Guillermo A. Sandoval, Adalsteinn D. Brown, Walter P. Wodchis and Geoffrey M. Anderson
The purpose of this paper is to investigate the relationship between hospital adoption and use of computed tomography (CT) scanners, and magnetic resonance imaging (MRI) machines…
Abstract
Purpose
The purpose of this paper is to investigate the relationship between hospital adoption and use of computed tomography (CT) scanners, and magnetic resonance imaging (MRI) machines and in-patient mortality and length of stay.
Design/methodology/approach
This study used panel data (2007–2010) from 124 hospital corporations operating in Ontario, Canada. Imaging use focused on medical patients accounting for 25 percent of hospital discharges. Main outcomes were in-hospital mortality rates and average length of stay. A model for each outcome-technology combination was built, and controlled for hospital structural characteristics, market factors and patient characteristics.
Findings
In 2010, 36 and 59 percent of hospitals had adopted MRI machines and CT scanners, respectively. Approximately 23.5 percent of patients received CT scans and 3.5 percent received MRI scans during the study period. Adoption of these technologies was associated with reductions of up to 1.1 percent in mortality rates and up to 4.5 percent in length of stay. The imaging use–mortality relationship was non-linear and varied by technology penetration within hospitals. For CT, imaging use reduced mortality until use reached 19 percent in hospitals with one scanner and 28 percent in hospitals with 2+ scanners. For MRI, imaging use was largely associated with decreased mortality. The use of CT scanners also increased length of stay linearly regardless of technology penetration (4.6 percent for every 10 percent increase in use). Adoption and use of MRI was not associated with length of stay.
Research limitations/implications
These results suggest that there may be some unnecessary use of imaging, particularly in small hospitals where imaging is contracted out. In larger hospitals, the results highlight the need to further investigate the use of imaging beyond certain thresholds. Independent of the rate of imaging use, the results also indicate that the presence of CT and MRI devices within a hospital benefits quality and efficiency.
Originality/value
To the authors’ knowledge, this study is the first to investigate the combined effect of adoption and use of medical imaging on outcomes specific to CT scanners and MRI machines in the context of hospital in-patient care.
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Walter Wodchis, Carolyn Steele Gray, Jay Shaw, Kerry Kuluski, Gayathri Embuldeniya, G. Ross Baker and Maritt Kirst
Hedayet Chowdhury, Walter Wodchis and Audrey Laporte
The purpose of this paper is to present a productivity measure for hospital services in Ontario.
Abstract
Purpose
The purpose of this paper is to present a productivity measure for hospital services in Ontario.
Design/methodology/approach
The study applied the Malmquist Productivity Index (MPI) to assess the efficiency of hospital services in Ontario, Canada, over the period 2003‐2006. The MPI was decomposed into efficiency change and technological change. Efficiency change was further decomposed into pure efficiency change and scale efficiency change. A bootstrapping technique was also used to obtain confidence intervals for the output oriented MPI and its decompositions.
Findings
By estimating confidence intervals it was found that a large number of hospitals did not achieve significant progress in terms of productivity. By taking geometric means of estimates for all years it was observed that while overall productivity and efficiency of hospitals in Ontario declined during the study period, technological progress increased at a rate of 5.95 percent on average.
Practical implications
The present study helps to understand the productivity and technological change and change in technical efficiency in this vital sector of the economy, which is important for policy making identifying improvement opportunities in resource allocation. It was observed that Ontario hospitals did not improve the efficiency with which they employed their inputs (i.e. staff and supplies) over the study period; they did achieve gains through application of technologies.
Originality/value
The paper provides a thorough study on productivity growth of health care services in Ontario using a non‐parametric framework with bootstrapping. It also provides a robust measurement and analysis of the contributions of technology, size of operation and use of inputs to the performance of hospitals in Ontario.
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Gabriela Uribe, Ferdinand Mukumbang, Corey Moore, Tabitha Jones, Susan Woolfenden, Katarina Ostojic, Paul Haber, John Eastwood, James Gillespie and Carmen Huckel Schneider
Integrated health and social care initiatives are increasing and health and social care systems are aiming to improve health and social outcomes in disadvantaged groups. There is…
Abstract
Purpose
Integrated health and social care initiatives are increasing and health and social care systems are aiming to improve health and social outcomes in disadvantaged groups. There is a global dialogue surrounding improving services by shifting to an integrated health and social care approach. There is consensus of what is “health care”; however, the “social care” definition remains less explored. The authors describe the state of “social care” within the current integrated care literature and identify the depth of integration in current health and social care initiatives.
Design/methodology/approach
A narrative literature review, searching Medline, PsychINFO, CINAHL, PubMed, Scopus and Cochrane databases and grey literature (from 2016 to 2021), employing a search strategy, was conducted.
Findings
In total. 276 studies were eligible for full-text review, and 33 studies were included and categorised in types: “social care as community outreach dialogues”, “social care as addressing an ageing population”, “social care as targeting multimorbidity and corresponding social risks factors” and “social care as initiatives addressing the fragmentation of services”. Most initiatives were implemented in the United Kingdom. In total, 21 studies reported expanding integrated governance and partnerships; 27 studies reported having health and social care staff with clear integrated governance; 17 had dedicated funding and 11 used data-sharing and the integration of systems’ records.
Originality/value
The authors' demonstrate that social care approaches are expanding beyond the elderly, and these models have been used to respond to multimorbidity [including coronavirus disease 2019 (COVID-19)], targeting priority groups and individuals with complex presentations.
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Rohit Pradhan and Robert Weech-Maldonado
Private equity has acquired multiple large nursing home chains within the past few years; by 2007, it owned 6 of the 10 largest chains. Despite widespread public and policy…
Abstract
Private equity has acquired multiple large nursing home chains within the past few years; by 2007, it owned 6 of the 10 largest chains. Despite widespread public and policy interest, evidence on the purported impact of private equity on nursing home performance is limited. In our review, we begin by briefly reviewing the organizational and environmental changes in the nursing home industry that facilitated private equity investments. We offer a conceptual framework to hypothesize the relationship between private equity ownership and nursing home performance. Finally, we offer a research agenda focused on the important parameters of nursing home performance: financial performance, and quality of care.
Marissa Bird, James Shaw, Christopher D. Brinton, Vanessa Wright and Carolyn Steele Gray
A synthesis of integrated care models classified by their aims and central characteristics does not yet exist. We present a collection of five “archetypes” of integrated care…
Abstract
Purpose
A synthesis of integrated care models classified by their aims and central characteristics does not yet exist. We present a collection of five “archetypes” of integrated care, defined by their aims, to facilitate model comparison and dialogue.
Design/methodology/approach
We used a purposive literature search and expert consultation strategy to generate five archetypes. Data were extracted from included articles to describe the characteristics and defining features of integrated care models.
Findings
A total of 25 examples of integrated care models (41 papers) were included to generate five archetypes of integrated care. The five archetypes defined include: (1) whole population models, (2) life stage models, (3) disease-focused models, (4) identity group-based models and (5) equity-focused models.
Research limitations/implications
The five presented archetypes offer a conceptual framework for academics, health system decision makers and patients, families, and communities seeking to develop, adapt, investigate or evaluate models of integrated care.
Originality/value
Two cross-cutting themes were identified, including (1) minimal reporting of patient, caregiver and community engagement efforts in integrated care development, implementation and evaluation, and (2) the nuanced emphasis and implementation of electronic data sharing methods across archetypes, and the need for further definition of the role of these data sharing methods.
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Kathryn Peri, Ngaire Kerse, Simon Moyes, Shane Scahill, Charlotte Chen, Jae Beom Hong and Carmel M Hughes
– The purpose of this paper is to establish the relationship between organisational culture and psychotropic medication use in residential care.
Abstract
Purpose
The purpose of this paper is to establish the relationship between organisational culture and psychotropic medication use in residential care.
Design/methodology/approach
Cross-sectional analyses of staff and resident’s record survey in residential aged care facilities in Auckland, New Zealand (NZ). The competing values framework categorised organisational culture as clan, hierarchical, market driven or adhocracy and was completed by all staff. The treatment culture tool categorised facilities as having resident centred or traditional culture and was completed by registered nursing staff and general practitioners (GP). Functional and behavioural characteristics of residents were established by staff report and health characteristics and medications used were ascertained from the health record. Multiple regression was used to test for associations between measures of culture with psychotropic medication use (anxiolytics, sedatives, major tranquillisers).
Findings
In total 199 staff, 27 GP and 527 residents participated from 14 facilities. On average 8.5 medications per resident were prescribed and 42 per cent of residents received psychotropic medication. Having a diagnosis of anxiety or depression (odds ratio (OR) 3.18, 95 per cent confidence interval (CI) 1.71, 5.91), followed by persistent wandering (OR 2.53, 95 per cent CI 1.59, 4.01) and being in a dementia unit (OR 2.45, 95 per cent CI 1.17, 5.12) were most strongly associated with psychotropic use. Controlling for resident- and facility-level factors, health care assistants’ assignation of hierarchical organisational culture type was independently associated with psychotropic medication use, (OR 1.29, CI 1.08, 1.53) and a higher treatment culture score from the GP was associated with lower use of psychotropic medication (OR 0.95, CI 0.92, 0.98).
Originality/value
Psychotropic medication use remains prevalent in residential care facilities in NZ. Interventions aimed at changing organisational culture towards a less hierarchical and more resident-centred culture may be another avenue to improve prescribing in residential aged care.
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Chung-Yi Chiu, Jessica Brooks and Ruopeng An
The purpose of this paper is to inquiry dietary behavior and the physical and mental health status of food pantry users to better understand issues related to food insecurity and…
Abstract
Purpose
The purpose of this paper is to inquiry dietary behavior and the physical and mental health status of food pantry users to better understand issues related to food insecurity and to explore predictors of intentions for self-sufficiency.
Design/methodology/approach
The authors randomly surveyed 12 food pantries (151 consumers) sponsored by the North Texas Food Bank in USA, regarding dietary behavior, health status, reasons for food pantry use, satisfaction with services provided, and self-sufficient behavior and support.
Findings
About 37 percent of survey participants would expect to continue using food pantry services for one or more years. Reasons for food pantry use included low job earnings, unemployment, poor health, and disability. Over 83 percent of them were either overweight or obese, and over half (57 percent) of them had moderate or severe mental disorder symptoms that warrant examination by healthcare practitioners. On average, their health-related quality of life was lower than the general population. Participants’ physical health was significantly correlated with work intention. The hierarchical regression model predicting work intention had a large effect size.
Research limitations/implications
This research has highlighted the importance of improving food pantry consumers’ health and self-sufficiency in order to live sufficiently and healthily.
Practical implications
Community health practitioners need to help food banks address the needs beyond hunger to focus on the larger ramification of food insecurity such as self-sufficiency and health-related quality of life.
Originality/value
This work extends the existing studies focused on food insecurity, and it will enable the collaborations among food banks, social workers, vocational rehabilitation counselors, and public health practitioners.
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Joy Akehurst, Paul Stronge, Karen Giles and Jonathon Ling
The aim of this action research was to explore, from a workforce and a patient/carer perspective, the skills and the capacity required to deliver integrated care and to inform…
Abstract
Purpose
The aim of this action research was to explore, from a workforce and a patient/carer perspective, the skills and the capacity required to deliver integrated care and to inform future workforce development and planning in a new integrated care system in England.
Design/methodology/approach
Semi-structured interviews and focus groups with primary, community, acute care, social care and voluntary care, frontline and managerial staff and with patients and carers receiving these services were undertaken. Data were explored using framework analysis.
Findings
Analysis revealed three overarching themes: achieving teamwork and integration, managing demands on capacity and capability and delivering holistic and user-centred care. An organisational development (OD) process was developed as part of the action research process to facilitate the large-scale workforce changes taking place.
Research limitations/implications
This study did not consider workforce development and planning challenges for nursing and care staff in residential, nursing care homes or domiciliary services. This part of the workforce is integral to the care pathways for many patients, and in line with the current emerging national focus on this sector, these groups require further examination. Further, data explore service users' and carers' perspectives on workforce skills. It proved challenging to recruit patient and carer respondents for the research due to the nature of their illnesses.
Practical implications
Many of the required skills already existed within the workforce. The OD process facilitated collaborative learning to enhance skills; however, workforce planning across a whole system has challenges in relation to data gathering and management. Ensuring a focus on workforce development and planning is an important part of integrated care development.
Social implications
This study has implications for social and voluntary sector organisations in respect of inter-agency working practices, as well as the identification of workforce development needs and potential for informing subsequent cross-sector workforce planning arrangements and communication.
Originality/value
This paper helps to identify the issues and benefits of implementing person-centred, integrated teamworking and the implications for workforce planning and OD approaches.