US Health Care Industry Research Articles

Addressing the Regulatory and Scientific Challenges with Generic Orally Inhaled Drug Products

Generic products offer a considerable cost savings for American consumers and the US healthcare industry. While generics for many products have become available, the approval and adoption of generics for orally inhaled drug products (OIDPs) has lagged behind, owing to the difficulties in bringing these complex generic products to the market. As a complex product, OIDP performance is impacted by numerous factors derived from the product's formulation, delivery to a local site of action within the lung, the performance of the device, and the patient population that uses the medication. Therefore, determining equivalence between generic and brand-name OIDPs requires an approach that considers each of these aspects in order to ensure bioequivalence. FDA's recommended aggregate weight-of-evidence approach for generic OIDPs provides a paradigm where studies and conditions, when taken together, establish equivalence in device performance, systemic exposure, and local drug delivery. This review article covers the various aspects of OIDP complexity, the challenges each presents to equivalence, and FDA's efforts to address these challenges and complex drug development as a whole under the Generic Drug User Fee Amendments (GDUFA). The aggregate weight-of-evidence approach, its rationale, and scientific support is also described.

Algorithmic Decision-making in the US Healthcare Industry: Good for Whom?

In this paper we present an ethnographic study undertaken at a healthcare network in the US. Our goal was to understand how healthcare organizations in the US use algorithms to improve efficiency (...

Enhancing the Value Chain to Increase Customer Satisfaction and Build Successful Breast Imaging Practices.

The US health care industry is increasingly shifting to a value seeking mindset. The breast imaging value chain elucidates how breast imaging radiologists generate and deliver value to their customers, who include both patients and referring health care providers. The breast imaging value chain can be used by radiologists to improve operational effectiveness and to plan new value creation strategically. The overarching goals are increased customer satisfaction and successful practices.

Trends in Infusion Administrative Practices in US Health Care Organizations: An Exploratory Analysis.

While specialized infusion clinical services remain the standard of care, widespread curtailing and disbanding of infusion teams as a cost-cutting measure has been documented in health care organizations for nearly 2 decades. Owing to this trend, as well as recent government interventions in medical error control, the authors engaged in an exploratory study of infusion administration practices in the US health care industry. This article presents the authors' exploratory findings, as well as their potential implications.

Confronting Clinical Rotations.

The pace and scope of change in the US healthcare industry has been relentless. Organizational and system responses include dramatic redesign of structures, processes, and services to support cross-continuum care. The education of nursing students must keep up with rapid delivery system change. Beyond significant curricular revision, innovation in undergraduate clinical rotations to better prepare students for cross-continuum practice will be key.

Cascading Workflow of Healthcare Services

Despite rapid advancements in technology, the healthcare industry is known to lag behind when it comes to adopting new changes. Most often, when a new technology such as CPOE or EHR systems presents themselves in the healthcare industry, clinicians are left struggling to keep up with their workloads while learning to adjust a new workflow. Instead of disrupting the clinician's clinical workflow, the authors propose a system for transforming clinical narratives presented in the form of discharge summaries from the i2b2 Natural Language Processing dataset into a standardized order set. The proposed system uses natural language processing techniques based on Scala, which extracts discharge summary information about a patient and is proven to be highly scalable. The goal of this system is to increase interoperability between CPOE systems by performing further transformations on the extracted data. The authors adhere to HL7's FHIR standards and use JSON as the primary medical messaging format, which is used both in the US and international healthcare industry organizations and companies.

Algorithmic Decision-making in the US Healthcare Industry

In this research in progress we present the initial stage of a large ethnographic study at a healthcare network in the US. Our goal is to understand how healthcare organizations in the US use algorithms to improve efficiency (cost saving) and effectiveness (quality) of healthcare. Our preliminary findings illustrate that at the national level, algorithms might be detrimental to healthcare quality because they do not consider (and differentiate) contextual issues such as social and cultural (local) settings. At the practice (hospital/physician) level, they help managing the tradeoff between following national “best practices” and accommodating needs of special patients or particular situations, because hospital-based algorithms can be over-ridden by clinicians. We conclude that, while more data needs to be collected, a responsible use of algorithms requires their constant supervision and their application with respect to specific social and cultural settings.

Health Economics: National Health Expenditures

A picture of the overall structure of the US health care industry can be garnered by examining national health expenditures. In 2015, US national health expenditures grew to $3.2 trillion (US), outpacing growth in gross domestic product. Valuable insights are found by examining categories of spending, sources of funds, and target areas of spending, raising questions about the logic and performance of the US system. These perspectives can inform deeper consideration of healthcare policy and reform. This review contains 3 tables and 20 references. Key Words: health economics, health policy, Medicaid, Medicare, national health expenditures, opportunity cost, projections

Health Economics: National Health Expenditures

A picture of the overall structure of the US health care industry can be garnered by examining national health expenditures. In 2015, US national health expenditures grew to $3.2 trillion (US), outpacing growth in gross domestic product. Valuable insights are found by examining categories of spending, sources of funds, and target areas of spending, raising questions about the logic and performance of the US system. These perspectives can inform deeper consideration of healthcare policy and reform. This review contains 3 tables and 20 references. Key Words: health economics, health policy, Medicaid, Medicare, national health expenditures, opportunity cost, projections

Health Economics: National Health Expenditures

A picture of the overall structure of the US health care industry can be garnered by examining national health expenditures. In 2015, US national health expenditures grew to $3.2 trillion (US), outpacing growth in gross domestic product. Valuable insights are found by examining categories of spending, sources of funds, and target areas of spending, raising questions about the logic and performance of the US system. These perspectives can inform deeper consideration of healthcare policy and reform. This review contains 3 tables and 20 references. Key Words: health economics, health policy, Medicaid, Medicare, national health expenditures, opportunity cost, projections

Health Economics: National Health Care Expenditures

A picture of the overall structure of the US health care industry can be garnered by examining national health expenditures. In 2015, US national health expenditures grew to $3.2 trillion (US), outpacing growth in gross domestic product. Valuable insights are found by examining categories of spending, sources of funds, and target areas of spending, raising questions about the logic and performance of the US system. These perspectives can inform deeper consideration of healthcare policy and reform. This review contains 3 tables and 20 references. Key Words: health economics, health policy, Medicaid, Medicare, national health expenditures, opportunity cost, projections

Making care a business

What changes across the US healthcare industry mean for dentistry as a business.

Abstract 16: Home Care Workers Who Care for Adults With Heart Failure: A Community-Partnered Qualitative Study

Background: Paid home care workers (HCWs) represent one of the fastest growing sectors of the US workforce and healthcare industry. They are increasingly utilized by home-dwelling adults with heart failure (HF) for long term assistance and post-acute care. Yet, little is known about the perspectives of HCWs regarding their role in HF management and as part of the healthcare team. Objective: We sought to understand the perspectives of HCWs who take care of adults with HF as the foundation for the development of future intervention(s). Methods: We conducted 8 focus groups with English and Spanish-speaking HCWs at the 1199SEIU’s Home Care Industry Education Fund, a non-profit organization that oversees the training of 65,000 HCWs from 50 home care agencies across NYC. Eligibility criteria included taking care of a client with HF within the last year and being a HCW for at least 2 years. Purposeful sampling ensured equal representation of English and Spanish speaking HCWs. Focus groups were audio recorded and professionally transcribed. Data were organized using qualitative software and analyzed using grounded theory. Results: The 46 participants were mean age of 49 years (SD 10), 45 (98%) were female, 17 (37%) were Black, 25 (54%) were Hispanic, and 42 (91%) had at least a high school education. Participants had been HCWs for 16 years (8.4 SD) and spent 3.5 days per week (1.8 SD) with HF clients. Seven major themes emerged: 1. HF has an unpredictable disease course, which is frightening to HCWs. “One minute we’re watching TV and the next, he crumps.” 2. HCWs often assist with HF management , although most have not received HF training. “Over time, you pick up on the symptoms - the shortness of breath, the swollen legs. But, I’ve never received HF training.” 3. Communication is fragmented. ?No one at the agency picks up the phone, so I just take him to the emergency room instead.? 4. HCWs are ignored by the healthcare team. “We’re with the clients all day, more than anyone else. So why aren’t we included in the conversation?” 5. Role definition is lacking . “The agency doesn’t make clear who we are or what we do. We aren’t just the help!” 6. Delicate family dynamics. “I’m always in the middle and I can’t afford to lose my job.” 7. Social isolation and burnout. “I’m with her all day, and she has Dementia too. It’s hard -- I’ve literally got nobody to talk to.” Conclusions and Implications: Our findings suggest that while HCWs are frequently involved in their clients’ HF management, most have not received formal HF training or resources. Additionally, despite spending so much time caring for their clients, they often feel invisible to healthcare providers. HF-specific training, as well as interventions that aim to integrate HCWs into the healthcare team, may improve HCWs’ HF knowledge and the quality of care delivered to adults with HF.

Transmedia Theory’s Author Discourse and Its Limitations

Transmedia Theory’s Author Discourse and Its Limitations

Experiences of internationally educated nurses holding management positions in the United States: Descriptive phenomenological study.

The purpose of this study was to explore the experiences of internationally educated nurses in management positions in United States health care organisations to understand the obstacles and support these individuals' experience when pursuing and working in managerial roles. Although internationally educated nurses are an integral part of the US health care industry, few work in managerial roles. Little is known about the experiences of internationally educated nurses who do obtain management positions. In this qualitative, phenomenological study, seven internationally educated nurses who were managers in Chicago, Illinois, responded to open-ended interview questions. Supervisors contributed to the participants' acceptance of management positions. The participants experienced challenges such as cultural differences, language, and communication. Despite these challenges, the participants had positive working relationships with staff and supervisors. Further, the participants had opportunities for education and professional growth. Internationally educated nurses benefit from participating in organisational committees. They face challenges related to work responsibilities, cultural differences and communication but can succeed in management roles through developing strategies to overcome the challenges and through receiving support from staff, colleagues and supervisors. More internationally educated nurses may obtain managerial positions if supervisors provide encouragement and support.

International Classification of Diseases, Tenth Revision Implementation: Is the Workforce Ready?

After many delays, the United States finally implemented the International Classification of Diseases, Tenth Revision, Clinical Modification/Procedural Coding System on October 1, 2015, bringing the United States into line with other industrialized nations, most of which had been using the International Classification of Diseases, Tenth Revision for many years. We outline the benefits and challenges to the preparatory activities of the International Classification of Diseases, Tenth Revision, Clinical Modification/Procedural Coding System implementation for the US health care industry. To ease the transition, the Centers for Medicare & Medicaid Services allowed health care facilities to submit test claims prior to the implementation date and delivered feedback on the acceptability of those claims. Early results indicated a relatively smooth transition, although some questions regarding the available data remain. Additional data, especially data concerning outcomes, are required.

Machine Intelligence in Healthcare and Medical Cyber Physical Systems: A Survey

Today, the US healthcare industry alone can save $300 B per year by using machine intelligence to analyze a rich set of existing medical data; results from these analyses can lead to breakthroughs such as more accurate medical diagnoses, discovery of new cures for diseases, and cost savings in the patient admission process at healthcare organizations. Because healthcare applications intrinsically imply a vast amount of data, the execution of any algorithm on medical data is computationally intensive. Significant advancements made in computational power in the past decade have provided the opportunity for many researchers to successfully implement various machine intelligence-based healthcare applications, which didn’t run efficiently on earlier computational platforms. In this paper, we provide a survey of machine intelligence algorithms within the context of healthcare applications; our survey includes a comprehensive list of the most commonly used computational models and algorithms. We view the application of these algorithms in multiple steps, namely, data acquisition, feature extraction, and aggregation, modeling, algorithm training, and algorithm execution and provide details—as well as representative case studies—for each step. We provide a set of metrics that are used to evaluate modeling and algorithmic performance, which facilitate the comparison of the presented models and algorithms. Medical cyber-physical systems are presented as an emerging application case study of machine intelligence in healthcare. We conclude our paper by providing a list of opportunities and challenges for incorporating machine intelligence in healthcare applications and provide an extensive list of tools and databases to help other researchers.

The US Healthcare Facilities Management Industry's State of Hiring from Facilities Management Academic Programs

ABSTRACT The purpose of this research is to better understand the current state of US healthcare FM industry hiring practices from FM academic programs. A national survey was distributed to healthcare FM directors to collect quantifiable information on healthcare organizations and their hiring practices from FM academic programs. Survey respondents that hired directly from an academic program were contacted for phone interviews. Results indicate that the healthcare FM industry is hiring very few college interns and new college graduates for entry-level management jobs. This paper is valuable in establishing the current state of the US healthcare industry's hiring practices from FM academic programs. Results will be used to better understand the needs and barriers of entry-level FM employment from FM academic programs as a potential source for new talent to the healthcare FM industry.

Big Data Management in US Hospitals: Benefits and Barriers.

Big data has been considered as an effective tool for reducing health care costs by eliminating adverse events and reducing readmissions to hospitals. The purposes of this study were to examine the emergence of big data in the US health care industry, to evaluate a hospital's ability to effectively use complex information, and to predict the potential benefits that hospitals might realize if they are successful in using big data. The findings of the research suggest that there were a number of benefits expected by hospitals when using big data analytics, including cost savings and business intelligence. By using big data, many hospitals have recognized that there have been challenges, including lack of experience and cost of developing the analytics. Many hospitals will need to invest in the acquiring of adequate personnel with experience in big data analytics and data integration. The findings of this study suggest that the adoption, implementation, and utilization of big data technology will have a profound positive effect among health care providers.

Stakeholder enrolment and business network formation: a process perspective on technology innovation

Entrepreneurial healthcare firms rarely possess all requisite resources to successfully develop and deploy knowledge-intensive technological innovations. It is critical for such firms to understand, manage, and cultivate networks of partners to gain access to essential strategic resources and to shape the viability of resultant networks in a mutually beneficial way. Firms accomplish this through an intentional process of stakeholder enrolment under conditions of risk and uncertainty. This paper examines a multi-year case study about the development and deployment of a personal health management system (PHMS) within the US healthcare industry in order to illustrate how organisational goals shape stakeholder enrolment processes and how outcomes affect the way in which networks form, adapt, and evolve. This study integrates and draws upon business network adaptation and stakeholder enrolment processes to present a theoretical framework for conceptualising and understanding entrepreneurial networks for technological innovations.