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BackgroundThere is growing recognition that health care providers are embedded in networks formed by the movement of patients between providers. However, the structure of such networks and its impact on health care are poorly understood.PurposeWe examined the level of dispersion of patient-sharing networks across U.S. hospitals and its association with three measures of care delivered by hospitals that were likely to relate to coordination.Methodology/approachWe used data derived from 2016 Medicare Fee-for-Service claims to measure the volume of patients that hospitals treated in common. We then calculated a measure of dispersion for each hospital based on how those patients were concentrated in outside hospitals. Using this measure, we created multivariate regression models to estimate the relationship between network dispersion, Medicare spending per beneficiary, readmission rates, and emergency department (ED) throughput rates.ResultsIn multivariate analysis, we found that hospitals with more dispersed networks (those with many low-volume patient-sharing relationships) had higher spending but not greater readmission rates or slower ED throughput. Among hospitals with fewer resources, greater dispersion related to greater readmission rates and slower ED throughput. Holding an individual hospital's dispersion constant, the level of dispersion of other hospitals in the hospital's network was also related to these outcomes.ConclusionDispersed interhospital networks pose a challenge to coordination for patients who are treated at multiple hospitals. These findings indicate that the patient-sharing network structure may be an overlooked factor that shapes how health care organizations deliver care.Practice implicationsHospital leaders and hospital-based clinicians should consider how the structure of relationships with other hospitals influences the coordination of patient care. Effective management of this broad network may lead to important strategic partnerships.

The Dialysis Facility Compare Star Rating and the Quality Incentive Program (QIP) generate separate performance scores from clinical measures, and the In-Center Hemodialysis Consumer Assessment of Healthcare Providers and Systems (ICH-CAHPS) survey evaluates patient satisfaction across 6 separate domains related to nephrologists, dialysis facility, and information transmission. This study examined the relationship of the 3 measures for US clinics, modeling the 6 ICH-CAHPS domains as independent variables and QIP and star ratings as dependent variables. Among 3176 dialysis clinics, domains assessing dialysis facility and information transmission had a consistently stronger relationship with QIP and star ratings than the domains assessing nephrologists: QIP, β (95% CI) = 1.62 (1.26-1.97) for dialysis facility staff rating, 0.70 (0.35-1.05) for nephrologists; star rating, odds ratio (95% CI) = 1.38 (1.29-1.49) for dialysis facility staff rating, 1.17 (1.09-1.25) for nephrologists. Patient satisfaction is associated with dialysis care quality, with surprising differences between nephrologists and dialysis facilities.

Partnerships that effectively engage in certain key structural and process functions are more likely to meet their research goals and contribute to longer-term health equity outcomes. Ongoing evaluation of partnerships' level of achievement of these key functions, along with their fidelity to the guiding principles of community-based participatory research (CBPR), is therefore essential to understand how they can achieve desired partnership outcomes. This article describes the validated Measurement Approaches to Partnership Success (MAPS) Questionnaire and the use of an accompanying Facilitation Guide in helping members of CBPR partnerships evaluate their partnership's state of development and interpret findings to improve its structure, processes, and outcomes. We describe the conceptual framework guiding the development of the MAPS Questionnaire and its 81-item across seven key outcome dimensions, along with 28 items measuring precursor characteristics of CBPR partnership outcomes. The Facilitation Guide provides general guidelines for sharing, interpreting, and applying results within partnerships using a participatory process, definitions and items for each dimension, an example of presenting summary means, and dimension-specific reflective questions for discussion. We offer recommendations for practical uses of the MAPS Questionnaire and Facilitation Guide. Whether used as a comprehensive tool or by dimension, the MAPS Questionnaire is conceptually sound and empirically validated for evaluating how CBPR partnerships can achieve long-standing success. CBPR partnerships at any stage of development will find the MAPS Questionnaire and Facilitation Guide useful in measuring and interpreting indicators of partnership success, sharing results, and improving their ability to contribute to achieving health equity goals. [ABSTRACT FROM AUTHOR]

Conceptualizing and testing factors that contribute to the success of community–academic partnerships are critical to understanding their contributions to the health and well-being of communities. Most measures to date focus on factors that contribute to the development of new partnerships, and only a few have been adequately tested and validated. Methods. The Measurement Approaches to Partnership Success (MAPS) study followed a community-based participatory research (CBPR) approach and a multiphase process that included the construction and pilot testing of a questionnaire, and a national survey to validate the psychometric properties of the questionnaire in long-standing CBPR partnerships (existing ≥ six years). All members within partnerships were recruited to complete the survey (55 partnerships with 563 partners). We used confirmatory factor analysis (CFA), Cronbach's alpha statistics, and a pairwise correlations approach to assess discriminant and convergent validity, and assessed internal consistency, and test–retest reliability. Results. All MAPS Questionnaire dimensions demonstrated strong validity and reliability and demonstrated agreement over time. Conclusion. The MAPS Questionnaire includes seven dimensions and 81 items related to the MAPS conceptual model and provides a scientific, in-depth measurement tool that allows long-standing CBPR partnerships to evaluate their work toward achieving health equity. [ABSTRACT FROM AUTHOR]

As part of a 5-year study to develop and validate an instrument for measuring success in long-standing community-based participatory research (CBPR) partnerships, we utilized the Delphi method with a panel of 16 community and academic CBPR experts to assess face and content validity of the instrument's broad concepts of success and measurement items. In addition to incorporating quantitative and qualitative feedback from two online surveys, we included a 2-day face-to-face meeting with the Expert Panel to invite open discussion and diversity of opinion in line with the CBPR principles framing and guiding the study. The face-to-face meeting allowed experts to review the survey data (with maintained anonymity), convey their perspectives, and offer interpretations that were untapped in the online surveys. Using a CBPR approach facilitated a synergistic process that moved above and beyond the consensus achieved in the initial Delphi rounds, to enhance the Delphi technique and the development of items in the instrument. [ABSTRACT FROM AUTHOR]

This paper advances the study of organizational demography and its relationship to organizational turnover by examining two of Blau's concepts of social structure: non-linear and multiform heterogeneity. In a sample of 383 community hospitals, nursing turnover was examined in relation to four dimensions of demographic heterogeneity among nursing staff in those hospitals. The form of the relationships between turnover and heterogeneity was specified to test whether heterogeneity relates to higher turnover in a linear fashion or, alternatively, whether heterogeneity affects turnover in an inverted U-shaped pattern. Results of multivariate analyses suggested strong support for the former proposition. Three of the four dimensions of demographic heterogeneity in hospital nursing staffs were positively and monotonically related to voluntary turnover among full-time registered nurses (RNs). No support was found for a curvilinear relationship, nor did mean levels of the demography measures, reflecting the locus of concentration, account for the observed relationship between demographic heterogeneity and turnover.

Extant health literacy research is unclear about the contribution of health literacy to health behaviors and is limited regarding women's health issues. The primary purpose of this study is to investigate the association between health literacy and five health behaviors (Pap smear screening, annual physical checkup, smoking, checking food expiration dates, and monitoring physical changes) in women and to test whether the association is mediated by health knowledge. A national sample of 1,754 female adults in Taiwan was included in the study. Result showed that health literacy was positively and independently related to checking food expiration dates and monitoring physical changes, and that health literacy was not related to physical checkup and Pap smear screening. Interestingly, women with high health literacy were more likely to be a current smoker. Study findings suggest that efforts to improve health promotion behaviors in women should consider health literacy as an important factor and that the effect of health literacy on health prevention behaviors may vary by women's access to care. (Contains 3 tables and 1 figure.)

The study examines whether social support interacts with health literacy in affecting the health status of older adults. Health literacy is assessed using the short version of the Test of Functional Health Literacy in Adults. Social support is measured with the Medical Outcome Study social support scale. Results show, unexpectedly, that rather than buffering the negative effect of low health literacy, social support has a more positive impact on physical health in older adults with high health literacy. Implications for improving the health status of older adults through health literacy and social support are discussed. (Contains 3 tables.)

This study extends the literature on governing boards and organizational change by examining how governing board configurations have influenced profound organizational change in U.S. hospitals, and the conditions under which such change occurs. Hospitals governed by boards that more closely resembled a corporate governance model were more likely to experience positive changes such as diversification and merger and less likely to undergo negative changes such as closure. Organizational performance influenced change, but largely independent of governance configurations. Only in the case of closure did we find that governance configuration operated jointly with organizational performance. (Contains 9 notes and 3 tables.)

Mixed methods research (MMR) is versatile, pragmatic, and adaptable to constraints and opportunities during a research process. Although MMR has gain popularity in health services management research, little is known about how the research approach has been used and the quality of research. We conducted a systematic review of 198 MMR articles published in selected U.S.-based and international health services management journals from 2000 through 2018 to examine the extent of MMR application and scientific rigor. Results showed limited, yet increasing, use of MMR and a high degree of correspondence between MMR designs and study purposes. However, most articles did not clearly justify using MMR designs and the reporting of method details and research integration were inadequate in a significant portion of publications. We propose a checklist to assist the preparation and review of MMR manuscripts. Additional implications and recommendations to improve transparency, rigor, and quality in MMR are discussed. [ABSTRACT FROM AUTHOR]

Fragmentation of substance abuse treatment represents a major barrier to effective treatment for individuals with cooccurring substance abuse and mental and physical health disorders. Linkages of substance abuse treatment organizations with primary care and mental health agencies are widely considered to be a feasible way to integrate services. In this study, we analyzed information collected from a national sample of 62 outpatient substance abuse treatment units (OSATs) to understand the extent of services linkages in these organizations and to identify facilitators and barriers to service linkages. Results showed that OSATs had limited service linkages with primary care and mental health providers. The cited barriers to linkages included clients' financial problems, managed care restrictions, and limited organizational capacity. Onsite service provision was implemented in some OSATs. The pattern of service linkages in OSATs appeared to reflect the health needs of substance abuse clients. Keywords: Substance abuse, interagency linkage, comorbidities, mental health, primary care, managed care, INTRODUCTION One of the major challenges facing the field of substance abuse treatment is the coordination of community-based services for clients with cooccurring mental or physical health disorders (1). Given [...]

Amid increased concerns about the adverse consequences of low health literacy, it remains unclear how health literacy affects health status and health service utilization. Moreover, studies have shown significant variation in individual adaptation to health literacy problems. This article proposes research hypotheses to address two questions: (1) What are the causal pathways or intermediate steps that link low health literacy to poor health status and high utilization of expensive services such as hospitalization and emergency care? (2) What impact does social support have on the relationships between health literacy and health service utilization? Empirical studies of health literacy are reviewed to indicate the limitations of current literature and to highlight the importance of the proposed research agenda. In particular, we note the individualistic premise of current literature in which individuals are treated as isolated and passive actors. Thus, low health literacy is considered simply as an individual trait independent of support and resources in an individual's social environment. To remedy this, research needs to take into account social support that people can draw on when problems arise due to their health literacy limitations. Examination of the proposed agenda will make two main contributions. First, we will gain a better understanding of the causal effects of health literacy and identify missing links in the delivery of care for patients with low health literacy. Second, if social support buffers the adverse effects of low health literacy, more effective interventions can be designed to address differences in individuals' social support system in addition to individual differences in reading and comprehension. More targeted and more cost-efficient efforts could also be taken to identify and reach those who not only have low health literacy but also lack the resources and support to bridge the unmet literacy demands of their health conditions. Keywords: USA; Health literacy; Social support; Health information: Health service utilization