Dennis J. Scotti

Effects of high-involvement work systems on employee satisfaction and service costs in veterans healthcare.

EXECUTIVE SUMMARY Two strong imperatives for healthcare managers are reducing costs of service and attracting and retaining highly dedicated and competent patient care and support employees. Is there a trade‐off or are there organizational practices that can further both objectives at the same time? High‐involvement work systems (HIWS) represent a holistic work design that includes interrelated core features such as involvement, empowerment, development, trust, openness, teamwork, and performance‐based rewards. HIWS have been linked to higher productivity, quality, employee and customer satisfaction, and market and financial performance in Fortune 1000 firms. Apparently, few prior studies have looked at the impacts of this holistic design within the healthcare sector. This research found that HIWS were associated with both greater employee satisfaction and lower patient service costs in 146 Veterans Health Administration centers, indicating that such practices pay off in both humanistic and financial terms. This suggests that managers implementing HIWS will incur real expenses that are likely to be more than offset by more satisfied employees, less organizational turmoil, and lower service delivery costs, which, in this study, amounted to over

Percutaneous cardiac assist devices compared with surgical hemodynamic support alternatives: cost-effectiveness in the emergent setting.

1.2 million in savings for an average VHA facility.

Procedural and clinical outcomes after catheter ablation of unstable ventricular tachycardia supported by a percutaneous left ventricular assist device

This study evaluates the cost‐effectiveness of percutaneous cardiac assist device (pVAD) therapy in the emergent setting compared with traditional surgical hemodynamic support alternatives. Background: Previous research has demonstrated the cost‐effectiveness of pVAD hemodynamic support for patients undergoing high‐risk percutaneous coronary intervention. For patients in cardiogenic shock (CS), use of pVAD therapy has been shown to reduce length of stay (LOS). Methods: National utilization and outcome data from the 2010–2011 MedPAR and state‐sponsored all‐payer databases were collected for patients with an acute myocardial infarction complicated by CS who were treated with either a pVAD (n = 883) or with traditional surgical hemodynamic support alternatives (ECMO and extracorporeal VAD) (n = 305). Results: Discharge survival was greater with pVADs than with surgical alternatives (56% vs. 42%, P < 0.001) and was achieved with a strong trend toward reduced LOS (13.2 and 17.9 days, respectively, P = 0.055) and a significantly lower cost of the index admission (

Cognitive predictors of satisfaction with hospital inpatient service encounters among the elderly: a matter of trust.

90,929 and

Satisfaction with medical care among elderly patients: a review of research findings with implications for management practice and future inquiry.

144,257, respectively, P < 0.001). Cost‐effectiveness analysis based on the national data demonstrated that pVAD achieved improved outcomes at lower cost. Data were also collected for similar patients who underwent protocol‐guided pVAD therapy (using Impella 2.5) at PinnacleHealth, between 2009 and 2011 (n = 30). At this site, the survival rate increased to 60%, length of hospitalization was shortened to 6 days, and admission costs were lowered to

Health economics of percutaneous hemodynamic support in the treatment of high-risk cardiac patients: a systematic appraisal of the literature

53,850 relative to the surgical alternatives strategy. Conclusions: For patients in CS requiring emergent hemodynamic support, pVAD therapy offers a less invasive alternative that can be deployed sooner, resulting in better outcomes, shorter LOS, lower costs and with no incremental cost, and a survival benefit when compared with traditional surgical hemodynamic support alternatives. PVAD therapy (and Impella 2.5 in particular) is emerging as a dominant strategy for this challenging patient population.

Use of combinatorial pharmacogenomic guidance in treating psychiatric disorders: financial impact on a health plan

BACKGROUND Hemodynamic support using percutaneous left ventricular assist devices (pLVADs) during catheter mapping and ablation of unstable ventricular tachycardia (VT) can provide effective end-organ perfusion. However, its effect on procedural and clinical outcomes remains unclear. OBJECTIVE To retrospectively evaluate the procedural and clinical outcomes after the catheter ablation of unstable VT with and without pLVAD support. METHODS Sixty-eight consecutive unstable, scar-mediated endocardial and/or epicardial VT ablation procedures performed in 63 patients were evaluated. During VT mapping and ablation, hemodynamic support was provided by intravenous inotropes with a pLVAD (n = 34) or without a pLVAD (control; n = 34). RESULTS Baseline patient characteristics were similar. VT was sustained longer with a pLVAD (27.4 ± 18.7 minutes) than without a pLVAD (5.3 ± 3.6 minutes) (P < .001). A higher number of VTs were terminated during ablation with a pLVAD (1.2 ± 0.9 per procedure) than without a pLVAD (0.4 ± 0.6 per procedure) (P < .001). Total radiofrequency ablation time was shorter with a pLVAD (53 ± 30 minutes) than without a pLVAD (68 ± 33 minutes) (P = .022), but with similar procedural success rates (71% for both pLVAD and control groups; P = 1.000). Although during 19 ± 12 months of follow-up VT recurrence did not differ between pLVAD (26%) and control (41%) groups (P = .305), the composite end point of 30-day rehospitalization, redo-VT ablation, recurrent implantable cardioverter-defibrillator therapies, and 3-month mortality was lower with a pLVAD (12%) than without a pLVAD (35%) (P = .043). CONCLUSION In this nonrandomized retrospective study, catheter ablation of unstable VT supported by a pLVAD was associated with shorter ablation times and reduced hospital length of stay. While pLVAD support did not affect VT recurrence, it was associated with a lower composite end point of 30-day rehospitalization, redo-VT ablation, recurrent implantable cardioverter-defibrillator therapies, and 3-month mortality.

A Multi-Theory Approach to Managing Knowledge Assets: The Case of Complex Professional Human Service Organizations

ABSTRACT Given the burgeoning growth of the elderly population, ensuring the satisfaction of senior consumers of health services is worthy of heightened attention by healthcare administrators both on economic and social grounds. By examining inpatient satisfaction among the elderly, we have focused our attention on an important and understudied segment of health consumers within a dominant service delivery context. Moreover, we have supplemented traditional hospital service satisfaction indicators by including a variety of rarely used psychological variables as cognitive predictors of service assessments. This study reinforces the empirical connection between trust in ones physician and elderly inpatient satisfaction at an increased level. The results suggest that increased levels of trust is positively associated with overall satisfaction of elderly inpatients as well as their satisfaction with several subdimensions of service that represent specific attributes of the hospital inpatient encounter.

Questionnaire Inclusion in a Second Mailing: A Matter of Time and Money

Abstract Research on patient satisfaction has focused predominantly on the mainstream adult population (ages 18–64). Satisfaction in older patients has not been adequately studied. Moreover, a systematic review of the research literature that does exist on this topic has not yet been conducted. The literature search yielded only 17 studies that met the selection criteria established for this review. Key research elements and findings from each of the studies are arrayed in matrix form. The results of the literature review are organized and analyzed in terms of four major categories of variables: background characteristics, predispositional variables, service quality attributes, and contextual factors. Special attention is awarded to identifying the determinants of satisfaction among elderly patients and the ways in which their service quality appraisals may differ in comparison with the general adult population of medical care consumers. Implications for management practice and directions for future research are discussed.

IMPORTANT POPULATION MANAGEMENT CONSIDERATIONS FOR PERCUTANEOUS CARDIAC ASSIST DEVICES

This article systematically appraises the findings and conclusions derived from six recent studies of the economic impact and relative value of using percutaneous ventricular assist devices to render short-term hemodynamic support to high-risk patients with particular attention to the settings of cardiogenic shock and percutaneous coronary interventions. Although the extant body of literature is still growing, these studies offer evidence and insight regarding the health economics of traditional and emerging technologies in this treatment domain, and generally find the latter to be cost-effective in the long term. As the incidence of heart disease rises and the attendant economic burden of healthcare climbs, technologies for mitigating cardiovascular illness will be the target for more robust empirical evidence to justify the comparative value of minimally invasive hemodynamic support interventions in the armamentarium of treatment options available to physicians.