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.
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.
Substance Use Treatment Barriers for Patients with Frequent Hospital Admissions
Journal of Substance Abuse Treatment
Billings, J., Raven, M., Carrier, E. et al.
Substance use (SU) disorders adversely impact health status and contribute to inappropriate health services use. This qualitative study sought to determine SU-related factors contributing to repeated hospitalizations and to identify opportunities for preventive interventions. Fifty Medicaid-insured inpatients identified by a validated statistical algorithm as being at high-risk for frequent hospitalizations were interviewed at an urban public hospital. Patient drug/alcohol history, experiences with medical, psychiatric and addiction treatment, and social factors contributing to readmission were evaluated. Three themes related to SU and frequent hospitalizations emerged: (a) barriers during hospitalization to planning long-term treatment and follow-up, (b) use of the hospital as a temporary solution to housing/family problems, and (c) unsuccessful SU aftercare following discharge. These data indicate that homelessness, brief lengths of stay complicating discharge planning, patient ambivalence regarding long-term treatment, and inadequate detox-to-rehab transfer resources compromise substance-using patients' likelihood of avoiding repeat hospitalization. Intervention targets included supportive housing, detox-to-rehab transportation, and postdischarge patient support.
"New Politics of Health Policy"
Journal of the Society of Reproductive Medicine. 7:1
The Politics of Obesity: A Current Assessment & Look Ahead
Milbank Quarterly 87:1
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.
Portfolios of the Poor: How the World's Poor Live on $2 a Day
Princeton University Press. May South African edition, University of Capt Town Press.
Morduch, J., Collins, D., Rutherford, S. & Ruthven, O.
About forty percent of the world's people live on incomes of two dollars a day or less. If you've never had to survive on an income so small, it is hard to imagine. How would you put food on the table, afford a home, and educate your children? How would you handle emergencies and old age? Every day, more than a billion people around the world must answer these questions. Portfolios of the Poor is the first book to explain systematically how the poor find solutions.
The authors report on the yearlong "financial diaries" of villagers and slum dwellers in Bangladesh, India, and South Africa--records that track penny by penny how specific households manage their money. The stories of these families are often surprising and inspiring. Most poor households do not live hand to mouth, spending what they earn in a desperate bid to keep afloat. Instead, they employ financial tools, many linked to informal networks and family ties. They push money into savings for reserves, squeeze money out of creditors whenever possible, run sophisticated savings clubs, and use microfinancing wherever available. Their experiences reveal new methods to fight poverty and ways to envision the next generation of banks for the "bottom billion."
Evidence-Based Management in Healthcare
Chicago: Health Administration Press,
Kovner, A.R., Fine, D.R. & D'Aquila, R.
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.
Evaluating Environmental and Economic Benefits of Yellow-Dust Storm Related Policies in Northern China
International Journal of Sustainable Development and World Ecology, Vol. 15, pp. 457-470
Guo, Z. & Ning, A., Ploenske, K.R.
Yellow-dust storms (YDSs) have attracted increasing attention worldwide in the past decade. They can extensively disrupt socioeconomic activities and pose hazards to ecosystems, as well as human health. In recent years, China has invested multi-billions of dollars to mitigate the impact of YDSs. However, the effectiveness of such YDS-control programs has rarely been evaluated. This research develops a causal model to quantify the environmental benefits of YDS-control programs in China, and further employs regional economic models to evaluate the ensuing economic impacts. The economic benefits generated from the YDS-control programs have remained stable across the years, primarily because of the multiplier effect of the investments, while the environmental benefits tend to decline over time. Our results suggest that YDS-control programs should consider stimulating local economic activities in addition to environmental goals in order to be cost-effective and sustainable in the long term.
How Personalized and Socialized Power Motivation Facilitate Antisocial and Prosocial Decision-Making
Journal of Research in Personality, 42, 1547-1559
Magee, J.C. & Langner, C.A.
In two studies, we investigate the effects of individuals’ power motivation on decision-making. We distinguish between two types of power motivation [McClelland, D. C. (1970). The two faces of power. Journal of International Affairs, 24, 29–47; Winter, D. G. (1973). The power motive. New York: The Free Press] and demonstrate that both types of power motivation facilitate influential decision-making but that each type plays a different role in different contexts. In a conflict context (Study 1), individuals’ personalized (self-serving) power motivation was associated with antisocial decisions, and in a healthcare context (Study 2), individuals socialized (other-serving) power motivation was associated with prosocial decisions. Furthermore, the type of power motivation elicited in each context was associated with less perceived need to deliberate over the relevant policy decision. In separating out the independent effects of each type of power motivation, we are able to explain more variance in decision-making behavior across various contexts than in models using aggregate power motivation (personalized plus socialized).
Seeing Power in Action: The Roles of Deliberation, Implementation, and Action in Inferences of Power
Journal of Experimental Social Psychology, 45, 1-14.
Six experiments investigate the hypothesis that social targets who display a greater action orientation are perceived as having more power (i.e., more control, less dependence, and more influence) than less action-oriented targets. I find evidence that this inference pattern is based on the pervasive belief that individuals with more power experience less constraint and have a greater capacity to act according to their own volition. Observers infer that targets have more power and influence when they exhibit more implementation than deliberation in the process of making decisions in their personal lives (Study 1a), in a public policy context (Study 1b), and in small groups (Study 2). In an organizational context, observers infer that a target who votes for a policy to change from the status quo has more power than a target who votes not to change from the status quo (Study 3). People also infer greater intra-organizational power and higher hierarchical rank in targets who take physical action toward a personal goal than in those who do not (Studies 4–5).
Public Opinion toward Legislating for the Future: An Update
Policy Report for New York University's Brademas Center for the Study of Congress,
The past two years have been unsettled at best for Congress. Public approval toward Congress remains low, legislative debates have been contentious, polarization remains high, and Congress has a mixed record in dealing with major long-term issues such as Social Security and Medicare. The State Children's Health Insurance program has been delayed awaiting a compromise that might expand coverage, immigration reform has been waylaid by the intensity of opposition across the party lines, energy reform was diluted by ongoing disputes about how to reduce the nation's dependence on foreign oil, and the war in Iraq continues to dictate the pace of major legislative debates.
Service Level Agreements - A Tool for Negotiating and Sustaining Information Technology Performance
Performance Improvement in Health Systems. Edited by Langabeer II, James R. Chicago: Healthcare Information and Management Systems Society (Chicago: HIMSS).
Scalzi, G. & Kropf, R.
A comprehensive and concise guide to performance improvement in healthcare, Performance Improvement in Hospitals and Health Systems describes the management engineering principles focused on designing optimal management and information systems and processes. The book covers topics such as:
- Key terminology and concepts in PI
- Scope, value and management of performance improvement projects
- Developing and leading performance improvement departments
- Simulation methods in patient flow
- Understanding cost and quality relationships
- Six Sigma and Lean in healthcare
- Data mining methods for process improvment
- Integrating nursing/clinical staff with performance improvement
- Evaluation and selection criteria for projects
- Decision support systems
Written for management engineers, performance improvement professionals, quality managers and internal consultants who use a combination of methods to improve systems and processes, this book has timely, practical and actionable information and valuable insights into improving the healthcare environment.
Race/Ethnicity and Patient Confidence to Self-manage Cardiovascular Disease
Medical Care. 2008; 46(9):924-9
Blustein, J., Valentine, M., Mead, H. & Regenstein, M.
Background: Minority populations bear a disproportionate burden of chronic disease, due to higher disease prevalence and greater morbidity and mortality. Recent research has shown that several factors, including confidence to self-manage care, are associated with better health behaviors and outcomes among those with chronic disease.
Objective: To examine the association between minority status and confidence to self-manage cardiovascular disease (CVD).
Study Sample: Survey respondents admitted to 10 hospitals participating in the Expecting Success program, with a diagnosis of CVD, during January-September 2006 (n = 1107).
Results: Minority race/ethnicity was substantially associated with lower confidence to self-manage CVD, with 36.5% of Hispanic patients, 30.7% of Black patients, and 16.0% of white patients reporting low confidence (P < 0.001). However, in multivariate analysis controlling for socioeconomic status and clinical severity, minority status was not predictive of low confidence.
Conclusions: Although there is an association between race/ethnicity and confidence to self-manage care, that relationship is explained by the association of race/ethnicity with socioeconomic status and clinical severity.
Comparative Analysis of Health Systems in Wealthy Nations
Health Care Delivery in the United States. Revised and updated for 9th Edition. Edited by Kovner, A. and J. Knickman, J. New York: Springer,
How do we understand and also assess the health care of America? Where is health care provided? What are the characteristics of those institutions which provide it? Over the short term, how are changes in health care provisions affecting the health of the population, the cost of care, and access to care? These core issues regarding our health policy are answered in this text.This is a textbook for course work in health care, the handbook for administrators and policy makers, and the standard for in-service training programs.
Health Services Management: Readings, Cases and Commentary
Chicago: Health Administration Press, 8th edition,
Kovner, A.R. & Neuhauser, D.
Managers of a healthcare organization have numerous demands on their time, their skills, their knowledge, and their budgets. They are responsible for adapting to change, managing their office, making effective decisions, among countless other tasks. This text-newly revised to include readings, commentary, and cases-offers a bridge from management theory to the actual world of healthcare management that will help your students learn the role of manager in a healthcare organization.
Throughout its past editions, Health Services Management has featured the best literature on health services management to help learners understand the role of the manager, organizational design and control, the blending of organization and health professionals, change (adaptation), and responsiveness (accountability). This new edition continues that effort, and features new readings and classroom-tested cases.
The cases take place in a variety of organizations, including a faculty practice, a neighborhood health center, a small rural hospital, an HMO, as well as a variety of other settings. This book will prepare your future managers for the multitude of healthcare settings they could face in their careers.
Managing Relationships: Take Care of Your Nurses
Case Readings and Commentaries
Improving Financial Management in the Orthopedic Unit
Cases, Readings and Commentaries
IT Management and Governance Systems and Their Emergence in Healthcare
Journal of Healthcare Information Management, Winter,
Mohrmann, G. & Kropf, R.
Today's healthcare IT departments are challenged with understanding the total service demand imposed by their user communities and how much of their limited resources are available to meet that demand.This challenge is being addressed through the use of new IT management and governance (IT-MG) systems.This software supports IT governance and project and portfolio management. IT-MG is a relatively new term to healthcare; it entails reviewing and managing demand for IT services from inception to completion through the application of IT resources. These systems help save time through automated reporting and quicker delivery of services; they save money by more effectively addressing resource needs
on time and on budget.The systems also reduce the number of administrative tasks through process automation; increase customer satisfaction by communicating services and deliverables more quickly and accurately; and help executives make better and more informed decisions about priorities and expectations through reporting that was previously nonexistent.This article will explore IT-MG systems and present a case study of a hospital that rapidly implemented this type of system.
Demand Management in Healthcare IT: Controlling IT Demand to Meet Constrained IT Resource Supply
Journal of Healthcare Information Management, Fall,
Mohrmann, G., Schlusberg, C. & Kropf, R.
From everyday support requests to large capital projects, the IT department's ability to meet demand is limited. Organizational and IT leaders need to proactively address this issue and do a better job of predicting when services will be needed and whether appropriate resources will be available. This article describes the common issues that healthcare IT departments face in the efficient delivery of services as a result of factors such as budget constraints, skill sets and project dependencies. Best practices for controlling demand are discussed, including resource allocation, governance processes and a graphical analysis of forecasted vs. actual thresholds. Using specific healthcare provider examples, the article intends to provide IT management with an approach to predicting and controlling resource demand.
Making Information Technology Work: Maximizing the Benefits for Health Care Organizations
Health Forum/AHA Press, Chicago,
Kropf, R. & Scalzi, G.
A book for senior executives, managers and clinicians that covers the "before, during and after" stages of a health care information technology (IT) project and provides guidance on how projects can be successfully managed. It shows readers how to assess IT project value before approval, monitor whether projects are on-time and on-budget, and measure performance after implementation. Case studies and effective project management tools and techniques help readers maximize project benefits.
Effective Project Management Improves the Chances of IT Project Success
Physician Executive, May/June 2008, 34:3.
Kropf, R. & Scalzi, G.