Health services research
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To understand hospital- and county-level factors for rural obstetric unit closures, using mixed methods. ⋯ Rural obstetric unit closures are more common in smaller hospitals and communities with a limited obstetric workforce. Concerns about continuity of rural maternity care arise for women with local prenatal care but distant intrapartum care.
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Health services research · Aug 2016
Effects of Expanded California Health Coverage on Hospitals: Implications for ACA Medicaid Expansions.
To assess the effects on hospitals of early California actions to expand insurance coverage for low-income uninsured adults after passage of the Affordable Care Act. ⋯ California hospitals that treated the most uninsured prior to insurance expansions did not as a group experience substantial benefit in terms of reduced uninsured burden or better financial performance after program expansions occurred.
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Health services research · Jun 2016
The Quality of Surgical and Pneumonia Care in Minority-Serving and Racially Integrated Hospitals.
To explore the association between quality of care for surgical and pneumonia patients and the racial/ethnic composition of hospitals' patients. ⋯ Efforts to improve quality of care for patients in minority-serving and racially integrated hospitals should focus on the lowest performers.
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Health services research · Apr 2016
Office-Based Tools and Primary Care Visit Communication, Length, and Preventive Service Delivery.
The use of physician office-based tools such as electronic health records (EHRs), health risk appraisal (HRA) instruments, and written patient reminder lists is encouraged to support efficient, high-quality, patient-centered care. We evaluate the association of exam room use of EHRs, HRA instruments, and self-generated written patient reminder lists with patient-physician communication behaviors, recommended preventive health service delivery, and visit length. ⋯ Office-based tools intended to facilitate the implementation of desired primary care practice redesign are associated with both positive and negative cost and quality outcomes. Findings highlight the need for monitoring both intended and unintended consequences of office-based tools commonly used in primary care practice redesign.
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Health services research · Dec 2015
Beyond Measurement and Reward: Methods of Motivating Quality Improvement and Accountability.
The article examines public policies designed to improve quality and accountability that do not rely on financial incentives and public reporting of provider performance. ⋯ Public policies related to quality improvement should focus more on methods of enhancing professional intrinsic motivation, while recognizing the potential role of organizations to actively promote and facilitate that motivation. Actually achieving improvement, however, will require a reexamination of the role played by financial incentives embedded in payments and the unrealistic expectations placed on marginal incentives in pay-for-performance schemes.