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Biomedical subjects

Gloria J Bazzoli

Publications and source records attributed to Gloria J Bazzoli.

At least 19 recordsLinked to original sources
PubMed2006

Hospitals' responses to nurse staffing shortages.

Hospitals have used a mix of short-term and long-term strategies to deal with nurse shortages, particularly efforts emphasizing nurse education, competitive compensation, and temporary staff. Interviews with health care leaders from Round Five of the Community Tracking Study indicate that these activities, in conjunction with other factors, have assisted in reducing shortages of hospital nurses. However, hospitals' actions have increased costs and raised concerns about their potential impact on patient care. Additionally, a large degree of doubt exists among hospitals about their ability to meet future nursing needs.

Education, Nursing, Continuing↗
PubMed2006

The transition from excess capacity to strained capacity in U.S. hospitals.

After many years of concern about excess hospital capacity, a growing perception exists that the capacity of some hospitals now seems constrained. This article explores the reasons behind this changing perception, looking at the longitudinal data and in-depth interviews for hospitals in four study sites monitored by the Community Tracking Study of the Center for Studying Health System Change. Notwithstanding the differences for individual hospitals, we observed that adjustments to the supply of hospital services tend to be slow and out of sync with changes in the demand for hospital services. Those hospitals reporting capacity problems are often teaching hospitals, located near previously closed facilities or in population growth areas. These findings suggest therefore that approaches to dealing with capacity problems might best focus on better matching individual hospitals' supply and demand adjustments.

Delivery of Health Care↗
PubMed2006

The effect of changes in hospital reimbursement on nurse staffing decisions at safety net and nonsafety net hospitals.

RESEARCH OBJECTIVE: The financial savings from the Balanced Budget Act (BBA) are attractive to policy makers, but such savings come at a cost. We measure changes in nurse staffing at hospitals related to potential declines in reimbursement through the BBA. STUDY DESIGN: Following Hadley, Zuckerman, and Feder (1989), we define a fiscal pressure index (FPI) to measure the differential effect of the BBA. We estimate the effect of the FPI on the number of full-time equivalent registered nurses (RN) and licensed practical nurses (LPN) per adjusted patient day using American Hospital Association (AHA) data of a panel of hospitals from 1996 to 2001. The AHA data are combined with the Area Resource Files and health maintenance organizations penetration data. We control for hospital heterogeneity using fixed effects. POPULATION STUDIED: All urban short-term general hospitals that responded to the staffing and uncompensated care questions in the AHA survey between 1996 and 2001. We define safety net hospitals as those with a high ratio of uncompensated costs to total hospital expenses (see, e.g., Zuckerman et al. 2001). PRINCIPAL FINDINGS: We find that the nonsafety net hospitals that were most susceptible to the provisions of the BBA experienced a decline in RN staffing ratios about twice the rate of the nonsafety net hospitals that were least susceptible to the BBA. We are unable to detect an effect of the BBA on staffing at safety net hospitals. CONCLUSIONS: RN and LPN staffing levels per adjusted patient day declined, on average, between 1996 and 2001. Within the context of the general decline, we find that RN staffing per adjusted patient day declined even more at nonsafety net hospitals that were most susceptible to lower reimbursement related to the BBA. Thus, there was a small but statistically significant incremental effect of potential BBA losses on RN staffing at hospitals that were expected to be affected most. This incremental decline represented about a 6 percent increase in nurse workload that in isolation might not affect quality. Nevertheless, the BBA contributed to the contemporaneous trends toward higher nurse workloads that could have deleterious effects on quality. In contrast, safety net hospitals did not respond to the provisions of the BBA by reducing staffing ratios. This conclusion is tempered by the fact that we have few safety net hospitals in the sample.

Algorithms↗
PubMed2006

The influence of health policy and market factors on the hospital safety net.

OBJECTIVE: To examine how the financial pressures resulting from the Balanced Budget Act (BBA) of 1997 interacted with private sector pressures to affect indigent care provision. DATA SOURCES/STUDY SETTING: American Hospital Association Annual Survey, Area Resource File, InterStudy Health Maintenance Organization files, Current Population Survey, and Bureau of Primary Health Care data. STUDY DESIGN: We distinguished core and voluntary safety net hospitals in our analysis. Core safety net hospitals provide a large share of uncompensated care in their markets and have large indigent care patient mix. Voluntary safety net hospitals provide substantial indigent care but less so than core hospitals. We examined the effect of financial pressure in the initial year of the 1997 BBA on uncompensated care for three hospital groups. Data for 1996-2000 were analyzed using approaches that control for hospital and market heterogeneity. DATA COLLECTION/EXTRACTION METHODS: All urban U.S. general acute care hospitals with complete data for at least 2 years between 1996 and 2000, which totaled 1,693 institutions. PRINCIPAL FINDINGS: Core safety net hospitals reduced their uncompensated care in response to Medicaid financial pressure. Voluntary safety net hospitals also responded in this way but only when faced with the combined forces of Medicaid and private sector payment pressures. Nonsafety net hospitals did not exhibit similar responses. CONCLUSIONS: Our results are consistent with theories of hospital behavior when institutions face reductions in payment. They raise concern given continuing state budget crises plus the focus of recent federal deficit reduction legislation intended to cut Medicaid expenditures.

Budgets↗
PubMed2006

Do specialty hospitals promote price competition?

Policy makers continue to debate the correct public policy toward physician-owned heart, orthopedic and surgical specialty hospitals. Do specialty hospitals offer desirable competition for general hospitals and foster improved quality, efficiency and service? Or do specialty hospitals add unneeded capacity and increased costs while threatening the ability of general hospitals to deliver community benefits? In three Center for Studying Health System Change (HSC) sites with significant specialty hospital development--Indianapolis, Little Rock and Phoenix--recent site visits found that purchasers generally believe specialty hospitals are contributing to a medical arms race that is driving up costs without demonstrating clear quality advantages.

Arizona↗
PubMed2005

Adoption of hospital case management: economic and institutional influences.

Case management became prevalent in US hospitals in the 1990s and is believed to be beneficial in controlling resource utilization, improving quality of care, reducing variation of care processes and enhancing both patient and staff satisfaction. This research investigates the adoption of case management by US hospitals at three time periods: 1994, 1997, and 2000. We propose that both economic and institutional factors influence the adoption of this management innovation, with economic factors being more influential in early and mid-periods (1994-1997) and institutional factors being more influential in later periods (after 1997). Using American Hospital Association Annual Survey Data and community data from the Area Resources File, we assess the relationship of baseline (1994) hospital and market characteristics to the likelihood of early adoption compared to late adoption, and mid-adoption compared to late adoption. We confirm that both economic and institutional forces influence the likelihood of early and mid-period adoption of case management compared to late adoption. We conclude that institutional influences aimed at achieving or maintaining legitimacy may be as strong a motivator for hospitals to adopt case management as are economic incentives. Implications for practice and further research are discussed.

Case Management↗
PubMed2004

Reexamining organizational configurations: an update, validation, and expansion of the taxonomy of health networks and systems.

OBJECTIVES: To (a) assess how the original cluster categories of hospital-led health networks and systems have changed over time; (b) identify any new patterns of cluster configurations; and (c) demonstrate how additional data can be used to refine and enhance the taxonomy measures. DATA SOURCES; 1994 and 1998 American Hospital Association (AHA) Annual Survey of Hospitals. STUDY DESIGN: As in the original taxonomy, separate cluster solutions are identified for health networks and health systems by applying three strategic/structural dimensions (differentiation, integration, and centralization) to three components of the health service/product continuum (hospital services, physician arrangements, and provider-based insurance activities). DATA EXTRACTION METHODS: Factor, cluster, and discriminant analyses are used to analyze the 1998 data. Descriptive and comparative methods are used to analyze the updated 1998 taxonomy relative to the original 1994 version. PRINCIPAL FINDINGS: The 1998 cluster categories are similar to the original taxonomy, however, they reveal some new organizational configurations. For the health networks, centralization of product/service lines is occurring more selectively than in the past. For the health systems, participation has grown in and dispersed across a more diverse set of decentralized organizational forms. For both networks and systems, the definition of centralization has changed over time. CONCLUSIONS: In its updated form, the taxonomy continues to provide policymakers and practitioners with a descriptive and contextual framework against which to assess organizational programs and policies. There is a need to continue to revisit the taxonomy from time to time because of the persistent evolution of the U.S. health care industry and the consequent shifting of organizational configurations in this arena. There is also value in continuing to move the taxonomy in the direction of refinement/expansion as new opportunities become available.

American Hospital Association↗
PubMed2004

Two decades of organizational change in health care: what have we learned?

The 1980s and 1990s witnessed a substantial wave of organizational restructuring among hospitals and physicians, as health providers rethought their organizational roles given perceived market imperatives. Mergers, acquisitions, internal restructuring, and new interorganizational relationships occurred at a record pace. Matching this was a large wave of study and discourse among health services researchers, industry experts, and consultants to understand the causes and consequences of organizational change. In many cases, this literature provides mixed signals about what was accomplished through these organizational efforts. The purpose of this review is to synthesize this diverse literature. This review examines studies of horizontal consolidation and integration of hospitals, horizontal consolidation and integration of physician organizations, and integration and relationship development between physicians and hospitals. In all, around 100 studies were examined to assess what was learned through two decades of research on organizational change in health care.

Delivery of Health Care↗
PubMed2003

The effect of urban hospital closure on markets.

We measure the effect of urban hospital closure on the operating efficiency of the remaining hospitals in the local market. Closure of a hospital other than the least efficient can be detrimental to social welfare because treatment costs will be higher at surviving hospitals. The results show that hospital closure has led to an evolutionary increase in efficiency in urban markets. The hospitals that closed were less efficient at baseline, and after closure their competitors realized lower costs per adjusted admission through an increase in inpatient admissions and emergency room visits. Overall, we estimate that costs per adjusted admission declined by 2-4% for all patients and about 6-8% for patients who would have been treated at the closed hospital.

Catchment Area, Health↗
PubMed2003

Whom do they serve? Community responsiveness among hospitals affiliated with health systems and networks.

BACKGROUND: As the US hospital sector becomes more consolidated, concerns have been raised about whether participation in health systems and health networks may reduce community hospitals' response to community health needs. OBJECTIVES: The following were examined: (1) whether freestanding hospitals and system- and network-affiliated hospitals differed in their level of community responsiveness; and (2) how systems and networks affect the level of community responsiveness in community hospitals. METHODS: A cross-sectional design was used. The dependent variables included community orientation, provision of community health services, and Medicaid inpatient load. Independent variables were system/network membership and policy and organizational attributes of the health system/network. RESULTS: With few exceptions, a significantly greater involvement of system and network hospitals was found in providing community health services and inpatient services to Medicaid patients, relative to freestanding hospitals. Community health mission of the system/network and the involvement of the system/network in community partnerships or coalitions were positively related to community orientation in member hospitals. Hospitals affiliated with health systems and hospitals affiliated with more diversified systems or networks tended to provide more community health services. Community health mission of the health system or network was related to greater Medicaid inpatient load in member hospitals. CONCLUSIONS: In general, affiliation with health systems and health networks appears to be positively related to community responsiveness in community hospitals. Research future can examine whether such greater community responsiveness is because of the development and improvement of communication channels among elements of health systems and health networks and the ability of health systems and health networks to build a platform of general, administrative services to link various constituencies.

Community Health Services↗
PubMed2003

Sustainability of collaborative capacity in community health partnerships.

Sustainability is a key requirement for partnership success and a major challenge for such organizations. Despite the critical importance of sustainability to the success of community health partnerships and the many threats to sustainability, there is little evidence that would provide partnerships with clear guidance on long-term viability. This article attempts to (1) develop a conceptual model of sustainability in community health partnerships and (2) identify potential determinants of sustainability using comparative qualitative data from four partnerships from the Community Care Network (CCN) Demonstration Program. Based on a grounded theory examination of qualitative data from the CCN evaluation, the authors hypothesize that there are five primary attributes/ activities of partnerships leading to consequential value and eventually to sustainability of collaborative capacity. They include outcomes-based advocacy, vision-focus balance, systems orientation, infrastructure development, and community linkages. The context in which the partnership operates provides the conditions for determining the appropriateness and relative impact of each of the factors related to creating consequential value in the partnership.

Community Networks↗
PubMed2003

Using theories of action to guide national program evaluation and local strategy in the community care network demonstration.

Evaluations of multisite community-based projects are notoriously difficult to conceptualize and conduct. Projects may share an overarching vision but operate in varying contexts and pursue different initiatives. One tool that can assist evaluators facing these challenges is to develop a "theory of action" (TOA) that identifies critical assumptions regarding how a program expects to achieve its goals. Community Care Network (CCN) evaluators used the TOA to refine research questions, define key variables, relate questions to each other, and identify when we might realistically expect to observe answers. In this article, the authors present their national-level CCN TOA. They also worked with sites to help them "surface" their local TOA; the article analyzes the results to determine the content, clarity, extent of evidence base, and strategic orientation of theories articulated by different sites.

Community Networks↗
PubMed2003

Collaborative initiatives: where the rubber meets the road in community partnerships.

Amajor challenge facing a community partnership is the implementation of its collaborative initiatives. This article examines the progress Community Care Networks (CCNs) made in implementing their initiatives and factors that helped or hindered their progress. Study findings suggest that partnership progress is affected by external market and regulatory factors beyond the control of the partnership, the availability of local community resources to support efforts, the scope and intensity of tasks associated with an initiative, expansion of the partnership to include new members, and the balance of work between partners and paid partnership staff. Implications of study findings for community partnerships include (1) recognizing and anticipating dependency on others, (2) acknowledging that the tasks that lie ahead will be more complicated than imagined, (3) maintaining focus on priorities, and (4) learning to be adaptive and creative, given a constantly changing environment.

Community Health Services↗
PubMed2003

Community care networks: linking vision to outcomes for community health improvement.

This article examines the relationship between progress toward the Community Care Network (CCN) vision and "intermediate outcomes" of 25 community-based health partnerships (CCNs). Specific components of the CCN vision were community accountability, community health focus, creation of a seamless service continuum, and managing under limited resources. Four community outcome dimensions were evaluated: access, cost, health, and quality of service delivery integration. Overall progress toward the CCN vision was significantly positively related to average intermediate outcome score and most highly correlated with two dimensions: access and quality of service integration. Qualitative analysis suggests that CCN sites accomplished the most along two dimensions--access and health--noting that intermediate health outcomes generally were in health assessment and information rather than actual health status improvement. Keys to outcome achievement appear to be (1) clearly focused intervention; (2) explicit, ongoing outcome measurement; and (3) strong integration of separate intervention components.

Community Health Services↗
PubMed2003

Members' perceptions of community care network partnerships' effectiveness.

Investment in voluntary partnerships raises important questions: Should we invest in collaboration in moving toward the goals of health system redesign? What makes collaborative groups effective? Given the voluntary nature of these partnerships, membership perceptions of their experiences and the partnership's effectiveness should be important predictors of success. This article provides a preliminary analyses of perceived effectiveness of participants' perceptions of their own partnership, particularly focusing on leadership, conflict management, decision-making dynamics, and the breadth and depth of partnership membership. Members' perceptions that the partnership membership was "sufficiently broad to accomplish objectives" had a negative and highly significant relationship to perceived effectiveness. Members' perceptions about leadership being ethical was positively related to perceived effectiveness while perceptions that the leadership was not effective a keeping the group focused was negatively related to perceived effectiveness.

Community Networks↗
PubMed2003

U.S. hospital industry restructuring and the hospital safety net.

The U.S. hospital industry was reshaped during the 1990s, with many hospitals becoming members of health systems and networks. Our research examines whether safety net hospitals (SNHs) were generally included or excluded from these arrangements, and the factors associated with their involvement. Our analysis draws on the earlier work of Alexander and Morrisey (1988), and not only studies factors affecting SNH participation in multihospital arrangements but also updates their earlier study. We constructed measures for hospital market conditions, management, and mission, and examined network and system affiliation patterns between 1994 and 1998. Our findings suggest that larger and more technically advanced hospitals joined systems in the 1990s, which contrasts with 1980s findings that smaller, financially weak institutions joined systems. Further, SNH participation in networks and systems was more common when hospitals faced less market pressure and where only a limited number of unaffiliated hospitals remained. If networks and systems are key parties in negotiating with private payers, SNHs may be going it alone in these negotiations in highly competitive markets.

Decision Making, Organizational↗
PubMed2002

Hospital reorganization and restructuring achieved through merger.

This article examines hospital reorganization and restructuring activities following merger for two study periods: 1983-1988 and 1989-1996. In both periods, hospitals rated strengthening hospital financial position as the most important reason for merger. There were also similarities in reorganizing actions, especially reductions in service duplication, consolidation of departments and programs, reductions in medical and support FTEs, and reductions in administrative staffing. Hospital mergers during 1989-1996, however, focused increasingly on reducing nursing FTEs and less on converting acquired hospitals to new service lines.

Centralized Hospital Services↗