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Biomedical subjects

P A Rivers

Publications and source records attributed to P A Rivers.

At least 19 recordsLinked to original sources
PubMed2002

Emerging factors shaping the future of the Veterans' Health Administration: a strategic analysis.

In response to societal and industry-wide forces, the Veterans' Health Administration (VHA) has undertaken a re-engineering process, changing the operational and management structure from individual, independent, and often competing large hospital centres into 22 integrated service networks or VISNs to provide structural incentives for efficiency, quality and improved access as well as transitioning the system to one that is grounded in ambulatory and primary care (Ashton et al., 1998). This paper presents a framework for evaluating the successes and/or failures of the recent re-organization efforts of the VHA in bringing together this multitude of medical care 'parts' or modules into an integrated, cost-effective healthcare delivery system. In total, this paper attempts to delineate an analytical framework by which the threats and opportunities as well as the strengths and weaknesses of the VHA are identified. More specifically, this paper addresses the external pressures driving reform in the VHA system and how the Veterans' Administration can respond to these pressures. Implications for the future of the VHA if its reform efforts are not successful are examined.

Delivery of Health Care, Integrated↗
PubMed2001

Managing costs and managing care.

With a defined population served, contracted provider panels and the nature of care delivery integration, managed care has provided a solution, though not a panacea, to provide equitable services, standardized and prevention oriented cares to its enrolled members. Combined with the earmarked capitation reimbursement system and a series of cost containment and utilization review techniques, managed care has also demonstrated potently its capacity in cost-saving and quality promotion. Presents steps and measures related to managed care that federal government has taken to manage care and contain cost. It is crucial to identify and promulgate best practices continually, while managing utilization of resources for improving health care, containing cost, and equalizing medical care access to a greater proportion of the population. Concludes that it may take time for a universal adoption of managed care. However, Americans may actually benefit more from having a standard level of health care that managed care could achieve and provide.

Cost Control↗
PubMed2001

Hospital re-admissions: an empirical analysis of quality management in Taiwan.

This retrospective study uses discharge-level data to analyse and assess the situation of re-admissions within 15 days of discharge, for quality evaluation. The re-admission rate of the study period was 3.22%. Among those re-admission cases, 45.7% patients were re-admitted within five days of discharge, and 33.5% cases returned to hospital six to 10 days after discharge. The average length of stays of re-admissions (9.86 days for previous stay and 8.10 days for re-admitted stay) were both longer than the hospital's overall average (7.63 days) at the same period. Paediatric patients comprised the greatest number of re-admissions. Re-admissions were more likely to have higher percentage of emergency admission. Significant relationships were found between factors for re-admissions and patient characteristics (e.g. age and insurance status), admitted department, and diagnosis. Further investigation and strategies, combined with the application of severity adjustment technique to better monitor and avoid unnecessary re-admissions, need to be developed.

Adolescent↗
PubMed2000

Osteoarthritic changes in the biochemical composition of thumb carpometacarpal joint cartilage and correlation with biomechanical properties.

The biochemical composition and biomechanical properties of articular cartilage from 53 human thumb carpometacarpal (CMC) joints from cadavers aged 20 to 79 years were measured and studied in normal, mildly fibrillated, and advanced osteoarthritic (OA) joints. Statistical analyses were performed to determine the correlations between the compositional measures and biomechanical properties. For these CMC joint tissues we found that water content increased, proteoglycan content decreased, and collagen content per dry weight remained unaltered with progression of OA degeneration. We also found that with disease progression, as defined by an OA staging score, the aggregate modulus (ie, compressive stiffness) decreased, along with an unexpected moderate decrease in permeability. This latter finding appears to be specific to CMC cartilage degeneration since articular cartilage from knees and hips generally demonstrates an increase in permeability with water content and OA score. Correlations between biochemical composition and biomechanical properties were found to be stronger in joints with OA than in joints without OA. This finding suggests that OA changes in biochemical composition, relative to baseline normal values, directly affect the biomechanical properties of cartilage, even though the baseline compositional values themselves do not directly determine the magnitude of the biomechanical properties in normal tissue.

Adult↗
PubMed2000

Strategic choices for a primary care advantage: re-engineering osteopathic medicine for the 21st century.

The rapidly growing area of osteopathic medicine takes us beyond high technology, life-saving equipment, or at least the most accurate diagnostic test. Whether it is called 'alternative', 'complementary' or 'holistic' medicine, it cannot be ignored as a legitimate healthcare choice, with well-defined benefits for healthcare consumers. This paper examines the history, development, philosophy of practice and challenges facing the viability of osteopathic medicine. More specifically, we address the following key questions: What is osteopathy medicine? What role does osteopathic medicine play in the provision of health services? What challenges face this professional group? And is osteopathic medicine an alternative approach to healthcare?

American Medical Association↗
PubMed2000

The ABCs for deciding on a decision support system in the health care industry.

As the information superhighway becomes clustered with various organizations sharing the hope of staying solvent with the aid of technology, managers in the health care industry are more and more looking to efficient Decision Support Systems (DSS). The focus of DSS selection has often been on evaluations that measure decision performance for determining the influence and efficacy of the tool. Such evaluations, in many instances, ignore pertinent measurements for a successful selection and implementation of a DSS. In this article, the authors present a simple but important set of evaluation factors that can "make or break" a DSS implementation in the health care industry.

Contract Services↗
PubMed2000

Long-term care financing: are current methods enough?

Financing long-term care services can be extremely cost prohibitive to the average United States citizen. Given the complex patchwork of multidisciplinary services that may be required, operational issues and system efficiencies often draw considerable attention. Notwithstanding these challenges, this article reviews the major sources of long-term care financing, including some lesser-known options. Potential advantages and disadvantages are presented. A descriptive analysis of existing policies and consumer practices raises the question of whether recent incremental reforms will lead to future solutions for the major constituents most affected by their implementation.

Aged↗
PubMed2000

Hospital competition in major U.S. metropolitan areas: empirical evidence.

In response to dramatic rises in health care costs, policy-makers have been debating the relative merits of competitive strategies as a means of containing costs. This article represents a study of the 29 largest MSAs for 1991. Controlling for environmental conditions in each market, the impact of competition on hospital costs was examined. Competition was found to have had a significant positive impact on overall hospital costs.

Catchment Area, Health↗
PubMed1999

Medicare risk contracting: analyzing managed care for the aging population in the USA.

This paper focuses on Medicare risk contracting in the USA. The issue of the current method of reimbursement versus Medicare risk contracting is explored. Risk sharing and payment mechanisms are described and analyzed. The strengths and weaknesses (score-card) of Medicare beneficiaries entering HMOs are reviewed. Finally, the issue of selection bias in Medicare HMOs is discussed regarding future implementation strategy.

Aged↗
PubMed1999

The effects of organizational structure on hospital performance.

The relationship between organizational structure and organizational performance would seem at first to be straightforward and obvious. The more complex organizational structures will result in positive organizational performance (i.e. greater effectiveness or profitability). The premise is that the ability of an organization to achieve its mission successfully should be a result of the organizational structure. It is generally accepted that certain structural configurations are able to achieve certain goals better than others (i.e. a diversified structure as opposed to a simple structure). The research to date indicates that this is not necessarily true. The specific issue examined in this paper will be the effect of structural diversification on performance in industry and healthcare.

Communication↗
PubMed1999

Diversification strategy and performance: implications for health services research.

Health care represents a promising area of research due to its uniqueness. In recent years, considerable progress has been made in diversification strategy and performance research but not the study of health services strategy research. This article reviews diversification strategy and performance in health services domains. Adopting Datta, Rajagopalan, and Rasheed's (1991) framework, the authors evaluate the theoretical and empirical contributions of this research. The limitations and theoretical implications of these efforts are also explored.

Financial Audit↗
PubMed1999

The U.S. Medicaid reform: the current state and policy implications for low-income population.

Medicaid is the health care program that is financed jointly by the federal and state governments. Many states are seeking ways to contain the increased budgetary strain that has resulted from the increases in Medicaid spending. For many states, managed care has been viewed as the means to hold down costs for some of the population served by Medicaid. This article examines the origins and status of Medicaid and the options available to extend coverage to the low-income population.

Cost Control↗
PubMed1998

Retiree health benefits revisited.

A review of the current literature on retiree health benefits finds that supplemental coverage for the majority of Medicare beneficiaries is in the form of employer-provided coverage. Findings in current literature also suggest that Medicare risk contracts can contain costs but efforts must be made to provide quality information to Medicare beneficiaries in order to increase enrollment in HMOs. Finally, a linear relationship is implied between income and the probability of supplementary insurance ownership.

Health Benefit Plans, Employee↗
PubMed1998

Accountability and quality in managed care: implications for health care practitioners.

The development of managed care plans is the most dramatic change in the USA's health care system in recent decades. Despite the widespread growth, society is increasingly concerned with the quality of managed care programs. This article addresses the regulatory pressures that are being placed on managed care organisations and examines what health care practitioners can do to minimize the impact of increased regulation. We look at the major factors that are likely to bring about changes in the health care sector, and predict how these changes will affect the quality of health care that is being delivered in the near future. Addresses how quality can become and remain the primary factor in the delivery of health care services. Finally, concludes that greater involvement by the federal government is necessary to protect consumers' rights, and ensure better quality health care from managed care programs.

Consumer Advocacy↗
PubMed1998

Substance abuse and dependence in physicians: detection and treatment.

Substance abuse continues to increase and permeate all sectors of US society including the medical profession. This article details the importance of testing everyone associated with health care organizations, including physicians, as a means of protecting patient welfare, increasing quality of care, and reducing negligence lawsuits, as well as providing treatment and recovery opportunities for those with addictions.

American Hospital Association↗
PubMed1998

Ensuring quality and accountability in managed care.

The rapid growth of new forms of managed care in the United States in recent decades has brought with it increasing concerns regarding the quality of care delivered by practitioners in these plans. This article examines the various regulatory demands that are being placed on Managed Care Organizations (MCOs). The authors look at the major determinants that are likely to bring about significant changes in the health care sector for both patients and providers and predict how these shifts will affect the quality of health care services in the near future. They discuss how the quality of health care, rather than the cost of those services, can become and remain the primary factor in the delivery of health care services. Ultimately, they conclude that increased participation by the federal government is required to protect the rights of patients and ensure better quality and accountability for health care services delivered by MCOs.

Consumer Behavior↗
PubMed1998

Strategic decision-making processes in health care organizations.

Health care represents a promising area of research due to its uniqueness. In recent years, considerable progress has been made in strategic decision-making processes research but not the study of health care strategy research. This article reviews strategic decision-making in health care domains. Adopting Rajagopalan, Rusheed, and Datta's (1993) framework, the authors evaluate the theoretical and empirical contributions of this research. The limitations and theoretical implications of these efforts are also explored.

Decision Making, Organizational↗