Na+/Ca2+ exchanger inhibitor restores endothelium-dependent relaxation in diabetic rat aorta.

The aims of this study were to examine the effects of KB-R7943, an inhibitor of Na(+)/Ca(2+) exchanger, on the endothelium-dependent relaxation (EDR) in diabetic rat aorta. Both acetylcholine (ACh)-induced EDR and sodium nitroprusside (SNP)-induced endothelium-independent relaxation (EIR) were measured in aortic rings of nondiabetic and streptozotocin-diabetic rats. Diabetes mellitus was induced by single injection of streptozotocin (60 mg/kg). The treated rats received 0.01 or 0.1 mg/kg/day of KB-R7943 for 8 weeks. ACh-induced relaxation was impaired in diabetic compared to control rings and the vasodilatation to SNP was unaffected. Treatment with KB-R7943 markedly enhanced relaxation to ACh in diabetic but not in control rings. KB-R7943 significantly increased superoxide dismutase (SOD) activity and the nitric oxide (NO) release. These results suggest that KB-R7943 can restore impaired EDR in aortic rings of diabetic rats, which may be related to scavenging oxygen free radicals and enhancing NO production.

Exploring hospitals' adoption of information technology.

This study explores the adoption of information technology (IT) and the association between organizational and market factors, and IT adoption in hospitals. Results suggest that a wide range of amounts and types of IT are adopted. Hospitals with higher overall IT adoption adopt strategic IT most often. Hospitals with lower IT adoption adopt administrative IT most often. Results also show hospital IT adoption to be positively associated with hospital size, location, system membership, ownership, and market competition.

An exploration of the complex relationship of socioecologic factors in the treatment and outcomes of acute myocardial infarction in disadvantaged populations.

OBJECTIVE: To examine the relationship of patients' socioeconomic status (SES) as measured by race, health insurance status, and median income by zip code to in-hospital mortality of acute myocardial infarction (AMI), paying special attention to patients with multiple unfavorable socioeconomic risk factors. DATA SOURCES/STUDY SETTING: The data set was abstracted from patient-level hospital discharges in the Nationwide Inpatient Sample, Release 3, 1994. A total of 95,971 AMI discharges in 11 states were extracted. STUDY DESIGN: The risk adjustment methodology was adapted from the California Hospital Outcomes Project. Risk factors included demographic and clinical characteristics. Patients in double jeopardy had inferior insurance status and lived in poorer neighborhoods. PRINCIPAL FINDINGS: Compared with patients with health care coverage under Medicare and private insurance uninsured AMI patients had the highest risk-adjusted mortality odds and Medicaid AMI patients had the second highest odds. Probably because of the modest association of median income by zip code areas with mortality odds, the double jeopardy phenomenon was not observed. However, compared to patients who had two favorable SES attributes, patients who carried two unfavorable SES attributes had much higher mortality risk, more comorbidities, longer length of stay, and higher total hospital charges, while they received fewer AMI specialized procedures. Race did not seem to be a significant factor after adjustment for other SES attributes. CONCLUSIONS: SES is significantly related to the mortality of AMI patients. The disadvantaged patients receive fewer specialized procedures, possibly because of their higher levels of severity and financial barriers. The variation in mortality between patients who had favorable and unfavorable SES becomes wider when multiple socioeconomic risks are borne by the latter.

Managed care, vertical integration strategies and hospital performance.

OBJECTIVE: The purpose of this study is to examine the association of managed care with hospital vertical integration strategies, as well as to observe the relationships of different types of vertical integration with hospital efficiency and financial performance. DATA AND METHODS: The sample consists of 363 California short-term acute care hospitals in 1994. Linear structure equation modeling is used to test six hypotheses derived from the strategic adaptation model. Several organizational and market factors are controlled statistically. PRINCIPAL FINDINGS: Results suggest that managed care is a driving force for hospital vertical integration. In terms of performance, hospitals that are integrated with physician groups and provide outpatient services (backward integration) have better operating margins, returns on assets, and net cash flows (p < 0.01). These hospitals are not, however, likely to show greater productivity. Forward integration with a long-term-care facility, on the other hand, is positively and significantly related to hospital productivity (p < 0.001). Forward integration is negatively related to financial performance (p < 0.05), however, opposite to the direction hypothesized. CONCLUSIONS: Health executives should be responsive to the growth of managed care in their local market and should probably consider providing more backward integrated services rather than forward integrated services in order to improve the hospital's financial performance in today's competitive health care market.

Effects of environmental threats on the quality of care in acute care hospitals.

This study investigates how environmental threats may adversely affect internal resources (slacks) and how hospitals' slack level may mediate the adverse effect of environmental threats on quality. Two testable hypotheses are (1) The environmental threat and level of organizational slack in hospitals are inversely related; and (2) Hospitals' slack level and quality of care are positively related. Both hypotheses are supported by the data in analysis of the structural relationships among the environmental threat, organizational slack, and quality of care indicators.

Management strategies and financial performance in rural and urban hospitals.

This study identifies the difference in financial performance between rural and urban hospitals and examines whether or not that difference may be attributed to the emphasis of revenue enhancement over cost management strategies. Hospitals in Virginia were included in this study except for the two state university medical centers. Rural and urban hospitals were compared on 10 performance indicators grouped into four categories: revenues, costs, profits, and productivity. The results suggest that rural hospital profitability is dependent on cost management. Since rural hospitals achieved lower cost, better efficiency and productivity level than urban hospitals in Virginia, they demonstrate a significant higher level of profit.

Effect of organizational and environmental factors on service differentiation strategy of integrated healthcare networks.

During the past decade, the missions/goals of medical providers of healthcare services in the United States have shifted--from emphasizing individual, independent illness treatments to focusing on the continuum of care, population-based wellness, and providing the appropriate care in the most efficient way. Integrated healthcare networks (IHNs)--or integrated healthcare delivery systems--have been focusing heavily on their level of various partnership integration (i.e. service differentiation strategy) in order to offer a full continuum of care. The aim of this study, using the individual IHN as the unit of analysis, was to identify organizational and environmental factors that influence IHN administrators to focus on their service differentiation of market lines, including the establishment of third-party payers' contracts, the affiliation of managed-care organizations, and the alliances of various nonhospital medical providers, to provide a continuum of care. The study findings show that tax status of an IHN, its age, and market competition affect its service differentiation strategy in the provision of a full continuum of care.

Integration and the performance of healthcare networks: do integration strategies enhance efficiency, profitability, and image?

PURPOSE: This study examines the integration effects on efficiency and financial viability of the top 100 integrated healthcare networks (IHNs) in the United States. THEORY: A contingency-strategic theory is used to identify the relationship of IHNs' performance to their structural and operational characteristics and integration strategies. METHODS: The lists of the top 100 IHNs ranked in two years, 1998 and 1999, by the SMG Marketing Group were merged to create a database for the study. Multiple indicators were used to examine the relationship between IHNs' characteristics and their performance in efficiency and financial viability. A path analytical model was developed and validated by the Mplus statistical program. Factors influencing the top 100 IHNs' images, represented by attaining ranking among the top 100 in two consecutive years, were analysed. RESULTS AND CONCLUSION: No positive associations were found between integration and network performance in efficiency or profits. Longitudinal data are needed to investigate the effect of integration on healthcare networks' financial performance.

Market, hospital, and nursing unit characteristics as predictors of nursing unit skill mix: a contextual analysis.

The objective was to examine the relative contributions of market, hospital, and nursing unit characteristics to the prediction of nursing unit skill mix. The strongest predictors of nursing skill mix were found to be the technological sophistication of the hospital, the volume of services offered, and the percentage of patients covered by managed care payors. The results suggest that skill mix on nursing units is buffered from market forces but is highly sensitive to hospital characteristics. These factors need to be taken into account when decisions are made about the allocation of personnel resources. In this article, the terms "nursing skill mix" and "nurse staffing" are used interchangeably.

The impact of the prospective payment system on the technical efficiency of hospitals.

In a longitudinal panel study design, 80 hospitals in Virginia were selected for analysis to test the hypothesis that the introduction of the prospective payment system (PPS) in October 1983 had helped hospitals enhance their operational performance in technical efficiency. A non-parametric method called Data Envelopment Analysis (DEA) was used to calculate and compare the efficiency scores for each peer group of hospitals (by bed size) between the year 1984 and the year 1993. Contrary to expectations, no significant difference in technical efficiency was found in each hospital peer group over the study period. Nevertheless, the case study demonstrates that if hospital managers use this analytical tool appropriately, they may spot where any organizational weakness lies and how they can improve it.

Evolving health services administration education: keeping pace with change.

Virginia Commonwealth University (VCU) celebrated its golden anniversary in 1999. It was an occasion for faculty and alumni to renew memories of their experiences together and marvel at the dramatic changes they have seen in the health care industry. This qualitative study was undertaken to reflect on the department's immediate future course, and to learn how to reposition the education program and curricula to respond to evolving industry needs and demands. Results and conclusions are based on interviews conducted with several stake-holder groups, including VCU alumni, who are executives in the health sector; human resources recruitment officers; and selected program directors from leading health administration (HA) education programs in the U.S. Trends are identified in the health care industry environment, and strategies are proposed for the HA education programs to strategically adapt for the future.

The stability of health status measurement (SF-36) in a working population.

This study tests the stability of health status measurement (SF-36) in a working population. A total of 4,225 employees from two sectors (one state agency, one private company) enrolled in three health plans at Trigon BlueCross/BlueShield of Virginia. An eight-dimension short-form health survey (SF-36) was first tested on a cross-sectional basis for its validity. Then, a panel study was established to test for the stability of health status instrument over time. Structural equation modeling built on equality constraint conditions was the statistical technique for this study. Data were collected through two-wave mail surveys. Both comprehensive (original eight scales) and parsimonious (revised five scales) models of health status were found fit into the data quite well. Furthermore, the revised parsimonious model was shown highly stable over time. Within a working population aged 18 to 64, people are relatively healthy. Their perception of health issues is reflected mainly on "physical health status," as indicated by physical functionings or role limitations. The high stability of revised health status model warrants the possibility of using a more concise health status instrument for the majority of people in working force.

Trends in hospital efficiency among metropolitan markets.

This study evaluates trends in efficiency among American hospital markets. A total of 6010 hospitals were identified for use in the analysis from the American Hospital Association's Annual Surveys for 1989 and 1993. Using data envelopment analysis (DEA), a longitudinal study of hospital efficiency was conducted on all 314 metropolitan markets in the United States. Results suggest that large hospital markets generally demonstrated higher inefficiency. The major inefficiencies exist in the availability of hospital services, the number of operating beds, the utilization of hospital staffing and operating expenses. Consequently, the large hospital market had a significant excess of health manpower that resulted in inefficiency that amounted to approximately $23 billion. From a policy perspective, this study has shed some light on the need to establish more specific policies to address inefficiency in the health care industry.

The determinants of CABG patients' outcomes.

This study examined the self-reported health status of 90 patients who had undergone Coronary Artery Bypass Grafting (CABG). Data were collected by the Short Form-36 (SF-36) instrument, administered twice at preoperative and postoperative periods. The reliability of the SF-36 ranged from 0.68 to 0.93 in the analysis of preoperative and postoperative measures of health status. The CABG patients reported markedly lower health status on all eight SF-36 dimensions at the preoperative period and considerable improvements on all dimensions at the postoperative period. The assessment of CABG patients' outcomes showed that perceived usefulness of the procedure contributed positively to their perceived health status when the effect of preoperative health status was controlled. Patients who perceived the CABG procedure as useful appeared to have more improved postoperative health status after the procedure.

Analysis of integrated healthcare networks' performance: a contingency-strategic management perspective.

Few empirical analyses have been done in the organizational researches of integrated healthcare networks (IHNs) or integrated healthcare delivery systems. Using a contingency derived contact-process-performance model, this study attempts to explore the relationships among an IHN's strategic direction, structural design, and performance. A cross-sectional analysis of 100 IHNs suggests that certain contextual factors such as market competition and network age and tax status have statistically significant effects on the implementation of an IHN's service differentiation strategy, which addresses coordination and control in the market. An IHN's service differentiation strategy is positively related to its integrated structural design, which is characterized as integration of administration, patient care, and information system across different settings. However, no evidence supports that the development of integrated structural design may benefit an IHN's performance in terms of clinical efficiency and financial viability.

Organizational and market determinants of HMOs' performance of preventive practices.

This study validates the measurements of performance of preventive practices and identifies organizational and market factors that affect variations in the preventive care practices of health maintenance organizations (HMOs). Confirmatory factor analysis was used to assess HMO performance, reflecting the rates of five preventive practice services. A structural equation model of the preventive practice performance of HMOs was evaluated. It was discovered that HMOs that employ more board-certified primary care practitioners have a higher rate of preventive care practices and that market competition and market forces do not influence the variation in HMO preventive care practices.

Mastering health care executive education: creating transformational competence.

The effective health services executive needs to continue to develop analytical, technical and behavioral skills to anticipate and meet the changing requirements of the health care industry. Those leading the field of health administration will need to be competent in achieving transformations. Lifelong learning is a necessity. As the structure and knowledge of the field change, so must the ways of exchanging information about health and medical care. Distance learning is a strategy for lifelong learning that can be used to continue one's education. In order to be successful in positioning a health care organization in the competitive world, investment in continued education to update strategic thinking and the analytical competency of executives and managers is imperative. Academic programs able to respond to the educational needs of the health care industry have a dedicated faculty who understand corporate culture and competitiveness in the health care marketplace and are able to offer effective adult education using cutting-edge computer technology for distance learning.

Hospital service scope expansion and market share improvement: a dynamic modeling and multivariate approach.

In a national trend, large, acute-care hospitals located in urban areas of the nation were continuously broadening their service scope, adding services at the rate of one each year, from 1982 to 1987. This study proposes that the underlying rationale of hospital service-scope expansion is status-gap minimization. This perspective was quantitatively interpreted and tested by a dynamic modeling analysis. Findings support status-gap minimization as the rationale for service-scope expansion. Using multivariate regression and dynamic modeling analysis, the study demonstrates that the cross-sectional relationship between two steady states--the relationship between service scope and market share--is positive and statistically significant. However, the market share change is not related to hospital service scope. The interpretation offered is that hospitals expand the scope of services looking not so much to increase their market share benefit in the short run as to raise their organizational status. In the long run, higher organizational status such as broader service scope then benefits market share.

Modeling two dimensions of patient satisfaction: a panel study.

Measurement of patient satisfaction is an essential part of health outcome assessment. The purpose of this study is (a) to compare the stability of an aggregate summary measure and two separate summary measures of patient satisfaction; and, (b) to examine causal effects between two separate summary measures at two points in time. Data were collected from 1,451 Medicare HMO beneficiaries. In conclusion, (a) separate summary measures are recommended for constructing the measure of patient satisfaction and (b) moderate causal relationships and cross-lagged effects between the patient satisfaction measures of qualify of care and access to care were found.