracy that are not essential to assuring efficiency and quality care.

Analysis of Variance↗

PubMed2004

Federal tax-exemption requirements for joint ventures between nonprofit hospital providers and for-profit entities: form over substance?

This article discusses the IRS rule on hospital joint ventures and related legal developments. The central thesis is that the IRS's emphasis on operational control is misplaced from both a legal and a policy perspective, and reflects a decidedly strong preference for the form of a joint venture's governance over the substance of its charitable and community service activities. More specifically, the article challenges the IRS position that the rule is a corollary of existing tax law principles. Additionally, social science research is presented to demonstrate that the rule is not likely to promote, and may in fact undermine, United States health policy objectives.

Hospital-Physician Joint Ventures↗

PubMed2003

Quality improvement implementation in the nursing home.

OBJECTIVE: To examine quality improvement (QI) implementation in nursing homes, its association with organizational culture, and its effects on pressure ulcer care. DATA SOURCES/STUDY SETTING: Primary data were collected from staff at 35 nursing homes maintained by the Department of Veterans Affairs (VA) on measures related to QI implementation and organizational culture. These data were combined with information obtained from abstractions of medical records and analyses of an existing database. STUDY DESIGN: A cross-sectional analysis of the association among the different measures was performed. DATA COLLECTION/EXTRACTION METHODS: Completed surveys containing information on QI implementation, organizational culture, employee satisfaction, and perceived adoption of guidelines were obtained from 1,065 nursing home staff. Adherence to best practices related to pressure ulcer prevention was abstracted from medical records. Risk-adjusted rates of pressure ulcer development were calculated from an administrative database. PRINCIPAL FINDINGS: Nursing homes differed significantly (p<.001) in their extent of QI implementation with scores on this 1 to 5 scale ranging from 2.98 to 4.08. Quality improvement implementation was greater in those nursing homes with an organizational culture that emphasizes innovation and teamwork. Employees of nursing homes with a greater degree of QI implementation were more satisfied with their jobs (a 1-point increase in QI score was associated with a 0.83 increase on the 5-point satisfaction scale, p<.001) and were more likely to report adoption of pressure ulcer clinical guidelines (a 1-point increase in QI score was associated with a 28 percent increase in number of staff reporting adoption, p<.001). No significant association was found, though, between QI implementation and either adherence to guideline recommendations as abstracted from records or the rate of pressure ulcer development. CONCLUSIONS: Quality improvement implementation is most likely to be successful in those VA nursing homes with an underlying culture that promotes innovation. While QI implementation may result in staff who are more satisfied with their jobs and who believe they are providing better care, associations with improved care are uncertain.

Aged↗

PubMed2002

Competition among hospitals for HMO business: effect of price and nonprice attributes.

OBJECTIVE: To investigate patterns of competition among hospitals for the business of health maintenance organizations (HMOs). The study focused on the relative importance of hospital price and nonprice attributes in the competition for HMO business. DATA SOURCES/STUDY SETTING: The study capitalized on hospital cost reports from Florida that are unique in their inclusion of financial data regarding HMO business activity. The time frame was 1992 to 1997. STUDY DESIGN: The study was designed as an observational investigation of acute care hospitals. PRINCIPAL FINDINGS: Results indicated that a hospital's share of HMO business was related to both its price and nonprice attributes. However, the importance of both price and nonprice attributes diminished as the number of HMOs in a market increased. Hospitals that were market share leaders in terms of HMO business (i.e., 30 percent or more market share) were superior, on average, to their competitors on both price and nonprice attributes. CONCLUSIONS: Study results indicate that competition among hospitals for HMO business involves a complex set of price and nonprice attributes. The HMOs do not appear to focus on price alone. Hospitals likely to be the most attractive to HMOs are those that can differentiate themselves on the basis of nonprice attributes while being competitive on price as well.

Catchment Area, Health↗

PubMed2002

The financial experience of hospitals with HMO contracts: evidence from Florida.

In this paper, we report results from the first study to systematically examine trends in the financial experience of hospitals with health maintenance organization (HMO) contracts. The longitudinal analysis (1990 through 1997) focused on hospitals in Florida. Hospital operating margins for HMO contracts grew tighter toward the end of the study period when the median margin was less than 1%. Teaching hospitals had operating margins that on average were below that of their nonteaching counterparts. The continued growth of HMOs and other managed care entities may have important implications for the future financial viability of U.S. hospitals.

Catchment Area, Health↗

PubMedDate not supplied

The effects of changes in nursing home staffing on pressure ulcer rates.

OBJECTIVE: To examine the relationships between various components of nursing home staffing (total staffing levels and staff mix, staff turnover, and changes in staffing patterns) to an important measure of quality, risk-adjusted rates of pressure ulcer development. DESIGN, SETTING, AND MEASUREMENTS: Staffing records from 35 Department of Veterans Affairs (DVA) nursing homes were reviewed and nursing home administrators from each of the facilities were interviewed. Incidence rates for pressure ulcers were obtained from DVA's national long-term care database and risk adjusted using patients' baseline characteristics. The relationships of risk-adjusted pressure ulcer rates to staffing patterns were tested. RESULTS: Although there was no linear association between staffing levels and pressure ulcer rates, data analysis revealed a strong trend (P = .07) that among the nursing homes meeting staffing guidelines, 60% were among the best performing. Ten nursing homes reduced staffing levels from their baseline levels at the beginning of the study and/or changed their staffing mix by replacing licensed personnel with nursing assistants. This change was associated with a 2.1% higher rate of pressure ulcer development (P = .004). CONCLUSION: Changes in nursing home staffing patterns (either a decrease in overall staffing levels or a change in staffing mix) are related to the quality of nursing home care. Staff stability is associated with better outcomes.

Cross-Sectional Studies↗

PubMedDate not supplied

Conceptual issues in the design and implementation of pay-for-quality programs.

This article identifies and discusses key conceptual issues in designing and implementing pay-for-quality programs. Such programs offer financial incentives to providers for achieving predefined quality targets. The purpose of the article is to provide health care professionals with a framework for designing, implementing, and evaluating pay-for-quality programs. Examples are drawn from the Rewarding Results demonstration project for which the authors serve as the national evaluation team.

Physician Incentive Plans↗