Strategies of High-Performing Teaching Hospitals.

Teaching hospitals are large and complex, and under constant financial pressure. In this study, we examine the financial performance of 80 large teaching hospitals in the 20 largest cities in the U.S. over the last five years, to identify which strategic and operational management factors separate high-performing hospitals from lower-performing ones. Results suggest that growth strategies should continue to be sought for improving long-term financial condition. Operational efficiency was less important than market share, economic status of surrounding community, hospital size, and teaching intensity. This study's findings should help guide strategic planning for teaching hospitals.

Predicting Financial Distress in Acute Care Hospitals.

Hospitals continue to face financial pressures from healthcare reform and heightened competition. In this study, our objective was to quantify the financial distress in acute care hospitals in Texas, applying multivariate logistic regression in a four-year longitudinal analysis. Of the 310 acute care hospitals, 50 (16.1%) were in financial distress in the most recent year, up considerably year over year. Distressed hospitals had fewer beds, lower patient acuity, and less outpatient revenues than those in good financial condition. Administrators should identify business turnaround strategies for combating distress to avoid potential closure.

Interorganizational Collaboration in Emergency Cardiovascular Care.

BACKGROUND: Interorganizational collaboration management theory contends that cooperation between distinct but related organizations can yield innovation and competitive advantage to the participating organization. Yet, it is unclear if a multi-institutional collaborative can improve quality outcomes across communities. METHODS: We developed a large regional collaborative network of 15 hospitals and 24 emergency medical service agencies surrounding Dallas, Texas, and collected patient-level data on treatment times for acute myocardial infarctions. Using a pre-/posttest research design, we applied median tests of differences to explore outcome changes between groups and over the 6-year period, using data extracted from participating hospital electronic health records. RESULTS: We analyzed temporal trends and changes in treatment times for 2302 patients with ST-elevation myocardial infarction between the pre- and posttest groups. We found a statistically significant 19-minute median reduction in the key outcome metric (total ischemic time, the time difference between the patient's first reported symptoms and the definitive opening of the artery). This represents a 10.8% community-wide improvement over time. CONCLUSIONS: Interorganizational collaboration focused on quality improvement can impact population health across a community. This study provides a basis for broader understanding and participation by health care organizations in multi-institutional community change efforts.

Longitudinal changes in the operating efficiency of public safety-net hospitals.

Government-operated trauma facilities fill an important role as safety nets in our health system, providing care to millions of individuals who lack health insurance. Because these hospitals are often the most financially constrained, continuous improvement in operating efficiency seems to be a necessary component of their organizational strategy. In this study, we analyze the longitudinal changes in efficiency of a large sample of government-operated safety-net hospitals from 2004 to 2008. Employing an analytical tool called data envelopment analysis, our findings suggest that as a group these hospitals have become more efficient over time, improving by 2.1 percent over the five-year study period.

Avoiding fraud risks associated with EHRs.

Fraud associated with electronic health records (EHRs) generally falls into two categories: inappropriate billing by healthcare providers and inappropriate access by a system's users. A provider's EHR system requires controls to be of any significant help in detecting such fraudulent activity, or in gathering transactional evidence should such activity be identified. To protect against potential EHR-related healthcare fraud, providers should follow the recommendations established in 2007 by RTI International for the Office of the National Coordinator for Health Information Technology of the U.S. Department of Health and Human Services.