ABSTRACT
Health care is, at its core, comprised of complex sequences of transactions among patients, providers, and other stakeholders; these transactions occur in markets as well as within systems and organizations. Health care transactions serve one of two functions: the production of care (i.e., the laying on of hands) or the coordination of that care (i.e., scheduling, logistics). Because coordinating transactions is integral to care delivery, it is imperative that they are executed smoothly and efficiently. Transaction cost economics (TCE) is a conceptual framework for analyzing health care transactions and quantifying their impact on health care structures (organizational forms), processes, and outcomes.
Subject(s)
Continuity of Patient Care/economics , Continuity of Patient Care/organization & administration , Health Care Sector/organization & administration , Models, Economic , Organizational Innovation , Efficiency, Organizational , Health Benefit Plans, Employee/economics , Health Benefit Plans, Employee/organization & administration , Health Care Costs , Health Services Research , Humans , Investments/economics , United StatesABSTRACT
This article describes one health system's efforts to improve HEDIS measurement by integrating claims information from its managed care organization with data from its medical center's automated billing, scheduling, and clinical information systems. The authors discuss problems encountered while establishing an integrated measurement process and offer suggestions for others considering such an approach.
Subject(s)
Ambulatory Care/statistics & numerical data , Delivery of Health Care, Integrated/statistics & numerical data , Managed Care Programs/statistics & numerical data , Professional Staff Committees , Statistics as Topic , Health Maintenance Organizations/statistics & numerical data , Humans , Quality of Health Care , Sensitivity and Specificity , United StatesABSTRACT
Advanced practice nurses are charged with basing their practice on research by evaluating and engaging in research studies. Review of research, however, is often hampered by the difficulty in accessing research. The breadth and depth of the literature on innovation and information dissemination demonstrate that nurse practitioners' (NPs) access to and use of the research literature are not trivial matters. This paper suggests some guidelines that may make research more accessible to the NP community. Because the issue is viewed as a problem of access, a seminal work on patients' access to healthcare services is employed to frame the discussion and proposed solutions.
Subject(s)
Information Storage and Retrieval , Models, Nursing , Nurse Practitioners/education , Nurse Practitioners/organization & administration , Nursing Research , Diffusion of Innovation , Evidence-Based Medicine , HumansABSTRACT
Achieving high-quality outcomes in healthcare organizations requires effective systems of control. Such systems consist of formal and informal transactions between patients, providers, payors, and policymakers, among others (Shortell 1972; Stiles and Mick 1997). One method for evaluating the suitability of control-oriented transactions to tasks is to compare the costs of controlling the quality of the good or service produced to the cost of its material and labor inputs. Activity-based cost (ABC) accounting provides the methodology for explicating the causal relationship between healthcare organizations' control-oriented transactions, the services whose quality they ensure, and the costs of both control activities and services delivered. Understanding these relationships is of vital importance to those charged with evaluating the feasibility of proposed managed care contracts, new product lines, and existing service configurations. In this article, we explain why traditional accounting practices are poorly suited to accomplishing the control function in today's healthcare arena, highlight activity-based costing's potential to redress the shortcomings of conventional practice, and elaborate the strategic importance of adopting the new methodology.
Subject(s)
Accounting/methods , Cost Allocation/methods , Health Care Costs , Total Quality Management/economics , Cost Control/methods , Decision Support Systems, Management , Health Care Costs/standards , Laboratories/economics , Laboratories/organization & administration , Personnel Management/economics , Personnel Management/methods , Personnel Selection/economics , Personnel Selection/methods , Salaries and Fringe Benefits , United States , WorkforceABSTRACT
This article identifies the components that contribute to a healthcare organization's costs in controlling quality. A central tenet of our argument is that at its core, quality is the result of a series of transactions among members of a diverse network. Transaction cost economics is applied internally to analyze intraorganizational transactions that contribute to quality control, and questions for future research are posed.
Subject(s)
Cost Allocation/methods , Health Care Costs , Models, Economic , Total Quality Management/economics , Employee Performance Appraisal , Health Care Costs/standards , Health Personnel/standards , Health Services Research/methods , Models, Organizational , Organizational Policy , Process Assessment, Health Care/economics , Task Performance and Analysis , United StatesABSTRACT
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.
