Management

Evidence-Based Management in Healthcare

Evidence-Based Management in Healthcare
Chicago:  Health Administration Press,

Kovner, A.R., Fine, D.R. & D'Aquila, R.
04/01/2009

Too often in the fast-moving healthcare field, decision makers rely primarily on what has worked before. Evidence-Based Management in Healthcare explains how healthcare leaders can move from making educated guesses to using the best available information to make decisions.

Learn what evidence-based management (EB management) is and how it can focus thinking and clarify the issues surrounding a decision. The book provides a straightforward process for asking the right questions, gathering supporting information from various sources, evaluating the information, and applying it to solve management challenges.

Numerous real-life examples illustrate how the EB management approach is used in a variety of situations, from inpatient bed planning to operating room scheduling to leadership development. These examples also demonstrate the potential costs and benefits of EB management.

The Politics of Obesity: A Current Assessment and Look Ahead

The Politics of Obesity: A Current Assessment and Look Ahead
Milbank Quarterly 2009 Mar;87(1):295-316. doi: 10.1111/j.1468-0009.2009.00556.x.

Kersh, R.
03/03/2009

Context: The continuing rise in obesity rates across the United States has proved impervious to clinical treatment or public health exhortation, necessitating policy responses. Nearly a decade's worth of political debates may be hardening into an obesity issue regime, comprising established sets of cognitive frames, stakeholders, and policy options.

Methods: This article is a survey of reports on recently published studies.

Findings: Much of the political discussion regarding obesity is centered on two "frames," personal-responsibility and environmental, yielding very different sets of policy responses. While policy efforts at the federal level have resulted in little action to date, state and/or local solutions such as calorie menu labeling and the expansion of regulations to reduce unhealthy foods at school may have more impact.

Conclusions: Obesity politics is evolving toward a relatively stable state of equilibrium, which could make comprehensive reforms to limit rising obesity rates less feasible. Therefore, to achieve meaningful change, rapid-response research identifying a set of promising reforms, combined with concerted lobbying action, will be necessary.

Obesity burst onto the U.S. national policy agenda in 2000/2001, initially fuelled by a widely disseminated set of maps by the Centers for Disease Control and Prevention (CDC) depicting sharply rising obesity rates nationwide, followed by the surgeon general's warning that obesity had become a "new national epidemic" (Mokdad et al. 2003; Oliver 2006; Satcher 2001). A snapshot of responses since then would include alarmed reactions from medical, media, and policy actors alike. The health establishment has rushed to devise medical treatments, from surgical to pharmaceutical, for obesity and its manifold health effects. Surging media attention to obesity and overweight features reports ranging from dire health alarms ("the current generation may be the first to live shorter lives than their parents-and obesity is to blame"; Belluck 2005, p. A1; see also Daniels 2006; Olshansky et al. 2005) to economic warnings (over $120 billion lost annually to obesity-related illnesses; see e.g., Bhattacharya and Sood 2006) to "lifestyle" stories of coffins, airplane seats, and hospital beds all made larger to suit the "supersizing of America" (St. John 2003, p. A13). Public officials at all levels have decried the "epidemic," although statutory reforms have been concentrated in a few energetic local and state polities; the federal government has been noticeably slow to act. All the while obesity rates continue to rise, with thirty-seven states reporting significant year-to-year increases from 2007 to 2008, with none reporting a decrease (TFAH 2008).

This article explores obesity politics as it has evolved in recent years. First I discuss the sustained struggles over framing the topic now that public agendas have begun to solidify into an "issue regime" around obesity. Then I examine popular local and state policy options and review approaches that could have an impact on soaring obesity rates, along with an assessment of the likelihood of their widespread adoption. While promising policy approaches exist, the opportunity to take action may be closing fast. On most public health issues, policymaking features a bustle of activity followed by a period of quiescence as a regime coalesces-even when the underlying problems continue to mount. Antiobesity advocates who face declining interest from lawmakers will therefore need to devise creative ways to sustain a focus on this topic.

 

Medicaid Patients at High Risk for Frequent Hospital Admission: Real-time Identification and Remedial Risks

Medicaid Patients at High Risk for Frequent Hospital Admission: Real-time Identification and Remedial Risks
Journal of Urban Health. 86, no 2 230-241

Goldfrank, L., Billings, J., Raven, M., et al.
03/01/2009

Patients with frequent hospitalizations generate a disproportionate share of hospital visits and costs. Accurate determination of patients who might benefit from interventions is challenging: most patients with frequent admissions in 1 year would not continue to have them in the next. Our objective was to employ a validated regression algorithm to case-find Medicaid patients at high-risk for hospitalization in the next 12 months and identify intervention-amenable characteristics to reduce hospitalization risk. We obtained encounter data for 36,457 Medicaid patients with any visit to an urban public hospital from 2001 to 2006 and generated an algorithm-based score for hospitalization risk in the subsequent 12 months for each patient (0 = lowest, 100 = highest). To determine medical and social contributors to the current admission, we conducted in-depth interviews with high-risk hospitalized patients (scores >50) and analyzed associated Medicaid claims data. An algorithm-based risk score >50 was attained in 2,618 (7.2%) patients. The algorithm’s positive predictive value was equal to 0.67. During the study period, 139 high-risk patients were admitted: 60 met inclusion criteria and 50 were interviewed. Fifty-six percent cited the Emergency Department as their usual source of care or had none. Sixty-eight percent had >1 chronic medical conditions, and 42% were admitted for conditions related to substance use. Sixty percent were homeless or precariously housed. Mean Medicaid expenditures for the interviewed patients were $39,188 and $84,040 per patient for the years immediately prior to and following study participation, respectively. Findings including high rates of substance use, homelessness, social isolation, and lack of a medical home will inform the design of interventions to improve community-based care and reduce hospitalizations and associated costs.

A critical Review of Race and Ethnicity in the Leadership Literature: Surfacing Context, Power and the Collective Dimensions of Leadership.

A critical Review of Race and Ethnicity in the Leadership Literature: Surfacing Context, Power and the Collective Dimensions of Leadership.
The Leadership Quarterly, 20  

Ospina, S. and E. G. Foldy
01/01/2009


Leadership studies focusing on race–ethnicity provide particularly rich contexts to illuminate the human condition as it pertains to leadership. Yet insights about the leadership experience of people of color from context-rich research within education, communications and black studies remain marginal in the field. Our framework integrates these, categorizing reviewed studies according to the effects of race–ethnicity on perceptions of leadership, the effects of race–ethnicity on leadership enactments, and actors' approach to the social reality of race–ethnicity. The review reveals a gradual convergence of theories of leadership and theories of race–ethnicity as their relational dimensions are increasingly emphasized. A shift in the conceptualization of race–ethnicity in relation to leadership is reported, from a constraint to a personal resource to a simultaneous consideration of its constraining and liberating capacity. Concurrent shifts in the treatment of context, power, agency versus structure and causality are also explored, as are fertile areas for future research.

La Révolution Tranquille du Managed Care aux Etats Unis. (The Silent Revolution of Managed Care in the United States)

La Révolution Tranquille du Managed Care aux Etats Unis. (The Silent Revolution of Managed Care in the United States)
Ch. 21 in Tabuteau, D. Bras, P.L. and de Pouvourville, G., eds. Traité d’Economie et de Gestion de la Santé. Paris. Presses de Sciences Politiques

Rodwing, V.G.
01/01/2009

Looking a Gift Horse in the Mouth: Challenges in Managing Philanthropic Support for Public Services

Looking a Gift Horse in the Mouth: Challenges in Managing Philanthropic Support for Public Services
Public Administration Review, Special Issue.

Brecher, C. & Wise, O.
01/01/2009

Collaborations between nonprofit and public sector organizations have become an increasingly important phenomenon in state and local public service delivery since the publication of the Winter Commission report in 1993. This article focuses on one of the less studied types of public–nonprofit collaborations, those in which philanthropic support from nonprofit organizations supplements the resources and activities of public agencies. Drawing on the case of "nonprofit-as-supplement collaborations" that support park services in New York City, this article documents the benefits and drawbacks associated with such collaborations. While they can provide increased resources and encourage management innovations, they also can lead to inequities in the availability and quality of services, the preponderance of particularistic goals over the broader public interest, and the politicization of previously bureaucratic decision making. The authors offer two strategies for public managers to realize more effectively the benefits yet mitigate the shortcomings of these collaborations.

Recent Changes in Dutch Health Insurance: Individual Mandate or Social Insurance

Recent Changes in Dutch Health Insurance: Individual Mandate or Social Insurance
Expanding Access to Health Care. T.F. Buss and P. Van de Water (eds.) National Academy of Public Administration. New York: M.E. Sharpe.

Okma, K.
01/01/2009

The U.S. health care system faces well-known problems: 47 million people without health insurance, rapidly rising costs that consume 16 percent of the country'e economic output, and widely uneven quality of care. Even many people with coverage are experiencing serious problems paying for the rapidly rising costs of health care and insurance.

This book--a joint product of the National Academy of Public Administration and the National Academy of Social Insurance--undertakes a sweeping analysis of the management and administrative issues that arise in expanding health care coverage. The book identifies the core administrative functions that need to be performed in assuring access to health coverage, describes how these functions are performed at present and under proposed alternatives, draws lessons from experience in the U.S. and abroad, and assesses suggested administrative approaches designed to facilitate the improvement and expansion of health care coverage.

Adequate health care is one of today's most crucial domestic policy concerns. Expanding Access to Health Care is designed to bring together in one place some of the best thinking on the subject, not as an exercise in advocacy, but rather to lay out the issues in a balanced way so that policymakers, researchers, and citizens can better understand the complex details of health care reform.

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