Individuals living in rural areas represent approximately 20% of the total United States populati... more Individuals living in rural areas represent approximately 20% of the total United States population and, compared to their urban counterparts, generally have worse health outcomes. One potentially modifiable determinant of rural public health is the surgical care-seeking behavior of rural patients. The decision of where to receive elective surgical care can have direct effects on surgery-related outcomes as well as downstream effects on rural hospitals, public health, and economies.
La continuité en tant qu’objectif est un sujet fort débattu dans le domaine des soins de santé me... more La continuité en tant qu’objectif est un sujet fort débattu dans le domaine des soins de santé mentale mais encore peu étudié, en partie à cause des difficultés que sa mesure pose. Un petit nombre de projets de recherche ont permis d’établir, en évaluant le degré d’utilisation des services, les caractéristiques des programmes que l’on peut associer à la continuité. Récemment, un projet de planification a fourni l’occasion d’étudier, à l’aide d’un nouvel instrument d’auto-évaluation, l’effet de ces facteurs sur la continuité. On a mesuré neuf caractéristiques et fait appel à la régression linéaire pour analyser leur incidence sur la continuité, tout en tenant compte également des caractéristiques des clients. On a constaté que les programmes fournissant certains services le soir ou la fin de semaine affichaient un degré de continuité élevé et que ceux où l’on fournissait davantage de soins dans le milieu affichaient un degré moindre. Cette dernière observation était inattendue et ref...
Administration and Policy in Mental Health and Mental Health Services Research, 2006
Continuity of care is a concern for mental health clients in the post deinstitutionalization era ... more Continuity of care is a concern for mental health clients in the post deinstitutionalization era of community care. A proposed solution is systems integration. This paper reviewed research on systems integration, focusing on continuity of care outcomes. A positive association between systems integration and client continuity of care was consistently demonstrated. Better results were obtained in systems characterized by stronger management arrangements, fewer service sectors, and system wide implementation of intensive case management and centralized access to services. Future research should evaluate a wider range of systems integrating mechanisms, using client-based measures that more directly represent continuity of care experiences.
This is a revised version of a previous protocol (https://osf.io/6ghzu). The proposed research wi... more This is a revised version of a previous protocol (https://osf.io/6ghzu). The proposed research will build on the understanding of factors influencing surgical care-seeking behavior among rural residents. Systematically analyzing the literature on surgical care-seeking behavior will elucidate trends in bypass rates and factors that may predict higher or lower rates. Main research question: What are the factors that have been proposed to affect hospital choice among rural residents seeking surgery? Objective: Using results from a scoping review of the literature, we will build a conceptual model of hospital choice for rural residents seeking surgery.
This study developed and applied benchmarks for five indicators included in the CAH Financial Ind... more This study developed and applied benchmarks for five indicators included in the CAH Financial Indicators Report, an annual, hospital-specific report distributed to all critical access hospitals (CAHs). An online survey of Chief Executive Officers and Chief Financial Officers was used to establish benchmarks. Indicator values for 2004, 2005, and 2006 were calculated for 421 CAHs and hospital performance was compared to the benchmarks. Although many hospitals performed better than benchmark on one indicator in 1 year, very few performed better than benchmark on all five indicators in all 3 years. The probability of performing better than benchmark differed among peer groups.
The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association, Jan 16, 2016
The low-volume hospital (LVH) payment adjustment established in the Patient Protection and Afford... more The low-volume hospital (LVH) payment adjustment established in the Patient Protection and Affordable Care Act (ACA) of 2010 is scheduled to sunset on October 1, 2017. The purpose of this analysis was: (1) to estimate the effect of the ACA LVH adjustment on qualifying hospitals' profitability margins; and (2) to examine hospital and market characteristics of the hospitals that would be most adversely affected by the loss of the ACA LVH adjustment. 2004-2015 data from the Hospital Cost Report Information System, Hospital Market Service Area File and Nielsen-Claritas Pop-Facts file were used to estimate difference-in-difference regression models with hospital-level random effects in order to determine whether the ACA LVH adjustment improved qualifying rural hospitals' profitability margins. Recycled predictions estimated the effect of losing the ACA LVH adjustment on profitability margins. Bivariate analyses explored associations between the predicted profitability margins and...
Under the Income Tax Act, Registered Pension Funds, including Registerd Retirement Savings Plans ... more Under the Income Tax Act, Registered Pension Funds, including Registerd Retirement Savings Plans (RRSPs), may invest no more than 10 percent of their assets in foreign securities and property. Financial theory states that restricting the opportunity for diversification should result in inferior investment performance. This study tests the effects of the 10 percent restriction on the investment performance of a
In the 1990s every Canadian province is struggling to reduce health care expenditures without jeo... more In the 1990s every Canadian province is struggling to reduce health care expenditures without jeopardizing access to health care or quality of care. The authors propose a new model for health care delivery: the Canadian Integrated Delivery System (CIDS). A CIDS is a network of health care organizations; it would provide, or arrange to provide, a coordinated continuum of services to a defined population and would be held clinically and fiscally accountable for the outcomes in and health status of that population. A CIDS would serve 100,000 to 2 million people; the care it would provide would be funded on a capitation basis. For providers, there would be explicit financial incentives to minimize costs. At the same time, service quality and consumer choice of primary care practitioner would be maintained. Primary care physicians and specialists would work with other health care service providers to offer a full spectrum of care. CIDS providers would form strategic alliances with commun...
The Canadian journal of nursing research = Revue canadienne de recherche en sciences infirmières, 2004
Continuity has been a much discussed but under-researched objective of mental health care, in par... more Continuity has been a much discussed but under-researched objective of mental health care, in part due to measurement challenges. A small body of research has identified program features associated with continuity, based on measures of service use. A recent planning project provided an opportunity to examine the effects of these features on continuity using a new self-report continuity measure. Nine program features were measured and linear regression analyses were used to assess the relationship between these features and continuity, controlling for client characteristics. Client continuity was higher in programs that offered some night or weekend coverage and lower in programs that provided more care in the community. This latter finding was unexpected and may represent program efforts to engage individuals experiencing difficulties with service access. The association between each of the other 7 program features and continuity was not significant. Possible explanations for this f...
CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, Jan 15, 1994
In the first of two articles on the subject, the authors explain what Case Mix Groups (CMGs) and ... more In the first of two articles on the subject, the authors explain what Case Mix Groups (CMGs) and Resource Intensity Weights (RIWs) are and how they are used. The former categorize hospital patients into groups. The latter are ratios showing the relative use of hospital resources for a typical case (successful course of treatment in an acute care hospital and discharge when the patient no longer requires the hospital's services) and atypical cases (death, transfer, sign-out and substantially longer than average stay) in each CMG. As such, CMGs and RIWs define the relation between the medical and financial dimensions of hospital cases for use in planning and management. Ontario and Alberta are the first provinces to use them to adjust hospital funding. CMGs are limited by the number of diagnoses contained in each category, and RIWs are limited by the use of New York cost data due to the lack of Canadian data.
Individuals living in rural areas represent approximately 20% of the total United States populati... more Individuals living in rural areas represent approximately 20% of the total United States population and, compared to their urban counterparts, generally have worse health outcomes. One potentially modifiable determinant of rural public health is the surgical care-seeking behavior of rural patients. The decision of where to receive elective surgical care can have direct effects on surgery-related outcomes as well as downstream effects on rural hospitals, public health, and economies.
La continuité en tant qu’objectif est un sujet fort débattu dans le domaine des soins de santé me... more La continuité en tant qu’objectif est un sujet fort débattu dans le domaine des soins de santé mentale mais encore peu étudié, en partie à cause des difficultés que sa mesure pose. Un petit nombre de projets de recherche ont permis d’établir, en évaluant le degré d’utilisation des services, les caractéristiques des programmes que l’on peut associer à la continuité. Récemment, un projet de planification a fourni l’occasion d’étudier, à l’aide d’un nouvel instrument d’auto-évaluation, l’effet de ces facteurs sur la continuité. On a mesuré neuf caractéristiques et fait appel à la régression linéaire pour analyser leur incidence sur la continuité, tout en tenant compte également des caractéristiques des clients. On a constaté que les programmes fournissant certains services le soir ou la fin de semaine affichaient un degré de continuité élevé et que ceux où l’on fournissait davantage de soins dans le milieu affichaient un degré moindre. Cette dernière observation était inattendue et ref...
Administration and Policy in Mental Health and Mental Health Services Research, 2006
Continuity of care is a concern for mental health clients in the post deinstitutionalization era ... more Continuity of care is a concern for mental health clients in the post deinstitutionalization era of community care. A proposed solution is systems integration. This paper reviewed research on systems integration, focusing on continuity of care outcomes. A positive association between systems integration and client continuity of care was consistently demonstrated. Better results were obtained in systems characterized by stronger management arrangements, fewer service sectors, and system wide implementation of intensive case management and centralized access to services. Future research should evaluate a wider range of systems integrating mechanisms, using client-based measures that more directly represent continuity of care experiences.
This is a revised version of a previous protocol (https://osf.io/6ghzu). The proposed research wi... more This is a revised version of a previous protocol (https://osf.io/6ghzu). The proposed research will build on the understanding of factors influencing surgical care-seeking behavior among rural residents. Systematically analyzing the literature on surgical care-seeking behavior will elucidate trends in bypass rates and factors that may predict higher or lower rates. Main research question: What are the factors that have been proposed to affect hospital choice among rural residents seeking surgery? Objective: Using results from a scoping review of the literature, we will build a conceptual model of hospital choice for rural residents seeking surgery.
This study developed and applied benchmarks for five indicators included in the CAH Financial Ind... more This study developed and applied benchmarks for five indicators included in the CAH Financial Indicators Report, an annual, hospital-specific report distributed to all critical access hospitals (CAHs). An online survey of Chief Executive Officers and Chief Financial Officers was used to establish benchmarks. Indicator values for 2004, 2005, and 2006 were calculated for 421 CAHs and hospital performance was compared to the benchmarks. Although many hospitals performed better than benchmark on one indicator in 1 year, very few performed better than benchmark on all five indicators in all 3 years. The probability of performing better than benchmark differed among peer groups.
The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association, Jan 16, 2016
The low-volume hospital (LVH) payment adjustment established in the Patient Protection and Afford... more The low-volume hospital (LVH) payment adjustment established in the Patient Protection and Affordable Care Act (ACA) of 2010 is scheduled to sunset on October 1, 2017. The purpose of this analysis was: (1) to estimate the effect of the ACA LVH adjustment on qualifying hospitals' profitability margins; and (2) to examine hospital and market characteristics of the hospitals that would be most adversely affected by the loss of the ACA LVH adjustment. 2004-2015 data from the Hospital Cost Report Information System, Hospital Market Service Area File and Nielsen-Claritas Pop-Facts file were used to estimate difference-in-difference regression models with hospital-level random effects in order to determine whether the ACA LVH adjustment improved qualifying rural hospitals' profitability margins. Recycled predictions estimated the effect of losing the ACA LVH adjustment on profitability margins. Bivariate analyses explored associations between the predicted profitability margins and...
Under the Income Tax Act, Registered Pension Funds, including Registerd Retirement Savings Plans ... more Under the Income Tax Act, Registered Pension Funds, including Registerd Retirement Savings Plans (RRSPs), may invest no more than 10 percent of their assets in foreign securities and property. Financial theory states that restricting the opportunity for diversification should result in inferior investment performance. This study tests the effects of the 10 percent restriction on the investment performance of a
In the 1990s every Canadian province is struggling to reduce health care expenditures without jeo... more In the 1990s every Canadian province is struggling to reduce health care expenditures without jeopardizing access to health care or quality of care. The authors propose a new model for health care delivery: the Canadian Integrated Delivery System (CIDS). A CIDS is a network of health care organizations; it would provide, or arrange to provide, a coordinated continuum of services to a defined population and would be held clinically and fiscally accountable for the outcomes in and health status of that population. A CIDS would serve 100,000 to 2 million people; the care it would provide would be funded on a capitation basis. For providers, there would be explicit financial incentives to minimize costs. At the same time, service quality and consumer choice of primary care practitioner would be maintained. Primary care physicians and specialists would work with other health care service providers to offer a full spectrum of care. CIDS providers would form strategic alliances with commun...
The Canadian journal of nursing research = Revue canadienne de recherche en sciences infirmières, 2004
Continuity has been a much discussed but under-researched objective of mental health care, in par... more Continuity has been a much discussed but under-researched objective of mental health care, in part due to measurement challenges. A small body of research has identified program features associated with continuity, based on measures of service use. A recent planning project provided an opportunity to examine the effects of these features on continuity using a new self-report continuity measure. Nine program features were measured and linear regression analyses were used to assess the relationship between these features and continuity, controlling for client characteristics. Client continuity was higher in programs that offered some night or weekend coverage and lower in programs that provided more care in the community. This latter finding was unexpected and may represent program efforts to engage individuals experiencing difficulties with service access. The association between each of the other 7 program features and continuity was not significant. Possible explanations for this f...
CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, Jan 15, 1994
In the first of two articles on the subject, the authors explain what Case Mix Groups (CMGs) and ... more In the first of two articles on the subject, the authors explain what Case Mix Groups (CMGs) and Resource Intensity Weights (RIWs) are and how they are used. The former categorize hospital patients into groups. The latter are ratios showing the relative use of hospital resources for a typical case (successful course of treatment in an acute care hospital and discharge when the patient no longer requires the hospital's services) and atypical cases (death, transfer, sign-out and substantially longer than average stay) in each CMG. As such, CMGs and RIWs define the relation between the medical and financial dimensions of hospital cases for use in planning and management. Ontario and Alberta are the first provinces to use them to adjust hospital funding. CMGs are limited by the number of diagnoses contained in each category, and RIWs are limited by the use of New York cost data due to the lack of Canadian data.
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Papers by George Pink