Previous research has noted that schools vary in substance use prevalence rates, but explanations for school differences have received little empirical attention. We assess variability across elementary (N = 36) rates of early adolescent alcohol, cigarette, and marijuana use. Characteristics neighborhoods potentially related to are examined, as well whether these characteristics independent effects or neighborhood mediated by characteristics. Neighborhood were measured using student, parent,...

This study examines whether the effects of peer substance use on adolescent alcohol and tobacco are due to endogeneity adolescents selecting their group. We analyzed data collected for a longitudinal analysis drug-use prevention programme upper elementary school students. used two-step probit regression control potentially endogenous explanatory variable use. Rigorous tests validity instrumental variables showed that controlling reduce bias is not worth reduction in mean squared error these...

Decisions by states about whether to expand Medicaid under the Affordable Care Act (ACA) have implications for hospitals’ financial health. We hypothesized that expansion of eligibility childless adults prevents hospital closures because increased coverage previously uninsured people reduces uncompensated care expenditures and strengthens position. tested this hypothesis using data period 2008–16 on performance. found ACA’s was associated with improved performance substantially lower...

BackgroundIn efforts to improve the quality of care, many have suggested that health care adopt management approaches been successful in manufacturing and technology sectors.However, there is relatively little information about how these practices are disseminated hospitals, whether they associated with better performance. MethodsWe adapted an approach used measure organizational collect data on cardiac units, scoring performance 18 practices, covering "Lean" methods, tracking key...

Higher proportions of BSN-educated nurses were associated with improved outcomes in hospital-level studies. A recent Institute Medicine report calls for increasing the proportion to 80% by 2020. Patient-level evidence cost and quality implications BSN threshold is needed a business case support these efforts.To conduct economic analysis meeting on patient costs, using linked patient-nurse data.Retrospective observational patient-level electronic data. Linear logistic regression modeling...

Research Objective The Internal Revenue Service (IRS) has required nonprofit hospitals to document their community benefit spending in order justify tax exemption since 2009. This potential improve social welfare and should be considered, along with efficiency prices of traditional hospital services, when evaluating the impact acquisitions. Existing evidence links variation local needs, priorities boards, financial performance. We hypothesize that independent have stronger ties communities...

Abstract Concerns about deficiencies in the quality of care delivered US hospitals grew during a time period when an increasing number were experiencing financial problems. Our study examines six‐year longitudinal database general acute 11 states to assess relationship between hospital condition and care. We evaluate two measures performance: operating margin broader profitability measure that encompasses both non‐operating sources income. model specification allows for gradual adjustments...

Several state Medicaid reforms are under way, but the relative performance of different approaches is unclear.To compare Oregon's and Colorado's Accountable Care Organization (ACO) models.Oregon initiated its transformation in 2012, supported by a $1.9 billion investment from federal government, moving most enrollees into 16 Coordinated Organizations, which managed care within global budget. Colorado Collaborative 2011, creating 7 Regional Organizations that received funding to coordinate...

Recent forces have created new financial stress for hospitals but also some relief. This paper explores hospitals' changing involvement in the safety net between 1996 and 2002. We replicate approaches used a study of 1990-1997 thus provide needed update on U.S. hospital net. Overall, groups safety-net increased uncompensated care, others did not. Non-safety-net trimmed certain services commonly by indigent; this may point to future reductions access. examine implications these findings

Financial pressure mounted for hospitals nationwide during the late 1990s. Our study examines how this affected quality of their operations in terms organizational infrastructure and processes that support delivery care. sample consisted community operating between 1995 2000. was measured based on changes net patient revenues per adjusted day ratio cash flow to total revenues. The authors examined effects hospital investments plant equipment standards compliance with selected Joint...

Abstract We investigate whether the modern management practices and publicly reported performance measures are associated with choice of hospital for patients acute myocardial infarction (AMI). define measure at approximately half US cardiac care units using a novel survey approach. A patient's is modeled as function hospital's on quality its management. The estimates, based grouped conditional logit specification, reveal that higher scores better positively choice. Management appear to have...

Although Magnet hospitals (MHs) are known for their better nursing care environments, little is about whether MHs achieve this at a higher (lower) cost of health or superior environment yields net patient revenue versus non-MHs over an extended period time.To examine how achieving status related to subsequent inpatient costs and revenues controlling other hospital characteristics.Data from the American Hospital Association Annual Survey, Cost Reporting Information System reports collected by...

Many high utilizers of the emergency department (ED) have public insurance, especially through Medicaid. We evaluated how participation in Bridges to Care (B2C)—an ED-initiated, multidisciplinary, community-based program—affected subsequent ED use, hospital admissions, and primary care use among publicly insured or Medicaid-eligible utilizers. During six months after B2C intervention was completed, participants had significantly fewer visits (a reduction 27.9 percent) more (an increase 114.0...

Importance The US 340B Drug Pricing Program enables eligible hospitals to receive substantial discounts on outpatient drugs improve hospitals’ financial sustainability and maintain access care for patients who have low income and/or are uninsured. However, it is unclear whether use program savings subsidize as intended. Objective To evaluate the associated with improvements in hospital-based services test association varies by hospital ownership. Design, Setting, Participants...

Importance Medicare Advantage (MA) plans are designed to incentivize the use of less expensive drugs through capitated payments, formulary control, and preauthorizations for certain drugs. These conditions may reduce spending on high-cost therapies such as cancer, a condition that is among most treat. Objective To determine whether patients insured by MA receive than those traditional (TM). Design, Setting, Participants This cohort study used data from linked Colorado All Payer Claims...

Not-for-profit hospitals are required to provide community benefits improve the well-being of their communities. However, hospitals' benefit spending has remained mostly flat despite federal and state regulations intended increase it. A new Oregon policy takes a multiphase approach not-for-profit investment. In 2020, phase 1 expanded patient financial assistance requirements medical debt protections. 2021, 2 imposed hospital-specific minimum floor. Using nearest-neighbor matching...

Objective The aims of the study were to (1) estimate relative nurse effectiveness, or individual value-added (NVA), patients’ clinical condition change during hospitalization; (2) examine characteristics contributing NVA; and (3) contribution nursing care patient outcomes. Data Sources/Study Setting Electronic data on 1,203 staff nurses matched with 7,318 adult medical–surgical patients discharged between July 1, 2011 December 31, from an urban Magnet-designated, 854-bed teaching hospital....

Community Benefit spending by not-for-profit hospitals has served as a critical, formalized part of the nation's safety net for almost 50 years. This occurred mostly through charity care. article examines how spent dollars prior to full implementation Affordable Care Act (ACA).Using data from 2009 2012 hospital tax and other governmental filings, we constructed national, hospital-referral-region, facility-level estimates spending. Data were collected in 2015 analyzed 2016. matched at...