Lawton R Burns
Datos Biográficos
| ID | 309931 |
|---|---|
| NOMBRE | Lawton R Burns |
| NOMBRES | Lawton R |
| APELLIDO | Burns |
| FIRMA | BURNS L R |
| AFILIACIONES | University of Pennsylvania |
| ORCID | 0000-0003-1252-8155 |
| VERIFICADO | Sí |
| TOTAL DE OBRAS | 25 |
| TOTAL DE CITAS | 11 |
| TOTAL COMO AUTOR | 25 |
| TOTAL COMO EDITOR | 0 |
| PRIMER AÑO DE PUBLICACIÓN | 1980 |
| AÑO MÁS RECIENTE DE PUBLICACIÓN | 2025 |
| ÍNDICE H | 1 |
Hospital Consolidation and Quality
Authors response to the commentaries on “Integrating network theory into study of integrated healthcare”
Integrating network theory into the study of integrated healthcare
Big Med
Health Maintenance Organization
A health maintenance organization (HMO) is a managed care organization that integrates health insurance and delivery functions in an effort to contain costs and maximize quality. HMOs differ from indemnity health insurance, where the insurer compensates the consumer for the cost of specified services. On the continuum between indemnity health insurance and HMOs lie organizations such as preferred provider organizations (PPOs) that manage care del…
The Ties That Bind
OBJECTIVES: To examine the association between the degree of alignment between physicians and health care systems, and interorganizational linkages between physician groups and health care systems. METHODS: The study used a cross sectional, comparative analysis using a sample of 1,279 physicians practicing in loosely affiliated arrangements and 1,781 physicians in 61 groups closely affiliated with 14 vertically integrated health systems. Measures…
Physician Commitment to Organized Delivery Systems
BACKGROUND: Health care systems have developed many types of contracting vehicles with physicians. The immediate aim of these vehicles has been to foster physician commitment and alignment to the system. The ultimate aim of these vehicles has been to garner managed care contracts, reduce costs, and improve quality. To date, most of these vehicles have failed to improve physician commitment. This may be one reason why the ultimate outcomes have no…
Physician-System Relationships
OBJECTIVES: To identify the barriers, facilitators, and potential better practices to achieving physician-system alignment. METHODS: Interviews using a semi-structured, open-ended protocol were conducted during a total of 18 site visits, each usually 2 days in length, covering multiple topics of physician group-system alignment. Interviews were conducted with members of the target physician group, key leaders of the health care system, and repres…
Implementing Evidence-Based Medicine
OBJECTIVES: To assess the extent to which market pressures, compensation incentives, and physician medical group culture are associated with the use of evidence-based medicine practices in physician organizations. METHODS: Cross-sectional exploratory study of 56 medical groups affiliated with 15 integrated health systems from across the United States, involving 1,797 physician respondents. Larger medical groups and multispecialty groups were over…
Risk Assumption and Physician Alignment With Health Care Organizations
OBJECTIVES: To examine the association between risk assumption by individual physicians and physician groups and the degree of alignment between physicians and health care systems. METHODS: A cross sectional comparative analysis using a sample of 1,279 physicians practicing in loosely affiliated arrangements and 1,781 physicians in 61 groups closely affiliated with 14 vertically integrated health systems. Measures of physician alignment were base…
Factors Associated With Physician Involvement in Care Management
Appropriate physician and management involvement, as well as financial incentives and useful management information systems may facilitate physician participation in CM activities. Physician involvement in implementation of CM practices appears to be important, whereas their involvement in the development phase may be negatively related to later attitudes and participation. The findings call for a more in-depth understanding of the timing of phys…
Physician-System Alignment
The papers in this Special Supplement are based on research funded by the participating members of the joint Center for Health Management Research (CHMR) and Center for Organized Delivery Systems (CODS), and supported by the National Science Foundation under its Industry-University Cooperative Research Center Program. This 3-year research initiative from 1996 through 1999 involved 69 physician organizations (primarily organized medical groups as …
Is Provider Capitation Working
BACKGROUND: Capitation holds health providers fiscally responsible for the services they deliver or arrange and thus provides strong motivation for physicians and hospitals to integrate activities and reduce costs of care. OBJECTIVES: The objective of this study was to assess 2 potential effects of capitation: (1) its effects on the integration of functional, financial, and clinical processes between hospitals and physicians and (2) its effects, …
Impact of Physicians' Perceptions of Malpractice and Adaptive Changes on Intention to Cease Obstetrical Practice
Physicians who provide obstetrical care in rural areas face exposure to liability action and confront a critical decision–––whether to continue to offer these services. This paper draws upon social‐psychological and decision theories to investigate this decision. Ninety four percent of all obstetricians and family and general physicians practicing in the 22 non metropolitan counties of one state responded to a mail survey that asked about their i…
The Effects of Managed Care on Physician and Clinical Integration in Hospitals
OBJECTIVE: To empirically estimate the effects that managed care has had on physician and clinical integration in urban hospitals. DATA SOURCES: The 1993 Hospital-Physician Relationship Survey conducted for the Prospective Payment Assessment Commission, augmented with data from a variety of secondary sources. The entire 1,495 responding hospitals were used to construct measures of integration; 591 responding hospitals in urban areas were used for…
Physician and Clinical Integration Among Rural Hospitals
The pressures for closer alignment between physicians and hospitals in both rural and urban areas are increasing. This study empirically specifies independent dimensions of physician and clinical integration and compares the extent to which such activities are practiced between rural and urban hospitals and among rural hospitals in different organizational and market contexts. Results suggest that both rural and urban hospitals practice physician…
The Impact of Physician Involvement in Managed Care on Efficient Use of Hospital Resources
OBJECTIVES: This research assesses the impact of managed care on the physician's efficient use of hospital resources. It examines three questions. (1) Does a higher percentage and volume of managed care patients in the physician's hospital practice lead to more efficient utilization? (2) Do physicians shift cost to nonmanaged care patients in an effort to compensate for lower reimbursement for managed care patients? (3) Are there threshold effect…
The Effect of Physician Factors on the Cesarean Section Decision
The number of deliveries by cesarean section (c-section) has increased dramatically. Clinical and demographic factors have not adequately explained the increased rate, however. This study investigates the role of nonclinical (i.e., physician) factors in explaining variations in c-section rates, including the physician's training/experience, financial and convenience incentives, and practice characteristics. The study measures the impact of these …
Medicare's New Hospital Payment System
An abstract is not available for this content so a preview has been provided. Please use the Get access link above for information on how to access this content
The Effects of Patient, Hospital, and Physician Characteristics on Length of Stay and Mortality
This article compares the ability of hospital and physician characteristics to explain variations in length of stay and mortality, controlling for factors associated with severity of illness. The analysis is based on 54,571 discharges, covering 11 medical and five surgical conditions, from nonfederal general hospitals in one state during 1988. Results suggest that both hospital and physician characteristics are important predictors of both outcom…
Convenience and Independence
This paper contrasts economic and professional models of physician admitting behavior. Economic models emphasize physician convenience and income maximization, while professional models emphasize physician autonomy and independence. The paper examines the relative power of these models to explain two types of admitting decisions made by physicians: which hospitals to begin admitting patients to, and how many patients to admit to a hospital. Analy…
The Impact of Corporate Structures on Physician Inclusion and Participation
This study examines the impact of corporate arrangements on the hospital-physician relationship. Specifically, it investigates the effects of for-profit ownership and membership in a multihospital system on physician inclusion (salaried employment, hospital-based practice) and participation (involvement in governance and management). Contrary to common perceptions and several hypotheses drawn from the literature, corporate arrangements are associ…
All Organizations are Public
Consumerism in Medicine
The Chicago school and the study of organization-environment relations
The ecological perspective on organizational change represents the most significant development in contemporary organization research. The two reigning paradigms explain organizational change in terms of ‘environmental selection’ and ‘adaptation,’ respectively. What is generally unrecognized is that these developments are anticipated in the writings of the Chicago School of Sociology–specifically in their model of Ecological, Economic, and Cultur…
The Chicago school and the study of organization-environment relations
The ecological perspective on organizational change represents the most significant development in contemporary organization research. The two reigning paradigms explain organizational change in terms of ‘environmental selection’ and ‘adaptation,’ respectively. What is generally unrecognized is that these developments are anticipated in the writings of the Chicago School of Sociology–specifically in their model of Ecological, Economic, and Cultur…
Consumerism in Medicine
All Organizations are Public
The Impact of Corporate Structures on Physician Inclusion and Participation
This study examines the impact of corporate arrangements on the hospital-physician relationship. Specifically, it investigates the effects of for-profit ownership and membership in a multihospital system on physician inclusion (salaried employment, hospital-based practice) and participation (involvement in governance and management). Contrary to common perceptions and several hypotheses drawn from the literature, corporate arrangements are associ…
Medicare's New Hospital Payment System
An abstract is not available for this content so a preview has been provided. Please use the Get access link above for information on how to access this content
The Effects of Patient, Hospital, and Physician Characteristics on Length of Stay and Mortality
This article compares the ability of hospital and physician characteristics to explain variations in length of stay and mortality, controlling for factors associated with severity of illness. The analysis is based on 54,571 discharges, covering 11 medical and five surgical conditions, from nonfederal general hospitals in one state during 1988. Results suggest that both hospital and physician characteristics are important predictors of both outcom…
Convenience and Independence
This paper contrasts economic and professional models of physician admitting behavior. Economic models emphasize physician convenience and income maximization, while professional models emphasize physician autonomy and independence. The paper examines the relative power of these models to explain two types of admitting decisions made by physicians: which hospitals to begin admitting patients to, and how many patients to admit to a hospital. Analy…
The Effect of Physician Factors on the Cesarean Section Decision
The number of deliveries by cesarean section (c-section) has increased dramatically. Clinical and demographic factors have not adequately explained the increased rate, however. This study investigates the role of nonclinical (i.e., physician) factors in explaining variations in c-section rates, including the physician's training/experience, financial and convenience incentives, and practice characteristics. The study measures the impact of these …
The Impact of Physician Involvement in Managed Care on Efficient Use of Hospital Resources
OBJECTIVES: This research assesses the impact of managed care on the physician's efficient use of hospital resources. It examines three questions. (1) Does a higher percentage and volume of managed care patients in the physician's hospital practice lead to more efficient utilization? (2) Do physicians shift cost to nonmanaged care patients in an effort to compensate for lower reimbursement for managed care patients? (3) Are there threshold effect…
Physician and Clinical Integration Among Rural Hospitals
The pressures for closer alignment between physicians and hospitals in both rural and urban areas are increasing. This study empirically specifies independent dimensions of physician and clinical integration and compares the extent to which such activities are practiced between rural and urban hospitals and among rural hospitals in different organizational and market contexts. Results suggest that both rural and urban hospitals practice physician…
Impact of Physicians' Perceptions of Malpractice and Adaptive Changes on Intention to Cease Obstetrical Practice
Physicians who provide obstetrical care in rural areas face exposure to liability action and confront a critical decision–––whether to continue to offer these services. This paper draws upon social‐psychological and decision theories to investigate this decision. Ninety four percent of all obstetricians and family and general physicians practicing in the 22 non metropolitan counties of one state responded to a mail survey that asked about their i…
The Effects of Managed Care on Physician and Clinical Integration in Hospitals
OBJECTIVE: To empirically estimate the effects that managed care has had on physician and clinical integration in urban hospitals. DATA SOURCES: The 1993 Hospital-Physician Relationship Survey conducted for the Prospective Payment Assessment Commission, augmented with data from a variety of secondary sources. The entire 1,495 responding hospitals were used to construct measures of integration; 591 responding hospitals in urban areas were used for…
Is Provider Capitation Working
BACKGROUND: Capitation holds health providers fiscally responsible for the services they deliver or arrange and thus provides strong motivation for physicians and hospitals to integrate activities and reduce costs of care. OBJECTIVES: The objective of this study was to assess 2 potential effects of capitation: (1) its effects on the integration of functional, financial, and clinical processes between hospitals and physicians and (2) its effects, …
The Ties That Bind
OBJECTIVES: To examine the association between the degree of alignment between physicians and health care systems, and interorganizational linkages between physician groups and health care systems. METHODS: The study used a cross sectional, comparative analysis using a sample of 1,279 physicians practicing in loosely affiliated arrangements and 1,781 physicians in 61 groups closely affiliated with 14 vertically integrated health systems. Measures…
Physician Commitment to Organized Delivery Systems
BACKGROUND: Health care systems have developed many types of contracting vehicles with physicians. The immediate aim of these vehicles has been to foster physician commitment and alignment to the system. The ultimate aim of these vehicles has been to garner managed care contracts, reduce costs, and improve quality. To date, most of these vehicles have failed to improve physician commitment. This may be one reason why the ultimate outcomes have no…
Physician-System Relationships
OBJECTIVES: To identify the barriers, facilitators, and potential better practices to achieving physician-system alignment. METHODS: Interviews using a semi-structured, open-ended protocol were conducted during a total of 18 site visits, each usually 2 days in length, covering multiple topics of physician group-system alignment. Interviews were conducted with members of the target physician group, key leaders of the health care system, and repres…
Implementing Evidence-Based Medicine
OBJECTIVES: To assess the extent to which market pressures, compensation incentives, and physician medical group culture are associated with the use of evidence-based medicine practices in physician organizations. METHODS: Cross-sectional exploratory study of 56 medical groups affiliated with 15 integrated health systems from across the United States, involving 1,797 physician respondents. Larger medical groups and multispecialty groups were over…
Risk Assumption and Physician Alignment With Health Care Organizations
OBJECTIVES: To examine the association between risk assumption by individual physicians and physician groups and the degree of alignment between physicians and health care systems. METHODS: A cross sectional comparative analysis using a sample of 1,279 physicians practicing in loosely affiliated arrangements and 1,781 physicians in 61 groups closely affiliated with 14 vertically integrated health systems. Measures of physician alignment were base…
Factors Associated With Physician Involvement in Care Management
Appropriate physician and management involvement, as well as financial incentives and useful management information systems may facilitate physician participation in CM activities. Physician involvement in implementation of CM practices appears to be important, whereas their involvement in the development phase may be negatively related to later attitudes and participation. The findings call for a more in-depth understanding of the timing of phys…
Physician-System Alignment
The papers in this Special Supplement are based on research funded by the participating members of the joint Center for Health Management Research (CHMR) and Center for Organized Delivery Systems (CODS), and supported by the National Science Foundation under its Industry-University Cooperative Research Center Program. This 3-year research initiative from 1996 through 1999 involved 69 physician organizations (primarily organized medical groups as …
Health Maintenance Organization
A health maintenance organization (HMO) is a managed care organization that integrates health insurance and delivery functions in an effort to contain costs and maximize quality. HMOs differ from indemnity health insurance, where the insurer compensates the consumer for the cost of specified services. On the continuum between indemnity health insurance and HMOs lie organizations such as preferred provider organizations (PPOs) that manage care del…
Big Med
Authors response to the commentaries on “Integrating network theory into study of integrated healthcare”
Integrating network theory into the study of integrated healthcare
Hospital Consolidation and Quality
Healthcare Policy and Management (17 obras) · Primary Care and Health Outcomes (17 obras) · Business (14 obras) · Medicine (14 obras) · Political science (12 obras) · Health care (11 obras) · Family medicine (10 obras) · Finance (9 obras) · Economics (8 obras) · Finance (8 obras)