Management

Hospital Performance, the Local Economy, and the Local Workforce: Findings from a US National Longitudinal Study

Hospital Performance, the Local Economy, and the Local Workforce: Findings from a US National Longitudinal Study
PLoS Med 7(6): e1000297. doi:10.1371/journal.pmed.1000297

Blustein, J., Borden, W.B., Valentine, M.
06/29/2010

Abstract

Background: Pay-for-performance is an increasingly popular approach to improving health care quality, and the US government will soon implement pay-for-performance in hospitals nationwide. Yet hospital capacity to perform (and

improve performance) likely depends on local resources. In this study, we quantify the association between hospital performance and local economic and human resources, and describe possible implications of pay-for-performance for socioeconomic equity.

Methods and Findings: We applied county-level measures of local economic and workforce resources to a national sample of US hospitals (n = 2,705), during the period 2004–2007. We analyzed performance for two common cardiac conditions (acute myocardial infarction [AMI] and heart failure [HF]), using process-of-care measures from the Hospital Quality Alliance [HQA], and isolated temporal trends and the contributions of individual resource dimensions on performance, using multivariable mixed models. Performance scores were translated into net scores for hospitals using the Performance Assessment Model, which has been suggested as a basis for reimbursement under Medicare’s ‘‘Value-Based Purchasing’’ program. Our analyses showed that hospital performance is substantially associated with local economic and workforce resources. For example, for HF in 2004, hospitals located in counties with longstanding poverty had mean HQA composite scores of 73.0, compared with a mean of 84.1 for hospitals in counties without longstanding poverty (p,0.001). Hospitals located in counties in the lowest quartile with respect to college graduates in the workforce had mean HQA composite scores of 76.7, compared with a mean of 86.2 for hospitals in the highest quartile (p,0.001). Performance on AMI measures showed similar patterns. Performance improved generally over the study period. Nevertheless, by 2007—4 years after public reporting began—hospitals in locationally disadvantaged areas still lagged behind their locationally advantaged counterparts. This lag translated into substantially lower net scores under the Performance Assessment Model for hospital reimbursement.

Conclusions: Hospital performance on clinical process measures is associated with the quantity and quality of local economic and human resources. Medicare’s hospital pay-for-performance program may exacerbate inequalities across regions, if implemented as currently proposed. Policymakers in the US and beyond may need to take into consideration the balance between greater efficiency through pay-for-performance and socioeconomic equity.

Please see later in the article for the Editors’ Summary.

How to House the Homeless

How to House the Homeless
Russell Sage Foundation Press

Ellen, I.G. & O'Flaherty, B. (eds.).
06/01/2010

How to House the Homeless, editors Ingrid Gould Ellen and Brendan O’Flaherty propose that the answers entail rethinking how housing markets operate and developing more efficient interventions in existing service programs. The book critically reassesses where we are now, analyzes the most promising policies and programs going forward, and offers a new agenda for future research. How to House the Homeless makes clear the inextricable link between homelessness and housing policy. Contributor Jill Khadduri reviews the current residential services system and housing subsidy programs. For the chronically homeless, she argues, a combination of assisted housing approaches can reach the greatest number of people and, specifically, an expanded Housing Choice Voucher system structured by location, income, and housing type can more efficiently reach people at-risk of becoming homeless and reduce time spent homeless. Robert Rosenheck examines the options available to homeless people with mental health problems and reviews the cost-effectiveness of five service models: system integration, supported housing, clinical case management, benefits outreach, and supported employment. He finds that only programs that subsidize housing make a noticeable dent in homelessness, and that no one program shows significant benefits in multiple domains of life. Contributor Sam Tsemberis assesses the development and cost-effectiveness of the Housing First program, which serves mentally ill homeless people in more than four hundred cities. He asserts that the program’s high housing retention rate and general effectiveness make it a viable candidate for replication across the country. Steven Raphael makes the case for a strong link between homelessness and local housing market regulations—which affect housing affordability—and shows that the problem is more prevalent in markets with stricter zoning laws. Finally, Brendan O’Flaherty bridges the theoretical gap between the worlds of public health and housing research, evaluating the pros and cons of subsidized housing programs and the economics at work in the rental housing market and home ownership. Ultimately, he suggests, the most viable strategies will serve as safety nets—“social insurance”—to reach people who are homeless now and to prevent homelessness in the future. It is crucial that the links between effective policy and the whole cycle of homelessness—life conditions, service systems, and housing markets—be made clear now. With a keen eye on the big picture of housing policy, How to House the Homeless shows what works and what doesn’t in reducing the numbers of homeless and reaching those most at risk.

Health Care in World Cities: New York, London and Paris

Health Care in World Cities: New York, London and Paris
Johns Hopkins University Press, April

Gusmano, M.K., Rodwin, V.G. & Weisz, D.
04/01/2010

New York. London. Paris. Although these cities have similar sociodemographic characteristics, including income inequalities and ethic diversity, they have vastly different health systems and services. This book compares the three and considers lessons that can be applied to current and future debates about urban health care.

Highlighting the importance of a national policy for city health systems, the authors use well-established indicators and comparable data sources to shed light on urban health policy and practice. Their detailed comparison of the three city health systems and the national policy regimes in which they function provides information about access to health care in the developed world's largest cities.

The authors first review the current literature on comparative analysis of health systems and offer a brief overview of the public health infrastructure in each city. Later chapters illustrate how timely and appropriate disease prevention, primary care, and specialty health care services can help cities control such problems as premature mortality and heart disease.

In providing empirical comparisons of access to care in these three health systems, the authors refute inaccurate claims about health care outside of the United States.

Click here for a brief excerpt of the content.

How much should we invest in preventing childhood obesity?

How much should we invest in preventing childhood obesity?
Health Aff (Millwood). 2010 Mar-Apr;29(3):372-8.

Trasande L
03/01/2010

Policy makers generally agree that childhood obesity is a national problem. However, it is not always clear whether enough is being spent to combat it. This paper presents nine scenarios that assume three different degrees of reduction in obesity/overweight rates among children in three age groups. A mathematical model was then used to project lifetime health and economic gains. Spending $2 billion a year would be cost-effective if it reduced obesity among twelve-year-olds by one percentage point. The analysis also found that childhood obesity has more profound economic consequences than previously documented. Large investments to reduce this major contributor to adult disability may thus be cost-effective by widely accepted criteria.

Medicare Payments, Health Care Services Use, and Telemedicine Implementation Cost in Randomized Trial Comparing Telemedicine Case Management With Usual Care in Medically Underserved Patients With Diabetes Mellitus

Medicare Payments, Health Care Services Use, and Telemedicine Implementation Cost in Randomized Trial Comparing Telemedicine Case Management With Usual Care in Medically Underserved Patients With Diabetes Mellitus
Journal of the American Medical Informatics Association

Palmas, W., Shea, S., Starren, J., Teresi, J.E., Ganz, M.L., Burton, T.M., Pashos, C.L., Blustein, J., Field, L., Morin, P.C., Izquierdo, R.E., Silver, S., Eimicke, J.P., Langiua, R.A. & Weinstock, S.
03/01/2010

Objective
To determine whether a diabetes case management telemedicine intervention reduced healthcare expenditures, as measured by Medicare claims, and to assess the costs of developing and implementing the telemedicine intervention.
Design
We studied 1665 participants in the Informatics for Diabetes Education and Telemedicine (IDEATel), a randomized controlled trial comparing telemedicine case management of diabetes to usual care. Participants were aged 55 years or older, and resided in federally designated medically underserved areas of New York State.
Measurements
We analyzed Medicare claims payments for each participant for up to 60 study months from date of randomization, until their death, or until December 31, 2006 (whichever happened first). We also analyzed study expenditures for the telemedicine intervention over six budget years (February 28, 2000- February 27, 2006).
Results
Mean annual Medicare payments (SE) were similar in the usual care and telemedicine groups, $9040 ($386) and $9669 ($443) per participant, respectively (p>0.05). Sensitivity analyses, including stratification by censored status, adjustment by enrollment site, and semi-parametric weighting by probability of dropping-out, rendered similar results. Over six budget years 28 821 participant/months of telemedicine intervention were delivered, at an estimated cost of $622 per participant/month.
Conclusion
Telemedicine case management was not associated with a reduction in Medicare claims in this medically underserved population. The cost of implementing the telemedicine intervention was high, largely representing special purpose hardware and software costs required at the time. Lower implementation costs will need to be achieved using lower cost technology in order for telemedicine case management to be more widely used.

Power Differences in the Construal of a Crisis: The Immediate Aftermath of September 11, 2001

Power Differences in the Construal of a Crisis: The Immediate Aftermath of September 11, 2001
Personality and Social Psychology Bulletin, 36(3), 354-370.

Magee, J.C., Milliken, F.J. & Lurie, A.R.
03/01/2010

In this research, we examine the relationship between power and three characteristics of construal-abstraction, valence, and certainty-in individuals' verbatim reactions to the events of September 11, 2001 and during the immediate aftermath of the terrorist attacks. We conceptualize power as a form of social distance and find that position power (but not expert power) was positively associated with the use of language that was more abstract (vs. concrete), positive (vs. negative), and certain (vs. uncertain). These effects persist after controlling for temporal distance, geographic distance, and impression management motivation. Our results support central and corollary predictions of Construal Level Theory (Liberman, Trope, & Stephan, 2007; Trope & Liberman, 2003) in a high-consequence, real-world context, and our method provides a template for future research in this area outside of the laboratory.

The Responsibility Revolution: How the Next Generation of Businesses Will Win

The Responsibility Revolution: How the Next Generation of Businesses Will Win
San Francisco: Jossey-Bass, 2010. Print.

Hollender, Jeffrey and Bill Breen.
03/01/2010

How to create a company that not only sustains, but surpasses-that moves beyond the imperative to be "less bad" and embrace an ethos to be "all good"

From the Inspired Protagonist and Chairman of Seventh Generation, the country's leading brand of household products and a pioneering "good company," comes a one-of-a-kind book for leaders, entrepreneurs, and change agents everywhere. The Responsibility Revolution reveals the smartest ways for companies to build a better future-and hold themselves accountable for the results. Thousands of companies have pledged to act responsibly; very few have proven that they know how. This book will guide them. The Responsibility Revolution presents fresh ideas and actionable strategies to commit your company to a genuine socially and environmentally responsible business and culture, one that not only competes but wins on values.

  • Points the way for innovators and influencers to generate trust by becoming transparent, elicit people's passion and creativity, turn customers into collaborators, transform critics into allies, rewrite the rules and reinvent business
  • Shows how to build a socially and environmentally responsible yet genuinely good company and an authentic brand
  • Drawing on groundbreaking interviews with real-world change leaders, Hollender and Breen present lessons and insights from the "good company"' parts of big companies like IBM and eBay, trailblazers like Patagonia and Timberland, and emerging dynamos like Linden Lab and Etsy

The Responsibility Revolution equips people with the tactics, models, and mind-sets they need to compete in a world where consumers now demand that companies contribute to the greater good.

Infrastructure Impacts and Adaptation Challenges

Infrastructure Impacts and Adaptation Challenges
Chapter 4 in New York City Panel on Climate Change 2010 Report, Climate Change Adaptation in New York City: Building a Risk Management Response, C. Rosenzweig and W. Solecki, Eds. Prepared for use by the New York City Climate Change Adaptation Task Force.

Zimmerman, R. & Faris, C.
01/01/2010

Creating an overall climate change adaptation strategy for urban infrastructure poses considerable conceptual and operational challenges. An understanding of the characteristics of a city's infrastructure that make it particularly vulnerable to the impacts of climate change is a critical foundation for understanding the severity of the impacts and the means for adaptation. Historical events that have compromised a city's infrastructure under conditions similar to those associated with climate change also provide information about what a city might expect in the way of consequences from a future of increased temperatures, precipitation, and sea level rise. This chapter explores the challenges to climate change adaptation in major urban infrastructure sectors with a focus on New York City, draws lessons from adaptation efforts under way in other large metropolitan regions, and discusses the role of the private sector in urban adaptation.

Paradox and Collaboration in Network Management. Administration and Society

Paradox and Collaboration in Network Management. Administration and Society
Administration & Society July 2, 2010 vol. 42 no. 4 404-440

Ospina, S.
01/01/2010

Qualitative evidence from action networks is used to answer the research question, How do leaders of successful networks manage collaboration challenges to make things happen? This study of two urban immigration coalitions in the United States found that their leaders developed practices as a response to two paradoxical requirements of network collaboration: managing unity and diversity when doing inward work and confrontation and dialogue when doing outward work. By illuminating how leaders responded to these complex demands inherent in action networks, the authors open up the black box of managing whole networks of organizations and underscore the role of leadership in interorganizational collaboration.

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