Alberto Coustasse

Organizational Culture in a Terminally Ill Hospital

Abstract This study analyzed an organizational culture in a community hospital in Texas to measure organizational culture change and its impact on Patient Satisfaction (PS). The study employed primary and secondary data, combining quantitative and qualitative methods for a case study. Participant observation was used and archival data were collected to provide a better understanding of the organizational culture and the context in which change was taking place. This study also applied a “Shared Vision” of the organization as the central process in bringing forth the knowledge shared by members of the community hospital who were both subjects and research participants. The results from the study suggest an increase in PS due to the shared vision of one subculture within the hospital. There were powerful subcultures in this organization based on occupation and specialization, and their interests and functional orientations were not conducive to a systems approach. Hospital management was conducted in “silos” and there was lack of feedback between organizational levels of the hospital, especially in financial management, with organizational dysfunctionality in reacting and adapting to the health care market.

Disparities in self-reported activities of daily living and instrumental activities of daily living disability among Asian American subgroups in the United States: Results from the National Health Interview Survey 2001–2003

BACKGROUND The purpose of this study was to compare disability and functional limitations among elderly Asian American subgroups using datasets from the National Health Interview Survey 2001-2003. METHODS This retrospective cross-sectional study analyzed whether activities of daily living (ADL) and instrumental ADL (IADL) disabilities were different among Asian American subgroups in the United States using data retrieved from the 2001-2003 National Health Interview Survey. For comparing all Asian American subgroups, χ(2) analysis was applied for the bivariate comparisons. RESULTS Rates of 7.1% and 12.2% for ADL and IADL disability, respectively, within Asian American group were found. The elder Chinese subgroup accounted for the highest ADL and IADL disability (11.6% and 17.3%, respectively, p < .05). Being female, not married, and older was associated with higher ADL and IADL disability (p < .05). CONCLUSIONS The findings of the study highlight the intergroup variability among the elder Asian American subpopulations.

Gender disparities: a medical detoxification program.

Abstract Significant gaps exist in health care regarding gender in the United States. Health status, social roles, culturally patterned behavior and access to health care can be influenced by gender. Women have been the primary users of health care and minority women usually have received poorer quality care than Non-Hispanic White (NHW) females. The objectives of this study were to identify gender, racial and ethnic disparities in access to substance abuse treatment in a Texas hospital. Secondary data collected on 1,309 subjects who underwent detoxification were studied. Gender, race/ethnicity, drug of abuse, relapse and financial classification were included in the analysis. Results indicate Hispanic females and Non-Hispanic Black (NHB) females were about 5 and 3.5 more likely than NHW females to use Medicaid services respectively (p < .05). NHW and NHB males were more likely to use Medicare than females (p < .05). NHB and Hispanic females were 5.8 and 2.1 times more likely to receive care for abuse of cocaine when compared to NHW females respectively (p < .05). Hispanic females were 2.3 times more likely to relapse than Non-Hispanic females, and uninsured NHB females were 7.1 times at a higher risk to abuse multiple drugs compare to NHW females (p < .05). Socio-economic factors, lower labor force participation rates, and less financial independence can explain females utilizing more often Medicaid regardless of their race/ethnicity. These results can be also explained by aggressive case management utilization, socio cultural barriers and/or discriminatory practices, both intentional and unintentional.

To the Bitter End: Disparities in End-of-Life Care

ABSTRACT Although technological advancements have provided the means to sustain life and provide care regardless of whether the treatment is appropriate and compassionate given the condition of the patient, bioethical, legal, and moral concerns related to disparities in care still arise in the United States. These concerns call into question the necessity to continue life-sustaining or palliative care treatments when patients and/or families are faced with end-of-life decisions. This study will focus on various historical, clinical cultural, and ethical issues that have placed this dilemma into a controversial public spectrum, by using case studies retrieved from referenced literature, which illustrate disparities in care at the end of life.

Disparities in Access to Healthcare: The Case of a Drug and Alcohol Abuse Detoxification Treatment Program among Minority Groups in a Texas Hospital

The authors analyzed ethnic/racial disparities in healthcare access and length of stay from a defined population of individuals seeking medical detoxification services at a hospital in Texas. Results indicated Blacks were more likely to be insured compared with Whites, mostly by public insurance, but this did not hold for Hispanics, who were about three times more likely to be uninsured compared with Blacks. In addition, the authors observed lower median of length of stay in the Medicaid category among Hispanics. These results can be explained by aggressive case management, sociocultural barriers, or discriminatory practices, both intentional and unintentional.

Cost of medical detoxification among drug and alcohol users in a private Texas hospital

Purpose – The purpose of this paper is to estimate the costs of medical detoxification among patients with alcohol and substance abuse disorders.Design/methodology/approach – The study data was drawn from a medical detoxification program in a community hospital in Texas. Secondary data analysis of 1337 cases from three years was reviewed. Age, gender, race, alcohol, cocaine, cannabis, amphetamines, sedatives, opioids, financial classification, cost, length of stay (LOS) and cost by LOS were analyzed using Kruskal‐Wallis test and Mann‐Whitney U‐test.Findings – The sample comprised of 42.8 percent women and 57.2 percent males. The mean cost and cost by LOS was highest for cocaine (

Latino Access to Health Care: The Role of Insurance, Managed Care, and Institutional Barriers

2560.1 and

Disparities and Access Barriers to Health Care Among Mexican American Elders

1,044, P<0.01), while opioid and cannabis (

Comparative Cost Analysis of CRRT in ICU/CCU Patients Undergoing Cardiovascular Surgery vs. Other Procedures at a Texas Hospital

815.5, p<0.01;

Management of Kawasaki Disease in Texas: Policy implications

823.7, p<0.01) had significantly higher values than the rest. In each individual drug detoxification class, except for amphetamines, the mean and median LOS has been reported to be less among the uninsured category compared to privately insured subjects. In a...