Sharon B. Schweikhart

Empirical support for the Baldrige Award framework in U.S. hospitals.

Examined are relationships among constructs in the Baldrige Award Health Care Criteria framework to investigate whether quality management systems are related to organizational results and customer satisfaction in hospitals. Measures for the 19 dimensions of the Baldrige Criteria are obtained from 220 U.S. hospitals. This study provides empirical evidence that focusing on the content addressed in the Baldrige Criteria leads hospitals to improvement on some dimensions of performance.

Location and service mix decisions for a managed health care network

Abstract For managers of managed health care organizations, the problem of designing a competitive multiple facility network cannot be solved by existing mathematical models. This paper thus presents a nonlinear integer model for determining a facilities design strategy that embodies the economic tradeoffs encompassed in a competitive strategy: minimizing cost and maximizing market share. The integrated location and service mix model determines the number, location and service offerings of facilities that maximize profitability in a two-level hierarchical referral delivery network where an organizations market share is represented by a multiplicative competitive interaction model. To demonstrate the usefulness of the proposed integrated model, a series of problems is solved by an interchange heuristic and compared to the solutions derived by a simpler approach that ignores market competition.

Quality-adjusted life-years and other health indices: A comparative analysis

This article provides a descriptive overview of both unadjusted and adjusted health indices that are being applied in the current health-services research literature. We describe, give examples, and discuss a variety of the better-known health indices. Summary tables that compare health indices across dimensions, such as level of analysis, weighting methodology, preference measurement, and longevity measurement, are also included. Our goal is to provide information about similarities among and differences between health indices and enhance understanding of comparative health-outcome measurement. An extensive list of references is included to guide the reader toward additional discussions of metrics and methodologies. Given the multitude of health indices reported in the literature, this descriptive and comparative overview provides a framework for understanding these metrics in the context of health-outcomes research.

Shifts in Functions of a New Technology over Time: An Analysis of Logged Electronic Intensive Care Unit Interventions

A study of logged interventions at an electronic intensive care unit (e-ICU) was conducted to examine how functions changed over a two-year period. In total, 2301 log entries of e-ICU interventions from 2005 and 2007 were uniquely coded as to function. A Chi square goodness of fit analysis revealed that 7 out of 11 functions (64%) significantly changed over the two years that were measured. There were increases seen by the log data in the e-ICU nurses calling ICU nurses to supply missing information, recommend the use of best practices, and providing education to ICU nurses. Additionally, increases were seen for e-ICU physicians receiving requests for ordering actions to be taken on patients. Decreases were seen in e-ICU nurses communicating critical lab results and vital sign changes to ICU nurses. We discuss how these shifts relate to several of our predicted archetypical patterns for how new technologies change over time, both in terms of their primary functions as well as changes to positive and negative “unintended” consequences on secondary functions.

A Comparison of Benefit Limits in Mental Health.

Abstract This study provides insight to policy makers and stakeholders on how three types of benefits limits on Medicaid-covered mental health services might affect access for consumers diagnosed with severe mental illness. The study used a retrospective cohort design with data for Medicaid-covered, community-based mental health services provided in Ohio during fiscal year 2010. Log-binomial regression was used for the analysis. Results indicate that limits compared have significant, varying consequences based on Medicaid coverage and diagnoses. When constraining Medicaid costs, policy makers should consider how limits will disrupt care and include clinicians in discussions prior to implementation.