Thomas T.H. Wan and George J. Wan
This commentary presents the analytic development of patient classification, health resource use and outcome research and identifies opportunities to perform longitudinal research.
Abstract
Purpose
This commentary presents the analytic development of patient classification, health resource use and outcome research and identifies opportunities to perform longitudinal research.
Design/methodology/approach
The authors use a transdisciplinary framework to formulate multilevel models for ascertaining the causal relationship between hospital efficiency and effectiveness in panel data analysis.
Findings
The longitudinal design of organization research enables to delineate the relationship between hospital performance and quality of care in future research.
Research limitations/implications
The inclusion of multivariates in health organization research and modeling is pivotal to the identification of a comprehensive set of predictor variables. The authors signify the need to build a systems-oriented theoretical framework to integrate micro- and macro-level predictor variables in conducting data analysis.
Practical implications
The authors signify the need to build a theoretical framework to integrate micro- and macro-level predictor variables in conducting data analysis.
Social implications
Health organization research is essential to broaden the scope of health services research and policy development, particularly related to global health as noted in the promotion of sustainable development and health goals.
Originality/value
Health organization research should include a complex set of exogenous and endogenous variables in designing and modeling the determinants of hospital performance and patient care outcomes.
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Matt T. Bagwell and Thomas T. H. Wan
Purpose – This study analyzed individual factors of race and dual eligibility on emergency room (ER) utilization of older adult Medicare patients treated by RHCs in CMS Region 4…
Abstract
Purpose – This study analyzed individual factors of race and dual eligibility on emergency room (ER) utilization of older adult Medicare patients treated by RHCs in CMS Region 4.
Methodology/approach – A prospective, longitudinal design was employed to analyze health disparities that potentially exist among RHC Medicare beneficiary patients (+65) in terms of ER use. The years of investigation were 2010 through 2012, using mixed multilevel, binary logistic regression.
Findings – This study found that dual eligible RHC patients utilized ER services at higher rates than nondual eligible, Medicare only RHC patients at: 77%, 80%, and 66%, in 2010, 2011, and 2012, respectively; and above the White reference group, Black RHC Medicare patients utilized ER services at higher rates of: 18%, 20%, and 34%, in 2010, 2011, and 2012, respectively.
Research limitations/implications – Regarding limitations, cohort data observations within the window of 3 years were only analyzed; regarding generalizability, in different CMS regions, results will likely vary; and linking other variables together in the study was limited by the accessible data. Future research should consider these limitations, and attempt to refine. The findings support that dual Medicare and Medicaid eligibility, as a proxy measure of socioeconomic status, and race continue to influence higher rates of ER utilization in CMS Region 4.
Originality/value – In terms of ER utilization disparities, persistently, as recent as 2012, Black, dual eligible RHC Medicare beneficiary patients age 65 years and over may be twice as likely to utilize ER services for care than their counterparts in the Southeastern United States.
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Wylie H. Wan, Sarah N. Haverly and Leslie B. Hammer
This chapter focuses on military couples and factors that affect their experiences of work, stress, and health using a life course perspective. An introduction to the definition…
Abstract
This chapter focuses on military couples and factors that affect their experiences of work, stress, and health using a life course perspective. An introduction to the definition of military couples is provided followed by a brief review of previous research on marital quality and divorce among military couples. The core of the chapter describes the advantages of using a life course perspective to examine the military life course for couples, and two critical transitions of military life are more fully examined. Specifically, periodic relocation and deployment and their impacts on military couples are reviewed in detail. Future directions for research on military couples are provided, and the use of the Convoy Model of Social Relations as an integrative approach to examine military personnel and family members’ stress and health across the military life course is introduced.
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Thomas T. H. Wan, Yi-Ling Lin and Judith Ortiz
This study is to examine factors contributing to the variability in chronic obstructive pulmonary disorder (COPD) and asthma hospitalization rates when the influence of patient…
Abstract
Purpose
This study is to examine factors contributing to the variability in chronic obstructive pulmonary disorder (COPD) and asthma hospitalization rates when the influence of patient characteristics is being simultaneously considered by applying a risk adjustment method.
Methodology/approach
A longitudinal analysis of COPD and asthma hospitalization of rural Medicare beneficiaries in 427 rural health clinics (RHCs) was conducted utilizing administrative data and inpatient and outpatient claims from Region 4. The repeated measures of risk-adjusted COPD and asthma admission rate were analyzed by growth curve modeling. A generalized estimating equation (GEE) method was used to identify the relevance of selected predictors in accounting for the variability in risk-adjusted admission rates for COPD and asthma.
Findings
Both adjusted and unadjusted rates of COPD admission showed a slight decline from 2010 to 2013. The growth curve modeling showed the annual rates of change were gradually accentuated through time. GEE revealed that a moderate amount of variance (marginal R 2 = 0.66) in the risk-adjusted hospital admission rates for COPD and asthma was accounted for by contextual, ecological, and organizational variables.
Research limitations/implications
The contextual, ecological, and organizational factors are those associated with RHCs, not hospitals. We cannot infer how the variability in hospital practices in RHC service areas may have contributed to the disparities in admissions. Identification of RHCs with substantially higher rates than an average rate can portray the need for further enhancement of needed ambulatory or primary care services for the specific groups of RHCs. Because the risk-adjusted rates of hospitalization do not vary by classification of rural area, future research should address the variation in a specific COPD and asthma condition of RHC patients.
Originality/value
Risk-adjusted admission rates for COPD and asthma are influenced by the synergism of multiple contextual, ecological, and organizational factors instead of a single factor.
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Thomas T. H. Wan, Maysoun Dimachkie Masri and Judith Ortiz
The implementation of the Patient Protection and Affordable Care Act has facilitated the development of an innovative and integrated delivery care system, Accountable Care…
Abstract
Purpose
The implementation of the Patient Protection and Affordable Care Act has facilitated the development of an innovative and integrated delivery care system, Accountable Care Organizations (ACOs). It is timely, to identify how health care managers in rural health clinics (RHCs) are responding to the ACO model. This research examines RHC managers’ perceived benefits and barriers for implementing ACOs from an organizational ecology perspective.
Methodology/approach
A survey was conducted in spring of 2012 covering the present RHC network working infrastructures – (1) Organizational social network; (2) organizational care delivery structure; (3) ACO knowledge, perceived benefits, and perceived barriers; (4) quality and disease management programs; and (5) health information technology (HIT) infrastructure. One thousand one hundred sixty clinics were surveyed in the United States. They cover eight southeastern states (Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee) and California. A total of 91 responses were received.
Findings
RHC managers’ personal perceptions on ACO’s benefits and knowledge level explained the most variance in their willingness to join ACOs. Individual perceptions appear to be more influential than organizational and context factors in the predictive analysis.
Research limitations/implications
The study is primarily focused in the Southeastern region of the United States. The generalizability is limited to this region. The predictors of RHCs’ participation in ACOs are germane to guide the development of organizational strategies for enhancing the general knowledge about the innovativeness of delivering coordinated care and containing health care costs inspired by the Affordable Care Act.
Originality/value of chapter
RHCs are lagged behind the growth curve of ACO adoption. The diffusion of new knowledge about pros and cons of ACO is essential to reinforce the health care reform in the United States.
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Frank May, Alokparna Basu Monga and Kartik Kalaignanam
Very little research addresses whether the values that consumers bring to a situation can affect their reactions to a brand failure. This paper suggests the interesting…
Abstract
Purpose
Very little research addresses whether the values that consumers bring to a situation can affect their reactions to a brand failure. This paper suggests the interesting possibility that consumers may react very differently to the same brand failure depending upon their values. Here, the authors introduce a new construct to the marketing literature – honor values – and demonstrate its effect on responses to brand failures.
Methodology
Three experiments and one secondary data study were utilized.
Findings
Across four studies, honor values are shown to aggravate consumers’ desire for vengeance following a brand failure. That is, as honor values increase, so too does desire for vengeance in the face of a brand failure. Additionally, this desire can be attenuated by allowing the consumer to play a role in resolving the failure or by giving a heartfelt apology.
Practical implications
High-honor consumers are a major obstacle for firms facing a brand failure. To overcome this challenge, the authors offer strategies, including (1) allowing high-honor consumers to suggest ways to punish the offending employee, and (2) offering simple, heartfelt apologies to high-honor consumers, which are as effective as monetary compensations.
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Thomas T.H. Wan and Blossom Y.J. Lin
Understanding the determinants of health services use is essential for planning for effective services, particularly health care policies in a newly independent state, the…
Abstract
Understanding the determinants of health services use is essential for planning for effective services, particularly health care policies in a newly independent state, the Republic of Kazakhstan. The main purpose of this study is to examine the relative importance of social capital factors in affecting the variation in health status and use of health services, using structural equation modeling. The results show that health status is a strong predictor of health services use when the effect of social capital is held constant; and that social capital is directly linked with health status.
Motivated by the apparent presence of the “productivity paradox” of information technology (IT) in agri-food supply chain (SC), the purpose of this paper is to explore how IT…
Abstract
Purpose
Motivated by the apparent presence of the “productivity paradox” of information technology (IT) in agri-food supply chain (SC), the purpose of this paper is to explore how IT capabilities affect agri-food supply chain performance (SCP). Specifically, this paper investigates the direct and indirect impacts of IT capabilities on agri-food SCP through interorganizational relationships.
Design/methodology/approach
This paper employs the questionnaire survey method based on relevant literatures. Data are collected from Chinese 265 core firms' agri-food SC. Structural equation modelling (SEM) is mainly employed for hypothesis testing and analysis.
Findings
The main findings are as follows. First, IT capabilities have significant direct impact on agri-food SCP. Second, IT capabilities enhance interorganizational relationships in the agri-food SC. Third, interorganizational relationships positively influence agri-food SCP. Last, interorganizational relationships are important path factors and mediate the indirect impact of IT capabilities on agri-food SCP.
Research limitations/implications
This research is limited to a particular sample, that is, agriculture-related firms in Chinese agri-food SC. The results need to be generalized to encompass wider samples. Future research could in greater detail study the links among IT capabilities, interorganizational relationships and agri-food SCP.
Practical implications
The study's findings could provide practical reference value for agriculture-related firms to design appropriate strategies to solve the IT “productivity paradox” and improve agri-food SCP from the perspectives of IT capabilities and interorganizational relationships.
Originality/value
This paper constructs a newly developed framework based on the resource-based view (RBV) and relational view to examine the links among IT capabilities, interorganizational relationships and agri-food SCP, and innovatively verifies the mediating effect of interorganizational relationships on the impact of IT capabilities on agri-food SCP.