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Volume 53, Number 4
July/August 2008

  • INTERVIEW
    Interview with Mark Howard, FACHE, Recipient of the 2008 ACHE Gold Medal Award, Kyle L. Grazier

  • CONSUMER-DRIVEN HEALTHCARE
    Imagining Seamless Healthcare Transactions, David Harris and Sandy Lutz
  • STUDENT ESSAYS
    Managers and the New Definition of Quality, Allison A. Chilgren
    Provider and Policy Response to Reverse the Consequences of Low Health Literacy, Cathy Bryan
  • ARTICLES
    Advertising Expenditures in the Nursing Home Sector: Evaluating the Need for and Purpose of Advertising, Bita A. Kash and Gregory J. Boyer
    The COA360: A Tool for Assessing the Cultural Competency of Healthcare Organizations, Thomas A. LaVeist, Rachel Relosa and Nadia Sawaya
    From the Emergency Department to the General Hospital: Hospital Ownership and Market Factors in the Admission of the Seriously Mentally Ill, Jay J. Shen, Christopher R. Cochran, and Charles B. Moseley

Executive Summary

Advertising Expenditures in the Nursing Home Sector: Evaluating the Need for and Purpose of Advertising, Bita A. Kash and Gregory J. Boyer

Marketing and advertising activities in the nursing home sector have increased in recent years, following the example of hospitals and health systems. The reasons for this trend may be related to the growth in competition but are not clearly identified yet. Theoretically, advertising becomes necessary to gain an advantage over the competition. The purpose of this study was to identify the reasons for the variation in advertising expenditures among nursing homes in Texas.

For this study, we merged 2003 data from the Texas Medicaid Nursing Facility Cost Report, the Texas Nursing Home Quality Reporting System, and the Area Resource File for Texas. Using the Herfindahl-Hirschman Index, we then examined the correlations between advertising expenses and the level of market concentration. We evaluated the association between advertising expenditures and market competition using two logistic and four linear regression models.

Total advertising expenses in Texas nursing homes ranged from $0 to $165,000 per year. Higher advertising expenditures were associated with larger facilities, higher occupancy, and high Medicare census. Market competition, however, was not a significant predictor of such expenses. Advertising seems to be more resource-driven than market-driven. Therefore, some advertising expenditures may be unnecessary, may lack impact, and may even be wasteful. Reducing unnecessary advertising costs could free up resources, which may be allocated to necessary resident care activities.

Executive Summary

The COA360: A Tool for Assessing the Cultural Competency of Healthcare Organizations, Thomas A. LaVeist, Rachel Relosa, and Nadia Sawaya

The U.S. Census Bureau projects that by 2050, non-Hispanic whites will be in the numerical minority. This rapid diversification requires healthcare organizations to pay closer attention to cross-cultural issues if they are to meet the healthcare needs of the nation and continue to maintain a high standard of care. Although scorecards and benchmarking are widely used to gauge healthcare organizations’ performance in various areas, these tools have been underused in relation to cultural preparedness or initiatives. The likely reason for this is the lack of a validated tool specifically designed to examine cultural competency. Existing validated cultural competency instruments evaluate individuals not organizations.

In this article, we discuss a study to validate the Cultural Competency Organizational Assessment—360 or the COA360, an instrument designed to appraise a healthcare organization’s cultural competence. The Office of Minority Health and the Joint Commission have each developed standards for measuring the cultural competency of organizations. The COA360 is designed to assess adherence to both of these sets of standards. For this validation study, we enlisted a panel of national experts. The panel rated each dimension of the COA360, and the combination of items for each of the scale’s 14 dimensions was rated above 4.13 (on 5-point scale). Our conclusion points to the validity of the COA360. As such, it is a valuable tool not only for assessing a healthcare organization’s cultural readiness but also for benchmarking its progress in addressing cultural and diversity issues.

Executive Summary

From the Emergency Department to the General Hospital: Hospital Ownership and Market Factors in the Admission of the Seriously Mentally Ill, Jay J. Shen, Christopher R. Cochran, and Charles B. Moseley

General hospitals are becoming the safety net provider for the seriously mentally ill (SMI) in the United States, but these patients are faced with a number of potential barriers when accessing these hospitals. Hospital ownership and market forces are two potential organizational and healthcare system barriers that may affect the SMI patient’s access, because the psychiatric and medical services they need are unprofitable services.

This study examines the relationship among hospital ownership, market forces, and admission of the SMI patient from the emergency department into the general hospital. This was a cross-sectional study of a large sample of SMI patients from the 2002 State Inpatient Datasets for five states. Multiple logistic regression was applied in the multivariable analysis. After controlling for patient, hospital, and county covariates and when compared with not-for-profit hospitals, public hospitals were more likely to admit while investor-owned hospitals were less likely to admit SMI patients. Hospitals in competitive markets were less likely to admit while hospitals with capitation revenues were slightly less likely to admit these patients.

Policy options that can address this “market failure” include strengthening the public psychiatric inpatient care system, making private health insurance coverage of the SMI more equitable, revising Medicare prospective payment system to better reimburse the treatment of the SMI, and allowing not-for-profit hospitals to count care of the SMI as a community benefit.