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Biomedical subjects

J Spetz

Publications and source records attributed to J Spetz.

11 recordsLinked to original sources
PubMed2001

What should we expect from California's minimum nurse staffing legislation?

In 1999, California passed the first legislation in the United States to establish minimum staffing levels in hospitals for registered nurses (RNs) and licensed vocational nurses. The author provides estimates of the increase in RN expenditures required by this mandate, by hospital size and for regions of California. Issues related to the implementation of minimum ratios also are discussed. Attention must be paid to other staffing regulations, special concerns of rural hospitals, the possibility that minimum ratios result in lower RN staffing, and the effect of the nursing shortage on the ability of hospitals to meet requirements.

California↗
PubMed2001

Physician incentives and the timing of cesarean sections: evidence from California.

OBJECTIVES: The timing of cesarean sections is studied to examine how physician convenience and financial incentives play a role in the decision to perform a cesarean section. METHODS: Using birth certificate and hospital financial data from California, the likelihood of cesarean sections being performed at particular times of day was examined, controlling for maternal characteristics and the mother's insurance coverage. Two diagnoses associated with cesarean sections are examined separately: fetal distress and prolonged/dysfunctional labor. The hypotheses are that cesarean sections performed for physician convenience are more likely to occur in the evening hours and that type of insurance will affect the incentive to perform cesarean sections to obtain leisure. RESULTS: The probability of cesarean sections for patients insured by a group-model HMO is more stable during the course of a day than that for patients insured by all other insurance plans. Group-model HMO patients with previous cesarean sections are less likely to have cesarean sections in the evening hours and are less likely to be diagnosed with fetal distress or prolonged/dysfunctional labor. CONCLUSIONS: The differences in cesarean sections and diagnosis rates between group-model HMO patients and other patients could arise from several mechanisms: group-model HMOs provide consistent financial incentives to their staff, they may be better able to guide physician practice, and they might provide staff support to physicians so there is less leisure-based incentive to perform cesarean sections. In contrast, nongroup-model HMOs do not appear to reduce the incentive of physicians to maximize leisure relative to traditional insurance.

California↗
PubMed2001

Measuring shortages of hospital nurses: how do you know a hospital with a nursing shortage when you see one?

Lack of clarity in definitions of shortages of hospital registered nurses may cause problems for effective policy making, particularly if different measures for identifying a nurse shortage lead to different conclusions about which hospitals and regions are experiencing a shortage. The authors compared different methods of identifying hospitals and regions with a shortage of registered nurses, including both relatively subjective measures (e.g., a hospital administrator's report of a nurse shortage) and more objective measures (e.g., number of registered nurses per inpatient year). Associations were strongest between self-reported shortage status and nursing vacancy rates and weaker for self-reported shortage status and registered nurses per inpatient year and overall regional supply of nurses. Different definitions of nursing shortage are not equally reliable in discriminating between hospitals and regions with and without nursing shortages. When faced with reports sounding an alarm about a hospital nursing shortage, policy makers should carefully consider the definition of shortage being used.

Catchment Area, Health↗
PubMed2001

Hospital registered nurse shortages: environmental, patient, and institutional predictors.

OBJECTIVE: To examine the characteristics of acute-care hospitals that report registered nurse shortages when a widespread shortage exists and when a widespread shortage is no longer evident. DATA SOURCE: Secondary data from the American Hospital Association's Nursing Personnel Survey from 1990 and 1992 were used. The study population was all acute-care hospitals in the United States. STUDY DESIGN: Outcome variables included whether a hospital experienced a shortage in 1990, when many hospitals reported a nursing shortage, or whether a hospital reported a shortage in both 1990 and 1992. Predictor variables included environmental, patient, and institutional characteristics. Associations between predictor and outcome variables were investigated using probit analyses. PRINCIPAL FINDINGS: Location in the South, a high percentage of nonwhite county residents, a high percentage of patients with Medicaid or Medicare as payer, a higher patient acuity, and use of team or functional nursing care delivery consistently predicted hospitals reporting shortages both when there was a widespread shortage and when there was no widespread shortage. CONCLUSIONS: Although some characteristics under the direct control of hospitals, such as nursing care delivery model, are associated with their reporting a shortage of nurses, shortage is also strongly associated with broader population characteristics such as minority communities and a public insurance payer mix. Awareness of these broader factors may help inform policies to improve the distribution of nurse supply.

Aged↗
PubMed2000

The effect of passing an "anti-immigrant" ballot proposition on the use of prenatal care by foreign-born mothers in California.

This study examines whether the passage of California's Proposition 187, a proposition designed to restrict undocumented immigrants from using public services, had a negative effect on the use of prenatal care and birth outcomes. Comparisons of prenatal care use and birth outcomes before and after the passage of the proposition are made between low-education foreign-born and U.S.-born mothers using California's Birth Public Use files. Multivariate linear and logistic regressions were used to control for regional and maternal characteristics. We find a significant but small decline in the use of prenatal care by low-education foreign-born women after Proposition 187 passed; however, there was no detectable deterioration of birth outcomes. Whether future reductions in the availability of prenatal care would damage the health of children is unclear.

Journal Article↗
PubMed1999

Maintaining an adequate supply of RNs in California.

PURPOSE: Over the past 2 years, concerns have arisen about the adequacy of the supply of RNs in California and the rest of the United States. Nurse leaders have called upon the California State Legislature to respond to concerns by increasing funding for RN education at public colleges and universities. DESIGN: Descriptive--to ascertain whether California faces a shortage of RNs and whether greater state government funding of RN educational programs is necessary to alleviate such a shortage. Secondary data from several sources were analyzed. METHODS: Cross-sectional analysis of data from the 1996 National Sample Survey of Registered Nurses concerning California RNs' demographic characteristics and employment patterns was conducted. Longitudinal analysis of data was examined for trends in California's population, utilization of RNs, and graduations from RN education programs. FINDINGS: Approximately 230,000 RNs lived in and were licensed to practice in California; 77% of California RNs were employed in nursing (70% working full-time; 30% part-time). Only a small number of California RNs were not currently working in nursing but were likely to enter the labor market. Most RNs who were not working were older retired women. CONCLUSIONS: A large increase in the RN workforce is needed to keep pace with the rapid growth of California's population. For California to maintain a stable ratio of RNs to population, we estimated an additional 43,000 RNs will be needed by 2010, and an additional 74,000 will be needed by 2020. Educators, employers, and state policymakers should implement concerted and coordinated efforts to avert a shortage. The magnitude of the impending shortage of RNs in California is too large for the RN labor market to resolve. State government should provide additional resources for basic RN education programs.

Adult↗
PubMed1999

The effects of managed care and prospective payment on the demand for hospital nurses: evidence from California.

OBJECTIVE: To examine the effects of managed care and the prospective payment system on the hospital employment of registered nurses (RNs), licensed practical nurses (LPNs), and aides. DATA SOURCES: Hospital-level data from California's Office of Statewide Health Planning and Development (OSHPD) Hospital Disclosure Reports from 1976/1977 through 1994/1995. Additional information is extracted from OSHPD Patient Discharge Data. STUDY DESIGN: Multivariate regression equations are used to estimate demand for nurses as a function of wages, hospital output, technology level, and ownership. Separate equations are estimated for RNs, LPNs, and aides for all daily services and for medical-surgical units. Instrumental variables are used to correct for the endogeneity of wages, and fixed effects are included to control for unobserved differences across hospitals. PRINCIPAL FINDINGS: HMOs are associated with a lower use of LPNs and aides, and HMOs do not have a statistically significant effect on the demand for RNs. Managed care has a smaller effect on nurse staffing in medical-surgical units than in daily service units as a whole. The prospective payment system does not have a statistically significant effect on nurse staffing. CONCLUSIONS: HMOs have affected nursing employment both because HMOs have reduced the number of discharges and because of a direct relationship between HMO penetration and the demand for LPNs and aides. Contrary to press reports, LPNs and aides have been affected more by HMOs than have registered nurses.

California↗
PubMed1998

Hospital employment of nursing personnel. Has there really been a decline?

There was a steady increase in the number of hours worked by nursing personnel in California hospitals from 1977 through 1996, mostly due to an increase in the number of hours worked by registered nurses (RNs). The hours worked by nursing personnel and RNs per case-mix adjusted discharge and per adjusted patient day also have increased. Possible explanations for the discrepancy between perceptions of declining nursing staffing and the data are discussed.

California↗
PubMedDate not supplied

Errors in data on hospital ownership.

In recent years, there has been increased public concern about changes in hospital ownership and consolidation in the hospital market. Numerous studies have examined the relationship between hospital ownership and prices, costs, organization, service mix, access to care and quality of care. However, the data on which these studies are based are often incomplete and inaccurate. In this paper, we examine several sources of data employed by researchers examining hospital ownership and discuss the degree of inaccuracy we found in each source. Substantial primary data collection is necessary to accurately account for changes in ownership and system affiliation.

American Hospital Association↗