Search

Providing person-centered care is a fundamental value and guiding philosophy for all health care delivery across Catholic Health Initiatives. Exceptional service excellence with every patient and family encounter is one way in which this value is demonstrated. The consequences of treating every person with dignity, respect, and a positive attitude can have real benefit on clinical outcomes, individual healing, health system reputation, and financial incentives. In our changing health care landscape, there are now financial motivations to improve patient satisfaction. In addition, a connection can be drawn between our relationships with patients, their experience with an organization, and the subsequent philanthropic and charitable donation to that organization. This article describes one health care system's journey toward improved patient experience through service excellence infrastructure, standard processes, and expected service behaviors.

Objective: To assess the impact of occupational medicine board certification and career stage on practice characteristics., Methods: Two hundred sixty occupational medicine physicians completed a questionnaire and 25 activity log descriptions about 72 items in 9 major domains. For each item, the percentage of activities involving the item and the percentage of physicians conducting the item at least once were calculated. Results were analyzed by board certification status and career stage., Results: Board-certified physicians had more-diverse practice activities and skills. They were more involved in management and public health-oriented activities, with greater emphasis on toxicology and less on musculoskeletal disorders. The noncertified physicians received more payment from workers' compensation. Early-career physicians spent more time in direct injury/illness treatment, being paid by workers' compensation, and addressing musculoskeletal problems., Conclusions: Formal training confers advantages in practice diversity and population medicine orientation.

Objectives: Although information technology (IT) may improve efficiency and quality of patient care, the adoption of clinical IT by physicians has been limited. This study investigates the relationships between physician practice revenue and use of clinical IT., Research Design: We undertook a cross-sectional analysis of data on 6849 U.S. physicians in physician-owned practices who responded to the 2000-2001 Community Tracking Study Physician Survey. Physician practice revenues, measured as the percentage of total revenues, is defined along 2 dimensions: type (capitation, noncapitated managed care, or fee-for-service) and source (Medicare, Medicaid, or private/other). Analyses were adjusted for physician and practice characteristics and geographic location., Measures: The proportion of physicians using IT for 5 functions of patient care: treatment guidelines, formularies, patient notes or lists, electronic prescriptions, and data exchange with other physicians., Results: Practice revenues are associated with differences in physicians' use of IT in patient care. Above-average Medicaid revenue was associated with 20% higher use of IT overall (incidence density ratio = 1.20, 95% confidence interval [CI] = 1.12-1.30). Above-average capitation revenue corresponds to higher use of IT overall (incidence density ratio = 1.10, 95% CI = 1.02-1.19) and greater odds of using IT for guidelines (odds ratio = 1.26, 95% CI = 1.05-1.53). Above-average noncapitated managed care revenue, however, has no apparent relationship with IT use., Conclusions: Differences in the type and source of physician revenues were associated with differences in the use of IT in patient care in 2000-2001. The relationships between practice revenues and IT use varied across clinical IT functions.

Unlabelled: Previously, the authors reported trends in anesthesia quality and productivity in a university-based anesthesia practice as it responded to increasing service demands with shortages of qualified staff and decreasing reimbursement. From 1992 to 1997, productivity increased, with a significant decrease in patient injury. In this study, we analyzed whether previous productivity and quality gains were sustained from 1998 to 2000 despite continued staff shortages. Productivity, caseload, and outcome data were abstracted from departmental administrative and quality-improvement reports. Retrospective cohort analysis compared trends during 3 yr of moderate productivity (1994-1996) with those during 3 yr of high productivity (1998-2000). The mean monthly productivity in 1998-2000 (15 +/- 0.6 billed hours per attending per clinical day) was larger than levels from 1994 to 1996 (mean, 14 +/- 0.7 h; P < 0.01). The overall continuous quality improvement report rate was slower at larger productivity levels, as were rates of patient injuries. When adjusted for declining report rates, patient injury rates showed no change between smaller- and larger-productivity years. Adjusted rates of operational inefficiencies and human errors were more frequent at larger productivity levels. Although the pressures of increased demands, shrinking resources, and shortages of qualified academic anesthesiologists have not abated, productivity and quality have been sustained. Future management must be directed toward reductions in operational inefficiencies and human error., Implications: Our academic anesthesia service sustained increases in productivity with maintenance of quality. During a 3-yr period of high productivity, patient injury rates did not increase compared with prior years with lower productivity.

This article verifies if the increase in the percentage of women in the medical profession led to the convergence of male and female physicians' hours of work as well as income. Active physicians in Quebec in 1978 were compared to the ones in 1988. Data were obtained from the computerized files of the Quebec Corporation of Physicians and the Régie d'assurance-maladie du Quebec. Despite the increasing representation of women in the medical profession, gender differences in hours worked and income remained. However, results also showed a tendency toward a convergence in total hours of work, more behavioral variation among women physicians and some behavioral change among men. The experience of the past should thus not be used as the basis for projections of future physician productivity or for medical manpower planning purposes without a careful analysis of trends in behavioral changes.

Because a salaried/exempt compensation structure is assumed to support professional status, it is a part of several professional practice models. The authors identify the placement of the salary component in a hospital-based professional nursing practice model and propose necessary conditions for successfully introducing a salary compensation structure.

Compensation of nurses in differentiated practice is based on distinctive job descriptions. The employer can then pay according to education, position, and actual performance level and seek to hire the staff mix that is most cost-effective for the institution. Both staff nursing and manager job descriptions are presented in this article. The authors discuss generic job descriptions that differentiate the practice of the staff nurse and the nurse unit manager according to the incumbent's educational level.

A pilot project evaluated the effect of incorporating nursing assistive personnel (NAP) into the existing nursing professional practice model at a tertiary care university medical center. A plan to use permanent, unit-based NAP was developed, implemented, and evaluated. Among the findings were a redistribution of selected nursing activities and conditions enhancing the integration of NAP to fulfill nonprofessional tasks and thus support the work of the registered nurse.

This paper examines how changes in Medicare reimbursement rates affect the degree to which physicians induce demand for Medicare services. Demand inducement is measured by analyzing changes in the intensity and quantity of services provided and the number of ancillary services ordered. The empirical work is based on data that include copies of all Medicare claims for Colorado physicians between 1976 and 1978. During that period a change in the state's Medicare reimbursement system occurred, resulting in a large increase in some physicians' reimbursement rates and a relative decrease in those of others. Using this "natural experiment," we can determine how changes in financial incentives affect various forms of demand inducement. The study results are consistent with the theory that demand inducement exists. It appears to take several forms: provision of more highly intensive medical and surgical services, greater quantities of surgical services, and ordering of more laboratory tests.

Mental health services were included in a comprehensive package of benefits available to low income enrollees in a prepaid group practice plan (PGP) and in an independent practice plan (IPP) under the Seattle Prepaid Health Care Project. There were no out-of-pocket costs for enrollees. Utilization of services was studied for four years under conditions that might simulate universal entitlement. The analyses indicated that females used substantially more mental health services than males and that enrollees aged 20-44 used more services than those in other age groups. The prepaid group practice generally experienced higher utilization than the prepaid independent plan. Significant racial differences were evident with whites using more services than blacks and black males using strikingly few services. The prepaid independent plan was oriented toward physician providers and emphasized individual psychotherapy while the prepaid group practice employed a diversity of practitioners and therapeutic modalities. The data indicated that the per cent of enrollees using any mental health services was twice as great in the PGP as in the IPP. However, once access to the provider system was achieved, the number of services utilized was greater in the PGP. Inpatient services were also examined. A significantly higher proportion of IPP enrollees were admitted for inpatient care as compared to PGP enrollees. Finally, the cost of mental health services was less than ten per cent of total health service costs in both plans.

Financial return is one of several factors that may affect a physician's decision to order services for a patient. The extent of financial incentives to perform in-office medical procedures and laboratory tests is illustrated by four hypothetical models of general internal medicine office practice. The model practices consist of fixed ratios of history and physical examinations to return visits, with numbers and types of medical procedures and laboratory tests increasing stepwise through the four models. The procedures and tests included are an electrocardiogram, urinalysis, complete blood count, sigmoidoscopy, tuberculin skin test, two-view chest x-ray, cardiovascular treadmill stress test, and an automated 12-channel blood chemistry test. Charges and office expenses are estimated at 1977 Northern California levels. Net incomes derived for the four models are as follows: $31,000, $55,000; $60,000; and $90,000. The demonstrated financial incentives, which apply not only to internal medicine, but to all fields of medical care, are in conflict with policies that would emphasize personal rather than technical services. National health insurance proposals should include a continuing review of medical services valuation.