Nazik M.A. Zakari

Does value-based purchasing affect US hospital utilization pattern: A comparative study

ABSTRACT We evaluated the effect US hospital performance as measured by the Medicare hospital value-based purchasing (HVBP) program has on the volume of hospitals inpatient and outpatient services. We analyzed data from the 2013 to 2014 American Hospital Association database, HVBP total performance scores database through Centers for Medicare and Medicaid Services (CMS) and the area health resources files database through CMS. This study utilized a multinomial logistic regression and transaction cost economic theory, adjusting for the Herfindahl–Hirschman Index, number of facility beds, beds per thousand, individuals 65+, teaching status, location, ownership, and system affiliation. The prominent study findings indicate a significant relationship between percent utilization of inpatient, outpatient and HVBP score. Furthermore, environmental factors such as the Herfindahl–Hirschman Index, and system participation were found to significantly impact hospitals ratio of inpatient to outpatient. Relative risk ratios show that hospitals with overall lower HVB are more likely to be in the top 25 percentile for outpatient services. With the decline in inpatient volume of services and the rise in outpatient utilization, inpatient metrics will continue to be relevant as key indicators of quality of care. Inpatient services will never become irrelevant to the overall financial profile of hospital performance.

Impact of Simulation on Nursing Students’ Competence: A Perspective Qualitative Study in Saudi Arabia

The goal of transformation in nursing education is to improve the quality of nursing training, which will impact the quality of holistic nursing care. This paper presents results from a rich active discussion of faculty perspective about the impact of simulation on student competence. The study used inductive, interpretive and constructive types of qualitative research design. The author conducted three focus group discussions, and 22 faculty members from the College of Nursing at King Saud University participated. Each focus group was interviewed and audio recorded for 60 minutes. The study yielded three main themes: students ’readiness for simulated reality, required processes for successful simulation, and challenges of simulation implementation. Understanding the faculty perspectives will help appropriately support and facilitate nursing simulation education.