Charles B. Moseley

The impact of state community benefit laws on the community health orientation and health promotion services of hospitals.

This study examined the effect of state community benefit laws and guidelines on the community health orientation and the provision of hospital-based health promotion services in hospitals. The sample included all not-for-profit and investor-owned acute-care hospitals in the United States during the year 2000. Multiple regression procedures were used to test the effect of community benefit laws and type of ownership while controlling for organizational and environmental variables. The results of these procedures indicated that, on average, not-for-profit hospitals in the ten states with community benefit laws/guidelines reported significantly more community health orientation activities than did not-for-profit hospitals in the forty other states. The results of the multiple regression procedures also indicated that, on average, the investor-owned hospitals in the ten states with laws/guidelines reported significantly more community health orientation activities than did the investor-owned hospitals in the forty other states. The study found that community benefit laws had the effect of decreasing ownership-related differences in reported community health orientation activities. Further, Levenes test of equality of variance showed that the not-for-profit hospitals in community benefit states exhibited significantly lower variance in the community health orientation activities when compared with the not-for-profit hospitals in non-community benefit states. However, none of the statistical tests supported the hypotheses that community benefit laws compelled or induced hospitals to offer significantly more health promotion services. The study concluded that coercive measures such as community benefit laws were effective in compelling not-for-profit hospitals to report increased community orientation activities, and it also concluded that the mimetic pressures associated with these laws were effective in inducing investor-owned hospitals to report increased community orientation activities.

The Impact of Federal Regulations on Urethral Catheterization in Virginia Nursing Homes

The 1990 Omnibus Budget and Reconciliation Act (OBRA) nursing home regulations limit the use of in dwelling urinary catheterization to certain appropriate cases. This study examines the impact of OBRA on cath eterization among 3149 pre-OBRA and 5073 post-OBRA Virginia residents. The two cohorts were similar in ac tivities of daily living function and medical status, but the post-OBRA cohort was more incontinent. A higher percentage of residents were catheterized pre-OBRA than post-OBRA. Post-OBRA, catheterized residents were more likely to meet OBRA conditions for appro priate catheterization than noncatheterized residents, and less than 1% of long-term catheterized residents were catheterized inappropriately. Long-term catheter ized residents had more urinary tract infections than short-term catheterized residents, however. Also, some nursing homes may substitute ostomies for catheters. Catheter use may no longer be a reliable indicator of quality of care at the nursing home level, if homes are minimizing catheterization in response to OBRA.

hospital Financial Position and the Adoption of Electronic Health Records

EXECUTIVE SUMMARY The objective of this study was to examine the relationship between financial position and adoption of electronic health records (EHRs) in 2,442 acute care hospitals. The study was cross‐sectional and utilized a general linear mixed model with the multinomial distribution specification for data analysis. We verified the results by also running a multinomial logistic regression model. To measure our variables, we used data from (1) the 2007 American Hospital Association (AHA) electronic health record implementation survey, (2) the 2006 Centers for Medicare and Medicaid Cost Reports, and (3) the 2006 AHA Annual Survey containing organizational and operational data. Our dependent variable was an ordinal variable with three levels used to indicate the extent of EHR adoption by hospitals. Our independent variables were five financial ratios: (1) net days revenue in accounts receivable, (2) total margin, (3) the equity multiplier, (4) total asset turnover, and (5) the ratio of total payroll to total expenses. For control variables, we used (1) bed size, (2) ownership type, (3) teaching affiliation, (4) system membership, (5) network participation, (6) full‐time equivalent nurses per adjusted average daily census, (7) average daily census per staffed bed, (8) Medicare patients percentage, (9) Medicaid patients percentage, (10) capitation‐based reimbursement, and (11) nonconcentrated market. Only liquidity was significant and positively associated with EHR adoption. Asset turnover ratio was significant but, unexpectedly, was negatively associated with EHR adoption. However, many control variables, most notably bed size, showed significant positive associations with EHR adoption. Thus, it seems that hospitals adopt EHRs as a strategic move to better align themselves with their environment.

Community health orientation, community-based quality improvement, and health promotion services in hospitals.

EXECUTIVE SUMMARY The objective of the study presented in this article was to examine the relationship between hospital community orientation and the provision of health promotion services. The study used data from the 2000 American Hospital Association survey and the 2000 Area Resource File to examine acute care hospitals throughout the United States. The study was a cross‐sectional multiple regression analysis. Hospital community orientation was measured by two independent variables: (1) community health orientation and (2) community‐based quality orientation. Health promotion services were represented by two dependent variables: (1) hospitalbased health promotion services and (2) collaborative health promotion services. Organizational control variables included bed‐size code, not‐for‐profit ownership, network participation, and joint venture/alliance membership. Environmental control variables included the proportion of population over age 65, the percentage of population below the poverty level, the square root of the proportion of Medicaid inpatient revenue, the presence of state community benefit laws/guidelines, a Herfindahl‐Hirschman Index of level of competition, and an index of managed care influence. Results of regression analyses showed that community health and communitybased quality orientations were positively and significantly related to both the direct provision of health promotion services by hospitals and the collaborative provision of health promotion services through systems, joint ventures, and networks. The study concludes that a community health orientation and a community‐based quality orientation lead to greater provision of health promotion services.

Inappropriate Clinical Care in Nursing Homes

Using secondary data, an analysis was done of the prevalence of inappropriate clinical care among 3,149 Virginia Medicaid nursing home residents. Six types of inappropriate care were examined: the un derprovision of skilled nursing care, physical reha bilitation and routine medical care; and the overuse of psychotropic drugs, physical restraints and uri nary catheterization. Thirty-two (32) percent of the residents received inappropriate care in at least one care area and 7% received inappropriate care in two or more areas. Residents who received the most in appropriate care were more dependent in their ac tivities of daily living, uncommunicative, inconti nent, likely to have had a stroke, and less disruptive. Residents who received the most inappropriate care are among the most vulnerable residents, and stronger regulation and outside advocacy may be needed to protect them from inappropriate care.

The Impact of Restraints on Nursing Home Resident Outcomes

This article is an examination of the impact of phys ical restraints on physical activities of daily living (PADL), walking, and orientation to reality outcomes among nursing home residents. Computerized assess ment data for a cohort of 5073 Virginia Medicaid nurs ing home admissions with complete data for their first and second post-admission assessments were analyzed. Multiple regression analysis was used to compare the outcomes of restrained and nonrestrained residents, after controlling statistically for the influence of case mix variables that might impact outcomes. Restraint use was associated with increased PADL dependence and dis orientation for residents restrained at their first and second assessments, both assessments, and either as sessment. Restraint was associated with increased walk ing dependence for residents restrained at their second assessment and either assessment.

Community benefit laws, hospital ownership, community orientation activities, and health promotion services.

BACKGROUND The hospital industry has exhibited a pattern of isomorphic change with regard to business operations. Many states have enacted community benefit laws to compel hospitals to provide community benefits to improve their community orientation. PURPOSES We seek to identify what kinds of isomorphic change might be associated with the enactment of these state community benefit laws. To do this, we conducted a longitudinal study of changes in community benefit provided by hospitals in both states with community benefit laws and states without community benefit laws. METHODOLOGY/APPROACH This study used a quasi-experimental panel design with the passage of community benefit laws/guidelines as the treatment variable. Our sample was composed of 390 not-for-profit hospitals and 129 investor-owned hospitals in 9 treatment states and 1,493 not-for-profit and 714 investor-owned hospitals in 35 control states. Community benefit was measured by the (a) community orientation activities reported and the (b) health promotion services offered by hospitals. FINDINGS The not-for-profit hospitals in the states without community benefit laws had increased their community orientation activities and health promotion services in a manner similar to that of the not-for-profit hospitals in the states with community benefit laws. There was no significant difference between the not-for-profit hospitals in the states without community benefit laws and those in the states with community benefit laws in 1994 or 2006 for either dependent variable. The changes in the community benefit for the not-for-profit hospitals in the states without community benefit laws and in the states with community benefit laws were significant and positive for both dependent variables. PRACTICE IMPLICATIONS Managers of acute care hospitals should engage in community orientation activities to maintain their legitimacy, differentiate themselves from other hospitals, avoid regulation, and manage resource dependency on managed-care payers.

Elderly casino gambling behavior: marketing implications.

ABSTRACT More elderly individuals are gambling, and, as the “Baby Boomers” age, the elderly will represent an increasingly important customer for casinos. Regression analysis was used to determine whether southern Nevada elderly were more likely to gamble in casinos than the non-elderly. Overall, the elderly were not more likely to gamble than the non-elderly, but elderly females were more likely to gamble than non-elderly females. The typical elderly female gambler was a recent arrival to southern Nevada, smoked cigarettes, had no college education, and was not low income. Casinos should develop strategies to market to the elderly female gambler that focus on personal safety, socialization, and basic gambling education.

Characteristics of Acute Care Hospitals with Diversity Plans and Translation Services

EXECUTIVE SUMMARY Hospitals provide diversity activities for a number of reasons. The authors examined community demand, resource availability, managed care, institutional pressure, and external orientation related variables that were associated with acute care hospital diversity plans and translation services. The authors used multiple logistic regression to analyze the data for 478 hospitals in the 2006 National Inpatient Sample (NIS) dataset that had available data on the racial and ethnic status of their discharges. We also used 2004 and 2006 American Hospital Association (AHA) data to measure the two dependent diversity variables and the other independent variables. We found that resource, managed care, and external orientation variables were associated with having a diversity plan and that resource, managed care, institutional, and external orientation variables were associated with providing translation services. The authors concluded that more evidence for diversitys impact, additional resources, and more institutional pressure may be needed to motivate more hospitals to provide diversity planning and translation services.

Regional Disparities in Prenatal Care Services in Rural China

The study compared the prenatal care programs in the Central–East, Northwest, and Southwest regions of China. Data were collected on 14 indicators of the quality of the prenatal care process, as well as the percentage of women with high-risk pregnancies who were screened. The average number of prenatal examinations for those women who received prenatal care was 5.01, and 62.6% of pregnant women had their first examination within 12 weeks of their pregnancy. About 35% of these pregnant women had at least 1 high-risk screening, and 20.8% had 3 high-risk screenings. Among the 3 regions, the Central–East region had the best overall quality prenatal services, and the Northwest area had the poorest quality. The quality of prenatal health care in poor, rural China is in need of improvement.