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Article
Publication date: 10 July 2017

Chenzhang Bao and Indranil Bardhan

The purpose of this study is to evaluate the determinants of health outcomes of dialysis patients, while specifically focusing on the role of dialysis process measures and…

Abstract

Purpose

The purpose of this study is to evaluate the determinants of health outcomes of dialysis patients, while specifically focusing on the role of dialysis process measures and dialysis practice characteristics. The dialysis industry is facing a major transition from a volume-based health care system to a value-based cost-efficient care model, in the USA. Under the bundled Prospective Payment System, the treatment-based payment model is subject to meeting quality thresholds as defined by clinical process measures including dialysis adequacy and anemia management. Few studies have focused on studying these two processes and their association with the quality of patient health outcomes.

Design/methodology/approach

In this study, the authors focus on identifying the determinants of patient health outcomes among freestanding dialysis clinics, using a large cross-sectional data set of 4,571 dialysis clinics in the USA. The authors use econometric analyses to estimate the association between dialysis facility characteristics and practice patterns and their association with dialysis process measures and hospitalization risk.

Findings

The authors find that reusing dialyzers and increasing the number of dialysis stations is associated with higher levels of clinical quality. This research indicates that deploying more nurses on-site allows patients to avail adequate dialysis, while increasing the supply of physicians can hurt anemia control process. In addition, the authors report that offering peritoneal dialysis and late night shifts are not beneficial practices in terms of their impact on the hospitalization risk.

Research limitations/implications

While early studies of dialysis care mainly focused on the associations between practice patterns and patient outcomes, this research reveals the underlying mechanisms of these relationships by exploring the mediation effects of clinical dialysis processes on patient outcomes. The results indicate that dialysis process measures mediate the impact of the operational characteristics of dialysis centers on patient hospitalization rates.

Practical implications

This study offers several managerial insights for owners and operators of dialysis clinics with respect to the association between managerial and clinical practices that they deploy within dialysis clinics and their impact on clinical quality measures as well as hospitalization risk of patients. Managers can draw on this study to optimize staffing levels in their dialysis clinics, and implement innovative clinical practices.

Social implications

Considering the growth in healthcare expenditures in developing and developed countries, and specifically for costly diagnoses such as dialyses, this study offers several insights related to the inter-relationships between dialysis practice patterns and their clinical quality measures.

Originality/value

This study makes several major contributions. First, the authors address the extant gap in the literature on the relationships between dialysis facility and practice characteristics and clinical outcomes, while specifically highlighting the role of clinical process measures as antecedents of patient hospitalization ratio, a key metric used to measure performance of dialysis clinics. Second, this study sheds light on the underlying mechanisms that serve as enablers of the dialysis adequacy and anemia management. To the best of the authors’ knowledge, this is the first study to explore these relationships in the dialysis industry. The authors’ approach provides a new direction for future studies to explore the pathways that may impact clinical quality measures in the delivery of dialysis services.

Details

Journal of Centrum Cathedra, vol. 10 no. 1
Type: Research Article
ISSN: 1851-6599

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Book part
Publication date: 14 August 2014

Nancy G. Kutner and Rebecca Zhang

Disparities in transplant rates across social categories provide limited information about gatekeeping processes in access to kidney transplantation. We hypothesized that…

Abstract

Purpose

Disparities in transplant rates across social categories provide limited information about gatekeeping processes in access to kidney transplantation. We hypothesized that early opportunities for discussion of kidney transplantation potentially generate social capital that serves as a resource for patients as they navigate the transplantation pathway.

Methodology

A national sample of first-year dialysis patients was surveyed and asked if kidney transplantation had been discussed with them before and after starting dialysis treatment. Associations between reported discussion and patient-specific clinical and nonclinical (sociodemographic) indicators of attributed utility for transplantation were investigated, and the association of reported transplant discussion with subsequent transplant waitlisting was analyzed.

Findings

Time to placement on the kidney transplant waiting list was significantly shorter for patients who reported that transplantation had been discussed with them before, as well as after, starting dialysis. Likelihood of reported discussion varied by patient age, employment and insurance status, cardiovascular comorbidity burden, and perceived health status; in addition, women were less likely to report early discussion.

Research limitations

It would be valuable to know more about the nature of the transplant discussions recalled by patients to better understand how social capital may be fostered through these discussions.

Practical implications

Indicators of attributed utility for successful transplantation were associated with transplant discussion both before and after starting dialysis, potentially contributing to observed disparities in access to kidney transplantation.

Social implications

Predialysis nephrology care and patient participation in discussion of kidney transplantation may foster social capital that facilitates navigating the transplantation pathway.

Details

Social Determinants, Health Disparities and Linkages to Health and Health Care
Type: Book
ISBN: 978-1-78190-588-3

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Article
Publication date: 23 September 2019

Erdal Aydemir and Yusuf Sahin

The purpose of this paper is to investigate the relative influences of technical and functional quality levels of service quality and patient satisfaction. In this…

Abstract

Purpose

The purpose of this paper is to investigate the relative influences of technical and functional quality levels of service quality and patient satisfaction. In this context, the healthcare service quality and the factors affecting customer satisfaction were evaluated using the grey relational analysis (GRA) method.

Design/methodology/approach

This is a survey-based study which involves 15 patients in a dialysis center, so the GRA is applied to clarify the uncertainty on service quality level with a limited number of patients without any statistical distribution. In order to reveal whether service quality and customer satisfaction are two different structures, a GRA model is built with ten different quality factors.

Findings

Results show that each quality factor has a different effect on the quality of service. Another important finding is that service quality and customer satisfaction are different structures for customers.

Practical implications

The results enable healthcare managers to understand the importance of patient care and the importance of service quality if they want to facilitate their use of their expectations in related factors.

Originality/value

The study is the first in terms of the application of GRA models in a private health institution operating in Turkey. Successful implementation of the GRA method allows a reasonable decision to be made with a limited number of data at hand. It is considered that the method can be used successfully in other health institutions in the Turkish Health System.

Details

Grey Systems: Theory and Application, vol. 9 no. 4
Type: Research Article
ISSN: 2043-9377

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Article
Publication date: 1 March 1989

V. Standing, J. Walsworth‐Bell, D. Allen, A. Haycox, P. Ackrill, R. Gokal and J. Twomey

Advances in recombinant drug technology will impose pressure for swift action by decision‐makers who may be required to operate on the basis of very limited information…

Abstract

Advances in recombinant drug technology will impose pressure for swift action by decision‐makers who may be required to operate on the basis of very limited information. This paper is the by‐product of a recently initiated North Western Regional Health Authority interim procedure designed to give swift consideration to innovations, to provide additional information for decision‐makers and to permit both clinicians and decision‐makers to combine in ensuring that greater rationality is applied to the introduction of drug innovations than might otherwise be the case. It is envisaged that this procedure will be of equal value in other areas where new medicines may have major revenue consequences.

Details

Journal of Management in Medicine, vol. 4 no. 3
Type: Research Article
ISSN: 0268-9235

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Article
Publication date: 25 November 2013

Magda Ismail Abdel Mohsin

Recently the revival of the institution of waqf took a movable form especially in terms of the creation of cash waqf which found its ways as one of the financial…

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Abstract

Purpose

Recently the revival of the institution of waqf took a movable form especially in terms of the creation of cash waqf which found its ways as one of the financial institutions financing different goods and services in the different countries. In an attempt to enrich the literature on this area, this study is an extension to the authors' work, focusing mainly on the different goods and services provided by different cash waqf schemes in Muslim and Muslim minority countries without depending on the government to provide their needs. The paper aims to discuss these issues.

Design/methodology/approach

This study uses data collected from primary sources including text from the Hadith, while data collected from secondary sources include books, articles, journals besides web sites and e-books.

Findings

The findings show the potential of cash waqf in financing not only religious areas but also financing different goods and services needed globally, such as education, health, social care and commercial activates, basic infrastructures, besides opening jobs for the majority of people.

Practical implications

The expected outcome of this research is to open the door wider for more researchers to explore the potential of cash waqf as one of the instruments to finance all sectors in Muslim and Muslim minority countries without exhausting government budget.

Originality/value

A revitalization of an old Islamic financial product to meet the different needs.

Details

International Journal of Islamic and Middle Eastern Finance and Management, vol. 6 no. 4
Type: Research Article
ISSN: 1753-8394

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Book part
Publication date: 31 July 2009

Carol A. Caronna, Seth S. Pollack and W. Richard Scott

In this chapter, we describe a multilevel, longitudinal, comparative case study approach for investigating organizational heterogeneity based on our experience studying…

Abstract

In this chapter, we describe a multilevel, longitudinal, comparative case study approach for investigating organizational heterogeneity based on our experience studying institutional change in the health care field (Scott, Ruef, Mendel, & Caronna, 2000). By examining the relationship between organizations, populations, and fields, differences between organizations can be captured in terms of their organizational identities as well as their (changing) relationships with the organizational field. We discuss the analytical strategies we used in our study of institutional change and describe our findings of organizational heterogeneity across levels and over time. We conclude with suggestions for future research that incorporate elements of our study design and lessons from our research process and outcomes.

Details

Studying Differences between Organizations: Comparative Approaches to Organizational Research
Type: Book
ISBN: 978-1-84855-647-8

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Article
Publication date: 1 April 1996

Martha E. Williams and Linda C. Smith

This is the eighth article on science, technology and medicine (STM) databases in a continuing series of articles summarising and commenting on new database products. Two…

Abstract

This is the eighth article on science, technology and medicine (STM) databases in a continuing series of articles summarising and commenting on new database products. Two companion articles will appear in the next two issues of this journal, one covering social sciences, humanities, news and general (SSH) (Online & CDROM Review, vol. 20, no. 5) and the other covering business and law (BSL) (Online & CDROM Review, vol. 20, no. 6). These articles are based on the newly appearing database products in the Gale Directory of Databases. The Gale Directory of Databases (GDD) was created in January 1993 by merging Computer‐Readable Databases: A Directory and Data Sourcebook (CRD) together with the Directory of Online Databases (DOD) and the Directory of Portable Databases (DPD).

Details

Online and CD-Rom Review, vol. 20 no. 4
Type: Research Article
ISSN: 1353-2642

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Book part
Publication date: 30 December 2004

Nancy Blythe and Cecilia Benoit

Late nephrology referral, a problem currently identified across many high income countries, has been associated with reduced opportunities for delaying or halting the…

Abstract

Late nephrology referral, a problem currently identified across many high income countries, has been associated with reduced opportunities for delaying or halting the progression of chronic kidney disease (CKD), delayed dialysis initiation, reduced choice in treatment modality, increased morbidity and hospitalization, and premature death. Despite a recent finding that the progression of CKD nearly always presents warning signs, and despite the fact that all Canadians are entitled to receive medically necessary health care free at the point of patient entry, each year in the province of British Columbia (BC) a substantial number of people with CKD experience late or no referral to nephrology care prior to requiring renal replacement therapy. A subset of these CKD patients experience no referral and “crash” onto dialysis (experience an acute or emergent start). Existing research has not fully explored the range of potential health determinants that may affect the timing of nephrology referral. This paper adopts a “determinants of health” framework and assesses the impact of a variety of indicators on patients’ physical health, demographics, socioeconomic status, social support, geographic and health system characteristics. Using a late referral definition of <3 months and data on BC patients who began dialysis between April 2000 and March 2003, multiple regression analysis indicates that the following determinants have an independent effect on the timing of referral: cause of end-stage renal disease (p=<0.0001); age (p=<0.0001); race/ethnicity (p=0.0019); English ability (p=0.0158); marital status (p=0.0202); proximity to care (p=0.0118); and, “age by first language” (p=0.0244).

Details

Chronic Care, Health Care Systems and Services Integration
Type: Book
ISBN: 978-1-84950-300-6

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Article
Publication date: 18 May 2018

Chia-Ching Cho, AnAn Chiu, Shaio Yan Huang and Shuen-Zen Liu

As the rise in expenditures will be even faster when the baby-boom generation soon reaches healthcare-dependent ages, healthcare providers are facing cost management…

Abstract

Purpose

As the rise in expenditures will be even faster when the baby-boom generation soon reaches healthcare-dependent ages, healthcare providers are facing cost management decision of achieving superior performance. Taiwan provides a unique environment that the dialysis service providers face only one medical buyer. The purpose of this paper is to discuss cost factors of dialysis facilities.

Design/methodology/approach

This study provides a comprehensive analysis of factors influencing the dialysis costs using the data collected from a large renal clinic chain at Taiwan. The multiple linear regression analysis is employed to examine the factors influencing dialysis costs. The research sample composed of 1,255 patients is collected from 16 dialysis centers in Taiwan.

Findings

The results indicate that the treatment costs of dialysis are influenced by managerial factors including capacity utilization rate (CUR), the percentage of shares held by the owners and the geographical location of clinics (LC). The findings assist renal clinics to identify the parts critical to the cost control. Our results indicate that medical variable costs for performing the dialysis treatments are significantly influenced by such managerial factors as CUR, the percentage of owners’ shares holding and LC.

Practical implications

By identifying a comprehensive set of costs drivers for dialysis services, this study provides useful information for both health providers and policy makers. In specific, the result assists these providers to consider the utilization of better mechanisms/instruments to control costs by increasing the operational efficiency and achieving the economies of scale.

Originality/value

This paper contributes to exploring costs drivers that are generally absent from the extant literature. The result suggests that the regulators should be aware that the dialysis providers may reject costly patients. Hence, to establish the appropriate monitoring mechanisms to prevent such incidence is important. Finally, many other countries in addition to Taiwan also have a similar practice as national health insurances or services (e.g. Medicare in the USA or National Health Service in the UK). Those health systems may all face a similar cost control issues for handling end-stage renal disease patients. The analysis can help health systems worldwide to better design the reimbursement rates to account for the differences existed in dealing with the dialysis treatment costs.

Details

Management Decision, vol. 56 no. 10
Type: Research Article
ISSN: 0025-1747

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Article
Publication date: 30 June 2021

Sophie Haesen, Sebastian Rauch, Bernice Elger and Michael Rost

According to the principle of equivalence of care, health care in prison has to be of the same standard and quality as in the general population. This study aims to…

Abstract

Purpose

According to the principle of equivalence of care, health care in prison has to be of the same standard and quality as in the general population. This study aims to determine the geographic accessibility of dialysis services for older prisoners and the older general population in Switzerland and whether accessibility and availability of dialysis care are equivalent.

Design/methodology/approach

Spatial accessibility analysis incorporated four different data types: population data, administrative data, street network data and addresses of prisons and hemodialysis services.

Findings

Analysis revealed that the average travel time to the nearest dialysis service was better for prisoners (11.5 min) than for the general population (14.8 min). However, dialysis service for prisoners is hampered by the necessary lead-time in correctional settings, which, ultimately, leads to longer overall access times (36.5 min). Accordingly, the equivalence of dialysis care for older Swiss prisoners is not entirely respected for availability and accessibility.

Originality/value

The strength of the study lies in the combination of ethical principles and the highly tangible results of a spatial accessibility analysis. The ethics-driven empirical analysis provides arguments for policy-makers to review the current practices.

Details

International Journal of Prisoner Health, vol. ahead-of-print no. ahead-of-print
Type: Research Article
ISSN: 1744-9200

Keywords

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