Management

What Matters to Low-Income Patients in Ambulatory Care Facilities?

What Matters to Low-Income Patients in Ambulatory Care Facilities?
Medical Care Research and Review. Sep 2004; 61: 352 - 375.

Delia, D., Hall, A. & Billings, J.
01/01/2004

Poor, uninsured, and minority patients depend disproportionately on hospital outpatient departments (OPDs) and freestanding health centers for ambulatory care. These providers confront significant challenges, including limited resources, greater demand for services, and the need to improve quality and patient satisfaction. The authors use a survey of patients in OPDs and health centers in New York City to determine which aspects of the ambulatory care visit have the greatest influence on patients’ overall site evaluation. The personal interaction between patients and physicians, provider continuity, and the general cleanliness/appearance of the facility stand out as high priorities. Access to services and interactions with other facility staff are of significant, although lesser, importance. These findings suggest ways to restructure the delivery of care so that it is more responsive to the concerns of low-income patients.

The Role of Social and Behavioral Science in Public Health Practice: A Study of the New York City Department of Health

The Role of Social and Behavioral Science in Public Health Practice: A Study of the New York City Department of Health
Journal of Urban Health 2003;80(4)625-634.

Van Devanter, N., Shinn, B., Tannert-Naing, K, Bleakley, A., Perl, S. & Cohen, N.
12/01/2003

Studies over the last decade have demonstrated the effectiveness of public health interventions based on social and behavioral science theory for many health problems. Little is known about the extent to which health departments are currently utilizing these theories. This study assesses the application of social and behavioral science to programs in the New York City Department of Health (NYCDOH). Structured open-ended interviews were conducted with executive and program management staff of the health department. Respondents were asked about the application of social and behavioral sciences within their programs, and about the benefits and barriers to increasing the use of such approaches. Themes related to the aims of the study were identified, a detailed coding manual developed, narrative data were coded independently by two investigators (kappa.85), and data analyzed. Interviews were conducted with 61 eligible individuals (response rate 88%). The most common applications of social and behavioral science were individual-level behavior change to prevent HIV transmission and community-level interventions utilizing community organizing models and/or media interventions for health promotion and disease prevention. There are generally positive attitudes about the benefits of utilizing these sciences; however, there are also reservations about expanded use because of resource constraints. While NYCDOH has successfully applied social and behavioral sciences in some areas of practice, many areas use them minimally or not at all. Increasing use will require additional resources. Partnerships with academic institutions can bring additional social and behavioral science resources to health departments and benefit researchers understanding of the health department environment.

Evidence Based Financial Management

Evidence Based Financial Management
Healthcare Financial Management, October

Finkler, S.A., Henley, R.J. & Ward, D.M.
10/01/2003

Focuses on the importance of evidence-based financial management of hospitals in the U.S. Concept behind evidenced-based financial management; Mechanics of an evidence-based financial management; Benefits provided by this type of financial management; Financial implications if this type of financial management is used.

Functional Outcomes of Pediatric Liver Transportation

Functional Outcomes of Pediatric Liver Transportation
Journal of Pediatric Gastroenterology & Nutrition, 37(2), 155-60.

Alonso, E.M. Neighbors, K., Mattson, C., Sweet, E., Ruch-Ross, H., Berry, C. & Sinacore, J.
08/01/2003

The functional status and health-related quality of life (HRQOL) of children who survive liver transplantation (LT) have not been well documented. The purpose of this study was to determine the functional status and HRQOL in this population using a validated measure for children, the Child Health Questionnaire-Parent Form 50 (CHQ-PF50).

Methods: The CHQ-PF50 instrument was completed by the parents of 55 children who agreed to participate in a mailing survey. Subscale scores for the sample were compared with those of a published normal population (n = 391).

Results: Study sample characteristics were: 87% Caucasian, 54.5% female, mean age at survey was 9.6 years (range, 5-17 years). Responding caregivers were 95% biologic parents and 93% female. Compared with the normal population, LT recipients had lower subscale scores for general health perceptions (P < 0.0005), emotional impact on parents (<0.0005) and disruption of family activities (0.0005). The mean physical summary score of the LT recipients was lower than that of the normal population 48.1 /- 12.1 (P = 0.005), but the mean psychosocial summary score was similar 48.8 /- 11.9 (P = 0.156). Within the LT population, the original diagnosis (biliary atresia vs. other), type of LT (living donor vs. cadaveric), age at LT, z score for height, and hospital days did not significantly influence any of the subscale scores.

Conclusions: Children who have survived LT have functional outcomes in the physical domain that are lower than those of normal children. Self-esteem and mental health in this group appeared normal. The parents in this sample experienced more emotional stress and disruption of family activities than did parents in a normal population.

Understanding Cooperative Behavior in Labor Management Cooperation: A Theoy-Building Exercise

Understanding Cooperative Behavior in Labor Management Cooperation: A Theoy-Building Exercise
Public Administration Review, July 2003, vol.63, no.4, pp. 455-471(17) Blackwell Publishing Inc.

Ospina, S.
07/01/2003

This article proposes a theory of how mandated institutional cooperation transforms into individual cooperative behavior. Using qualitative strategies, we draw insights about cooperation in three public-sector efforts of labor-management cooperation (LMC). We report an association between critical shifts in the roles of stakeholders and the change from adversarial to cooperative labor relations. While managers became team players along with their employees, labor representatives assumed managerial responsibilities. These changes were also associated with a service-oriented perspective, better understanding of the other's experiences, and a view of cooperation as partnership. At the heart of these transformations, we found critical changes in communication patterns associated with incrementally growing levels of trust. We propose a model that depicts the links between collective and individual levels of organizational action related to LMC. We conclude that the positive shifts in mental models regarding work and the value of cooperation justify the promotion of LMC efforts.

A Nonprofit Organization

A Nonprofit Organization
in Ruth Towse, editor, A Handbook of Cultural Economics. Cheltenham, U.K. and Nothhampton, MA: Edward Elgar,

Netzer, D.
01/01/2003

In all rich countries, firms organized on a not-for-profit basis produce cultural goods and services, along with for-profit firms (including independent professional artists) and the state. This is also true in many poorer countries. Non-profit firms are defined as organizations that have a formal structure and governance, which differ greatly among countries but share the characteristics that (1) the managers of the organization do not own the enterprise or have an economic interest that can be sold to other firms or individuals and (2) any surplus of revenue over expenditure may not be appropriated by the managers of the organization, but must be reinvested in ways that further the stated purposes of the organization. Obviously, such organizations will not be formed and continue to exist unless the organizers and managers expect and realize some economic rewards, including money compensation for their own services and non-financial rewards like consumption benefits (producing cultural goods and services that they want to enjoy but which will not be produced without their efforts) and personal status.

Agenda Setting for Health Care Management Research: Report of a Conference

Agenda Setting for Health Care Management Research: Report of a Conference
Health Care Management Review, Vol. 28, No. 4, pp. 319-322.

Kovner, A.R.
01/01/2003

Highlights the "Agenda Setting for Health Care Management Research," conference held in New York City on January 23-24, 2003. Generating research funding; Barriers to using management research; Overcoming barriers to funding.

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