Publications by authors named "Larry Gamm"

37 Publications

Enhanced Transitions of Care: Centralizing Discharge Phone Calls Improves Ability to Reach Patients and Reduces Hospital Readmissions.

J Healthc Qual 2017 Mar/Apr;39(2):e10-e21

Background: The discharge phone call (DPC) is an important initiative aimed at improving transitions of care and reducing readmissions. It is of added importance as financial penalties will be imposed on hospitals with "excessive" Medicare readmissions. This study examines the impact of DPCs on percentages of patients reached through the DPCs and hospital readmission rates based on the centralized or noncentralized mode of DPCs.

Methods: The health system centralized the Studer Group Discharge Phone Call program into one central call center with the goals of reaching more discharged patients and to ultimately reduce hospital readmissions. The study analyzed hospital visits from 74,754 patient admissions that could result in an unplanned hospital readmission. Hospital discharge data were analyzed from August 2010 to January 2014. Primary outcomes included DPCs reaching discharged patients and effects on hospital readmission rates as a result of centralizing the DPC program.

Results: Centralized DPCs are significantly associated with increases in the percentage of patients reached by the DPC, which in turn reduces readmissions rates. Patients not reached were 1.32 times more likely to be readmitted than patients reached by centralized DPCs.

Conclusions: Centralizing the DPC program within a call center helps reach more patients and reduce readmission rates further compared with noncentralized DPCs.
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http://dx.doi.org/10.1097/JHQ.0000000000000063DOI Listing
February 2018

Hospital Characteristics are Associated With Readiness to Attain Stage 2 Meaningful Use of Electronic Health Records.

J Rural Health 2017 06 18;33(3):275-283. Epub 2016 Jul 18.

Department of Epidemiology, School of Medicine, University of California-Irvine, Irvine, California.

Purpose: To examine the difference between rural and urban hospitals as to their overall level of readiness for stage 2 meaningful use of electronic health records (EHRs) and to identify other key factors that affect their readiness for stage 2 meaningful use.

Methods: A conceptual framework based on the theory of organizational readiness for change was used in a cross-sectional multivariate analysis using 2,083 samples drawn from the HIMSS Analytics survey conducted with US hospitals in 2013.

Findings: Rural hospitals were less likely to be ready for stage 2 meaningful use compared to urban hospitals in the United States (OR = 0.49) in our final model. Hospitals' past experience with an information exchange initiative, staff size in the information system department, and the Chief Information Officer (CIO)'s responsibility for health information management were identified as the most critical organizational contextual factors that were associated with hospitals' readiness for stage 2. Rural hospitals lag behind urban hospitals in EHR adoption, which will hinder the interoperability of EHRs among providers across the nation. The identification of critical factors that relate to the adoption of EHR systems provides insights into possible organizational change efforts that can help hospitals to succeed in attaining meaningful use requirements.

Conclusion: Rural hospitals have increasingly limited resources, which have resulted in a struggle for these facilities to attain meaningful use. Given increasing closures among rural hospitals, it is all the more important that EHR development focus on advancing rural hospital quality of care and linkages with patients and other organizations supporting the care of their patients.
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http://dx.doi.org/10.1111/jrh.12193DOI Listing
June 2017

Organizational capacity for change in health care: Development and validation of a scale.

Health Care Manage Rev 2017 Apr/Jun;42(2):151-161

Aaron Spaulding, PhD, is Associate Consultant I, Department of Health Sciences Research, Division of Health Care Policy and Research, Mayo Clinic, Jacksonville, Florida. E-mail: Bita A. Kash, PhD, MBA, FACHE, is Associate Professor and Director, Center for Health Organization Transformation, Health Policy & Management, Texas A&M University, College Station. Christopher E. Johnson, PhD, is Professor and Chair Department of Health Management and Systems Sciences, School of Public Health and Information Sciences, University of Louisville, Kentucky. Larry Gamm, PhD, is Regents Professor, Health Policy & Management, Texas A&M University, College Station.

Background: We do not have a strong understanding of a health care organization's capacity for attempting and completing multiple and sometimes competing change initiatives. Capacity for change implementation is a critical success factor as the health care industry is faced with ongoing demands for change and transformation because of technological advances, market forces, and regulatory environment.

Purpose: The aim of this study was to develop and validate a tool to measure health care organizations' capacity to change by building upon previous conceptualizations of absorptive capacity and organizational readiness for change.

Methodology/approach: A multistep process was used to develop the organizational capacity for change survey. The survey was sent to two populations requesting answers to questions about the organization's leadership, culture, and technologies in use throughout the organization. Exploratory and confirmatory factor analyses were conducted to validate the survey as a measurement tool for organizational capacity for change in the health care setting.

Findings: The resulting organizational capacity for change measurement tool proves to be a valid and reliable method of evaluating a hospital's capacity for change through the measurement of the population's perceptions related to leadership, culture, and organizational technologies.

Practical Implications: The organizational capacity for change measurement tool can help health care managers and leaders evaluate the capacity of employees, departments, and teams for change before large-scale implementation.
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http://dx.doi.org/10.1097/HMR.0000000000000096DOI Listing
February 2018

Studer GroupĀ® ' s evidence-based leadership initiatives.

J Health Organ Manag 2015 ;29(6):684-700

Masters of Public Health Program, University of North Dakota, Grand Forks, Dakota, USA.

Purpose: The purpose of this paper is to analyze the implementation of an organizational change initiative--Studer GroupĀ®'s Evidence-Based Leadership (EBL)--in two large, US health systems by comparing and contrasting the factors associated with successful implementation and sustainability of the EBL initiative.

Design/methodology/approach: This comparative case study assesses the responses to two pairs of open-ended questions during in-depth qualitative interviews of leaders and managers at both health systems. Qualitative content analysis was employed to identify major themes.

Findings: Three themes associated with success and sustainability of EBL emerged at both health systems: leadership; culture; and organizational processes. The theme most frequently identified for both success and sustainability of EBL was culture. In contrast, there was a significant decline in salience of the leadership theme as attention shifts from success in implementation of EBL to sustaining EBL long term. Within the culture theme, accountability, and buy-in were most often cited by interviewees as success factors, while sense of accountability, buy-in, and communication were the most reported factors for sustainability.

Originality/value: Cultural factors, such as accountability, staff support, and communication are driving forces of success and sustainability of EBL across both health systems. Leadership, a critical factor in several stages of implementation, appears to be less salient as among factors identified as important to longer term sustainability of EBL.
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http://dx.doi.org/10.1108/JHOM-10-2013-0211DOI Listing
January 2017

The influence of organization tenure on nurses' perceptions of multiple work process improvement initiatives.

Health Care Manage Rev 2016 Oct-Dec;41(4):344-55

Nicholas Edwardson, PhD, MS, is Assistant Professor, University of New Mexico, Albuquerque. E-mail: Sean Gregory, PhD, MBA, is Assistant Professor, University of South Florida, Tampa, Florida. Larry Gamm, PhD, is Regents Professor, Texas A&M Health Science Center, College Station, TX.

Background: A nurse's optimism or skepticism toward an organization-mandated change initiative largely depends on their experience with similar change initiatives and their unit's and organization's track record with previous change efforts. Thus, depending on the context, organization tenure can work in favor or against any particular change initiative. However, few studies have examined the impact of organization tenure on perceptions toward change initiatives. The few studies that have been conducted have yielded mixed results and have only targeted single or similar work initiatives.

Purpose: The aim of this study was to examine how organization tenure impacts nurses' perceptions toward a diverse array of work process improvement initiatives.

Methodology: The data are derived from a survey of 421 medical-surgical nurses representing 41 units across four hospitals. The survey was designed to capture nurses' perceptions toward three change initiatives-AIDET (Acknowledge, Introduce, Duration, Explanation, and Thank You), hourly rounding, and discharge phone calls-and their impact across two subscales-patient care and individual work change.

Findings: Organization tenure is significantly and negatively associated with change receptivity for the non-patient safety-oriented initiative (AIDET). This negative relationship dissipates as we evaluate more patient safety-oriented work process initiatives (hourly rounding and discharge phone calls).

Practice Implications: Significant differences in nurses' perceptions toward change do exist depending on how long they have worked for their employer. For non-patient safety-oriented change initiatives, veteran-to-the-organization nurses may exhibit more recalcitrance than their new-to-the-organization counterparts. However, our findings also suggest the presence of a patient safety exception rule where veteran-to-the-organization nurses do not exhibit differences in opinion than their new-to-the-organization counterparts for patient safety-oriented change initiatives.
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http://dx.doi.org/10.1097/HMR.0000000000000078DOI Listing
February 2018

Physician Engagement: Strategic Considerations among Leaders at a Major Health System.

Hosp Top 2014 ;92(3):66-73

The authors utilize qualitative interviews with 38 health administrators at one large metropolitan, multihospital system to help identify perspectives regarding physician engagement. Here they focus on 1) lessons learned from past physician engagement efforts, 2) strategic considerations concerning the engagement of physicians, and 3) recommendations for future action. The authors conclude that current hospital leaders have learned from the failures of the past based on the identification of success factors critical to physician engagement. However, future success may relate directly to the increased attention to criteria by which the organization assesses the success of such engagement.
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http://dx.doi.org/10.1080/00185868.2014.937970DOI Listing
October 2016

Bedside shift reports: what does the evidence say?

J Nurs Adm 2014 Oct;44(10):541-5

Author Affiliations: Assistant Professor (Dr Gregory), Graduate Research Assistant (Ms Tan), Research Assistant (Mr Tilrico), and Professor (Dr Gamm), Department of Health Policy & Management, School of Public Health, Health Sciences Center, Texas A&M University, College Station; Assistant Professor (Dr Edwardson), School of Public Administration, University of New Mexico, Albuquerque; and Assistant Professor (Dr Gregory), Department of Pediatrics, College of Medicine, Health Sciences Center, Texas A&M University College Station.

Bedside shift reports are viewed as an opportunity to reduce errors and important to ensure communication between nurses and communication. Models of bedside report incorporating the patient into the triad have been shown to increase patient engagement and enhance caregiver support and education. Nurse shift reports and nurse handovers are 2 of the most critical processes in patient care that can support patient safety and reduce medical errors in the United States. Nurses continue to not recognize the evidence supporting this practice and adopt bedside report into practice.
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http://dx.doi.org/10.1097/NNA.0000000000000115DOI Listing
October 2014

Success factors for strategic change initiatives: a qualitative study of healthcare administrators' perspectives.

J Healthc Manag 2014 Jan-Feb;59(1):65-81

Center for Health Organization Transformation, Texas A&M University Health Science Center, USA.

Success factors related to the implementation of change initiatives are well documented and discussed in the management literature, but they are seldom studied in healthcare organizations engaged in multiple strategic change initiatives. The purpose of this study was to identify key success factors related to implementation of change initiatives based on rich qualitative data gathered from health leader interviews at two large health systems implementing multiple change initiatives. In-depth personal interviews with 61 healthcare leaders in the two large systems were conducted and inductive qualitative analysis was employed to identify success factors associated with 13 change initiatives. Results from this analysis were compared to success factors identified in the literature, and generalizations were drawn that add significantly to the management literature, especially to that in the healthcare sector. Ten specific success factors were identified for the implementation of change initiatives. The top three success factors were (1) culture and values, (2) business processes, and (3) people and engagement. Two of the identified success factors are unique to the healthcare sector and not found in the literature on change models: service quality and client satisfaction (ranked fourth of 10) and access to information (ranked ninth). Results demonstrate the importance of human resource functions, alignment of culture and values with change, and business processes that facilitate effective communication and access to information to achieve many change initiatives. The responses also suggest opportunities for leaders of healthcare organizations to more formally recognize the degree to which various change initiatives are dependent on one another.
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April 2014

Discharge phone calls: a technique to improve patient care during the transition from hospital to home.

J Healthc Qual 2015 May-Jun;37(3):163-72

The discharge process is a transitional period when the patient's care is shifted from the hospital to the home and can be stressful for patients. One technique used to improve the quality and continuity of care is the discharge phone call (DPC). A large, metropolitan hospital implemented the DPC program to improve quality of care and decrease readmission rates. Qualitative interviews were performed with 24 hospital leaders, managers, and staff to determine the impact of the DPC program on the quality of care during the discharge process. Interviewees responded that the main benefits to the DPCs related to patient's medication management, follow-up appointment reminders, and answering questions. From a hospital perspective, the DPC can provide feedback to help improve the care delivery process related to discharge planning through improved discharge instructions and reinforcement of prescribed steps upon the patient's return home.
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http://dx.doi.org/10.1111/jhq.12051DOI Listing
November 2016

Multiproject interdependencies in health systems management: a longitudinal qualitative study.

Health Care Manage Rev 2014 Jan-Mar;39(1):31-40

Aaron Spaulding, PhD, MHA, is Assistant Professor, Department of Public Health, Brooks College of Health, University of North Florida, Jacksonville. E-mail: Larry Gamm, PhD, is Regents Professor, Director, Center for Health Organization Transformation, Texas A&M Health Science Center, College Station. E-mail: Jungyeon Kim, MBA, is Graduate Research Assistant, Department of Health Policy and Management, Texas A&M Health Science Center, College Station. E-mail: Terri Menser, MBA, is Graduate Research Assistant, Department of Health Policy and Management, Texas A&M Health Science Center, College Station. E-mail:

Background: A health care organization often engages in the simultaneous implementation of multiple organization change initiatives. However, the degree to which these initiatives are implemented and can be enhanced based on their interdependencies is an open question. How organizations and the change initiatives they pursue might benefit from more careful examination of potential interdependencies among projects was explored in this article.

Purpose: The aim of this study was to introduce a multiproject management conceptualization that stresses project interdependencies and suggests synergies can be found to enhance overall project and organizational performance. It examines this conceptualization in the context of a health system pursuing several major initiatives to capture insights into the nature of such interdependencies.

Methodology/approach: Longitudinal qualitative analysis of interviews conducted with hospital leaders attempting to manage multiple initiatives being implemented by the system's leadership team was used in this study.

Findings: The implementation of an electronic medical record (EMR) is empirically identified as the most central among multiple projects based on other projects dependencies on the EMR. Furthermore, concerns for data are identified most frequently as success factors across all projects. This reinforces the depiction of the EMR as a central organizational focus.

Practical Implications: A unique perspective on multiproject management in hospitals and on EMR projects is presented. In addition, the interdependency conceptualization and its application and results provide insights into multiproject management that can help ensure that benefits of individual projects are more fully optimized or exploited in leveraging the effectiveness of other project initiatives.
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http://dx.doi.org/10.1097/HMR.0b013e31828265f2DOI Listing
August 2014

Health care administrators' perspectives on the role of absorptive capacity for strategic change initiatives: a qualitative study.

Health Care Manage Rev 2013 Oct-Dec;38(4):339-48

Bita A. Kash, PhD, MBA, FACHE, is Assistant Professor, Department of Health Policy and Management, School of Rural Public Health, Texas A&M Health Science Center, College Station, Texas. E-mail: Aaron Spaulding, PhD, MHA, is Assistant Professor, Department of Public Health, Brooks College of Health, University of North Florida, Jacksonville, Florida. E-mail: Larry Gamm, PhD, is Regents Professor, Health Policy and Management Director, Center for Health Organization Transformation, College Station, Texas. E-mail: Christopher E. Johnson, PhD, is Associate Professor of Health Services, Director, Graduate Program in Health, Services Administration, Austin Ross Chair in Health Administration, Department of Health Services, School of Public Health, University of Washington, Seattle. E-mail:

Background: The dimensions of absorptive capacity (ACAP) are defined, and the importance of ACAP is established in the management literature, but the concept has not been applied to health care organizations attempting to implement multiple strategic initiatives.

Purpose: The aim of this study was to test the utility of ACAP by analyzing health care administrators' experiences with multiple strategic initiatives within two health systems.

Methodology: Results are drawn from administrators' assessments of multiple initiatives within two health systems using in-depth personal interviews with a total of 61 health care administrators. Data analysis was performed following deductive qualitative analysis guidelines. Interview transcripts were coded based on the four dimensions of ACAP: acquiring, assimilating, internalizing/transforming, and exploiting knowledge. Furthermore, we link results related to utilization of management resources, including number of key personnel involved and time consumption, to dimensions of ACAP.

Findings: Participants' description of multiple strategic change initiatives confirmed the importance of the four ACAP dimensions. ACAP can be a useful framework to assess organizational capacity with respect to the organization's ability to concurrently implement multiple strategic initiatives. This capacity specifically revolves around human capital requirements from upper management based on the initiatives' location or stage within the ACAP framework.

Practice Implications: Strategic change initiatives in health care can be usefully viewed from an ACAP perspective. There is a tendency for those strategic initiatives ranking higher in priority and time consumption to reflect more advanced dimensions of ACAP (assimilate and transform), whereas few initiatives were identified in the ACAP "exploit" dimension. This may suggest that health care leaders tend to no longer identify as strategic initiatives those innovations that have moved to the exploitation stage or that less attention is given to the exploitation elements of a strategic initiative than to the earlier stages.
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http://dx.doi.org/10.1097/HMR.0b013e318276faf8DOI Listing
May 2014

Use of a health information exchange system in the emergency care of children.

BMC Med Inform Decis Mak 2011 Dec 30;11:78. Epub 2011 Dec 30.

Health Policy & Management, Jiann-Ping Hsu College of Public Health, Georgia Southern University, 501 Forest Drive, Statesboro, GA 30460, USA.

Background: Children may benefit greatly in terms of safety and care coordination from the information sharing promised by health information exchange (HIE). While information exchange capability is a required feature of the certified electronic health record, we known little regarding how this technology is used in general and for pediatric patients specifically.

Methods: Using data from an operational HIE effort in central Texas, we examined the factors associated with actual system usage. The clinical and demographic characteristics of pediatric ED encounters (n = 179,445) were linked to the HIE system user logs. Based on the patterns of HIE system screens accessed by users, we classified each encounter as: no system usage, basic system usage, or novel system usage. Using crossed random effects logistic regression, we modeled the factors associated with basic and novel system usage.

Results: Users accessed the system for 8.7% of encounters. Increasing patient comorbidity was associated with a 5% higher odds of basic usage and 15% higher odds for novel usage. The odds of basic system usage were lower in the face of time constraints and for patients who had not been to that location in the previous 12 months.

Conclusions: HIE systems may be a source to fulfill users' information needs about complex patients. However, time constraints may be a barrier to usage. In addition, results suggest HIE is more likely to be useful to pediatric patients visiting ED repeatedly. This study helps fill an existing gap in the study of technological applications in the care of children and improves knowledge about how HIE systems are utilized.
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http://dx.doi.org/10.1186/1472-6947-11-78DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3295672PMC
December 2011

Factors associated with health information exchange system usage in a safety-net ambulatory care clinic setting.

J Med Syst 2012 Aug 27;36(4):2455-61. Epub 2011 Apr 27.

Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, USA.

The Meaningful Use criteria promises to make health information exchange (HIE) much more widespread. However, the usage of the information systems made available by existing HIE efforts tends to be very low. This study sought to examine the factors associated with usage of an operational HIE system during ambulatory care visits to safety-net clinics. Overall the HIE system was accessed for 21% of encounters. However, system access took on two distinct forms. In general, usage was more likely for patients with recent emergency department visits and chronic conditions. This study indicates the organizational commitment to engage in HIE does not necessarily mean that the information systems will be always used. In addition, system usage will take on various forms for different reasons. These results reveal considerations for the development, operation and evaluation of HIE efforts.
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http://dx.doi.org/10.1007/s10916-011-9712-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3398743PMC
August 2012

Rural Healthy People 2010, 2020, and beyond: the need goes on.

Fam Community Health 2011 Apr-Jun;34(2):182-8

Blue Cross and Blue Shield of Florida Center for Rural Health Research and Policy, Florida State University College of Medicine, Tallahassee, FL 32306-4300, USA.

Rural Healthy People 2010 represented the first effort to specifically include small and rural communities in the Healthy People movement to improve the health of Americans. Rural Healthy People 2010 set rural-specific health priority areas, documented what is known about health in rural areas, identified rural best practice programs/interventions, and promoted rural health services research and researchers. Over the last decade Rural Healthy People 2010 has provided policy makers, rural providers, and rural communities with a valuable resource for planning and policy making. Sustaining the Rural Healthy People project in collaboration with the broader Healthy People 2020 effort will provide an important infrastructure for improving rural health.
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http://dx.doi.org/10.1097/FCH.0b013e31820dea1cDOI Listing
July 2011

Patient-centered medical homes: will health care reform provide new options for rural communities and providers?

Fam Community Health 2011 Apr-Jun;34(2):93-101

Department of Health Policy and Management, Texas A&M Health Science Center, School of Rural Public Health, College Station, TX 77843, USA.

Many are calling for the expansion of the patient-centered medical home model into rural and underserved populations as a transformative strategy to address issues of access, efficiency, quality, and sustainability in the delivery of health care. Patient-centered medical homes have been touted as a promising cost-saving model for comprehensive management of persons with chronic diseases and disabilities, but it is unclear how rural practitioners in medically underserved areas will implement the patient-centered medical home. This article examines how the Patient Protection & Affordable Care Act of 2010 will enhance rural providers' ability to provide patient-centered care and services contemplated under the Act in a comprehensive, coordinated, cost-effective way despite leaner budgets and health workforce shortages.
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http://dx.doi.org/10.1097/FCH.0b013e31820e0d78DOI Listing
July 2011

Factors motivating and affecting health information exchange usage.

J Am Med Inform Assoc 2011 Mar-Apr;18(2):143-9. Epub 2011 Jan 24.

Department of Health Policy & Management, School of Rural Public Health, Texas A&M Health Science Center, College Station, Texas, USA.

Objective: Health information exchange (HIE) is the process of electronically sharing patient-level information between providers. However, where implemented, reports indicate HIE system usage is low. The aim of this study was to determine the factors associated with different types of HIE usage.

Design: Cross-sectional analysis of clinical data from emergency room encounters included in an operational HIE effort linked to system user logs using crossed random-intercept logistic regression.

Measurements: Independent variables included factors indicative of information needs. System usage was measured as none, basic usage, or a novel pattern of usage.

Results: The system was accessed for 2.3% of all encounters (6142 out of 271,305). Novel usage patterns were more likely for more complex patients. The odds of HIE usage were lower in the face of time constraints. In contrast to expectations, system usage was lower when the patient was unfamiliar to the facility.

Limitations: Because of differences between HIE efforts and the fact that not all types of HIE usage (ie, public health) could be included in the analysis, results are limited in terms of generalizablity.

Conclusions: This study of actual HIE system usage identifies patients and circumstances in which HIE is more likely to be used and factors that are likely to discourage usage. The paper explores the implications of the findings for system redesign, information integration across exchange partners, and for meaningful usage criteria emerging from provisions of the Health Information Technology for Economic & Clinical Health Act.
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http://dx.doi.org/10.1136/jamia.2010.004812DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3116259PMC
July 2011

Determinants of preventable readmissions in the United States: a systematic review.

Implement Sci 2010 Nov 17;5:88. Epub 2010 Nov 17.

Jiann-Ping Hsu College of Public Health, Georgia Southern University Hendricks Hall, PO Box 8015, Statesboro, GA 30460-8015, USA.

Background: Hospital readmissions are a leading topic of healthcare policy and practice reform because they are common, costly, and potentially avoidable events. Hospitals face the prospect of reduced or eliminated reimbursement for an increasing number of preventable readmissions under nationwide cost savings and quality improvement efforts. To meet the current changes and future expectations, organizations are looking for potential strategies to reduce readmissions. We undertook a systematic review of the literature to determine what factors are associated with preventable readmissions.

Methods: We conducted a review of the English language medicine, health, and health services research literature (2000 to 2009) for research studies dealing with unplanned, avoidable, preventable, or early readmissions. Each of these modifying terms was included in keyword searches of readmissions or rehospitalizations in Medline, ISI, CINAHL, The Cochrane Library, ProQuest Health Management, and PAIS International. Results were limited to US adult populations.

Results: The review included 37 studies with significant variation in index conditions, readmitting conditions, timeframe, and terminology. Studies of cardiovascular-related readmissions were most common, followed by all cause readmissions, other surgical procedures, and other specific-conditions. Patient-level indicators of general ill health or complexity were the commonly identified risk factors. While more than one study demonstrated preventable readmissions vary by hospital, identification of many specific organizational level characteristics was lacking.

Conclusions: The current literature on preventable readmissions in the US contains evidence from a variety of patient populations, geographical locations, healthcare settings, study designs, clinical and theoretical perspectives, and conditions. However, definitional variations, clear gaps, and methodological challenges limit translation of this literature into guidance for the operation and management of healthcare organizations. We recommend that those organizations that propose to reward reductions in preventable readmissions invest in additional research across multiple hospitals in order to fill this serious gap in knowledge of great potential value to payers, providers, and patients.
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http://dx.doi.org/10.1186/1748-5908-5-88DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2996340PMC
November 2010

Medical homes: "where you stand on definitions depends on where you sit".

Med Care Res Rev 2010 Aug 6;67(4):393-411. Epub 2010 May 6.

Texas A&M Health Science Center, School of Rural Public Health, Department of Health Policy & Management, Center for Health Organization Transformation, College Station, TX 77842, USA.

The medical home is a potentially transformative strategy to address issues of access, quality, and efficiency in the delivery of health care in the United States. While numerous organizations support a physician-driven definition, it is by no means the universally accepted definition. Several professional groups, payers, and researchers have offered differing, or nuanced, definitions of medical homes. This lack of consensus has contributed to uncertainty among providers about the medical home. We conducted a systematic review of the literature on the medical home and identified 29 professional, government, and academic sources offering definitions. While consensus appears to exist around a core of selected features, the medical home means different things to different people. The variation in definitions can be partly explained by the obligation of organizations to their members and whether the focus is on the patient or provider. Differences in definitions have implications at both the policy and practice levels.
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http://dx.doi.org/10.1177/1077558710367794DOI Listing
August 2010

Health information exchange: persistent challenges and new strategies.

J Am Med Inform Assoc 2010 May-Jun;17(3):288-94

Center for Health Organization Transformation, Department of Health Policy & Management, School of Rural Public Health, Texas A&M Health Science Center, Texas 77843-1266, USA.

Recent federal policies and actions support the adoption of health information exchange (HIE) in order to improve healthcare by addressing fragmented personal health information. However, concerted efforts at facilitating HIE have existed for over two decades in this country. The lessons of these experiences include a recurrence of barriers and challenges beyond those associated with technology. Without new strategies, the current support and methods of facilitating HIE may not address these barriers.
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http://dx.doi.org/10.1136/jamia.2010.003673DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2995716PMC
August 2010

Studer unplugged: identifying underlying managerial concepts.

Hosp Top 2010 Jan-Mar;88(1):1-9

Department of Health Policy and Management, School of Rural Public Health, Texas A&M Health Science Center, USA.

There is evidence that the application of Quint Studer's Hardwiring Excellence approach to organizational change is associated with significant accomplishments in hospitals. The authors' review finds the Studer approach to be closely aligned with management-related concepts of motivation and feedback, social networks, human capital, social capital, management by objectives, evidence based management, and organizational learning. The article is intended to familiarize more managers and management researchers with the content of the Studer approach, demonstrate its grounding in management concepts and principles, and stimulate additional discussion around the utility of such human resources-focused interventions in significant organizational change.
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http://dx.doi.org/10.1080/00185860903534125DOI Listing
May 2010

A critical review of the research literature on Six Sigma, Lean and StuderGroup's Hardwiring Excellence in the United States: the need to demonstrate and communicate the effectiveness of transformation strategies in healthcare.

Implement Sci 2009 Jul 1;4:35. Epub 2009 Jul 1.

Department of Health Policy and Management, School of Rural Public Health, Texas A&M Health Science Center, College Station, Texas, USA.

Background: U.S. healthcare organizations are confronted with numerous and varied transformational strategies promising improvements along all dimensions of quality and performance. This article examines the peer-reviewed literature from the U.S. for evidence of effectiveness among three current popular transformational strategies: Six Sigma, Lean/Toyota Production System, and Studer's Hardwiring Excellence.

Methods: The English language health, healthcare management, and organizational science literature (up to December 2007) indexed in Medline, Web of Science, ABI/Inform, Cochrane Library, CINAHL, and ERIC was reviewed for studies on the aforementioned transformation strategies in healthcare settings. Articles were included if they: appeared in a peer-reviewed journal; described a specific intervention; were not classified as a pilot study; provided quantitative data; and were not review articles. Nine references on Six Sigma, nine on Lean/Toyota Production System, and one on StuderGroup meet the study's eligibility criteria.

Results: The reviewed studies universally concluded the implementations of these transformation strategies were successful in improving a variety of healthcare related processes and outcomes. Additionally, the existing literature reflects a wide application of these transformation strategies in terms of both settings and problems. However, despite these positive features, the vast majority had methodological limitations that might undermine the validity of the results. Common features included: weak study designs, inappropriate analyses, and failures to rule out alternative hypotheses. Furthermore, frequently absent was any attention to changes in organizational culture or substantial evidence of lasting effects from these efforts.

Conclusion: Despite the current popularity of these strategies, few studies meet the inclusion criteria for this review. Furthermore, each could have been improved substantially in order to ensure the validity of the conclusions, demonstrate sustainability, investigate changes in organizational culture, or even how one strategy interfaced with other concurrent and subsequent transformation efforts. While informative results can be gleaned from less rigorous studies, improved design and analysis can more effectively guide healthcare leaders who are motivated to transform their organizations and convince others of the need to employ such strategies. Demanding more exacting evaluation of projects consultants, or partnerships with health management researchers in academic settings, can support such efforts.
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http://dx.doi.org/10.1186/1748-5908-4-35DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2709888PMC
July 2009

An attempt to forecast hospital market share using admission data.

J Healthc Manag 2009 Jan-Feb;54(1):44-55; discussion 55-6

Department of Health Policy and Management, School of Rural Public Health, Texas A&M University Health Science Center, College Station, USA.

The purpose of this study was to develop a model to forecast market share before actual market share data become available to a hospital system. The typical data lag is about six to nine months, and market share information is often based on incomplete admissions data. Therefore, this exploratory analysis of admissions for all hospitals in a Texas hospital system was performed as an attempt to improve the accuracy and timeliness of market share data. We used four data sources: (1) Texas Health Care Information Council Public Use Data File, (2) Solucient, (3) internal data on admissions for three small nearby hospitals not reporting to the state, and (4) population growth data based on the U.S. census. Data analysis was performed using STATA 9 and SAS statistical software. Six prediction models were chosen and evaluated that best predicted present and future market share using historical market share data, historical and current admissions data, and population growth data. These included models for the total market area; the core cluster; and the eastern, western, northern, and southern market clusters. Only two of the six forecasting equations were useful, with a relatively high prediction value. Overall, the attempt to predict market share based on historical and current admissions data while controlling for demographic factors and seasonality was of limited success. Future research should consider additional factors associated with market share; these factors could include changes in physician referral patterns and third-party-payer contracts. The value of this type of research for management is explored here as well.
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March 2009

Evaluation and management documentation and coding technology adoption.

Perspect Health Inf Manag 2007 Aug 27;4. Epub 2007 Aug 27.

AHIMA's Foundation of Research and Education in Chicago, IL, USA.

This study determines the relative effect of financial incentives, practice characteristics, and regulatory guidelines on the utilization of documentation and coding technology among physician practices employing HIM professionals. A total of 442 HIM professionals, 9.78 percent of the surveyed population, completed a Web-based survey regarding their practices and E/M documentation and coding methods used. More physician practices use the traditional documentation and coding methods than use automated methods. Less than half of the practices using automated documentation technology also utilized automated coding technology. Financial incentives and regulatory guidelines were not related to documentation or coding method used. Organization size and type were highly related to documentation or coding method used. Practices using coding technology were more likely to perform coding validation. The reasons for low levels of coding technology adoption, which requires little additional physician effort, suggest the potential presence of unique factors inhibiting the adoption of this technology.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2047297PMC
August 2007

Organizational technologies for transforming care: measures and strategies for pursuit of IOM quality aims.

J Ambul Care Manage 2007 Oct-Dec;30(4):291-301

Department of Health Policy and Management, Texas A&M HSC School of Rural Public Health, College Station, TX 77843, USA.

Progress on the Institute of Medicine's (IOM's) 6 aims to bridge the "quality chasm" requires both measurement and the concerting of multiple organizational technologies. The basic thesis of this article is that rapid progress on the IOM's multiple aims calls for transformative change within and among healthcare organizations. The promise of a number of types of transformative approaches is closely linked to their ability to simultaneously build upon several organizational technologies: clinical, social, information, and administrative technologies. To encourage and advance such efforts, this article identifies illustrative measures of attainment of the IOM's 6 aims or targeted areas for improvement that reflect the contributions of the 4 organizational technologies. It discusses examples of relationships between the IOM aims and the organizational technologies considered. Finally, the article offers illustrations of the interplay of these organizational technologies and IOM aims-across an array of organizational innovations with transformative potential. Included among such innovations are information technology in the form of electronic medical records, computer-based physician order entry, and patient health records; organization-wide patient-centered cultural change such as Studer's Hardwiring Excellence; Six Sigma and Toyota Production Management/LEAN; major clinical technology change, for example, minimally invasive cardiac surgery and broader treatment innovations such as disease management.
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http://dx.doi.org/10.1097/01.JAC.0000290397.58790.b9DOI Listing
December 2007

Who's coding and how in physician practices. A survey of E/M documentation and coding practices.

J AHIMA 2007 Jul-Aug;78(7):52-5

AHIMA's Foundation of Research and Education, USA.

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September 2007

Opportunities for administrators to promote disease management.

J Healthc Manag 2005 Sep-Oct;50(5):297-309; discussion 309-10

School of Rural Public Health, Texas A&M University System Health Science Center, College Station, Texas, USA.

Studies of disease management (DM) have shown that patients who participate in such programs achieve better health status and make fewer emergency room visits. Private and government payers have recently increased their efforts to promote DM initiatives through financial incentives to healthcare providers. This article explores opportunities for administrators of health services organizations (HSO) to promote DM in the current political and economic environment. Our survey of professionals (DM leaders, physicians, and DM nurses) in six DM programs reveals these professionals' assessments of the key players and resources that they deem important to their respective DM programs. They view DM programs as heavily dependent on the support of physicians, nurses, and health plan leaders but relatively less so on the support of HSO administrators- a situation that may suggest opportunities for administrators to take on greater leadership in moving the HSO toward developing DM programs. Survey results also indicate a strong need for the integration of resources such as communication systems, electronic medical records, and DM reporting. Taken collectively, these needs suggest a number of strategies for the administrator to play a larger role in supporting the adoption and effective implementation of DM. In the article, we propose that DM programs can benefit substantially from an administrator who can demonstrate a thorough knowledge of DM-related government and private-payer initiatives and who has the ability to provide leadership to develop and implement viable DM programs. Valued contributions that the administrator should bring to the table include support of standardized DM processes, use of practice guidelines, and provision of pertinent information systems.
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December 2005

Organizational technologies of chronic disease management programs in large rural multispecialty group practice systems.

J Ambul Care Manage 2005 Jul-Sep;28(3):210-21

Department of Health Policy and Management, School of Rural Public Health, Health Science Center, Texas A&M University System, College Station, USA.

Four large rural multispecialty group practice systems employ a mix of organizational technologies to provide chronic disease management with measurable impacts on their patient populations and costs. Four technologies-administrative, clinical, information, and social-are proposed as key dimensions for examining disease management programs. The benefits of disease management are recognized by these systems despite marked variability in the organization of the programs. Committees spanning health plans and clinics in the 4 systems and electronic medical records and/or other disease management information systems are important coordinating mechanisms. Increased reliance on nurses for patient education and care coordination in all 4 systems reflects significant extension of clinical and social technologies in the management of patient care. The promise of disease management as offered by these systems and other auspices are considered.
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http://dx.doi.org/10.1097/00004479-200507000-00004DOI Listing
October 2005

Chronic disease management in rural and underserved populations: innovation and system improvement help lead to success.

Manag Care Interface 2005 Mar;18(3):37-41, 55

Department of Health Policy and Management, School of Rural Public Health, Texas A & M Health Sciences Center, College Station, Texas 77843-1266, USA.

Successful implementation of disease management (DM) is based on the ability of an organization to overcome a variety of barriers to deliver timely, appropriate care of chronic illnesses. Such programs initiate DM services to patient populations while initiating self-management education among medication-resistant patients who are chronically ill. Despite formidable challenges, rural health care providers have been successful in initiating DM programs and have discovered several ways in which these programs benefit their organizations. This research reports on six DM programs that serve large rural and underserved populations and have demonstrated that DM can be successfully implemented in such areas.
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March 2005

Accountability framework for managing stakeholders of health programs.

J Health Organ Manag 2004 ;18(4-5):290-304

Department of Health Policy and Administration, The Pennsylvania State University, University Park, Pennsylvania, USA.

Understanding the incentives of stakeholders and employing effective management practices with various stakeholder groups is essential for program sustainability. This paper offers a conceptual model that depicts four different types of stakeholder interests that are relevant to health service organizations. The study identified the major stakeholders of telehealth programs, compared the influence of stakeholders by organizational ownership and investigated the practices used to manage these stakeholders. Quantitative and qualitative analyses demonstrated empirical support for the stakeholder model. The paper suggests that the model can be used as a stakeholder management tool in healthcare organizations and offers an assessment of the utility of the stakeholder framework in organizational research
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http://dx.doi.org/10.1108/14777260410554296DOI Listing
December 2004

Rural healthy people 2010--evolving interactive practice.

Am J Public Health 2004 Oct;94(10):1711-2

Professor of Health Policy and Management, School of Rural Public Health, Texas A&M University System Health Science Center, 1266 TAMU, College Station, TX 77843, USA.

The objectives of the Rural Healthy People 2010 project are to employ a survey of state and local rural health leaders to identify rural health priorities, to synthesize available research and other publications on these priorities, to identify and describe models for practice employed by rural communities to address these priorities, and to disseminate this information to rural communities. We describe these priorities; the content of Rural Healthy People 2010 products, methods, and target audiences; and the continuing evolution of the program. Rural Healthy People 2010 encourages rural support of Healthy People 2010 goals and invites state and local rural health leaders to share their successful models with others.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1448522PMC
http://dx.doi.org/10.2105/ajph.94.10.1711DOI Listing
October 2004