A model for understanding diagnostic imaging referrals and complex interaction processes within the bigger picture of a healthcare system

Using experiences from the South African public healthcare system with limited resources, this review proposes a model that captures a holistic perspective of diagnostic imaging services embedded in a network of negotiated decision-making processes. Professional interdependency and interprofessional collaboration, cooperation and coordination are built around the central notion of integration in order to achieve a seamless transition through the continuum of various types of services needed to come to a diagnosis. Health-system role players interact with patients who enter the system from the perspective of their life-world. The distribution of diagnostic imaging services – within one setting or at multiple levels of care – demonstrates how fragments of information are filtered, interpreted and transformed at each point of care. The proposed model could contribute to alignment towards a common goal: services providing holistic quality of care within and beyond a complex healthcare system.     

Uncovering waste in US healthcare: Evidence from ambulance referral patterns

There is widespread agreement that the US healthcare system wastes as much as 5% of GDP, yet much less agreement on the source of the waste. This paper uses the effectively random assignment of patients to ambulance companies to generate comparisons across similar patients treated at different hospitals. We find that assignment to hospitals whose patients receive large amounts of care over the three months following a health emergency have only modestly better survival outcomes compared to hospitals whose patients receive less. Outcomes are related to different forms of spending. Patients assigned to hospitals with high levels of inpatient spending are more likely to survive to one year, while high levels of outpatient spending result in lower survival. In particular, we discovered that downstream spending at skilled nursing facilities (SNF) is a strong predictor of mortality. Our results highlight SNF admissions as a quality measure to complement the commonly used measure of hospital readmissions and suggest that in the search for waste in the US healthcare, post-acute SNF care is a prime candidate.     

Thirty-Day Readmission Following Total Hip and Knee Arthroplasty – A Preliminary Single Institution Predictive Model

We sought to identify demographic or care process variables associated with increased 30-day readmission within the total hip and knee arthroplasty patient population. Using this information, we generated a model to predict 30-day readmission risk following total hip and knee arthroplasty procedures. Longer index length of stay, discharge disposition to a nursing facility, blood transfusion, general anesthesia, anemia, anticoagulation status prior to index admission, and Charlson Comorbidity Index greater than 2 were identified as independent risk factors for readmission. Care process factors during the hospital stay appear to have a large predictive value for 30-day readmission. Specific comorbidities and patient demographic factors showed less significance. The predictive nomogram constructed for primary total joint readmission had a bootstrap-corrected concordance statistic of 0.76.     

The impact of managers' perceptions of learning organizations on innovation in healthcare: sample of Turkey

Organizational learning is the process of increasing effective organizational activities through knowledge and understanding. Innovation is the creation of any product, service or process, which is new to a business unit. Significant amount of research on organizational learning place a central meaning on the fact that there is a positive relationship between organizational learning and innovation. Both organizational learning and innovation are essential for organizations to prepare for change. The aim of this study is to determine to what extent the identified learning organization dimensions are associated with innovation. The study used a quantitative non‐experimental design employing statistical analysis via multiple regression and correlation methods to identify the relationships between the variables examined. Because the research was conducted in a non‐experimental way, learning organization dimensions are referred to as predictor variables, and innovation is referred to as the criterion variable. Watkins and Marsick's Dimensions of the Learning Organization Questionnaire was used in the study. Questionnaires were distributed to 498 hospital managers and, 243 valid responses were used in this study. Therefore, 243 hospital managers working at 250 Ministry of Health (public) hospitals across Turkey participated in the study. Results demonstrate that there are significant and positive correlations between learning organization dimensions and innovation. Intercorrelations between learning organization dimensions and correlations between learning organization dimensions and innovation were average and high, respectively. Results further indicate that the dimensions of the learning organizations explained 66.5% of the variance for the innovation. Copyright © 2012 John Wiley & Sons, Ltd.     

Public versus private treatment of chronic diseases in seniors: Argentina,Brazil, Chile and Uruguay

Abstract

This article measures differences in the likelihood of treatment of chronic diseases in elders across types of coverage (private, public and social security) in four major Latin American cities: Buenos Aires (Argentina), Sao Paulo (Brazil), Santiago (Chile) and Montevideo (Uruguay). We used a logistic regression to estimate the odds ratio for treatment of chronic diseases carried by individuals with public, private and social security coverage. The data were from the Survey on health, well-being and aging in Latin America and the Caribbean (SABE) conducted in 1999 and 2000. We find a strong association between possession of public coverage only and treatment failure of chronic diseases in elders in Argentina. We find no significant association for Brazil, Chile and Uruguay. In Buenos Aires, access to private or social security coverage is a necessity for elders because the public sector fails to provide proper treatment. In the remaining cities, private or social security coverage provides similar coverage for chronic diseases in elders compared with the public sector. For this group of countries, the main difference between the former and the latter seems to be in terms of ‘luxurious’ characteristics, such as the quality of the facilities and waiting times.