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Article
Publication date: 15 April 2019

Guillermo A. Sandoval, Adalsteinn D. Brown, Walter P. Wodchis and Geoffrey M. Anderson

The purpose of this paper is to investigate the relationship between hospital adoption and use of computed tomography (CT) scanners, and magnetic resonance imaging (MRI…

Abstract

Purpose

The purpose of this paper is to investigate the relationship between hospital adoption and use of computed tomography (CT) scanners, and magnetic resonance imaging (MRI) machines and in-patient mortality and length of stay.

Design/methodology/approach

This study used panel data (2007–2010) from 124 hospital corporations operating in Ontario, Canada. Imaging use focused on medical patients accounting for 25 percent of hospital discharges. Main outcomes were in-hospital mortality rates and average length of stay. A model for each outcome-technology combination was built, and controlled for hospital structural characteristics, market factors and patient characteristics.

Findings

In 2010, 36 and 59 percent of hospitals had adopted MRI machines and CT scanners, respectively. Approximately 23.5 percent of patients received CT scans and 3.5 percent received MRI scans during the study period. Adoption of these technologies was associated with reductions of up to 1.1 percent in mortality rates and up to 4.5 percent in length of stay. The imaging use–mortality relationship was non-linear and varied by technology penetration within hospitals. For CT, imaging use reduced mortality until use reached 19 percent in hospitals with one scanner and 28 percent in hospitals with 2+ scanners. For MRI, imaging use was largely associated with decreased mortality. The use of CT scanners also increased length of stay linearly regardless of technology penetration (4.6 percent for every 10 percent increase in use). Adoption and use of MRI was not associated with length of stay.

Research limitations/implications

These results suggest that there may be some unnecessary use of imaging, particularly in small hospitals where imaging is contracted out. In larger hospitals, the results highlight the need to further investigate the use of imaging beyond certain thresholds. Independent of the rate of imaging use, the results also indicate that the presence of CT and MRI devices within a hospital benefits quality and efficiency.

Originality/value

To the authors’ knowledge, this study is the first to investigate the combined effect of adoption and use of medical imaging on outcomes specific to CT scanners and MRI machines in the context of hospital in-patient care.

Details

Journal of Health Organization and Management, vol. 33 no. 3
Type: Research Article
ISSN: 1477-7266

Keywords

Abstract

Details

How to Deliver Integrated Care
Type: Book
ISBN: 978-1-83867-530-1

Article
Publication date: 20 September 2011

Hedayet Chowdhury, Walter Wodchis and Audrey Laporte

The purpose of this paper is to present a productivity measure for hospital services in Ontario.

1075

Abstract

Purpose

The purpose of this paper is to present a productivity measure for hospital services in Ontario.

Design/methodology/approach

The study applied the Malmquist Productivity Index (MPI) to assess the efficiency of hospital services in Ontario, Canada, over the period 2003‐2006. The MPI was decomposed into efficiency change and technological change. Efficiency change was further decomposed into pure efficiency change and scale efficiency change. A bootstrapping technique was also used to obtain confidence intervals for the output oriented MPI and its decompositions.

Findings

By estimating confidence intervals it was found that a large number of hospitals did not achieve significant progress in terms of productivity. By taking geometric means of estimates for all years it was observed that while overall productivity and efficiency of hospitals in Ontario declined during the study period, technological progress increased at a rate of 5.95 percent on average.

Practical implications

The present study helps to understand the productivity and technological change and change in technical efficiency in this vital sector of the economy, which is important for policy making identifying improvement opportunities in resource allocation. It was observed that Ontario hospitals did not improve the efficiency with which they employed their inputs (i.e. staff and supplies) over the study period; they did achieve gains through application of technologies.

Originality/value

The paper provides a thorough study on productivity growth of health care services in Ontario using a non‐parametric framework with bootstrapping. It also provides a robust measurement and analysis of the contributions of technology, size of operation and use of inputs to the performance of hospitals in Ontario.

Details

International Journal of Productivity and Performance Management, vol. 60 no. 7
Type: Research Article
ISSN: 1741-0401

Keywords

Content available
Book part
Publication date: 11 January 2021

Abstract

Details

How to Deliver Integrated Care
Type: Book
ISBN: 978-1-83867-530-1

Book part
Publication date: 7 October 2011

Rohit Pradhan and Robert Weech-Maldonado

Private equity has acquired multiple large nursing home chains within the past few years; by 2007, it owned 6 of the 10 largest chains. Despite widespread public and…

Abstract

Private equity has acquired multiple large nursing home chains within the past few years; by 2007, it owned 6 of the 10 largest chains. Despite widespread public and policy interest, evidence on the purported impact of private equity on nursing home performance is limited. In our review, we begin by briefly reviewing the organizational and environmental changes in the nursing home industry that facilitated private equity investments. We offer a conceptual framework to hypothesize the relationship between private equity ownership and nursing home performance. Finally, we offer a research agenda focused on the important parameters of nursing home performance: financial performance, and quality of care.

Details

Biennial Review of Health Care Management
Type: Book
ISBN: 978-0-85724-714-8

Article
Publication date: 7 November 2016

Chung-Yi Chiu, Jessica Brooks and Ruopeng An

The purpose of this paper is to inquiry dietary behavior and the physical and mental health status of food pantry users to better understand issues related to food…

1225

Abstract

Purpose

The purpose of this paper is to inquiry dietary behavior and the physical and mental health status of food pantry users to better understand issues related to food insecurity and to explore predictors of intentions for self-sufficiency.

Design/methodology/approach

The authors randomly surveyed 12 food pantries (151 consumers) sponsored by the North Texas Food Bank in USA, regarding dietary behavior, health status, reasons for food pantry use, satisfaction with services provided, and self-sufficient behavior and support.

Findings

About 37 percent of survey participants would expect to continue using food pantry services for one or more years. Reasons for food pantry use included low job earnings, unemployment, poor health, and disability. Over 83 percent of them were either overweight or obese, and over half (57 percent) of them had moderate or severe mental disorder symptoms that warrant examination by healthcare practitioners. On average, their health-related quality of life was lower than the general population. Participants’ physical health was significantly correlated with work intention. The hierarchical regression model predicting work intention had a large effect size.

Research limitations/implications

This research has highlighted the importance of improving food pantry consumers’ health and self-sufficiency in order to live sufficiently and healthily.

Practical implications

Community health practitioners need to help food banks address the needs beyond hunger to focus on the larger ramification of food insecurity such as self-sufficiency and health-related quality of life.

Originality/value

This work extends the existing studies focused on food insecurity, and it will enable the collaborations among food banks, social workers, vocational rehabilitation counselors, and public health practitioners.

Details

British Food Journal, vol. 118 no. 11
Type: Research Article
ISSN: 0007-070X

Keywords

Article
Publication date: 16 November 2015

Kathryn Peri, Ngaire Kerse, Simon Moyes, Shane Scahill, Charlotte Chen, Jae Beom Hong and Carmel M Hughes

– The purpose of this paper is to establish the relationship between organisational culture and psychotropic medication use in residential care.

Abstract

Purpose

The purpose of this paper is to establish the relationship between organisational culture and psychotropic medication use in residential care.

Design/methodology/approach

Cross-sectional analyses of staff and resident’s record survey in residential aged care facilities in Auckland, New Zealand (NZ). The competing values framework categorised organisational culture as clan, hierarchical, market driven or adhocracy and was completed by all staff. The treatment culture tool categorised facilities as having resident centred or traditional culture and was completed by registered nursing staff and general practitioners (GP). Functional and behavioural characteristics of residents were established by staff report and health characteristics and medications used were ascertained from the health record. Multiple regression was used to test for associations between measures of culture with psychotropic medication use (anxiolytics, sedatives, major tranquillisers).

Findings

In total 199 staff, 27 GP and 527 residents participated from 14 facilities. On average 8.5 medications per resident were prescribed and 42 per cent of residents received psychotropic medication. Having a diagnosis of anxiety or depression (odds ratio (OR) 3.18, 95 per cent confidence interval (CI) 1.71, 5.91), followed by persistent wandering (OR 2.53, 95 per cent CI 1.59, 4.01) and being in a dementia unit (OR 2.45, 95 per cent CI 1.17, 5.12) were most strongly associated with psychotropic use. Controlling for resident- and facility-level factors, health care assistants’ assignation of hierarchical organisational culture type was independently associated with psychotropic medication use, (OR 1.29, CI 1.08, 1.53) and a higher treatment culture score from the GP was associated with lower use of psychotropic medication (OR 0.95, CI 0.92, 0.98).

Originality/value

Psychotropic medication use remains prevalent in residential care facilities in NZ. Interventions aimed at changing organisational culture towards a less hierarchical and more resident-centred culture may be another avenue to improve prescribing in residential aged care.

Details

Journal of Health Organization and Management, vol. 29 no. 7
Type: Research Article
ISSN: 1477-7266

Keywords

Open Access
Article
Publication date: 31 March 2021

Joy Akehurst, Paul Stronge, Karen Giles and Jonathon Ling

The aim of this action research was to explore, from a workforce and a patient/carer perspective, the skills and the capacity required to deliver integrated care and to…

1129

Abstract

Purpose

The aim of this action research was to explore, from a workforce and a patient/carer perspective, the skills and the capacity required to deliver integrated care and to inform future workforce development and planning in a new integrated care system in England.

Design/methodology/approach

Semi-structured interviews and focus groups with primary, community, acute care, social care and voluntary care, frontline and managerial staff and with patients and carers receiving these services were undertaken. Data were explored using framework analysis.

Findings

Analysis revealed three overarching themes: achieving teamwork and integration, managing demands on capacity and capability and delivering holistic and user-centred care. An organisational development (OD) process was developed as part of the action research process to facilitate the large-scale workforce changes taking place.

Research limitations/implications

This study did not consider workforce development and planning challenges for nursing and care staff in residential, nursing care homes or domiciliary services. This part of the workforce is integral to the care pathways for many patients, and in line with the current emerging national focus on this sector, these groups require further examination. Further, data explore service users' and carers' perspectives on workforce skills. It proved challenging to recruit patient and carer respondents for the research due to the nature of their illnesses.

Practical implications

Many of the required skills already existed within the workforce. The OD process facilitated collaborative learning to enhance skills; however, workforce planning across a whole system has challenges in relation to data gathering and management. Ensuring a focus on workforce development and planning is an important part of integrated care development.

Social implications

This study has implications for social and voluntary sector organisations in respect of inter-agency working practices, as well as the identification of workforce development needs and potential for informing subsequent cross-sector workforce planning arrangements and communication.

Originality/value

This paper helps to identify the issues and benefits of implementing person-centred, integrated teamworking and the implications for workforce planning and OD approaches.

Details

Journal of Integrated Care, vol. 30 no. 5
Type: Research Article
ISSN: 1476-9018

Keywords

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