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Trends in the use and capacity of California's emergency departments, 1990-1999

ANNALS OF EMERGENCY MEDICINE 2002年第4期39卷 389-396页

作者： Lambe, S Washington, DL Fink, A Herbst, K Liu, HH Fosse, JS Asch, SM VA Greater Los Angeles Helathcare Syst Dept Med Robert Wood Johnson Clin Scholars Program Los Angeles CA USA Univ Calif Los Angeles Dept Publ Hlth Los Angeles CA USA Univ Calif Los Angeles Div Gen Internal Med Los Angeles CA USA Herbst Med Geog Haddam CT USA

Study Objective: Concerns over the ability of the nation's emergency departments to meet current demands are growing among the public and health care professionals. Data supporting perceptions of inadequate capacity are sparse and conflicting. We describe changes in the use and capacity of California's EDs between 1990 and 1999, as well as trends in severity of patient illness or injury. Methods: Data from California's Office of Statewide Health Planning and Development (OSHPD), which describe all hospital and health service use in the state, were analyzed and later verified using a telephone survey of all 320 open EDs in California. Six variables were analyzed: hospital's ownership type (public or private), total number of annual ED visits, severity of patient illness or injury (percentage of visits categorized as critical, urgent, or nonurgent), number of ED beds, proximity to a closed ED, and teaching status. We tested 2 main hypotheses: (1) Have statewide ED visits, ED beds, visits per ED, and visits per bed increased or decreased between 1990 and 1999? and (2) Has severity of patient illness or injury, as reported to OSHPD, changed over the past decade? State level data were analyzed using ordinary least-squares regression. Hospital level data were analyzed using repeated measures analyses. Results: The number of EDs in California decreased by 12% (P<.0001). The number of ED treatment stations (ie, physical spaces for the treatment of patients) increased by 687 (16%) statewide (P=.0001), or an average of 79 beds per year. The average annual change in ED visits was not statistically significant (P=.5), whereas visits per ED increased by 27% for all EDs (P<.0001), although with differing trends noted at public and private hospitals. At private hospitals, the average increase was 512 visits/ED each year, whereas at public hospitals, visits decreased by an average of 1,085 visits/ED each year (P<.0001). Overall, critical visits per ED increased by 59% (P<.0001), an

关键词：急性病/流行病学加利福尼亚/流行病学危重病/流行病学急症/流行病学急诊室医院/统计学和数值数据卫生保健调查卫生设施关闭/统计学和数值数据卫生服务需求/发展趋势医院病床数医院教学/统计学和数值数据多元分析州卫生计划和开发署时间因素美国人类

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Indicators of hospital closure under pps and blue cross/blue shield cost-based reimbursements

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Journal of Hospital Marketing 1992年第2期6卷 149-182页

作者： Oswald, Sharon Gardiner, Lorraine Jahera, John Auburn University United States

Using an adaptation of discriminant analysis on a sample of 120 hospitals in the state of Alabama, this paper illuminates characteristics of hospitals closed due to financial failure under PPS and cost-based Blue Cross/Blue Sliield reimbursement systems. The results show high debt levels, poor revenue and cost ratios, poor utilization management, and the inability to collect effectively on outstanding accounts in the year prior to hospital failure. © 1992 Taylor & Francis Group, LLC.

关键词：亚拉巴马破产/统计学和数值数据卡方分布数据收集判别分析财务管理医院/统计学和数值数据卫生设施关闭/经济学卫生设施关闭/统计学和数值数据 Medicaid/经济学所有权/经济学预期支付系统/经济学偿还途径/经济学美国

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Closures and mergers of vna home care agencies: A model for the study of causal factors

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Home Health Care Services Quarterly 1992年第4期12卷 113-125页

作者： Scalzi, Cynthia C. Meyer, Marshall School of Nursing Philadelphia PA 19104 420 Service Drive United States The Wharton School The University of Pennsylvania Philadelphia PA 19104 420 Service Drive United States

Recent closures and mergers of visiting nurses associations (VNAs) raise some potentially serious questions regarding access to home care for the elderly Medicare and Medicaid populations. While VNAs comprise less than 10 percent of the nation's certified home health agencies, they provide approximately 31 percent of all medicare home care (HCFA, 1989). In March of 1986 there were 524 visiting nurses associations nationally whereas today there remain only 495 (HCFA, 1990). A model identifying potential causes of VNA mortality is presented along with some preliminary results. VNA mortality is defined and measured by the date that Medicare certification is terminated as a result of VNA closure or merger. © 1992 Taylor & Francis Group, LLC.

关键词：证明/立法和法学社区保健护理/经济学社区保健护理/统计学和数值数据卫生设施关闭/统计学和数值数据卫生设施合并/统计学和数值数据卫生服务研究/方法家庭医疗保健服务/经济学家庭医疗保健服务/供应和分配保险健康补偿/立法和法学保险护理工作/立法和法学 Medicare/经济学 Medicare/立法和法学模型统计学美国老年人人类

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Multihospital System Affiliation as a Survival Strategy for Rural Hospitals Under the Prospective Payment System

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The Journal of Rural Health 1992年第2期8卷 93-105页

作者： Halpern, Michael T. Alexander, Jeffrey A. Fennell, Mary L. Department of Public Health Policy and Administration University of Michigan in Ann Arbor Michigan United States Health Services Management and Policy University of Michigan Ann Arbor Michigan United States Pennsylvania State University University Park Pennsylvania United States

The introduction of Medicare's Prospective Payment System (PPS) has disproportionately increased financial pressures on rural hospitals and posed challenges to the survival of these institutions. Increasingly, rural hospitals are seeking strategies that can enhance their chances for survival in a turbulent and hostile environment. This study examined the survival effects of one such strategy, multihospital system affiliation. Specifically, we assessed: (1) whether and how different types of system affiliation in the post‐PPS era affect the likelihood of rural hospital survival;(2) whether particular structural, environmental and hospital performance characteristics moderate the effects of system affiliation on rural hospital survival;and (3) whether systematic selection by rural hospitals into multihospital systems potentially accounts for observed relationships between system affiliation and survival. Proportional hazards analyses indicate that system affiliation with investor‐owned systems significantly reduces survival probabilities of rural hospitals. Affiliation with not‐for‐profit systems or system affiliation under contract management arrangements does not affect survival probabilities of rural hospitals. These general findings are moderated by the effects of hospital ownership and size at the time of affiliation. Finally, study findings indicated that systematic selection by poor performing rural hospitals into investor‐owned systems has occurred in the post‐PPS era. No evidence of selection into not‐for‐profit systems was discovered. Copyright © 1992, Wiley Blackwell. All rights reserved

关键词：合同业务/经济学财务管理医院/发展趋势卫生设施关闭/统计学和数值数据卫生服务研究/方法医院乡村/经济学医院乡村/组织和管理多机构系统/经济学多机构系统/统计学和数值数据多元分析所有权/经济学预期支付系统/经济学回归分析危险美国

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Causes and Consequences of Rural Small Hospital Closures from the Perspectives of Mayors

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The Journal of Rural Health 1991年第3期7卷 222-245页

作者： Hart, L. Gary Pirani, Michael J. Rosenblatt, Roger A. Wami Rural Health Research Center Department of Family Medicine University of Washington Seattle Washington 98195 United States

ABSTRACT: Mayors of rural towns whose small general hospitals closed between 1980 and 1988 were surveyed. Only hospitals that were the sole hospitals in their towns and that had not reopened were included in the survey. Of the 132 hospitals meeting these criteria, 130 (98.5%) of the mayors of their communities responded to the survey. The typical study hospital had 31 beds, with an average daily census of 12. Three fourths of the hospital closures were in the North‐Central and South census regions. Half of the hospital closures were for hospitals that were 20 miles or more from another hospital. Mayors attributed the closure of their hospitals primarily to governmental reimbursement policies, poor hospital management and lack of physicians. To a lesser extent, they also implicated competition from other hospitals, reputation for poor quality care, lack of provider teamwork, and inadequate hospital board leadership. Respondents reported they had little warning that their hospitals were in imminent danger of closing. Warnings of six months or less were reported by 49 percent of the mayors;only 33 percent of mayors of towns with for‐profit hospitals reported having more than six months warning. Of the 132 hospital buildings that closed, only 38 percent were not in use in some capacity in the summer of 1989. Most were being utilized as some form of health care facility such as an ambulatory clinic, nursing home, or emergency room. More than three fourths of the mayors felt access to medical care had deteriorated in their communities after hospital closure, with a disproportionate impact on the elderly and poor. Nearly three fourths of the mayors also perceived that the health status of the community was worse because of the hospital closure, and more than 90 percent felt it had substantially impaired the community's economy. Copyright © 1991, Wiley Blackwell. All rights reserved

关键词：社区和机构的关系评价研究卫生设施关闭/统计学和数值数据卫生服务易得程度/统计学和数值数据卫生服务研究医院病床数 100张以下医院乡村/供应和分配地方政府所有权/统计学和数值数据医师/供应和分配问卷调查

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Hospital mergers and closures: Survival of rural hospitals

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JOURNAL OF RURAL HEALTH 1998年第4期14卷 357-365页

作者： Sinay, UT Univ Scranton Dept Hlth Adm & Human Resources Scranton PA 18510 USA

There are two major models to save financially failing rural hospitals: (1) expanding through an affiliation or merger with other hospitals to increase the utilization and diversity of services, or (2) downsizing by employing the limited-service model and providing only emergency and primary care service with limited acute care. This study investigates hospital mergers and closures from 1990 to 1992 using the American Hospital Association's (AHA's) data from the Annual Survey of U.S. Hospitals. The presence of potential scale and scope economies among merging and closing hospitals prior to the merger or closure suggests that has great potential for achieving scope and that rural hospitals are operating at a size level scale efficiencies through mergers.

关键词：美国医院协会病例对照研究费用效益分析横断面研究数据收集卫生设施关闭/经济学卫生设施关闭/统计学和数值数据卫生设施合并/经济学卫生设施合并/统计学和数值数据医院费用/统计学和数值数据医院乡村/经济学医院乡村/组织和管理多元分析人员减少回归分析美国人类

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