Jeffrey R. Helton

Impact of Electronic Health Records on Nurses' Productivity

As the use of electronic health records increases, it becomes necessary to address their global impact on nurses’ productivity in hospitals. A retrospective cross-sectional study was conducted to explore the impact of electronic health records on nurses’ productivity and to examine whether the impacts are moderated through case-mix index or adjusted patient-days. Two sources of data were linked and analyzed for years 2007 and 2008: the American Hospital Association survey and the Centers for Medicare & Medicaid Services data. Almost two-thirds of the respondent hospitals in both years (63.9% in 2007 and 68.4% in 2008) had a high electronic health record index (≥5). Hospitals with higher penetration of electronic health records had more RNs employed (coefficient = 0.234, P = .002) compared with hospitals with low penetration of electronic health records, even when controlling for adjusted patient-day volumes. This difference decreased for hospitals with higher case-mix index values. The study findings fail to suggest any financial savings or superior productivity in nurses due to usage of electronic health records.

Longitudinal changes in the operating efficiency of public safety-net hospitals.

EXECUTIVE SUMMARY Government‐operated trauma facilities fill an important role as safety nets in our health system, providing care to millions of individuals who lack health insurance. Because these hospitals are often the most financially constrained, continuous improvement in operating efficiency seems to be a necessary component of their organizational strategy. In this study, we analyze the longitudinal changes in efficiency of a large sample of government‐operated safety‐net hospitals from 2004 to 2008. Employing an analytical tool called data envelopment analysis, our findings suggest that as a group these hospitals have become more efficient over time, improving by 2.1 percent over the five‐year study period.

The Scope and Trends of Pediatric Hospitalizations in Texas, 2004–2010

OBJECTIVE To examine demographics and trends of financial cost and prominent diseases/conditions resulting in inpatient hospitalizations for infants, children, and adolescents in Texas between 2004 and 2010. METHODS Longitudinal retrospective cross-sectional study using the Texas Hospital Inpatient Discharge Database, including all pediatric hospitalizations in the state of Texas, 2004 to 2010. RESULTS Texas has an average of 591 571 pediatric hospitalizations per year. Birth was the most common reason for hospitalization, representing 64% of all pediatric hospitalization annually in Texas. Respiratory illnesses were the most common discharge diagnosis for hospitalized children ages 1 month to 9 years and demonstrated a 2% decrease over the study period. The rate of hospitalizations for digestive conditions and childbirth also demonstrated a decrease over this time frame: 4.7% and 3.0%, respectively. The rate of mental illness diagnoses increased 2.5% over the time frame and represented the most common discharge diagnosis for children aged 10 to 14. Childbirth was the most common reason for hospitalization for adolescents aged 15 to 17 years. There was no increase in total cost of pediatric hospitalizations over the time period under study. CONCLUSIONS After birth, respiratory illnesses represent the most common reason for hospitalization for children (between 1 month and 10 years of age) in Texas. Mental health conditions and childbirth represent the most common reason for hospitalization for young adolescents (10-14 years) and older adolescents (15-17 years), respectively.

Strategies of High-Performing Teaching Hospitals

ABSTRACT Teaching hospitals are large and complex, and under constant financial pressure. In this study, we examine the financial performance of 80 large teaching hospitals in the 20 largest cities in the U.S. over the last five years, to identify which strategic and operational management factors separate high-performing hospitals from lower-performing ones. Results suggest that growth strategies should continue to be sought for improving long-term financial condition. Operational efficiency was less important than market share, economic status of surrounding community, hospital size, and teaching intensity. This studys findings should help guide strategic planning for teaching hospitals.

Predicting Financial Distress in Acute Care Hospitals

ABSTRACT Hospitals continue to face financial pressures from healthcare reform and heightened competition. In this study, our objective was to quantify the financial distress in acute care hospitals in Texas, applying multivariate logistic regression in a four-year longitudinal analysis. Of the 310 acute care hospitals, 50 (16.1%) were in financial distress in the most recent year, up considerably year over year. Distressed hospitals had fewer beds, lower patient acuity, and less outpatient revenues than those in good financial condition. Administrators should identify business turnaround strategies for combating distress to avoid potential closure.

Integrative Healthcare: An Exploration of Students Who Choose This Undergraduate Major

OBJECTIVE Given the dearth of literature on this topic, the aim of this study was to understand who chooses to study integrative healthcare at an academic institution and why they choose to do so, the demographic characteristics of the student population, their background, and postgraduate plans. DESIGN A cross-sectional survey design. SETTING Data were collected at a large, urban, public university with a well-established undergraduate bachelor of science program in integrative healthcare. PARTICIPANTS A total of 105 declared integrative health undergraduate majors. MEASUREMENTS Online research software collected anonymous survey responses during a 2-month period. RESULTS Survey participants were more likely to be white and full-time students compared with the general undergraduate population. Many respondents discovered the integrative health major and then decided to enroll at the university. Most had used complementary and alternative medicine modalities, such as massage, yoga, and meditation. More than half of the survey participants were dissatisfied with conventional/Western medicine and its providers. Most respondents had a personal interest in complementary and alternative medicine and holistic health that influenced their decision to declare the major. Additionally, more than half of the respondents want to become a complementary and alternative medicine provider. Most survey participants plan to pursue postgraduate training/education in an integrative healthcare-related field. CONCLUSION Students who choose to study integrative healthcare in an undergraduate academic institution may mirror the patient population of complementary and alternative medicine practitioners. Their profile, rationale, exposures, intentions, and directions may be helpful to universities considering adding this type of program or postgraduate education programs in attracting new students to integrative health fields. It also informs existing integrative healthcare programs regarding program enhancement. A larger sample involving more integrative health academic institutions would be useful for a future study.

A Business Planning Model to Identify New Safety Net Clinic Locations

PURPOSE Community health clinics serving the poor and underserved are geographically expanding due to changes in U.S. health care policy. This paper describes the experience of a collaborative alliance of health care providers in a large metropolitan area who develop a conceptual and mathematical decision model to guide decisions on expanding its network of community health clinics. DESIGN/METHODOLOGY/APPROACH Community stakeholders participated in a collaborative process that defined constructs they deemed important in guiding decisions on the location of community health clinics. This collaboration also defined key variables within each construct. Scores for variables within each construct were then totaled and weighted into a community-specific optimal space planning equation. This analysis relied entirely on secondary data available from published sources. FINDINGS The model built from this collaboration revolved around the constructs of demand, sustainability, and competition. It used publicly available data defining variables within each construct to arrive at an optimal location that maximized demand and sustainability and minimized competition. PRACTICAL IMPLICATIONS This is a model that safety net clinic planners and community stakeholders can use to analyze demographic and utilization data to optimize capacity expansion to serve uninsured and Medicaid populations. ORIGINALITY/VALUE Communities can use this innovative model to develop a locally relevant clinic location-planning framework.