Ning Jackie Zhang

Health Information Technology Adoption in U.S. Acute Care Hospitals

Previous studies show that the healthcare industry lags behind many other economic sectors in the adoption of information technology. The purpose of this study is to understand differences in structural characteristics between providers that do and that do not adopt Health Information Technology (HIT) applications. Publicly available secondary data were used from three sources: American Hospital Association (AHA) annual survey, Healthcare Information and Management Systems Society (HIMSS) analytics annual survey, and Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) databases. Fifty-two information technologies were grouped into three clusters: clinical, administrative, and strategic decision making ITs. Negative binomial regression was applied with adoption of technology as the dependent variables and eight organizational and contextual factors as the independent variables. Hospitals adopt a relatively larger proportion of administrative information technology as compared to clinical and strategic IT. Large size, urban location and HMO penetration were found to be the most influential hospital characteristics that positively affect information technology adoption. There are still considerable variations in the adoption of information technology across hospitals and in the type of technology adopted. Organizational factors appear to be more influential than market factors when it comes to information technology adoption. The future research may examine whether the Electronic Health Record (EHR) Incentive Program in 2011 would increase the information technology uses in hospitals as it provides financial incentives for HER adoptions and uses among providers.

Nurse staffing and patient safety in hospitals: new variable and longitudinal approaches.

Background:Most studies of the relationship between nurse staffing and patient outcomes in hospitals have shown that worse patient outcomes are associated with lower registered nurse (RN) staffing. However, inconsistent results exist, possibly because of the use of a variety of nurse staffing and patient outcomes measures and because of statistical methods that employ static, instead of change, relationships. Objectives:The aim of the study was to examine the relationship between changes in RN staffing and patient safety events in Florida hospitals from 1996 through 2004. Methods:Using 9 years of data from 124 Florida hospitals, latent growth curve models were used to assess the impact on patient safety of RN staffing changes in hospitals. Patient safety measures were 4 of the 20 provider-level patient safety indicators (PSIs) developed by the Agency for Healthcare Research and Quality. Two measures of RN staffing—RN full-time equivalents and RN per adjusted patient day—were analyzed. Results:Changes in RN full-time equivalents were positively related to changes in RN per adjusted patient day. All PSIs were negatively and significantly related to one or both RN staffing measures. Failure to rescue had the strongest relationship to RN staffing. Models of change relationships between staffing and PSIs were more likely to show significant relationships than models using initial levels. Initial levels of RN staffing tended to be unrelated to initial levels of PSIs. Discussion:A negative relationship between RN staffing and PSIs was strongly supported with failure to rescue and was weakly supported with decubitus ulcers, selected infections, and postoperative sepsis. The PSIs should be retested in an expanded change model study using multistate or national sample Healthcare Cost and Utilization Project data.

Improving Doctor---Patient Communication: Examining Innovative Modalities Vis-à-vis Effective Patient-Centric Care Management Technology

This analysis investigates what patients and practitioners can do to improve their interactive communications to achieve optimal patient-centric (PC) care. One goal of this clinical practice approach is to improve patient satisfaction, compliance, and outcomes. The mutual responsibilities required of both the patients and practitioners to attain PC care are discussed. Innovative, information technology techniques in the healthcare environment in general and in care delivery in particular are explored. Practitioner-to-patient encouragement vis-à-vis self education on their conditions is also provided.

Predictors of Resident Outcome Improvement in Nursing Homes

The effects of contextual characteristics and nursing-related factors on the overall quality improvement of resident outcomes, measured by a weighted index in incidents of pressure ulcers, physical restraints, and catheter use in nursing homes, were investigated by autoregressive latent trajectory modeling of panel data (1997-2003). Findings show that in the initial study period, nursing homes with a smaller bed size, being for-profit, caring for more Medicare residents, having residents with lower acuity levels, being located elsewhere than the South, having a high level of nurse staffing, and certified with lower frequencies of nursing care deficiencies had better quality. The intercept factor, representing the baseline of quality, was well predicted by six of the eight contextual and facility characteristics variables, and the slope trajectory of quality was only weakly predicted by them. The improved quality in resident outcomes was associated with facilities having fewer nursing care deficiency citations than their counterparts.

Changes in Nursing Home Staffing Levels, 1997 to 2007

A positive relationship has been demonstrated between the quality of care delivered in nursing homes and the quality of nursing staff providing the care. The general perception, however, is that there is a decline in registered nurses’ staff hours in nursing homes. The primary objective of this study is to investigate whether the levels of registered nurses (RNs), licensed practical nurses (LPNs), and nursing assistants (NAs) as well as skill mix has changed in nursing homes between the years 1997 and 2007. A descriptive research design was employed on data derived from Online Survey Certification and Reporting System database. After accounting for facility size and ownership, it was found that more nursing homes have increased—rather than decreased—LPN and NA hours per resident day between 1997 and 2007. On the other hand, more nursing homes have decreased—rather than increased—RN hours per resident day and skill mix during the same time period.

Has the Medicare Prospective Payment System Led to Increased Nursing Home Efficiency

RESEARCH OBJECTIVE To assess the impact of recent Medicare prospective payment system (PPS) changes on efficiency in skilled nursing homes. DATA SOURCE/STUDY SETTING Medicare Cost Reports (MCR), On-line Survey Certification and Reporting System (OSCAR), Area Resource Files (ARF), a Centers for Medicare and Medicaid Services (CMS) hospital wage index website, a Consumer Price Index (CPI) database, and a survey of state Medicaid reimbursement rates. The sample was 8,361 nursing homes in the Medicare Cost Report databases from the years 1997 to 2003. STUDY DESIGN Data-envelopment analyses (DEA) calculated efficiency scores for three separate DEA models: unadjusted, acuity-adjusted, and acuity-and-quality-adjusted efficiency. The efficiency scores from these models were regressed on the Medicare PPS changes (the Balanced Budget Act [BBA], the Balanced Budget Refinement Act [BBRA] and the Benefits Improvement and Protection Act) and other organizational and market explanatory variables using a panel-data truncated regression. PRINCIPAL FINDINGS Mean values for all efficiency measures decreased over time, the acuity-quality-adjusted efficiency measures decreasing the most. All policy variables were significantly negatively related to all efficiency measures. Higher nurse staffing was negatively related to efficiency in all but the acuity-quality-adjusted model. Other explanatory variables varied in their relationships to the efficiency variables. CONCLUSIONS The results suggest that the reimbursement policy changes had a significantly negative impact on efficiency. Higher nurse staffing contributed to lower efficiency only when efficiency was not adjusted for quality. Various organizational and market factors also played significant roles in all efficiency models.

Evaluation of chronic disease management on outcomes and cost of care for Medicaid beneficiaries

OBJECTIVES To evaluate the impacts of the chronic disease management program on the outcomes and cost of care for Virginia Medicaid beneficiaries. METHODS A total of 35,628 patients and their physicians and pharmacists received interventions for five chronic diseases and comorbidities from 1999 to 2001. Comparisons of medical utilization and clinical outcomes between experimental groups and control group were conducted using ANOVA and ANCOVA analyses. RESULTS Findings indicate that the disease state management (DSM) program statistically significantly improved patients drug compliance and quality of life while reducing (ER), hospital, and physician office visits and adverse events. The average cost per hospitalization would have been

Introducing Ehealth to Nursing Homes: Theoretical Analysis of Improving Resident Care

42 higher without the interventions. CONCLUSIONS A coordinated disease management program designed for Medicaid patients experiencing significant chronic diseases can substantially improve clinical outcomes and reduce unnecessary medical utilization, while lowering costs, although these results were not observed across all disease groups. The DSM model may be potentially useful for Medicaid programs in states or other countries. If the adoption of the DSM model is to be promoted, evidence of its effectiveness should be tested in broader settings and best practice standards are expected.

The Measurement of Nursing Home Quality: Multilevel Confirmatory Factor Analysis of Panel Data

The purpose of this analysis argues that the technology acceptance model and the theory of task technology fit offer justification for the introduction and integration of ehealth web sites (i.e., WebMd.com) into nursing home care facility operations in the United States and abroad. The driving force behind this study concerns the significant care deficiencies in nursing homes, and how ehealth can ameliorate these conditions. Ehealth has never been a focus of study in nursing homes. Examining logistics relating to nursing homes and their residents may reveal which nursing homes would benefit from integrating ehealth as a referential resource.

Nursing home research in Jinan, China: a focus group approach

This study examined the validity of a measurement model of nursing home quality by using multilevel confirmatory factor analysis. Based on Mullan and Harrington’s (2001) facility-level quality measurement model, a two-level analysis (facility and state) of the measurement model were performed. Two research questions were asked: (1) Can the measurement model developed at the facility-level be applied to state-level nursing home quality measurement? (2) Is the measurement model of nursing home quality stable over time? Panel data of 1997 and 2001, from the national OSCAR database, were used to test the assumptions. The results show that the state-level measurement model fits the data better than the facility-level model does. When the indicator “assessment” was removed from the state-level measurement model, a better-fitted measurement model was found. The two-level measurement model is relatively stable over time, demonstrating the construct validity of this measurement model.