Jong-Deuk Baek

The Relationship Between Workplace Environment and Job Satisfaction Among Nursing Assistants: Findings From a National Survey

OBJECTIVES To identify supervisory factors related to job satisfaction among certified nursing assistants (CNAs). Although this topic has been studied at the facility and state levels, it has not previously been addressed in a nationally representative sample. DESIGN Cross-sectional analysis of data from the 2004 National Nursing Assistant Survey, conducted by the National Center for Health Statistics. SETTING Nationally representative sample of nursing homes (n = 790). PARTICIPANTS Eight randomly selected CNAs from each nursing home, 4 who had been at that job for less than 1 year and 4 at the job for a year or more (n = 3011). Analysis was limited to 2897 individuals working at the same facility when interviewed. MEASURES Job satisfaction was measured by a 6-item score addressing workplace morale, challenging work, benefits, salary or wages, learning new skills, and overall satisfaction. Characteristics of the work environment included supervisor behavior, time pressures, organizational climate, perception that the CNAs work was valued, and whether the CNA principally cared for the same residents. RESULTS In adjusted analysis, organizational climate, supervisor behavior, sufficient time for tasks, and being valued were positively associated with job satisfaction, as were hourly earnings. CONCLUSIONS Clear communication from supervisors and evidence that the CNA function is valued were associated with job satisfaction. Specific strategies, such as merit raises and job design, may increase job satisfaction.

Reasons Why Women Do Not Initiate Breastfeeding: A Southeastern State Study

PURPOSE Despite the increase in breastfeeding initiation and duration in the United States, only five states have met the three Healthy People 2010 breastfeeding objectives. Our objectives are to study womens self-reported reasons for not initiating breastfeeding and to determine whether these reasons vary by race/ethnicity, and other maternal and hospital support characteristics. METHODS Data are from the 2000-2003 Arkansas Pregnancy Risk Assessment Monitoring System, restricting the sample to women who did not initiate breastfeeding (unweighted n=2,917). Reasons for not initiating breastfeeding are characterized as individual reasons, household responsibilities, and circumstances. Analyses include the chi(2) test and multiple logistic regression. RESULTS About 38% of Arkansas mothers of live singletons did not initiate breastfeeding. There was a greater representation of non-Hispanic Blacks among those who did not initiate breastfeeding (32%) than among those who initiated breastfeeding (9.9%). Among those who never breastfed, individual reasons were most frequently cited for noninitiation (63.0%). After adjusting for covariates, Hispanics had three times the odds of citing circumstances than Whites (odds ratio [OR], 3.07; 95% confidence interval [CI], 1.31-7.18). Women who indicated that the hospital staff did not teach them how to breastfeed had more than two times greater odds of citing individual reasons (OR, 2.25; 95% CI, 1.30-3.91) or reasons related to household responsibilities (OR, 2.27; 95% CI, 1.19-4.36) as compared with women who indicated they were taught. CONCLUSIONS Findings suggest the need for targeting breastfeeding interventions to different subgroups of women. In addition, there are implications for policy particularly regarding breastfeeding support in hospitals.

Disparities in access to care among asthmatic children in relation to race and socioeconomic status.

Asthma is one of the leading chronic illnesses among children in the United States. International epidemiological studies have also shown asthma prevalence is an increasing problem. The objective of this study was to examine the correlates of access to care among asthmatic children age 0—17 in the United States. This is a retrospective study and secondary data analysis of the 2000 National Health Interview Survey. Parametric testing using univariate, bivariate, and multivariate analyses were performed to examine health care utilization among children with asthma in the United States. It was found that Black children were highly associated with not visiting a general doctor in the past 12 months (OR 0.47; 95% CI 0.30, 0.75). Uninsured asthmatic children were associated with the risk of not seeing a general doctor in the past 12 months (OR 0.40; 95% CI 0.23, 0.69). Our study findings indicate disparities among Black children with asthma and their ability to access appropriate health care services. Additional studies are required to identify factors that contribute to the temporal trends in asthma and country of origin.

Physician-Targeted Financial Incentives and Primary Care Physicians’ Self-Reported Ability to Provide High-Quality Primary Care

Objective: High-quality primary care is envisaged as the centerpiece of the emerging health care delivery system under the Affordable Care Act. Reengineering the US health care system into a primary care–driven model will require widespread, rapid changes in the management and organization of primary care physicians (PCPs). Financial incentives to influence physician behavior have been attempted with various approaches, without empirical evidence of their effectiveness in improving care quality. This study examines the above research question adjusting for the patient-centeredness of the practice climate, a major contextual factor affecting PCPs’ ability to provide high-quality care. Methods: Secondary data on a sample of salaried PCPs (n = 1733) from the nation-wide Community Tracking Study Physician Survey 2004-2005 were subject to generalized multinomial logit modeling to examine associations between financial incentives and PCPs’ self-reported ability to provide quality care. Results: After adjusting for patient-centered medical home (PCMH)–consistent practice environment, financial incentive aligned with care quality/care content is positively associated with PCPs’ ability to provide high-quality care. An encouraging finding was that financial incentives aligned with clinic productivity/profitability do not to impede high-quality care in a PCMH practice environment. Conclusion: Financial incentives targeted to care quality or content indicators may facilitate rapid transformation of the health system to a primary care–driven system. The study provides empirical evidence of the utility of practically deployable financial incentives to facilitate high-quality primary care.

Disparities Between Asthma Management and Insurance Type Among Children

Asthma is a chronic illness among children. Minority children may be vulnerable to asthma complications since more than half are from households that are poor or near poor, and some have no health insurance. Asthma management plans are important for the long-term treatment of asthma and beneficial for self-management. This study analyzed insurance type and the relationship between having an asthma management plan among children across all races with asthma. This study utilized the 2002 and 2003 National Health Interview Survey. Findings showed that whites were significantly more likely than Non-Hispanic blacks and Hispanics to have an asthma management plan (OR, 1.66; p = .0031). In this study, children who reported Childrens Health insurance Program (CHIP) coverage were twice as likely to have an asthma management plan (OR, 2.67; p = .0004). Mandating all insurers to provide an asthma management plan to children with asthma may reduce the race-based inequities and differences in asthma management plan status.

Impact of Information Technology, Clinical Resource Constraints, and Patient-Centered Practice Characteristics on Quality of Care

Objective: Factors in the practice environment, such as health information technology (IT) infrastructure, availability of other clinical resources, and financial incentives, may influence whether practices are able to successfully implement the patient-centered medical home (PCMH) model and realize its benefits. This study investigates the impacts of those PCMH-related elements on primary care physicians’ perception of quality of care. Methods: A multiple logistic regression model was estimated using the 2004 to 2005 CTS Physician Survey, a national sample of salaried primary care physicians (n = 1733). Results: The patient-centered practice environment and availability of clinical resources increased physicians’ perceived quality of care. Although IT use for clinical information access did enhance physicians’ ability to provide high quality of care, a similar positive impact of IT use was not found for e-prescribing or the exchange of clinical patient information. Lack of resources was negatively associated with physician perception of quality of care. Conclusion: Since health IT is an important foundation of PCMH, patient-centered practices are more likely to have health IT in place to support care delivery. However, despite its potential to enhance delivery of primary care, simply making health IT available does not necessarily translate into physicians’ perceptions that it enhances the quality of care they provide. It is critical for health-care managers and policy makers to ensure that primary care physicians fully recognize and embrace the use of new technology to improve both the quality of care provided and the patient outcomes.

Utilization and Cost Analysis of a Chronically Ill, Newly Insured Indigent Population

Abstract:The Affordable Care Act expanded health insurance for low-income, uninsured individuals. Few longitudinal analyses have investigated how insurance expansion influences cost and utilization among adults with chronic conditions. This study conducted longitudinal analysis investigating time trends in utilization and cost among newly insured, chronically ill, low-income individuals using Generalized Estimating Equations models. For hospitalization, hospital outpatient services, emergency department (ED) visits, and primary care visits, two indicators were measured: the proportion of enrollees with services and the average number of visits among users. The average health expenditure per person was estimated using a gamma distribution. Results indicate that the number of individuals using inpatient or ED services was highest during the first six months following insurance coverage and decreased in subsequent periods, while primary care visits increased during the first year. Using six-month rather than annual measures of utilization and cost may be necessary to identify short-run changes following initial insurance coverage.