Laurence C. Baker

Relationship of Safety Climate and Safety Performance in Hospitals

OBJECTIVE To examine the relationship between measures of hospital safety climate and hospital performance on selected Patient Safety Indicators (PSIs). DATA SOURCES Primary data from a 2004 survey of hospital personnel. Secondary data from the 2005 Medicare Provider Analysis and Review File and 2004 American Hospital Associations Annual Survey of Hospitals. STUDY DESIGN A cross-sectional study of 91 hospitals. DATA COLLECTION Negative binomial regressions used an unweighted, risk-adjusted PSI composite as dependent variable and safety climate scores and controls as independent variables. Some specifications included interpersonal, work unit, and organizational safety climate dimensions. Others included separate measures for senior managers and frontline personnels safety climate perceptions. PRINCIPAL FINDINGS Hospitals with better safety climate overall had lower relative incidence of PSIs, as did hospitals with better scores on safety climate dimensions measuring interpersonal beliefs regarding shame and blame. Frontline personnels perceptions of better safety climate predicted lower risk of experiencing PSIs, but senior manager perceptions did not. CONCLUSIONS The results link hospital safety climate to indicators of potential safety events. Some aspects of safety climate are more closely related to safety events than others. Perceptions about safety climate among some groups, such as frontline staff, are more closely related than perceptions in other groups.

The effect of HMOs on fee-for-service health care expenditures: evidence from Medicare.

This paper examines the relationship between HMO market share and fee-for-service health care expenditures using 1986-1990 county- and metropolitan statistical area-level data on Medicare expenditures and HMO market share. Fixed-effects estimates imply that fee-for-service expenditures are concave and decreasing in market share. Increases in market share from 20% to 30% are associated with 3-7% expenditure reductions. Instrumental variable estimates that exploit cross-sectional variation in HMO activity also indicate a concave relationship, with expenditures declining in market share for market shares above 15-18%, but imply larger expenditure responses to market share changes.

Patient safety climate in 92 US hospitals: differences by work area and discipline.

Background:Concern about patient safety has promoted efforts to improve safety climate. A better understanding of how patient safety climate differs among distinct work areas and disciplines in hospitals would facilitate the design and implementation of interventions. Objectives:To understand workers’ perceptions of safety climate and ways in which climate varies among hospitals and by work area and discipline. Research Design:We administered the Patient Safety Climate in Healthcare Organizations survey in 2004–2005 to personnel in a stratified random sample of 92 US hospitals. Subjects:We sampled 100% of senior managers and physicians and 10% of all other workers. We received 18,361 completed surveys (52% response). Measures:The survey measured safety climate perceptions and worker and job characteristics of hospital personnel. We calculated and compared the percent of responses inconsistent with a climate of safety among hospitals, work areas, and disciplines. Results:Overall, 17% of responses were inconsistent with a safety climate. Patient safety climate differed by hospital and among and within work areas and disciplines. Emergency department personnel perceived worse safety climate and personnel in nonclinical areas perceived better safety climate than workers in other areas. Nurses were more negative than physicians regarding their work units support and recognition of safety efforts, and physicians showed marginally more fear of shame than nurses. For other dimensions of safety climate, physician-nurse differences depended on their work area. Conclusions:Differences among and within hospitals suggest that strategies for improving safety climate and patient safety should be tailored for work areas and disciplines.

Association of coronary CT angiography or stress testing with subsequent utilization and spending among Medicare beneficiaries.

CONTEXT Coronary computed tomography angiography (CCTA) is a new noninvasive diagnostic test for coronary artery disease (CAD), but its association with subsequent clinical management has not been established. OBJECTIVE To compare utilization and spending associated with functional (stress testing) and anatomical (CCTA) noninvasive cardiac testing in a Medicare population. DESIGN, SETTING, AND PATIENTS Retrospective, observational cohort study using claims data from a 20% random sample of 2005-2008 Medicare fee-for-service beneficiaries 66 years or older with no claims for CAD in the preceding year, who received nonemergent, noninvasive testing for CAD (n = 282,830). MAIN OUTCOME MEASURES Cardiac catheterization, coronary revascularization, acute myocardial infarction, all-cause mortality, and total and CAD-related Medicare spending over 180 days of follow-up. RESULTS Compared with stress myocardial perfusion scintigraphy (MPS), CCTA was associated with an increased likelihood of subsequent cardiac catheterization (22.9% vs 12.1%; adjusted odds ratio [AOR], 2.19 [95% CI, 2.08 to 2.32]; P < .001), percutaneous coronary intervention (7.8% vs 3.4%; AOR, 2.49 [2.28 to 2.72]; P < .001), and coronary artery bypass graft surgery (3.7% vs 1.3%; AOR, 3.00 [2.63 to 3.41]; P < .001). CCTA was also associated with higher total health care spending (

Variation in access to health care for different racial/ethnic groups by the racial/ethnic composition of an individual's county of residence.

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Managed Care, Technology Adoption, and Health Care: The Adoption of Neonatal Intensive Care

3193 to

Expanded Use Of Imaging Technology And The Challenge Of Measuring Value

5267]; P < .001), which was almost entirely attributable to payments for any claims for CAD (

The Role of Organizational Infrastructure in Implementation of Hospitals' Quality Improvement

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Integrated Telehealth And Care Management Program For Medicare Beneficiaries With Chronic Disease Linked To Savings

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Managed Care, Consolidation Among Health Care Providers, and Health Care: Evidence from Mammography

4835]; P < .001). Compared with MPS, there was lower associated spending with stress echocardiography (-