bluuebunny/crossref_metadata_2025_split huggingface dataset:
Establishing Values-Based Leadership and Value Systems in Healthcare Organizations
Authors: Graber David R. , Kilpatrick Anne Osborne 
Published: May 2024

The importance of values in organizations is often discussed in management literature. Possessing strong or inspiring values is increasingly considered to be a key quality of successful leaders. Another common theme is that organizational values contribute to the culture and ultimate success of organizations. These conceptions or expectations are clearly applicable to healthcare organizations in the United States. However, healthcare organizations have unique structures and are subject to societal expectations that must be accommodated within an organizational values system. This article describes theoretical literature on organizational values. Cultural and religious influences on Americans and how they may influence expectations from healthcare providers are discussed. Organizational cultures and the training and socialization of the numerous professional groups in healthcare also add to the considerable heterogeneity of value systems within healthcare organizations. These contribute to another challenge confronting healthcare managers -competing or conflicting values within a unit or the entire organization. Organizations often fail to reward members who uphold or enact the organization's values, which can lead to lack of motivation and commitment to the organization. Four key elements of values-based leadership are presented for healthcare managers who seek to develop as values-based leaders. 1) Recognize your personal and professional values, 2) Determine what you expect from the larger organization and what you can implement within your sphere of influence, 3) Understand and incorporate the values of internal stakeholders, and 4) Commit to values-based leadership.
Drug Treatment Program Compliance and Resistance Activities during Implementation of California'S Proposition 36
Authors: Reynolds Grace 
Published: May 2024

The Substance Abuse and Crime Prevention Act (SACPA), also known as Proposition 36, was implemented statewide in 2001 in California. This legislation remands non-violent drug offenders to drug treatment rather than prison or jail. Structured telephone interviews were conducted with a purposive sample of 72 drug treatment programs from six Southern California counties concerning compliance and resistance activities during implementation. A linear regression model was developed that used a dependent variable capturing overall experience with Proposition 36 and compliance and resistance activities as independent variables. The final model included three compliance variables (sharing problems and solutions with other treatment providers, hiring new staff, acquiring additional space through rental or purchase) that were most predictive of the programs’ overall experience with Proposition 36. The implications of these findings in the context of organizational compliance and resistance activities are discussed.
Healthcare Managers’ Perceptions of Professional Development and Organizational Support
Authors: Gumus Gulcin , Borkowski Nancy , Deckard Gloria J. , Martel Karen J. 
Published: May 2024

Purpose This article explores the participation of healthcare managers in professional development (PD) activities, the reasons for seeking PD and the perceived support of their organizations in terms of reward and recognition. Methodology An exploratory survey was emailed to current and past members of three professional associations who share similar missions “to provide educational and networking opportunities” for their members in the southern region of Florida. Findings Findings suggest that healthcare managers and healthcare organizations both support and value personal and professional development. Certification by professional organizations appears to be a key credential for upward mobility. Research limitations This study serves as an initial attempt to account for the factors that explain differences in pursuing professional development activities. Given the exploratory nature of the study and low response rates, the findings provide direction for further research rather than conclusive judgments. Practical implications Continuous learning by managers and organizations should allow the healthcare industry to position itself for future challenges. Originality Across all settings, positions, age groups, and perceived organizational support, individuals seek professional certification suggesting recognition of the professional value associated with these certifications. the value attributed to certification and PD by healthcare managers is further demonstrated by our finding that individuals engage in these activities even in the absence of employer reimbursement.
Adoption of An Algorithm and Client Pathway for the Aged and Disabled: Training Implications for the Health and Human Service Sectors
Authors: Hewitt Anne M. , Polansky Patricia A. , Day Nancy , Field Nancy , Moore Alice 
Published: May 2024

Objectives This paper reports on a state agency's training activities undertaken to totally redesign a long-term-care (LTC) delivery system as part of the national Aging and Disability Resource Center (ADRC) initiative. Method Through the development of an ADRC algorithm and the implementation of a corresponding client pathway, NJ DACS, a division of aging, aligned 14 separate core functions necessary for lifespan services. a Training Academy facilitated the adoption of five new health service delivery products and processes by state and county health and human services personnel. Results Intensive training activities resulted in the algorithm and client pathway framework being successfully disseminated in all 21 counties within a short timeframe. Barriers to training were reduced and acceptance of new protocols and processes were facilitated leading to rapid adoption. Implications for training of health and human service personnel are presented. Full adoption of the complete ADRC model across the state was directly linked to agency software integration. Conclusions Promoting standardized service delivery for the aging population through the use of an algorithm and parallel client pathway is feasible as a training model for health care service delivery.
Reducing Health Disparities: Medical Advice Received for Minorities with Diabetes
Authors: Vaccaro Joan A. , Huffman Fatma G. 
Published: May 2024

Objective to examine the relationships among reported medical advice, diabetes education, health insurance and health behavior of individuals with diabetes by race/ethnicity and gender. Method Secondary analysis of data (N = 654) for adults ages ≥ 21 years with diabetes acquired through the National Health and Nutrition Examination Survey (NHANES) for the years 2007–2008 comparing Black, non-Hispanics (BNH) and Mexican-Americans (MA) with White, non-Hispanics (WNH). the NHANES survey design is a stratified, multistage probability sample of the civilian non-institutionalized U.S. population. Sample weights were applied in accordance with NHANES specifications using the complex sample module of IBM SPSS version 18. Results The findings revealed statistical significant differences in reported medical advice given. BNH [OR = 1.83 (1.16, 2.88), p = 0.013] were more likely than WNH to report being told to reduce fat or calories. Similarly, BNH [OR = 2.84 (1.45, 5.59), p = 0.005] were more likely than WNH to report that they were told to increase their physical activity. Mexican-Americans were less likely to self-monitor their blood glucose than WNH [OR = 2.70 (1.66, 4.38), p < 0.001]. There were differences by race/ethnicity for reporting receiving recent diabetes education. Black, non-Hispanics were twice as likely to report receiving diabetes education than WNH [OR = 2.29 (1.36, 3.85), p = 0.004]. Having recent diabetes education increased the likelihood of performing several diabetes self-management behaviors independent of race. Conclusions There were significant differences in reported medical advice received for diabetes care by race/ethnicity. the results suggest ethnic variations in patient-provider communication and may be a consequence of their health beliefs, patient-provider communication as well as length of visit and access to healthcare. These findings clearly demonstrate the need for government sponsored programs, with a patient-centered approach, augmenting usual medical care for diabetes. Moreover, the results suggest that public policy is needed to require the provision of diabetes education at least every two years by public health insurance programs and recommend this provision for all private insurance companies.
Management Challenges at the Intersection of Public Policy Environments and Strategic Decision Making in Public Hospitals
Authors: Longest Beaufort B. 
Published: May 2024

Hospitals in the United States are heavily impacted by public policies that affect them. for example, Medicare and Medicaid programs account for more than half the revenue in most of the nation's almost 5,000 community hospitals, including the almost 1,100 public hospitals controlled by state and local governments (American Hospital Association, 2012). the public hospitals are especially closely aligned with and controlled by governmental entities compared with hospitals with other kinds of sponsorship. This article addresses the management challenges at the intersection of the strategic management of public hospitals and their public policy environments. Public hospitals are complicated entities designed not only to provide health services but also in many cases to play key roles in health-related research and education and to play important general economic development roles in their communities. the multi-faceted strategic decision making in these organizations is as heavily affected by their public policy environments as by their business, demographic, technological or other external environments. Effectively managing the intersection of their public policy environments and their strategic management is indeed vital for contemporary public hospitals. This article is intended to clarify certain aspects of this intersection through a description and model of the strategic activity in public hospitals and the connection between this activity and their external environments. Specific attention is focused on the concept of public policy environments and their features. Attention is also given to how managers can assess public policy environments and incorporate the results into strategic activities.
Physical Symptoms, Chronic and Life-Threatening Illness Trajectories among Minority and Aging Populations
Authors: Lyons Beverly P. , Levine Helisse 
Published: May 2024

The purpose of this study is to determine the relationship across race/ethnicity relative to reported subjective physical symptoms and clinically assessed medical conditions among the aging minority population using the Health and Retirement Study data for years 1998–2000. Poisson and negative binomial regressions were used to estimate three count dependent variables: physical symptom, chronic, and life-threatening medical conditions. Results indicate that while Black respondents were 18% more likely to report physical symptoms when compared to White respondents (B = .171, p < .01, e.171 = 1.18) and 1.06 times more likely to report life-threatening medical conditions (B = .058, p < .01, e.058 = 1.06), when SES variables were added being Black was no longer significantly associated with physical symptoms and chronic conditions. However, being Black did remain statistically significant and positively associated with life-threatening conditions, even after controlling for SES. Results bear statistical and clinical significance, given that we are examining racial and ethnic groups. First, Blacks are at higher risk for premature death for a variety of reasons; this has implications on financial expenditures and on the quality of life. Second, growth among the Hispanic population is outpacing both White and Black populations. Policy initiatives, including geriatric health education, partnerships with community and grass-roots leaders will promote awareness.
Who Pays? How Reimbursement Impacts the Emergency Department
Authors: Downey Lavonne , Zun Leslie S. , Burke Trena , Jefferson Tangula 
Published: May 2024

Background Nationwide from 1996 to 2004, the overall proportion of Emergency Department (ED) reimbursement ratios for outpatient ED visits decreased from 57% to 42%. the continued falling of ED reimbursement ratios, which is the share of ED charges that are ultimately paid, is an indicator of the financial pressures facing the ED. Once the healthcare reforms are put in place what will the impact be on reimbursement rates of overburdened and underfunded emergency departments. Purpose The purpose of this study is to examine if there is a declining disparity in payment rates for ED care based on payment sources in a safety net ED provider. Findings of this study could indicate how the healthcare reforms might impact these types of ED reimbursement ratios in the upcoming years. Methods This was a retrospective study that examined randomly selected charts of all ED visits charts from May 2002 to May 2008 at a level one adult and pediatric emergency trauma center with 45,000 annual visits. This study was IRB approved. Results A regression model was used to predict if there was a relationship between amount received and types of insurance payers within the ED. a significant relationship was found between types of insurance (payers) as the independent variable, and the dependent variables of charges ( p = .00), payments ( p = .00), amount of adjustments (p = .00), and balance remaining after 90 days (p = .00). Conclusions Who pays for the ED services does impact the ED's bottom line. the privately funded patients will provide an ED with a higher reimbursement ratio per year as compared to those patients who are publicly or self pay. This explains why EDs that provide care for 40% or more publicly or self pay patients have seen a decline in reimbursement ratios. Healthcare reform has the potential to change and possibly improve safety net ED rate of reimbursement depending on how private, public and self pay patients pay for ED services.
Earnings Management in U.S. Hospitals
Authors: Dong Gang Nathan 
Published: May 2024

Objective This paper examines the hospital management practices of manipulating financial earnings within the bounds of generally accepted accounting principles (GAAP). Study Design We conduct regression analyses that relate earnings management to hospital characteristics to assess the economic determinants of hospital earnings management behavior. Method and Data From the CMS Cost Reports we collected hospital financial data of all U.S. hospitals that request reimbursement from the federal government for treating Medicare patients, and regress discretionary accruals on hospital size, profitability, asset liquidity, operating efficiency, labor cost, and ownership. Results Hospitals with higher profit margin, current ratio, working capital, days of patient receivables outstanding and total wage are associated with more earnings management, whereas those with larger size and higher debt level, asset turnover, days cash on hand, fixed asset age are associated with lower level of earnings manipulation. Additionally, managers of non-profit hospitals are more likely to undertake some form of window-dressing by manipulating accounting accruals without changing business models or pricing strategies than their public hospital counterparts. Conclusions We provide direct evidence of the use of discretionary accruals to manage financial earnings among U.S. hospitals and the finding has profound policy implications in terms of assessing the pervasiveness of accounting manipulation and the overall integrity of financial reporting in this very special public and quasi-public service sector.
Effect of Gni on Infant Mortality Rate in Low Income, Lower Middle Income, Upper Middle Income and High Income Countries
Authors: Jalal Sabeena , Khan Najib Ullah , Younis Mustafa Z. 
Published: May 2024

Global disparities in health form a complex issue adversely affecting much of the world's population. What has been found is that national income and other general socio-economic factors are strong determinants of population health (Houweling, 2005 & Schell, 2007). In countries where resources are less, people are much less healthy than people living in rich countries. In wealthier countries that have made immense progress in health indicators, the resulting change in age structure and morbidity and mortality patterns portends even greater financial demands on the health sector. This study noted the trends in several health indicators versus economic indicators and related it to low income, lower middle income, upper middle income and high income countries. We noted that there is improvement in all health indicators along with an increasing GNI per Capita and GDP. In low income regions though, the rate of improvement is slower as opposed to high income countries. However, there is progress, which is leading to an increase in aging population.
Creating A Culture of Health in Rural Arkansas
Authors: Day Cynthia R. , Ashcraft Pamela F. , Scott Patricia 
Published: May 2024

Residents of Yell County have high rates of childhood and adult overweight/obesity, physical inactivity, teen births, and children in poverty. A recent community health needs assessment performed by John Ed Chambers Memorial Hospital (JECMH) identified an unprecedented opportunity to improve the health and the quality of life for residents of this small west central Arkansas county. In order to effect change, JECMH sought to go outside the confines of traditional hospital based responses and utilize the Culture of Health (COH) Action Framework to engage the community in developing an action plan. The COH Action Framework include four focus areas: Action Area 1, Making Health a Shared Value; Action Area 2, Fostering Cross-sector Collaboration to Improve Well-being; Action Area 3, Creating Healthier, More Equitable Communities; and Action Area 4, Strengthening Integration of Health Services and Systems. Three outcomes specific to Healthy People 2020 are proposed for the residents of Yell County. Over the next 10 years, reduce the proportion of adults who are obese in Yell County from 35% to 31%; reduce the proportion of adults that participate in no leisure time activities from 37% to 33%; and increase access to locations for physical activity from 41% to 44%. The aim of this article is to demonstrate how a rural community hospital can utilize the COH Action Framework to conduct a community health needs assessment and engage the community in developing a long-term action plan. The methods of data collection include a combination of community opinion surveys and key informant interviews. This article illustrates how moving beyond the traditional patient/healthcare organization relationship can lead to healthier communities.
The effect of body mass index on stroke prognosis: A systematic review and meta-analysis of 32 cohort studies with 330,353 patients
Authors: Qin Jiangxia , Zhang Tong , Chen Yajing , Wei Xiaoqin , Yang Yiyi , Yuan Yue , Guo Jiali , Han Lin , Ma Yuxia 
Published: May 2024

Background: Many studies have explored the impact of body mass index (BMI) on stroke prognosis, yet findings remain inconsistent. Aims: The aims of this study were to conduct a systematic review and meta-analyses to summarize the existing evidence on BMI and stroke outcomes. Methods: PubMed, Web of Science, Embase, The Cochrane Library, CNKI, CBM, Wanfang Database, and VIP Database were systematically searched from inception to 1 January 2023. Cohort studies were included if they reported on a population of patients with stroke, evaluated BMI on stroke outcomes (mortality/recurrence/score of modified Rankin scale (mRs)), and reported original data. Data extraction and quality assessment were independently undertaken by two reviewers. Stata 16.0 software was used for meta-analysis. Results: Thirty-two studies involving 330,353 patients (5 Chinese language articles) were included in the analysis. The proportion of underweight, overweight, and obese patients was 1.85%, 18.2%, and 15.6%, respectively. Compared with normal weight, being underweight was associated with an increased risk of mortality (relative risk (RR) = 1.78, 95% confidence interval (CI) = 1.60–1.96), poor functional outcomes defined as modified Rankin scale ⩾ 3 (RR = 1.33, 95% CI = 1.22–1.45), and stroke recurrence (RR = 1.19, 95% CI = 1.04–1.37). Being overweight but not obese was associated with reduced mortality (RR = 0.81, 95% CI = 0.74–0.89) and better functional outcomes (RR = 0.92, 95% CI = 0.89–0.96), but did not alter the risk of stroke recurrence (RR = 1.03, 95% CI = 0.90–1.17). Obesity was associated with lower risk of mortality (RR = 0.76, 95% CI = 0.72–0.81) and better functional outcomes (RR = 0.89, 95% CI = 0.84–0.94). Conclusions: Our findings indicate that in patients with stroke, being underweight is associated with an increased risk of mortality, poor functional outcomes, and stroke recurrence. In contrast, being overweight but not obese, or being obese, was associated with a decreased risk of mortality and better functional outcomes. This is consistent with the obesity paradox in stroke, whereby obesity increases stroke risk in the general population but is associated with improved outcome in patients suffering stroke.
Limited Return to Preinjury Performance in NCAA Division I American Football Players With Hamstring Injuries
Authors: Hannay William M. , Sliepka Joseph M. , Parker Kate , Sammons Kyle , Gee Albert O. , Kweon Christopher Y. , Hagen Mia S. 
Published: May 2024

Background: Hamstring strains are common among elite athletes, but their effect on return to the same level of play in American football has been incompletely characterized. Purpose: Data on National Collegiate Athletics Association Division I college football players with acute hamstring strains were gathered to identify the effects these injuries have on both return to play and athletic performance regarding velocity, workload, and acceleration. Study Design: Case Series; Level of evidence, 4. Methods: Injury data for a single Division I football team were prospectively recorded over a 4-year period. Players wore global navigation satellite system and local positioning system (GNSS/LPS) devices to record movement data in practices and games. The practice and game data were cross-referenced to evaluate players with isolated acute hamstring strains. Comparisons were made regarding players’ pre- and postinjury ability to maintain high velocity (>12 mph [19.3 kph]), maximal velocity, triaxial acceleration, and inertial movement analysis (IMA). There were 58 hamstring injuries in 44 players, of which 25 injuries from 20 players had GNSS/LPS data. Results: Players were able to return to play from all 25 injury incidences at a mean of 9.2 days. At the final mean follow-up of 425 days, only 4 players had reached preinjury function in all measurements; 12 players were able to return in 2 of the 4 metrics; and only 8 players reached their preinjury ability to maintain high velocity. For those who did not achieve this metric, there was a significant difference between pre- and postinjury values (722 vs 442 m; P = .016). A total of 14 players were able to regain their IMA. Players who returned to prior velocity or acceleration metrics did so at a mean of 163 days across all metrics. Conclusion: While players may be able to return to play after hamstring strain, many players do not reach preinjury levels of acceleration or velocity, even after 13.5 months. Further studies are needed to confirm these findings, assess clinical relevance on imaging performance, and improve hamstring injury prevention and rehabilitation.