Olena Mazurenko

Environmental market factors associated with physician career satisfaction.

EXECUTIVE SUMMARY Previous research has found that physician career satisfaction is declining, but no study has examined the relationship between market factors and physician career satisfaction. Using a theoretical framework, we examined how various aspects of the market environment (e.g., munificence, dynamism, complexity) are related to overall career satisfaction. Nationally representative data from the 2008 Health Tracking Physician Survey were combined with environmental market variables from the 2008 Area Resource File. After controlling for physician and practice characteristics, at least one variable each representing munificence, dynamism, and complexity was associated with satisfaction. An increase in the market number of primary care physicians per capita was positively associated with physician career satisfaction (OR = 2.11, 95% CI: 1.13 to 3.9) whereas an increase in the number of specialists per capita was negatively associated with physician satisfaction (OR = 0.68, 95% CI: 0.48 to 0.97). Moreover, an increase in poverty rates was negatively associated with physician career satisfaction (OR = 0.95, 95% CI: 0.91 to 1.01). Lastly, physicians practicing in states with a malpractice crisis (OR = 0.81, 95% CI: 0.68 to 0.96) and/or those who perceived high competition in their markets (OR = 0.76, 95% CI: 0.61 to 0.95) had lower odds of being satisfied. A better understanding of an organizations environment could assist healthcare managers in shaping their policies and strategies to increase physician satisfaction.

Environmental factors associated with physician's engagement in communication activities.

Background: Communication between patients and providers is a crucial component of effective care coordination and is associated with a number of desired patient and provider outcomes. Despite these benefits, physician–patient and physician–physician communication occurs infrequently. Purpose: The purpose of this study was to examine the relationship between a medical practice’s external environment and physician engagement in communication activities. Methodology/Approach: This was a cross-sectional examination of 4,299 U.S. physicians’ self-reported engagement in communication activities. Communication was operationalized as physician’s time spent on communication with patients and other providers during a typical work day. The explanatory variables were measures of environmental complexity, dynamism, and munificence. Data sources were the Health Tracking Physician Survey, the Area Resource File database, and the Dartmouth Atlas. Binary logistic regression was used to estimate the association between the environmental factors and physician engagement in communication activities. Findings: Several environmental factors, including per capita income (odds ratio range, 1.17–1.38), urban location (odds ratio range, 1.08–1.45), fluctuations in Health Maintenance Organization penetration (odds ratio range, 3.47–13.22), poverty (odds ratio range, 0.80–0.97) and population rates (odds ratio range, 1.01–1.02), and the presence of a malpractice crisis (odds ratio range, 0.22–0.43), were significantly associated with communication. Practice Implications: Certain aspects of a physician’s external environment are associated with different modes of communication with different recipients (patients and providers). This knowledge can be used by health care managers and policy makers who strive to improve communication between different stakeholders within the health care system (e.g., patient and providers).

International medical graduates and health information technology use in the United States.

PURPOSE Health information technology (HIT) holds promise for improving the quality of health care and reducing health care system inefficiencies. Numerous studies have examined HIT availability, specifically electronic health records (EHRs), and utilization among physicians in individual countries. However, no one has examined EHR use among physicians who train in one country and move to practice in another country. In the United States, physicians who complete medical school outside the country but practice within the United States are commonly referred to as International Medical Graduates (IMGs). IMGs have a growing presence in the United States, yet little is known about the availability and use of HIT among these physicians. The purpose of this study is to explore the availability and use of HIT among IMGs practicing in United States. DESIGN/METHODOLOGY/APPROACH The Health Tracking Physician Survey (2008) was used to examine the relationship between availability and use of HIT and IMG status controlling for several physician and practice characteristics. Our analysis included responses from 4,720 physicians, 20.7% of whom were IMGs. FINDINGS Using logistic regression, controlling for physician gender, specialty, years in practice, practice type, ownership status and geographical location, we found IMGs were significantly less likely to have a comprehensive EHR in their practices (OR = 0.84; p = 0.005). In addition, findings indicate that IMGs are more likely to have and use several so-called first generation HIT capabilities, such as reminders for clinicians about preventive services (OR = 1.31; p = 0.001) and other needed patient follow-up (OR = 1.26; p = 0.007). ORIGINALITY/VALUE This study draws attention to the need for further research regarding barriers to HIT adoption and use among IMGs.

Predictors of Hospital Patient Satisfaction as Measured by Hcahps: A Systematic Review

EXECUTIVE SUMMARY Because Medicare reimbursements are now, in part, based on patient satisfaction scores, hospitals are increasingly concerned about improving patient satisfaction. However, little is known about the different characteristics that are associated with higher patient satisfaction. This study was conducted to systematically review the patient satisfaction literature and to identify predictors of patient satisfaction based on measures from the HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey. We searched the PubMed and Scopus databases from January 2007 to February 2015 for relevant peer-reviewed studies. A total of 41 studies met our inclusion criteria and were categorized into three groups (levels) based on the types of predictors used in the study: patient (12 articles, 29.9%), hospital (29 articles, 70.1%), or market (4 articles, 9.7%) predictors. We present a narrative review of the included studies in which certain patient- and hospital-level predictors were consistently associated with higher patient satisfaction (e.g., patient perception of well-managed pain and not-for-profit status) or lower patient satisfaction (e.g., racial/ethnic minority, hospital’s safety net status, metropolitan area). Moreover, several predictors had mixed relationships with patient satisfaction across studies (e.g., teaching status, number of beds). Finally, we found that only a small number of studies have examined the association between market-level predictors and patient satisfaction.

Use of foreign-educated nurses and patient satisfaction in U.S. hospitals.

Purpose: In the context of value-based purchasing, this study examines the association between the utilization of foreign-educated registered nurses (RNs) and patient satisfaction among U.S. acute care hospitals. Data Sources/Study Setting: We utilized data from the Hospital Consumer Assessment of Healthcare Providers and Systems to measure patient satisfaction and data from the American Hospital Association regarding the utilization of foreign-educated RNs in 2012. Methodology/Approach: In this study, a cross-sectional design with propensity score adjustment to examine the relationship between use of foreign-educated nurses and 10 patient satisfaction outcome measures. Control variables include hospital size, ownership, geographic location, teaching status, system membership, a high-technology index, and U.S. region based on census categories. Findings: The utilization of foreign-educated RNs was negatively and significantly related to six patient satisfaction measures. Specifically, hospitals with foreign-educated RNs scored, on average, lower on measures related to nurse communication (&bgr; = −0.649, p = .01), doctor’s communication (&bgr; = −0.837, p ⩽ .001), communication about administered drugs (&bgr; = −0.539, p = .81), and communication about what to do during their recovery at home (&bgr; = −0.571, p = .01). Moreover, hospitals utilizing foreign-educated RNs scored, on average, lower on overall satisfaction measures including rating the hospital as 9 or 10 overall (&bgr; = −1.20, p = .005), and patients would definitely recommend the hospital (&bgr; = −1.32, p = .006). Practice Implications: Utilization of foreign-educated RNs is negatively associated with measures of patient satisfaction pertaining to communication and overall perceptions of care. Hospitals that utilize foreign-educated RNs should consider strategies that enhance communication competency and aid improving perception of care among patients.

Trends in governance structure and activities among not-for-profit U.S. hospitals: 2009–2015

Background: In U.S. hospitals, boards of directors (BODs) have numerous governance responsibilities including overseeing hospital activities and guiding strategic decisions. BODs can help hospitals adapt to changes in their markets including those stemming from a shift from fee-for-service to value-based purchasing. The recent increase in market turbulence for hospitals has brought renewed attention to the work of BODs. Purpose: The aim of the study was to examine trends in hospital BOD structure and activities and determine whether these changes are commensurate with approaches designed to respond to market pressures. Methodology/Approach: We examined hospital level data from The Governance Institute Survey (2009, 2011, 2013, and 2015) and corresponding years of the American Hospital Association Annual Survey in a pooled, cross-sectional design. We conducted individual multivariate models with adjustments for hospital and market characteristics, comparing the changes in BOD structures, demographics, and activities over time. Findings: The sample included 1,811 hospital-year observations, including 682 unique facilities. We found that BODs in 2015 had less internal management (β = −2.25, p < .001) and fewer employed and nonemployed physicians (β = −8.28, p < .001) involved on the BOD. Moreover, compared to 2009, racial and ethnic minorities (2013 β = 2.88, p < .001) and women (2013 β = 1.60, p = .045; 2015 β = 2.06, p = .049) on BODs increased over time. In addition, BODs were significantly less likely to spend time on the following activities in 2015, as compared to 2009: discussing strategy and setting policy (β = −5.46, p = .002); receiving reports from management, board committees, and subsidiaries (β = −29.04, p < .001); and educating board members (β = −4.21, p < .001). Finally, BODs had no changes in the type of committees reported over time. Practice Implications: Our results indicate that hospital BODs deploy various strategies to adapt to current market trends. Hospital decision-makers should be aware of the potential effects of board structure on organization’s position in the changing health care market.

Determinants of physicians' career choices in Ukraine

Political and economic changes have created challenges for physician attrition rates in Ukraine. This study examined how a cross-section of Ukrainian physicians prioritised the factors hypothesised to influence decisions about continuing to work in medicine. A survey was conducted with 443 physicians in Ukraine. Latent class choice analysis (LCA) was used to model the heterogeneity in pair-wise comparisons of factors related to physician continued employment in medicine. The response rate was 70% (N = 310). Respondents, on average, were 45.4 years old, practiced 21.6 years. Four groups were identified on the basis of how they prioritised factors about work. Group 1 (47.7%) was ‘culture-focused’, group 2 (27.7%) was ‘advancement-focused’, group 3 (16.2%) was ‘routinisation-focused’, and group 4 (8.5%) was ‘externally-focused’. The use of a person-centred analytical approach represents an alternative for examining career decision issues that should be considered for subgroups within the workforce.