Do rural hospitals lag behind urban hospitals in addressing community health needs? An analysis of recent trends in US community hospitals

Objective:  This study examined whether rural and urban hospitals differ in their level of responsiveness to community health needs.
Design:  This study used a multivariate, longitudinal research design.
Research setting:  A cross-sectional survey was the setting for this study.
Participants:  The participants were rural or urban hospitals in the United States.
Main outcome measures:  The dependent variables were selected from the American Hospital Association hospital survey questions that are related to community health needs. The independent variable was rural or urban location.
Results:  Rural hospitals improved more than urban hospitals in addressing community health needs from 1997 through 2006 for most of the indicators, especially in working with other providers to conduct a community health assessment. However, rural hospitals still lag significantly behind urban hospitals in tracking health information.
Conclusions:  This study suggests that rural hospitals do not lag behind urban hospitals in addressing community health needs. Further research is needed to understand the role of community hospitals in influencing local health delivery system activities regarding the potential community benefits and their impact on improving health of local populations.     

Can marriage of academic, community hospitals work?

Can marriage of academic and community hospitals work? Executives at Fairview Health System in Minnesota believe it can--they have begun merging their system with University of Minnesota Hospital and Clinic, which Fairview purchased in January. But they admit the consolidation of two very diverse cultures will pose some intimidating challenges. If they succeed, Fairview's CEO says, "the potential is incredible."     

Is the corporate transformation of hospitals creating a new hybrid health care space? A case study of the impact of co-location of public and private hospitals in Australia

A common feature of health reforms in western nations has been the transformation or (re)construction of health and health care as both a commodity and product. In the hospital sector, this transformation has become increasingly evident in the growth of for-profit involvement in service delivery. Investor-owned hospitals are now prominent providers of hospital care in Australia. This paper examines the changing nature of health care space through the changing portrayal and meaning of hospitals as represented by and encoded in the built environment. Public hospitals once occupied 'pride of place'. In contrast, up to the early 1980s, the private sector was seen as a cottage industry. However, increased levels of state subsidisation and government incentives and pro-market policies, combined with market-based opportunities for profit generation, have seen the emergence of large private hospital chains with a new corporate image to hospital care and the blurring of 'public' and 'private'. A significant factor in the reconstruction of hospital space in Australia has been the co-location of private and public hospitals. Co-location is a popular strategy proffered by State governments and one that has been quickly acted on by corporate providers. Using Mayne Health Ltd, Australia's largest for-profit hospital chain, and four specific case studies, this paper explores four variants of co-location. Each of these examples represent a different public and private hospital space. The growth of for-profit hospital chains signifies a new phase in the delivery of health care in Australia but also importantly the creation of a new hybridised 'health care' space. This space is neither private nor public but a reflection of the economic, political and social processes underlying this transformation.     

Business continuity planning—a survey of hospitals in Delhi

Aim

This article aims to understand the status of business continuity planning (BCP) in hospitals in the National Capital Territory (NCT) of Delhi. The article also focuses on the role played by hospitals during a disaster.

Subject and methods

A mixed-methods research design was applied by developing a research instrument with qualitative and quantitative questions and collecting data by personally interviewing respondents. Two hundred seventeen interviews were conducted. Of these, 190 interviews were held with doctors and officials from hospitals in the NCT of Delhi. Twenty-seven experts from government departments, civil society organisations and the United Nations were also interviewed.

Results

This study shows that there is only limited understanding of the level of preparedness required for hospitals to continue functioning during and after a disaster event. All respondents confirmed having a BCP, but on investigation these plans were found to be either fire safety plans or contingency plans looking at mass casualties. A holistic plan for all critical aspects of hospital BCP is not available in 95.8% of hospitals; 47.4% of hospitals have poor to low levels of preparedness for all disaster risks; 48.4% of hospitals have a moderate level of preparedness, and only 4.2% have a high level of preparedness.

Conclusion

The findings indicate that the level of preparedness in hospitals in Delhi varies greatly. There is a need to approach BCP in a holistic manner, starting from an understanding of hazardous events, their impact on assets and planning for the continuation of critical functions when disaster strikes.

     

Are Michigan hospitals facing a shortage of trained personnel?

The 1990 MHA Health Personnel Shortage Survey requested information on 31 personnel positions to determine the extent of personnel shortages, the sources of replacement personnel, the positions for which it is most difficult to recruit applicants, and the positions for which it is most difficult to retain personnel. In addition, hospitals were asked about the impact of personnel shortages on hospital services, the strategies they had implemented to alleviate the problems caused by shortages, and their commitment to, and involvement in, training and educational programs to increase the availability of health care personnel in Michigan. A total of 77 Michigan hospitals and health care institutions responded to the survey. Analyses were performed on a sample of 69 community hospitals distributed similarly, with respect to hospital bed size category and geographic location, to the state total of 176 Michigan community hospitals. For more information, or for a copy of the complete 1990 MHA Health Personnel Shortage Survey report, contact the MHCI Health Policy Analysis Department.     

Homes or hospitals? Contradictions of the urban crisis.

Medical expansion is threatening to eliminate many urban residential areas, despite criticisim that argues for comprehensive planning, reduced costs, less concentrated power in the health sector, and a reversal of "medicalization." Our research on expansion, which grew partly from personal participation in a local struggle against expanding institutions in Boston, revealed certain tensions in combining sociomedical research with concrete political practice. From events in Boston and from an exploratory review of periodicals, we recognized that medical expansion and community conflict occur frequently in cities throughtout the United States. Based on general theoretical perspectives from organizational analysis and political economy, we made several hypotheses that we tested through a questionnaire sent to all hospitals in the 20 largest cities of the United States and through other data available on the same hospitals. In large part, this empirical study confirmed our theoretical expectations that (a) larger medical centers show a greater tendency toward territorial growth than smaller hospitals; (b) bureaucratic and administrative dynamics lead to facilities that do not necessarily enhance patient care; (c) despite short-term cycles of expansion and contraction in public hospital growth, expansion projects are widespread and generate considerable political conflict; (d) because of the state's contradictory roles in regulation and social capital expenditures, opposition to medical expansion comes more from community organizations than from governmental monitoring or planning bodies; and (e) the needs of capital determine that medical expansion has a more detrimental impact on housing than on commercial or industrial facilities. Future expansion of private medical facilities is more likely than that of public facilities, although much private expansion may receive public subsidization. As ideologic patterns are demystified, the contradictions between medical expansion and housing needs can provide a focus for successful community organizing.     

What affects rural beneficiaries use of urban and rural hospitals?

Analysis of the Medicare provider analysis record (MEDPAR) data during fiscal years 1984 through 1989 indicates that the proportion of rural Medicare beneficiaries hospitalized in urban hospitals has remained constant during the prospective payment system (PPS). Much of the use of urban hospitals by rural beneficiaries during this period was to obtain specialized care or surgery, as suggested by the analysis, and is consistent with historical patterns of referral of rural patients. Thus, the bypassing of rural hospitals by rural beneficiaries for treatment in urban hospitals has probably not increased during PPS.     

Process re-engineering in public hospitals: re-inventing of the wheel?

The purpose of this paper is that of analyzing the hypothesis that, as originally stated by its creators, the reengineering methodology for the improvement of efficiency and productivity, cannot be successfully implemented in Spanish public hospitals, and in fact, the so called experiences do not keep with the basics of such an approach. The technique employed for this study consisted, on one hand, of reviewing and comparing the literature published on this subject and, on the other, on experimentation by means of a case study conducted at a public hospital for the purpose of testing out the outlined hypothesis. The review and comparison of works previously published on this subject revealed that the technique for improving on-the-job efficiency according to the theory-based concepts of the process reengineering approach is not adaptable to public hospitals in Spain. The case study supported this finding, additionally highlighting the fact that in order for any relatively major changes in the working processes at public hospitals to be recommended, a number of organizational and human factors must be taken into consideration as aspects involved regardless of the methodological approach taken. The indiscriminate implementation in public hospital administration of trends currently fashionable in the business administration field may defeat its own purpose if these trends are not previously evaluated prior to being implemented. An assessment must first be made as to their being suited to the intended purpose.     

Is managed care restraining the adoption of technology by hospitals?

As health care costs increase, cost-control mechanisms become more widespread and it is crucial to understand their implications for the health care market. This paper examines the effect that managed care activity (based on the aim to control health care expenditure) has on the adoption of technologies by hospitals. We use a hazard rate model to investigate whether higher levels of managed care market share are associated with a decrease on medical technology adoption during the period 1982-1995. We analyze annual data on 5390 US hospitals regarding the adoption of 13 different technologies. Our results are threefold: first, we find that managed care has a negative effect on hospitals' technology acquisition for each of the 13 medical technologies in our study, and its effect is stronger for those technologies diffusing in the 1990s, when the managed care sector is at its largest. If managed care enrollment had remained at its 1984 level, there would be 5.3%, 7.3% and 4.1% more hospitals with diagnostic radiology, radiation therapy and cardiac technologies, respectively. Second, we find that the rise in managed care leads to long-term reductions in medical cost growth. Finally, we take into account that profitability analysis is one of the main dimensions considered by hospitals when deciding about the adoption of new technologies. In order to determine whether managed care affects technologies differently if they have a different cost-reimbursement ratio (CRR), we have created a unique data set with information on the cost-reimbursement for each of the 13 technologies and we find that managed care enrollment has a considerably larger negative effect on the adoption of less profitable technologies.     

A return of the sheepskin to nursing homes and hospitals?

The authors comment on the study conducted by Mistiaen et al. (Ned Tijdschr Geneeskd. 2011;155:A3034) and express their doubts regarding the efficacy of using Australian Medical Sheepskin to prevent sacral pressure ulcers. By their very nature sheepskins are not pleasant to use and their preventive effect is only significant in the very early stages of dermal pressure damage. No mention is made of the far more efficient method of prevention: the air mattress with alternating pressure.