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Biomedical subjects

S S Mick

Publications and source records attributed to S S Mick.

At least 37 records · Page 2Linked to original sources
PubMed1994

Classifying quality initiatives: a conceptual paradigm for literature review and policy analysis.

This article presents a conceptual paradigm by which health care executives and other interested parties can classify and organize the extant literature on quality improvement in health care. The paradigm also has utility as an operational tool by which health care managers may locate conceptually their own institutional efforts at quality improvement within the realm of possible action.

Health Services Research↗
PubMed1993

Foreign medical graduates and U.S. physician supply: old issues and new questions.

Recent increases in the number of foreign medical graduates (FMGs) in U.S. hospital-training positions raise new questions about the future role of FMGs in U.S. medicine. Despite an historical surplus of physicians, forces such as greater demand for resident house officers, stabilization in undergraduate medical education enrollment, increase in demand for medical services, growth in both the number of women in medicine and physician employment in group practices, and continuing imbalances in the distribution of physicians favor FMG migration to the United States. Health system reform must be sensitive to the historical, current, and future role FMGs play in medical care delivery, especially in regard to service in underserved areas, specialties, and employment settings.

Data Collection↗
PubMed1993

Horizontal and vertical integration-diversification in rural hospitals: a national study of strategic activity, 1983-1988.

This study examines both the magnitude of and factors influencing the adoption of 13 horizontal and vertical integration and diversification strategies in a national sample of 797 U.S. rural hospitals during the period 1983-1988. Using organization theory, hypotheses were posed relating environmental and market factors, geographic location, and hospital characteristics to the adoption of horizontal and vertical integration and diversification. Results indicate that only one of 13 strategies was adopted by more than 50 percent of all rural hospitals during the study period, and that most of the directional hypotheses were not confirmed using Cox's proportional hazards models. In particular, environmental and market factors were unrelated to the strategies studied. Issues of methodology and theory are discussed; however, during an historically turbulent period, both relatively low levels of rural hospital strategic activities and lack of predictive power of the theory suggest caution in relying heavily on a policy for rural hospital survival that is dependent on individual market-oriented strategic behavior.

Chi-Square Distribution↗
PubMed1993

Rural hospital-based alcohol and chemical abuse services: availability and adoption, 1983-1988.

Data from a 1983-88 retrospective panel study of 797 rural (non-Metropolitan Statistical Area) U.S. hospitals revealed that less than one in five (18.7%) had any alcohol and chemical abuse (ACA) service. About one-third of both inpatient and outpatient services had been established during the study period, but few hospitals not offering these services planned to offer them in the immediate future. These findings support other studies that the availability of such services may not meet population need or demand, although non-hospital-sponsored services might partially fill the gap. Bivariate analysis showed that hospital locations in counties that were more densely populated, had higher per capita income and had more physicians per 1,000 population were positively associated with ACA services. Hospitals that were in the New England, Mid-Atlantic, East North Central census divisions, and were large according to number of beds, presence of psychiatric services, availability of psychiatrists and other nonphysician personnel, certain organizational arrangements and strategic management activities were positively associated with ACA services. Multivariable logistic regression suggested the presence of psychiatric services as a key correlate of ACA services, and the scarcity of psychiatric personnel in rural areas appears to have been a major reason for the infrequency of rural hospital-sponsored ACA services.

Alcoholism↗
PubMed1993

Rural hospital administrators and strategic management activities.

This study examines the association of characteristics of rural hospital administrators and the adoption of seven strategic activities in a national sample of 797 U.S. rural hospitals during the period 1983-1988. Based on the premise that managerial activities can affect organizational change, we test five hypotheses relating head administrator characteristics to strategic adaptation, controlling for environment-market and hospital-related variables. Bivariate analysis of the strategic adoption showed a positive association with administrative turnover and a negative association with head administrator age. Multivariate logistic regression showed that only high levels of turnover were associated with strategic activities, net of control variables. The implications of these findings and the lack of predictive power of other rural hospital administrator characteristics--especially affiliation with the American College of Healthcare Executives--are discussed within the context of a "strategic management policy" for rural hospitals.

Age Factors↗
PubMed1991

The Foreign Medical Graduate Examination in the Medical Sciences (FMGEMS). An analysis of pass rates of the July 1984 through July 1987 examinations.

This report examines the experience of 48,509 (40,393 foreign nationals and 8,116 U.S. citizens) foreign medical students and graduates (FMGs) who took any part of the first seven Foreign Medical Graduate Examination in the Medical Sciences (FMGEMS) administered by the Educational Commission for Foreign Medical Graduates. The pass rate on all three sections (basic science, clinical science, and English) was 23.0%. Almost one-half (47.2%) of all FMGEMS examinees were between 25 and 29 years of age, 73.9% were men, 71.5% took FMGEMS after medical school graduation, and 79.7% claimed as their native tongue languages other than English. Correlates of pass rates included taking FMGEMS before medical school graduation (30.0% pass) and being a native English speaker (37.5% pass). The rates for foreign national FMGs (FNFMGs) and United States FMGs (USFMGs) were 22.5% and 25.2%, respectively. Native English-speaking FNFMGs achieved a 43.3% pass rate; native English-speaking USFMGs, 32.6%; non-native English-speaking FNFMGs, 19.9%; and non-native English-speaking USFMGs, 11.2%. Whereas FMGs were educated in 114 countries, 74.2% of USFMGs were educated in just eight countries, all located in the West Indies and Mexico. Logistical regression analysis showed that the strongest factors predicting full pass rates were being both younger than 30 years of age and a native English speaker. Conclusions are that approximately 3,200 FMGs per year pass FMGEMS and that FMGs with the highest probability of passing share characteristics of U.S. and Canadian medical graduates who pass the National Board medical examinations, which suggests that the latter examinations, when offered to FMGs, may have limited effect on overall pass rates.

Achievement↗
PubMed1990

America's rural hospitals: a selective review of 1980s research.

We review 1980s research on American rural hospitals within the context of a decade of increasing restrictiveness in the reimbursement and operating environments. Areas addressed include rural hospital definitions, organizational and financial performance, and strategic management activities. The latter category consists of hospital closure, diversification and vertical integration, swing-bed conversion, sole community provider designation, horizontal integration and multihospital system affiliation, marketing, and patient retention. The review suggests several research needs, including: developing more meaningful definitions of rural hospitals, engaging in methodologically sound work on the effects of innovative programs and strategic management activities--including conversion of the facility itself--on rural hospital performance, and completing studies of the effects of rural hospital closure or conversion on the health of the communities served.

Financial Management, Hospital↗
PubMed1988

The decision to integrate vertically in health care organizations.

A scheme to help health care managers make decisions regarding vertical integration (and deintegration) strategies and to alert health care managers to a more analytic view of vertical integration that may help avoid costly mistakes is presented. Central to the decision-making scheme is the comparison between the costs of purchasing goods and services from (and selling them to) other organizations and the costs of acquiring (and supplying) the same goods and services within one's own organization. Whether outside or inside an organizational boundary, these costs (called transaction costs) may be important in determining whether vertical integration is an appropriate organizational strategy (Williamson 1975).

Contract Services↗
PubMed1986

The future role of foreign medical graduates in U.S. medical practice: projections into the 1990s.

Projections of the effect of actual and hypothesized declines in the proportion of foreign medical graduates (FMGs) in residency training on the future distribution of physicians are explored. We find potential proportionate declines in the eventual location of physicians in rural areas and small towns in the North Central regions, and in solo and partnership arrangements in the Northeast, North Central, and Southern regions. Reductions in FMG house officers now could also lead to an increased proportionate presence of physicians in subspecialty practices in the largest U.S. cities. These changes might happen despite the current perception that there is a "surplus" of physicians.

Career Choice↗
PubMed1985

A theory of organizational response to hospital regulation: a reply.

A recently published general theory of organizational response to regulation is examined. A number of problems are observed in regard to the basic assumption underlying the theory, the directionality of predicted relationships forming the theory, the exclusion of goal attainment as a realistic motivation for managing, and the generality of the theory.

Certificate of Need↗
PubMed1984

Impact of women and foreign medical graduates on specialty distribution of U.S. house officers.

The increase in the number of women and the decline in the number of foreign medical graduates (both foreign- and U.S.-born graduates of medical schools outside the United States) in U.S. medicine are studied by comparing the specialty distributions of U.S. house officers in the 1973-74 and 1979-80 training years. The joint effect of the distribution of sex and foreign versus U.S. medical graduate status on specialty selection is also examined. The results showed that although male and female house officers who were graduates of U.S. medical schools increased in number over the seven-year period, the rate of increase for females was over 12 times as great as the rate for men. By contrast, although male and female house officers who were graduates of foreign medical schools decreased over the same period, the rate of decrease for males was over nine times as great as the rate for women. U.S.-educated men and foreign-educated men had similar distributions across the specialties, whereas U.S.-educated women and foreign-educated women differed not only from each other but also from both groups of men. The specialty selection of foreign-educated females in the 1979-80 training year was especially different from the other three groups. Implications of these data are discussed in the context of the argument that there is a physician surplus.

Education, Medical↗
PubMed1984

Foreign and United States medical graduates in practice. A follow-up.

A 9-year follow-up study of a national probability sample (n = 865) of foreign medical graduates (FMGs) and United States medical graduates (USMGs) who were house officers in United States hospitals in 1973-1974 reveals that more than three fourths of the alien FMGs were located in the United States in 1983. FMGs were distributed disproportionately across United States census regions (P less than 0.001), specialty areas (P = 0.071), and type of position (P = 0.059). Neither the switching of specialty areas nor the changing among United States census regions was significantly different for FMGs and USMGs. Census regions with net gains of FMGs over the 9-year period included the Pacific, South Atlantic, and West South Central regions, areas with either proportionately higher 1973-1974 USMG concentrations or net USMG gains. The results suggest a gradual assimilation of FMGs into the American medical system from an initial position different than that of USMGs.

Career Mobility↗
PubMed1984

Public attitudes toward health planning under the Health Systems Agencies.

The demise of the National Health Planning and Resources Development Act of 1974 (PL 93-641) raises questions about the degree of public support it had for planning goals. The results of a 1978 nationwide public opinion poll reveal (1) low confidence in and recognition of the Act's institutional arms, the Health Systems Agencies; (2) little support for hospital cost containment strategies and their consequences; and (3) less than average support for these goals and consequences among those groups traditionally under-represented in health planning activities. The results suggest that the Act did not reconcile centralized federal goal formation with democratic local health planning.

Cost Control↗
PubMed1984

Foreign medical graduates in the 1980s: trends in specialization.

Secondary analysis of data collected by the American Medical Association and the Graduate Medical Education National Advisory Committee (GMENAC) suggests that measures to diminish the flow of alien Foreign Medical Graduates (FMGs) into the United States have been less effective than planned. Declining trends in the proportion of FMG house officers in the mid- to late-1970s have recently stabilized around 19 per cent. There has also been a dramatic increase in the number of US citizen Foreign Medical Graduates ( USFMGs ) in house officer positions. A pattern of alien FMG and USFMG house officer specialization correlates with specialties designated by the GMENAC as shortage areas by 1990 (r = -.49, p less than .05). Despite the GMENAC prediction of a surplus of physicians by 1990, differential selection of alien FMGs and USFMGs into shortage specialties may assure their substantial future presence in the US health care system.

Foreign Medical Graduates↗