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Biomedical subjects

J E Rohrer

Publications and source records attributed to J E Rohrer.

At least 55 records · Page 3Linked to original sources
PubMed1995

Geographic variation in primary care visits in Iowa.

OBJECTIVE: This study investigates the determinants of primary care office visit rates. DATA SOURCES: Blue Cross and Blue Shield of Iowa subscriber information was sorted by residence into geographic health service areas. Cost-sharing information was also obtained from Blue Cross. Physician supply data were obtained from The University of Iowa, Office of Community-Based Programs. Hospital data were reported by the Iowa Hospital Association. STUDY DESIGN: Cases were classified into ambulatory care groups (ACGs). Use rates were computed for each group in each service area. Ordinary least squares regression models were developed to model geographic variation in each ACG-specific primary care visit rate. PRINCIPAL FINDINGS: Regression models were not significant for five out of eleven ACGs studied. Out-of-pocket expense significantly affected utilization in three out of six. The number of primary care practices per capita had a significant effect on utilization in two ACGs. The supply of hospital outpatient services was significant in one ACG. CONCLUSIONS: Study findings reveal that some ACGs are price-sensitive and some are not. Policies aimed at changing levels of primary care use should taken into account whether varying cost-sharing will influence consumer behavior in the desired direction.

Adult↗
PubMed1993

Organizational predictors of outcomes of long-stay nursing home residents.

Analysis of physical function as a measure of nursing home resident outcomes in 10 nursing homes revealed that organizational design variables were important. Results were consistent with contingency theory, which posits that to maximize performance organizational structure should be adjusted to variations in task difficulty and variability. This study revealed that better resident outcomes sometimes are achieved in faster-paced nursing homes when employees are less closely supervised and when the basis for job assignment is clear and consistent. A more hierarchical structure may be effective when workload is heavy. However, when workload and pace are held constant, better outcomes are associated with smaller hierarchies and non-specific job assignment. Implications for management and future research are discussed.

Activities of Daily Living↗
PubMed1992

Shifting the financial burden: the VA ambulatory care discharge policy.

The Department of Veterans Affairs is a primary source of health care services for many of the nation's uninsured and underinsured. Changes in congressionally mandated eligibility criteria and limited increases in appropriations have forced the Department to adopt a policy of discharging chronic but stable outpatients who have been treated for non-service-connected health conditions. Survey data from one VA medical center suggest that many, but not all, of those discharged: 1) have either Medicare or private insurance coverage; 2) have not sought or found alternative physician services in their local communities; 3) have discontinued taking previously prescribed medications; 4) report worsened health status since discharge; and, 5) have been hospitalized. In general, discharged patients from the lowest income group report the greatest financial access barriers. Preliminary analyses of the discharge policy suggest the potential for decreased access to needed medical services due to financial factors and cost-shifting from the VA to patients and other federal, state and local payers and providers.

Chronic Disease↗
PubMed1992

The role of the generalist in health administration education programs.

Health administration education programs frequently have at least one faculty member who is a nondisciplinary specialist in health services rather than a member of a mainline discipline such as economics, psychology, or sociology. Such personnel perform valuable functions in research areas requiring multidisciplinary teams and extensive knowledge about health services delivery. Policy analysis, planning, organizational analysis, and program evaluation are examples of research areas where the generalist can be of value. Generalists may have more knowledge of health services than other faculty and thus can insure that research findings are realistic. Second, the generalists' broad orientation is conducive to interdisciplinary research. Third, they often are well suited to lead research teams. And finally, generalists are often better equipped to explain how research findings are useful in the practice of health administration, thus increasing the relevance of health administration programs.

Faculty↗
PubMed1991

Implementing EACHs (essential access community hospitals) and RPCHs (rural primary care hospitals) on a statewide basis: a preliminary analysis.

Declining hospital utilization has created excess hospital capacity in rural areas, has depressed occupancy rates, and threatens the financial viability of rural hospitals. Access to hospital care could be reduced and rural economies damaged if rural hospitals close. The federal Essential Access Community Hospital (EACH) demonstration program is an attempt to address these issues by establishing regional hospital networks. A preliminary analysis of the impact of state-wide implementation of the EACH program in Iowa suggests that about 60% of rural hospital beds and about 28% of all hospital beds would be eliminated. The EACH program could well prove difficult to implement because of the need to select hospitals for reduced services.

Bed Occupancy↗
PubMed1991

Dilemmas surrounding the identification of essential rural hospitals.

Criteria are needed for use in designating some rural hospitals as essential so that they may receive state or federal assistance. Three types of criteria are considered in this analysis: hospital volume measures, hospital competitiveness measures, and community need measures. The criteria sets reflect different assumptions about the relationship between need and demand for health services. Analysis of available data reveals that neither hospital volume nor competitiveness is correlated with community need, meaning that different hospitals would be designated as essential under each system. Implications are discussed.

Bed Occupancy↗
PubMed1990

Supply-induced demand for hospital care.

Preliminary analysis of hospital utilization data indicates that Roemer's Law may still be operative in rural Iowa: counties with more hospital beds per capita have more hospital utilization per capita. However, when patient origin data are analyzed findings are entirely different. Bed supply is not related to utilization rates in Iowa counties. Instead, the number of unique hospital services is associated with higher utilization rates. The impact of this characteristic of hospital supply, however, is much weaker than the original Roemer effect. The contradiction of these findings with Roemer's Law is apparently a result of a methods effect: use of hospital utilization data which are not derived from actual population experience reveals a relationship which is a statistical artifact. The data also reveal that suburban counties have higher utilization rates than either rural or urban (MSA core) counties.

Bed Occupancy↗
PubMed1989

The effects of mental dysfunction on nursing home care.

Many of the residents of nursing homes have mental health problems. These can be expected to affect the quantity of nursing care they require. Analysis of 285 nursing home residents, most of whom had moderate behavioral problems, reveals that their mental health characteristics can be summarized in terms of three factors: cognition, affect and aggressiveness. Cognitive deficits significantly increase the quantity of basic nursing services patients require. Negative affect increases the amount of psychosocial care received. The results of the analysis are interpreted as indicating that nursing home reimbursement systems should account for moderate as well as severe mental illness.

Aged↗
PubMed1989

The effects of nursing and physician services: some preliminary results.

This paper examines the relationship between the future staff cost of nursing home patient care and the type and level of nursing and medical services these patients receive. Nursing times are grouped into eight categories based on a principal components analysis. We then investigate the effect of the level and type of nursing care and of physicians' services given in an earlier period on the staff cost of nursing home care in a later period. Psychosocial nursing care (emotional support, education) and number of physicians' visits given in the earlier period were found to be negatively associated with costs in a later period. The most powerful predictor of future costs were actual costs in the earlier period. These results suggest that more investment in psychosocial nursing effort and physicians' services may yield modest cost savings in future nursing home patient care.

Activities of Daily Living↗
PubMed1989

Health analytics: the road not traveled.

Review of the development of health administration by chronological examination of textbooks reveals that the definition of health administration has changed. In the process of conversion to a business management model, health analytics have been undervalued by health administration programs. Health analytics can be defined as "techniques for the analysis of health services that require in-depth understanding of the workings of the health system and are grounded in a rational-comprehensive public health model of health administration." Health analytics are not simply the application of business techniques to health services. Quality assessment and planning methods are examples of two important aspects of health administration that are addressed by health analytics.

Epidemiologic Methods↗
PubMed1989

The secret of medical management.

A review of the research on group practices punctures the myth of physician autonomy in hospitals and opens the way for administrators to join in controlling the patient care process.

Interprofessional Relations↗
PubMed1989

Closing rural hospitals: reducing "institutional bias" or denial of access?

The existence of many small rural hospitals in the United States may appear to be an expression of institutional bias in the health care system. Thus the impending demise of a large proportion of these facilities because of their inability to compete with urban centers may seem to be appropriate. However, in the absence of alternatives to institutional care or mechanisms for systematic movement of patients to urban centers, rural hospital closure could genuinely reduce access.

Efficiency↗
PubMed1988

Cost effectiveness. How should it be determined?

The purpose of this article is to compare three commonly used indices of cost-effectiveness: the cost-effectiveness ratio, the cost-benefit ratio, and net benefit. We show that these indices can be interpreted to be consistent with one another and consistent with the traditional economic definition of cost-effectiveness. Further, we show that the relative cost-effectiveness of competing strategies cannot be determined by simply comparing their respective cost-benefit or cost-effectiveness ratios, but can be determined by comparing their respective net benefits. Finally, we show that cost-effectiveness ratios cannot be properly interpreted without consideration of the dollar value of health benefits.

Abstracting and Indexing↗
PubMed1988

Multifactor prediction of hospital service workload.

Prediction of workload for hospital departments is a forecasting problem. Most forecasting techniques use time series methods. However, the unpredictability of hospital utilization which occurs because of environmental turbulence requires that predictions be based on strategic plans. Regression models developed from cross-sectional data can provide a methodology for linking predictions of service workload to strategic plans. The methodology is illustrated and evaluated in a pilot study, which produced models predicting measures of workload such as laboratory tests (R2 = .85), doses of medication given to inpatients (R2 = .43), outpatient prescriptions (R2 = .79), and x-rays (R2 = .86).

Forecasting↗