Linkages in the rural continuum: the balanced budget act and beyond.
Linkages in the rural continuum: the balanced budget act and beyond.
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农村连续体中的联系：平衡预算法及其他。
DOI：
10.1093/geront/43.2.151
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发表时间：
2003
期刊：
影响因子：
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通讯作者：
McKenney,Joyce
中科院分区：
文献类型：
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作者：
Angelelli,Joseph;Fennell,MaryL;Hyatt,RaymondR;McKenney,Joyce
目的：本研究考察了1997年平衡预算法案（BBA97）后农村医院如何改变其急性后和长期护理策略。设计与方法：1997年对全国具有代表性的540名农村医院出院计划人员进行了访谈。2000年，540名出院计划人员中的513人接受了重新面谈。这项研究是对农村医院如何在联邦政府报销政策动荡变化的时期形成新的和改变现有的组织战略的描述性分析。我们根据迈尔斯和斯诺的探勘者、分析者、防御者和反应者的类型对1997年农村医院的战略行为进行分类，然后我们研究了各种医院类型在BBA97之后是如何改变关键战略的。结果：1997年至2000年间，在1997年未参与摇摆床项目的抽样农村医院中，超过26%（44/167）在2000年选择了这一项目，而在1997年使用摇摆床的医院中，只有3%（12/346）取消了这一项目。其他策略，如剥离以医院为基础的养老院，与同时采用摇床有关。农村医院也更加依赖与外部长期护理提供者的正式联系。含义：在BBA97报销改变后，农村医院增加了对轮换床位的依赖，并与外部供应商建立了正式联系。我们观察到整体策略类型的变化，从防御者转向勘探者和分析者。我们的研究结果表明，在bba97后环境的不确定性挑战下，摇摆床作为乡村医院关键缓冲的重要性。
Purpose:This study examined how rural hospitals altered their postacute and long-term care strategies after the Balanced Budget Act of 1997 (BBA97).Design and Methods:A nationally representative sample of 540 rural hospital discharge planners were interviewed in 1997. In the year 2000, 513 of 540 discharge planners were reinterviewed. The study is a descriptive analysis of how rural hospitals formed new and altered existing organizational strategies during a time of turbulent changes in federal government reimbursement policy. We classify rural hospital strategic behavior in 1997 according to the Miles and Snow typology of Prospectors, Analyzers, Defenders, and Reactors, and then we examine how the various hospital types altered key strategies following BBA97.Results:Between 1997 and 2000, more than 26% of sampled rural hospitals that did not participate in the swing-bed program in 1997 (44/167) had chosen to do so in 2000, whereas only 3% of those using swing beds in 1997 had eliminated them (12/346). Other strategies such as divestiture of hospital-based nursing homes were related to concurrent swing-bed adoption. Rural hospitals also increased their reliance on formal linkages with external providers of long-term care.Implications:After the BBA97 reimbursement changes, rural hospitals increased their reliance on swing beds and formal linkages to external providers. We observed changes in overall strategy types, away from the Defender and toward the Prospector and Analyzer strategy types. Our findings illustrate the importance of swing beds as a critical buffer for rural hospitals challenged by the uncertainty of the post-BBA97 environment.