Dean G. Smith

Refusal to participate in heart failure studies: do age and gender matter?

AIMS AND OBJECTIVESnThe objective of this retrospective study was to evaluate reasons heart failure patients decline study participation, to inform interventions to improve enrollment.nnnBACKGROUNDnFailure to enrol older heart failure patients (age > 65) and women in studies may lead to sampling bias, threatening study validity.nnnDESIGNnThis study was a retrospective analysis of refusal data from four heart failure studies that enrolled 788 patients in four states.nnnMETHODSnChi-Square and a pooled t-test were computed to analyse refusal data (n = 300) obtained from heart failure patients who were invited to participate in one of the four studies but declined.nnnRESULTSnRefusal reasons from 300 patients (66% men, mean age 65·33) included: not interested (n = 163), too busy (n = 64), travel burden (n = 50), too sick (n = 38), family problems (n = 14), too much commitment (n = 13) and privacy concerns (n = 4). Chi-Square analyses showed no differences in frequency of reasons (p > 0·05) between men and women. Patients who refused were older, on average, than study participants.nnnCONCLUSIONSnSome reasons were patient-dependent; others were study-dependent. With not interested as the most common reason, cited by over 50% of patients who declined, recruitment measures should be targeted at stimulating patients interest. Additional efforts may be needed to recruit older participants. However, reasons for refusal were consistent regardless of gender.nnnRELEVANCE TO CLINICAL PRACTICEnHeart failure researchers should proactively approach a greater proportion of women and patients over age 65. With no gender differences in type of reasons for refusal, similar recruitment strategies can be used for men and women. However, enrolment of a representative proportion of women in heart failure studies has proven elusive and may require significant effort from researchers. Employing strategies to stimulate interest in studies is essential for recruiting heart failure patients, who overwhelmingly cited lack of interest as the top reason for refusal.

Managers’ Compensation in a Mixed Ownership Industry: Evidence from Nursing Homes

An extensive literature is devoted to differences between for-profit and non-profit health-care providers’ prices, utilization, and quality. Less is known about for-profit and non-profit managers’ compensation and its relationship with financial and quality performance. The aim of this study is to examine whether for-profit and non-profit nursing homes place differential weights on financial and quality performance in determining managers’ compensation. Using a unique 8-year dataset on Ohio nursing homes, fixed-effect regression models of managers’ compensation include financial and quality performance as well as other explanatory variables concerning firm and market characteristics and manager qualifications. Among for-profit nursing homes, compensation of owner-managers and non-owner managers are compared. Compensation of for-profit managers is significantly positively associated with profit margin and return-on-assets, while compensation of non-profit managers does not exhibit any consistent relationship with financial measures. Compensation of neither for-profit nor non-profit managers is significantly related to quality measures. Nursing home size and managers’ years of experience are the only consistent determinants of compensation. Owner-managers earn significantly higher compensation than non-owner managers and their compensation is less related to nursing home performance. Finding that home size and experience are strong determinants of compensation, and the association with ownership and financial performance for for-profit nursing homes are as expected. The insignificant relationship between compensation and quality performance is potentially troublesome.

Capital Investment by Independent and System-Affiliated Hospitals

Capital expenditures are a critical part of hospitals’ efforts to maintain quality of patient care and financial stability. Over the past 20 years, finding capital to fund these expenditures has become increasingly challenging for hospitals, particularly independent hospitals. Independent hospitals struggling to find ways to fund necessary capital investment are often advised that their best strategy is to join a multi-hospital system. There is scant empirical evidence to support the idea that system membership improves independent hospitals’ ability to make capital expenditures. Using data from the American Hospital Association and Medicare Cost Reports, we use difference-in-difference methods to examine changes in capital expenditures for independent hospitals that joined multi-hospital systems between 1997 and 2008. We find that in the first 5 years after acquisition, capital expenditures increase by an average of almost

The Cash Conversion Cycle And Profitability: A Study of Hospitals in the State of Washington

16u2009000 per bed annually, as compared with non-acquired hospitals. In later years, the difference in capital expenditure is smaller and not statistically significant. Our results do not suggest that increases in capital expenditures vary by asset age or the size of the acquiring system.