Antecedents of geographical expansion: The case of federally qualified health centers.

BACKGROUND: Federally qualified health centers (FQHCs) are pivotal safety net primary care providers for the medically underserved. FQHCs have complex organizational designs, with many FQHCs providing care at multiple physical locations ("sites"). The number of sites, however, varies considerably between FQHCs, which can have important implications for differential access that may perpetuate disparities in quality of care. PURPOSE: The objective of this study is to explore the organizational and environmental antecedents of the number of sites operated by each FQHC. The findings of this study contribute to a better understanding of FQHCs' expansion that has vital implications for cost and access outcomes. METHODOLOGY/APPROACH: The study is based on data between the years 2012 and 2018. Using multivariate growth curve modeling, we analyzed the final sample, consisting of 5,482 FQHC-years. RESULTS: The level of competition, measured as the number of FQHC sites in the Primary Care Service Area (PCSA) and the number of primary care physicians per 1,000 PCSA residents, was positively associated with the number of FQHC sites. The number of patients, the level of federal grant, and the year were also positively associated with the number of FQHC sites, whereas percentage of Medicaid patients; workforce supply, measured as primary care physician assistants per 1,000 PCSA residents; Medicaid expansion; and state/local funding available for FQHCs were not. CONCLUSION: Findings of this study indicate that competition, especially between peer FQHCs, is significantly associated with FQHC expansion. PRACTICE IMPLICATIONS: This result suggests that FQHC managers and policymakers may closely monitor cost, access, and quality implications of competition and FQHC expansion.

Environmental and organizational influences on magnet hospital recognition.

This article reports on research studying the influence of environmental and organizational factors on the adoption of the magnet hospital concept. Although research has been reported on the adoption of innovations by healthcare organizations, research on factors influencing the adoption of administrative advances remains an important area to investigate. Logistic regression was used to determine both the significance and direction of the association of environmental and organizational factors with innovation adoption. In addition, the size and type of the hospitals in the sample was used as a control variable. It was found for environmental factors that environmental complexity and community resources were associated with innovation adoption and that competition and network externalities were not. For the organizational factors examined, it was found that organizational complexity and control of domain were associated with innovation adoption. Slack resources and external communications were not associated with adoption. The findings from this study contribute to healthcare management research by enhancing the understanding of the innovation adoption process. The results have important implications for both healthcare providers and policy makers.

Physician and practice characteristics associated with longitudinal increases in electronic health records adoption.

This article identifies practice- and physician-related characteristics associated with the increased use of EHRs by physicians in outpatient practices. Two Florida surveys conducted in 2005 and 2008 on physician use of EHRs were examined to determine the practice and physician characteristics associated with increased EHR use over time. Based on multivariate analysis, several variables were found to influence increased EHR adoption. Practice variables included participation in a single-specialty practice and percentage of Medicare patients in the practice, but not percentage of Medicaid patients in the practice. Physician characteristics included younger physician age, but not specialty nor years practicing in the community. Factors associated with EHR adoption at any given point in time did not necessarily predict longitudinal increases in EHR adoption. These results are important for physicians to consider in their potential adoption of EHRs and should also be considered by policymakers interested in promoting increased use of EHRs by physicians.

The role of information technology usage in physician practice satisfaction.

BACKGROUND: Despite the growing use of information technology (IT) in medical practices, little is known about the relationship between IT and physician satisfaction. PURPOSE: The objective of this study was to examine the relationship between physician IT adoption (of various applications) and overall practice satisfaction, as well as satisfaction with the level of computerization at the practice. METHODS: Data from a Florida survey examining physicians' use of IT and satisfaction were analyzed. Odds ratios (ORs), adjusted for physician demographics and practice characteristics, were computed utilizing logistic regressions to study the independent relationship of electronic health record (EHR) usage, PDA usage, use of e-mail with patients, and the use of disease management software with satisfaction. In addition, we examined the relationship between satisfaction with IT and overall satisfaction with the current medical practice. RESULTS: In multivariate analysis, EHR users were 5 times more likely to be satisfied with the level of computerization in their practice (OR = 4.93, 95% CI = 3.68-6.61) and 1.8 times more likely to be satisfied with their overall medical practice (OR = 1.77, 95% CI = 1.35-2.32). PDA use was also associated with an increase in satisfaction with the level of computerization (OR = 1.23, 95% CI = 1.02-1.47) and with the overall medical practice (OR = 1.30, 95% CI = 1.07-1.57). E-mail use with patients was negatively related to satisfaction with the level of computerization in the practice (OR = 0.69, 95% CI = 0.54-0.90). Last, physicians who were satisfied with IT were 4 times more likely to be satisfied with the current state of their medical practice (OR = 3.97, 95% CI = 3.29-4.81). IMPLICATIONS: Physician users of IT applications, especially EHRs, are generally satisfied with these technologies. Potential adopters and/or policy makers interested in influencing IT adoption should consider the positive impact that computer automation can have on medical practice.

The evolution of rural hospitals viewed through a population ecology framework.

Rural hospitals face formidable environmental challenges and have experienced closure rates higher than those of their urban counterparts. However, many of these rural hospitals appear to be surviving by developing interorganizational relationships that include network formation, absorption into investor-owned systems, and contract management arrangements. The concept of population ecology has been applied to organizational survival and can be used to examine health care organizations and specifically explain the evolution of rural hospitals. In this paper concepts from population ecology are used to explain the survival of rural hospitals and how new organizational structures are being developed to compensate for environmental changes.

A resource-based view of partnership strategies in health care organizations.

The distribution of management structures in health care has been shifting from independent ownership to interorganizational relationships with other firms. A shortage of resources has been cited as one cause for such collaboration among health care entities. The resource- based view of the firm suggests that organizations differentiate between strategic alliances and acquisition strategies based on a firm's internal resources and the types of resources a potential partner organization possesses. This paper provides a review of the literature using the resource-based theory of the firm to understand what conditions foster different types of health care partnerships. A model of partnership alliances using the resource-based view is presented, strategic linkages are presented, managerial implications are outlined, and directions for future research are given.

The influence of time on changes in health status and patient satisfaction.

This article develops a framework that investigates the impact that a change in health status has on satisfaction with structure and process elements of health care delivery over time. We develop and present a structural equation model that encompasses these relationships based on a survey of 284 consumers of health care services. The results indicate that health status is directly related to satisfaction with process of care elements but not directly related to structural elements. These results contribute to the literature by examining the impact of health status on satisfaction in two distinct elements related to structure and process.

Improving health outcomes through patient empowerment.

The concept of empowerment can be successfully used in the healthcare industry to positively influence patient participation and compliance with their program of treatment. This paper examines the literature that has developed in the area and presents a model that incorporates patient empowerment into the healthcare delivery process. Managerial implications and directions for future research are also presented.