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The Effects of Health IT Innovation on Throughput Efficiency in the Emergency Department

By Michael Levin  

Overcrowding in United States hospitals’ emergency departments (EDs) has been identified as a significant barrier to receiving high-quality emergency care, resulting from many EDs struggling to properly triage, diagnose, and treat emergency patients in a timely and effective manner. Priority is now being placed on research that explores the effectiveness of possible solutions, such as heightened adoption of IT to advance operational workflow and care services related to diagnostics and information accessibility, with the goal of improving what is called throughput efficiency. However, high costs of technological process innovation as well as usability challenges still impede wide-spanning and rapid implementation of these disruptive solutions. This paper will contribute to the pursuit of better understanding the value of adopting health IT (HIT) to improve ED throughput efficiency.

Using hospital visit data, I investigate two ways in which ED throughput activity changes due to increased HIT sophistication. First, I use a probit model to estimate any statistically and economically significant decreases in the probability of ED mortality resulting from greater HIT sophistication. Second, my analysis turns to workflow efficiency, using a negative binomial regression model to estimate the impact of HIT sophistication on reducing ED waiting room times. The results show a negative and statistically significant (p < 0.01) association between the presence of HIT and the probability of mortality in the ED. However, the marginal impact of an increase in sophistication from basic HIT functionality to advanced HIT functionality was not meaningful. Finally, I do not find a statistically significant impact of HIT sophistication on expected waiting room time. Together, these findings suggest that although technological progress is trending in the right direction to ultimately have a wide-sweeping impact on ED throughput, more progress must be made in order for HIT to directly move the needle on confronting healthcare’s greatest challenges.

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Advisors: Professor Ryan McDevitt, Professor Michelle Connolly | JEL Codes: I1, I18, O33

The Effect of Competition on Strategic Discharge at Long-Term Acute-Care Hospitals

By Michael Karamardian

Because Medicare’s prospective payment system for long-term acute-care hospitals (LTCHs) makes a large lump-sum form of payment once patients reach a minimum length-ofstay threshold, LTCHs have a unique opportunity to maximize profits by strategically discharging patients as soon as the payment is received. This analysis explores how the level of competition between LTCHs in geographic markets affects the probability of a patient being strategically discharged. The results show that patients at LTCHs in more competitive markets have a lower probability of being strategically discharged than at those in less competitive markets, suggesting increased competition could help save Medicare funding.

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Advisors: Kent Kimbrough and James Roberts | JEL Codes: D22, I11, I18

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