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Wang X, Xu J. Evaluating private hospital performance before and during COVID-19 in China. Medicine (Baltimore) 2024; 103:e38327. [PMID: 38787968 PMCID: PMC11124748 DOI: 10.1097/md.0000000000038327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 05/01/2024] [Indexed: 05/26/2024] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic had a tremendous impact on the global medical system. The development of private hospitals is an important measure to deepen the reform of China's medical and health system, and an important driving force to improve the effective supply of medical services. This study aims to compare the performance of China's private hospitals before and during COVID-19 and determine the factors that affect hospital profitability between the 2 periods. Data are collected from 10 private listed hospitals from 2017 to 2022, and ratio analysis is used to measure hospital performance in 5 aspects, namely profitability, liquidity, leverage, activity (efficiency), and cost coverage. Multiple regression analysis is used to determine the influencing factors of hospital profitability. The results show a negative impact of COVID-19 on private hospital performance. Specifically, regardless of region, hospital profitability, liquidity, and cost coverage were reduced due to COVID-19, while hospital leverage was increased. COVID-19 had also an impact on hospital efficiency. In addition, before COVID-19, current ratio and cost coverage ratio were the determinants of hospital profitability, while only cost coverage ratio affected hospital profitability during the COVID-19 outbreak. We provide evidence that COVID-19 had an impact on China private hospitals, and the findings will aid private hospitals in improving their performance in the post-COVID-19 era.
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Affiliation(s)
- Xiaowen Wang
- Financial Department, Qingdao Qingte Zhongji Axle Co., Ltd., Qingdao, China
| | - Jian Xu
- Department of Economics and Management, Qingdao Agricultural University, Qingdao, China
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Ono H, Haga K, Nakanishi E, Watanabe R, Manabe M, Awamura K, Kawano T, Nii M, Muya M, Sakashita R. Factors and Challenges in Increasing the Utilization Rate of a New Long-term Care Service (Kantaki) in a Superaging Society: Cross-sectional Study. Asian Pac Isl Nurs J 2023; 7:e45779. [PMID: 37159260 DOI: 10.2196/45779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/26/2023] [Accepted: 04/14/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND Japan is a superaging society unparalleled in the world. Elderly people who need medical care do not receive adequate support in the community. As a new service to address this issue, a small-scale multifunctional in-home care nursing service called Kantaki was created in 2012. Kantaki, in collaboration with a primary physician, operates 24 hours a day and provides various nursing services (home visits, home care, day care, and overnight stays) to older people living in the community. The Japanese Nursing Association is working hard to promote this system; however, its low utilization rate is an issue. OBJECTIVE This study aimed to determine factors influencing the utilization rate of Kantaki facilities. METHODS This was a cross-sectional study. A questionnaire on the operation of Kantaki was sent to all administrators of Kantaki facilities operating in Japan from October 1 to December 31, 2020. A multiple regression analysis was used to determine factors associated with a high utilization rate. RESULTS Responses from 154 of the 593 facilities were analyzed. The average utilization rate for all valid responding facilities was 79.4%. The average number of actual users and the break-even point were almost equal, resulting in little surplus profit from facility operations. A multiple regression analysis showed that factors that had a significant impact on the utilization rate included the break-even point, a surplus of users relative to the break-even point (ie, the margin of revenues), the number of months in office of the administrator, the type of corporation (ie, nonprofit), and Kantaki's profit from operating home-visit nursing offices. The break-even point, a surplus of users relative to the break-even point, and the number of months in office of the administrator were robust. In addition, support for reducing the burden on family helpers, a service sought by the system, significantly and negatively affected the utilization rate. In the analysis that removed the most influential factors, the cooperation of the home-visit nursing office, Kantaki's profit from operating the home-visit nursing office, and the number of full-time care workers were significantly related. CONCLUSIONS To improve the utilization rate, managers need to stabilize their organization and increase profitability. However, a positive relationship was found between the break-even point and utilization rate, suggesting that simply increasing users did not contribute to cost reduction. Moreover, providing services that meet the needs of individual clients may result in lower utilization rates. These results, which are inconsistent with common sense, reflect the divergence between the assumptions underlying the system's design and actual conditions. To solve these issues, institutional reforms, such as an increase in nursing care fee points, may be necessary.
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Affiliation(s)
- Hiroshi Ono
- College of Nursing Art and Science, University of Hyogo, Akashi, Japan
| | - Kuniko Haga
- Faculty of Nursing, Tokyo University of Information Sciences, Chiba, Japan
| | - Eiko Nakanishi
- College of Nursing Art and Science, University of Hyogo, Akashi, Japan
| | - Rika Watanabe
- College of Nursing Art and Science, University of Hyogo, Akashi, Japan
| | - Masashi Manabe
- Faculty of Business Innovation, Kaetsu University, Kodaira Tokyo, Japan
| | - Kenji Awamura
- College of Nursing Art and Science, University of Hyogo, Akashi, Japan
| | - Takanori Kawano
- College of Nursing Art and Science, University of Hyogo, Akashi, Japan
| | - Manabu Nii
- Graduate School of Engineering, University of Hyogo, Himeji, Japan
| | - Makiko Muya
- College of Nursing Art and Science, University of Hyogo, Akashi, Japan
| | - Reiko Sakashita
- College of Nursing Art and Science, University of Hyogo, Akashi, Japan
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Kiss A, Kiss N, Váradi B. Do budget constraints limit access to health care? Evidence from PCI treatments in Hungary. INTERNATIONAL JOURNAL OF HEALTH ECONOMICS AND MANAGEMENT 2023; 23:281-302. [PMID: 37074540 PMCID: PMC10156867 DOI: 10.1007/s10754-023-09349-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 02/16/2023] [Indexed: 05/03/2023]
Abstract
Under Hungary's single payer health care system, hospitals face an annual budget cap on most of their diagnoses-related group based reimbursements. In July 2012, percutaneous coronary intervention (PCI) treatments of acute myocardial infarction were exempted from that hospital level budget cap. We use countrywide individual-level patient data from 2009 to 2015 to map the effect of such a quasi-experimental change in monetary incentives on health provider decisions and health outcomes. We find that direct admissions into PCI-capable hospitals increase, especially in central Hungary, where there are several hospitals which can compete for patients. The proportion of PCI treatments at PCI-capable hospitals, however, does not increase, and neither does the number of patient transfers from non-PCI hospitals to PCI-capable ones. We conclude that only patient pathways, plausibly influenced by hospital management, were affected by the shift in incentives, while physicians' treatment decisions were not. While average length of stay decreased, we do not find any effect on 30-day readmissions or in-hospital mortality.
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Affiliation(s)
- András Kiss
- KYOS Energy Consulting, Haarlem, The Netherlands.
- Department of Economics, University of Amsterdam, Amsterdam, The Netherlands.
| | - Norbert Kiss
- Institute of Management, Corvinus University of Budapest, Budapest, Hungary
| | - Balázs Váradi
- Department of Economics, ELTE University, Budapest, Hungary
- Budapest Institute for Policy Analysis, Budapest, Hungary
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Dubas-Jakóbczyk K, Kocot E, Tambor M, Szetela P, Kostrzewska O, Siegrist Jr RB, Quentin W. The Association Between Hospital Financial Performance and the Quality of Care - A Scoping Literature Review. Int J Health Policy Manag 2022; 11:2816-2828. [PMID: 35988029 PMCID: PMC10105205 DOI: 10.34172/ijhpm.2022.6957] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 07/20/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Improving the quality of hospital care is an important policy objective. Hospitals operate under pressure to contain costs and might face challenges related to financial deficits. The objective of this paper was to identify and map the available evidence on the association between hospital financial performance (FP) and quality of care (Q). METHODS A scoping review was performed. Searches were conducted in 7 databases: Medline via PubMed, EMBASE, Web of Science, Scopus, EconLit, ABI/INFORM, and Business Source Complete. The search strategy combined multiple terms from 3 topics: hospital AND FP AND Q. The collected data were analysed using both quantitative and qualitative methods. RESULTS 10 503 records were screened and 151 full text papers analysed. A total of 69 papers were included (60 empirical, 2 theoretical, 5 literature reviews, and 2 dissertations). The majority of identified studies were published within the last decade (2010-2021). Most empirical studies had been conducted in the United States (55/60), used cross-sectional approaches (32/60) and applied diverse regression models with FP measures as dependent variables, thus measuring the impact of Q on hospitals FP (34/60). The comparability of the studies' results is limited due to differences in applied methods and settings. Yet, the general overview shows that in almost half of the cases the association between hospital FP and Q was positive, while no study showed a clear negative association. CONCLUSION This scoping review provides an overview of the available literature on the association between hospital FP and Q. The results highlight numerous research gaps: (1) systematic reviews and meta-analyses of existing studies with similar measures of FP and Q are unavailable, (2) further methodological/conceptual work is needed on the metrics measuring hospital FP and Q, and (3) more empirical studies should analyse the association between FP and Q in non-US healthcare settings.
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Affiliation(s)
- Katarzyna Dubas-Jakóbczyk
- Health Economics and Social Security Department, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Ewa Kocot
- Health Economics and Social Security Department, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Marzena Tambor
- Health Economics and Social Security Department, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Przemysław Szetela
- Health Economics and Social Security Department, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Olga Kostrzewska
- Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | | | - Wilm Quentin
- Department of Health Care Management, Technische Universität Berlin, Berlin, Germany
- European Observatory on Health Systems and Policies, WHO European Centre for Health Policy Eurostation (Office 07C020), Brussels, Belgium
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Al-Saidat HM, Malak MZ, Alnawafleh AH. Patients' Perception of Quality Nursing Care and Services in Emergency Department in Jordan. Hosp Top 2022:1-10. [PMID: 36369913 DOI: 10.1080/00185868.2022.2144577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Patients are the main users of every hospital service particularly the emergency department. Hence, patients' perception is one of the quality care measures. Thus, this study purposed to assess the patients' perception of quality nursing care and services in emergency department in Jordan. A cross-sectional, descriptive correlational design was adopted on a sample of patients who attended the emergency department (N = 427). Findings demonstrated that most of the health sectors in Jordan had a high level of patients' perception of quality nursing care and related emergency department services (M = 3.93, SD = 0.72). Furthermore, the private sector had the highest mean score (M = 4.18, SD= 0.70), while the government sector had the lowest mean (M = 3.11, SD= 0.38). The level of perception had positive relationship with income (r = 0.097; p < 0.05) and qualifications (r p.b = 0.093; p < 0.05). The number of visits showed a significant negative correlation with patients' perception level (r = - 0.095; p < 0.05). Thus, there is a need for improving the quality of nursing care and services in the emergency department at hospitals by strengthening the policy and enhancing the nursing services supporting system. Establishing plans to develop the infrastructures, equipment, physical environment, sanitation, and facilities in the emergency department to meet the patients' needs to enhance the quality of care and services are needed.
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Affiliation(s)
| | - Malakeh Z Malak
- Community Health Nursing, Al-Zaytoonah University of Jordan, Amman, Jordan
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Shen YC, Sarkar N, Hsia RY. Structural Inequities for Historically Underserved Communities in the Adoption of Stroke Certification in the United States. JAMA Neurol 2022; 79:777-786. [PMID: 35759253 PMCID: PMC9237804 DOI: 10.1001/jamaneurol.2022.1621] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 04/28/2022] [Indexed: 12/22/2022]
Abstract
Importance Stroke centers are associated with better outcomes. There is substantial literature surrounding disparities in stroke outcomes for underserved populations. However, the existing literature has focused primarily on discrimination at the individual or institutional level, and studies of structural discrimination in stroke care are scant. Objective To examine differences in hospitals' likelihood of adopting stroke care certification between historically underserved and general communities. Design, Setting, and Participants This study combined a data set of hospital stroke certification from all general acute nonfederal hospitals in the continental US from January 1, 2009, to December 31, 2019, with national, hospital, and census data to define historically underserved communities by racial and ethnic composition, income distribution, and rurality. For all categories except rurality, communities were categorized by the composition and degree of segregation of each characteristic. Cox proportional hazard models were then estimated to compare the hazard of adopting stroke care certification between historically underserved and general communities, adjusting for population size and hospital bed capacity. Data were analyzed from June 2021 to April 2022. Main Outcomes and Measures Hospitals' likelihood of adopting stroke care certification. Results A total of 4984 hospitals were included. From 2009 to 2019, the total number of hospitals with stroke certification grew from 961 to 1763. Hospitals serving Black, racially segregated communities had the highest hazard of adopting stroke care certification (hazard ratio [HR], 1.67; 95% CI, 1.41-1.97) in models not accounting for population size, but their hazard was 26% lower than among those serving non-Black, racially segregated communities (HR, 0.74; 95% CI, 0.62-0.89) in models controlling for population and hospital size. Adoption hazard was lower in low-income communities compared with high-income communities, regardless of their level of economic segregation, and rural hospitals were much less likely to adopt any level of stroke care certification relative to urban hospitals (HR, 0.43; 95% CI, 0.35-0.51). Conclusions and Relevance In this analysis of stroke certification adoption across acute care hospitals in the US from 2009 to 2019, hospitals in low-income and rural communities had a lower likelihood of receiving stroke certification than hospitals in general communities. Hospitals operating in Black, racially segregated communities had the highest likelihood of adopting stroke care, but because these communities had the largest population, patients in these communities had the lowest likelihood of access to stroke-certified hospitals when the model controlled for population size. These findings provide empirical evidence that the provision of acute neurological services is structurally inequitable across historically underserved communities.
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Affiliation(s)
- Yu-Chu Shen
- Naval Postgraduate School, Monterey, California
- National Bureau of Economic Research, Cambridge, Massachusetts
| | - Nandita Sarkar
- National Bureau of Economic Research, Cambridge, Massachusetts
| | - Renee Y. Hsia
- Department of Emergency Medicine, University of California, San Francisco
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Hospitals during economic crisis: a systematic review based on resilience system capacities framework. BMC Health Serv Res 2022; 22:977. [PMID: 35907833 PMCID: PMC9339182 DOI: 10.1186/s12913-022-08316-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 07/11/2022] [Indexed: 11/30/2022] Open
Abstract
Background Hospitals are the biggest users of the health system budgets. Policymakers are interested in improving hospital efficiency while maintaining their performance during the economic crisis. This study aims at analysing the hospitals’ policy solutions during the economic crisis using the resilience system capacities framework. Method This study is a systematic review. The search strategy was implemented on the Web of Science, PubMed, Embase, Scopus databases, and Econbiz search portal. Data were extracted and analysed through the comparative table of resilience system capacities framework and the World Health Organization (WHO) health system’s six building blocks (i.e., leadership and governance, service delivery, health workforce, health systems financing, health information systems, and medicines and equipment). Findings After the screening, 78 studies across 36 countries were reviewed. The economic crisis and adopted policies had a destructive effect on hospital contribution in achieving Universal Health Coverage (UHC). The short-term absorptive capacity policies were the most frequent policies against the economic crisis. Moreover, the least frequent and most effective policies were adaptive policies. Transformative policies mainly focused on moving from hospital-based to integrated and community-based services. The strength of primary care and community-based services, types and combination of hospital financing systems, hospital performance before the crisis, hospital managers’ competencies, and regional, specialties, and ownership differences between hospitals can affect the nature and success of adopted policies. Conclusion The focus of countries on short-term policies and undermining necessary contextual factors, prioritizing efficiency over quality, and ignoring the interrelation of policies compromised hospital contribution in UHC. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08316-4.
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Dubas-Jakóbczyk K, Kocot E, Tambor M, Quentin W. The association between hospital financial performance and the quality of care-a scoping review protocol. Syst Rev 2021; 10:221. [PMID: 34380566 PMCID: PMC8359611 DOI: 10.1186/s13643-021-01778-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 07/28/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Hospitals operate under constant pressure to contain costs and improve the quality of care. The literature suggests that there is an association between health care providers' financial performance and the quality of care. On the one hand, providers that are financially more stable might have better capacity to maintain reliable systems and resources for quality improvement. On the other hand, providing better quality of care might lead to financial gains in the form of increased revenues or achieved savings and, in consequence, a higher profitability. The general objective of this scoping review is to identify and map the available evidence on the association between hospital financial performance and the quality of care. It aims to (1) provide a broad overview of the topic and (2) indicate a more precise research question for a future systematic review. METHODS This scoping review will follow five stages: (1) defining the research question; (2) identifying relevant literature; (3) study selection; (4) data extraction; (5) collating, summarizing, and reporting the results; and (6) the consultation process and engagement of knowledge users. The following databases will be searched: MEDLINE via PubMed, (2) EMBASE, (3) Web of Science, (4) Scopus, (5) EconLit, (6) ABI/INFORM, and (7) Business Source Premier. The reference lists of relevant papers will be visually scanned with the aim of identifying further studies of interest. Also, a gray literature search will be conducted by screening the websites of diverse organizations dealing with hospital performance and/or quality of care. The review will not apply a publication date limit and will include both quantitative and qualitative empirical studies as well as theoretical papers, technical reports, books/chapters, and thesis. The reporting will utilize the PRISMA extension for a Scoping Review checklist. DISCUSSION This scoping review will provide an overview of the existing literature on the association between hospital financial performance and the quality of care. The review process will apply a rigorous methodological approach while broad inclusion criteria should assure comprehensive coverage of the available literature. The main limitation of the review is related to the general limitation of scoping reviews, i.e., the lack of a systematic quality and risk of bias assessment of included studies. In addition, the review will include only publications in English. SYSTEMATIC REVIEW REGISTRATION Open Science Framework osf.io/z25ag.
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Affiliation(s)
- Katarzyna Dubas-Jakóbczyk
- Health Economic and Social Security Department, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, 8 Skawińska St., 31-066, Krakow, Poland
| | - Ewa Kocot
- Health Economic and Social Security Department, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, 8 Skawińska St., 31-066, Krakow, Poland
| | - Marzena Tambor
- Health Economic and Social Security Department, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, 8 Skawińska St., 31-066, Krakow, Poland
| | - Wilm Quentin
- Department of Health Care Management, Technische Universität Berlin, Strasse des 17. Juni, 135 10623 Berlin, Germany
- European Observatory on Health Systems and Policies, WHO European Centre for Health Policy Eurostation (Office 07C020), Place Victor Horta/Victor Hortaplein, 40, /10 1060 Brussels, Belgium
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Zinoviev R, Krumholz HM, Ciccarone R, Antle R, Forman HP. Multicentre methodological study to create a publicly available score of hospital financial standing in the USA. BMJ Open 2021; 11:e046500. [PMID: 34301654 PMCID: PMC8311305 DOI: 10.1136/bmjopen-2020-046500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES To create a straightforward scoring procedure based on widely available, inexpensive financial data that provides an assessment of the financial health of a hospital. DESIGN Methodological study. SETTING Multicentre study. PARTICIPANTS All hospitals and health systems reporting the required financial metrics in the USA in 2017 were included for a total of 1075 participants. INTERVENTIONS We examined a list of 232 hospital financial indicators and used existing models and financial literature to select 30 metrics that sufficiently describe hospital operations. In a set of hospital financial data from 2017, we used principal coordinate analysis to assess collinearity among variables and eliminated redundant variables. We isolated 10 unique variables, each assigned a weight equal to the share of its coefficient in a regression onto Moody's Credit Rating, our predefined gold standard. The sum of weighted variables is a single composite score named the Yale Hospital Financial Score (YHFS). PRIMARY OUTCOME MEASURES Ability to reproduce both financial trends from a 'gold-standard' metric and known associations with non-fiscal data. RESULTS The validity of the YHFS was evaluated by: (1) cross-validating it with previously excluded data; (2) comparing it to existing models and (3) replicating known associations with non-fiscal data. Ten per cent of the initial dataset had been reserved for validation and was not used in creating the model; the YHFS predicts 96.7% of the variation in this reserved sample, demonstrating reproducibility. The YHFS predicts 90.5% and 88.8% of the variation in Moody's and Standard and Poor's bond ratings, respectively, supporting its validity. As expected, larger hospitals had higher YHFS scores whereas a greater share of Medicare discharges correlated with lower YHFS scores. CONCLUSIONS We created a reliable and publicly available composite score of hospital financial stability.
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Affiliation(s)
- Radoslav Zinoviev
- Department of Internal Medicine, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut, USA
- Division of Cardiology, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, USA
| | | | - Rick Antle
- Yale School of Management, New Haven, Connecticut, USA
| | - Howard P Forman
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, USA
- Yale School of Management, New Haven, Connecticut, USA
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, USA
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Al Raoush AT, A’aqoulah A, Albalas S, Athamneh S. Impact of Financial Management on Improving Quality at Jordanian Public University Hospitals. JOURNAL OF INFORMATION & KNOWLEDGE MANAGEMENT 2020. [DOI: 10.1142/s0219649220500252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The main purpose of this study was to investigate the impact of financial management on improving quality at the public university hospitals in Jordan. We used a quantitative method with a sample of 220 public university hospital staff. Using simple linear regression analysis, we showed via our findings a significant impact of the financial management dimension on the quality management dimension. These findings emphasise that using a proficient financial management system would improve the quality of services and overall organisational performance in the Jordanian public healthcare sector.
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Affiliation(s)
- Atef T. Al Raoush
- Department of Hospital Management, Faculty of Business, Philadelphia University, Amman, Jordan
| | - Ashraf A’aqoulah
- Department of Health Systems Management, College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Samir Albalas
- Department of Basic Sciences, Faculty of Medicine, Yarmouk University, Irbid, Jordan
| | - Seif Athamneh
- Department of Public Administration, Faculty of Economics and Administrative, Sciences Yarmouk University, Irbid, Jordan
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Behzadifar M, Ghanbari MK, Bakhtiari A, Behzadifar M, Bragazzi NL. Ensuring adequate health financing to prevent and control the COVID-19 in Iran. Int J Equity Health 2020; 19:61. [PMID: 32375787 PMCID: PMC7201390 DOI: 10.1186/s12939-020-01181-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 04/24/2020] [Indexed: 12/23/2022] Open
Abstract
On February 19th 2020, the Iranian Ministry of Health and Medical Education (MoHME) has announced the first 2 cases of SARS-CoV-2, a novel emerging coronavirus which causes an infection termed as COVID-19, in Qom city. As such, the Iranian government, through the establishment of the “National Headquarters for the management and control of the novel Coronavirus”, has started implementing policies and programs for the prevention and control of the virus. These measures include schools and universities closure, reduced working hours, and increased production and delivery of equipment such as masks, gloves and hygienic materials for sterile environments. The government has also made efforts to divulge high-quality information concerning the COVID-19 and to provide laboratories and hospitals with diagnostic kits and adequate resources to treat patients. However, despite such efforts, the number of cases and deaths has progressively increased with rising trends in total confirmed cases and deaths, as well as in new daily cases and deaths associated with the COVID-19. Iran is a developing country and its economic infrastructure has been hit hardly by embargo and sanctions. While developed countries have allocated appropriate funding and are responding adequately to the COVID-19 pandemics, Iran has experienced a serious surge of cases and deaths and should strive to provide additional resources to the health system to make healthcare services more accessible and to increase the fairness of that access. All relevant actors and stakeholders should work together to fight this disease.
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Affiliation(s)
- Masoud Behzadifar
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran.
| | | | - Ahad Bakhtiari
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Meysam Behzadifar
- Department of Epidemiology and Biostatistics, School of Public Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Nicola Luigi Bragazzi
- Department of Health Sciences (DISSAL), Postgraduate School of Public Health, University of Genoa, Genoa, Italy.,Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, ON, Canada
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12
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The Creation of a Pediatric Health Care Learning Network: The ACTION Quality Improvement Collaborative. ASAIO J 2020; 66:441-446. [DOI: 10.1097/mat.0000000000001133] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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Dubas-Jakóbczyk K, Kocot E, Kozieł A. Financial Performance of Public Hospitals: A Cross-Sectional Study among Polish Providers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17072188. [PMID: 32218275 PMCID: PMC7177959 DOI: 10.3390/ijerph17072188] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 03/23/2020] [Accepted: 03/24/2020] [Indexed: 12/16/2022]
Abstract
There is growing evidence of a positive association between health care providers’ financial standing and the quality of care. In Poland, the instable financial situation and growing debt of public hospitals has been a source of concern for more than two decades now. The objectives of this paper were to compare the financial performance of public hospitals in Poland, depending on the ownership and organizational form; and analyze whether there is an association between financial performance and the chosen variables. We conducted a cross sectional study covering the whole population of public hospitals operating in 2018. The total number of included units was 805. The hospitals’ financial outcomes were measured by several variables; Spearman’s rank correlation was calculated, and a multivariable logistic regression model was performed. In 2018, the majority of public hospitals in Poland (52%) generated a gross loss, while 40% hospitals had overdue liabilities. There were statistically significant differences between hospital groups, with university hospitals and those owned by counties (local hospitals) being in the most disadvantageous situation. Additionally, corporatized public hospitals performed worse than those functioning in the classic legal form of independent health care units. Urgent actions are needed to measure and monitor the potential impact of financial performance on the quality of care.
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Affiliation(s)
- Katarzyna Dubas-Jakóbczyk
- Health Economic and Social Security Department, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, 31-008 Krakow, Poland;
- Correspondence:
| | - Ewa Kocot
- Health Economic and Social Security Department, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, 31-008 Krakow, Poland;
| | - Anna Kozieł
- Senior Health Specialist, Health, Nutrition & Population, World Bank, The World Bank Office in Poland, 00-113 Warsaw, Poland;
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Al Hamid A, Malik A, Alyatama S. An exploration of patient safety culture in Kuwait hospitals: a qualitative study of healthcare professionals' perspectives. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2019; 28:617-625. [PMID: 31468591 DOI: 10.1111/ijpp.12574] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 07/13/2019] [Accepted: 07/25/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Patient safety culture (PSC) represents a key component of the quality of care offered by healthcare professionals. Therefore, it is crucial to understand the factors that influence the implementation of a safe culture. This study explored the knowledge and attitudes of healthcare professionals in Kuwait towards the factors that might affect the PSC. METHODS A qualitative study using semi-structured interviews with healthcare professionals was conducted between February and June 2018 at two major hospitals in Kuwait. Both hospitals had been accredited and have been applying the safety programmes recommended by the Kuwaiti Ministry of Health. Participants were purposively selected where 20 healthcare professionals were interviewed. The interviewees comprised of six physicians, six clinical pharmacists, six nurses and two members of the patient safety committee. Inclusion criteria involved healthcare professionals who had more than 1-year clinical experience, have interest in patient safety and had a good level of English. Interviews were audio-recorded and transcribed verbatim. Thematic analysis of the interview transcripts was conducted to identify the emergent themes. KEY FINDINGS Thematic analysis of the interviews yielded three major themes related to 'management', 'regulations and policies' and 'healthcare professionals'. Management issues included managerial support, resources, safety environment and staff training. Regulations and policies highlighted issues related to policies and procedures and incident reporting system. Healthcare professionals' theme covered factors related to knowledge, communication and teamwork among healthcare professionals. CONCLUSIONS This study gave insight into how healthcare professionals perceive the current PSC in Kuwait. Despite their positive attitudes and knowledge towards patient safety, various barriers were reported that hinder optimal PSC. These barriers were related to support, staffing, resources and response to error.
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Affiliation(s)
| | - Aisha Malik
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - Shahad Alyatama
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, Hertfordshire, UK
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Weech-Maldonado R, Pradhan R, Dayama N, Lord J, Gupta S. Nursing Home Quality and Financial Performance: Is There a Business Case for Quality? INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2019; 56:46958018825191. [PMID: 30739511 PMCID: PMC6376502 DOI: 10.1177/0046958018825191] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
This study examines the relationship between nursing home quality and financial performance to assess whether there is a business case for quality. Secondary data sources included the Online Survey Certification and Reporting (OSCAR), Certification and Survey Provider Enhanced Reporting (CASPER), Medicare Cost Reports, Minimum Data Set (MDS 2.0), Area Resource File (ARF), and LTCFocus for all free-standing, nongovernment nursing homes for 2000 to 2014. Data were analyzed using panel data linear regression with facility and year fixed effects. The dependent variable, financial performance, consisted of the operating margin. The independent variables comprised nursing home quality measures that capture the three dimensions of Donabedian’s structure-process-outcomes framework: structure Registered Nurse (RN) hours per resident day, Licensed Practical Nurse (LPN) hours per resident day, Certified Nursing Assistant (CNA) hours per resident day, RN skill mix), process (facility-acquired restraints, facility-acquired catheters, pressure ulcer prevention, and restorative ambulation), and outcomes (facility-acquired contractures, facility-acquired pressure ulcers, hospitalizations per resident, rehospitalizations, and health deficiencies). Control variables included size, average acuity index, market competition, per capita income, and Medicare Advantage penetration rate. This study found that the operating margin was lower in nursing homes that reported higher LPN hours per resident day and higher RN skill mix (structure); higher use of catheters, lower pressure ulcer prevention, and lower restorative ambulation (process); and more residents with contractures, pressure ulcers, hospitalizations and health deficiencies (outcomes). The results suggest that there is a business case for quality, whereas nursing homes that have better processes and outcomes of care perform better financially.
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Affiliation(s)
| | - Rohit Pradhan
- 2 University of Arkansas for Medical Sciences, Little Rock, USA
| | - Neeraj Dayama
- 2 University of Arkansas for Medical Sciences, Little Rock, USA
| | - Justin Lord
- 3 Louisiana State University Shreveport, USA
| | - Shivani Gupta
- 4 The University of Southern Mississippi, Hattiesburg, MS, USA
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Akinleye DD, McNutt LA, Lazariu V, McLaughlin CC. Correlation between hospital finances and quality and safety of patient care. PLoS One 2019; 14:e0219124. [PMID: 31419227 PMCID: PMC6697357 DOI: 10.1371/journal.pone.0219124] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 06/17/2019] [Indexed: 11/19/2022] Open
Abstract
Background Hospitals under financial pressure may struggle to maintain quality and patient safety and have worse patient outcomes relative to well-resourced hospitals. Poor predictive validity may explain why previous studies on the association between finances and quality/safety have been equivocal. This manuscript employs principal component analysis to produce robust measures of both financial status and quality/safety of care, to assess our a priori hypothesis: hospital financial performance is associated with the provision of quality care, as measured by quality and safety processes, patient outcomes, and patient centered care. Methods This 2014 cross-sectional study investigated hospital financial condition and hospital quality and safety at acute care hospitals. The hospital financial data from the Centers for Medicare and Medicaid Services (CMS) cost report were used to develop a composite financial performance score using principal component analysis. Hospital quality and patient safety were measured with a composite quality/safety performance score derived from principal component analysis, utilizing a range of established quality and safety indicators including: risk-standardized inpatient mortality, 30-day mortality, 30-day readmissions for select conditions, patient safety indicators from inpatient admissions, process of care chart reviews, CMS value-based purchasing total performance score and patient experience of care surveys. The correlation between the composite financial performance score and the composite quality/safety performance score was calculated using linear regression adjusting for hospital characteristics. Results Among the 108 New York State acute care facilities for which data were available, there is a clear relationship between hospital financial performance and hospital quality/safety performance score (standardized correlation coefficient 0.34, p<0.001). The composite financial performance score is also positively associated with the CMS Value Based Purchasing Total Performance Score (standardized correlation coefficient 0.277, p = 0.002); while it is negatively associated with 30 day readmission for all outcomes (standardized correlation coefficient -0.236, p = 0.013), 30-day readmission for congestive heart failure (standardized correlation coefficient -0.23, p = 0.018), 30 day readmission for pneumonia (standardized correlation coefficient -0.209, p = 0.033), and a decrease in 30-day mortality for acute myocardial infarction (standardized correlation coefficient -0.211, p = 0.027). Used alone, operating margin and total margin are poor predictors of quality and safety outcomes. Conclusions Strong financial performance is associated with improved patient reported experience of care, the strongest component distinguishing quality and safety. These findings suggest that financially stable hospitals are better able to maintain highly reliable systems and provide ongoing resources for quality improvement.
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Affiliation(s)
- Dean D Akinleye
- School of Public Health, State University of New York, University at Albany, Albany, NY, United States of America
| | - Louise-Anne McNutt
- Institute for Health and the Environment, State University of New York, University at Albany, Albany, NY, United States of America
| | - Victoria Lazariu
- School of Public Health, State University of New York, University at Albany, Albany, NY, United States of America
| | - Colleen C McLaughlin
- Albany College of Pharmacy and Health Sciences, Albany, NY, United States of America
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Bunger AC, Despard M, Lee M, Cao Y. The Cost of Quality: Organizational Financial Health and Program Quality. JOURNAL OF EVIDENCE-BASED SOCIAL WORK (2019) 2019; 16:18-35. [PMID: 30381019 DOI: 10.1080/23761407.2018.1536575] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Purpose: Nonprofit health and human service organizations (NPHSOs) encounter pressure to improve program quality to continue to secure financial resources. Yet, organizations also struggle to innovate, evaluate, and monitor quality absent sufficient resources. This study explores the relationship between NPHSOs' financial health and quality indicators. Methods: Quality indicators were measured in an online survey with leaders from 32 nonprofit children's behavioral health organizations within a Midwestern urban region. Survey responses were matched with financial health metrics extracted from publicly available IRS 990 forms from 2010 to 2014. Results: Organizations struggled to maintain adequate reserve levels, although those with more quality capacities had greater assets and growth in those assets. Discussion: Although financial health appeared to be related to quality, it is unclear whether quality attracts financial resources, or if financial reserves support quality. Conclusion: Continuing research and dialogue are needed to understand the financial implications of an increasing emphasis on quality.
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Affiliation(s)
- Alicia C Bunger
- College of Social Work, The Ohio State University, 1947 College Road, Columbus, OH, USA
| | - Mathieu Despard
- Center for Community Capital, University of North Carolina, Chapel Hill, USA
| | - Madeline Lee
- Department of Social Work, California State University, San Marcos, USA
| | - Yiwen Cao
- Department of Family Medicine and Public Health, University of California, San Diego, USA
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Usher MG, Fanning C, Fang VW, Carroll M, Parikh A, Joseph A, Herrigel D. Insurance Coverage Predicts Mortality in Patients Transferred Between Hospitals: a Cross-Sectional Study. J Gen Intern Med 2018; 33:2078-2084. [PMID: 30276655 PMCID: PMC6258597 DOI: 10.1007/s11606-018-4687-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 06/30/2018] [Accepted: 07/22/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND Patients transferred between hospitals are at high risk of adverse events and mortality. The relationship between insurance status, transfer practices, and outcomes has not been definitively characterized. OBJECTIVE To identify the association between insurance coverage and mortality of patients transferred between hospitals. DESIGN We conducted a single-institution observational study, and validated results using a national administrative database of inter-hospital transfers. SETTING Three ICUs at an academic tertiary care center validated by a nationally representative sample of inter-hospital transfers. PATIENTS The single-institution analysis included 652 consecutive patients transferred from 57 hospitals between 2011 and 2012. The administrative database included 353,018 patients transferred between 437 hospitals. MEASUREMENTS Adjusted inpatient mortality and 24-h mortality, stratified by insurance status. RESULTS Of 652 consecutive transfers to three ICUs, we observed that uninsured patients had higher adjusted inpatient mortality (OR 2.67, p = 0.021) when controlling for age, race, gender, Apache-II, and whether the patient was transferred from an ED. Uninsured were more likely to be transferred from ED (OR 2.3, p = 0.026), and earlier in their hospital course (3.9 vs 2.0 days, p = 0.002). Using an administrative dataset, we validated these observations, finding that the uninsured had higher adjusted inpatient mortality (OR 1.24, 95% CI 1.13-1.36, p < 0.001) and higher mortality within 24 h (OR 1.33 95% CI 1.11-1.60, p < 0.002). The increase in mortality was independent of patient demographics, referral patterns, or diagnoses. LIMITATIONS This is an observational study where transfer appropriateness cannot be directly assessed. CONCLUSIONS Uninsured patients are more likely to be transferred from an ED and have higher mortality. These data suggest factors that drive inter-hospital transfer of uninsured patients have the potential to exacerbate outcome disparities.
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Affiliation(s)
- Michael G Usher
- Department of Medicine, Division of General Internal Medicine, University of Minnesota Medical School, Minneapolis, MN, USA.
| | - Christine Fanning
- Department of Medicine, Division of General Internal Medicine, Rutgers, Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Vivian W Fang
- Department of Accounting, Carlson School of Management, University of Minnesota, Minneapolis, MN, USA
| | - Madeline Carroll
- Department of Medicine, Division of General Internal Medicine, Rutgers, Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Amay Parikh
- Department of Medicine, Divisions of Nephrology and Critical Care, Rutgers, Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Anne Joseph
- Department of Medicine, Division of General Internal Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Dana Herrigel
- Department of Hospital Internal Medicine, Mayo Clinic Florida, Jacksonville, FL, USA
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A reason to renovate: The association between hospital age of plant and value-based purchasing performance. Health Care Manage Rev 2018; 46:66-74. [PMID: 30379712 DOI: 10.1097/hmr.0000000000000227] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND/PURPOSE Value-based purchasing (VBP) is increasing in influence in the health care industry; however, questions remain regarding the structural factors associated with improved performance. This study evaluates the association between age of hospital infrastructure and VBP outcomes. METHODOLOGY Data on 1,911 hospitals from three sources (the American Hospital Association Annual Survey Database, the American Hospital Association DataViewer Financial Module, and the Centers for Medicare & Medicaid Services Hospital VBP Total Performance Scores data set) were evaluated. Age of health care facilities was represented by the "average age of plant" financial ratio. VBP performance was measured by an aggregate Total Performance Score composed of four equally weighted domains, including Efficiency and Cost Reduction, Clinical Care, Patient- and Caregiver-Centered Experience, and Patient Safety. We hypothesize that average age of plant is negatively correlated with each of these measures. RESULTS Hospitals within the lowest quartile of average age of plant (0-8.13 years) were found to have a total Performance Score of 2.35 points higher than hospitals with a an average age of plant in the fourth quartile (14.63 years and above; R = 21.5%; p < .001) while controlling for hospital ownership, size, teaching status, geographic location, service mix, case mix, length of stay, community served, and labor force relative cost. Comparable results were found within the VBP domains, specifically for Clinical Care (β = 4.09, p < .001) and Patient Experience (β = 3.41, p < .001). Findings for the Patient Safety and Efficiency domains were not significant. A secondary and more granular examination of capitalized assets indicates organizations with higher building asset accumulated depreciation per bed in service were associated with lower total performance (β = -.25, p < .001), Clinical Care (β = -.31, p < .05), and Patient Experience scores (β = -.45, p < .001). CONCLUSIONS The results of this study provide evidence of an inverse association between a hospital's age of plant and specific elements of VBP performance. PRACTICE IMPLICATIONS To date, no studies have investigated the relationship between hospital age of plant and value-based care. The results of our study may serve as supportive foundational evidence for health care leaders to target future capital investments to improve VBP outcomes.
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