Biomedical subjects

John Engberg

Publications and source records attributed to John Engberg.

9 recordsLinked to original sources

PubMed2006

A descriptive analysis of average productivity among health maintenance organizations, 1985 to 2001.

This paper examines the evolution of average productivity among HMOs for 4,419 Health Maintenance Organizations (HMOs) from 1985 to 2001. For both IPA and non-IPA HMOs, HMO productivity increased from 1990 to 1996 and rapidly decreased from 1997 to 2001. In contrast to cost functions that show scale economies for IPA and non-IPA HMOs, production functions showed scale economies for IPA HMOs were constant and non-IPA HMOs having only slight scale economies. This suggests that much of the scale economies observed in cost functions are due to lower prices for resources used rather than improvements in production organization. Non-IPA HMOs and non-profit HMOs are more productive than IPA HMOs and for profit HMOs. Production organization for non-IPA HMOs appears to have improved over time, resulting in non-IPA HMOs being able to produce more member months of coverage with their production organization in 1997 to 2001 than they would have with their production organization in 1985 to 1990. Regulations requiring consumer involvement in HMO governance reduce productivity.

Efficiency, Organizational↗

PubMed2006

Organizational characteristics associated with staff turnover in nursing homes.

PURPOSE: The association between certified nurse aide, licensed practical nurse, and registered nurse turnover and the organizational characteristics of nursing homes are examined. DESIGN AND METHODS: Hypotheses for eight organizational characteristics are examined (staffing levels, top management turnover, resident case mix, facility quality, ownership, chain membership, size, and Medicaid census), using Online Survey, Certification, and Reporting (known as OSCAR) data. Turnover information came from primary data collected from 854 facilities in six states (Missouri, Texas, Connecticut, New York, Pennsylvania, and New Jersey). RESULTS: The 1-year turnover rates were 56.4%, 39.7%, and 35.8% for certified nurse aides, licensed practical nurses, and registered nurses, respectively. The results consistently show that, for all caregivers, lower staffing levels, lower quality, for-profit ownership, and higher bed size are associated with higher turnover. Some differences also are found for different levels of turnover, but there are few differences among types of nursing staff. IMPLICATIONS: Given that turnover rates are problematic, this study gives us a better understanding of the phenomenon and at the same time helps us further understand the wide variation that is known to exist between nursing homes, based on their organizational characteristics.

Aged↗

PubMed2006

Reducing substance use improves adolescents' school attendance.

AIMS: Substance use initiation and frequency are associated with reduced educational attainments among adolescents. We examined if decreases in substance use substantially improve youths' school attendance. DESIGN: A total of 1084 US adolescents followed quarterly for 1 year after entering substance abuse treatment. METHODS: Random and fixed effects regression models were used to differentiate the lagged effects of drug use from other time-varying and time-invariant covariates. Self-reports of alcohol, marijuana, stimulants, sedatives, hallucinogens and other drug use were used to predict subsequent school attendance, after controlling for demographic and drug use history characteristics, problem indices and other covariates. FINDINGS: Reductions in the frequency of alcohol, stimulants and other drug use and the elimination of marijuana use were each associated independently with increased likelihoods of school attendance. CONCLUSIONS: Because years of completed schooling is highly correlated with long-term social and economic outcomes, the possibility that reductions in substance use may improve school attendance has significant implications for the cost-effectiveness of substance abuse treatment and other interventions designed to reduce adolescents' substance use.

Absenteeism↗

PubMed2005

State variability in indicators of quality of care in nursing facilities.

BACKGROUND: The objective of this research was to profile and compare state-level physical restraint use, urethral catheterization, contractures, pressure ulcers, and psychoactive medication use as indicators of quality of care in nursing facilities. METHODS: Using nationally representative data from the Online Survey, Certification, and Reporting system for 2000 (N = 17,072), we calculated predicted quality scores using risk-adjusted models based on aggregate resident variables generated by hierarchical linear regression models for each of the five quality indicators. RESULTS: We observed significant variation in both the actual and risk-adjusted quality measures. The average risk-adjusted physical restraint quality score ranged from 8.4% to 12.8%; the average risk-adjusted catheterization quality score ranged from 3.6% to 7.7%; the average risk-adjusted contractures quality score ranged from 19.0% to 31.6%; the average risk-adjusted pressure ulcer quality score ranged from 3.8% to 7.6%; and the average risk-adjusted psychoactive medication quality score ranged from 47.8% to 56.9%. Eleven states had quality measures better than the risk-adjusted expectation for at least four of the five measures, and eight states were worse than expected in at least four of the five. CONCLUSIONS: This study provides evidence that there is variation in quality indicators across states. These differences exist even after risk adjustment. Our results may be important for state regulators trying to understand and improve quality.

Aged↗

PubMed2005

Staff turnover and quality of care in nursing homes.

PURPOSE: In this work, the association between nurse aide (NA) plus licensed practical nurse (LPN) and registered nurse (RN) turnover and quality indicators in nursing homes is examined. DESIGN AND METHODS: Indicators of care quality used are the rates of physical restraint use, catheter use, contractures, pressure ulcers, psychoactive drug use, and certification survey quality of care deficiencies. In addition, we used a quality index combining these indicators. Turnover information came from primary data collected from 354 facilities in 4 states and other information came from the 2003 Online Survey, Certification and Reporting data. The turnover rates were grouped into 3 categories, low, medium, and high, defined as 0% to 20%, 21% to 50%, and greater than 50% turnover, respectively. RESULTS: The average 1-year turnover rates identified in this study were high at 85.8% for NAs and LPNs and 55.4% for RNs. Multivariate analysis shows that decreases in quality are associated with increases in RN turnover, especially increases from low-to-moderate levels of turnover, and with increases in NA and LPN turnover, especially increases from moderate-to-high levels of turnover. IMPLICATIONS: These findings are significant because the belief that staff turnover influences quality is pervasive. The cross-sectional results are only able to show associations, nonetheless, few empirical studies in the literature have shown this relationship.

Connecticut↗

PubMed2004

Response formats and satisfaction surveys for elders.

PURPOSE: A factor common to the results of many satisfaction surveys of elders is a lack of response variability. Increasing response variability may be useful if satisfaction surveys of elders are to be productively used in the future. In this paper, we first examine elders' preferences between five response formats and then examine the response variability of these five commonly used formats. DESIGN AND METHODS: Satisfaction, demographic, and Short-Form 36 Health Survey data were self-reported by patients in four outpatient surgery centers during 1998 and 1999. We used six different survey instruments randomly given to 3,122 elders. Five instruments varied in response format (5-item Likert format, 5-item satisfaction format, 5-item valuation format, 4-item Chernoff faces, and 10-item visual analogue format). The sixth survey used all five different response sets, and then it asked for the respondents' preferences among the different response sets. RESULTS: A total of 2,450 questionnaires were examined (response rate of 78.5%). The response format using four Chernoff faces was liked the least, with only 5% of the respondents preferring this format. The 10-item visual analogue format (10VAF) was liked the most, with 39% of the respondents preferring this format. In addition, 10% more elders thought this format was easier to use than the second-place choice (i.e., 32% vs. 22%). The coefficient of variation for the 10VAF was also higher than those in identical domains using the other response formats. This would seem to indicate that the 10VAF is less prone to a ceiling effect than the other response formats. IMPLICATIONS: Our results show that elders have a preference for some response formats, and from the choices we gave them a 10VAF was preferred. The 10VAF also had more response variability then the other formats we tested.

Aged↗

PubMed2004

Use of claims data to examine the impact of length of inpatient psychiatric stay on readmission rate.

OBJECTIVE: This study analyzed the impact of length of stay for inpatient treatment of psychiatric disorders on readmission rates. METHODS: Hospitalization data were obtained from the MarketScan data set collected by Medstat. The instrumental variable method, an econometric technique, was used to estimate the impact of length of stay on the rate of readmission for 5,735 persons who had at least one discharge with a primary diagnosis of a psychiatric disorder during 1997 and 1998. RESULTS: Decreasing length of stay below ten days led to an increase in the readmission rate during the 30 days after discharge. Decreasing the length of stay from seven to six days increased the expected readmission rate from.04 to.047 (17.5 percent), whereas decreasing length of stay from four to three days increased the readmission rate from.09 to.136 (51.1 percent). CONCLUSION: Decreasing length of stay for inpatient psychiatric treatment increased the readmission rate. The use of instrumental variables could help better estimate the value of mental health services when using observational data.

Adult↗

PubMed2004

An adoption study of a clinical reminder system in ambulatory care using a developmental trajectory approach.

In this study, we assess 41 medical residents' acceptance and adoption of a clinical reminder system for chronic disease and preventive care management in the ambulatory care environment using a novel developmental trajectory approach. This group-based, semi-parametric statistical modeling method identifies distinct groups, following distinct usage trajectories, among those who recorded use of the reminder system within an evaluation period of 10 months. We trace system use within these groups over time using computer-generated logs and user satisfaction surveys. Our preliminary analysis of this small sample of users delineates three categories of users. Feedback from these categories of users is being used to re-engineer the application and adapt it better to their workflow and functionality requirements. Despite the small sample size in this particular study, we conclude that this methodology has considerable promise to provide new insights into system usability and adoption issues that may benefit clinical decision support systems as well as information systems more generally.

Ambulatory Care↗

PubMedDate not supplied

Downsizing in the nursing home industry.

Downsizing in the nursing home industry from 1992 to 2003 was examined. Most significantly, we show that downsizing is subsequently associated with improved quality.

Health Care Surveys↗