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Biomedical subjects

S Shortell

Publications and source records attributed to S Shortell.

15 recordsLinked to original sources
PubMed2002

Quality collaboratives: lessons from research.

Quality improvement collaboratives are increasingly being used in many countries to achieve rapid improvements in health care. However, there is little independent evidence that they are more cost effective than other methods, and little knowledge about how they could be made more effective. A number of systematic evaluations are being performed by researchers in North America, the UK, and Sweden. This paper presents the shared ideas from two meetings of these researchers. The evidence to date is that some collaboratives have stimulated improvements in patient care and organisational performance, but there are significant differences between collaboratives and teams. The researchers agreed on the possible reasons why some were less successful than others, and identified 10 challenges which organisers and teams need to address to achieve improvement. In the absence of more conclusive evidence, these guidelines are likely to be useful for collaborative organisers, teams and their managers and may also contribute to further research into collaboratives and the spread of innovations in health care.

Cooperative Behavior↗
PubMed1994

An examination of winners and losers under Medicare's prospective payment system.

Through case studies of 10 matched pairs of winner and loser hospitals under the Medicare prospective payment system (PPS), specific characteristics and management actions were identified that are related to strong financial performance. Because other payers are increasingly adopting PPS-like cost control incentives and because managed care is fundamental to the national health care reform debate, the successful strategies identified in this article may be of increasing importance to hospital managers.

Cost Control↗
PubMed1993

State experience with Medicare hospital mortality: how does New York State compare?

1987 Medicare hospital mortality statistics for 255 New York hospitals (including 57 hospitals in New York City) were compared with 4,617 hospitals located in other states. An analysis of covariance examined how overall Medicare hospital mortality rates differed across states; these rates were adjusted for expected mortality, hospital bed size, and major teaching status. This study tested for the hypothesis that New York State had an average 30-day post-admission Medicare mortality rate significantly different from the mean hospital mortality rate for all states. The results indicated that New York State was -0.43 percentage points below the average risk-adjusted mortality rate of the other states (p < 0.0001). Although it remains speculative to what extent differences in adjusted Medicare hospital mortality are a function of quality of care, these results indicate that New York's historically high level of hospital regulation has not resulted in inferior patient outcomes.

Hospital Mortality↗
PubMed1988

Management partnerships: improving patient care in healthcare organizations of the future.

The hospital of the future will have to be part of a system or network which will provide a continuum of care in primary care services, acute in-patient care and post-hospital care. Additionally, hospitals will become increasingly diversified and, at the same time, integrated, not only horizontally but more importantly, vertically. This amalgamation will be achieved either by acting alone or by a joint venture with another group, through shared services or through contract management. Technology and computerization will play an even larger role than currently, and there will be tremendous demands placed on the micro and macro levels of management partnership.

Canada↗
PubMed1988

The financial performance of selected investor-owned and not-for-profit system hospitals before and after Medicare prospective payment.

This article analyzes determinants of cost and profitability, including the influence of Medicare prospective payment (PPS), between 1983 and 1985 for nearly 300 hospitals belonging to investor-owned (IO) and not-for-profit (NFP) systems. Using approaches that assure comparability of financial data, and including case mix, quality, competition, and regulation measures, the findings indicate that (1) in both years, competitive environment, case mix, age of facility, and scope of diversified services were important determinants of average cost, while a process measure of quality was insignificant and the independent effect of ownership type was insignificant for cost; (2) effects of HMO competition and hospital strategy were stronger in 1985 than in 1983; (3) operating margins for all types of hospitals showed increases, with a somewhat greater improvement for NFP system members; and (4) significantly greater declines in volume of care occurred for IO system members. Implications for future research are discussed.

California↗
PubMed1981

Health status as a measure of need for medical care: a critique.

At the national level there has been a desire to assure that individuals have access to effective personal medical care services. Accordingly, there has been an interest in linking policies on access to care to the health needs of diverse population groups. This article critiques three measures of access linked to health status: the Use-Disability Ratio, the Symptoms-Response Ratio, and the Episode of Illness Analysis. Their utility in determining whether a given level of health-service utilization is appropriate for the optimization of health status in a population is considered. As part of this task, we review the concept of health, its measurement, and data on the relationship between changes in utilization and changes in health status. Although the Use-Disability ratio may be a useful instrument to measure access equity, it appears less suited for the purpose stated above. Elements of both the Symptoms-Response Ratio and the Episode of Illness Analysis appear better suited for this purpose. Recommendations are provided on 1) the scope of services that should be included in a comprehensive construct designed to assess access related to health status, and 2) the required research to develop such a construct.

Health↗
PubMed1979

The relationship of health beliefs and a postcard reminder to influenza vaccination.

The relationship of certain health beliefs to influenza vaccination and the effect of a postcard reminder on vaccination rates was studied among 232 high-risk patients. In agreement with the Health Belief Model tested, the patients vaccinated believed influenza to be more serious, believed they were more susceptible to influenza, and believed the vaccine to be more efficacious than did patients not vaccinated. Those not vaccinated were less satisfied with their medical care and felt the vaccine was more expensive than those vaccinated. A postcard reminding patients of influenza vaccination was an effective way to increase the vaccination rate. Patients receiving the card had a 59.7 percent vaccination rate compared to a 30.0 percent rate among those not receiving the postcard. This study suggests that a reminder postcard is an effective means to promote influenza vaccination and that these beliefs are important determinants of vaccination behavior.

Attitude to Health↗