Environmental and Organizational Factors Associated with Hospital Use of GPO Services.

Given the potential benefits of Group Purchasing Organizations in cost-containment efforts for hospitals on supplies and purchased services, an important question that remains unanswered is what conditions support or hinder the utilization of GPOs by hospitals. Therefore, this study explores the relationship between GPO use by hospitals and their market and organizational characteristics. Data on hospital GPO utilization and other organizational characteristics were combined with secondary hospital market characteristics. Panel logistic regression with random effects and state and year fixed effects analysis was used to examine the relationship between hospitals' utilization of GPO services and hospitals' organizational and market characteristics. Overall, the majority of hospitals utilized the services of GPOs. Specifically, the number of hospitals utilizing the services of GPOs increased slightly from 3290 (72.2%) in 2004 to 3337 (74.4%) in 2013. In regression analyses, hospitals utilizing the services of GPOs operated in an external environment with mixed levels of munificence, more dynamism, and less competition. Specifically, hospitals operating in a less munificent environment are more likely to utilize the services of GPOs. The study findings provide organizational decision-makers and policymakers' insights into how certain market and organizational factors influence hospital strategy choice, in this case, the use of GPOs.

Organizational, Regional, and Community Factors Determining Protocol Compliance for Patients With Acute Myocardial Infarction.

This study examined factors determining hospital compliance to Hospital Quality Alliance's protocol for patients with myocardial infarction. Using a spatially matched sample of 132 Magnet and 264 non-Magnet hospitals, multivariate regressions determined significant hospital characteristics associated with compliance per Hospital Quality Alliance protocol. Adherence to the Hospital Quality Alliance protocols varied widely by hospital characteristics. Registered nurse staffing/bed was a key factor determining patient care quality variation. Quality of care practices such as protocol compliance should be measured and examined separately.

Freestanding Emergency Departments Are Associated With Higher Medicare Costs: A Longitudinal Panel Data Analysis.

The number of freestanding emergency departments (FSEDs) is growing rapidly in the United States. Proponents of FSEDs cite potential benefits of FSEDs including lower waiting time and reduced travel distance for needed emergency care. Others have suggested that increased access to emergency care may lead to an increase in the use of emergency departments for lower acuity patients, resulting in higher overall health care expenditures. We examined the relationship between the number of FSEDs in each county and total Medicare expenditures between 2003 and 2009. Our results show that each additional FSED in a county is associated with an expenditure increase of $55 per Medicare beneficiary. This finding suggests that even if FSEDs may increase access to emergency care, it may result in higher overall Medicare expenditures.

Contextual factors associated with hospitals' decision to operate freestanding emergency departments.

BACKGROUND: Freestanding emergency departments (FSEDs) are fast growing entities in health care, delivering emergency care outside of hospitals. Hospitals may benefit in several ways by opening FSEDs. PURPOSE: The study used the resource dependence theory as a means to analyze the relationship between market and organizational factors and the likelihood of hospitals to operate FSEDs. METHODOLOGY: All acute care hospitals in 14 states with FSEDs present during the study period from 2002 to 2011. Data on FSEDs were merged with American Hospital Association Annual Survey, Centers for Medicare and Medicaid Services' Cost Reports, and Area Resource File data. The outcome variable consists of whether or not the hospital operates an FSED. Independent variables include per capita income, percent population over age of 65 years, primary care and specialist physicians per capita, urban location, change in the unemployment rate, change in the population, change in poverty level, market competition, total satellite and autonomous FSEDs in the market, Medicare-managed care penetration rate, hospital beds, total margin, and system membership. We used logistic regression analysis with state and year fixed effects. Standard errors in the regression were clustered by hospital. PRINCIPAL FINDINGS: The number of hospitals operating satellite FSEDs increased from 32 (2.33%) in 2002 to 91 (5.76%) hospitals in 2011 among the 14 states included in the study sample. The results support the hypothesis that hospitals located in munificent environments and more competitive environments (presence of other FSEDs) are more likely to operate an FSED. Organizational level factors such as bed size and system membership are associated with a hospital operating an FSED. PRACTICE IMPLICATIONS: The findings may be used by policy makers in developing regulations for hospitals opening FSEDs. Also, study findings of this study may be used by hospitals to make informed decisions when formulating strategies regarding FSEDs.

Succession Planning and Financial Performance: Does Competition Matter?

Succession planning has been defined as the process by which one or more successors are identified for key positions, development activities are planned for identified successors, or both. Limited research exists pertaining to the relationship between hospital succession planning and financial performance, particularly in the context of market competition. We used the resource-based view framework to analyze the differential effect of succession planning on hospitals' financial performance based on market competition. According to RBV, organizations can achieve higher performance by using their superior resources and capabilities. We used a panel design consisting of a national sample of hospitals in the United States for 2006-2010. We analyzed data using multivariate linear regression with facility random effects and year and state fixed effects. The sample included 22,717 hospital-year observations; more than one half of the hospitals (55.4%) had a succession planning program. The study found a positive relationship between the presence of succession planning and financial performance (ß = 1.41, p < .01), which was stronger in competitive markets (ß = 2.31, p = .03) than in monopolistic markets (ß = 1.06, p = .01). Hospitals can use these results to make informed decisions about investing in succession planning programs on the basis of competition in their market.

A silver lining to higher prices at the pump? Gasoline prices and teen driving behaviors.

PURPOSE: Existing literature shows negative relationships between gasoline price and motor vehicle crashes, particularly among teens. This paper extends that literature by evaluating the relationship between gasoline price and self-reported risky driving among teens. DESIGN: Observational study using multivariate empirical analysis, using pooled data from the Youth Risk Behavior Survey, waves 2003-2009. SETTING: Secondary data from survey administered in private and public high schools across the United States. SUBJECTS: Students in grades 9 through 12, surveyed biennially from 2003 to 2009 (n = 58,749). MEASURES: Outcomes are (self-reported) driving without seatbelts, driving after consuming alcohol, and moderate physical activity (like walking or bicycling). State-level retail gasoline prices constitute the main predictor variable. ANALYSIS: Multivariate logistic models are estimated for the full sample, as well as by gender, race/ethnicity, and age. Individual characteristics, state unemployment, and state driving policies are controlled for. Standard errors are clustered at the state level. Results are reported in form of risk differences. RESULTS: Higher gasoline prices are negatively and significantly associated with driving without seatbelts. Associations are particularly strong for males and minorities. There are fewer statistical associations between gasoline prices and driving after drinking. Higher gasoline prices are positively associated with more moderate physical activity. CONCLUSION: Higher gasoline prices are associated with less risky driving behaviors among teens, and they may be associated with more active forms of transportation, like walking and bicycling. The study limitations are discussed.

Geomapping telehealth access to developmental-behavioral pediatrics.

BACKGROUND: Geographic information systems (GIS) mapping is fairly novel in describing utilization of health services. Our study is the first to use GIS to demonstrate that telehealth pediatric specialty service access would create substantial savings in travel time and distance compared with accessing a tertiary-care center for similar service. MATERIALS AND METHODS: A retrospective chart review of telehealth encounters and geocoding of patients' address were done with actual travel along road calculations to estimate travel time and distance for a visit, compared with a hypothetical visit to the nearest tertiary-care site for the similar service. RESULTS: Over a 2-year period, 255 telehealth visits by 171 patients with a variety of developmental and behavioral diagnoses were made to five telehealth sites. The median travel time and distance saved by accessing a telehealth site were 66.9 min and 63.8 miles, respectively. Of these patients, 12.3% had a median negative estimated savings of 52.7 min and 39.0 miles, which was associated with longer travel burden. Using the straight-line method underestimated the total time and distance traveled by approximately one-quarter of the actual distance (median distance of 20.5 miles underestimate relative to the median distance of 100.7 miles). CONCLUSIONS: Telehealth patients experienced significant reduction in travel times and distances. Patients/families would accept an increased burden of spatial accessibility in exchange for reduced burdens in other aspects of access, such as accommodation or acceptability when engaging telehealth services. Using a road network-based method is more accurate than previously used straight-line methods in calculating distance impedance.