WHEN AND HOW DOES VALUE BASED PURCHASING IMPACT HOSPITAL PERFORMANCE?Kirsty Macauldy, MBA
To improve the overall quality of healthcare, The National Quality Strategy of the U.S. Department of Health and Human Services broadly defines the outcomes that the Centers for Medicare and Medicaid Services (CMS) wants to achieve through the care it purchases for its beneficiaries. The strategies; aims of better health, better care, and lower costs.
Copyright 2014 American Medical Association. All rights reserv.docxdickonsondorris
This study analyzed compensation data for 1877 CEOs of 2681 nonprofit US hospitals. The CEOs had a mean compensation of $595,781 and median of $404,938 in 2009. CEO compensation was higher for those managing larger hospitals, more hospitals, and major teaching hospitals. The study examined if compensation was associated with various hospital metrics. Compensation was higher for hospitals with more advanced technology and higher patient satisfaction, but was not associated with financial metrics, quality measures like mortality and readmissions, or community benefit provided. This suggests CEO pay was linked to some measures of hospital performance but not others aimed at quality and community impact.
NCBI Bookshelf. A service of the National Library of Medicine,.docxvannagoforth
NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.
Institute of Medicine (US) Roundtable on Value & Science-Driven Health Care; Yong PL, Olsen LA, McGinnis
JM, editors. Value in Health Care: Accounting for Cost, Quality, Safety, Outcomes, and Innovation.
Washington (DC): National Academies Press (US); 2010.
5 Approaches to Improving Value—Provider and Manufacturer
Payments
INTRODUCTION
Payment design, coverage policies, reimbursement rules, and other financial incentives and
disincentives are powerful motivators when attempting to steer the healthcare system toward
more desirable care patterns (Guterman et al., 2009). Experiments with payment design and
coverage and reimbursement policies are currently going on in both public and private healthcare
sectors, with varying results. Speakers in this session of the workshop explored current payment
design experiments and discussed the efficacy of utilizing these reimbursement tools to improve
the value received from health care.
In this chapter, Carolyn M. Clancy details the pay-for-performance (P4P) model, an effort to
more explicitly link provider payments to quality of care. She highlights the lack of coherent
approaches to P4P and the variable success this approach has had in fundamentally changing
provider practice patterns. For example, while financial incentives for individual physicians have
shown that P4P can induce quality improvements for diabetic patients (Beaulieu and Horrigan,
2005), group-level incentives have had no impact on mammography screening or hemoglobin A
testing rates (Rosenthal et al., 2005). After underscoring that the current incentive system and
healthcare infrastructure fail to accommodate the achievement of real efficiency and quality, she
outlines recommendations for rethinking medical training, measurement, system design, and the
reward system.
Building on Clancy’s recommendations, Donald A. Sawyer identifies how the current healthcare
system stymies innovation in product development. He suggests refocusing the myopic view of
innovation on the horizon of long-term health improvements and financial savings. Reed V.
Tuckson discusses the alignment of manufacturers, technologists, payers, patients, and providers
necessary to establish a system that continues to provide incentives for innovation and maintains
an open market for the development of promising but unproven interventions. He elaborates
specifically on a joint effort between UnitedHealth Group and the American College of
Cardiology to develop appropriateness criteria for cardiac single-photon emission computed
tomography myocardial perfusion imaging—a new and very expensive technology—based on
best evidence as an example of how the interests of diverse stakeholder groups could be aligned.
In conclusion, Steven D. Pearson likens coverage and reimbursement tools to a blunt knife that
lacks subtlety in effecting value improvements, bu ...
Running head QUALITY IMPROVEMENT FOR PUBLIC HEALTH FACILITIES .docxtoltonkendal
Running head: QUALITY IMPROVEMENT FOR PUBLIC HEALTH FACILITIES 1
QUALITY IMPROVEMENT FOR PUBLIC HEALTH FACILITIES 6
Quality Improvement for Public Health Facilities
Qualitative Research Methods Evaluation
AIU ONLINE
HLTH 335 1701A - 01
UNIT 2 IP
The type of study in the four listed articles include the following. Article one by Chaudhry et al., (2006) was a qualitative study. The authors conducted a system review from expert opinion and literature review to determine the role that information technology had played in enhancing health care quality, efficiency and costs of medical care. The authors hypothesized that information technology had played a significant role in improving the quality of medical care by increasing adherence to medical guidelines, improving disease surveillance and decreasing medication errors. The type of study for the second article was also a qualitative study that examined 260 hospital on the issue of pay for performance strategy. The authors compared their results to other hospital that did not have the current nationwide pay for performance system, (Werner et al., 2010). The authors hypothesized that pay-for-performance system improved quality health care among hospitals in this system. The third article was also a qualitative study where the authors hypothesized that public reporting of hospital quality data and the pay for performance have emerged as the widely advocated tools for these that accelerate health facility’s improvement (Lindenauer et al., 2007). The fourth article was also a qualitative study article. The authors of the article hypothesized that the Keystone ICU project was associated with a significant decrease on the hospital mortality within Michigan as compared to the surrounding areas, (Lipitz-Snyderman, et al., 2011).
Article one utilized data from published expert opinion and literature search from academic data bases. There was no direct involvement of the human subject when collecting data for this article. Article two utilized data from 260 hospitals. The authors chose acute care hospitals that began operating in 2004. The author’s excluded four critical-access hospitals. Researchers of the third article used 2490 health services providers nation-wide who met the criteria for Hospital Quality Alliance (HQA). In the fourth article, the authors chose the patients who were treated in Michigan’s 95 study hospitals from 238, 937 total admissions. All the samples and the populations for these studies were appropriate.
During the study documentation Chaudhry et al., (2006) reported that hospital facilities documented and reported data on costs and contextual factors. Limitations of data in this article is that the systematic review utilized a mixed data of private and public initiatives into hospital systems. The public and private initiatives have different agendas. Werner et al., (2010), study results indicated that the two groups of hospitals were simil ...
This thesis analyzes data from the Centers for Medicare and Medicaid Services (CMS) to identify which quality measurement parameters have the greatest impact on hospitals' overall performance scores and ratings. The author sorted CMS data into categories for mortality, readmissions, safety, and patient experience. Correlation coefficients were calculated between each measurement and hospitals' total performance scores. It was found that hospital-wide readmission rates, acute myocardial infarction 30-day readmission rates, and patient experience measures of doctor communication and responsiveness of hospital staff had the strongest correlations with overall performance scores. Therefore, hospitals looking to improve their ratings may want to focus most on improving these specific factors.
The Relationship BetweenPatient Satisfaction and Inpatient.docxssusera34210
The Relationship Between
Patient Satisfaction and Inpatient
Imissions Across Teaching
Daniel J. Messina, PhD, FACHE, LNHA, senior vice president and chief operating
officer, CentraState Healthcare System, Freehold, New Jersey; Dennis J. Scotti, PhD,
FACHE, FHFMA, Alfred E. Driscoll Professor, Healthcare and Life Sciences
Management, Fairleigh Dickinson University, Teaneck, New Jersey; Rodney Caney,
PhD, founder. Press Caney Associates, South Bend, Indiana; and Cenevieve
Pinto Zipp, EdD, PT, chair and associate professor, Craduate Programs in Health
Sciences, Seton Hall University, South Orange, New Jersey
E X E C U T I V E S U M M A R Y
The need for healthcare executives to better understand the relationship between
patient satisfaction and admission volume takes on greater importance in this age
of rising patient expectations and declining reimbursement. Management of patient
satisfaction has become a critical element in the day-to-day operations of healthcare
organizations pursuing high performance.
This study is guided by two principal research questions. First, what is the nature
of the relationship between patient satisfaction (as measured by scored instruments)
and inpatient admissions in acute care hospitals? Second, does the relationship
between patient satisfaction (as measured by scored instruments) and inpatient
admissions differ between teaching hospitals and nonteaching hospitals? Although
not suggestive of direct causation, the study findings revealed a statistically significant
and positive correlation between patient satisfaction and admission volume in teach-
ing hospitals only. In contrast, a nonsignificant, negative correlation was seen be-
tween patient satisfaction and admission in nonteaching hospitals. In the combined
teaching and nonteaching sample, a statistically significant, negative correlation was
found between patient satisfaction scores and admission volume.
With financial performance being driven in part by admission volume and with
patient satisfaction affecting hospital patronage, the business case for a strategic focus
on patient satisfaction in teaching hospitals is clearly evident. The article concludes
with a set of recommendations for strengthening patient satisfaction and organiza-
tional performance.
For more information on the concepts in this article, please contact Dr. Messina
at [email protected]
177
JOURNAL OF HEALTHCARE MANAGEMENT 5 4 : 3 M A Y / J U N E 2 0 0 9
n n today's healthcare marketplace,
U providers increasingly compete against
one another for business. In the late
1980s, healthcare executives were
confronted with the realization that
they could not just increase charges to
generate revenue, but rather they had
to contain costs as well. Providers now
compete on business factors other than
price, such as quality, service, reputa-
tion, and other nonmonetary attributes.
Ettinger (1998) stressed that success-
ful competition relies on the provider
retaining awareness of who it wa ...
The Relationship BetweenPatient Satisfaction and Inpatient.docxoreo10
The Relationship Between
Patient Satisfaction and Inpatient
Imissions Across Teaching
Daniel J. Messina, PhD, FACHE, LNHA, senior vice president and chief operating
officer, CentraState Healthcare System, Freehold, New Jersey; Dennis J. Scotti, PhD,
FACHE, FHFMA, Alfred E. Driscoll Professor, Healthcare and Life Sciences
Management, Fairleigh Dickinson University, Teaneck, New Jersey; Rodney Caney,
PhD, founder. Press Caney Associates, South Bend, Indiana; and Cenevieve
Pinto Zipp, EdD, PT, chair and associate professor, Craduate Programs in Health
Sciences, Seton Hall University, South Orange, New Jersey
E X E C U T I V E S U M M A R Y
The need for healthcare executives to better understand the relationship between
patient satisfaction and admission volume takes on greater importance in this age
of rising patient expectations and declining reimbursement. Management of patient
satisfaction has become a critical element in the day-to-day operations of healthcare
organizations pursuing high performance.
This study is guided by two principal research questions. First, what is the nature
of the relationship between patient satisfaction (as measured by scored instruments)
and inpatient admissions in acute care hospitals? Second, does the relationship
between patient satisfaction (as measured by scored instruments) and inpatient
admissions differ between teaching hospitals and nonteaching hospitals? Although
not suggestive of direct causation, the study findings revealed a statistically significant
and positive correlation between patient satisfaction and admission volume in teach-
ing hospitals only. In contrast, a nonsignificant, negative correlation was seen be-
tween patient satisfaction and admission in nonteaching hospitals. In the combined
teaching and nonteaching sample, a statistically significant, negative correlation was
found between patient satisfaction scores and admission volume.
With financial performance being driven in part by admission volume and with
patient satisfaction affecting hospital patronage, the business case for a strategic focus
on patient satisfaction in teaching hospitals is clearly evident. The article concludes
with a set of recommendations for strengthening patient satisfaction and organiza-
tional performance.
For more information on the concepts in this article, please contact Dr. Messina
at [email protected]
177
JOURNAL OF HEALTHCARE MANAGEMENT 5 4 : 3 M A Y / J U N E 2 0 0 9
n n today's healthcare marketplace,
U providers increasingly compete against
one another for business. In the late
1980s, healthcare executives were
confronted with the realization that
they could not just increase charges to
generate revenue, but rather they had
to contain costs as well. Providers now
compete on business factors other than
price, such as quality, service, reputa-
tion, and other nonmonetary attributes.
Ettinger (1998) stressed that success-
ful competition relies on the provider
retaining awareness of who it wa ...
1) Write a paper of 900 words regarding the statistical significanc.docxlindorffgarrik
1) Write a paper of 900 words regarding the statistical significance of outcomes as presented in Messina's, et al. article "The Relationship between Patient Satisfaction and Inpatient Admissions Across Teaching and Nonteaching Hospitals."
2) Assess the appropriateness of the statistics used by referring to the chart presented in the Module 4 lecture and the resource "Statistical Assessment."
3) Discuss the value of statistical significance vs. pragmatic usefulness.
4) Prepare this assignment according to the APA guidelines found in the APA Style Guide located in the Student Success Center. An abstract is not required.
h
Full text
Translate
Full text
Headnote
EXECUTIVE SUMMARY
The need for healthcare executives to better understand the relationship between patient satisfaction and admission volume takes on greater importance in this age of rising patient expectations and declining reimbursement. Management of patient satisfaction has become a critical element in the day-to-day operations of healthcare organizations pursuing high performance.
This study is guided by two principal research questions. First, what is the nature of the relationship between patient satisfaction (as measured by scored instruments) and inpatient admissions in acute care hospitals? Second, does the relationship between patient satisfaction (as measured by scored instruments) and inpatient admissions differ between teaching hospitals and nonteaching hospitals? Although not suggestive of direct causation, the study findings revealed a statistically significant and positive correlation between patient satisfaction and admission volume in teaching hospitals only. In contrast, a nonsignificant, negative correlation was seen between patient satisfaction and admission in nonteaching hospitals. In the combined teaching and nonteaching sample, a statistically significant, negative correlation was found between patient satisfaction scores and admission volume.
With financial performance being driven in part by admission volume and with patient satisfaction affecting hospital patronage, the business case for a strategic focus on patient satisfaction in teaching hospitals is clearly evident. The article concludes with a set of recommendations for strengthening patient satisfaction and organizational performance.
In today's healthcare marketplace, providers increasingly compete against one another for business. In the late 1980s, healthcare executives were confronted with the realization that they could not just increase charges to generate revenue, but rather they had to contain costs as well. Providers now compete on business factors other than price, such as quality, service, reputation, and other nonmonetary attributes. Ettinger (1998) stressed that successful competition relies on the provider retaining awareness of who it wants to serve, what value it creates for the customer, and how it will create that value operationally. In the end, the provider needs to be strateg.
WHEN AND HOW DOES VALUE BASED PURCHASING IMPACT HOSPITAL PERFORMANCE?Kirsty Macauldy, MBA
To improve the overall quality of healthcare, The National Quality Strategy of the U.S. Department of Health and Human Services broadly defines the outcomes that the Centers for Medicare and Medicaid Services (CMS) wants to achieve through the care it purchases for its beneficiaries. The strategies; aims of better health, better care, and lower costs.
Copyright 2014 American Medical Association. All rights reserv.docxdickonsondorris
This study analyzed compensation data for 1877 CEOs of 2681 nonprofit US hospitals. The CEOs had a mean compensation of $595,781 and median of $404,938 in 2009. CEO compensation was higher for those managing larger hospitals, more hospitals, and major teaching hospitals. The study examined if compensation was associated with various hospital metrics. Compensation was higher for hospitals with more advanced technology and higher patient satisfaction, but was not associated with financial metrics, quality measures like mortality and readmissions, or community benefit provided. This suggests CEO pay was linked to some measures of hospital performance but not others aimed at quality and community impact.
NCBI Bookshelf. A service of the National Library of Medicine,.docxvannagoforth
NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.
Institute of Medicine (US) Roundtable on Value & Science-Driven Health Care; Yong PL, Olsen LA, McGinnis
JM, editors. Value in Health Care: Accounting for Cost, Quality, Safety, Outcomes, and Innovation.
Washington (DC): National Academies Press (US); 2010.
5 Approaches to Improving Value—Provider and Manufacturer
Payments
INTRODUCTION
Payment design, coverage policies, reimbursement rules, and other financial incentives and
disincentives are powerful motivators when attempting to steer the healthcare system toward
more desirable care patterns (Guterman et al., 2009). Experiments with payment design and
coverage and reimbursement policies are currently going on in both public and private healthcare
sectors, with varying results. Speakers in this session of the workshop explored current payment
design experiments and discussed the efficacy of utilizing these reimbursement tools to improve
the value received from health care.
In this chapter, Carolyn M. Clancy details the pay-for-performance (P4P) model, an effort to
more explicitly link provider payments to quality of care. She highlights the lack of coherent
approaches to P4P and the variable success this approach has had in fundamentally changing
provider practice patterns. For example, while financial incentives for individual physicians have
shown that P4P can induce quality improvements for diabetic patients (Beaulieu and Horrigan,
2005), group-level incentives have had no impact on mammography screening or hemoglobin A
testing rates (Rosenthal et al., 2005). After underscoring that the current incentive system and
healthcare infrastructure fail to accommodate the achievement of real efficiency and quality, she
outlines recommendations for rethinking medical training, measurement, system design, and the
reward system.
Building on Clancy’s recommendations, Donald A. Sawyer identifies how the current healthcare
system stymies innovation in product development. He suggests refocusing the myopic view of
innovation on the horizon of long-term health improvements and financial savings. Reed V.
Tuckson discusses the alignment of manufacturers, technologists, payers, patients, and providers
necessary to establish a system that continues to provide incentives for innovation and maintains
an open market for the development of promising but unproven interventions. He elaborates
specifically on a joint effort between UnitedHealth Group and the American College of
Cardiology to develop appropriateness criteria for cardiac single-photon emission computed
tomography myocardial perfusion imaging—a new and very expensive technology—based on
best evidence as an example of how the interests of diverse stakeholder groups could be aligned.
In conclusion, Steven D. Pearson likens coverage and reimbursement tools to a blunt knife that
lacks subtlety in effecting value improvements, bu ...
Running head QUALITY IMPROVEMENT FOR PUBLIC HEALTH FACILITIES .docxtoltonkendal
Running head: QUALITY IMPROVEMENT FOR PUBLIC HEALTH FACILITIES 1
QUALITY IMPROVEMENT FOR PUBLIC HEALTH FACILITIES 6
Quality Improvement for Public Health Facilities
Qualitative Research Methods Evaluation
AIU ONLINE
HLTH 335 1701A - 01
UNIT 2 IP
The type of study in the four listed articles include the following. Article one by Chaudhry et al., (2006) was a qualitative study. The authors conducted a system review from expert opinion and literature review to determine the role that information technology had played in enhancing health care quality, efficiency and costs of medical care. The authors hypothesized that information technology had played a significant role in improving the quality of medical care by increasing adherence to medical guidelines, improving disease surveillance and decreasing medication errors. The type of study for the second article was also a qualitative study that examined 260 hospital on the issue of pay for performance strategy. The authors compared their results to other hospital that did not have the current nationwide pay for performance system, (Werner et al., 2010). The authors hypothesized that pay-for-performance system improved quality health care among hospitals in this system. The third article was also a qualitative study where the authors hypothesized that public reporting of hospital quality data and the pay for performance have emerged as the widely advocated tools for these that accelerate health facility’s improvement (Lindenauer et al., 2007). The fourth article was also a qualitative study article. The authors of the article hypothesized that the Keystone ICU project was associated with a significant decrease on the hospital mortality within Michigan as compared to the surrounding areas, (Lipitz-Snyderman, et al., 2011).
Article one utilized data from published expert opinion and literature search from academic data bases. There was no direct involvement of the human subject when collecting data for this article. Article two utilized data from 260 hospitals. The authors chose acute care hospitals that began operating in 2004. The author’s excluded four critical-access hospitals. Researchers of the third article used 2490 health services providers nation-wide who met the criteria for Hospital Quality Alliance (HQA). In the fourth article, the authors chose the patients who were treated in Michigan’s 95 study hospitals from 238, 937 total admissions. All the samples and the populations for these studies were appropriate.
During the study documentation Chaudhry et al., (2006) reported that hospital facilities documented and reported data on costs and contextual factors. Limitations of data in this article is that the systematic review utilized a mixed data of private and public initiatives into hospital systems. The public and private initiatives have different agendas. Werner et al., (2010), study results indicated that the two groups of hospitals were simil ...
This thesis analyzes data from the Centers for Medicare and Medicaid Services (CMS) to identify which quality measurement parameters have the greatest impact on hospitals' overall performance scores and ratings. The author sorted CMS data into categories for mortality, readmissions, safety, and patient experience. Correlation coefficients were calculated between each measurement and hospitals' total performance scores. It was found that hospital-wide readmission rates, acute myocardial infarction 30-day readmission rates, and patient experience measures of doctor communication and responsiveness of hospital staff had the strongest correlations with overall performance scores. Therefore, hospitals looking to improve their ratings may want to focus most on improving these specific factors.
The Relationship BetweenPatient Satisfaction and Inpatient.docxssusera34210
The Relationship Between
Patient Satisfaction and Inpatient
Imissions Across Teaching
Daniel J. Messina, PhD, FACHE, LNHA, senior vice president and chief operating
officer, CentraState Healthcare System, Freehold, New Jersey; Dennis J. Scotti, PhD,
FACHE, FHFMA, Alfred E. Driscoll Professor, Healthcare and Life Sciences
Management, Fairleigh Dickinson University, Teaneck, New Jersey; Rodney Caney,
PhD, founder. Press Caney Associates, South Bend, Indiana; and Cenevieve
Pinto Zipp, EdD, PT, chair and associate professor, Craduate Programs in Health
Sciences, Seton Hall University, South Orange, New Jersey
E X E C U T I V E S U M M A R Y
The need for healthcare executives to better understand the relationship between
patient satisfaction and admission volume takes on greater importance in this age
of rising patient expectations and declining reimbursement. Management of patient
satisfaction has become a critical element in the day-to-day operations of healthcare
organizations pursuing high performance.
This study is guided by two principal research questions. First, what is the nature
of the relationship between patient satisfaction (as measured by scored instruments)
and inpatient admissions in acute care hospitals? Second, does the relationship
between patient satisfaction (as measured by scored instruments) and inpatient
admissions differ between teaching hospitals and nonteaching hospitals? Although
not suggestive of direct causation, the study findings revealed a statistically significant
and positive correlation between patient satisfaction and admission volume in teach-
ing hospitals only. In contrast, a nonsignificant, negative correlation was seen be-
tween patient satisfaction and admission in nonteaching hospitals. In the combined
teaching and nonteaching sample, a statistically significant, negative correlation was
found between patient satisfaction scores and admission volume.
With financial performance being driven in part by admission volume and with
patient satisfaction affecting hospital patronage, the business case for a strategic focus
on patient satisfaction in teaching hospitals is clearly evident. The article concludes
with a set of recommendations for strengthening patient satisfaction and organiza-
tional performance.
For more information on the concepts in this article, please contact Dr. Messina
at [email protected]
177
JOURNAL OF HEALTHCARE MANAGEMENT 5 4 : 3 M A Y / J U N E 2 0 0 9
n n today's healthcare marketplace,
U providers increasingly compete against
one another for business. In the late
1980s, healthcare executives were
confronted with the realization that
they could not just increase charges to
generate revenue, but rather they had
to contain costs as well. Providers now
compete on business factors other than
price, such as quality, service, reputa-
tion, and other nonmonetary attributes.
Ettinger (1998) stressed that success-
ful competition relies on the provider
retaining awareness of who it wa ...
The Relationship BetweenPatient Satisfaction and Inpatient.docxoreo10
The Relationship Between
Patient Satisfaction and Inpatient
Imissions Across Teaching
Daniel J. Messina, PhD, FACHE, LNHA, senior vice president and chief operating
officer, CentraState Healthcare System, Freehold, New Jersey; Dennis J. Scotti, PhD,
FACHE, FHFMA, Alfred E. Driscoll Professor, Healthcare and Life Sciences
Management, Fairleigh Dickinson University, Teaneck, New Jersey; Rodney Caney,
PhD, founder. Press Caney Associates, South Bend, Indiana; and Cenevieve
Pinto Zipp, EdD, PT, chair and associate professor, Craduate Programs in Health
Sciences, Seton Hall University, South Orange, New Jersey
E X E C U T I V E S U M M A R Y
The need for healthcare executives to better understand the relationship between
patient satisfaction and admission volume takes on greater importance in this age
of rising patient expectations and declining reimbursement. Management of patient
satisfaction has become a critical element in the day-to-day operations of healthcare
organizations pursuing high performance.
This study is guided by two principal research questions. First, what is the nature
of the relationship between patient satisfaction (as measured by scored instruments)
and inpatient admissions in acute care hospitals? Second, does the relationship
between patient satisfaction (as measured by scored instruments) and inpatient
admissions differ between teaching hospitals and nonteaching hospitals? Although
not suggestive of direct causation, the study findings revealed a statistically significant
and positive correlation between patient satisfaction and admission volume in teach-
ing hospitals only. In contrast, a nonsignificant, negative correlation was seen be-
tween patient satisfaction and admission in nonteaching hospitals. In the combined
teaching and nonteaching sample, a statistically significant, negative correlation was
found between patient satisfaction scores and admission volume.
With financial performance being driven in part by admission volume and with
patient satisfaction affecting hospital patronage, the business case for a strategic focus
on patient satisfaction in teaching hospitals is clearly evident. The article concludes
with a set of recommendations for strengthening patient satisfaction and organiza-
tional performance.
For more information on the concepts in this article, please contact Dr. Messina
at [email protected]
177
JOURNAL OF HEALTHCARE MANAGEMENT 5 4 : 3 M A Y / J U N E 2 0 0 9
n n today's healthcare marketplace,
U providers increasingly compete against
one another for business. In the late
1980s, healthcare executives were
confronted with the realization that
they could not just increase charges to
generate revenue, but rather they had
to contain costs as well. Providers now
compete on business factors other than
price, such as quality, service, reputa-
tion, and other nonmonetary attributes.
Ettinger (1998) stressed that success-
ful competition relies on the provider
retaining awareness of who it wa ...
1) Write a paper of 900 words regarding the statistical significanc.docxlindorffgarrik
1) Write a paper of 900 words regarding the statistical significance of outcomes as presented in Messina's, et al. article "The Relationship between Patient Satisfaction and Inpatient Admissions Across Teaching and Nonteaching Hospitals."
2) Assess the appropriateness of the statistics used by referring to the chart presented in the Module 4 lecture and the resource "Statistical Assessment."
3) Discuss the value of statistical significance vs. pragmatic usefulness.
4) Prepare this assignment according to the APA guidelines found in the APA Style Guide located in the Student Success Center. An abstract is not required.
h
Full text
Translate
Full text
Headnote
EXECUTIVE SUMMARY
The need for healthcare executives to better understand the relationship between patient satisfaction and admission volume takes on greater importance in this age of rising patient expectations and declining reimbursement. Management of patient satisfaction has become a critical element in the day-to-day operations of healthcare organizations pursuing high performance.
This study is guided by two principal research questions. First, what is the nature of the relationship between patient satisfaction (as measured by scored instruments) and inpatient admissions in acute care hospitals? Second, does the relationship between patient satisfaction (as measured by scored instruments) and inpatient admissions differ between teaching hospitals and nonteaching hospitals? Although not suggestive of direct causation, the study findings revealed a statistically significant and positive correlation between patient satisfaction and admission volume in teaching hospitals only. In contrast, a nonsignificant, negative correlation was seen between patient satisfaction and admission in nonteaching hospitals. In the combined teaching and nonteaching sample, a statistically significant, negative correlation was found between patient satisfaction scores and admission volume.
With financial performance being driven in part by admission volume and with patient satisfaction affecting hospital patronage, the business case for a strategic focus on patient satisfaction in teaching hospitals is clearly evident. The article concludes with a set of recommendations for strengthening patient satisfaction and organizational performance.
In today's healthcare marketplace, providers increasingly compete against one another for business. In the late 1980s, healthcare executives were confronted with the realization that they could not just increase charges to generate revenue, but rather they had to contain costs as well. Providers now compete on business factors other than price, such as quality, service, reputation, and other nonmonetary attributes. Ettinger (1998) stressed that successful competition relies on the provider retaining awareness of who it wants to serve, what value it creates for the customer, and how it will create that value operationally. In the end, the provider needs to be strateg.
Exploring the Impact of Information System IntroductionSuelette Dreyfus
This document summarizes a study that explored the impact of introducing an information system at an Australian hospital emergency department. The study conducted a 9-month longitudinal case study at a major trauma center that recently introduced a large-scale IS. Through observations and interviews, the study identified both positive and negative consequences of the IS introduction on key work routines. The findings provide insights for both research and practice on understanding the impacts of implementing new information systems in healthcare settings.
Outcomes research tests evidence-based interventions to see how they impact individuals, groups, and populations. It examines the effects on both patients and healthcare providers. The Patient Protection and Affordable Care Act, Accountable Care Organizations, Center for Medicare and Medicaid Services, Agency for Healthcare Research and Quality, and Patient Centered Outcomes Research Institute all play roles in outcomes research. Outcomes research can help improve patient care by identifying effective interventions and understanding different treatment outcomes. However, outcomes may differ based on patient demographics and reported data could be skewed.
A Collaborative Product Commerce Approach To Value Based Health Plan PurchasingKate Campbell
This document discusses how collaborative product commerce (CPC) techniques, which are forms of supply chain management (SCM), are being applied to health care purchasing with the goals of controlling costs and improving quality. It describes the health care supply chain and identifies five national health initiatives that use CPC techniques like incentives and disincentives to influence supplier behavior. However, it also notes that CPC approaches face barriers like resistance to change, limitations of information systems, privacy regulations, lack of commitment and issues with sustainability.
Please follow instructions carefully. Thank you so kindly. Ass.docxmattjtoni51554
The document discusses key changes in quality management and patient safety in the healthcare industry. It outlines several major developments that have advanced this area, including a 1999 IOM report that found medical errors resulted in up to 98,000 deaths per year. This prompted increased focus on quality, errors, and transparency from hospitals and regulators. It also discusses ongoing challenges like the need for standardized quality measures and electronic medical records to further improve outcomes.
Top seven healthcare outcome measures of healthJosephMtonga1
The seven healthcare outcome measures are meant to understand the quality of health systems and how they could be measured and how quality care could be provided to clients.
The New Focus on Quality and OutcomesIntroductionIn 1999, the .docxoreo10
The New Focus on Quality and Outcomes
Introduction
In 1999, the Institute of Medicine (IOM) published a groundbreaking analysis of the impact of medical errors on the health care delivery system and the patients it serves. The analysis, published as "To Err is Human: Building a Safer Healthcare System," concluded that medical errors resulted in up to 98,000 patient deaths in American hospitals every year. This report hit the national press and participants in the health care system and the political system with the force of a large bomb. Since that time, hospitals and other health care entities have refocused their attention on quality, errors, and patient safety in an unprecedented way, urged on by public outcry and by federal and state efforts to compel improvements in the health care system. Such entities as the Institute for Healthcare Improvement (www.ihi.org) the National Quality Forum (www.qualityforum.org), and the Institute of Medicine (www.iom.edu) have all emerged as champions of quality and safety initiatives, offering training, resources, access to best practices, and data collection strategies to move the cause of quality and safety for patients forward.
History
The IOM report had a huge impact on the discussion of quality and safety in the health care field. Aspects of quality care have always been present in hospitals, typically focused around the quality assurance or quality management departments. They historically collected data on department indicators and monitored them as part of accreditation. However, departmental data was typically focused on operational performance in the departments in question, and not a great deal was collected on issues of medical errors and near-misses. The litigious legal climate caused most hospitals to fear collecting and sharing data that could potentially be used against them in a legal action. However, the IOM report caused a national demand to know what health care institutions were doing to protect their patients from injury caused by errors. A climate of increased transparency has begun to emerge, although it is still a very long way from the concept of full openness on standardized reporting of indicators. The Centers for Medicare and Medicaid Services (CMS) weighed in with publication of their never-events, as explored further below.
Finally there has been an increased push for public reporting of data on individual hospital performance on selected indicators. While some progress has been made, there is a large range of indicators that is not yet publically reported, and medical errors are not publically reported at all at this point, although those with great potential to cause harm must be reported to their relevant state licensing agency.
What Is Happening Now
Out of all this push has come an increasing focus on patient safety as a critical aspect of health care quality. Hospitals and other health care institutions are experimenting with the creation of cultures of quality, wherein ...
Submission Id ab299d7c-b547-4cf3-958a-07922ca71f2765 SIM.docxdeanmtaylor1545
Submission Id: ab299d7c-b547-4cf3-958a-07922ca71f27
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Patience Nehikhare
healthcaredeliverysystemchanges.docx
Summary
1175 Words
Running Head: HEALTHCARE DELIVERY SYSTEM
THE U.S. HEALTHCARE DELIVERY SYSTEM 2
Healthcare Delivery System
Patience Nehikhare
Grand Canyon University
December 22, 2019
The U.S. Healthcare Delivery System
There is a rapid change within the healthcare system in the United States. The
changes that have occurred were made for the purpose of improving quality,
rewarding value and not volume, as well as integrating and coordinating the care
(Seshamani & Sen, 2018). As such, this paper will seek to put into consideration
current healthcare laws within the U.S. and the nurse’s role within this continuously
changing environment; the manner in which quality measures and pay for performance
affect patient outcomes. Furthermore, the emerging trends in the healthcare system,
professional nursing leadership, and management roles will be discussed.
The Emerging Health Care Laws and their Effects on Nursing Practice
One of the most crucial healthcare legislat ions that has been enacted in the United
States since the inception of Medicare and Medicaid in 1965 is the Affordable Care
Act (Obama, 2016). The ACA was enacted in 2010. Issues relat ing to affordability,
ease of access, and the care quality within the United States healthcare system were
some of the driving factors that formed the list of many t ime spanning challenges
that compiled the init iat ion of this legislat ion. Between 2010 to 2015 there was a
decrease in the number of uninsured cit izens in the U.S. by forty three percent as an
effect of the Affordable Care Act.
The payment systems in healthcare are undergoing some changes and the access to
care has also improved (Obama, 2016). The ACA promotes preventive healthcare
models that put emphasis on quality care, primary care, and the funding of community
health init iat ives (Lathrop and Hodnicki, 2014). Millions of previously uninsured cit izens
are also provided insurance coverage and also some healthcare areas that need
reforms so as to meet the needs of patients’ improved healthcare outcomes are
highly focused by the act. The act has an effect on nursing practice in several ways.
The first effect is that the act creates a high demand for healthcare professionals
that are sufficiently trained to provide healthcare services that are up to the acts’
standards. The second effect is that Advanced Practice Registered Nurses (APRNs)
who hold the Doctor of Nursing Practice (DNP) are required to be prepared so that
they can meet the increased needs through the provision of leadership skills in
community health centers. These professionals are also held accountable for direct ing
and advocating for future init iates as well as ser.
This document summarizes a study that examined the effect of supply chain management on the quality of health services in Jordanian private hospitals. The study aimed to measure the impact of dimensions of supply chain management (relationship with suppliers, specifications and standards, delivery, after-sales service) on dimensions of health service quality (responsiveness, trust, safety). A questionnaire was distributed to procurement officers at 36 private hospitals in Jordan. The results showed that relationship with suppliers, specifications and standards, and delivery/after-sales service had a significant effect on quality of health services. There were no differences found due to gender, education, age, or experience.
Suggested ResourcesThe resources provided here are optional. You.docxdeanmtaylor1545
Suggested Resources
The resources provided here are optional. You may use other resources of your choice to prepare for this assessment; however, you will need to ensure that they are appropriate, credible, and valid. The MHA-FP5064 Health Care Information Systems Analysis and Design for Administrators Library Guide can help direct your research, and the Supplemental Resources and Research Resources, both linked from the left navigation menu in your courseroom, provide additional resources to help support you.
The Role of Informatics in Health Care
The following articles address the increasingly important role of informatics, which may provide useful insight when examining the data needs of an organization.
· Centers for Medicare & Medicaid Services. (2017). Data and program reports. Retrieved from https://www.cms.gov/regulations-and-guidance/legislation/ehrincentiveprograms/dataandreports.html
. The Web page provides access to Medicare and Medicaid Electronic Health Records Incentive Program payment and registration data contained in various reports.
· Chen, M., Lukyanenko, R., & Tremblay, M. C. (2017). Information quality challenges in shared healthcare decision making. Journal of Data and Information Quality (JDIQ), 9(1), 1–3.
. Discusses the challenges for patients in making sense of the enormous volume of health information made available through current information and communications technologies and how the quality of that information affects shared decision-making between patients and providers.
· Crawford, M. (2014). Making data smart. Journal of AHIMA, 85(2), 24–27, 28.
. Discusses applied informatics and how it can be used to derive useful information from big data, as health care becomes a data-driven industry.
· Dinov, I. D. (2016). Methodological challenges and analytic opportunities for modeling and interpreting big healthcare data. GigaScience, 5(1), 1–15.
. Discusses the challenges of big data analysis and addresses the need for technology and education in creating valuable knowledge assets from big data.
· Hegwer, L. R. (2014). Digging deeper into data. Healthcare Financial Management, 68(2), 80–84.
. Discusses the role of data analysts in improving the financial and clinical performance of health care organizations.
2
Running Head: Organizational Data needs
2
Organizational Data needs
Organization Data Needs Capella UniversityAssignment 2
Internal data sources can include data systems, for example, a radiology data system, medical library data, or the patient finance and billing system. Internal data sources also include EHR data systems such as the demographics, medical history of patients and disease records, medication and allergies records, laboratory test results, personal patient statistics such as gender age, weight and billing information (Porter et al, 2018).
External data sources include data from Centres for Medicare and Medicaid Services (CMS), benchmarking data from other hospitals are ex.
RESEARCH ARTICLE Open AccessHealthcare professionals’ view.docxrgladys1
RESEARCH ARTICLE Open Access
Healthcare professionals’ views on patient-
centered care in hospitals
Mathilde Berghout*, Job van Exel, Laszlo Leensvaart and Jane M. Cramm*
Abstract
Background: Patient-centered care (PCC) is a main determinant of care quality. Research has shown that PCC is a
multi-dimensional concept, and organizations that provide PCC well report better patient and organizational
outcomes. However, little is known about the relative importance of PCC dimensions. The aim of this study was
therefore to investigate the relative importance of the eight dimensions of PCC according to hospital-based
healthcare professionals, and examine whether their viewpoints are determined by context.
Methods: Thirty-four healthcare professionals (16 from the geriatrics department, 15 from a surgical intensive care
unit, 3 quality employees) working at a large teaching hospital in New York City were interviewed using Q
methodology. Participants were asked to rank 35 statements representing eight dimensions of PCC extracted from
the literature: patient preferences, physical comfort, coordination of care, emotional support, access to care,
continuity and transition, information and education and family and friends. By-person factor analysis was used to
reveal patterns of communality in statement rankings, which were interpreted and described as distinct viewpoints.
Results: Three main viewpoints on elements important for PCC were identified: “treating patients with dignity and
respect,” “an interdisciplinary approach” and “equal access and good outcomes.” In these viewpoints, not all dimensions
were equally important for PCC. Furthermore, the relative importance of the dimensions differed between departments.
Context thus appeared to affect the relative importance of PCC dimensions.
Conclusion: Healthcare organizations wishing to improve PCC should consider the relative importance of
PCC dimensions in their specific context of care provision, which may help to improve levels of patient-
centeredness in a more efficient and focused manner. However, as the study sample is not representative
and consisted only of professionals (not patients), the results cannot be generalized outside the sample.
More research is needed to confirm our study findings.
Keywords: Patient-centered care, Quality of care, Healthcare professionals, Q methodology, Hospital
Background
Since the Institute of Medicine described patient-
centered care (PCC) as one of the six most important
determinants of quality of care – along with safe, effect-
ive, timely, efficient and equitable care – PCC has re-
ceived much more attention [1]. Richardson and
colleagues [1] defined PCC as care that is “respectful of
and responsive to individual patient preferences, needs,
and values, and ensuring that patient values guide all
clinical decisions.” PCC has been shown to result in im-
proved health outcomes, including survival, greater
patient satisfaction and well-being [2]. Furtherm.
NRS 493 Grand Canyon University Improving Patients Quality Discussion.pdfbkbk37
This document discusses implementing effective bedside shift reporting to improve patient care quality. It proposes conducting bedside shift reporting where the incoming and outgoing nurses provide patient information directly to each other at the patient's bedside. This is compared to traditional reporting without patients present. The goal is to reduce adverse outcomes and support patient safety, satisfaction, and involvement in care. It reviews literature showing benefits like increased safety and proposes piloting the intervention in one unit before expanding it. Outcomes would be monitored to evaluate the impact on care quality and patient experience.
MHA6999 SEMINAR IN HEALTHCARE CASES-- WEEK 2 LECTURE, DISCUSSION, DioneWang844
MHA6999 SEMINAR IN HEALTHCARE CASES-- WEEK 2 LECTURE, DISCUSSION, AND PROJECT INSTRUCTIONS
Page | 1
Quality
Nearly fifteen years ago, the Institute of Medicine published the “To Err Is Human” report, which exposed the substantial impact of medical errors in the US healthcare system and called for a dramatic system change, including an improved understanding of those errors (McCarthy, Tuiskula, Driscoll, & Davis, 2017). Medical errors are considered to be failure to achieve the original goal or plan of action, and these errors may range from a patient falls to a mistake in the operating room. Not only do medical errors cause harm to the patient and jeopardize the patient’s trust, but they also cause a financial strain for the health system (“To Err is Human,” 1999). One of the contributing factors to medical errors is the lack of effective communication between doctors who are treating the same patient. This results in healthcare providers overprescribing medications for patients as well as increases the possibility of a patient having unnecessary tests or procedures performed. The report’s four-tiered approach includes:
· Focusing on creating a stronger foundation of education on patient safety
· Mandating a nationwide reporting system to encourage timely reporting of errors
· Increasing the standards of performance for healthcare providers
· Taking advantage of the security that safety systems offer (“To Err is Human,” 1999)
Creating a strong educational foundation for patient safety is most important. Healthcare personnel are much more likely to actively participate in reporting systems, encourage one another to perform at a higher level, and take advantage of safety systems when they are well educated on patient safety and the implications of medical errors. The reporting system seems to provide the least amount of impact on patient safety as they can result in losing patient trust in certain healthcare systems. The healthcare system as a whole has made progress in establishing a safe environment for patients when they are in need of care.
Challenges for Patient Safety and Steps for Improvement
Despite continuing evidence of problems in patient safety and gaps between the care that patients receive and the evidence about what they should receive, efforts to improve quality in healthcare show mostly inconsistent and patchy results.
Tap each image to know more.
Data Collection and Monitoring Systems
This always takes much more time and energy than anyone anticipates. It is worth investing heavily in data from the outset. Assess local systems, train people, and have quality assurance.
Tribalism and Lack of Staff Engagement
Overcoming a perceived lack of ownership and professional or disciplinary boundaries can be very difficult. Clarify who owns the problem and solution, agree roles and responsibilities at the outset, work to common goals, and use shared language.
Convince People That There's a Problem
Use hard data to secure emotional e ...
Quality measures and performance indicators are important for nurse practitioners (NPs) to demonstrate the impact of their care and meet organizational goals. Quality measures assess standards of care delivery and outcomes, ensuring patient safety and efficient use of healthcare services. They can improve access to preventive care, patient experience, and outcomes for high-risk groups. Performance indicators also evaluate clinical performance but from a holistic nursing perspective. Productivity measures for NPs may include patient visits, billing levels, or accomplishing specific clinical goals depending on specialty. Incentive plans that link pay to quality metrics and productivity can increase NP retention, satisfaction, and overall productivity, benefiting both NPs and healthcare organizations.
MSN 5650 Miami Regional University Reducing Hospital Readmission Presentation...bkbk37
This document discusses reducing hospital readmissions and improving quality of care. It identifies some key causes of hospital readmissions, such as medication errors, non-compliance by patients, and inappropriate transition from hospital to home. It notes that readmissions negatively impact quality of care and that hospitals have implemented programs to reduce readmissions. The document discusses the importance of clearly explaining medical instructions to patients and ensuring a smooth transition from hospital to home care through follow-up appointments and support.
CANCER DATA COLLECTION6The Application of Data to Problem-SoTawnaDelatorrejs
CANCER DATA COLLECTION 6
The Application of Data to Problem-Solving PEER RESPONSES
PEER NUMBER 1: Luis Arencibia
Top of Form
Clinical data is fundamental in the medical field. It is from this data that change and efficiency are made possible. Clinical data forms the basis of clinical care given to patients and research studies and is also used by the administration for decision-making and influencing change (Deckro et al., 2021). Modernization has come up with better ways of processing and storing clinical data, popularly known as informatics. This has led to the increased utilization of computers and information technology in clinical data management. The informatics results have increased efficiency in managing patients' data (McGonigle & Mastrian, 2022). It is crucial to ensure proper data management because it is from clinical data that crucial decisions and problems are solved in healthcare.
An example of a scenario where data can be helpful in problem-solving is the case where a healthcare facility wants to determine the average number of patients they receive in a day and use that information to establish whether the staff to patient ratio is satisfactory. This data can be obtained by registering all patients who attend the facility for a certain period, for example, three months, and stored electronically. The average is then done to get the approximate number of clients in a day. Additionally, the data should capture the age of patients, significant complaints, and the departments where the patients were attended. It is vital to secure this data to avoid unauthorized access to promote patients' privacy and compliance with the HIPAA to avoid legal consequences.
The knowledge derived from the data described above is the number of patients visiting the facility and their health needs. From this, the healthcare center will be able to critically analyze and evaluate whether the facility's staffing and resources are enough to meet the patients' demands. Suppose the number of patients is higher compared to the resources. In that case, the facility will be able to tell there is a shortage and the staff is being overworked, which is likely to compromise the services given to the patients.
From the data, a nurse leader can use clinical reasoning and judgment to explain why the health facility could be performing less efficiently and not meeting its goal of providing optimum medical services to patients. Additionally, the nurse could judge that the patients are not satisfied with the services provided from the data (Zhu et al., 2019). With that information, a nurse leader can successfully convince the management that there is a need for more staffing and resources to meet the patients' needs more successfully.
In conclusion, data management is crucial in the healthcare practice. With proper informatics, nurses and other healthcare providers will function optimally, and the results will be better quality ...
Payer Mix and EHR Adoptionin HospitalsDong Yeong Shin, doc.docxdanhaley45372
Payer Mix and EHR Adoption
in Hospitals
Dong Yeong Shin, doctoral student. Department of Health Services Administration,
University of Alabama at Birmingham; Nir Menachemi, PhD, professor, health care
organization and policy. University of Alabama at Birmingham; Mark Diana, PhD,
assistant professor. School of Public Health, Tulane University, New Orleans; Abby
Swanson Kazley, PhD, associate professor. Medical University of South Carolina,
Charleston; and Eric W. Ford, PhD, distinguished professor of healthcare, Bryan School
of Business, University of North Carolina at Creensboro
E X E C U T I V E S U M M A R Y
Payers are known to influence the adoption of health informarion technology (HIT)
among hospitals. However, previous studies examining the relationship between
payer mix and HIT have not focused specifically on electronic health record systems
(EHRs). Using data from the Nationwide Inpatient Sample and the American Hos-
pital Association Annual Survey, we examine how Medicare, Medicaid, commercial
insurance, and managed care caseloads are associated with EHR adoption in hospi-
tals. Overall, we found a weak relationship between payer mix and EHR adoption.
Medicare and, separately, Medicaid volumes were not associated with EHR adoption.
Furthermore, commercial insurance volume was not associated with EHR adoption;
however, a hospital located in the third quartile of managed care caseloads had a
decreased likelihood of EHR adoption. We did not find empirical evidence to sup-
port the hypothesis that payer generosity and other indirect mechanisms influence
EHR adoption in hospitals. The direct incentives embedded in the Health Informa-
tion Technology for Economic and Clinical Health Act may have a positive influence
on EHR adoption—especially for hospitals with high Medicare and/or Medicaid
caseloads. However, it is still uncertain whether the available incentives will offset the
barriers many hospitals face in achieving meaningfijl use of EHRs.
For more information about the concepts in this article, contact Dr. Menachemi
at [email protected]
435
JOURNAL O F HEALTHCARE M A N A G E M E N T 5 7 : 6 N O V E M B E R / D E C E M B E R 2 0 1 2
I N T R O D U C T I O N
Research has shown that payer mix,
defined as the combination of third-
party payers that makes up a hospital's
book of business, can influence hospi-
tals' strategic behaviors. Studies have
found that higher percentages of Medic-
aid (Cleverley and Harvey 1992; McKay
and Deily 2005) or Medicare patients
(Rosko 2001) are negatively associated
with financial performance. Further-
more, given that varying reimburse-
ment rates are negotiated in the private
insurance book of business, hospital
revenue per admission has been demon-
strated to predict operational efficiency
(Dor and Fariey 1996; McKay and Deily
2005) and clinical performance (Clem-
ent and Crazier 2001; Menachemi et al.
2007). Attempting to leverage the influ-
ence that the public insurance programs
have on hospi.
Running Head EVALUATION PLAN FOCUSEVALUATION PLAN FOCUS 1.docxcowinhelen
Running Head: EVALUATION PLAN FOCUS
EVALUATION PLAN FOCUS 1
Evaluation Plan Focus
Student Name
University Affiliations
Date
Professor
Scenario 1:
Your hospital is implementing a new unified acute and ambulatory Electronic Health Record (EHR) system through which patient care documentation will occur. Interdisciplinary assessment forms (including nursing), clinical decision support, and medical notes will be documented in this system. The implementation of the system is anticipated to improve the hospital’s performance in a multitude of areas. In particular, it is hoped that the use of the EHR system will reduce the rate of patient safety events, improve the quality of care, deter sentinel events, reduce patient readmissions, and impact spending. The implementation of the EHR system is also
Introduction
Evaluation plan involves an integral part regarding a grant suggestion providing information aimed at improving a project during the development and implementation. I will participate in the assessment of the scenario system in throughout the project. The scenario includes the hospital that is implementing the new unified as well as the Ambulatory EHR (Electronic Health Record) system that enhances the documentation of patient care. The purpose of the paper is explaining the selected scenario one, explanation of the reasons for selecting it, and summarizing of the research findings on the similar HIT implementations. More so, there is a description of the evaluation viewpoint, and goal guiding the assessment plan and same rationale.
HIT System Selected
The new system to be implemented has various modules that contain interdisciplinary assessment forms, medical notes, and clinical decision support where their documentation is guaranteed. The implementation of the unified system will enhance improved performance of the hospital in several departments. The new EHR system becomes of great importance to the hospital since there is a reduction of medical errors, reduction of the rate of the safety events of each patient, improving the quality of healthcare, deterrence of sentinel events, reduced patients readmissions as well as impact spending. Another reason for choosing the scenario is that the new system will enhance while fulfilling the requirements of meaningful use as stipulated in the HITECH (Health Information Technology for Economic and Clinical Health) Act. Therefore, the need for evaluation regarding the EHR implementation becomes paramount since it will help to identify the associated risks while adjusting the modules required when offering the medication services to the patients (Lanham, Leykum & McDaniel, 2012).
Summary of Research Findings on Similar HIT Implementations
Several evaluations are analogous to the HIT system implementation of the unified system with related differences regarding the outcomes based on the primary goals. For instance, some of the implemented systems fail to meet one hundred percent ...
NURS 521 Nursing Informatics And Technology.docxstirlingvwriters
This document discusses the application of clinical information systems in nursing. It reviews 4 peer-reviewed articles on this topic. The articles found that clinical information systems can help reduce medical errors, improve care quality by enhancing workflow and access to patient information, and engage patients more in their care when interactive technology is used. However, challenges remain around data integration across healthcare systems and technical, human, and organizational constraints. The document concludes that clinical information systems provide opportunities to improve care but must be effectively implemented and upgraded so nurses can benefit from these technologies.
Application of Data Analytics to Improve Patient Care: A Systematic ReviewIRJET Journal
This document summarizes a systematic review of research on applying data analytics to improve patient care. The review found that data analytics has significantly impacted the healthcare sector by improving patient care. Data analytics involves using scientific and mathematical methods to derive meaning from data to gain better insights. It can reduce costs, enable faster decision making, and minimize risks in healthcare. The review identified theories like the Magical Thinking Theory and Lightweight Theory that provide a framework for understanding the relationship between data analytics and patient care. The findings suggest data analytics plays an important role in improving patient health and experiences.
Introduction Healthcare system is considered one of the busiest.pdfbkbk37
The document discusses the application of clinical information systems in nursing. It reviews 4 peer-reviewed articles on the topic. The articles found that clinical information systems can improve workflow and reduce medical errors. However, challenges remain around data integration and sharing patient data across healthcare systems. The document concludes that clinical systems provide opportunities to improve care if effectively implemented and regularly updated to support nurses.
Explain in your own words why it is important to read a statistical .docxAlleneMcclendon878
Explain in your own words why it is important to read a statistical study carefully. Can you think of circumstance where it might be okay to misrepresent data?
Video Reflection 12 -
Do you think it is possible to create a study where there really is no bias sampling done? How would you manage to create one?
Video Reflection 13 -
What are your thoughts on statistics being misrepresented/ how does it make you feel? Why do you think the statistic are often presented in this way?
.
Explain how Matthew editedchanged Marks Gospel for each of the fol.docxAlleneMcclendon878
Explain how Matthew edited/changed Mark's Gospel for each of the following passages, and what reasons would he have had for doing that? What in Mk’s version was Mt trying to avoid – i.e., why he might have viewed Mk’s material as misleading, incorrect, or problematic? How did those changes contribute to Matthew’s overall message? How did that link up with other parts of Mt’s message?
Use both the following two sets of passages to support your claim, making use ONLY of the resources below, the Bible, textbooks and Module resources.
1. How did Matthew edit/change Mark 6:45-52 to produce Matthew 14:22-33 – and why?
2. How did Matthew edit/change Mark 9:2-10 to produce Matthew 17:1-13 – and why?
The paper should 350-750 words in length, double-spaced, and using MLA formatting for reference citations and bibliography. Submit the completed assignment to the appropriate Dropbox by
no later than Sunday 11:59 PM Eastern.
Resources for this paper:
See the ebook via SLU library:
New Testament History and Literature
by Martin (2012), pp. 83-88,105-108.
See the ebook via SLU library:
The Gospels
by Barton and Muddiman (2010), p. 53,56-57,102,109.
.
Exploring the Impact of Information System IntroductionSuelette Dreyfus
This document summarizes a study that explored the impact of introducing an information system at an Australian hospital emergency department. The study conducted a 9-month longitudinal case study at a major trauma center that recently introduced a large-scale IS. Through observations and interviews, the study identified both positive and negative consequences of the IS introduction on key work routines. The findings provide insights for both research and practice on understanding the impacts of implementing new information systems in healthcare settings.
Outcomes research tests evidence-based interventions to see how they impact individuals, groups, and populations. It examines the effects on both patients and healthcare providers. The Patient Protection and Affordable Care Act, Accountable Care Organizations, Center for Medicare and Medicaid Services, Agency for Healthcare Research and Quality, and Patient Centered Outcomes Research Institute all play roles in outcomes research. Outcomes research can help improve patient care by identifying effective interventions and understanding different treatment outcomes. However, outcomes may differ based on patient demographics and reported data could be skewed.
A Collaborative Product Commerce Approach To Value Based Health Plan PurchasingKate Campbell
This document discusses how collaborative product commerce (CPC) techniques, which are forms of supply chain management (SCM), are being applied to health care purchasing with the goals of controlling costs and improving quality. It describes the health care supply chain and identifies five national health initiatives that use CPC techniques like incentives and disincentives to influence supplier behavior. However, it also notes that CPC approaches face barriers like resistance to change, limitations of information systems, privacy regulations, lack of commitment and issues with sustainability.
Please follow instructions carefully. Thank you so kindly. Ass.docxmattjtoni51554
The document discusses key changes in quality management and patient safety in the healthcare industry. It outlines several major developments that have advanced this area, including a 1999 IOM report that found medical errors resulted in up to 98,000 deaths per year. This prompted increased focus on quality, errors, and transparency from hospitals and regulators. It also discusses ongoing challenges like the need for standardized quality measures and electronic medical records to further improve outcomes.
Top seven healthcare outcome measures of healthJosephMtonga1
The seven healthcare outcome measures are meant to understand the quality of health systems and how they could be measured and how quality care could be provided to clients.
The New Focus on Quality and OutcomesIntroductionIn 1999, the .docxoreo10
The New Focus on Quality and Outcomes
Introduction
In 1999, the Institute of Medicine (IOM) published a groundbreaking analysis of the impact of medical errors on the health care delivery system and the patients it serves. The analysis, published as "To Err is Human: Building a Safer Healthcare System," concluded that medical errors resulted in up to 98,000 patient deaths in American hospitals every year. This report hit the national press and participants in the health care system and the political system with the force of a large bomb. Since that time, hospitals and other health care entities have refocused their attention on quality, errors, and patient safety in an unprecedented way, urged on by public outcry and by federal and state efforts to compel improvements in the health care system. Such entities as the Institute for Healthcare Improvement (www.ihi.org) the National Quality Forum (www.qualityforum.org), and the Institute of Medicine (www.iom.edu) have all emerged as champions of quality and safety initiatives, offering training, resources, access to best practices, and data collection strategies to move the cause of quality and safety for patients forward.
History
The IOM report had a huge impact on the discussion of quality and safety in the health care field. Aspects of quality care have always been present in hospitals, typically focused around the quality assurance or quality management departments. They historically collected data on department indicators and monitored them as part of accreditation. However, departmental data was typically focused on operational performance in the departments in question, and not a great deal was collected on issues of medical errors and near-misses. The litigious legal climate caused most hospitals to fear collecting and sharing data that could potentially be used against them in a legal action. However, the IOM report caused a national demand to know what health care institutions were doing to protect their patients from injury caused by errors. A climate of increased transparency has begun to emerge, although it is still a very long way from the concept of full openness on standardized reporting of indicators. The Centers for Medicare and Medicaid Services (CMS) weighed in with publication of their never-events, as explored further below.
Finally there has been an increased push for public reporting of data on individual hospital performance on selected indicators. While some progress has been made, there is a large range of indicators that is not yet publically reported, and medical errors are not publically reported at all at this point, although those with great potential to cause harm must be reported to their relevant state licensing agency.
What Is Happening Now
Out of all this push has come an increasing focus on patient safety as a critical aspect of health care quality. Hospitals and other health care institutions are experimenting with the creation of cultures of quality, wherein ...
Submission Id ab299d7c-b547-4cf3-958a-07922ca71f2765 SIM.docxdeanmtaylor1545
Submission Id: ab299d7c-b547-4cf3-958a-07922ca71f27
65% SIMILARITY SCORE 12 CITATION ITEMS 20 GRAMMAR ISSUES 0 FEEDBACK COMMENT
Internet Source 0%
Inst itut ion 65%
Patience Nehikhare
healthcaredeliverysystemchanges.docx
Summary
1175 Words
Running Head: HEALTHCARE DELIVERY SYSTEM
THE U.S. HEALTHCARE DELIVERY SYSTEM 2
Healthcare Delivery System
Patience Nehikhare
Grand Canyon University
December 22, 2019
The U.S. Healthcare Delivery System
There is a rapid change within the healthcare system in the United States. The
changes that have occurred were made for the purpose of improving quality,
rewarding value and not volume, as well as integrating and coordinating the care
(Seshamani & Sen, 2018). As such, this paper will seek to put into consideration
current healthcare laws within the U.S. and the nurse’s role within this continuously
changing environment; the manner in which quality measures and pay for performance
affect patient outcomes. Furthermore, the emerging trends in the healthcare system,
professional nursing leadership, and management roles will be discussed.
The Emerging Health Care Laws and their Effects on Nursing Practice
One of the most crucial healthcare legislat ions that has been enacted in the United
States since the inception of Medicare and Medicaid in 1965 is the Affordable Care
Act (Obama, 2016). The ACA was enacted in 2010. Issues relat ing to affordability,
ease of access, and the care quality within the United States healthcare system were
some of the driving factors that formed the list of many t ime spanning challenges
that compiled the init iat ion of this legislat ion. Between 2010 to 2015 there was a
decrease in the number of uninsured cit izens in the U.S. by forty three percent as an
effect of the Affordable Care Act.
The payment systems in healthcare are undergoing some changes and the access to
care has also improved (Obama, 2016). The ACA promotes preventive healthcare
models that put emphasis on quality care, primary care, and the funding of community
health init iat ives (Lathrop and Hodnicki, 2014). Millions of previously uninsured cit izens
are also provided insurance coverage and also some healthcare areas that need
reforms so as to meet the needs of patients’ improved healthcare outcomes are
highly focused by the act. The act has an effect on nursing practice in several ways.
The first effect is that the act creates a high demand for healthcare professionals
that are sufficiently trained to provide healthcare services that are up to the acts’
standards. The second effect is that Advanced Practice Registered Nurses (APRNs)
who hold the Doctor of Nursing Practice (DNP) are required to be prepared so that
they can meet the increased needs through the provision of leadership skills in
community health centers. These professionals are also held accountable for direct ing
and advocating for future init iates as well as ser.
This document summarizes a study that examined the effect of supply chain management on the quality of health services in Jordanian private hospitals. The study aimed to measure the impact of dimensions of supply chain management (relationship with suppliers, specifications and standards, delivery, after-sales service) on dimensions of health service quality (responsiveness, trust, safety). A questionnaire was distributed to procurement officers at 36 private hospitals in Jordan. The results showed that relationship with suppliers, specifications and standards, and delivery/after-sales service had a significant effect on quality of health services. There were no differences found due to gender, education, age, or experience.
Suggested ResourcesThe resources provided here are optional. You.docxdeanmtaylor1545
Suggested Resources
The resources provided here are optional. You may use other resources of your choice to prepare for this assessment; however, you will need to ensure that they are appropriate, credible, and valid. The MHA-FP5064 Health Care Information Systems Analysis and Design for Administrators Library Guide can help direct your research, and the Supplemental Resources and Research Resources, both linked from the left navigation menu in your courseroom, provide additional resources to help support you.
The Role of Informatics in Health Care
The following articles address the increasingly important role of informatics, which may provide useful insight when examining the data needs of an organization.
· Centers for Medicare & Medicaid Services. (2017). Data and program reports. Retrieved from https://www.cms.gov/regulations-and-guidance/legislation/ehrincentiveprograms/dataandreports.html
. The Web page provides access to Medicare and Medicaid Electronic Health Records Incentive Program payment and registration data contained in various reports.
· Chen, M., Lukyanenko, R., & Tremblay, M. C. (2017). Information quality challenges in shared healthcare decision making. Journal of Data and Information Quality (JDIQ), 9(1), 1–3.
. Discusses the challenges for patients in making sense of the enormous volume of health information made available through current information and communications technologies and how the quality of that information affects shared decision-making between patients and providers.
· Crawford, M. (2014). Making data smart. Journal of AHIMA, 85(2), 24–27, 28.
. Discusses applied informatics and how it can be used to derive useful information from big data, as health care becomes a data-driven industry.
· Dinov, I. D. (2016). Methodological challenges and analytic opportunities for modeling and interpreting big healthcare data. GigaScience, 5(1), 1–15.
. Discusses the challenges of big data analysis and addresses the need for technology and education in creating valuable knowledge assets from big data.
· Hegwer, L. R. (2014). Digging deeper into data. Healthcare Financial Management, 68(2), 80–84.
. Discusses the role of data analysts in improving the financial and clinical performance of health care organizations.
2
Running Head: Organizational Data needs
2
Organizational Data needs
Organization Data Needs Capella UniversityAssignment 2
Internal data sources can include data systems, for example, a radiology data system, medical library data, or the patient finance and billing system. Internal data sources also include EHR data systems such as the demographics, medical history of patients and disease records, medication and allergies records, laboratory test results, personal patient statistics such as gender age, weight and billing information (Porter et al, 2018).
External data sources include data from Centres for Medicare and Medicaid Services (CMS), benchmarking data from other hospitals are ex.
RESEARCH ARTICLE Open AccessHealthcare professionals’ view.docxrgladys1
RESEARCH ARTICLE Open Access
Healthcare professionals’ views on patient-
centered care in hospitals
Mathilde Berghout*, Job van Exel, Laszlo Leensvaart and Jane M. Cramm*
Abstract
Background: Patient-centered care (PCC) is a main determinant of care quality. Research has shown that PCC is a
multi-dimensional concept, and organizations that provide PCC well report better patient and organizational
outcomes. However, little is known about the relative importance of PCC dimensions. The aim of this study was
therefore to investigate the relative importance of the eight dimensions of PCC according to hospital-based
healthcare professionals, and examine whether their viewpoints are determined by context.
Methods: Thirty-four healthcare professionals (16 from the geriatrics department, 15 from a surgical intensive care
unit, 3 quality employees) working at a large teaching hospital in New York City were interviewed using Q
methodology. Participants were asked to rank 35 statements representing eight dimensions of PCC extracted from
the literature: patient preferences, physical comfort, coordination of care, emotional support, access to care,
continuity and transition, information and education and family and friends. By-person factor analysis was used to
reveal patterns of communality in statement rankings, which were interpreted and described as distinct viewpoints.
Results: Three main viewpoints on elements important for PCC were identified: “treating patients with dignity and
respect,” “an interdisciplinary approach” and “equal access and good outcomes.” In these viewpoints, not all dimensions
were equally important for PCC. Furthermore, the relative importance of the dimensions differed between departments.
Context thus appeared to affect the relative importance of PCC dimensions.
Conclusion: Healthcare organizations wishing to improve PCC should consider the relative importance of
PCC dimensions in their specific context of care provision, which may help to improve levels of patient-
centeredness in a more efficient and focused manner. However, as the study sample is not representative
and consisted only of professionals (not patients), the results cannot be generalized outside the sample.
More research is needed to confirm our study findings.
Keywords: Patient-centered care, Quality of care, Healthcare professionals, Q methodology, Hospital
Background
Since the Institute of Medicine described patient-
centered care (PCC) as one of the six most important
determinants of quality of care – along with safe, effect-
ive, timely, efficient and equitable care – PCC has re-
ceived much more attention [1]. Richardson and
colleagues [1] defined PCC as care that is “respectful of
and responsive to individual patient preferences, needs,
and values, and ensuring that patient values guide all
clinical decisions.” PCC has been shown to result in im-
proved health outcomes, including survival, greater
patient satisfaction and well-being [2]. Furtherm.
NRS 493 Grand Canyon University Improving Patients Quality Discussion.pdfbkbk37
This document discusses implementing effective bedside shift reporting to improve patient care quality. It proposes conducting bedside shift reporting where the incoming and outgoing nurses provide patient information directly to each other at the patient's bedside. This is compared to traditional reporting without patients present. The goal is to reduce adverse outcomes and support patient safety, satisfaction, and involvement in care. It reviews literature showing benefits like increased safety and proposes piloting the intervention in one unit before expanding it. Outcomes would be monitored to evaluate the impact on care quality and patient experience.
MHA6999 SEMINAR IN HEALTHCARE CASES-- WEEK 2 LECTURE, DISCUSSION, DioneWang844
MHA6999 SEMINAR IN HEALTHCARE CASES-- WEEK 2 LECTURE, DISCUSSION, AND PROJECT INSTRUCTIONS
Page | 1
Quality
Nearly fifteen years ago, the Institute of Medicine published the “To Err Is Human” report, which exposed the substantial impact of medical errors in the US healthcare system and called for a dramatic system change, including an improved understanding of those errors (McCarthy, Tuiskula, Driscoll, & Davis, 2017). Medical errors are considered to be failure to achieve the original goal or plan of action, and these errors may range from a patient falls to a mistake in the operating room. Not only do medical errors cause harm to the patient and jeopardize the patient’s trust, but they also cause a financial strain for the health system (“To Err is Human,” 1999). One of the contributing factors to medical errors is the lack of effective communication between doctors who are treating the same patient. This results in healthcare providers overprescribing medications for patients as well as increases the possibility of a patient having unnecessary tests or procedures performed. The report’s four-tiered approach includes:
· Focusing on creating a stronger foundation of education on patient safety
· Mandating a nationwide reporting system to encourage timely reporting of errors
· Increasing the standards of performance for healthcare providers
· Taking advantage of the security that safety systems offer (“To Err is Human,” 1999)
Creating a strong educational foundation for patient safety is most important. Healthcare personnel are much more likely to actively participate in reporting systems, encourage one another to perform at a higher level, and take advantage of safety systems when they are well educated on patient safety and the implications of medical errors. The reporting system seems to provide the least amount of impact on patient safety as they can result in losing patient trust in certain healthcare systems. The healthcare system as a whole has made progress in establishing a safe environment for patients when they are in need of care.
Challenges for Patient Safety and Steps for Improvement
Despite continuing evidence of problems in patient safety and gaps between the care that patients receive and the evidence about what they should receive, efforts to improve quality in healthcare show mostly inconsistent and patchy results.
Tap each image to know more.
Data Collection and Monitoring Systems
This always takes much more time and energy than anyone anticipates. It is worth investing heavily in data from the outset. Assess local systems, train people, and have quality assurance.
Tribalism and Lack of Staff Engagement
Overcoming a perceived lack of ownership and professional or disciplinary boundaries can be very difficult. Clarify who owns the problem and solution, agree roles and responsibilities at the outset, work to common goals, and use shared language.
Convince People That There's a Problem
Use hard data to secure emotional e ...
Quality measures and performance indicators are important for nurse practitioners (NPs) to demonstrate the impact of their care and meet organizational goals. Quality measures assess standards of care delivery and outcomes, ensuring patient safety and efficient use of healthcare services. They can improve access to preventive care, patient experience, and outcomes for high-risk groups. Performance indicators also evaluate clinical performance but from a holistic nursing perspective. Productivity measures for NPs may include patient visits, billing levels, or accomplishing specific clinical goals depending on specialty. Incentive plans that link pay to quality metrics and productivity can increase NP retention, satisfaction, and overall productivity, benefiting both NPs and healthcare organizations.
MSN 5650 Miami Regional University Reducing Hospital Readmission Presentation...bkbk37
This document discusses reducing hospital readmissions and improving quality of care. It identifies some key causes of hospital readmissions, such as medication errors, non-compliance by patients, and inappropriate transition from hospital to home. It notes that readmissions negatively impact quality of care and that hospitals have implemented programs to reduce readmissions. The document discusses the importance of clearly explaining medical instructions to patients and ensuring a smooth transition from hospital to home care through follow-up appointments and support.
CANCER DATA COLLECTION6The Application of Data to Problem-SoTawnaDelatorrejs
CANCER DATA COLLECTION 6
The Application of Data to Problem-Solving PEER RESPONSES
PEER NUMBER 1: Luis Arencibia
Top of Form
Clinical data is fundamental in the medical field. It is from this data that change and efficiency are made possible. Clinical data forms the basis of clinical care given to patients and research studies and is also used by the administration for decision-making and influencing change (Deckro et al., 2021). Modernization has come up with better ways of processing and storing clinical data, popularly known as informatics. This has led to the increased utilization of computers and information technology in clinical data management. The informatics results have increased efficiency in managing patients' data (McGonigle & Mastrian, 2022). It is crucial to ensure proper data management because it is from clinical data that crucial decisions and problems are solved in healthcare.
An example of a scenario where data can be helpful in problem-solving is the case where a healthcare facility wants to determine the average number of patients they receive in a day and use that information to establish whether the staff to patient ratio is satisfactory. This data can be obtained by registering all patients who attend the facility for a certain period, for example, three months, and stored electronically. The average is then done to get the approximate number of clients in a day. Additionally, the data should capture the age of patients, significant complaints, and the departments where the patients were attended. It is vital to secure this data to avoid unauthorized access to promote patients' privacy and compliance with the HIPAA to avoid legal consequences.
The knowledge derived from the data described above is the number of patients visiting the facility and their health needs. From this, the healthcare center will be able to critically analyze and evaluate whether the facility's staffing and resources are enough to meet the patients' demands. Suppose the number of patients is higher compared to the resources. In that case, the facility will be able to tell there is a shortage and the staff is being overworked, which is likely to compromise the services given to the patients.
From the data, a nurse leader can use clinical reasoning and judgment to explain why the health facility could be performing less efficiently and not meeting its goal of providing optimum medical services to patients. Additionally, the nurse could judge that the patients are not satisfied with the services provided from the data (Zhu et al., 2019). With that information, a nurse leader can successfully convince the management that there is a need for more staffing and resources to meet the patients' needs more successfully.
In conclusion, data management is crucial in the healthcare practice. With proper informatics, nurses and other healthcare providers will function optimally, and the results will be better quality ...
Payer Mix and EHR Adoptionin HospitalsDong Yeong Shin, doc.docxdanhaley45372
Payer Mix and EHR Adoption
in Hospitals
Dong Yeong Shin, doctoral student. Department of Health Services Administration,
University of Alabama at Birmingham; Nir Menachemi, PhD, professor, health care
organization and policy. University of Alabama at Birmingham; Mark Diana, PhD,
assistant professor. School of Public Health, Tulane University, New Orleans; Abby
Swanson Kazley, PhD, associate professor. Medical University of South Carolina,
Charleston; and Eric W. Ford, PhD, distinguished professor of healthcare, Bryan School
of Business, University of North Carolina at Creensboro
E X E C U T I V E S U M M A R Y
Payers are known to influence the adoption of health informarion technology (HIT)
among hospitals. However, previous studies examining the relationship between
payer mix and HIT have not focused specifically on electronic health record systems
(EHRs). Using data from the Nationwide Inpatient Sample and the American Hos-
pital Association Annual Survey, we examine how Medicare, Medicaid, commercial
insurance, and managed care caseloads are associated with EHR adoption in hospi-
tals. Overall, we found a weak relationship between payer mix and EHR adoption.
Medicare and, separately, Medicaid volumes were not associated with EHR adoption.
Furthermore, commercial insurance volume was not associated with EHR adoption;
however, a hospital located in the third quartile of managed care caseloads had a
decreased likelihood of EHR adoption. We did not find empirical evidence to sup-
port the hypothesis that payer generosity and other indirect mechanisms influence
EHR adoption in hospitals. The direct incentives embedded in the Health Informa-
tion Technology for Economic and Clinical Health Act may have a positive influence
on EHR adoption—especially for hospitals with high Medicare and/or Medicaid
caseloads. However, it is still uncertain whether the available incentives will offset the
barriers many hospitals face in achieving meaningfijl use of EHRs.
For more information about the concepts in this article, contact Dr. Menachemi
at [email protected]
435
JOURNAL O F HEALTHCARE M A N A G E M E N T 5 7 : 6 N O V E M B E R / D E C E M B E R 2 0 1 2
I N T R O D U C T I O N
Research has shown that payer mix,
defined as the combination of third-
party payers that makes up a hospital's
book of business, can influence hospi-
tals' strategic behaviors. Studies have
found that higher percentages of Medic-
aid (Cleverley and Harvey 1992; McKay
and Deily 2005) or Medicare patients
(Rosko 2001) are negatively associated
with financial performance. Further-
more, given that varying reimburse-
ment rates are negotiated in the private
insurance book of business, hospital
revenue per admission has been demon-
strated to predict operational efficiency
(Dor and Fariey 1996; McKay and Deily
2005) and clinical performance (Clem-
ent and Crazier 2001; Menachemi et al.
2007). Attempting to leverage the influ-
ence that the public insurance programs
have on hospi.
Running Head EVALUATION PLAN FOCUSEVALUATION PLAN FOCUS 1.docxcowinhelen
Running Head: EVALUATION PLAN FOCUS
EVALUATION PLAN FOCUS 1
Evaluation Plan Focus
Student Name
University Affiliations
Date
Professor
Scenario 1:
Your hospital is implementing a new unified acute and ambulatory Electronic Health Record (EHR) system through which patient care documentation will occur. Interdisciplinary assessment forms (including nursing), clinical decision support, and medical notes will be documented in this system. The implementation of the system is anticipated to improve the hospital’s performance in a multitude of areas. In particular, it is hoped that the use of the EHR system will reduce the rate of patient safety events, improve the quality of care, deter sentinel events, reduce patient readmissions, and impact spending. The implementation of the EHR system is also
Introduction
Evaluation plan involves an integral part regarding a grant suggestion providing information aimed at improving a project during the development and implementation. I will participate in the assessment of the scenario system in throughout the project. The scenario includes the hospital that is implementing the new unified as well as the Ambulatory EHR (Electronic Health Record) system that enhances the documentation of patient care. The purpose of the paper is explaining the selected scenario one, explanation of the reasons for selecting it, and summarizing of the research findings on the similar HIT implementations. More so, there is a description of the evaluation viewpoint, and goal guiding the assessment plan and same rationale.
HIT System Selected
The new system to be implemented has various modules that contain interdisciplinary assessment forms, medical notes, and clinical decision support where their documentation is guaranteed. The implementation of the unified system will enhance improved performance of the hospital in several departments. The new EHR system becomes of great importance to the hospital since there is a reduction of medical errors, reduction of the rate of the safety events of each patient, improving the quality of healthcare, deterrence of sentinel events, reduced patients readmissions as well as impact spending. Another reason for choosing the scenario is that the new system will enhance while fulfilling the requirements of meaningful use as stipulated in the HITECH (Health Information Technology for Economic and Clinical Health) Act. Therefore, the need for evaluation regarding the EHR implementation becomes paramount since it will help to identify the associated risks while adjusting the modules required when offering the medication services to the patients (Lanham, Leykum & McDaniel, 2012).
Summary of Research Findings on Similar HIT Implementations
Several evaluations are analogous to the HIT system implementation of the unified system with related differences regarding the outcomes based on the primary goals. For instance, some of the implemented systems fail to meet one hundred percent ...
NURS 521 Nursing Informatics And Technology.docxstirlingvwriters
This document discusses the application of clinical information systems in nursing. It reviews 4 peer-reviewed articles on this topic. The articles found that clinical information systems can help reduce medical errors, improve care quality by enhancing workflow and access to patient information, and engage patients more in their care when interactive technology is used. However, challenges remain around data integration across healthcare systems and technical, human, and organizational constraints. The document concludes that clinical information systems provide opportunities to improve care but must be effectively implemented and upgraded so nurses can benefit from these technologies.
Application of Data Analytics to Improve Patient Care: A Systematic ReviewIRJET Journal
This document summarizes a systematic review of research on applying data analytics to improve patient care. The review found that data analytics has significantly impacted the healthcare sector by improving patient care. Data analytics involves using scientific and mathematical methods to derive meaning from data to gain better insights. It can reduce costs, enable faster decision making, and minimize risks in healthcare. The review identified theories like the Magical Thinking Theory and Lightweight Theory that provide a framework for understanding the relationship between data analytics and patient care. The findings suggest data analytics plays an important role in improving patient health and experiences.
Introduction Healthcare system is considered one of the busiest.pdfbkbk37
The document discusses the application of clinical information systems in nursing. It reviews 4 peer-reviewed articles on the topic. The articles found that clinical information systems can improve workflow and reduce medical errors. However, challenges remain around data integration and sharing patient data across healthcare systems. The document concludes that clinical systems provide opportunities to improve care if effectively implemented and regularly updated to support nurses.
Explain in your own words why it is important to read a statistical .docxAlleneMcclendon878
Explain in your own words why it is important to read a statistical study carefully. Can you think of circumstance where it might be okay to misrepresent data?
Video Reflection 12 -
Do you think it is possible to create a study where there really is no bias sampling done? How would you manage to create one?
Video Reflection 13 -
What are your thoughts on statistics being misrepresented/ how does it make you feel? Why do you think the statistic are often presented in this way?
.
Explain how Matthew editedchanged Marks Gospel for each of the fol.docxAlleneMcclendon878
Explain how Matthew edited/changed Mark's Gospel for each of the following passages, and what reasons would he have had for doing that? What in Mk’s version was Mt trying to avoid – i.e., why he might have viewed Mk’s material as misleading, incorrect, or problematic? How did those changes contribute to Matthew’s overall message? How did that link up with other parts of Mt’s message?
Use both the following two sets of passages to support your claim, making use ONLY of the resources below, the Bible, textbooks and Module resources.
1. How did Matthew edit/change Mark 6:45-52 to produce Matthew 14:22-33 – and why?
2. How did Matthew edit/change Mark 9:2-10 to produce Matthew 17:1-13 – and why?
The paper should 350-750 words in length, double-spaced, and using MLA formatting for reference citations and bibliography. Submit the completed assignment to the appropriate Dropbox by
no later than Sunday 11:59 PM Eastern.
Resources for this paper:
See the ebook via SLU library:
New Testament History and Literature
by Martin (2012), pp. 83-88,105-108.
See the ebook via SLU library:
The Gospels
by Barton and Muddiman (2010), p. 53,56-57,102,109.
.
Explain the degree to which media portrayal of crime relates to publ.docxAlleneMcclendon878
Explain the degree to which media portrayal of crime relates to public fear of crime and explain how.
Explain whether public fear of crime might influence individual behavior or not and explain how or how not.
Share an insight about whether media should be responsible or not for the portrayal of crime as it relates to public fear of crime.
2 Pages in APA Format
.
Explain the difference between genotype and phenotype. Give an examp.docxAlleneMcclendon878
Explain the difference between genotype and phenotype. Give an example of each and describe both in an account that relates to you personally, the
paper should be 2-3 pages in length (not counting the title and resources pages), APA style (no abstract required), and should be supported with appropriate citations.
.
Explain the history behind the Black Soldier of the Civil War In t.docxAlleneMcclendon878
Explain the history behind the Black Soldier of the Civil War
In this forum look beyond the book for information on specific units, soldiers and even the reasons for why Lincoln allowed the African American to service in the war.
Soldiers - the trained and untrained
Initial post of at least 300 words due by Friday.
Darlene Hine, William Hine, and Stanley Harrold.
The African-American Odyssey: Volume I, 6th ed. New Jersey: Pearson 2014.
.
Explain the fundamental reasons why brands do not exist in isolation.docxAlleneMcclendon878
Explain the fundamental reasons why brands do not exist in isolation but do exist in larger environments that include other brands. Provide two (2) specific recommendations or solutions that can help a health care facility improve patient satisfaction.
Assess the value of Lederer and Hill's Brand Portfolio Molecule when used to understand brand relationships. Provide at least two (2) specific examples of strategic or tactical initiatives within a health care organization.
.
Explain the difference between hypothetical and categorical imperati.docxAlleneMcclendon878
Hypothetical imperatives are conditional principles that apply if one wants to achieve a goal, while categorical imperatives are unconditional moral rules. This distinction could be used to argue that placing violent prisoners in solitary confinement is a hypothetical imperative to maintain safety, but it may violate the categorical imperative of respecting human dignity for all.
Explain in 100 words provide exampleThe capital budgeting decisi.docxAlleneMcclendon878
Explain in 100 words provide example
The capital budgeting decision techniques that we've discussed all have strengths and weaknesses, but they do comprise the most popular rules for valuing projects. Valuing entire businesses, on the other hand, requires that some adjustments be made to various pieces of these methodologies. For example, one alternative to NPV used quite frequently for valuing firms is called Adjusted Present Value (APV).
What is APV, and how does it differ from NPV?
.
Explain how Supreme Court decisions influenced the evolution of the .docxAlleneMcclendon878
Explain how Supreme Court decisions influenced the evolution of the death penalty.
Explain the financial impact of the death penalty on society. Include at least one specific cost associated with the death penalty.
Explain the social impact of the death penalty on society. Provide examples and use Learning Resources to support your statements. 2 pages in APA format
.
Explain how an offender is classified according to risk when he or s.docxAlleneMcclendon878
Explain how an offender is classified according to risk when he or she is placed on probation or parole. Include how static and dynamic factors are taken into account by the supervising officer when both determining the level of supervision an offender needs and in developing the case-supervision plan for the offender. Include a discussion on the various levels of probation/parole supervision and the amount of surveillance and contact with the offender involved with each level. Do you agree or disagree with how often probation and parole officers have contact with high-risk offenders? Make sure to support your opinion.
.
Explain a lesson plan. Describe the different types of information.docxAlleneMcclendon878
Explain a lesson plan. Describe the different types of information found in a detailed lesson plan. Include in your discussion a design document and its usefulness. (A Minimum 525 Words)
Reference:
Noe, R. A. (2013). Employee training and development (6th ed.). New York, NY: McGraw-Hill.
.
explain the different roles of basic and applied researchdescribe .docxAlleneMcclendon878
explain the different roles of basic and applied research
describe the different criteria for success of basic and applied research
explain why government policymakers seem to prefer applied research
describe how basic research reflects liberal democratic values
Over fifty years ago, Vannevar Bush released his enormously influential report, Science, the Endless Frontier, which asserted a dichotomy between basic and applied science. This view was at the core of the compact between government and science that led to the golden age of scientific research after World War II—a compact that is currently under severe stress. In this book, Donald Stokes challenges Bush’s view and maintains that we can only rebuild the relationship between government and the scientific community when we understand what is wrong with that view.
Stokes begins with an analysis of the goals of understanding and use in scientific research. He recasts the widely accepted view of the tension between understanding and use, citing as a model case the fundamental yet use-inspired studies by which Louis Pasteur laid the foundations of microbiology a century ago. Pasteur worked in the era of the “second industrial revolution,” when the relationship between basic science and technological change assumed its modern form. Over subsequent decades, technology has been increasingly science-based. But science has been increasingly technology-based–with the choice of problems and the conduct of research often inspired by societal needs. An example is the work of the quantum-effects physicists who are probing the phenomena revealed by the miniaturization of semiconductors from the time of the transistor’s discovery after World War II.
On this revised, interactive view of science and technology, Stokes builds a convincing case that by recognizing the importance of use-inspired basic research we can frame a new compact between science and government. His conclusions have major implications for both the scientific and policy communities and will be of great interest to those in the broader public who are troubled by the current role of basic science in American democracy.
Why the distinction between basic (theoretical) and applied
(practical) research is important in the politics of science
.
Explain the basics of inspirational and emotion-provoking communicat.docxAlleneMcclendon878
Explain the basics of inspirational and emotion-provoking communication.
Explain the key features of a power-oriented linguistic style.
Explain the six basic principles of persuasion.
Evaluate basic approaches to resolving conflict and negotiating.
Choose one of the above topics
1 Paragraph
1 APA citation
.
Explain how leaders develop through self-awareness and self-discipli.docxAlleneMcclendon878
This paper discusses how leaders develop through self-awareness, self-discipline, education, experience, and mentoring. It will explain and classify different types of leadership development programs and discuss the importance of leadership succession planning. The paper will be 3-4 pages long using APA style and citing at least 4 sources.
Explain five ways that you can maintain professionalism in the meeti.docxAlleneMcclendon878
Explain five ways that you can maintain professionalism in the meeting and convention planning industry.
1.
Order of precedence
2.
Titles and styles of address
3.
Invitations
4.
Flags
5.
Religious, cultural and ritual observations
.
Explain security awareness and its importance.Your response should.docxAlleneMcclendon878
Explain security awareness and its importance.
Your response should be at least 200 words in length.
Explain network and data privacy policies.
Your response should be at least 200 words in length.
Explain the different security positions within information security.
Your response should be at least 200 words in length.
Explain what a security incident response team handles.
Your response should be at least 200 words in length.
.
Experimental Design AssignmentYou were given an Aedesaegyp.docxAlleneMcclendon878
Experimental Design Assignment
You were given an
Aedes
aegypti
gene of unknown function. Using Blast you were able to find the homologs of your gene. You have done research regarding the function of the homologs. Using this information:
A.Construct
a hypothesis
Give a hypothesis on the function of your gene SHAKER is in Aedesaegypti.
B.Design
an experiment to test your hypothesis.
Include a
labeled
sketch and written summary of experiment. (
include drawing of all conditions
, negative/positive etc)
C. Variables
List the Dependent and Independent
List Control variable
List a Positive and /or Negative controls
D.
Create a
data
set
and figure
Create a graph that clearly conveys to the reader what your experiment is about.
F.Interpretation
Give an interpretation of the possible meaning of your data. (although this isn’t conclusive since we are not doing statistics) . Does it align with your hypothesis?
G.Self-critique
and follow-up questions:
Why might your conclusion be wrong, what other questions do you have.
.
Expand your website plan.Select at least three interactive fea.docxAlleneMcclendon878
This document recommends selecting at least three interactive features to add to a website, identifying the purpose each feature would serve visitors, and how they would be constructed. Potential interactive features could include a contact form to collect visitor information, an events calendar to promote upcoming activities, and a feedback survey to gather user opinions.
Exercise 7 Use el pronombre y la forma correcta del verbo._.docxAlleneMcclendon878
Este documento presenta 22 oraciones con pronombres y verbos en forma personal que deben completarse correctamente. Las oraciones contienen sujetos como "yo", "nosotros", "ellos", etc. y verbos como "gustar", "faltar", "quedar", etc. que deben conjugarse de acuerdo al sujeto para completar cada oración.
Exercise 21-8 (Part Level Submission)The following facts pertain.docxAlleneMcclendon878
Exercise 21-8 (Part Level Submission)
The following facts pertain to a noncancelable lease agreement between Windsor Leasing Company and Sheridan Company, a lessee.
Inception date:
May 1, 2017
Annual lease payment due at the beginning of
each year, beginning with May 1, 2017
$21,737.01
Bargain-purchase option price at end of lease term
$3,800
Lease term
5
years
Economic life of leased equipment
10
years
Lessor’s cost
$68,000
Fair value of asset at May 1, 2017
$93,000
Lessor’s implicit rate
10
%
Lessee’s incremental borrowing rate
10
%
The collectibility of the lease payments is reasonably predictable, and there are no important uncertainties surrounding the costs yet to be incurred by the lessor. The lessee assumes responsibility for all executory costs.
Click here to view factor tables
(c)
Your answer is partially correct. Try again.
Prepare a lease amortization schedule for Sheridan Company for the 5-year lease term.
(Round present value factor calculations to 5 decimal places, e.g. 1.25125 and Round answers to 2 decimal places, e.g. 15.25.)
SHERIDAN COMPANY (Lessee)
Lease Amortization Schedule
Date
Annual Lease Payment Plus
BPO
Interest on
Liability
Reduction of Lease
Liability
Lease Liability
5/1/17
$
[removed]
[removed]
[removed]
[removed]
[removed]
[removed]
(To record depreciation.)
[removed]
[removed]
[removed]
[removed]
[removed]
[removed]
(To record interest.)
1/1/18
[removed]
[removed]
[removed]
[removed]
[removed]
[removed]
[removed]
[removed]
[removed]
(To record second payament.)
Question 27
Pearl Corporation manufactures replicators. On January 1, 2017, it leased to Althaus Company a replicator that had cost $100,000 to manufacture. The lease agreement covers the 5-year useful life of the replicator and requires 5 equal annual rentals of $40,200 payable each January 1, beginning January 1, 2017. An interest rate of 12% is implicit in the lease agreement. Collectibility of the rentals is reasonably assured, and there are no important uncertainties concerning costs.
Prepare Pearl’s January 1, 2017, journal entries.
(Credit account titles are automatically indented when amount is entered. Do not indent manually. If no entry is required, select "No Entry" for the account titles and enter 0 for the amounts. Round present value factor calculations to 5 decimal places, e.g. 1.25124 and the final answer to 0 decimal places e.g. 58,971
.
)
Click here to view factor tables
Date
Account Titles and Explanation
Debit
Credit
January 1, 2017
[removed]
[removed]
[removed]
[removed]
[removed]
[removed]
(To record the lease.)
January 1, 2017
[removed]
[removed]
[removed]
[removed]
[removed]
[removed]
(To record cost.)
January 1, 2017
[removed]
[removed]
[removed]
[removed]
[removed]
[removed]
(To record first lease payment.)
6 years ago
16.01.2017
8
Report Issue
Answer
(
0
)
Bids
(
0
)
other Questions
(
10
)
what can i bring to class that symbolizes growth and change
calculate it.
A Visual Guide to 1 Samuel | A Tale of Two HeartsSteve Thomason
These slides walk through the story of 1 Samuel. Samuel is the last judge of Israel. The people reject God and want a king. Saul is anointed as the first king, but he is not a good king. David, the shepherd boy is anointed and Saul is envious of him. David shows honor while Saul continues to self destruct.
This presentation was provided by Rebecca Benner, Ph.D., of the American Society of Anesthesiologists, for the second session of NISO's 2024 Training Series "DEIA in the Scholarly Landscape." Session Two: 'Expanding Pathways to Publishing Careers,' was held June 13, 2024.
Walmart Business+ and Spark Good for Nonprofits.pdfTechSoup
"Learn about all the ways Walmart supports nonprofit organizations.
You will hear from Liz Willett, the Head of Nonprofits, and hear about what Walmart is doing to help nonprofits, including Walmart Business and Spark Good. Walmart Business+ is a new offer for nonprofits that offers discounts and also streamlines nonprofits order and expense tracking, saving time and money.
The webinar may also give some examples on how nonprofits can best leverage Walmart Business+.
The event will cover the following::
Walmart Business + (https://business.walmart.com/plus) is a new shopping experience for nonprofits, schools, and local business customers that connects an exclusive online shopping experience to stores. Benefits include free delivery and shipping, a 'Spend Analytics” feature, special discounts, deals and tax-exempt shopping.
Special TechSoup offer for a free 180 days membership, and up to $150 in discounts on eligible orders.
Spark Good (walmart.com/sparkgood) is a charitable platform that enables nonprofits to receive donations directly from customers and associates.
Answers about how you can do more with Walmart!"
The chapter Lifelines of National Economy in Class 10 Geography focuses on the various modes of transportation and communication that play a vital role in the economic development of a country. These lifelines are crucial for the movement of goods, services, and people, thereby connecting different regions and promoting economic activities.
How to Make a Field Mandatory in Odoo 17Celine George
In Odoo, making a field required can be done through both Python code and XML views. When you set the required attribute to True in Python code, it makes the field required across all views where it's used. Conversely, when you set the required attribute in XML views, it makes the field required only in the context of that particular view.
LAND USE LAND COVER AND NDVI OF MIRZAPUR DISTRICT, UPRAHUL
This Dissertation explores the particular circumstances of Mirzapur, a region located in the
core of India. Mirzapur, with its varied terrains and abundant biodiversity, offers an optimal
environment for investigating the changes in vegetation cover dynamics. Our study utilizes
advanced technologies such as GIS (Geographic Information Systems) and Remote sensing to
analyze the transformations that have taken place over the course of a decade.
The complex relationship between human activities and the environment has been the focus
of extensive research and worry. As the global community grapples with swift urbanization,
population expansion, and economic progress, the effects on natural ecosystems are becoming
more evident. A crucial element of this impact is the alteration of vegetation cover, which plays a
significant role in maintaining the ecological equilibrium of our planet.Land serves as the foundation for all human activities and provides the necessary materials for
these activities. As the most crucial natural resource, its utilization by humans results in different
'Land uses,' which are determined by both human activities and the physical characteristics of the
land.
The utilization of land is impacted by human needs and environmental factors. In countries
like India, rapid population growth and the emphasis on extensive resource exploitation can lead
to significant land degradation, adversely affecting the region's land cover.
Therefore, human intervention has significantly influenced land use patterns over many
centuries, evolving its structure over time and space. In the present era, these changes have
accelerated due to factors such as agriculture and urbanization. Information regarding land use and
cover is essential for various planning and management tasks related to the Earth's surface,
providing crucial environmental data for scientific, resource management, policy purposes, and
diverse human activities.
Accurate understanding of land use and cover is imperative for the development planning
of any area. Consequently, a wide range of professionals, including earth system scientists, land
and water managers, and urban planners, are interested in obtaining data on land use and cover
changes, conversion trends, and other related patterns. The spatial dimensions of land use and
cover support policymakers and scientists in making well-informed decisions, as alterations in
these patterns indicate shifts in economic and social conditions. Monitoring such changes with the
help of Advanced technologies like Remote Sensing and Geographic Information Systems is
crucial for coordinated efforts across different administrative levels. Advanced technologies like
Remote Sensing and Geographic Information Systems
9
Changes in vegetation cover refer to variations in the distribution, composition, and overall
structure of plant communities across different temporal and spatial scales. These changes can
occur natural.
2. guidance to hospitals as to
which quality improvements lead to better outcome and why.
Using data from 4793
hospitals, this research explores the relationship using the triad
of structure, process, and
outcome. Our results show that the star rating system is
inadequate for making disease-
specific decision. More importantly, there is little evidence
linking the structure and
process related variables with disease specific clinical qual ity
outcomes.
Keywords: Medicare, Triple Aim Performance, Hospital
Performance, Clinical
Quality, Efficiency
INtRoduCtIoN
To bring transparency and efficiency in health services, Centers
for Medicare and
Medicaid Services (CMS) provides consumers with a tool to
assess the quality
of hospitals and other health care providers in their vicinity
through its Hospital
Compare website. (Medicare, n.d.). The data in Hospital
Compare originate from
3. An Evaluation of Medicare’s Hospital Compare
43
different quality and cost-effectiveness initiatives undertaken
by CMS where indi-
vidual hospitals report on various outcome and process
measures regarding mor-
tality, safety, readmissions, patient experience, and timeliness
and effectiveness of
care (Kaye et al., 2017). Using a complex methodology, CMS
assigns a star-rating
system on a scale of 1 through 5 (1: worst, 5:best) to individual
hospitals (Hospital
Compare Overall Ratings Resources, n.d.). Upon entering a zip
code or a hospital
name in the Hospital Compare website, a summary of nearby
hospitals along with
their star-ratings are displayed. Up to three hospitals can then
be selected to make
detailed side-by-side comparisons related to heart attack, heart
failure, pneumonia,
surgery and other conditions. These comparisons are organized
by patient satisfac-
tion, timeliness and effectiveness of care, readmissions and
4. deaths, among others.
While the star rating system is widely used by patients, care
providers,
insurance companies, and policymakers (Mehta et al., 2020),
there is also a
considerable debate regarding its deviance from other quality
rankings (Austin
et al., 2015). Furthermore, there is often little information
explaining the relation-
ship between star ratings and a specific disease outcome (e.g.
Acute Myocardial
Infarction, commonly known as heart attack) due to
methodological reasons of
standardization and inability to use data from low -volume
hospitals (George,
et al., 2017). Often, there is no underlying pattern of correlation
among different
outcome measures, thus raising the concern whether consumers
decision should
rely on global ranking systems (Hu et al., 2017).
Furthermore, there are limitations of the Hospital Compare
database
regarding its ability to provide direction to the hospitals as to
which quality
5. improvement and efficiency initiatives are yielding better
outcomes (MacLean
& Shapiro, 2016). Only a handful of hospitals achieve “triple
aim performance,”
i.e. scoring high on all three outcome dimensions measured by
CMS—clinical
quality, patient experience, and efficiency (Roth, et al., 2019).
Despite the vast
amount of data collected by CMS regarding hospitals’
technology capabilities,
quality, and cost effectiveness initiatives, there is a lack of
comprehensive studies
to assess how these relate to different outcome measures.
In this regard, the current study explores the relationship of
different classes
of outcome variables with technology capabilities and process
related variables. The
objective of the study is two-fold. First, whether the CMS star
ratings system provides
sufficient information to consumers towards choosing a hospital
for a disease-specific
condition. Second, how and to what extent structural and
process initiatives affect the
6. Sagnika Sen
44 e-Service Journal Volume 12 Issue 1
different outcome dimensions, such as patient satisfaction, cost
efficiency, and qual-
ity. Using data from 4,793 hospitals included in 2018 Hospital
Compare database,
we focus on general outcomes such as patient survey of hospital
and spending per
beneficiary as well as readmission rates and excess days spent
in care specific to acute
myocardial infarction (AMI), commonly known as heart attack.
While the CMS star rating is used by hospitals as an
endorsement of
quality, there is a lack of understanding as to whether these
ratings really help
and patients and family members in their choice of care. More
importantly, to
the best of our knowledge there are no studies exploring the
causal relationship
between structural and process variables to hospital
performance.
The rest of the paper is organized as follows. We present a brief
7. review
of the literature in the next section, followed by a description of
our data and
methodology. Analysis and discussion of the results are
presented next. Finally,
we discuss the limitations of the study and concluding remarks.
lItERAtuRE REVIEw
In a seminal article, Donabedian (1966) proposed using the triad
of structure,
process, and outcome to evaluate the quality of health care.
Ever since its intro-
duction, the Donabedian framework has been the most cited in
health services
research, especially regarding the theory and practice of quality
assurance in
healthcare (Ayanian & Markel, 2016).
According to the Donabedian framework, structure is defined as
the set-
tings where healthcare takes place and includes provider
qualifications and organ-
izational characteristics. Process includes the functions
surrounding the delivery
of care such as diagnosis, treatment, prevention. Finally,
8. outcome relates to the
effect of healthcare service on the patient and population. These
concepts were
further extended to identify different dimensions of quality
(Donabedian, 1990)
and still constitutes the foundation of quality assessment. In the
following, we
briefly describe the extant literature on each of the three
dimensions of structure,
process, and outcome as it relates to healthcare research.
Structural Measures
One of the most important structural measures arguably
revolves around a hospi-
tal’s technology capabilities. While the Donabedian framework
includes provider
An Evaluation of Medicare’s Hospital Compare
45
qualification, we feel that hospitals participating in CMS
programs such as
Medicare and Medicaid have standard qualification rules for
their doctors and
9. nurses, and as such would have similar effect on all hospitals.
However, since the
introduction of the HITECH (Health Information Technology
for Economic
and Clinical Health) act in 2010, considerable emphasis has
been placed on hos-
pital capabilities regarding electronic healthcare records (EHR),
especially the
ability to collect, receive, and transmit patient healthcare
records in standardized
format. Hospitals were incentivized to achieve “meaningful use”
of EHR with
respect to healthcare quality (Gholami et al., 2015).
A significant body of academic research has explored the
relationship of
technology and healthcare quality (Chaudhry et al., 2006). A
longitudinal study
of hospitals in the US have shown that healthcare technology
usage is not only
is associated with increase in healthcare quality but also
reducing operating costs
(Bardhan & Thouin, 2013). Also, investme nts in technology
leads hospitals to
disclose quality measures voluntarily (Angst et al., 2014).
10. While extant literature predominantly have shown positive
effect of health-
care technology (Buntin et al., 2011), a recent article also cites
the existence of
“productivity paradox” seen earlier in the manufacturing sector
(Bui et al., 2018).
Their study of hospitals in the state of New York show only
mixed outcomes after
a considerable investment in technology, especially since their
research found no
evidence of relationship between technology use and patient
satisfaction, mortal-
ity, and readmission rates. The authors of this paper call for
further research to
explore the causal linkage between technology use and specific
outcomes such as
patient satisfaction, spending, mortality, and readmission rates.
Process Measures
The quality improvement literature has long recognized the role
of process man-
agement in impacting outcomes. Quality initiatives such as Six
Sigma aim to
improve quality through a rational modularization and
11. streamlining of workflows
followed by the implementation of standardized best practices
(McCormack
et al., 2009). Healthcare organizations have embraced various
process improve-
ment initiatives towards improving hospital efficiency, clinical
outcomes, and
patient experience (Roth et al., 2019). In general, these
programs have resulted
in improved outcomes (Zheng et al., 2018).
Sagnika Sen
46 e-Service Journal Volume 12 Issue 1
In order to reduce the number of preventable medical errors,
CMS devel-
oped a set of best practices to improve care delivery. These
processes are specif-
ically aimed to improve the care for acute myocardial infarction
(heart attack),
heart failure, pneumonia, as well as surgical processes and
infections. It has been
shown that participating in process improvement initiatives for
heart attack
12. resulted in reducing clinical outcomes of mortality and
readmission rates (Ding,
2015). However, other studies have shown that hospitals’
emphasis on process
management leads to increases in clinical quality but reduction
in patient satis-
faction (Chandrasekaran et al., 2012).
Measuring healthcare Service outcomes
Effectiveness and efficiency are inherent indicators of process
performance and
have been captured in the literature as quality and efficiency
(Melville et al.,
2004). Quality can be measured in terms of process results and
is determined
by how well a process meets the customer’s needs. In the
context of healthcare,
quality can be measured by customer perceptions, and/or
ranking and rating pro-
vided by insurance agencies (e.g. Medicare) and independent
third parties (e.g.
US News and World Report).
Efficiency, on the other hand, is a simple ratio of output to
input and is
13. representative of how well the results are achieved. Recent
literature in healthcare
services have emphasized on the triple aim performance—
clinical quality, patient
satisfaction, and reduction in cost (Roth et al., 2019; Zheng et
al., 2018). We
adopt all three outcome measures in our analysis described
below.
dAtA ANd MEthodology
This research utilizes data from CMS Hospital Compare
(Medicare, n.d.) for
the year 2018. A total of 4,793 acute care hospitals registered
with Medicare
are included in the database. Hospital Compare reports
information on vari-
ous performance metrics such as spending, quality and
efficiency of care, HIT
implementation, and customer satisfaction collected from the
hospitals. In addi-
tion, CMS also provides ranking and benchmarking for each of
the hospitals.
Information regarding Veterans Administration hospitals,
children’s hospitals,
14. and critical access hospitals are also included in Hospital
Compare but was not
part of the current study.
An Evaluation of Medicare’s Hospital Compare
47
Details of the variables used in this study are provided in Table
1. As
previously mentioned, the triple aim performance goals are
used. For patient
satisfaction, we use the aggregate scores from Hospital
Consumer Assessment
of Healthcare Providers and Systems (HCAHPS) patient
experience survey.
In addition, the CMS overall star rating is also used. For cost
reduction/effi-
ciency, the Medicare Spending Per Beneficiary (MSPB) is used.
MSPB is a
price-standardized, risk-adjusted measures of spending
efficiency (Trzeciak
et al., 2017). It assesses the cost of services performed by
hospitals and other
healthcare providers during the period immediately prior to,
15. during, and
following a beneficiary’s hospital stay compared to a median
national hos-
pital. The measure adjusts for geographic differences, patient
severity, and
age (Medicare Spending Per Beneficiary (MSPB) Measure
Methodology, n.d.).
For clinical quality, the heart attack measures are chosen. Since
hospital per-
formance varies across different disease and treatment
conditions, we chose
to focus on one disease (Hu et al., 2017). In the past, disease
specific mor-
tality and readmission rates were used as standard clinical
quality outcomes.
However, these measures sometimes created skewed incentives
for hospitals
(Psotka et al., 2020). Consequently, more recent measures by
CMS include
Excess Days in Care instead or mortality which measures
unplanned patient
encounters such as observation stays, emergency department
visits 30 days
post discharge (Horwitz et al., 2018).
16. The process variables are a combination of heart attack specific
measures
(e.g. percentage of patients who were admitted with complaints
of chest pain and
received aspirin) and general emergency department (ED)
throughput measures
(e.g. time spent in ED). We have also included emergency
department volume as
one of the control variables.
Structural measures included health information technology
(HIT) related
measures, as well as safety measures. Descriptive statistics of
all variables are pro-
vided in Table 2.
Sagnika Sen
48 e-Service Journal Volume 12 Issue 1
T
ab
le
1
: S
114. ig
n
if
ic
an
t
at
p
=
0.
01
Sagnika Sen
52 e-Service Journal Volume 12 Issue 1
These different pieces of data reside in separate reports within
Hospital
Compare indexed by each hospital. Once data from these
different sources are
combined, separate regression models were run for each
outcome variable. For
categorical variables, the “not available” group was used as the
baseline. Results
of the regression are provided in Table 3.
115. RESultS
First glance at the results reveal that not all outcome variables
are equally impacted
by the structure and process variables. Survey-based patient
satisfaction and CMS
computed star rating outcomes are the ones best explained, as is
evidenced from
the adjusted R2 values of 21.1% and 17.7% respectively. The
efficiency meas-
ure, Medicare Spending Per Beneficiary (MSPB), and one of the
heart attack
related measures (excess days of care) have moderate values of
adjusted R2 values,
whereas heart-attack readmission rates are not at all impacted
by the structure
and process related variables. In the following section, the
structure-outcome and
process-outcome relationships are discussed in detail.
Structure-outcome Relationships
Interestingly, the two HIT variables did not have any effect on
any of the
five outcomes despite about two-thirds of the hospitals
reporting both
116. capabilities. While it seems counterintuitive, recent research
suggests that
electronic health care capabilities cannot be fully harnessed
unless the organ-
ization’s capabilities are built to exploit those technologies
(Jena et al., 2020).
Hospitals that did not have an inpatient safe surgery checklist
(compared to
the ones that did not report on this measure) highly impacted
excess days
of care. Not having a safe surgery checklist increased the excess
days of care
considerably. However, this measure did not have any effect on
the other four
outcomes. The outpatient safe surgery checklist on the other
hand, resulted
in reduced patient satisfaction (compared to hospitals that did
not report on
the surgery checklist). A possible explanation may be that it
increased the
time taken for outpatient procedures. Also, hospitals that did
not have an
outpatient safe surgery checklist had reduced excess days.
Finally, hospitals
117. that used a survey of patient safety culture led to both an
increase in spending
and excess days of care.
An Evaluation of Medicare’s Hospital Compare
53
Process-outcome Relationships
For the process variables specific to heart attack care,
administering aspirin has a
positive effect both on CMS hospital rating as well as in
reducing spending per
beneficiary. Surprisingly, it also slightly increases excess days
in acute care.. The
average time it takes for a probable heart attack patient to get
an ECG reduces
patient satisfaction but does not have any effect on the other
outcome variables.
The average time spent in the emergency department (ED) for
patients
who were ultimately admitted as inpatients reduces patient and
CMS rating,
increases spending per beneficiary, and increases readmission
118. rates. Overall time
spent in ED for all patients increases both patient satisfaction
and CMS ratings.
The percentage of people who left the ED before being seen
reduces both patient
satisfaction and CMS rating.
A hospital’s emergency department volume seems to play a
significant role
for most outcomes. In general, higher volume hospitals had less
satisfaction,
lower ratings, more spending, and higher amount of excess
days. Not all volume
categories have the same impact on the outcome variables
though. It is only the
very high-volume hospitals that resulted in more excess days.
For both spending
per beneficiary and CMS rating, the ED volume, which can
serve as a proxy for
hospital size, resulted in increased spending and lower rating.
dISCuSSIoN
One of the key findings from our analysis is that the CMS
overall rating pro-
vides a broad overview of hospital performance. All outcomes
119. show an improving
trend towards the higher star rated hospitals. However, while
the structure and
process variables explain quite a bit about patient satisfaction
and CMS com-
puted hospital ratings, they provide less information regarding
spending effi-
ciency, and even less for disease-specific clinical outcomes. In
other words, while
the current structure and process-related variables demonstrably
improve patient
performance, their impact on reducing unplanned visits and
readmission rates
is not evident. A closer look at the distribution on excess days
and readmission
rates show a significant overlap of these measures across
hospital ratings (Figure
1), implying that hospitals even in high-star rating category may
have less-than-
standard outcome for heart attack patients. Interestingly,
hospitals that were not
assigned a star rating by CMS had worse performance than
those that received
120. Sagnika Sen
54 e-Service Journal Volume 12 Issue 1
star ratings of 4 and 5, but at par or slightly better than those
with ratings 1–3.
It should be noted here that consumers do not have ready access
to the clinical
quality scores through the Hospital Compare website, and are
shown the per-
formance of the hospital as compared to national median. In
order to access the
actual scores, patients have to look through the enormous
number of data files
in the archives.
Figure 1: Heart Attack Readmission Rates and Excess Days In
Care Across Hospital Rating
An Evaluation of Medicare’s Hospital Compare
55
In summary, the CMS star ratings, while providing a general
overview of
a hospital’s performance, may not be the best way to choose
care for a specific
121. disease. More importantly, the structure and process variables,
currently captured
by the CMS, fail to provide hospitals with any insights as to
which initiatives
result in better clinical and spending outcomes.
CoNCluSIoNS ANd futuRE RESEARCh
In this study, we assess of the utility of the Hospital Compare
star rating ser-
vice in helping patients make informed decision for the choice
of their care. We
also explore which structure and process variables impact
different dimensions of
hospital performance and how. Our analysis highlights the
shortcomings of the
current service for both patients and providers.
At this point, the limitations of our study should be recognized.
This is a
cross-sectional study of hospitals reporting on many of their
process and quality
related initiatives. Since CMS does not report any data where
the number of
cases are very small, some methodological issues are raised
regarding the under-
122. estimation of quality risks at low-volume hospitals (George et
al., 2017). More
information regarding the variation in patient demographics as
well as hospital
characteristics (size, urban/rural location) should be included in
future studies to
appropriately assess the clinical quality. Apart from a low
volume of cases, some
hospitals did not report performance data on excess days and
quality of care,
although they reported other process and structural measures.
Further longitu-
dinal studies may investigate if the proportion of hospitals
reporting these meas-
ures increase over time, and whether such changes explain the
causal relationship
between process initiatives and quality measures.
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59
Nidhi Singh is Assistant Professor and Dean (Students Affairs)
at Jaipuria
Institute of Management, Noida. She is an active researcher
enrolled with IP
University, Delhi. She has qualified UGC Net also. She has
presented many
papers in various Seminars & Conferences including IIMR,
IICA, NLSIU etc.
and published papers in journals of National & International
Repute like the
International Journal of Information Management, Elsevier,
Journal of Retailing
and Consumer Services, Elsevier, International Journal of Bank
Marketing,
Emerald, Decision-Springer publication, Management and
Labour Studies
-Sage Publication, International Journal of Sustainable Strategic
Management
-Inderscience publication, FIIM, SERD, GSCCR etc.
Dr. Sagnika Sen is an Associate Professor of Information
130. Systems in the School
of Graduate Professional Studies at Pennsylvania State
University. She received
her Ph.D. from Arizona State University. Her research focuses
on process per-
formance, metrics and incentive design in organizations, mainly
the design of
effective decision-making frameworks and the use of data-
driven decision models
to obtain analytical insights on processes and performance
measures. She has
published in top academic journals in the field of Information
Systems such as
Information Systems Research and Journal of Management
Information Systems. Her
work has also appeared in other prestigious academic outlets
such as Decision
Support Systems, Information and Management,
Communications of the ACM,
Human Resources Management, Service Sciences, Journal of
Managerial Psychology,
etc.
131. Reproduced with permission of copyright owner.
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References
Saunders, H., Gallagher-Ford, L., Kvist, T., & Vehvilainen-
Julkunen, K. (2019). Practicing Healthcare
Professionals’ Evidence-Based Practice Competencies: An
Overview of Systematic Reviews.
Worldviews on Evidence-Based Nursing, 16(3), 176.
https://doi.org/10.1111/wvn.12363
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Practicing Healthcare Professionals' Evidence‐ Based Practice
Competencies: An Overview of
Systematic Reviews
Background: Evidence‐ based practice (EBP) competencies are
essential for all practicing healthcare
professionals to provide evidence‐ based, quality care, and
improved patient outcomes. The multistep
EBP implementation process requires multifaceted competencies
to successfully integrate best
evidence into daily healthcare delivery. Aims: To summarize
and synthesize the current research
literature on practicing health professionals' EBP competencies
(i.e., their knowledge, skills, attitudes,
beliefs, and implementation) related to employing EBP in
clinical decision‐ making. Design: An overview
of systematic reviews. Methods: PubMed/MEDLINE, CINAHL,
Scopus, and Cochrane Library were
systematically searched on practicing healthcare professionals'
EBP competencies published in January
2012–July 2017. A total of 3,947 publications were retrieved, of
which 11 systematic reviews were
eligible for a critical appraisal of methodological quality. Three
independent reviewers conducted the
critical appraisal using the Rapid Critical Appraisal tools
developed by the Helene Fuld National Institute
for Evidence‐ Based Practice in Nursing & Healthcare. Results:
Practicing healthcare professionals' self‐
reported EBP knowledge, skills, attitudes, and beliefs were at a
moderate to high level, but they did not
translate into EBP implementation. Considerable overlap
existed in the source studies across the
included reviews. Few reviews reported any impact of EBP
133. competencies on changes in care processes
or patient outcomes. Most reviews were methodologically of
moderate quality. Significant variation in
study designs, settings, interventions, and outcome measures in
the source studies precluded any
comparisons of EBP competencies across healthcare disciplines.
Linking Evidence to Action: As EBP is
a shared competency, the development, adoption, and use of an
EBP competency set for all healthcare
professionals are a priority along with using actual (i.e.,
performance‐ based), validated outcome
measures. The widespread misconceptions and
misunderstandings that still exist among large
proportions of practicing healthcare professionals about the
basic concepts of EBP should urgently be
addressed to increase engagement in EBP implementation and
attain improved care quality and patient
outcomes.
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Keywords: evidence‐ based practice; knowledge; competence;
systematic review; healthcare
professional
134. Knowledge of the principles of evidence‐ based practice (EBP)
and skills to perform the steps of the EBP
implementation process are essential competencies for all
practicing healthcare professionals (Melnyk,
Gallagher‐ Ford, & Fineout‐ Overholt, [16]). In nursing,
competence has been defined as the "ability to
perform the task with desirable outcomes under the varied
circumstances of the real world" (Benner, [
3], p. 304), referring to the expected knowledge, attitudes,
beliefs, skills, and abilities (i.e.,
competencies) for successful performance of critical work
functions. In health care, "core competencies
offer a common shared language for all health professions for
defining what all are expected to be able
to do to work optimally" (Albarqouni et al., [ 1], p. 2).
However, defining core competencies in EBP (i.e.,
outlining the expected EBP knowledge, skills, attitudes, beliefs,
and implementation, which are crucially
important for improving care quality and patient outcomes
because they enable healthcare professionals
to make clinical decisions grounded on best available evidence
and integrate the evidence into their
daily practice; Melnyk et al., [18]; Wallen et al., [34]) has been
a relatively recent development both in
nursing (Melnyk et al., [16]; Stevens, [28]) and in health care
(Albarqouni et al., [ 1]). Moreover, the
uptake and use of the EBP core competencies in daily practice
have been slow, which hinders
healthcare organizations from delivering highest quality,
evidence‐ based health care via consistent,
broad‐ based EBP implementation. Furthermore, systematic
integration of best evidence into practice is
challenging due to the complexity of the EBP implementation
process consisting of multiple sequential
steps, the mastery of which requires multifaceted interventions,
135. such as developing individual readiness
for EBP, translating and ensuring availability of best evidence
in usable forms for clinical practice, and
building organizational readiness, culture, and structures
supportive of EBP (Melnyk, Gallagher‐ Ford, &
Fineout‐ Overholt, [17]; Saunders, Vehviläinen‐ Julkunen, &
Stevens, [25]).
Similar to the idea of EBP itself (DiCenso, Cullum, & Ciliska, [
6]; Sackett, Rosenberg, Gray, Haynes, &
Richardson, [22]), the realization about the importance for all
healthcare professionals to develop a
sufficient level of EBP competence is not new, as the first
Sicily statement (Dawes et al., [ 5]) outlined
that it is a minimum requirement for all healthcare professionals
to understand and implement the
principles and process of EBP. To this end, two sets of nurses'
EBP competencies have been developed
through separate national consensus processes in the USA to
evaluate practicing nurses' abilities to
employ EBP (Melnyk et al., [16]) and to guide EBP professional
development and education programs
in nursing (Stevens, [28]). However, the EBP competencies
published thus far in nursing have been
self‐ reported and discipline‐ specific (i.e., they have focused
on measuring the perceived EBP
competencies of nurses). Although there have been a few actual
(i.e., performance‐ based) evaluation
tools developed in the last 10 years for more objective
measurement of EBP competencies, they have
also been discipline‐ specific and undertaken primarily in the
fields of medicine, occupational therapy,
physical therapy, and most recently, in nursing (Halm, [ 8]; Ilic,
Nordin, Glasziou, Tilson, & Villanueva,
[10]; Laibhen‐ Parkes, Kimble, Melnyk, Sudia, & Codone, [11];
McCluskey & Bishop, [12]; Spurlock &
136. Wonder, [27]; Tilson, [29]). However, as EBP is a shared
competency (i.e., the key principles and steps
of the EBP process are universal and applicable to all healthcare
disciplines), a unique opportunity
exists to jointly develop interprofessional core competencies in
EBP that objectively measure the actual
EBP performance of all healthcare professionals.
The Current State of Practicing Healthcare Professionals' EBP
Competencies
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A recent integrative review on EBP readiness of nurses
(Saunders & Vehviläinen‐ Julkunen, [24])
concluded that EBP competencies of nurses internationally are
at a low to moderate level, particularly in
terms of their EBP knowledge, EBP skills, and their confidence
in employing EBP. These results are
consistent with the findings from other recent reviews of EBP
competencies across other healthcare
disciplines (Mota da Silva, da Cunha Menezes Costa, Narciso
Garcia, & Oliveira Pena Costa, [20];
Scurlock‐ Evans, Upton, & Upton, [26]; Upton, Stephens,
Williams, & Scurlock‐ Evans, [32]). Therefore,
instead of setting high performance expectations for EBP, it is
essential to first focus on advancing
practicing healthcare professionals' EBP competencies, before
they will be capable of consistently
137. implementing EBP and integrating best evidence into their daily
care delivery. Once healthcare
professionals are competent in EBP, they will be more likely to
engage in EBP in their daily work, and
patient care delivery in most healthcare organizations will
likely become more evidence‐ based. This
substantial chasm between the EBP implementation goals of
healthcare organizations and the current
EBP implementation capabilities of large numbers of healthcare
professionals due to their low level of
EBP competence is precisely the gap that urgently requires
attention and immediate action in
healthcare organizations worldwide.
Aims
The aim of this overview of systematic reviews was to
summarize and synthesize the current
international research literature on practicing healthcare
professionals' EBP competencies (i.e., their
knowledge, skills, attitudes, beliefs, and implementation of
EBP) related to employing EBP in clinical
decision‐ making. This overview addresses the following
research question: What do systematic reviews
published in international peer‐ reviewed journals state about
practicing healthcare professionals' EBP
competencies?
Design
Published systematic reviews on the EBP competencies of all
practicing healthcare professionals,
including nurses, physicians, physical therapists, occupational
therapists, and other allied health
professionals, were considered for inclusion in this overview of
systematic reviews. The relevant data in
the reviews were systematically extracted, summarized, and
synthesized according to the guidelines
138. provided by the Cochrane Collaboration (Becker & Oxman, [
2]). The review process is presented
according to the Preferred Reporting Items for Systematic
Reviews and Meta‐ Analyses (PRISMA)
statement or guideline for reporting study methods and results
(Moher, Liberati, Tetzlaff, Altman, & The
PRISMA Group, [19]).
Methods
Systematic literature search methods were used to conduct
electronic database searches in
PubMed/MEDLINE, Cumulative Index for Nursing and Allied
Health Literature (CINAHL), Scopus, and
Cochrane Library for primary empirical studies and reviews
published between January 1, 2012, and
July 31, 2017 (i.e., for a period of approximately the last 5
years), without any language restrictions.
With the expert assistance of a university librarian, keywords
and search terms related to the various
healthcare disciplines, EBP, and competencies were first
searched independently and then in
combination, with appropriate modifications made for the
various databases (e.g., MeSH terms in
PubMed). The term "research utilization" was not used as the
aim of this overview of systematic reviews
was to focus on healthcare professionals' EBP competencies
(i.e., their EBP knowledge, skills, attitudes,
beliefs, and implementation). Moreover, research utilization
focuses on the retrieval, critique, and use of
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the research results from a single primary study, whereas EBP is
commonly considered to be a much
broader concept including research utilization and the
integration of summarized and translated best
evidence from several well‐ defined studies into clinical
practice (Melnyk & Fineout‐ Overholt, [14]). In
addition to the searched databases, authors of the included
reviews were contacted for any missing key
information, the reviews were reference‐ chased, and the lists
of contents of the following peer‐ reviewed
journals between the years of 2012–2017 were hand‐ searched:
Worldviews on Evidence‐ Based
Nursing, Journal of Advanced Nursing, BMC Health Services
Research, BMC Medical Education, BMJ
Open, Physiotherapy, and British Journal of Occupational
Therapy. These journals were selected
because they had published the majority of the reviews focusing
on the topic of healthcare
professionals' EBP competencies yielded by the systematic
literature searches conducted for this
overview.
Inclusion and Exclusion Criteria
The inclusion and exclusion criteria for systematic reviews are
listed in Table S1. Systematic reviews
were defined as reviews that had clearly stated aims or
objectives, predetermined inclusion criteria,
searched at least three databases, performed data extraction,
provided a synthesis of data, and
performed a quality appraisal of the included studies. To be
eligible for inclusion in this overview,
reviews were required to (a) focus on one or more of the
outcomes of interest (i.e., EBP competencies
140. of healthcare professionals), (b) fulfill the definition of a
systematic review, (c) meet the inclusion and
exclusion criteria, and (d) meet the benchmark set for the
methodological quality of the reviews. Before
undertaking this overview of systematic reviews, the Cochrane
Library and the Joanna Briggs Institute
Library of Systematic Reviews were searched. No published or
in‐ progress systematic reviews or
overviews of systematic reviews on this topic were found.
Search Results and Data Evaluation
The database searches yielded a total of 3,932 publications, and
15 additional publications were
identified through other sources. Titles were screened, and
duplicates as well as those not clearly
indicating a focus on practicing healthcare professionals' EBP
competencies were excluded. All
remaining abstracts (n = 407) were screened against the purpose
and inclusion criteria before being
selected for further appraisal. After eliminating a total of 392
records that did not meet one or more
inclusion criteria, the second screening resulted in 12 reviews.
Three reviews were added through
reference‐ chasing and hand‐ searching tables of content of the
selected peer‐ reviewed journals,
resulting in a total of 15 full‐ text reviews, which were assessed
for eligibility. Four full‐ text reviews were
excluded from the overview, as they contained no critical
appraisal of methodological quality and
therefore did not meet the definition of a systematic review
outlined for this overview. As a result, data
were extracted from 11 systematic reviews. Figure S1 details
the stages of searching and selecting
reviews for inclusion or exclusion using the PRISMA flow
diagram (Moher et al., [19]).
141. Data Extraction
The following data were extracted for each of the 11 reviews
and organized in a data matrix, using a
standardized data extraction form developed according to the
guidance from the PRISMA statement
(Moher et al., [19]): Author(s), country, year of publication,
types of participants, settings, study design(s)
included, EBP aspects reviewed, quality appraisal(s) performed,
main findings, and author's
conclusions. The data were extracted by one reviewer and
independently checked for accuracy and
consistency by two other reviewers to ensure rigor and
reproducibility. Any differences in opinion
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between the three researchers were discussed until a mutual
agreement was formed. All 11 reviews
were included in the critical appraisal of methodological
quality.
Critical Appraisal of Methodological Quality
The overall quality and differences in quality between the
included reviews were compared and
contrasted, in order to help interpret the results of the reviews
synthesized in this overview. The overall
quality of the reviews was not used as a criterion for inclusion,
as the reviews included in this overview
were required to meet the definition of a systematic review,
142. specific inclusion criteria, and to pass a
critical appraisal of methodological quality, the main purpose of
which was to ensure that the included
reviews conformed to usual research norms.
The criteria used by the three independent reviewers for
evaluating the methodological quality were
those in the Rapid Critical Appraisal (RCA) tool for systematic
reviews and meta‐ analyses of
quantitative studies developed by the Helene Fuld National
Institute for Evidence‐ Based Practice in
Nursing & Healthcare of the Ohio State University College of
Nursing ([OSUCN] 2017). The reviewers
used the tool to critically appraise the validity, reliability, and
applicability and generalizability through
independently answering a series of 15 appraisal questions and
subquestions. In addition, an evaluation
quantifying the strength of evidence (i.e., quality + level of
evidence) in the included reviews was added
to the standardized form for conducting the critical appraisal of
methodological quality. The three
independent reviewers critically appraised the strength of
evidence as being low, moderate, or high,
based on the percentage of critical appraisal criteria fulfilled
(0–33%, 34–66%, and 67% and over). Any
discrepancies and differences in opinion in the critical
appraisals of methodological quality related to the
included reviews were discussed among the three researchers
until consensus was reached. The
benchmark of methodological quality for the reviews included
in this overview was set at a total
minimum score of at least five out of a total of 15 appraisal
criteria on the RCA tool fulfilled (i.e., 34%),
indicating acceptable scientific rigor.
Data Synthesis
143. To answer the primary research question of this overview, the
data from the 11 included reviews on
practicing healthcare professionals' EBP competencies were
summarized, analyzed, and synthesized
by using guidance from the Cochrane Collaboration (Becker &
Oxman, [ 2]). A narrative synthesis is
presented, as a meta‐ analysis was not possible due to the
heterogeneity of the source studies
contained in the reviews, including substantial variation in
outcomes and educational interventions, as
well as the poor quality of reporting of the results in some of
the included reviews.
Findings
Characteristics of the Systematic Reviews Included in the
Overview
The 11 included reviews originated from all around the globe:
Though the majority (n = 6, 55%) were
from Europe, another two were from Australia, and one each
were from Asia, South America, and North
America. As expected, almost one‐ half (n = 5, 45%) of the
included reviews originated from English‐
speaking countries, which traditionally comprise the nations
leading the international EBP movement.
Unexpectedly, the majority (n = 6, 55%) of the reviews
originated from smaller countries, such as
Ireland, Greece, Finland, and the Netherlands, many of which
are non‐ English‐ speaking and have
embarked on the EBP journey more recently. The number of
source studies in the 11 included
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systematic reviews ranged from n = 6 to n = 32, with a total of
204 source studies from 24 different
countries on six continents of the world.
Seven (64%) of the 11 reviews included source studies using a
cross‐ sectional survey design, another
seven (64%) included randomized controlled trials (RCTs) or
cluster RCTs, six (55%) included source
studies using a pretest–posttest intervention or a cluster
nonrandomized study design, four (36%)
included qualitative study designs, two each of the 11
systematic reviews included mixed‐ methods study
designs and longitudinal observational designs, and one each of
the 11 reviews included prospective
cohort designs or reviews. Although the majority (n = 7, 64%)
of the 11 included systematic reviews
contained one or more source studies using an experimental
design (i.e., used a second group for
comparison), the vast majority of the source studies were
nonrandomized, one‐ group quasi‐
experimental study designs, cross‐ sectional surveys, or
qualitative study designs. Similarly, although the
vast majority of the total number of source studies used a
nonrandom sample (e.g., a convenience or
purposive sample), seven of the 11 (64%) systematic reviews
included at least one source study that
used a random sample.
Only five of the 11 included reviews discussed or displayed
(e.g., in their extracted data tables) the
response rates of their source studies, and even when they were
145. actually reported, they frequently were
not reported for all source studies in the reviews. Overall, the
reported response rates were relatively
low, and there was wide variability in the response rates from
9% to 100%. Furthermore, healthcare
professionals' EBP competencies were measured using a wide
variety of published and unpublished
instruments, some of which were general instruments measuring
several EBP competencies, such as
the EBP Questionnaire (Upton & Upton, [33]), whereas other
instruments measured one specific EBP
competency, such as the EBP Beliefs Scale (Melnyk &
Fineout‐ Overholt, [13]). Selected characteristics
of the included reviews (n = 11) are presented in Table S2.
Participants and Practice Settings in the Systematic Reviews
A total of 59,382 healthcare professionals participated in the
source studies of the 11 included reviews
published between January 2012 and July 2017. Healthcare
disciplines represented in the reviews were
primarily nursing, medicine, physical therapy, and occupational
therapy, but participants from at least 10
additional allied health disciplines were included in the source
studies of the reviews, as listed in the
Turnbull et al. ([30]) model for allied health professionals. In
almost one‐ half (n = 5, 45%) of the
systematic reviews, the source studies focused on only one
healthcare discipline (e.g., nurses).
However, six of the 11 included systematic reviews contained
source studies with multidisciplinary
samples, which included health professionals other than nurses,
doctors, physical therapists, and
occupational therapists. All 11 included systematic reviews
focused on practicing healthcare
professionals, but four of the 11 (36%) systematic reviews also
contained small subsamples of
146. healthcare students in some of their source studies. The clinical
settings of the source studies were
poorly identified with only general statements such as "various
settings" or "any clinical setting," or the
settings were not described at all in the majority (n = 7, 64%) of
the included reviews. However, some of
the included reviews did disclose containing source studies
from hospital, primary care, and community
care settings.
Outcomes Measured and Overlap Between the Included Reviews
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Outcomes measured in the included reviews varied
considerably, with several reviews containing other
outcomes in addition to those related to healthcare
professionals' EBP competencies. Moreover, the
instruments used to measure the outcomes also varied
considerably. Healthcare professionals' EBP
competencies were measured by using self‐ report assessments
in the source studies of all of the 11
included reviews (i.e., perceived EBP competencies were
measured, instead of using more objective
measures of actual performance, such as EBP knowledge tests).
A total of 204 source studies were
contained in the 11 reviews included in this overview. There
was substantial overlap across the included
reviews in terms of their source studies, as the 11 included
147. reviews with a total of 204 source studies
referred to a total of 133 separate studies, of which 48 were
included in more than one review. An effort
was made to avoid double counting which might lend extra
weight to those study results that had been
included in more than one review. A summary of the main
findings from the source studies can be found
in the fuller version of this overview published online. Table S3
summarizes the EBP competency
outcomes of healthcare professionals from the included reviews.
Overall Quality and Completeness of Reporting in the Included
Systematic Reviews
The overall quality of the included reviews was appraised using
guidance from the Cochrane
Collaboration (Becker & Oxman, [ 2]). All of the reviews met
the definition of systematic reviews as
outlined for this overview. Interestingly, although two of the 11
included reviews were characterized as a
"scoping review" or a "systematic scoping review," they
nevertheless included a critical appraisal of
methodological quality of their source studies, which reflects
the wide variety of terms that are used,
sometimes inconsistently, to describe the various types of
reviews published in the international
literature.
The critical appraisal of methodological quality conducted by
the three reviewers with the RCA tool
(OSUCN, [21]) revealed a broad range of strength of evidence
among the included reviews. The
benchmark for the strength of evidence indicating acceptable
methodological quality was set at 34%
(i.e., a total minimum score of at least 5 out of a total of 15
critical appraisal criteria fulfilled). All 11
included reviews met this minimum standard for acceptable
148. scientific rigor, with 10 out of the 11 reviews
appraised at moderate quality. The median score (0–15) was 8
(moderate), with the scores ranging from
5 to 10 (out of 15). Only one of the 11 included reviews barely
attained a high score (i.e., a score of at
least 10 out of 15 appraisal criteria fulfilled).
The pronounced heterogeneity in the source studies of the
included reviews in terms of their study
designs, practice settings, outcome measures, outcomes of
interest, and educational interventions,
combined with poor and inconsistent reporting quality (e.g., not
reporting source study settings) and
missing or incomplete data (e.g., only one of the 11 reviews
reported effect sizes for the source studies
and few reported p‐ values or confidence intervals), prompted
the results of this overview to be
narratively summarized. This also precluded any comparisons of
EBP competencies across healthcare
disciplines. In particular, there was considerable variation in the
outcome measures used in the source
studies of the reviews, including unpublished, not theoretically
based, and not psychometrically tested
instruments, which were inconsistently or incompletely
described. Moreover, many assertions were
made in the reporting of the source studies, but few assertions
were backed up by actual data in the
reviews. Furthermore, although the educational interventions
may have had a positive effect on EBP
competencies, the impact of the improved EBP competencies on
patient outcomes or practice changes
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remains unclear, as healthcare professionals' improved EBP
competencies may not necessarily have
influenced practice in any way.
On the other hand, although the vast majority of the source
studies in the included reviews used
nonprobability sampling methods and cross‐ sectional survey,
pretest–posttest intervention, or qualitative
study designs, it is important to acknowledge that seven (64%)
of the 11 reviews contained at least one
RCTs or cluster RCT as a source study. In total, the 11 reviews
contained 33 RCTs or cluster RCTs as
source studies, some of which were included in more than one
review. These results are consistent with
the findings of Young, Rohwer, Volmink, and Clarke ([36]),
who found that despite the commonly held
perception of relatively rare use of experimental study designs
such as RCTs in some healthcare
disciplines, the reviews included in their overview nevertheless
included a total of 25 RCTs. In summary,
the overall quality and completeness of evidence in the included
reviews of this overview was low to
moderate at best, as the majority of the reviews did not contai n
a comprehensive literature search,
report on both included and excluded studies, or discuss the
potential biases of the reviews. Lastly,
some of the reviews did not report on the response rates, the
number of participants in their source
studies, or match the stated objectives of the review with what
was actually discussed in the review.
150. Discussion
The first Sicily statement (Dawes et al., [ 5]) outlined that
knowledge and understanding of the principles
of EBP and skills to implement the steps of the EBP process are
essential competencies for all
practicing healthcare professionals. To that end, this overview
of systematic reviews summarized and
synthesized evidence from 11 systematic reviews containing
204 source studies that assessed the
current state of the EBP competencies for practicing healthcare
professionals, provided critical
appraisals of their ability to implement the steps of the EBP
process, and evaluated the effectiveness of
various educational interventions for advancing their EBP
competencies using a wide variety of study
designs, outcome measures, and outcomes of interest.
Although the majority of healthcare professionals across
disciplines indicated familiarity with both the
concept of "evidence‐ based practice" and the
discipline‐ specific terms of (e.g., "evidence‐ based
nursing" or "evidence‐ based medicine") widespread confusion
appeared to exist among large
proportions of healthcare professionals about the commonly
accepted definitions of EBP and the
meanings of the basic concepts related to EBP (Condon,
McGrane, Mockler, & Stokes, [ 4]; Scurlock‐
Evans et al., [26]; Ubbink, Guyatt, & Vermeulen, [31]; Upton et
al., [32]), which were consistent with the
results of other reviews (Saunders & Vehviläinen‐ Julkunen,
[24]). This is disconcerting because the lack
of clarity about even the most basic definitions and concepts of
EBP among large proportions of
healthcare professionals impedes healthcare organizations from
delivering the highest quality, evidence‐
based health care. It also may contribute to a perception among
151. healthcare professionals and
organizations that EBP is being implemented, when in reality,
clinical care delivery is still more closely
associated with the traditions, routines, and customs of
opinion‐ based practice (Saunders &
Vehviläinen‐ Julkunen, [24]; Wonder, Spurlock, Lancaster, &
Gainey, [35]). Furthermore, large
proportions of healthcare professionals across disciplines
appear to hold a variety of misconceptions,
misinterpretations, and misunderstandings of what actually
constitutes EBP (Saunders, Stevens, &
Vehviläinen‐ Julkunen, [23]; Scurlock‐ Evans et al., [26];
Upton et al., [32]). For example, Scurlock‐ Evans
et al. ([26]) contended that physical therapists may not only be
confused as to the meaning of the term
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"evidence," they may also be confused about how they should
go about integrating evidence and about
what type of evidence they should be implementing in practice.
Practicing healthcare professionals' self‐ reported EBP attitudes
toward and beliefs in the importance
and value of EBP for improving care quality and patient
outcomes were mainly positive across health
disciplines, and generally at a higher level than their
self‐ reported EBP knowledge and skills.
Unfortunately, however, these EBP competencies did not
152. translate into EBP behaviors, as EBP
implementation in daily practice was generally at a low level
across disciplines (Saunders & Vehviläinen‐
Julkunen, [24]; Scurlock‐ Evans et al., [26]; Ubbink et al., [31];
Upton et al., [32]). Furthermore, although
healthcare professionals' self‐ rated EBP knowledge and skills
were higher than their EBP
implementation, healthcare professionals across disciplines
rated their EBP knowledge and skills to be
at an insufficient level for integrating best evidence into daily
practice. Perhaps for this reason, large
proportions of healthcare professionals across disciplines did
not use best available evidence or
implement EBP in daily care delivery. This is consistent with
the findings of previous studies indicating
that the majority of clinicians do not consistently engage in
EBP (Melnyk, Fineout‐ Overholt, Gallagher‐
Ford, & Kaplan, [15]; Melnyk et al., [17]; Wallen et al., [34]).
Another concern related to the included reviews was failing to
measure the impact of healthcare
professionals' EBP competencies on patient outcomes, even
when it was explicitly stated as one of the
objectives of the review. Although four of the 11 included
reviews reported measuring the impact of
healthcare professionals' EBP competencies on practice changes
or patient outcomes as a stated
objective, only one review actually discussed any results related
to patient outcomes. The lack of
measuring the impact on patient outcomes of healthcare
professionals' EBP competencies and that of
educational interventions promoting healthcare professionals'
EBP competencies is consistent with the
results of other reviews (Hecht, Buhse, & Meyer, [ 9];
Häggman‐ Laitila, Mattila, & Melender, [ 7]) and
overviews (Young et al., [36]).
153. Limitations in the Overview
The main limitation of this overview of systematic reviews is
the potential for various biases, including
selection, publication, and indexing biases. To reduce the
potential for bias, we followed guidance from
the Cochrane Collaboration and PRISMA on the methodology
for conducting rigorous systematic
reviews and reporting their results, followed a prespecified
review protocol, and systematically searched
multiple electronic databases in collaboration with a university
librarian, using keywords and search
terms modified appropriately for the various databases. In
addition, we searched for ongoing systematic
reviews prior to undertaking this overview, reference‐ chased
the systematic reviews included in this
overview, and hand‐ searched the tables of contents of the
peer‐ reviewed scientific journals in which the
majority of the systematic reviews on healthcare professionals'
EBP competencies had been published.
As hand‐ searching the tables of contents did not result in
additional searches, we believe that our
search strategy would effectively capture most of the relevant
systematic reviews published on this topic
between January 2012 and July 2017. However, as in any
review, it is possible that some relevant
systematic reviews were not identified.
Second, three reviewers independently used a study
design‐ specific critical appraisal tool to evaluate
the methodological quality of each included review, with any
discrepancies and differences discussed to
form a mutual agreement, which increased the reliability of the
data. In addition, all of the included
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reviews, originating from 10 different countries worldwide, had
passed an international peer review and
had been published in high‐ quality scientific journals. As the
majority (n = 6, 55%) of the included
reviews originated from non‐ English‐ speaking countries
representing six different languages, publication
and language biases, although possible, are unlikely.
Third, self‐ reported assessments were used to measure
healthcare professionals' EBP competencies in
all of the 11 included reviews (i.e., perceived EBP
competencies were assessed, instead of using more
objective measures of actual performance, such as EBP
knowledge tests). Because of a lack of
congruence between self‐ reported and more objectively
measured knowledge and ability, especially
when measuring complex tasks such as EBP implementation
(Saunders, Vehviläinen‐ Julkunen, et al.,
[25]; Scurlock‐ Evans et al., [26]; Wonder et al., [35]), using
self‐ reports may result in bias (through the
participants giving more socially acceptable responses than
nonrespondents), and in overestimation of
some EBP competencies, such as EBP knowledge, for which
more objective measures are available.
Fourth, the search term "research utilization" was not used for
our overview of systematic reviews as the
aim was to focus on the EBP competencies that practicing
155. healthcare professionals need to
successfully integrate translated best evidence into daily
clinical practice. However, we acknowledge
that it is not uncommon for research utilization to be used in
studies as if it were an alternative term for
EBP, and therefore, we are aware that some of the published
systematic reviews may have been
missed by our search. Fifth, the modest methodological quality
of the identified systematic reviews and
the relatively low quality of reporting of the results in the
systematic reviews may have affected the
results of this overview. Finally, effect sizes were not reported
in all but one of the included systematic
reviews. Therefore, generalizability of the results is limited,
and the results of this overview should be
extrapolated with caution.
Implications for Practice and Research
Evidence‐ based practice competencies are essential for all
practicing healthcare professionals in
guiding their integration of best evidence into their clinical
decision‐ making and thus enabling them to
provide higher‐ quality care and produce better patient
outcomes. However, as EBP is a shared
competency and the steps of EBP implementation are universal,
there is an urgent need for the
collaborative development, implementation, and evaluation of
an EBP competency set for all healthcare
professionals (i.e., an interprofessional set of EBP competencies
that can be used by all practicing
healthcare professionals from any healthcare discipline).
Recently, the development of a first set of such
interprofessional core competencies in EBP for all healthcare
professionals was published as a
consensus statement based on a systematic review and Delphi
survey (Albarqouni et al., [ 1]), which
156. contained 68 core competencies in EBP applicable to all
healthcare professionals. This type of
interprofessional core competencies in EBP for all healthcar e
professionals should be the focus of future
research studies, as the EBP competencies will guide the
development of interprofessional EBP
competency measures (via self‐ ratings or actual performance)
as well as joint EBP curricula for
practicing healthcare professionals, and thus, their subsequent
uptake, adoption, and use in clinical
practice should be a high priority for all practicing healthcare
professionals. In addition, addressing the
widespread misconceptions and misunderstandings currently
existing among large proportions of
healthcare professionals about the basic concepts of EBP is
crucially important for increasing their
engagement in EBP implementation and for attaining improved
care quality and patient outcomes.
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Nursing and some allied health disciplines, such as physical
therapy and occupational therapy, have
traditionally relied on measuring competencies through
self‐ report assessments even when the
constructs of interest, such as EBP knowledge, ability, or
competence, could be assessed through more
objective measures. Therefore, future studies should focus on
developing and using actual, that is,
157. performance‐ based, validated outcome measures for EBP
competencies through using rigorous study
and review methodologies and robust reporting practices.
Although EBP is a shared competency,
implementation of EBP is a complex process requiring
multifaceted educational interventions that
contain interacting components, and thus, it should be
investigated whether the differences in
healthcare professionals' primary roles, educational
backgrounds across disciplines, and in contextual
factors may influence the effects of the EBP educational
interventions.
Conclusions
The findings of this overview of systematic reviews suggest that
irrespective of their healthcare
discipline, large proportions of practicing healthcare
professionals perceive their EBP competencies to
be insufficient for employing EBP in daily care delivery. These
perceptions as well as widespread
confusion, misconceptions, and misunderstandings about the
meanings of the most basic concepts of
EBP among healthcare professionals across disciplines
contribute to their low levels of EBP
implementation both in terms of the principles and in terms of
the process of EBP (i.e., healthcare
professionals neither using translated best evidence as the basis
for clinical decision‐ making in daily
practice nor implementing all the steps of the EBP process). As
EBP is a shared competency, practicing
healthcare professionals should actively participate in the
uptake, adoption, and use of the
interprofessional core competencies in EBP for all healthcare
professionals as well as collaboratively
advance EBP implementation through the development and
evaluation of the effectiveness of research‐
158. based EBP interventions, strategies, and tools.
EBP competencies are essential for all practicing healthcare
professionals as they guide healthcare
professionals' integration of best evidence into their clinical
decision‐ making and thus, enable them to
provide higher‐ quality care to patients, resulting in better
patient outcomes.
It is important to recognize that EBP is a shared competency;
that is, the key principles and steps of the
EBP implementation process are universal and applicable to all
healthcare disciplines.
There is an urgent need for conducting research studies on the
applicability in practice, as well as the
uptake, adoption, and evaluation of the interprofessional core
competencies in EBP for all healthcare
professionals recently published as a consensus statement based
on a systematic review and Delphi
survey (Albarqouni et al., [ 1]).
Future research studies should also focus on developing and
using actual, that is, performance‐ based,
validated outcome measures for assessing nurses' EBP
competencies, instead of continuing to evaluate
perceived (i.e., self‐ rated) competencies via self‐ assessments,
even when the constructs of interest,
such as EBP knowledge and ability, could be assessed through
more objective, performance‐ based
measures.
Linking Evidence to Action
GRAPH: Figure S1. The modified PRISMA Flow diagram
(Moher et al., [19]): Identification, screening
and selection of systematic reviews for inclusion in the
159. overview.
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GRAPH: Table S1. Inclusion and Exclusion Criteria for the
Overview of Systematic Reviews.Table S2.
Characteristics of Included Systematic Reviews in the
Overview.Table S3. Summary Table of EBP
Outcomes in the Systematic Reviews Included in the Overview.
Footnotes
1 This research was supported by grants awarded to Dr.
Saunders from the Finnish Work Environment
Fund, which are gratefully acknowledged.
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~~~~~~~~
By Hannele Saunders; Lynn Gallagher‐ Ford; Tarja Kvist and
Katri Vehviläinen‐ Julkunen
Reported by Author; Author; Author; Author
This article is copyrighted. All rights reserved.
Source: Worldviews on Evidence-Based Nursing
168. staffing structure. In addition to providing management of
frontline nurses, they also oversee the organizational
structure of nursing treatment for DSH patients and are
therefore well-positioned to shape the processes of care
for these patients. Essential to improving this process is
understanding the aspects of care that managers perceive
as important to providing quality care, as well as the extent
to which evidence-based practices (EBPs) have translated
889673 JAPXXX10.1177/1078390319889673Journal of the
American Psychiatric Nurses AssociationDiana et al.
research-article2019
1Amaya H. Diana, The University of Pennsylvania,
Philadelphia, PA,
USA
2Mark Olfson, MD, MPH, Columbia University, New York, NY,
USA
3Sara Wiesel Cullen, PhD, MSW, The University of
Pennsylvania,
Philadelphia, PA, USA
4Steven C. Marcus, PhD, The University of Pennsylvania,
Philadelphia,
PA, USA
Corresponding Author:
Sara Wiesel Cullen, School of Social Policy and Practice, the
University of Pennsylvania, 3701 Locust Walk, Philadelphia,
PA 19104-
6243, USA.
Email: [email protected]
The Relationship Between
Evidence-Based Practices and
Emergency Department Managers’
Perceptions on Quality of
169. Care for Self-Harm Patients
Amaya H. Diana1, Mark Olfson2, Sara Wiesel Cullen3 ,
and Steven C. Marcus4
Abstract
OBJECTIVE: To understand the extent to which implementation
of evidence-based practices affects emergency
department (ED) nurse managers’ perceptions of quality of care
provided to deliberate self-harm patients.
METHODS: ED nursing leadership from a nationally
representative sample of 513 hospitals completed a survey on
the ED management of deliberate self-harm patients, including
the quality of care for deliberate self-harm patients on
a 1 to 5 point Likert-type scale. Unadjusted and adjusted
analyses, controlling for relevant hospital characteristics,
examined associations between the provision of evidence-based
practices and quality of care. RESULTS: The overall
mean quality rating was 3.09. Adjusted quality ratings were
higher for EDs that routinely engaged in discharge planning
(β = 0.488) and safety planning (β = 0.736) processes. Ratings
were also higher for hospitals with higher levels
of mental health staff (β = 0.368) and for teaching hospitals (β
= 0.319). CONCLUSION: Preliminary findings
suggest a national institutional readiness for further
implementation of evidence-based practices for deliberate self-
harm patients.
Keywords
emergency department, deliberate self-harm, suicide prevention,
evidence-based practices, quality of care
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Diana et al. 289
to the ED. For instance, after a DSH event, the provision
of appropriate assessment and safety planning reduces
risk for repeat DSH and suicide attempts (Boudreaux
et al., 2016; Stanley et al., 2018). Safety planning is a
brief behavioral intervention that can be performed by
nurses in the ED that involves restricting access to lethal
means, teaching coping skills, identifying a social and
emergency network, and building motivation for con-
tinuing mental health treatment (Stanley et al., 2018).
Despite the evidence supporting the efficacy of assess-
ment and safety planning, it remains unknown how often
these strategies are actually employed in EDs or the
extent to which they improve the quality of care for DSH
patients.
In order to assess the gap between research and prac-
tice in this area, a national survey of over 500 ED manag-
ers collected data on the extent to which EDs provide
assessments, the elements of safety planning practices
identified above, and mental health referrals on discharge.
We then examined the extent to which implementation of
these practices influenced ED nurse managers’ percep-
tions of the quality of care provided to DSH patients.
Methods
Between May 2017 and January 2018, we mailed an ED
management of DSH survey to a random sample of 665