The Effects of Organization Design and Patient Perceptions of Care on Switching Behavior and Reliance on a Health Care System Across Time.

Sustaining ongoing relationships with patients is a strategic, clinically relevant goal of health care systems. This study develops and tests a conceptual model that aims to account for the influence of organization design, perceptions of quality of patient care, and other patient-level factors on the extent to which patients sustain reliance on a health care system. We use a longitudinal survey design and structural equation modeling to predict increases or decreases in patient reliance on the Department of Veterans Affairs health care system across a 4-year period for Veterans with Parkinson's Disease.

Bringing responsibility for small area variations in hospitalization rates back to the hospital: the propensity to hospitalize index and a test of the Roemer's Law.

Objective: To assign responsibility for variations in small area hospitalization rates to specific hospitals and to evaluate the Roemer's Law in a way that does not artificially induce correlation between bed supply and utilization.

Data Sources/study Setting: We used data on hospitalizations and outpatient treatment for 15 medical conditions of nonmanaged care Part B eligible Medicare enrollees of 65 years and older in Massachusetts in 2000.

Study Design: We used a Bayesian model to estimate each hospital's pool of potential patients and the fraction of the pool hospitalized (its propensity to hospitalize, PTH).

How well can we identify the high-performing hospital?

Sharing lessons from high-performing hospitals facilitates quality improvement. High-performing hospitals have usually been identified using a small number of performance measures. The objective was to analyze how well 1,006 hospitals performed across a broader range of measures.

Risk of venous thromboembolism after total hip and knee replacement in older adults with comorbidity and co-occurring comorbidities in the Nationwide Inpatient Sample (2003-2006).

Background: Venous thromboembolism is a common, fatal, and costly injury which complicates major surgery in older adults. The American College of Chest Physicians recommends high potency prophylaxis regimens for individuals undergoing total hip or knee replacement (THR or TKR), but surgeons are reluctant to prescribe them due to fear of excess bleeding. Identifying a high risk cohort such as older adults with comorbidities and co-occurring comorbidities who might benefit most from high potency prophylaxis would improve how we currently perform preoperative assessment.

The effect of maternal child marriage on morbidity and mortality of children under 5 in India: cross sectional study of a nationally representative sample.

Objective: To assess associations between maternal child marriage (marriage before age 18) and morbidity and mortality of infants and children under 5 in India. Design Cross-sectional analyses of nationally representative household sample. Generalised estimating equation models constructed to assess associations.

Recruitment of hospitals for a safety climate study: facilitators and barriers.

Background: Despite increasing emphasis on safety culture assessment, little is known about the factors that affect hospitals' participation in such studies. Factors affecting recruitment of 30 Department of Veterans Affairs (VA) hospitals into a study to evaluate perceptions of safety culture, or safety "climate," were examined.

Methods: To minimize selection bias, hospitals were recruited that represented the spectrum of safety performance on the basis of Patient Safety Indicator scores.

Does more "appropriateness" explain higher rates of cardiac procedures among patients hospitalized with coronary heart disease?

Background: There have been few studies of the extent to which differences in the pool of patients being managed might account for geographic variations in treatment rates.

Objective: For two cardiac procedures, cardiac catheterization and revascularization, we evaluate the hypothesis that differences in "the percentage of patients for whom the procedure is appropriate" is a factor explaining variations in use rates among those hospitalized with coronary heart disease (CHD).

Research Design: Based on hospital utilization patterns in Massachusetts in 1990, we created 70 small geographic areas.