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[PMID]:29373587
[Au] Autor:Palmer KS; Brown AD; Evans JM; Marani H; Russell KK; Martin D; Ivers NM
[Ad] Endereço:Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.
[Ti] Título:Qualitative analysis of the dynamics of policy design and implementation in hospital funding reform.
[So] Source:PLoS One;13(1):e0191996, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: As in many health care systems, some Canadian jurisdictions have begun shifting away from global hospital budgets. Payment for episodes of care has begun to be implemented. Starting in 2012, the Province of Ontario implemented hospital funding reforms comprising three elements: Global Budgets; Health Based Allocation Method (HBAM); and Quality-Based Procedures (QBP). This evaluation focuses on implementation of QBPs, a procedure/diagnosis-specific funding approach involving a pre-set price per episode of care coupled with best practice clinical pathways. We examined whether or not there was consensus in understanding of the program theory underpinning QBPs and how this may have influenced full and effective implementation of this innovative funding model. METHODS: We undertook a formative evaluation of QBP implementation. We used an embedded case study method and in-depth, one-on-one, semi-structured, telephone interviews with key informants at three levels of the health care system: Designers (those who designed the QBP policy); Adoption Supporters (organizations and individuals supporting adoption of QBPs); and Hospital Implementers (those responsible for QBP implementation in hospitals). Thematic analysis involved an inductive approach, incorporating Framework analysis to generate descriptive and explanatory themes that emerged from the data. RESULTS: Five main findings emerged from our research: (1) Unbeknownst to most key informants, there was neither consistency nor clarity over time among QBP designers in their understanding of the original goal(s) for hospital funding reform; (2) Prior to implementation, the intended hospital funding mechanism transitioned from ABF to QBPs, but most key informants were either unaware of the transition or believe it was intentional; (3) Perception of the primary goal(s) of the policy reform continues to vary within and across all levels of key informants; (4) Four years into implementation, the QBP funding mechanism remains misunderstood; and (5) Ongoing differences in understanding of QBP goals and funding mechanism have created challenges with implementation and difficulties in measuring success. CONCLUSIONS: Policy drift and policy layering affected both the goal and the mechanism of action of hospital funding reform. Lack of early specification in both policy goals and hospital funding mechanism exposed the reform to reactive changes that did not reflect initial intentions. Several challenges further exacerbated implementation of complex hospital funding reforms, including a prolonged implementation schedule, turnover of key staff, and inconsistent messaging over time. These factors altered the trajectory of the hospital funding reforms and created confusion amongst those responsible for implementation. Enacting changes to hospital funding policy through a process that is transparent, collaborative, and intentional may increase the likelihood of achieving intended effects.
[Mh] Termos MeSH primário: Administração Financeira de Hospitais/organização & administração
Inovação Organizacional
Política Organizacional
[Mh] Termos MeSH secundário: Ontário
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180127
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0191996


  2 / 7979 MEDLINE  
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[PMID]:28672304
[Au] Autor:Jha AK
[Ad] Endereço:Ashish K. Jha, MD, MPH, is K. T. Li Professor of International Health and Health Policy at the Harvard T. H. Chan School of Public Health and a practicing internist at the Veterans Affairs Boston Healthcare System.
[Ti] Título:Payment Power to the Patients.
[So] Source:JAMA;318(1):18-19, 2017 Jul 04.
[Is] ISSN:1538-3598
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Administração Financeira de Hospitais
Satisfação do Paciente
Qualidade da Assistência à Saúde/economia
Mecanismo de Reembolso
[Mh] Termos MeSH secundário: Seres Humanos
Medicare
Avaliação de Processos e Resultados (Cuidados de Saúde)/métodos
Risco Ajustado
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170822
[Lr] Data última revisão:
170822
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170704
[St] Status:MEDLINE
[do] DOI:10.1001/jama.2017.7533


  3 / 7979 MEDLINE  
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[PMID]:28617202
[Au] Autor:Choi S
[Ad] Endereço:1 University of Minnesota School of Public Health, Minneapolis, MN, USA.
[Ti] Título:Hospital Capital Investment During the Great Recession.
[So] Source:Inquiry;54:46958017708399, 2017 Jan 01.
[Is] ISSN:1945-7243
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Hospital capital investment is important for acquiring and maintaining technology and equipment needed to provide health care. Reduction in capital investment by a hospital has negative implications for patient outcomes. Most hospitals rely on debt and internal cash flow to fund capital investment. The great recession may have made it difficult for hospitals to borrow, thus reducing their capital investment. I investigated the impact of the great recession on capital investment made by California hospitals. Modeling how hospital capital investment may have been liquidity constrained during the recession is a novel contribution to the literature. I estimated the model with California Office of Statewide Health Planning and Development data and system generalized method of moments. Findings suggest that not-for-profit and public hospitals were liquidity constrained during the recession. Comparing the changes in hospital capital investment between 2006 and 2009 showed that hospitals used cash flow to increase capital investment by $2.45 million, other things equal.
[Mh] Termos MeSH primário: Financiamento de Capital/tendências
Recessão Econômica
Administração Financeira de Hospitais/organização & administração
Investimentos em Saúde
[Mh] Termos MeSH secundário: California
Bases de Dados Factuais
Administração Financeira de Hospitais/estatística & dados numéricos
Modelos Teóricos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170713
[Lr] Data última revisão:
170713
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170616
[St] Status:MEDLINE
[do] DOI:10.1177/0046958017708399


  4 / 7979 MEDLINE  
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[PMID]:28094836
[Au] Autor:Falk L
[Ti] Título:[Management theory in a new suit--or the emperor's new clothes].
[Ti] Título:Managementteori i ny kostym ­ eller kejsarens nya kläder?.
[So] Source:Lakartidningen;114, 2017 01 16.
[Is] ISSN:1652-7518
[Cp] País de publicação:Sweden
[La] Idioma:swe
[Mh] Termos MeSH primário: Administração Financeira de Hospitais/organização & administração
Reforma dos Serviços de Saúde/normas
Modelos Organizacionais
[Mh] Termos MeSH secundário: Seres Humanos
Suécia
[Pt] Tipo de publicação:LETTER
[Em] Mês de entrada:1705
[Cu] Atualização por classe:171011
[Lr] Data última revisão:
171011
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170118
[St] Status:MEDLINE


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[PMID]:28075362
[Au] Autor:Yan YH; Kung CM; Fang SC; Chen Y
[Ad] Endereço:Department of Medical Research, Tainan Municipal Hospital, No. 670, Chung Te Road, Tainan City 701, Taiwan. 2d0003@mail.tmh.org.tw.
[Ti] Título:Transparency of Mandatory Information Disclosure and Concerns of Health Services Providers and Consumers.
[So] Source:Int J Environ Res Public Health;14(1), 2017 Jan 09.
[Is] ISSN:1660-4601
[Cp] País de publicação:Switzerland
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: This study analyzed differences between transparency of information disclosure and related demands from the health service consumer's perspective. It also compared how health service providers and consumers are associated by different levels of mandatory information disclosure. METHODS: We obtained our research data using a questionnaire survey (health services providers, = 201; health service consumers, = 384). RESULTS: Health service consumers do not have major concerns regarding mandatory information disclosure. However, they are concerned about complaint channels and settlement results, results of patient satisfaction surveys, and disclosure of hospital financial statements ( < 0.001). We identified significant differences in health service providers' and consumers' awareness regarding the transparency of information disclosure ( < 0.001). CONCLUSIONS: It may not be possible for outsiders to properly interpret the information provided by hospitals. Thus, when a hospital discloses information, it is necessary for the government to consider the information's applicability. Toward improving medical expertise and information asymmetry, the government has to reduce the burden among health service consumers in dealing with this information, and it has to use the information effectively.
[Mh] Termos MeSH primário: Conscientização
Revelação/normas
Administração Financeira de Hospitais/normas
Programas Nacionais de Saúde/normas
Satisfação do Paciente/legislação & jurisprudência
[Mh] Termos MeSH secundário: Adulto
Feminino
Seres Humanos
Masculino
Meia-Idade
Programas Nacionais de Saúde/estatística & dados numéricos
Inquéritos e Questionários
Taiwan
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170608
[Lr] Data última revisão:
170608
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170112
[St] Status:MEDLINE


  6 / 7979 MEDLINE  
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[PMID]:27926643
[Au] Autor:Hofler LG; Cordes S; Cwiak CA; Goedken P; Jamieson DJ; Kottke M
[Ad] Endereço:Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia.
[Ti] Título:Implementing Immediate Postpartum Long-Acting Reversible Contraception Programs.
[So] Source:Obstet Gynecol;129(1):3-9, 2017 Jan.
[Is] ISSN:1873-233X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To understand the most important steps required to implement immediate postpartum long-acting reversible contraception (LARC) programs in different Georgia hospitals and the barriers to implementing such a program. METHODS: This was a qualitative study. We interviewed 32 key personnel from 10 Georgia hospitals working to establish immediate postpartum LARC programs. Data were analyzed using directed qualitative content analysis principles. We used the Stages of Implementation to organize participant-identified key steps for immediate postpartum LARC into an implementation guide. We compared this guide to hospitals' implementation experiences. RESULTS: At the completion of the study, LARC was available for immediate postpartum placement at 7 of 10 study hospitals. Participants identified common themes for the implementation experience: team member identification and ongoing communication, payer preparedness challenges, interdependent department-specific tasks, and piloting with continuing improvements. Participants expressed a need for anticipatory guidance throughout the process. Key first steps to immediate postpartum LARC program implementation were identifying project champions, creating an implementation team that included all relevant departments, obtaining financial reassurance, and ensuring hospital administration awareness of the project. Potential barriers included lack of knowledge about immediate postpartum LARC, financial concerns, and competing clinical and administrative priorities. Hospitals that were successful at implementing immediate postpartum LARC programs did so by prioritizing clear communication and multidisciplinary teamwork. Although the implementation guide reflects a comprehensive assessment of the steps to implementing immediate postpartum LARC programs, not all hospitals required every step to succeed. CONCLUSION: Hospital teams report that implementing immediate postpartum LARC programs involves multiple departments and a number of important steps to consider. A stage-based approach to implementation, and a standardized guide detailing these steps, may provide the necessary structure for the complex process of implementing immediate postpartum LARC programs in the hospital setting.
[Mh] Termos MeSH primário: Anticoncepção
Implementação de Plano de Saúde/organização & administração
Hospitais
Papel do Médico
Desenvolvimento de Programas/métodos
[Mh] Termos MeSH secundário: Comunicação
Anticoncepção/economia
Anticoncepcionais Femininos/administração & dosagem
Implantes de Medicamento
Registros Eletrônicos de Saúde
Feminino
Administração Financeira de Hospitais
Georgia
Seres Humanos
Entrevistas como Assunto
Dispositivos Intrauterinos
Papel do Profissional de Enfermagem
Serviço de Farmácia Hospitalar
Período Pós-Parto
Mecanismo de Reembolso
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Contraceptive Agents, Female); 0 (Drug Implants)
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170614
[Lr] Data última revisão:
170614
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:161208
[St] Status:MEDLINE
[do] DOI:10.1097/AOG.0000000000001798


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[PMID]:28957591
[Au] Autor:Hrickiewicz M
[Ti] Título:Keeping up with changes in health care real estate.
[So] Source:Health Facil Manage;29(7):12-13, 2016 Jul.
[Is] ISSN:0899-6210
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Financiamento de Capital
Administração Financeira de Hospitais/métodos
Instalações de Saúde/economia
[Mh] Termos MeSH secundário: Tomada de Decisões Gerenciais
Seres Humanos
Investimentos em Saúde/economia
Aluguel de Propriedade/economia
Serviço Hospitalar de Compras/economia
Estados Unidos
[Pt] Tipo de publicação:INTERVIEW
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171113
[Lr] Data última revisão:
171113
[Sb] Subgrupo de revista:H
[Da] Data de entrada para processamento:170929
[St] Status:MEDLINE


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[PMID]:28936862
[Au] Autor:Peltzman M
[Ti] Título:The 2017 Inpatient Prospective Payment System: What it means for surgery.
[So] Source:Bull Am Coll Surg;101(12):32-9, 2016 12.
[Is] ISSN:0002-8045
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Centers for Medicare and Medicaid Services (U.S.)
Administração Financeira de Hospitais/legislação & jurisprudência
Pacientes Internados
Medicare/legislação & jurisprudência
Sistema de Pagamento Prospectivo/legislação & jurisprudência
Métodos de Controle de Pagamentos/legislação & jurisprudência
[Mh] Termos MeSH secundário: Grupos Diagnósticos Relacionados
Seres Humanos
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171016
[Lr] Data última revisão:
171016
[Sb] Subgrupo de revista:H
[Da] Data de entrada para processamento:170925
[St] Status:MEDLINE


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[PMID]:27789497
[Au] Autor:Grove A; Oo V; Sequeira A
[Ad] Endereço:Tower Hamlets VTS, London.
[Ti] Título:Bridging the gap: are charities the way forward?
[So] Source:Br J Gen Pract;66(652):571, 2016 Nov.
[Is] ISSN:1478-5242
[Cp] País de publicação:England
[La] Idioma:eng
[Mh] Termos MeSH primário: Instituições de Caridade/organização & administração
Medicina Geral/organização & administração
Promoção da Saúde
[Mh] Termos MeSH secundário: Administração Financeira de Hospitais
Medicina Geral/recursos humanos
Seres Humanos
Carga de Trabalho
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1707
[Cu] Atualização por classe:171101
[Lr] Data última revisão:
171101
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161030
[St] Status:MEDLINE


  10 / 7979 MEDLINE  
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[PMID]:27779968
[Au] Autor:Moazzez A; de Virgilio C
[Ad] Endereço:Harbor UCLA Medical Center, Torrance, California, USA.
[Ti] Título:Role of Surgical Services in Profitability of Hospitals in California: An Analysis of Office of Statewide Health Planning and Development Annual Financial Data.
[So] Source:Am Surg;82(10):894-897, 2016 Oct.
[Is] ISSN:1555-9823
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:With constant changes in health-care laws and payment methods, profitability, and financial sustainability of hospitals are of utmost importance. The purpose of this study is to determine the relationship between surgical services and hospital profitability. The Office of Statewide Health Planning and Development annual financial databases for the years 2009 to 2011 were used for this study. The hospitals' characteristics and income statement elements were extracted for statistical analysis using bivariate and multivariate linear regression. A total of 989 financial records of 339 hospitals were included. On bivariate analysis, the number of inpatient and ambulatory operating rooms (ORs), the number of cases done both as inpatient and outpatient in each OR, and the average minutes used in inpatient ORs were significantly related with the net income of the hospital. On multivariate regression analysis, when controlling for hospitals' payer mix and the study year, only the number of inpatient cases done in the inpatient ORs (ß = 832, P = 0.037), and the number of ambulatory ORs (ß = 1,485, 466, P = 0.001) were significantly related with the net income of the hospital. These findings suggest that hospitals can maximize their profitability by diverting and allocating outpatient surgeries to ambulatory ORs, to allow for more inpatient surgeries.
[Mh] Termos MeSH primário: Administração Financeira de Hospitais/organização & administração
Planejamento em Saúde/economia
Centro Cirúrgico Hospitalar/economia
Procedimentos Cirúrgicos Operatórios/economia
[Mh] Termos MeSH secundário: California
Bases de Dados Factuais
Economia Hospitalar
Feminino
Seres Humanos
Modelos Lineares
Masculino
Análise Multivariada
Desenvolvimento de Programas
Avaliação de Programas e Projetos de Saúde
Estudos Retrospectivos
Papel (Figurativo)
Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1701
[Cu] Atualização por classe:170126
[Lr] Data última revisão:
170126
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161026
[St] Status:MEDLINE



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