Managerial process improvement: a lean approach to eliminating medication delivery.

PURPOSE: Statistical evidence shows that medication errors are a major cause of injuries that concerns all health care oganizations. Despite all the efforts to improve the quality of care, the lack of understanding and inability of management to design a robust system that will strategically target those factors is a major cause of distress. The paper aims to discuss these issues. DESIGN/METHODOLOGY/APPROACH: Achieving optimum organizational performance requires two key variables; work process factors and human performance factors. The approach is that healthcare administrators must take in account both variables in designing a strategy to reduce medication errors. However, strategies that will combat such phenomena require that managers and administrators understand the key factors that are causing medication delivery errors. FINDINGS: The authors recommend that healthcare organizations implement the Toyota Production System (TPS) combined with human performance improvement (HPI) methodologies to eliminate medication delivery errors in hospitals. ORIGINALITY/VALUE: Despite all the efforts to improve the quality of care, there continues to be a lack of understanding and the ability of management to design a robust system that will strategically target those factors associated with medication errors. This paper proposes a solution to an ambiguous workflow process using the TPS combined with the HPI system.

Health information technology capacity at federally qualified health centers: a mechanism for improving quality of care.

BACKGROUND: The adoption of health information technology has been recommended as a viable mechanism for improving quality of care and patient health outcomes. However, the capacity of health information technology (i.e., availability and use of multiple and advanced functionalities), particularly in federally qualified health centers (FQHCs) on improving quality of care is not well understood. We examined associations between health information technology (HIT) capacity at FQHCs and quality of care, measured by the receipt of discharge summary, frequency of patients receiving reminders/notifications for preventive care/follow-up care, and timely appointment for specialty care. METHODS: The analyses used 2009 data from the National Survey of Federally Qualified Health Centers. The study included 776 of the FQHCs that participated in the survey. We examined the extent of HIT use and tested the hypothesis that level of HIT capacity is associated with quality of care. Multivariable logistic regressions, reporting unadjusted and adjusted odds ratios, were used to examine whether 'FQHCs' HIT capacity' is associated with the outcome measures. RESULTS: The results showed a positive association between health information technology capacity and quality of care. FQHCs with higher HIT capacity were significantly more likely to have improved quality of care, measured by the receipt of discharge summaries (OR=1.43; CI=1.01, 2.40), the use of a patient notification system for preventive and follow-up care (OR=1.74; CI=1.23, 2.45), and timely appointment for specialty care (OR=1.77; CI=1.24, 2.53). CONCLUSIONS: Our findings highlight the promise of HIT in improving quality of care, particularly for vulnerable populations who seek care at FQHCs. The results also show that FQHCs may not be maximizing the benefits of HIT. Efforts to implement HIT must include strategies that facilitate the implementation of comprehensive and advanced functionalities, as well as promote meaningful use of these systems. Further examination of the role of health information systems in clinical decision-making and improvements in patient outcomes are needed to better understand the benefits of HIT in improving overall quality of care.

Strategies for dealing with future shortages in the nursing workforce: a review.

The well-anticipated and well-documented demographic shift attributed to ageing of the baby boomer generation will place significant demands upon the health-care industry in the future. Significant resources such as the nurse workforce, will be needed to provide health-care services to this cohort. There is a looming shortage of professional and paraprofessional nurses. This paper evaluates strategies that can be utilized to decrease the rate of the nursing shortage, while retaining the current supply of nurses. Recommendations for solving the nursing shortage problem include enhancing the work environment through fostering open communication, improving technology, nurse empowerment, building long-lasting and fulfilling partnerships, and efficient workplace organization.

Strategic groups in health care: a literature review.

The purpose of this study is to review the literature that discusses the relationship between strategic group membership and performance in the nursing home industry. This literature review examines the relationship between organizational structure and performance in the nursing home industry. Results from these studies suggest industry stability of segmentation; limitation of strategic choice due to high mobility barriers (as represented by facility, staffing and location variables); quality is controlled by the existing combinations of industry regulation and market competition; and the existence of performance differences among strategic groups.

The empowerment and quality health value propositions of e-health.

E-health, as well as its value and benefits, has been characterized as a concept defined in various ways depending on intended audience and use. Attempts to define, characterize and appreciate e-health inadvertently portray it as something out of main stream academia; thus, undermining the relevance and importance of the transformation capabilities of e-health on the practice of health care from the individual and organizational perspectives. In order to contribute towards an understanding and appreciation of e-health as a main stream concept, we propose the use of existing models, theories and principles in support of e-health. Specifically, the empowerment theory and the principles of quality health will be used to discuss the value proposition of e-health. An understanding of the e-health value proposition is important, because it helps organizations to develop a shared vision and context, which in turn keeps organizations focused and realistic as they expend resources and adopt e-health. It also helps e-health consumers understand what is possible and impossible, and how they can best participate in e-health for the betterment of their health and health care.

The importance of examining movements within the US health care system: sequential logit modeling.

BACKGROUND: Utilization of specialty care may not be a discrete, isolated behavior but rather, a behavior of sequential movements within the health care system. Although patients may often visit their primary care physician and receive a referral before utilizing specialty care, prior studies have underestimated the importance of accounting for these sequential movements. METHODS: The sample included 6,772 adults aged 18 years and older who participated in the 2001 Survey on Disparities in Quality of Care, sponsored by the Commonwealth Fund. A sequential logit model was used to account for movement in all stages of utilization: use of any health services (i.e., first stage), having a perceived need for specialty care (i.e., second stage), and utilization of specialty care (i.e., third stage). In the sequential logit model, all stages are nested within the previous stage. RESULTS: Gender, race/ethnicity, education and poor health had significant explanatory effects with regard to use of any health services and having a perceived need for specialty care, however racial/ethnic, gender, and educational disparities were not present in utilization of specialty care. After controlling for use of any health services and having a perceived need for specialty care, inability to pay for specialty care via income (AOR = 1.334, CI = 1.10 to 1.62) or health insurance (unstable insurance: AOR = 0.26, CI = 0.14 to 0.48; no insurance: AOR = 0.12, CI = 0.07 to 0.20) were significant barriers to utilization of specialty care. CONCLUSIONS: Use of a sequential logit model to examine utilization of specialty care resulted in a detailed representation of utilization behaviors and patient characteristics that impact these behaviors at all stages within the health care system. After controlling for sequential movements within the health care system, the biggest barrier to utilizing specialty care is the inability to pay, while racial, gender, and educational disparities diminish to non-significance. Findings from this study represent how Americans use the health care system and more precisely reveals the disparities and inequalities in the U.S. health care system.

Specialty care use in US patients with chronic diseases.

Despite efforts to eliminate health disparities, racial, ethnic, and geographic groups continue lag behind their counterparts in health outcomes in the United States. The purpose of this study is to determine variation in specialty care utilization by chronic disease status. Data were extracted from the Commonwealth Fund 2006 Health Care Quality Survey (n = 2475). A stratified minority sample design was employed to ensure a representative sample. Logistic regression was used in analyses to predict specialty care utilization in the sample. Poor perceived health, minority status, and lack of insurance was associated with reduced specialty care use and chronic disease diagnosis.

Risk factor and cost accounting analysis for dialysis patients in Taiwan.

According to the 2004 US Renal Data System's annual report, the incidence rate of chronic renal failure in Taiwan increased from 120 to 352 per million populations between 1990 and 2003. This incidence rate is the highest in the world. The prevalence rate, which ranks number two in the world (Japan ranks number one), also increased from 384 to 1630 per million populations. Based on 2005 Taiwan national statistics, there were 52,958 end-stage renal disease (ESRD) patients receiving routine dialysis treatment. This number, which comprised less than 0.2% of the total population and consumed $2.6 billion New Taiwan dollars, was more than 6.12% of the total annual spending of national health insurance during 2005. Dialysis expenditures for patients with ESRD rank the highest among all major injuries (traumas) and diseases. This article identifies and discusses the risk factors associated with consumption of medical resources during dialysis. Instead of using reimbursement data to estimate cost, as seen in previous studies, this study uses cost data within organizations and focuses on evaluating and predicting the resource consumption pattern for dialysis patients with different risk factors. Multiple regression analysis was used to identify 23 risk factors for routine dialysis patients. Of these risk factors, six were associated with the increase of dialysis cost: age (i.e. 75 years old and older), liver function disorder, hypertension, bile-duct disorder, cancer and high blood lipids. Patients with liver function disorder incurred much higher costs for injection medication and supplies. Hypertensive patients incurred higher costs for injection medication, supplies and oral medication. Patients with bile-duct disorder incurred a significant difference in check-up costs (i.e. costs were higher for those aged 75 years and older than those who were younger than 30 years of age). Cancer patients also incurred significant differences in cost of medical supplies. Patients with high blood lipids incurred significant differences in cost of oral medication. This study identified the relationship between cost and risk factors of dialysis procedures for ESRD patients based on average variable costs for each dialysis treatment. The results show that certain risk factors (e.g. aged 75 and older, hypertension, bile-duct disease, cancer and high blood lipids) are associated with higher cost. The results from this study could enable health policy makers and the National Health Insurance Bureau to design a fairer and more convincible reimbursement system for dialysis procedures. This study also provides a better understanding of what risk factors play more influential roles in affecting ESRD patients to receive haemodialysis treatment. It will help policy makers and health-care providers in better control or even prevent the disease and manage the distribution of the treatment. In addition, with the results from the analysis of cost information, we can tell which risk factors have more impacts on the dialysis cost. It will further help us control the cost for those high-risk dialysis patients more efficiently.

Data mining for health executive decision support: an imperative with a daunting future!

Data mining is highly profiled. It has the potential to enhance executive information systems. Such enhancement would mean better decision-making by management, which in turn would mean better services for customers. While the future of data mining as technology should be exciting, some are worried about privacy concerns, which make the future of data mining daunting. This paper examines why data mining is highly profiled - the imperative toward data mining, data mining models and processes. Additionally, the paper examines some of the benefits and challenges of using data mining processes within the health-care arena. We cast the future of data mining by highlighting two of the many data mining tools available - one commercial and one freely available. Subsequently, we discuss a number of social and technical factors that may thwart the extensive deployment of data mining, especially when the intent is to know more about the people that organizations have to serve and cast a view of what the future holds for data mining. This component is especially important when attempting to determine the longevity of data mining within health-care organizations. It is hoped that our discussions would be useful to organizations as they engage data mining, strategies for executive information systems and information policy issues.

Policy challenges in US health care system reform.

Once again, efforts are being made to overhaul the US health care system. Democrats and Republicans have conflicting views on how to repair this ailing system. However, this is not a new phenomenon. Reformers have long struggled to form a universal health care system only to find themselves in conflict with groups whose financial stake is threatened as well as numerous labor associations who are concerned about a loss of power. This struggle is also caused by differences in ideologies. This article surveys social movements for national health insurance (NHI) that occurred in the United States and will examine features that prevented NHI policy formation.

Strategic information technology alliances for effective health-care supply chain management.

To gain and sustain competitive advantage, health-care providers have to continuously review and renovate their operational and information technology (IT) strategies through collaborative and cooperative endeavour with their supply chain channel members. This paper explores new ways of enhancing a health-care organization's responsiveness to changes and increasing its competitiveness through implementing strategic information technology alliances among channel members in a health-care supply chain network. An overview of issues and problems (e.g. bullwhip effect, negative externalities and free-riding phenomenon in multichannel supply chains) presented in the health-care supply chains is first delineated. This paper further goes over the issues of health-care supply chain coordination and integration for strategic IT alliances, followed by the discussion of the spillover effect of IT investments. A number of viable IT practices (such as information sharing and Internet-enabled supply chain portal) for effective health-care supply chain collaboration and coordination are then examined in this research. Finally, the paper discusses how strategic IT alliances can help improve the effectiveness of health-care supply chain management.

The economic value of investing in regenerative medicine.

This article discusses the science of regenerative medicine and presents evidence that investments towards the development of this technology will reduce total health care output. Use of regenerative medicine will also be an important factor in eliminating chronic diseases such as diabetes, heart disease, and Parkinson's disease. Investment in regenerative medicine is a sound strategy for several reasons: human suffering will be reduced, if not eliminated; and the economy will be stimulated by creating employment opportunities, generating additional income and tax revenues, increasing worker productivity, creating new conglomerates, and reducing insurance costs. This article discusses some of the latest advances in regenerative medicine as well as the progress that has been made in the development of new stem cell therapies.

Confronting the challenges of long-term health care crisis in the United States.

This article examines the factors that comprise long-term health care and the impact that the aging population will have in dramatically increasing the costs of long-term health care in the United States if current health policies are not amended. It further analyzes the reasons that will cause the health care expenditures to expand. It also discusses the economic challenges and the impact that absent reform can have on state and federal budgets, ultimately affecting the national economy. Aside from that, this article presents numerous options that communities across the nation can embark on to reduce health care costs and it briefly glances at the proposed legislation called America's Affordable Health Choices Act of 2009 that was submitted by the House Committee on Ways and Means and in summary discusses the key features of the bill.

Treatment disparities in medication prescribing for Alzheimer's: disease among ethnic groups.

OBJECTIVES: The purpose of this explanatory study was to determine whether medication prescribing for Alzheimer's disease (AD) differs by racial and ethnic group membership. The following research question was examined in this study: Are there prescribing pattern differences for AD among racial and ethnic groups? Additional beneficiary characteristic variables examined included: diabetes, memory loss, psychological disorder, age category, and gender. METHODS: This research project employed a time series study design to analyze three years of a national secondary dataset to examine Medicare beneficiaries with Alzheimer's disease (AD). Specific medications were identified as the standard of care treatment regimen for severe and mild to moderate AD (Aricept and Exelon, respectively). RESULTS: Descriptive statistics for medications for the AD group were obtained. Total prescribed medications for the AD group was analyzed for treatment differences for the study variables race, age category, gender, psychological disorder, diabetes, and memory loss. An association was found for all three years between treatment (Aricept) and the following variables: diabetes, memory loss, and psychological disorder. DISCUSSION: Treatment type trends indicated that Aricept use for both blacks and whites has decreased. High frequency of antiseizure medications were found, which could indicate their use as mood enhancers. Study findings indicate that patients on AD treatment were not also taking mood enhancers. Diabetic patients were found to be on Aricept and Exelon and mood altering medications. Hormones were present among the medications; since the sample was over 65 (post menopausal), could indicate use of hormone therapy as a treatment option for this sample despite standard treatment recommendations.

Does increasing cigarette excise tax improve people's health? The cases of heart attacks and stroke.

INTRODUCTION: Recently, public health advocates have fervently supported an increase in the cigarette excise tax as a means of reducing smoking. Likewise, political leaders have heavily relied on the cigarette excise tax as a means of encouraging a reduction in the overall rates of cigarette use. However, little is known about whether the cigarette excise tax is a valid tool for reducing the negative effects of smoking on public health. Our objective is to examine whether increasing the cigarette excise tax will reduce the morbidity rates of heart attack and stroke, which have consistently been among the major causes of death and disability in the United States. METHODS: We used the static and dynamic panel-data model to explore the impact of the US regional cigarette excise tax on morbidity rates of heart attack and stroke. These rates of heart attack and stroke are estimated based on the 1970-2000 National Hospital Discharge Survey (NHDS). RESULTS: Study results show that the causal relationship between cigarette excise tax and morbidity rates of heart attack and stroke is unclear. However, the morbidity rates of non-smoking-related hypertension and high cholesterol-related diseases are positively correlated with the morbidity rates of heart attack and stroke. CONCLUSIONS: We did not find clear empirical evidence to support the hypothesis that raising the cigarette excise tax effects a reduction the morbidities of heart attack and stroke. Therefore, use of the cigarette excise tax may not be an effective means to improve the health of the US population.

Racial and ethnic disparities in the use of mental health services.

The authors used data from the 1998-1999 Community Tracking Study (CTS) household survey to examine variations in predictors of use of mental health services among different racial and ethnic groups (white, African American, Hispanic, and other). African Americans and Hispanics were less likely to have visited a mental health professional (MHP) in the prior year than were whites. Independent of health insurance and health status, low- to middle-income African Americans may be at particular risk for inadequate use of an MHP compared to higher-income African Americans. Similarly, upper-income Hispanics were more likely to have visited an MHP than Hispanics in the lowest income range. Adults aged 50 and older were less likely to visit an MHP than individuals aged 18-49. Depressed men were more likely to visit an MHP than depressed women. Efforts to reduce disparities should focus on lower-income racial and ethnic minorities.

A strategic approach of E-health initiatives.

The Internet is transforming the US economy. Though it continues to lag behind other industries, healthcare has begun to incorporate this technology on a wider scale to reduce costs and more effectively address quality and patient-choice issues. This article presents the background of the US healthcare system, examines the application of e-health, advocates for the integration of e-health components and discusses the roles of major stakeholders in e-health as the basis for the strategic planning, initiation and implementation of integrated e-health systems. Strategic planning provides the opportunity for an insightful view and consideration of the impacts, expectations and responses of e-health stakeholders while implementing integrated e-health solutions for access to more cost-effective and better patient care delivery.

Health care competition, strategic mission, and patient satisfaction: research model and propositions.

PURPOSE: In all industries, competition among businesses has long been encouraged as a mechanism to increase value for patients. In other words, competition ensures the provision of better products and services to satisfy the needs of customers This paper aims to develop a model that can be used to empirically investigate a number of complex issues and relationships associated with competition in the health care industry. DESIGN/METHODOLOGY/APPROACH: A literature review was conducted. A total of 50 items of literature related to the subject were reviewed. Various perspectives of competition, the nature of service quality, health system costs, and patient satisfaction in health care are examined. FINDINGS: A model of the relationship among these variables is developed. The model depicts patient satisfaction as an outcome measure directly dependent on competition. Quality of care and health care systems costs, while also directly dependent on the strategic mission and goals, are considered as determinants of customer satisfaction as well. The model is discussed in the light of propositions for empirical research. PRACTICAL IMPLICATIONS: Empirical studies based on the model proposed in this paper should help identify areas with significant impact on patient satisfaction while maintaining high quality of service at lower costs in a competitive environment. ORIGINALITY/VALUE: The authors develop a research model which included propositions to examine the complex issues of competition in the health care industry.

A research model of health-care competition and customer satisfaction.

In all industries, competition among businesses has long been encouraged as a mechanism to increase value for customers. In other words, competition ensures the provision of better products and services to satisfy the needs of customers. Various perspectives of competition, the nature of service quality, health-care system costs and customer satisfaction in health care are examined. A model of the relationship among these variables is developed. The model depicts customer satisfaction as an outcome measure directly dependent on competition. Quality of care and health-care system costs, while also directly dependent on competition, are considered as determinants of customer satisfaction as well. The model is discussed in the light of propositions for empirical research.

Comparison of health behaviors among single- and multiple-member households.

OBJECTIVE: To assess the differences in health behavior between multiple-member and single-member households by gender. METHODS: Face-to-face household survey interviews were conducted. The relationship between health behaviors and living arrangement was assessed by adjusting for SES. RESULTS: Women living alone exercised more and ate less food high in fat. More highly educated men were less likely to exercise 5 or more times a week than high school or less educated men. CONCLUSIONS: By analyzing local data, a profile can be established to develop and implement appropriate public health programs aimed at these various target communities for effective intervention and healthy change in the community.