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PubMed1998

An interview with Dick Davidson. Interview by Mary Grayson.

Dick Davidson, president of the American Hospital Association since 1991, has witnessed--and advocated--a revolution among the members. Hospitals have become much more than providers of acute care. Many of them now strive to manage a continuum of coordinated services to their communities. Their next big step is learning to manage risk for Medicare patients by becoming provider sponsored organizations. None of this is made easier, Davidson believes, by the public's sagging confidence in hospitals. In fact, he sees regaining that trust and respect as health care's top priority.

American Hospital Association↗

PubMed2002

Identifying and measuring hospital characteristics using the SEER-Medicare data and other claims-based sources.

The context in which health care is delivered may have an impact on the outcomes and processes of care. Researchers analyzing claims data that reflect care rendered at many institutions may wish to identify hospital characteristics such as bed size, teaching status, degree of specialization, and case volume to evaluate their influence on outcomes. The authors describe the resources available from administrative data for characterizing hospitals. The article focuses on analyses using the SEER-Medicare-linked data, but has direct relevance for investigators working with other sources of claims data. First, the authors focus on assessment of hospital case volume, which is the principal hospital attribute that can be obtained directly from the SEER-Medicare data files. Second, they assess the information regarding hospital characteristics that can be gleaned from the American Hospital Association (AHA) survey and the annual cost reports submitted to the Center for Medicare and Medicaid Services (CMS) by all certified hospitals. From a comparison of the responses of 4,434 hospitals to 1994 AHA and CMS surveys, the authors conclude that the two data sources contain very similar information, but that for most investigators, use of data from CMS cost reports will be preferable to use of AHA data because of higher survey-completion rates and public availability.

Aged↗

PubMed2006

Toward the creation of an institutional logic for the management of hospitals: efficiency in the early nineteen hundreds.

This research focuses on the creation of an institutional logic--efficiency--and on its organizing principles of standardization and business practices through a study of the American Hospital Association and its publication, the Modern Hospital. In the early years of the 20th century, efficiency began to emerge as a first institutional logic for the management of hospitals. The term was defined broadly, encompassing not only economy but also quality and breadth of services, as well as access to care. This early emphasis on efficiency foreshadowed three issues that affect health policy and hospital management to this day: the pressure on hospitals to introduce new technology while containing cost, the assumption that hospitals should act like businesses, and the practice of offering large hospitals as the model for other providers.

American Hospital Association↗

PubMed1981

Data on U.S. hospitals: a comparison of the two principal sources.

Rapid changes in the nation's health-care requirements and systems of health-care delivery are making detailed and reliable information about the nation's hospitals increasingly important to researchers. This article compares the two principal sources of regular data about the utilization, finances, and staffing of U.S. hospitals--the American Hospital Association's Annual Survey of Hospitals and the National Hospital Panel Survey. It describes the kinds of data collected by the surveys and the methods by which they are processed and verified; and it shows how the surveys complement one another in providing a picture of the nation's hospital industry. The Annual, a yearly survey of all U.S. hospitals, obtains a data set suitable for detailed cross-sectional analyses. The Panel, a monthly survey of a sample of U.S. community hospitals, obtains a data set from which estimated projections suitable for broad longitudinal analysis are derived.

American Hospital Association↗

PubMed2001

A population ecology study of hospital closures in Florida between 1965 and 1995.

The population ecology literature argues that, at the macro level, organizations experience various liabilities to their continued survival. This study examined the effect of size, age, and niche density on the closure of acute care hospitals in Florida between 1965 and 1995. The data for the study were created using information about Florida hospitals found in the annual reports of the American Hospital Association (n = 427). Using the technique of survival analysis, it was found that newer hospitals and hospitals originally established in organizationally dense areas (five or more hospitals within a five-mile radius) experienced a significantly greater incidence of closure than did those that were older or founded in less dense areas. Small hospitals (<100 beds) were also shown to be significantly more likely to close than large ones (>300 beds) as were hospitals located in organizationally dense areas (>five hospitals in a five-mile radius). The study concludes with an examination of the policy and management implications of the results.

American Hospital Association↗

PubMed1995

NOVA Awards. Building healthier communities.

The following profiles of this year's winners of the second annual NOVA Awards, sponsored by the American Hospital Association and Hospitals & Health Networks magazine, exemplify humanity, which is what health care is all about. The winners all set out to boost the health and well-being of their communities. That frequently means expanding the traditional hospital mission to ensure that disadvantaged and underserved people not only get good health care, but also safer streets, nutritious food, a decent place to live, and a future for their children. They're all part of a community's ecology. None of these projects is finished. But you have to start somewhere to get somewhere else.

American Hospital Association↗

PubMed1997

Analysis of factors affecting U.S. emergency physician workforce projections. SAEM Workforce Task Force.

OBJECTIVES: To use existing data sources to refine prior estimates of the U.S. emergency medicine (EM) workforce and to estimate effects of proposed changes in the U.S. health care system on the EM workforce. METHODS: Relevant data were extracted from the American College of Emergency Physicians (ACEP) 1995 Membership Activity Report, the American Medical Association (AMA) publication "1995/96 Physician Characteristics and Distribution in the U.S.," the American Hospital Association (AHA) 1994 hospital directory, a written survey of each state's medical licensing board and state medical society, and the American Board of Emergency Medicine (ABEM) annual activity report for 1995. These data were used to project workforce supply and demand estimates applicable to workforce models. RESULTS: None of the available information sources had complete data on the number and distribution of emergency physicians (EPs) currently practicing in the United States. Extrapolating the limited reliable statewide EP numbers to make nationwide projections reveals a shortage of EPs needed to fully staff the nation's existing EDs. At least 22 states had an average ratio of < 5 EPs per existing ED. Additional national projections incorporating a decreasing number of U.S. EDs indicate that the current annual number of EM residency graduates will not eliminate the deficit of EPs for at least several decades, given that projected numbers of retiring EPs annually will soon equal the total annual EM residency graduate production. CONCLUSIONS: Although the current data on EPs in practice in the United States are incomplete, the authors project a relative shortage of EPs. More accurate and complete information on the numbers and distribution of EPs in America is needed to improve workforce projections.

Certification↗

PubMed2000

The prevalence of hospital health promotion and disease prevention services: good news, bad news, and policy implications.

In recent years, American health care has shifted toward an emphasis on population health in communities. National data from the American Hospital Association Annual Survey of Hospitals are used to describe the prevalence of 26 services provided by general hospitals that could contribute to health promotion and disease prevention (HPDP). Cross-sectional descriptive analyses, based on national data sources, linked HPDP services to hospital characteristics, and factor analysis identified significant categories of HPDP activities. The results showed that many specific HPDP services are offered by thousands of hospitals, but prevalence, distribution, and availability of the services are uneven across the size and ownership of hospitals and their communities. Policy initiatives could increase the prevalence of hospitals' health promotion and disease prevention services, thereby improving the health status of their communities.

American Hospital Association↗

PubMed1991

Journals indexed by the AHA Resource Center for Hospital Literature Index and HEALTH database.

The American Hospital Association (AHA) Resource Center indexes journals for the Health Planning and Administration (HEALTH) database and Hospital Literature Index (HLI). These journals, designated special list health journals, are selected to provide access to a wide and balanced coverage of hospital and health care administration and health policy literature. This article provides background information on HEALTH and HLI and describes special list health journals in detail (including historical information, information sources, and broad subject divisions). It also discusses AHA policies relating to journal and article selection and current subject distribution of special list health journals.

Abstracting and Indexing↗

PubMed1993

A survey of health sciences libraries in hospitals: implications for the 1990s.

In response to an expressed need for comprehensive data on health sciences libraries in hospitals, the American Hospital Association (AHA) conducted a survey of all U.S. registered hospitals in 1990. The response rate was 57%. Results showed that 2,167 hospitals (31.6% of all U.S. registered hospitals) had on-site libraries that met four definitional criteria. Survey results also indicated that hospitals use diverse resources and approaches to provide information services to a wide array of health care providers and consumers. These baseline data, combined with an assessment of key environmental factors affecting hospitals, can provide guidance to hospital libraries as they face the challenges of the 1990s. The AHA has added the health sciences library to services tracked in its annual survey of hospitals; additional research opportunities in this area remain.

American Hospital Association↗

PubMed1983

Structural determinants of union activity in hospitals.

This study uses national data from the American Hospital Association and the National Labor Relations Board in a multivariate framework to assess the impact of various structural factors on union activity in hospitals. The theoretical framework includes both management and union perspectives in evaluating (1) whether the hospital had a signed collective-bargaining contract in 1980; (2) whether a union election had been held; and (3) whether the union won the election. The results indicate that certain structural characteristics (hospital size, ownership, teaching status, and location) have had a significant impact on union activity in hospitals, while other characteristics (third-party reimbursement and area factors) have not. The results also show that prospective reimbursement has a positive impact on union activity.

American Hospital Association↗

PubMed2000

The effect of changing state health policy on hospital uncompensated care.

This paper examines the effect of changing state policy, such as Medicaid eligibility, payment generosity, and HMO enrollment on provision of hospital uncompensated care. Using national data from the American Hospital Association for the period 1990 through 1995, we find that not-for-profit and public hospitals' uncompensated care levels respond positively to Medicaid payment generosity, although the magnitude of the effect is small. Not-for-profit hospitals respond negatively to Medicaid HMO penetration. Public and for-profit hospitals respond negatively to increases in Medicaid eligibility. Results suggest that public insurance payment generosity is an effective but inefficient policy instrument for influencing uncompensated care among not-for-profit hospitals. Further, in localities with high HMO penetration or high penetration of for-profit hospitals, it may be necessary to establish explicit payments for care of the uninsured.

American Hospital Association↗

PubMed1999

Trends in hospital efficiency among metropolitan markets.

This study evaluates trends in efficiency among American hospital markets. A total of 6010 hospitals were identified for use in the analysis from the American Hospital Association's Annual Surveys for 1989 and 1993. Using data envelopment analysis (DEA), a longitudinal study of hospital efficiency was conducted on all 314 metropolitan markets in the United States. Results suggest that large hospital markets generally demonstrated higher inefficiency. The major inefficiencies exist in the availability of hospital services, the number of operating beds, the utilization of hospital staffing and operating expenses. Consequently, the large hospital market had a significant excess of health manpower that resulted in inefficiency that amounted to approximately $23 billion. From a policy perspective, this study has shed some light on the need to establish more specific policies to address inefficiency in the health care industry.

American Hospital Association↗

PubMed1980

The hospital's perspective on cost containment.

Cost containment has long been a concern of hospitals and the American Hospital Association (AHA). In recent years, however, cost containment has assumed a special prominence in hospitals, becoming both a political and social necessity. The hospitals' and AHA's activities in cost containment fall into four major categories: first, the Voluntary Effort to Contain Health Care Costs, of which AHA is a founding partner; second, administrative effectiveness; third, capital effectiveness, and, finally, medical effectiveness. Some programs to promote administrative effectiveness are shared administrative services, energy conservation, careful attention to staffing patterns and management effectiveness review. Capital effectiveness involves technology assessment and other means of deciding how to make the most of the hospital's dollar. Medical effectiveness can be accomplished by such methods as medical audits, utilization reviews and shared clinical services.

American Hospital Association↗

PubMed1995

Consequences of hospital financial distress.

This study identifies a group of financially distressed hospitals and tracks them over time to identify the consequences of their financial distress and the factors that may precipitate different events. Of 2,547 that supplied complete financial data to the American Hospital Association for the period 1983-1985, a total of 340 community hospitals met our definition for distress. The most striking finding is that 91.2 percent of hospitals that were distressed in 1983-1985 survived through the end of 1990. Distressed hospitals also had significantly higher rates of system acquisition and merger, as well as higher rates of system divesture. Growing competition in a market appeared to be a major factor in the closure of a distressed hospital. The results of this study suggest that financially distressed hospitals have a remarkable resiliency that allows them to continue operation without dramatic change. This may be good news to local community officials concerned about maintaining financially weakened hospitals. Alternatively, it may be bad news if poor financial performance is a signal of unneeded capacity.

American Hospital Association↗

PubMed1989

Hospital productivity and intensity trends: 1980-87.

This paper takes advantage of a unique set of annual MONITREND data from the American Hospital Association (AHA) to study the effects of Medicare's Prospective Payment System (PPS) and other public/private programs on hospital productivity and intensity between 1980 and 1987. The results on over 30 cost centers show major improvements in inpatient productivity per discharge in the first two years of PPS--improvements that are largely attributable to shifts of care to the outpatient department. Inpatient intensity, which was growing 4.5% annually between 1980 and 1982, turned negative from 1983-85 due to this shifting locus of care. Productivity per intermediate service also improved but at a slower rate because of the large declines in inpatient volumes. Productivity improvements were greater in urban hospitals, resulting in slower cost inflation and a better financial position compared with rural hospitals.

American Hospital Association↗

PubMed1995

Special report. Hospital maintenance staffing study: history and process.

This special report provides an overview of the ASHE Hospital Maintenance Staffing Study, which was conducted by the society in 1994-95 through the efforts of the ASHE Facilities Management Committee. The intent of the study was to develop a standard staffing equation to assist hospitals in determining appropriate maintenance staffing levels based on current practices of American Hospital Association member hospitals. Throughout the study, extensive survey data were collected and over 200 variables were considered. Statistical analyses were performed to determine which factors were most closely related to variations in staffing patterns, and whether staffing could be reliably predicted by a standard staffing equation. As with any benchmarking or other similar efforts, the results of this study should be approached with caution. There is variability in the data and the variability may change over time. However, the study has shown that high-quality predictability is possible Health care facilities will be able to use the resulting model to determine whether their staffing levels are significantly out of line and may help point to contributing factors.

American Hospital Association↗

PubMed1993

The relationship between adjusted hospital mortality and the results of peer review.

This study assessed the relationship between the Health Care Financing Administration adjusted mortality rate for a hospital and the errors in care found by the peer review process. The three data sets used were: (1) the 1987-1988 completed reviews from 38 peer review organizations (PROs) of 4,132 hospitals and 2,035,128 patients; (2) all 1987 hospital mortality rates for Medicare patients as adjusted by HCFA for patient mix; and (3) the 1986 American Hospital Association Survey. The PRO data were used to compute the percentage of cases reviewed from each hospital confirmed by a reviewing physician to have a quality problem. The average percentage of confirmed problems was 3.73 percent with state rates ranging from 0.03 percent to 38.5 percent. The average within-state correlation between the problem rate and the adjusted mortality rate for all PROs was .19 (p < .0001), but the correlations were much higher for relatively homogeneous groups of hospitals, .42 for public hospitals and .36 for hospitals in large metropolitan statistical areas (MSAs). These results suggest that the HCFA adjusted hospital mortality rate and the PRO-confirmed problem rate are related methods to compare hospitals on the basis of quality of care. Both methods may compare quality better if used within a group of homogenous hospitals.

American Hospital Association↗