Outcomes among orthopedic patients in skilled nursing facilities: does managed care make a difference?

The use of rehabilitative care has increased greatly. This study evaluates whether managed care affects health outcomes among Medicare orthopedic patients receiving rehabilitative treatments. Managed care versus fee-for-service patients had better outcomes at four months following discharge from skilled nursing facilities. It is important to address predictive factors, such as age, length of hospital stay, debilitation and social living arrangements, which can also influence health outcomes when planning rehabilitative treatment for older patients.

Comparison of older adult subject and proxy responses on the SF-36 health-related quality of life instrument.

Studies of older adults' health status and health-related quality of life (HRQoL) often rely on proxy responses when subjects have problems that affect their ability to respond. With the increased interest in outcomes research in health care, it is important to examine proxy reliability on HRQoL instruments. This study compares 32 pairs of subject-andproxy responses on the eight subscales and two summary scales of the Short Form 36 (SF-36). Subjects and their proxies, recruited from senior centers and residential facilities, were interviewed face-to-face within a seven-day period. Subjects were 60 years of age or older and had passed a brief cognitive screen, and proxies were geographically proximate and had seen the subject during the past week. Results showed that although moderate intra-class correlations were found on six of the eight measures, an item-level kappa statistic indicated poor to fair agreement on all subscales except items of Physical Functioning and Role Physical. Moreover, paired t-tests revealed proxy mean scores that were significantly lower on the Physical Functioning, Vitality, and Mental Health subscales. Given the mixed findings, until further research is done, researchers and clinicians should exercise caution when using proxy responses for older adults with the SF-36.

Career patterns of healthcare executives.

This research examines the job and career changes of healthcare executives and managers working in different segments of the healthcare industry in the western United States. The results suggest that the job and career patterns in the healthcare delivery sector are undergoing significant transformation. One third of the respondents reports that at least one of their last four job changes was involuntary or unplanned. One half of those attempted to make a career change. This study identifies four different executive and management career patterns. The most common was one of multiple career changes. The second pattern was that of a single career change, followed by a 'traditional' career in which one did not seek a career change. The final pattern was characterized as a movement back and forth between two different segments of the healthcare industry. Age, gender, marital status and education were not associated with any specific career pattern. The need to achieve results early in the respondent's career had a strong influence on career patterns. This study confirms the fluidity of career movement and the changing permeability between the various segments of the healthcare industry. It also suggests that career success increasingly will require broad management experience in those different segments.

Improving service delivery: provider perspectives on building community-based systems of care.

This article examines the views of service providers toward different public policy efforts to improve service delivery to elders requiring multiple services from an array of organizations. The authors examine the relationship between provider assessments of the adequacy of their community-based systems of care and community resource levels, coordination strategies, and client characteristics. Findings, based on responses from managers of programs serving older adults (n = 250) to a mailed survey, were that two-thirds (69.4%) evaluated their service delivery systems as adequate or better. A regression model used to explain system adequacy indicated that 22% of the variance was accounted for by community resource level, information and service availability, attention to specific need clients, and percentage of minority clients served by the respondents' programs. Findings suggest that community resource level appears to be an important factor in respondents' evaluation of system adequacy. While respondents indicated that improved coordination could enhance their efforts to deliver services, this strategy was not one they favored in improving their community-based system of care. Instead, they preferred strategies which expanded or improved the services that were available.

Factors affecting decisions to adopt medical technologies in acute care hospitals.

The results of this research have added an expanded perspective on the decision to adopt particular technologies. The perception had been that, given the current state of health care reimbursement, decisions to acquire radical and often expensive devices will center around economic or strategic considerations. However, it was discovered that technology acquisition appeared to be a physician centered activity with less consideration given to strategic or economic factors. While these data suggest that hospitals have not been listening to complaints about rising health care costs and continue to operate in a "business as usual" manner, it may because physicians continue to be the dominant players in what is for them an unrestrained free market. This trend, if continued, may ultimately lead to a reimposition of heavy handed government regulation in the adoption of even the most routine medical technology. As a result, it is vital that health care administrators begin to explore ways for moving from physician centered and tactical considerations to a more strategic focus which builds upon the needs and interests of the medical staff to serve the community in a more responsible fashion before that ability is taken away from them.

The marketing activities of hospitals: environmental, organizational, and managerial influences.

This article reports the results of a study designed to examine the relationship of environmental, organizational and structural factors, perceptions of key decision makers about competitive conditions, and changes in operational performance with the level of the marketing activities engaged in by 145 California hospitals. Measures assessing the impact of environmental conditions and the perception of the key decision makers were found to be related to the marketing activities of the organization. However, the relationship between measures which examined the structural and performance impacts on the marketing activities did not demonstrate the same predictive ability. The results suggest that marketing activities were affected by the key decision maker's assessment of the competitive nature of the environment, influence of key stakeholders, and tangible changes in the organization's task environment. Performance and other measures were not found to be as influential in determining these activities.

Conditions influencing the marketing efforts of hospitals.

This research assesses the degree to which environmental change, competitive conditions and position, hospital characteristics, and organizational performance influence the extensiveness of a hospital's marketing activities. Changes in occupancy, revenue, and patient mix did not predict the level of marketing activities. Instead, the perceptions of marketing decision makers about changing environmental conditions were found to predict these activities.

Determinants of job satisfaction in nursing care units.

Considerable attention has been placed on containing health care costs through structural approaches and budgetary means. Often overlooked in this process are costs associated to employee turnover and absenteeism. One of the important contributing factors to this withdrawal behavior is job satisfaction. Unfortunately few studies have explored the factors which influence the job satisfaction of health care workers. This study, using data collected from four hospitals, identifies fifteen factors that make major contributions to predicting the job satisfaction of nursing employees. This research suggests that the job satisfaction of nursing aides is influenced by procedures and practices that are organizational in their impact, by interactions with the work team and supervisor, and the daily activities of the nursing job. By understanding the interactive nature of these factors on job satisfaction, improvements in absenteeism and turnover can be realized with a reduction in personnel costs and improvements in quality of care.

How nursing administrators view conflict.

Fifty-one nursing administrators attending an institute on administration were asked to respond to two questions: "What is good about conflict?" "What is bad about conflict?" Findings indicated that nursing administrators: made more positive than negative statements about conflict, associated conflict's effects to be greater on people than on task accomplishment, indicated that conflict had greater intrapersonal than interpersonal effects, believed that the beneficial effects of conflict on task accomplishment lie in the realm of problem resolution, and reported that the major negative effects of conflict on task accomplishment were felt on productivity. These findings underscore the complex nature of conflict and its benefits and costs to the individual, organization, and nursing administrator. Views of these nursing administrators are in concert with contemporary behavioral science literature which suggests that conflict is necessary for organizational growth and is not automatically symptomatic of organizational pathology.