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Volume 55, Number 5
September/October 2010

    Interview with Rear Admiral Eleanor Valentin, FACHE, Commander, U.S. Navy Medicine Support Command, and Director, Navy Medical Service Corps
    Stephen J. O'Connor

    Cost-Containment and Cost-Management Strategies
    Alan J. Goldberg and William Fleming

    A Randomized Trial of Telemonitoring Heart Failure Patients
    Christopher Tompkins and John Orwat
    Hospital-Affiliated and Hospital-Owned Retail Clinics: Strategic Opportunities and Operational Challenges
    Amer Kaissi
    From the Perspective of CEOs: What Motivates Hospitals to Embrace Cultural Competence?
    Amy Wilson-Stronks and Sunita Mutha
    Emerging Technologies in Healthcare: Navigating Risks, Evaluating Rewards
    Elizabeth McGrady, Sue Conger, Sandra Blanke, and Brett J.L. Landry

Executive Summary
A Randomized Trial of Telemonitoring Heart Failure Patients, Christopher Tompkins and John Orwat

The purpose of this study was to measure the ability of telemonitoring to reduce hospital days and total costs for Medicare managed care enrollees diagnosed with heart failure. Patients were recruited and randomly assigned for six months to either telemonitoring or standard care. Telemonitoring transmitted vital signs and clinical alerts daily to a central nursing station. Utilization of covered services was analyzed for the six-month telemonitoring period to test for hypothesized reductions in hospital days and changes in utilization of the emergency department (ED), urgent care, and primary care. Negative binomial regressions adjusted for gender, age, co-occurring diabetes, co-occurring chronic obstructive pulmonary disease, and residence neighborhood were used to analyze units of service, and two-part (hurdle) multivariable models were used for expenditures. The main finding was a tendency for lower total number of hospital days for patients assigned to telemonitoring. Results for other covered services were generally consistent with hypothesized direction and magnitude; however, statistical power was reduced because of lowerthan- expected recruitment rates into the study. Within a managed-care environment, telemonitoring appears to facilitate better ambulatory management of heart failure patients, including fewer ED visits, which were offset by more frequent primary care
and urgent care visits.

Executive Summary
Hospital-Affiliated and Hospital-Owned Retail Clinics: Strategic Opportunities and Operational Challenges, Amer Kaissi

Retail clinics have experienced an exponential growth in the last few years. While the majority of retail clinics are freestanding, venture-backed companies affiliated with retail hosts, an increasing number of hospital systems have decided to develop their own retail clinics or partner with existing national companies. Using a stakeholder approach, the purpose of this article is to assess the strategic considerations behind these decisions and the operational challenges associated with them and to use the results to develop a questionnaire that can be applied in future research in a national sample of healthcare executives. We conducted eight in-depth interviews with administrative and clinical leaders in seven hospital systems across the United States that have or had a relationship with retail clinics in the last three years. Our findings show that the hospital systems’ association with retail clinics involves two main models: an affiliation with retail chains that operate the clinics and ownership of the clinics with an arms-length relationship with the retail chain. Hospital systems are engaging in these relationships for several strategic reasons: to increase market share through enhanced referrals to physician offices and hospitals, to become closer to consumers, and to experiment with nontraditional ways of delivering health care. Operational challenges included physician resistance and skepticism, poor financial performance, people’s perception of retail clinics, staffing issues, and the newness of the business model. Six out of eight respondents thought that hospital affiliation with/ownership of retail clinics is a trend that is here to stay, although many provided
caveats and stipulations. Further research is needed to provide more evidence about this emerging way of healthcare delivery.

Executive Summary
From the Perspective of CEOs: What Motivates Hospitals to Embrace Cultural Competence?, Amy Wilson-Stronks and Sunita Mutha

The quality domains of patient-centered and equitable care are increasingly relevant to today’s healthcare leaders as hospitals care for patients with increasingly diverse cultural and linguistic needs. Hospital leaders face substantial tensions in defining
their organization’s strategic priorities to improve care for diverse populations with limited resources, increased competition, and complex regulatory and accreditation requirements. We sought to understand what motivates hospitals to focus on and commit resources to supporting the delivery of culturally competent care by analyzing interviews with chief executive officers (CEOs) in 60 hospitals across the United States. Hospital CEOs in our study most often embraced cultural competence efforts because doing so helped them achieve the organization’s mission and priorities and/ or meet the needs of a particular patient population. Less often, they were motivated by perceived benefits and legal or regulatory issues. Many CEOs articulated a link between quality and cultural competence, and a smaller number went on to link cultural competence efforts to improved financial outcomes through cost savings, increased market share, and improved efficiency of care. However, the link between quality and cultural competence is still in the early stages. Fortunately, frameworks for hospitals to adopt and steps that hospitals can take to improve the quality of care
for all patients have been identified. They begin with a commitment from hospital leaders based on understanding the needs of patients and communities and are propelled by data that reveal the impact of efforts to improve care. Leaders must communicate
and shepherd organizations to align the congruence between improvement efforts and business strategies.

Executive Summary
Emerging Technologies in Healthcare: Navigating Risks, Evaluating Rewards, Elizabeth McGrady, Sue Conger, Sandra Blanke, and Brett J.L. Landry

The purpose of this prescriptive research is to help decision makers become better informed about three technologies emerging in the healthcare arena by providing a basic description of the technology and describing their current applications, future healthcare deployment, potential risks, and related managerial issues. Two of the technologies, radio frequency identification (RFID) and global positioning systems (GPS), are currently available to healthcare organizations and appear capable of decreasing cost but may require significant initial investment and have disruptive potential. The third technology, nanotechnology, has limited current use but may revolutionize both the delivery of medicine and hospital infrastructure management. With cautious attention to managerial issues and meticulous attention to implementation details, healthcare organizations that can successfully navigate the coming technologically driven paradigm shifts will emerge more resilient organizations.