Biomedical subjects

Rebecca Wells

Publications and source records attributed to Rebecca Wells.

15 recordsLinked to original sources

PubMed2006

Community-based coalitions' capacity for sustainable action: the role of relationships.

Given both the importance and difficulty of promoting community-based public health coalitions, their capacity for sustainable action merits systematic examination. The current study addresses this need, focusing specifically on the relational dimension of capacity, that is, how relationships both among members and with external actors affect coalition-level activity. The context is a multimethod comparative case study of two rural cancer control coalitions. The authors began by using quantitative and qualitative data to characterize relational capacity in each coalition and then assessed the association between coalition-level relational capacity and level of subsequent interventions. The more active coalition had a more inclusive relational structure than did its less active counterpart but also placed less emphasis on personal friendships. The authors conclude that coalitions' relational structures are measurable and that this dimension of capacity may affect sustainable capacity for health promotion.

Appalachian Region↗

PubMed2006

Insights from a national survey into why substance abuse treatment units add prevention and outreach services.

BACKGROUND: Previous studies have found that even limited prevention-related interventions can affect health behaviors such as substance use and risky sex. Substance abuse treatment providers are ideal candidates to provide these services, but typically have little or no financial incentive to do so. The purpose of this study was therefore to explore why some substance abuse treatment units have added new prevention and outreach services. Based on an ecological framework of organizational strategy, three categories of predictors were tested: (1) environmental, (2) unit-level, and (3) unit leadership. RESULTS: A lagged cross-sectional logistic model of 450 outpatient substance abuse treatment units revealed that local per capita income, mental health center affiliation, and clinical supervisors' graduate degrees were positively associated with likelihood of adding prevention-related education and outreach services. Managed care contracts and methadone treatment were negatively associated with addition of these services. No hospital-affiliated agencies added prevention and outreach services during the study period. CONCLUSION: Findings supported the study's ecological perspective on organizational strategy, with factors at environmental, unit, and unit leadership levels associated with additions of prevention and outreach services. Among the significant predictors, ties to managed care payers and unit leadership graduate education emerge as potential leverage points for public policy. In the current sample, units with managed care contracts were less likely to add prevention and outreach services. This is not surprising, given managed care's emphasis on cost control. However, the association with this payment source suggests that public managed care programs might affects prevention and outreach differently through revised incentives. Specifically, government payers could explicitly compensate substance abuse treatment units in managed care contracts for prevention and outreach. The effects of supervisor graduate education on likelihood of adding new prevention and outreach programs suggests that leaders' education can affect organizational strategy. Foundation and government officials may encourage prevention and outreach by funding curricular enhancements to graduate degree programs demonstrating the importance of public goods. Overall, these findings suggest that both money and professional education affect substance abuse treatment unit additions of prevention and outreach services, as well as other factors less amenable to policy intervention.

Community-Institutional Relations↗

PubMed2006

Does money really matter? A review of the literature on the relationships between healthcare organization finances and quality.

The authors review empirical literature from 1980 to 2005 on relationships between healthcare organizations' finances and quality of care. They found only 16 studies of this topic that employed statistical methods. This research indicates cumulatively that expenses, fiscal margin, and asset and liability management all affect healthcare outcome quality. There is less evidence about how organizational finance factors affect structural or process quality, and there is no information about how structural or process quality mediates between finances and outcomes. The authors note what patterns have emerged from previous studies and make specific suggestions about what future research is necessary and why.

Financial Management, Hospital↗

PubMed2006

Hepatitis A prevalence among injection drug users.

OBJECTIVE: The purpose of this study was to develop a descriptive model of the association between injection drug use and hepatitis A (HAV) in a sample of injection drug users (IDUs). DESIGN: From May 1997 to July 1999, 493 subjects were administered the NIDA Risk Behavior Assessment (RBA). Participants had blood drawn; sera were tested for antibodies to HAV, hepatitis B core (HBcAB), and hepatitis C. The principal method of analysis was logistic regression. SETTING: The study took place in a community-based field station in Anchorage, Alaska. PARTICIPANTS: Eligibility was determined using the following criteria: a) age greater than 17 years, b) possession of picture identification, c) positive urinalysis for cocaine metabolites, morphine, and/or amphetamines using the ONTRAK system (Roche Diagnostics), and d) injection drug use in the last six months as confirmed by presentation of track marks. MAIN OUTCOME MEASURE: Presence of antibodies to HAV infection. RESULTS: The prevalence of total HAV antibody in our sample was 33% (161/493). The final multivariate logistic model, using positive HAV serostatus as the outcome, included positive HBcAB serostatus (OR = 3.43; 95% CI, 2.22-5.30), less than high school education (vs. high school or greater education) (OR = 2.05; 95% CI, 1.33-3.17), age (OR = 1.06 (each year); 95% CI, 1.03-1.09), number of days injected heroin in the last 30 days (OR = 1.05 (each day), 95% CI, 1.01-1.08), and race (White vs. all other race/ethnicities) (OR = 0.49; 95% CI, 0.32-0.75). CONCLUSIONS: A model including both demographic and drug use variables best describes HAV prevalence in this sample. Findings suggest that IDUs are targets for interventions focusing on hepatitis vaccinations and hygiene practices. Further research is needed to understand the association of HAV with hepatitis B infection.

Adult↗

PubMed2005

Team leadership and patient outcomes in US psychiatric treatment settings.

Previous studies suggest that psychiatric patients mirror the behaviors of the staff members who treat them, but there is little empirical evidence about how staff dynamics affect patients over time. The goals of this study were to examine associations between: (1) team leader discipline and mutual respect among treatment team members; and (2) mutual respect among team members and improvements in patient quality of life. Two models were tested on data from psychiatric treatment teams within the US Veterans Administration. The first examined associations between the discipline of each team's emergent leader and the level of mutual respect among that team's members. The second model tested associations between mutual respect among staff and changes over time in patients' quality of life. The subjects for model 1 were psychiatric staff members (n=785) whose responses were aggregated for team-level analyses (n=78). Mutual respect was highest in social worker-led teams and lowest in physician-led teams. The subjects for model 2 were 1,638 seriously mentally ill patients in 44 of the units examined in the first model. When mutual respect among staff was greater, patients improved more over time in their satisfaction with the quality of their housing, relations with families, social life, and finances. Together, these analyses imply that mutual respect may improve patient outcomes and that leadership by some disciplines may facilitate such dynamics. In general, leaders may consider learning from other disciplines' strengths to improve their impact.

Hospitals, Psychiatric↗

PubMed2005

Cross-functional team processes and patient functional improvement.

OBJECTIVE: To test the hypothesis that higher levels of participation and functioning in cross-functional psychiatric treatment teams will be related to improved patient outcomes. DATA SOURCES/STUDY SETTING: Primary data were collected during the period 1992-1999. The study was conducted in 40 teams within units treating seriously mentally ill patients in 16 Veterans Affairs hospitals across the U.S. STUDY DESIGN: A longitudinal, multilevel analysis assessed the relationship between individual- and team-level variables and patients' ability to perform activities of daily living (ADL) over time. Team data were collected in 1992, 1994, and 1995. The number of times patient data were collected was dependent on the length of time the patient was treated and varied from 1 to 14 between 1992 and 1999. Key variables included: patients' ADL scores (the dependent variable); measures of team participation and team functioning; the number of days from baseline on which a patient's ADLs were assessed; and several control variables. DATA COLLECTION METHODS: Team data were obtained via self-administered questionnaires distributed to staff on the study teams. Additional team data were obtained via questionnaires completed by unit directors contemporaneously with the staff survey. Patient data were collected by trained clinicians at regular intervals using a standard assessment instrument. PRINCIPAL FINDINGS: Results indicated that patients treated in teams with higher levels of staff participation experienced greater improvement in ADL over time. No differences in ADL change were noted for patients treated in teams with higher levels of team functioning. CONCLUSIONS: Findings support our premise that team process has important implications for patient outcomes. The results suggest that the level of participation by the team as a whole may be a more important process attribute, in terms of patient improvements in ADLs, than the team's smooth functioning. These findings indicate the potential appropriateness of managerial interventions to encourage member investment in team processes.

Activities of Daily Living↗

PubMed2005

Factors associated with interorganizational relationships among outpatient drug treatment organizations 1990-2000.

OBJECTIVE: To identify the factors associated with drug abuse treatment center participation in interorganizational relationships (IORs). DATA SOURCES: Three nationally representative samples of outpatient drug abuse treatment units surveyed in 1990, 1995, and 1999/2000 as part of the National Drug Abuse Treatment System Survey (NDATSS), stratified by public/private status, treatment modality (methadone or nonmethadone), and organizational affiliation. STUDY DESIGN: Probit analyses on 647 lagged treatment center-year observations from the years 1990 to 1995 with outcomes in 1995 and 2000, respectively. Standard errors were adjusted for clustering of center-year observations within centers. PRINCIPAL FINDINGS: Centers with greater motivation to form IORs (e.g., as a result of client diversity or government revenue) were more likely to do so, as were centers with greater opportunities to form IORs (e.g., centers whose directors participated in policy making). CONCLUSIONS: Both motivating and enabling factors promoted the formation of IORs by drug abuse treatment centers. Managed care also played a distinct role, in this case appearing to undermine interorganizational cooperation. Because IORs can improve access to care and quality, policy makers should consider using both incentives and support such as management training to promote IOR formation.

Cooperative Behavior↗

PubMed2005

Organizational survival in the outpatient substance abuse treatment sector, 1988-2000.

Substance abuse remains one of the most pressing health issues in the United States today, yet treatment supply continues to lag far behind need. Given the hostile environments treatment facilities face, their survival is a matter of pressing policy concern. Results from analyses of National Drug Abuse Treatment System Survey (NDATSS) data from 1988 through 2000 suggest that organizational attributes such as age, size, and client severity and resource dependencies such as reliance on government revenue affect survival, but their effects change over time. By the mid-1990s, director involvement in state and local policy making was positively associated with subsequent survival; later that decade, directors' professional credentials affected survival as well. Results also show that serving clients with multiple substance abuse problems became a survival liability by the late 1990s. Facilities that treat clients with multiple addictions may need additional financial support to serve these particularly vulnerable clients.

Ambulatory Care↗

PubMed2005

Using the balanced scorecard to characterize benefits of integration in the safety net.

The purpose of this study was to develop a comprehensive framework depicting the potential benefits of integration among health-care providers that serve vulnerable populations. Research teams interviewed participants in 12 integrated functions across seven community health-centre-led networks. Functions included clinical processes; managed care contracting; and administrative services such as human resources, finance, and information systems. Using a Balanced Scorecard framework, benefits were identified across financial, customer, internal business, and learning and growth perspectives. Financial benefits were more frequently cited relative to managed care and administrative functions than relative to clinical functions. Clinical functions were frequently characterized by perceived improvements in patient care quality, while managed-care functions appeared to yield most benefits in access. Administrative functions were most often associated with improvements in internal business operations. There were substantial findings in learning and growth across all three types of integration, in keeping with the early stages of the integrated functions in the study. Findings imply that integration among health-care providers yields a wide range of benefits, but not necessarily quickly or financial in nature.

Attitude of Health Personnel↗

PubMed2004

Status differences in cross-functional teams: effects on individual member participation, job satisfaction, and intent to quit.

Cross-functional teams (CFTs) play an increasingly important role in health care. However, despite their potential, CFTs often fail to function effectively. This paper contributes to the literature in medical sociology by examining how the steep and well-defined hierarchy characteristic of the health occupations proves to be dysfunctional in the CFT setting. Previous research has shown that status differences among members of work teams negatively affect their functioning. Yet the specific mechanisms that connect variations in status to poor team functioning remain unclear. We hypothesize that it is the suppression of participation among low status team members that leads to poor CFT functioning. Our theoretical model integrates status characteristics theory and the value attainment theory of job satisfaction to link team members' statuses to participation in team decision-making and, ultimately, to their attitudes about the job. We use causal modeling to test our hypotheses. Our results indicate that relationships between health professionals defined in broader social contexts affect status, roles, and functions within CFTs, and these, in turn, affect the team's interpersonal processes. We suggest changes in organizational structure and in team leadership styles that might make CFTs more effective.

Adult↗

PubMed2003

A comparison of schizophrenic patients with or without coexisting substance use disorder.

Increasing numbers of research investigations have documented psychosocial, demographic, and treatment course differences between schizophrenic patients with and without additional substance use disorder. However, many of these studies have failed to control for additional psychiatric diagnoses. This study sought to elucidate differences between schizophrenic patients with versus without coexisting substance use disorder, while controlling for the possible confounding impact of additional Axis I or Axis II diagnoses. We explored the records of 308 psychiatric inpatients who were either solely diagnosed with schizophrenia or solely diagnosed with coexisting schizophrenia and substance use disorder. We compared these two groups on a variety of psychosocial, demographic, and clinical variables shown in prior research to differentiate these two types of patients. Findings revealed that substance use interacts with schizophrenia to increase psychiatric admissions and decrease lengths of stay upon admission. Findings also revealed that patients with coexisting substance use and schizophrenia have unique psychosocial and demographic presentations that reflect more challenging life circumstances. Differences were not revealed between groups in terms of legal and criminal involvement. Based on pure diagnostic groupings, findings indicate that an additional substance use disorder is associated with psychosocial, demographic, and treatment course differences among individuals with a schizophrenia diagnosis. When screening, developing treatment, and planning aftercare, it is crucial to not view individuals with schizophrenia diagnoses as a monolithic group, but rather to consider the presence of a substance abuse diagnosis; such consideration will increase the likelihood of appropriate treatment and successful outcomes.

Adult↗

PubMed2003

High performance public health: assessing agencies' strategic management capabilities.

Limited knowledge about state health agencies' strategic management capabilities constrains their capacity to improve public health. The current study addresses this gap through two objectives: 1) To assess agencies' strategic management capabilities, conceptualized through a learning framework and 2) To portray both those capabilities and where the agencies have progressed along a developmental pathway of strategic management ability. Forty-one state health agencies' documents from 1995-2000 were content analyzed. Latent Trait Analysis (LTA) was used to depict both the progressive levels of strategic management capabilities and states' relative mastery along the continuum. Findings indicate that strategic management capabilities have path dependent characteristics and a distinct learning paradigm exists. Therefore, policy-makers wishing to improve agency performance can utilize this framework to assess and target capabilities that need improvement.

Aged↗

PubMedDate not supplied

Sustainable network advantages: a game theoretic approach to community-based health care coalitions.

Health care organizations often enter into a cooperative arrangement to create safety-net programs and coordinate care. Maintaining effective cooperation in such alliances poses special problems that can be examined using network analysis and explained in game theory terms. A mental health coalition case study is presented using network analysis and game theory interpretations. Had a positive-sum game approach been applied to the coalition's initial design, its subsequent suboptimal performance might have been averted. The application of network analysis plus a game theoretic paradigm has significant implications for improving both the design and the coordination of such coalitions.

Community Health Planning↗

PubMedDate not supplied

Strategy development in small hospitals: stakeholder management in constrained circumstances.

Small hospitals form a vital part of the health care safety net, serving communities that would often otherwise lack acute care. It is, therefore, important to understand how strategies unfold in these organizations. We used semistructured interviews to ask chief executive officers (CEOs) of seven small hospitals in Pennsylvania how they viewed their competitive environments and how their strategies evolved. Systematic semi-inductive analyses of these data reveal two major themes. First, CEOs of small hospitals perceive highly dynamic and hostile environments but do not stress complexity. Second, continual negotiations with key stakeholders facilitate the translation of CEOs' insights into organizational strategies.

Chief Executive Officers, Hospital↗

PubMedDate not supplied

Tracing the evolution of pluralism in community-based coalitions.

In this study, a crisis of leadership succession led to greater subsequent pluralism by the previously less inclusive coalition. Substantial tension existed between both coalitions and the federally funded Appalachia Cancer Network, especially around its evidence-based mission. The fact that this tension occurred even at the more locally inclusive site indicates that pluralism may vary across levels within the same coalition. This article contributes to theory by exploring how coalitions evolve over time across community boundaries, as well as to management practice by yielding guidance about how to build inclusive organizations.

Appalachian Region↗