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Agency for Healthcare Research Quality

Jiang, H. Joanna

Author: Jiang HJ, Elixhauser A, et al.
Title: Care of Women in U.S. Hospitals, 2000.
Publication: HCUP Factbook No. 3.
Date: 2002
Abstract: Based on HCUP Nationwide Inpatient Sample (NIS) data, this report provides an overview of hospital care for women and compares hospital stays for women and men. It also includes statistics on obstetric care in hospitals. Six out of the top 10 conditions for nonobstetric hospital stays pertain to the circulatory system, making up 18 percent of all stays for women and 23 percent for men. Depression is the most common reason for nonobstetric hospitalization among women ages 18-44. For two cardiac conditions—heart attack and hardening of the arteries of the heart—hospital stays for women are less likely to involve heart procedures than those for men. Hypertension is the most common co morbidity among nonobstetric patients. Among patients covered by Medicaid or uninsured, the percentage of nonobstetric hospital stays for ambulatory care sensitive (ACS) conditions is higher for women than for men. Two out of five obstetric stays are attributed to women with Medicaid or no insurance. Women with private insurance are more likely to have Cesarean sections than women uninsured or covered by Medicaid.
Topics: Hospitals, Women.
Availability: AHRQ Publication No. 02-0044, available from the AHRQ Publications Clearinghouse.

Authors: Jiang HJ, Begun JW.
Title: Dynamics of Change in Local Physician Supply: An Ecological Perspective.
Publication: Social Science and Medicine 54(10):1525-41.
Date: 2002
Abstract: An ecological framework was proposed that explains the growth of a physician population by four mechanisms—the intrinsic properties of this physician population; the local market's carrying capacity, determined by three environmental dimensions (munificence, concentration, diversity); competition within the same physician population; and interdependence between different physician populations. The study period is from 1985 to 1994, during which dramatic changes occurred in the health care sector—an unprecedented growth in managed care, increased hospital consolidation and organized physician practice. MSA level data were compiled from ARF, the AHA Annual Surveys of Hospitals, the AMA Census of Medical Groups, the InterStudy National HMO Census, and the U.S. County Business Patterns. Both changes in the number and percentage of physicians in a particular specialty population were examined. Variables measuring three environmental dimensions were found to have significant and differential effects on change in the size of different specialty populations. For instance, hospital consolidation and managed care penetration both showed significant positive effects on growth of the generalist population but suppressing effects on growth of the specialist population. MSAs with higher percentages of for-profit hospitals had significant increases in the percentage of specialists.
Topics: Markets, Managed Care, Hospitals, Public Policy.

Authors: Jiang HJ, Ciccone K, Urlaub CJ, Boyd D, Meeks G, Horton L.
Title: Adapting the HCUP Quality Indicators for Hospital Use: The Experience in New York State.
Publication: The Joint Commission Journal on Quality Improvement 27(4):200-15.
Date: 2001
Abstract: The Healthcare Association of New York State (HANYS) has adapted the HCUP QIs to produce comparative reports for more than 200 member hospitals since 1997. Risk adjustment was added to the complication measures to control for demographic and clinical factors. Indirect standardization of demographics and payer status was applied to measures of utilization and access to care. Each hospital received its own report with comparisons to statewide norms, regional, and peer group averages. Specifically designed for internal use, the reports have provided valuable information for individual hospitals to assess quality of care and target potential areas for improvement. The reports also provided hospitals a broad perspective to look beyond their own institutions and develop community-based quality improvement initiatives. Nevertheless, given the limitations common with administrative databases and the lack of standard risk adjustment methods, the HCUP QIs are best used for internal purposes and not for public reporting.
Topic: Hospitals

Authors: Jiang HJ, Lagasse R, Ciccone K, Jakubowski MS, Kitain EM.
Title: Factors Influencing Hospital Implementation of Acute Pain Management Practice Guidelines.
Publication: The Journal of Clinical Anesthesia 13(4):268-76.
Date: 2001
Abstract: Undertreatment of postoperative acute pain is well documented in the medical literature. Pain management practice guidelines developed by national entities have not been consistently implemented at the local level. To identify barriers and incentives to guideline implementation, two separate surveys were administered to 220 hospitals in New York State. One survey was addressed to each hospital's chief executive officer (CEO); the second survey was addressed to the clinical director of the Department of Anesthesiology or Acute Pain Service. Survey results show that only 27 percent of the responding hospitals were using a published pain management practice guideline. Factors predictive of guideline adoption include resource availability and belief in the benefits of using guidelines to improve quality of care or to achieve economic/legal advantages. Guideline implementation, however, does not necessarily include applying all key elements recommended by AHRQ guideline. For example, a collaborative, interdisciplinary approach to pain control was used in only 42 percent of the hospitals. Resource availability, particularly staff with expertise in pain management and existence of a formal quality assurance program to monitor pain management, was significantly predictive of compliance with key guideline elements.
Topic: Hospitals

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