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Managed care and patient safety: risks and opportunities.

Published on Jul 1, 2005in The health care manager
· DOI :10.1097/00126450-200507000-00009
Lynn Unruh18
Estimated H-index: 18
,
Nancy Rudner Lugo1
Estimated H-index: 1
+ 1 AuthorsJacqueline Fowler Byers6
Estimated H-index: 6
Cite
Abstract
Objective:Patient safety practices have primarily focused on providers, such as hospitals and ambulatory or long-term care. Based on the premise that most medical errors and patient safety problems arise from system issues, and that managed care constitutes the largest, most integrated system in hea
  • References (35)
  • Citations (6)
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References35
Newest
Published on Jan 1, 2003in Medical Care3.79
Lynn Unruh18
Estimated H-index: 18
OBJECTIVE. To examine the changes in licensed nursing staff in Pennsylvania hospitals from 1991 to 1997, and to assess the relationship of licensed nursing staff with patient adverse events in hospitals. DATA SOURCE. A convenience sample of all Pennsylvania, acute-care, hospitals, 1991 to 1997. STUDY DESIGN. The study first describes the percentage change of licensed nursing staff categories in Pennsylvania hospitals from 1991 to 1997. Second, random effects Poisson regressions are used to asses...
Published on Oct 23, 2002in JAMA51.27
Linda H. Aiken74
Estimated H-index: 74
,
Sean P. Clarke44
Estimated H-index: 44
+ 2 AuthorsJeffrey H. Silber50
Estimated H-index: 50
ContextThe worsening hospital nurse shortage and recent California legislation mandating minimum hospital patient-to-nurse ratios demand an understanding of how nurse staffing levels affect patient outcomes and nurse retention in hospital practice.ObjectiveTo determine the association between the patient-to-nurse ratio and patient mortality, failure-to-rescue (deaths following complications) among surgical patients, and factors related to nurse retention.Design, Setting, and ParticipantsCross-se...
Published on Sep 1, 2002in Health Affairs5.71
Kelly J. Devers20
Estimated H-index: 20
Providers report maintaining, but not greatly enhancing, their quality improvement (QI) programs between 1999 and 2001. In addition, recent market developments are intensifying barriers to providers’ QI efforts. A notable exception is the tremendous attention to medical errors, which is stimulating patient-safety activities in hospitals. It is too early to tell if the momentum from these activities can be sustained and provide a spark for revolutionary changes in QI more broadly.
Published on Jul 1, 2002in Health Affairs5.71
Robert H. Miller22
Estimated H-index: 22
,
Harold S. Luft45
Estimated H-index: 45
This paper synthesizes results from peer-reviewed literature published from 1997 to mid-2001, on various dimensions of health maintenance organization (HMO) plan performance. Results from seventy-nine studies suggest that both types of plans provide roughly comparable quality of care, while HMOs lower use of hospital and other expensive resources somewhat. At the same time, HMO enrollees report worse results on many measures of access to care and lower levels of satisfaction, compared with non-H...
Published on Jun 1, 2002in Journal of Health Politics Policy and Law1.84
Robert H. Miller22
Estimated H-index: 22
,
Randall R. Bovbjerg19
Estimated H-index: 19
This paper is among the first to analyze patient safety in ambulatory care. Based on detailed interviews, it categorizes safety innovations among large physician groups, models the key determinants of innovation, and suggests policies to support further improvements. Medical injuries targeted were similar across groups, but interventions varied greatly. We developed a conceptual model to explain advances in safety innovation: (1) Demand for safety comes from external factors?legal, market, and p...
Published on Jun 1, 2002in Health Services Research2.71
Christine Kovner26
Estimated H-index: 26
(NYU: New York University),
Cheryl B. Jones21
Estimated H-index: 21
(UNC: University of North Carolina at Chapel Hill)
+ 2 AuthorsJayasree Basu15
Estimated H-index: 15
(AHRQ: Agency for Healthcare Research and Quality)
Objective. To examine the impact of nurse staffing on selected adverse events hypothesized to be sensitive to nursing care between 1990 and 1996, after controlling for hospital characteristics. Data Sources/Study Setting. The yearly cross-sectional samples of hospital discharges for states participating in the National Inpatient Sample (NIS) from 1990–1996 were combined to form the analytic sample. Six states were included for 1990–1992, four states were added for the period 1993–1994, and three...
Published on May 30, 2002in The New England Journal of Medicine70.67
J Ack N Eedleman1
Estimated H-index: 1
,
P Eter B Uerhaus1
Estimated H-index: 1
,
M Aureen S Tewart1
Estimated H-index: 1
Background It is uncertain whether lower levels of staffing by nurses at hospitals are associated with an increased risk that patients will have complications or die. Methods We used administrative data from 1997 for 799 hospitals in 11 states (covering 5,075,969 discharges of medical patients and 1,104,659 discharges of surgical patients) to examine the relation between the amount of care provided by nurses at the hospital and patients' outcomes. We conducted regression analyses in which we con...
Published on Sep 1, 2001in Pharmacotherapy3.04
C. A. Bond23
Estimated H-index: 23
(TTUHSC: Texas Tech University Health Sciences Center),
Cynthia L. Raehl1
Estimated H-index: 1
(UCLA: University of California, Los Angeles),
Todd Franke1
Estimated H-index: 1
(TTUHSC: Texas Tech University Health Sciences Center)
This study evaluated hospital demographics, staffing, pharmacy variables, health care outcomes measures (severity of illness-adjusted mortality rates, drug costs, total cost of care, and length of stay) and medication errors. A database was constructed from the 1992 American Hospital Association's Abridged Guide to the Health Care Field, the 1992 National Clinical Pharmacy Services database, and 1992 mortality data from the Health Care Financing Administration. Simple statistical tests and a sev...
Published on Sep 1, 2001in Journal of Law Medicine & Ethics0.73
Alice A. Noble3
Estimated H-index: 3
(Harvard University),
Troyen A. Brennan83
Estimated H-index: 83
(Harvard University)
We now stand at the intersection of three major trends in American health policy: the dominance of managed care in health-care delivery; concerns about the impact of financial incentives on the quality of managed care, expressed in particular through litigation against managed care companies; and a renewed interest in medical "error" reduction at the system level. Managed care incentives are part of the system of health care. Financial influence on physicians affect behavior and could presumably...
Cited By6
Newest
Published on Dec 1, 2015in Service Business2.29
Luu Trong Tuan16
Estimated H-index: 16
(VNUHCM: Vietnam National University, Ho Chi Minh City)
Clinical governance is a transcendent force to steer clinicians toward patients and other clinicians in healthcare organizations. This empirical research seeks to examine the chain effect from clinical governance, through corporate social responsibility (CSR) and knowledge sharing, to clinical error control. Through the investigation of the responses from 418 middle level clinicians, the proposed model was tested through the structural equation modeling-based analysis. Research results confirmed...
Published on Jul 30, 2015
Dean G. Smith2
Estimated H-index: 2
(LSU: Louisiana State University),
Xiao Xu21
Estimated H-index: 21
(Yale University),
Kathryn R. McCool (Yahoo!)
Objective: Medical liability continues to be a concern among physicians and policy makers. This study examines the interaction among managed care, the systems that physicians put into place in their offices to address managed care demands and their resultant medical liability risks. Methods: A survey instrument based on a conceptual model of risk was mailed to 882 physicians identified by a medical liability insurance company. Multivariate methods were used to compare rates of claims of medical ...
Purpose – This study aims to fathom the role of nursing governance as a mechanism to activate the chain effect from corporate social responsibility (CSR) through psychological contract to knowledge sharing, which in turn reduces clinical errors in hospitals in the Vietnam context. Clinical errors not merely result from human factors but also from mechanisms which influence human factors. Design/methodology/approach – The clues for the research model were established through structural equation m...
Published on Jan 1, 2010in The Quality Management Journal
Gregory N. Stock23
Estimated H-index: 23
,
Kathleen L. McFadden18
Estimated H-index: 18
,
Charles R. Gowen15
Estimated H-index: 15
The relationships among organizational culture, knowledge management, and patient safety performance in the healthcare industry are investigated. A test model for patient safety performance is developed using data from existing literature and a survey o..
Published on Apr 1, 2007in International Journal of Production Economics5.00
Gregory N. Stock23
Estimated H-index: 23
(NIU: Northern Illinois University),
Kathleen L. McFadden18
Estimated H-index: 18
(NIU: Northern Illinois University),
Charles R. Gowen15
Estimated H-index: 15
(NIU: Northern Illinois University)
Abstract The problem of errors in patient care is a critical issue facing hospitals today. An Institute of Medicine [ To err is human, building a safer health system . Washington DC: National Academy Press.] study estimates that medical errors are linked to more than 98,000 deaths annually, and that 58% of these error-related deaths are preventable. This paper investigates how organizational culture and specific management techniques (termed critical success factors (CSFs) in this paper) may lea...
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