Keon-Hyung Lee

Factors Affecting Inpatient Satisfaction: Structural Equation Modeling

Objective: Our study aimed to identify factors affecting patient satisfaction. Data: The study was conducted at a training hospital in Turkey. The final sample consisted of 302 inpatients. In this study, patient satisfaction was examined using a survey questionnaire with 22 questions collected under five dimensions. Method: Factor analysis was used to group 22 questions measuring patients’ satisfaction questions into certain dimensions. Then, structural equation model (SEM) was performed to determine the influence of patient characteristics on patient satisfaction. Results: Our analysis showed the questionnaire has an appropriate reliability and validity. The structural equation model (SEM) was used to determine those factors which could affect patient satisfaction. The results of SEM analysis showed that 15% of the total variance in patients’ satisfaction was explained by the model. The SEM analysis found that variables of education and type of clinic (surgical vs. non-surgical) were significant on patient satisfaction. Persons with a higher level of education were less satisfied when compared to those with a lower level of education. Surgical patients are more satisfied with the care they received when compared to non-surgical patients. Conclusion: The education level of patients and the type of clinics had a significant influence on patient satisfaction.

Can case management interventions reduce the number of emergency department visits by frequent users

This study examined the impact of nurse case management interventions on the number of visits of frequent users of a level 1, urban Emergency Department that sees over 70,000 patient visits per year. Frequent users, defined as those having over 3 visits in a month, were tracked before and after implementation of nurse case management interventions designed to reduce their visit rate. It is a 50-patient pilot study and data collection includes whether or not the patient had a primary care provider, the patients age and gender, insurance status, and the type of case management interventions including medical social work, community referrals, referrals to primary care providers, and limitation of narcotic prescriptions. Based on statistical tests, pre and post case management interventions suggest that case management interventions do not make a statistically significant reduction in the overall number of visits. This is a medically vulnerable patient group whose visits add to the contemporary problem of Emergency Department overcrowding. The ability of case management interventions to reduce the volume of visits and associated impact on reducing Emergency Department overcrowding was not proven.

LINKING EMPOWERMENT AND JOB ENRICHMENT TO TURNOVER INTENTION: THE INFLUENCE OF JOB SATISFACTION

Because of the increasing turnover rate in government organizations and the fact that turnover induces costs, both managers and scholars need to better understand the factors affecting turnover among public employees. Using the 2006 General Social Survey (GSS) data, this study examines the complex causal paths between empowerment, job enrichment, job satisfaction, and turnover intention. We argue that job satisfaction plays an important role in explaining turnover intention among public employees. Empowerment is significantly indirectly related to turnover intention through its impact on job satisfaction. Likewise, job enrichment is also significantly indirectly related to turnover intention through its impact on job satisfaction.

Determinants of Hospital Choice of Rural Hospital Patients: The Impact of Networks, Service Scopes, and Market Competition

Among 10,384 rural Colorado female patients who received MDC 14 (obstetric services) from 2000 to 2003, 6,615 (63.7%) were admitted to their local rural hospitals; 1,654 (15.9%) were admitted to other rural hospitals; and 2,115 (20.4%) traveled to urban hospitals for inpatient services. This study is to examine how network participation, service scopes, and market competition influences rural women’s choice of hospital for their obstetric care. A conditional logistic regression analysis was used. The network participation (p < 0.01), the number of services offered (p < 0.05), and the hospital market competition had a positive and significant relationship with patients’ choice to receive obstetric care. That is, rural patients prefer to receive care from a hospital that participates in a network, that provides more number of services, and that has a greater market share (i.e., a lower level of market competition) in their locality. Rural hospitals could actively increase their competitiveness and market share by increasing the number of health care services provided and seeking to network with other hospitals.

The Association Between Clinical Pathways and Hospital Length of Stay: A Case Study

Clinical pathways are the treatment protocol in order to reduce or eliminate variation of care by specifying to nursing and medical staff. The effectiveness of the clinical pathways to accomplish this goal, however, is in question. With the implementation of the clinical pathways in 2001, this study evaluates the effectiveness of clinical pathway in reducing the inpatient length of stay in a rural hospital in a Midwestern state. All inpatient cases were used with the primary diagnoses of chronic obstructive pulmonary disease, congestive heart failure, diabetes, myocardial infarction, and pneumonia from the years of 1999–2003. By controlling for gender, age, insurance type, and year, this study employs a multiple regression analysis to evaluate the association between clinical pathways and the length of stay. Only one (the clinical pathway for myocardial infarction) out of the five pathways studied showed an association with a statistical significance in decreasing the length of stay. Health care administrators should consider other aspects as well as the hospital length of stays when implementing clinical pathways in their facility.

THE ADOPTION OF STATE GROWTH MANAGEMENT REGULATION (SGMR) : REGARDING INSTITUTIONAL ANALYSIS AND DEVELOPMENT (IAD) FRAMEWORK AND EVENT HISTORY ANALYSIS

Growth management means specific regulatory policies aimed at influencing future growth so that it occurs in a more rational manner than would occur without any overall planning. Currently, thirteen U.S. states have adopted state growth management regulation (SGMR). The contemporary SGMR provides the statewide planning programs and goals that reduce negative externality and spillover effects and emphasize balanced sustainable development. The mediating role of SGMR is well matched with the explanatory framework of institutional analysis and development (IAD) in terms of solving social dilemmas in social contextual circumstances. This paper seeks to explain what factors account for the adoption of SGMR. By applying the IAD framework, the authors analyze the impact of political party ideology, community characteristics, and physical conditions. Through event history analysis, the authors found influencing important factors: political party ideology and citizen liberalism, real estate interest, and growth pressure.

Has competition increased hospital technical efficiency

Hospital competition and managed care have affected the hospital industry in various ways including technical efficiency. Hospital efficiency has become an important topic, and it is important to properly measure hospital efficiency in order to evaluate the impact of policies on the hospital industry. The primary independent variable is hospital competition. By using the 2001-2004 inpatient discharge data from Florida, we calculate the degree of hospital competition in Florida for 4 years. Hospital efficiency scores are developed using the Data Envelopment Analysis and by using the selected input and output variables from the American Hospital Association’s Annual Survey of Hospitals for those acute care general hospitals in Florida. By using the hospital efficiency score as a dependent variable, we analyze the effects of hospital competition on hospital efficiency from 2001 to 2004 and find that when a hospital was located in a less competitive market in 2003, its technical efficiency score was lower than those in a more competitive market.

The association between managed care enrollments and potentially preventable hospitalization among adult Medicaid recipients in Florida

BackgroundThe intent of adopting managed care plans is to improve access to health care services while containing costs. To date, there have been a number of studies that examine the relationship between managed care and access to health care. However, the results from previous studies have been inconsistent. Specifically, previous studies did not demonstrate a clear benefit of Medicaid managed care. In this study we have examine whether Medicaid managed care is associated with the probabilities of preventable hospitalizations. This study also analyzes the spillover effect of Medicaid managed care into Medicaid patients in traditional FFS plans and the interaction effects of other patient- and county-level variables on preventable hospitalizations.MethodsThe study included 254,321 Medicaid patients who were admitted to short-term general hospital in the 67 counties in Florida. Using 2008 hospital inpatient discharge data for working-age adult Medicaid enrollees (18-64 years) in Florida, we conduct multivariate logistic regression analyses to identify possible factors associated with preventable hospitalizations. The first model includes patient- and county-level variables. Then, we add interaction terms between Medicaid HMO and other variables such as race, rurality, market-level factors, and resource for primary care.ResultsThe results show that Medicaid HMO patients are more likely to be hospitalized for ambulatory care sensitive conditions (ACSCs) (OR = 1.30; CI = 1.21, 1.40). We also find that market structure (i.e., competition) is significantly associated with preventable hospitalizations. However, our study does not support that there are spillover effects of Medicaid managed care on preventable hospitalizations for other Medicaid recipients. We find that interactions between Medicaid managed care and race, rurality and market structure are significant.ConclusionsThe results of our study show that the Medicaid managed care program in Florida was associated with an increase in potentially preventable hospitalizations for Medicaid enrollees. The results suggest that lower capitation rate has been associated with a greater likelihood of preventable hospitalizations for Medicaid managed care patients. Our findings also indicate that increased competition in the Medicaid managed care market has no clear benefit in Medicaid managed care patients.

Growth Management Priority and Land-Use Regulation in Local Government: Employing a Full Structural Equation Model

Growth management is a rational means of controlling local land use and development patterns in terms of regulatory policy. The authors expand the scope of previous research by addressing the causal relationship between the land-use policy-making process and its consequences. In terms of the political market perspective, this research examines direct and indirect causalities among interest groups, government, land-use policy choice, and the policy outcome. On the basis of the theoretical and analytical setting, the authors conclude that local governments are positively influenced by growth management–oriented interest groups, and they are more likely to devise smart growth land-use tools, but less likely to choose direct land-use regulation. Within governmental regulatory actions, however, direct regulations such as urban growth restrictions, greenbelts, and rural protection lines are regarded as more effective instruments to identify the stringency of land-use regulation for reducing urban sprawl rather than smart growth land-use policy tools. Finally, the causal relationships found in this research imply that, rather than using one direct effect measurement in the study of land-use regulation, the different dimensions have various causalities on land-use regulation and regulatory performances.

An Analysis of Structural Relationships among Financial Indicators of Hospitals in Korea: Applying Structural Equation Modeling(SEM)

Financial ratios are key indicators of an organization`s financial and business conditions. Among various financial indicators, profitability, financial structure, financial activity and liquidity ratios are frequently used and analyzed. Using the structural equation modeling(SEM) technique, this study examines the structural causal relationships among key financial indicators. Data for this study are taken from complete financial statements from 142 hospitals that passed the standardization audit undertaken by the Korean Hospital Association from 1998 to 2001 for the purpose of accrediting teaching hospitals. In order to improve comparability, ratio values are standardized using the Blom`s normal distribution. The final model of the SEM has four latent constructs: financial activity(total asset turnover, fixed asset turnover), liquidity(current ratio, quick ratio, collection period), financial structure(total debt to equity, long-term debt to equity, fixed assets to fund balance), and profitability(return on assets, normal profit to total assets, operating margin to gross revenue, normal profit to gross revenue). While examining several model fit indices(Chi-square (df)