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Biomedical subjects

R M Mullner

Publications and source records attributed to R M Mullner.

At least 19 recordsLinked to original sources
PubMed1999

Monitoring changes in home health care: a comparison of two national surveys.

Home health care is the fastest growing component of medical care in the United States. To understand better the nature and scope of changes taking place in home health, two current national surveys are described and compared. The two federally sponsored surveys are the National Home and Hospice Care Survey (NHHCS) conducted by the National Center for Health Statistics and the Medical Expenditure Panel Survey (MEPS) of the Agency for Health Care Policy and Research. Computer data files from both surveys are publicly available.

Aged↗
PubMed1990

Preventive control of AIDS by the dental profession: a survey of practices in a large urban area.

The purpose of this study was threefold: (1) to report the proportion of dental practitioners adhering to the 1987 Centers for Disease Control (CDC) procedures for using infection control techniques (ICTs); (2) to identify attitudes toward infection control and disease; and (3) to establish whether certain practitioner characteristics or use of certain ICTs were related to willingness to treat HIV-positive patients, willingness to volunteer for an HIV specialty clinic outside of regular practice, vaccination against hepatitis B, and a felt need for a specialty clinic within the practice to treat HIV patients effectively. A survey of approximately 3,800 members of a major metropolitan dental society found that 89 percent of respondents regularly used at least one CDC ICT beyond routine medical histories. Ninety-one percent indicated a moderate to extreme change in attitude toward the risks of infectious diseases and the regular use of ICTs (80.2% identified AIDS as the major factor in this change). Twenty-seven percent indicated that they would knowingly treat HIV-positive patients. No differences were found among practitioners willing to treat HIV-infected patients and those unwilling to treat these patients in terms of adherence to the CDC ICT recommendations for dentists. Statistical association between ICT use and other practitioner response variables are discussed.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Rural hospital survival: an analysis of facilities and services correlated with risk of closure.

To test whether the facilities and services offered by rural hospitals can put them at risk of closure or protect against it, this study compares U.S. rural community hospitals that closed during the period 1980-1987, with a matched set of hospitals that remained open. Utilizing epidemiologic matched case-control methods and controlling for type of ownership, we found that (1) physical therapy, respiratory therapy, intensive care unit, computed tomography scanner, hospital auxiliary, and diagnostic radioisotope were negatively correlated with closure (i.e., had a protective effect); (2) the facilities and services correlated with risk of closure differed significantly between the pre-PPS (1980-1983) and post-PPS (1984-1987) periods; and (3) the presence of a skilled nursing or other long-term care unit was a significant risk factor during the period 1984-1987. Implications of these findings for hospital survival strategies and rural health care delivery under PPS are discussed.

Ancillary Services, Hospital↗
PubMed1989

Hospital closure: management and policy issues.

As hospital closures have increased between the years 1980-1987, it has become essential for hospital administrators to be aware of the effects of an increasingly complex and competitive environment on their institutions. The purpose of this paper is to examine variables correlated with risk of closure, and to use these data in a context to suggest a managerial approach that will minimize risk. The open systems perspective, which emphasizes uncertainty as an essential component of the planning environment, is suggested as the optimal managerial approach.

Health Facilities↗
PubMed1988

Rural community hospital closure and health policy.

Closure of rural community hospitals in the U.S.A. is a growing and important trend with serious implications for rural communities and the overall health care system. This study analyzes characteristics of all U.S. rural hospitals that closed between 1980 and 1986. Variables correlated with risk of closure--for-profit ownership status, non-government not-for-profit ownership status, number of other hospitals in the county, presence of a nursing or other long-term care unit, few facilities and services offered, lack of accreditation by the Joint Commission of Accreditation of Hospitals, lack of membership in a multihospital system--indicate that a rural hospital's survival depends upon its ability to compete and adapt in a volatile, competitive health care marketplace. five policy options are discussed: changes in Medicare payments, expansion of the number of hospitals designated as sole Community Hospitals, the use of swing beds, establishment of state offices of rural health, and short-term federal and state grants. Allowing hospitals the flexibility to adapt and compete, while ensuring adequate quality health care to rural residents, is suggested as the priority in rural health policy.

Economic Competition↗
PubMed1988

Modeling hospital closure relative to organizational theory: the applicability of ecology theory's environmental determinism and adaptation perspectives.

The writers present a set of hypotheses testing the strength of organizational ecology theory's environmental determinism perspective and the adaptation perspective. Some of these hypotheses are analyzed relative to data on hospital closures in the United States between 1980 and 1985. Initial empirical analyses indicate that environmental determinism's liability of smallness holds relative to hospital closure, but the liability of newness doesn't hold. There are no published accounts where the liability of newness hypothesis hasn't held in research on other industries. The writers speculate that the inverse relationship between a highly changing health care environment and the liability of newness of hospitals may be because newer hospitals are better able to tap into the ongoing changes of the today's turbulent health care delivery environment in the United States. Also, analysis findings show that the environmental interdependence orientation of the adaptation models has some explanatory power in that hospitals with greater community support have much lower closure rates. Consideration of the more organization action oriented framework of the adaptation perspective is called for over the environmental determinism perspective that has been promoted in recent publications. The writers suggest that the more community sponsored a hospital is, the less likely its survival will hinge solely on standard environmental selection criteria, and that the ability of a hospital's administration to correctly adapt to environmental fluctuations is critical, especially in today's turbulent health care delivery environment in the United States.

Health Facilities↗
PubMed1988

Health care coalitions: continuity and change.

The purpose of this study has been to investigate how coalitions have changed during 1983-1986, to describe the current characteristics of coalitions, and to speculate about their future roles and likely evolution. Several insights emerge from the empirical findings of this study. First, the number of operational health care coalitions has greatly expanded over the last several years to the point where almost every state and metropolitan area of the country has at least one. Second, the service area of most coalitions is generally county-wide, although there has been significant growth in the number of coalitions that serve states. Third, coalitions are expanding their membership composition and including not only business members but also hospitals, physicians, insurance companies, and labor organizations. Fourth, coalitions are becoming more financially secure; most have annual cash budgets, and most rely on dues. Fifth, coalitions are increasingly hiring and using paid professional staff. Last, coalitions are expanding their agendas beyond investigating direct health care costs to examine some of the underlying issues (such as hospital and medical professional liability issues, the financing of uncompensated care, and ethical issues) and are developing programs to address them. For the near future, the extension of recent trends suggests how coalitions will look and function. Further down the road, health care coalitions may evolve into health care public/private policy forums or associations of health benefits managers and/or associations for managed care purchasers. In conclusion, the trends we documented and the projections of the future of coalitions appear to be in keeping with the summary perspective of John T. Dunlop (1987) who indicates: Coalitions provide a continuing forum in which parties become more interested and informed about health care costs, utilization and the problems and operations of the other participants. The discourse encourages a more extensive and informed development and sharing of data. Coalitions reflect and need to recognize the inevitable internal conflicts and interests of the constituent organizations. While some coalitions tend to flounder on internal conflicts and capacity to generate effective leadership; many are fruitfully addressing the hard issues of health care in a community, such as managed care, capitation payments, excess beds and capital requirements, and access to health care by the uninsured. As coalitions mature, beyond discourse and data, they are likely to concentrate on a few of the distinctive problems of their communities and the interaction within the health care environment to address these problems.

Budgets↗
PubMed1987

Black-white differences in health status: methods or substance?

Apparent differences in the health status of blacks and whites vary according to methods of measurement, errors in the measurement process and interpretation of the measures, and types of measures used. This article uses the literature and secondary analysis of available data to explore the impact of methods on health status comparisons by race. Methods to measure health status include records, direct observations, and self-reports. Blacks generally show the greatest health deficits based on observation and least on some types of self-reports. Major types of errors in health status estimates are random errors and biases. Random errors tend to be greater for blacks because samples used to estimate their characteristics have often been smaller than white samples. Biases include noncoverage or failure to include some types of individuals in the reporting systems at all, nonresponse or lack of complete information on some persons, and use of inaccurate information due to faulty data collection or processing. Such biases tend to be greater for black persons than for whites. Their impact often is to give the illusion that blacks may be in better health than is actually the case. The types of measures that show blacks in the poorest health status are those considered to be most objective: mortality rates and some clinical examinations and health provider records. Subjective measures of dissatisfaction with health level also show blacks to be much less healthy than whites. In contrast, self-reports of illness conditions, symptoms, and restricted-activity days show blacks, particularly children, to be relatively well off compared to whites. These self-reports may be misleading due to differential perceptions of illness and reporting biases between blacks and whites. There is no doubt that measured differences in the health status of blacks and whites often reflect substance. There are also significant methodological problems, however, in comparing health status by race, which tend to underestimate the problems experienced by the black population. This article and others in this volume stress the need to know much more about the sources and impact of these methodological problems. In the meantime, these problems need to be recognized and adjusted for, where possible, when health status measures are compared. It is particularly important to consider them when policy questions of equity and resource allocation are to be decided using indicators of health status.

Black or African American↗
PubMed1986

Hospital closure: who will be at risk in the upcoming decade?

Although the number of community hospitals that close in the United States is not large in proportion to the number that remain open, hospital closure is attracting increasing attention. National trends and patterns of closure occurring over the last five years, 1980-1984, can be seen in terms of hospital bed size, control, location, period of operation, and financial characteristics. These trends indicate that those hospitals that close generally are small, urban, and investor-owned or nongovernment, not-for-profit; they have been in existence for quite some time; and have low current ratios, net to gross patient revenue ratios, and total margins.

Catchment Area, Health↗
PubMed1985

Health care machine-readable data files: secondary analysis, access, and the role of the library.

Access to health care machine-readable data files (MRDF) is becoming increasingly important to students and researchers in the health care field who use the data in secondary analysis. Health sciences libraries must play a role in providing such access, and this role should consist primarily in providing users with information about the identity and contents of available MRDF and about how they may be obtained. Libraries should therefore collect extensive materials containing information about the MRDF that may be of interest to their users. Many such materials are available in print, and their quality may be expected to improve as newly developed methods and procedures for constructing bibliographic citations, abstracts, and catalog entries for MRDF are put into practice. Also, it is now feasible to incorporate data file abstracts into existing online bibliographic databases.

Health Services Research↗
PubMed1984

A guide to available machine-readable data bases in the field of public health.

This paper presents brief descriptions of 130 available nonbibliographic machine-readable data bases that researchers in the field of public health may find particularly useful. Each description includes the title of the data base and the name of its sponsor, information about the contents and scope of the data base, and the name, address, and telephone number of a contact person or agency.

Directories as Topic↗
PubMed1983

An inventory of U.S. health care data bases.

This inventory presents brief descriptions of 144 current (1976-1982) nonbibliographic, computer-readable data bases containing national health care information that have been collected by public and private sector organizations and agencies throughout the United States and that are available to researchers outside the sponsoring organization. The descriptions include information about sponsors, purpose and scope, sampling procedures, frequency, and availability; they also include Medical Subject Headings (MeSH) indicating the content of each data base. In addition, names and telephone numbers of persons to be contacted for further information are provided. The descriptions are indexed by data base titles and by MeSH terms.

Data Collection↗
PubMed1982

The American Hospital Association's National Data Network and hospital data bases.

The growth and increasing complexity of the hospital industry has created an urgent need for hospital data. However, existing data bases have not been used as extensively or as intensively as they could be. This paper describes the major data bases of the American Hospital Association--the Annual Survey of Hospitals, the National Hospital Panel Survey, and the Special Surveys--and then discusses the American Hospital Association National Data Network, a remote-access, computer-time-sharing system that provides on-line entry into the AHA's data bases. The speed, economy, and ease with which Network data can be retrieved and manipulated means that national hospital data can now be disseminated more widely throughout the health care industry and can be regularly used for decision making even at the institutional level.

American Hospital Association↗