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Performance improvement in medical care: do mandated reporting requirements work?

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TitleInfo
Title
Performance improvement in medical care: do mandated reporting requirements work?
Name (type = personal)
NamePart (type = family)
Martin
NamePart (type = given)
John Eric
DisplayForm
John Eric Martin
Role
RoleTerm (authority = RULIB)
author
Name (type = personal)
NamePart (type = family)
Monheit
NamePart (type = given)
Alan
DisplayForm
Alan Monheit
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Advisory Committee
Role
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chair
Name (type = personal)
NamePart (type = family)
Grafova
NamePart (type = given)
Irina
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Irina Grafova
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Advisory Committee
Role
RoleTerm (authority = RULIB)
internal member
Name (type = personal)
NamePart (type = family)
Gusmano
NamePart (type = given)
Michael
DisplayForm
Michael Gusmano
Affiliation
Advisory Committee
Role
RoleTerm (authority = RULIB)
internal member
Name (type = personal)
NamePart (type = family)
Chakravarty
NamePart (type = given)
Sujoy
DisplayForm
Sujoy Chakravarty
Affiliation
Advisory Committee
Role
RoleTerm (authority = RULIB)
outside member
Name (type = corporate)
NamePart
Rutgers University
Role
RoleTerm (authority = RULIB)
degree grantor
Name (type = corporate)
NamePart
School of Graduate Studies
Role
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school
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Text
Genre (authority = marcgt)
theses
OriginInfo
DateCreated (encoding = w3cdtf); (keyDate = yes); (qualifier = exact)
2019
DateOther (encoding = w3cdtf); (qualifier = exact); (type = degree)
2019-05
Language
LanguageTerm (authority = ISO 639-3:2007); (type = text)
English
Abstract (type = abstract)
Background
Hospitals have been required to publicly report outcomes of care or costs for many years based on state level mandates. In 2003 the federal government began requiring similar public reporting for hospitals to be reimbursed by Medicare. The goal has been to allow consumer demand to drive quality improvement in patient care and to reduce the cost of care. This dissertation explores the effectiveness of such programs by evaluating inpatient mortality rates and the length of stay (LOS) in acute myocardial infarction and heart failure patients from 1988 through 2006 using publicly reported data and Health Care Utilization Project – Nationwide Inpatient Sample data.
Methods
First, an evaluation was completed to ensure no endogeneity existed with variables associated with the likelihood of implementing the mandated reporting at the state level and the outcomes of interest. A linear probability model was run with several state level factors as independent variables that were potentially associated with mandate implementation. Factors found to be significant in that model were incorporated into subsequent regression models. Second, regression models were developed to identify the association between the state level mandate and the outcomes of interest. Third, regression models were used to evaluate the association between federal mandates and the outcomes of interest. Linear probability models were used for the probability of dying while in the hospital and Poisson regression models were used for LOS.
Results
Factors that were potentially associated with the implementation of mandates were the state fiscal margin, the average hospital level LOS and the average inpatient mortality rates leading up to the implementation of the mandate. The implementation of state level mandates was associated with a decrease in the probability of dying while an inpatient and a decrease in the inpatient LOS for AMI and HF patients. The implementation of federal mandates was associated with an increase int the probability of dying while an inpatient and an increase in the inpatient LOS for AMI and HF patients. Federal mandates appeared to wash out the positive effect of state mandates in AMI patients.
Conclusion
Mandated hospital reporting can be effective, but be done at the most effective level of government respective level of government.
Subject (authority = local)
Topic
Health
Subject (authority = RUETD)
Topic
Public Health
Subject (authority = LCSH)
Topic
Hospitals -- Public records
Subject (authority = LCSH)
Topic
Hospital patients -- Mortality -- Statistics
Subject (authority = LCSH)
Topic
Hospital utilization -- Length of stay -- Statistics
RelatedItem (type = host)
TitleInfo
Title
Rutgers University Electronic Theses and Dissertations
Identifier (type = RULIB)
ETD
Identifier
ETD_9547
PhysicalDescription
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application/pdf
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text/xml
Extent
1 online resource (vi, 138 pages)
Note (type = degree)
Ph.D.
Note (type = bibliography)
Includes bibliographical references
RelatedItem (type = host)
TitleInfo
Title
School of Graduate Studies Electronic Theses and Dissertations
Identifier (type = local)
rucore10001600001
Location
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NjNbRU
Identifier (type = doi)
doi:10.7282/t3-0q4p-hd97
Genre (authority = ExL-Esploro)
ETD doctoral
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Rights

RightsDeclaration (ID = rulibRdec0006)
The author owns the copyright to this work.
RightsHolder (type = personal)
Name
FamilyName
Martin
GivenName
John
MiddleName
Eric
Role
Copyright Holder
RightsEvent
Type
Permission or license
DateTime (encoding = w3cdtf); (qualifier = exact); (point = start)
2019-01-30 07:16:26
AssociatedEntity
Name
John Martin
Role
Copyright holder
Affiliation
Rutgers University. School of Graduate Studies
AssociatedObject
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License
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Author Agreement License
Detail
I hereby grant to the Rutgers University Libraries and to my school the non-exclusive right to archive, reproduce and distribute my thesis or dissertation, in whole or in part, and/or my abstract, in whole or in part, in and from an electronic format, subject to the release date subsequently stipulated in this submittal form and approved by my school. I represent and stipulate that the thesis or dissertation and its abstract are my original work, that they do not infringe or violate any rights of others, and that I make these grants as the sole owner of the rights to my thesis or dissertation and its abstract. I represent that I have obtained written permissions, when necessary, from the owner(s) of each third party copyrighted matter to be included in my thesis or dissertation and will supply copies of such upon request by my school. I acknowledge that RU ETD and my school will not distribute my thesis or dissertation or its abstract if, in their reasonable judgment, they believe all such rights have not been secured. I acknowledge that I retain ownership rights to the copyright of my work. I also retain the right to use all or part of this thesis or dissertation in future works, such as articles or books.
Copyright
Status
Copyright protected
Availability
Status
Open
Reason
Permission or license
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Technical

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2019-02-28T13:00:24
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2019-02-28T13:00:24
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