Stephen M Shortell
Dados Biográficos
| ID | 252047 |
|---|---|
| NOME | Stephen M Shortell |
| PRENOMES | Stephen M |
| SOBRENOME | Shortell |
| ASSINATURA | SHORTELL S M |
| AFILIAÇÕES | University of California, Berkeley |
| ORCID | 0000-0002-7392-9801 |
| VERIFICADO | Sim |
| TOTAL DE OBRAS | 61 |
| TOTAL DE CITAÇÕES | 101 |
| TOTAL COMO AUTOR | 61 |
| TOTAL COMO EDITOR | 0 |
| PRIMEIRO ANO DE PUBLICAÇÃO | 1973 |
| ANO MAIS RECENTE DE PUBLICAÇÃO | 2026 |
| ÍNDICE H | 7 |
Health and Social Care as Complex Adaptive Systems
Background: Building on concepts from Complex Adaptive Systems (CAS), this paper proposes an overarching social science framework for addressing the fragmentation that exists in health and social care systems worldwide. The focus is on how relational networks might be strengthened to deliver more coordinated, integrated, whole person-centered care. The framework examines a major planned social experiment occurring in New South Wales, Australia: “…
Changes in US Primary Care Access and Capabilities During the Covid-19 Pandemic
In this cohort study, over the time period including the COVID-19 pandemic, primary care practices reported a decline in access to care, while average practice capabilities improved. Integrated practice ownership and ACO participation were both associated with better access and capability scores, suggesting that value-based payment and integrated care delivery support the development of higher-quality primary care. Variations across practices poi…
Safety Net Primary Care Capabilities After the Covid-19 Pandemic
The results of this survey study suggest that FQHCs outperformed non-FQHC practices on important care processes while serving a patient population with lower incomes who are medically underserved compared with patients in other practice types. Legislation to expand funding for the FQHC program should improve services for underserved populations and target current non-FQHC safety net practices to serve these populations. Increased support for thes…
Telehealth Use, Care Continuity, and Quality
BACKGROUND: Community health centers (CHCs) pivoted to using telehealth to deliver chronic care during the coronavirus COVID-19 pandemic. While care continuity can improve care quality and patients' experiences, it is unclear whether telehealth supported this relationship. OBJECTIVE: We examine the association of care continuity with diabetes and hypertension care quality in CHCs before and during COVID-19 and the mediating effect of telehealth. …
Hospital Characteristics Associated With Clinically Integrated Network Participation
BACKGROUND: Increased integration of physician organizations and hospitals into health systems has not necessarily improved clinical integration or patient outcomes. However, federal regulators have issued favorable opinions for clinically integrated networks (CINs) as a way to pursue coordination between hospitals and physicians. Hospital organizational affiliations, including independent practice associations (IPA), physician-hospital organizat…
Authors response to the commentaries on “Integrating network theory into study of integrated healthcare”
Integrating network theory into the study of integrated healthcare
Factors Associated With Family Medicine and Internal Medicine First-Year Residents’ Ambulatory Care Training Time
PURPOSE: Despite the importance of training in ambulatory care settings for residents to acquire important competencies, little is known about the organizational and environmental factors influencing the relative amount of time primary care residents train in ambulatory care during residency. The authors examined factors associated with postgraduate year 1 (PGY-1) residents' ambulatory care training time in Accreditation Council for Graduate Medi…
Assessing the Short‐Term Association Between Rural Hospitals’ Participation in Accountable Care Organizations and Changes in Utilization and Financial Performance
PURPOSE: Although much research has been done on accountable care organizations (ACOs), little is known about their impact on rural hospitals. We examine the association between rural hospitals' participation in an ACO and their performance on utilization and financial measures. METHODS: This quasi-experimental study estimates the relationship between voluntary ACO participation and hospital metrics using propensity score-matched, longitudinal re…
Learning from Accountable Health Models in Spain
The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 5.120 (2020 JCR, received in June 2021)
Patient Engagement in ACO Practices and Patient-reported Outcomes Among Adults With Co-occurring Chronic Disease and Mental Health Conditions
BACKGROUND: Accountable care organizations (ACOs) have increased their use of patient activation and engagement strategies, but it is unknown whether they achieve better outcomes for patients with comorbid chronic physical and mental health conditions. OBJECTIVES: To assess the extent to which practices with patient-centered cultures, greater shared decision-making strategies, and better coordination among team members have better patient-reporte…
Organizational Influences on Time Pressure Stressors and Potential Patient Consequences in Primary Care
BACKGROUND: Primary care teams face daily time pressures both during patient encounters and outside of appointments. OBJECTIVES: We theorize 2 types of time pressure, and test hypotheses about organizational determinants and patient consequences of time pressure. RESEARCH DESIGN: Cross-sectional, observational analysis of data from concurrent surveys of care team members and their patients. SUBJECTS: Patients (n=1291 respondents, 73.5% response r…
Performance Management in Accountable Care Organizations in the U.S. and Germany
The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 5.120 (2020 JCR, received in June 2021)
The new frontier of strategic alliances in health care
Associations between patients’ perceptions of care integration and organizational features of medical groups in the United States
Background: Prior studies suggest structurally integrating healthcare organizations may not yield care that is integrated for patients. This research has been limited by lack of comprehensive measures of integrated patient care. Our study establishes an evidence base of care integration from the patient’s perspective among a national sample in the United States using a reliable and valid survey. We explore the relationship between patient-perceiv…
The Use of Enhanced Appointment Access Strategies by Medical Practices
BACKGROUND: Strategies to enhance appointment access are being adopted by medical practices as part of patient-centered medical home (PCMH) implementation, but little is known about the use of these strategies nationally. OBJECTIVES: We examine practice use of open access scheduling and after-hours care. RESEARCH DESIGN: Data were analyzed from the Third National Study of Physician Organizations (NSPO3) to examine which enhanced appointment acces…
The Next Step Towards Making Use Meaningful
BACKGROUND: Care for patients with chronic conditions often requires coordination between multiple physicians and delivery sites. Electronic Health Record (EHR) use could improve care quality and efficiency in part by facilitating care coordination. OBJECTIVE: We examined the association between EHR use and clinician perceptions of care coordination for patients transferred across clinicians and delivery sites. RESEARCH DESIGN: Repeated surveys o…
Quality-Based Payment for Medical Groups and Individual Physicians
This paper measures the extent to which medical groups experience external pay-for-performance incentives based on quality and patient satisfaction and the extent to which these groups pay their primary care and specialist physicians using similar criteria. Over half (52%) of large medical groups received bonus payments from health insurance plans in the period 2006-2007 based on measures of quality and patient satisfaction. Medical groups facing…
Improving Chronic Illness Care
BACKGROUND: An increasing number of people suffer from chronic illness. Processes exist to provide better chronic illness care and yet for the most part, they are not used. OBJECTIVE: To examine the change in use of commonly recommended chronic illness care management processes (CMPs) in large medical groups between 2000 and 2006 and the factors associated with the change. DESIGN AND MEASURES: Cohort analysis of data from a national telephone sur…
Development of a Core Competency Model for the Master of Public Health Degree
Core competencies have been used to redefine curricula across the major health professions in recent decades. In 2006, the Association of Schools of Public Health identified core competencies for the master of public health degree in graduate schools and programs of public health. We provide an overview of the model development process and a listing of 12 core domains and 119 competencies that can serve as a resource for faculty and students for …
Response to Letter From Amy Kosifas, MBA, and Dale N. Schumacher, MD, MPH
Blue Cross of California Distinguished, Professor of Health Policy and, Management, Dean, School of Public Health, UC-Berkeley, Berkeley, California
From the doctor's workshop to the iron cage? Evolving modes of physician control in US health systems
Implementing the Institute of Medicine’s Recommended Curriculum Content in Schools of Public Health
In September 2003, the Association of Schools of Public Health administered an online survey to representatives of all 33 accredited US schools of public health. The survey assessed the extent to which the schools were offering curriculum content in the 8 areas recommended by the Institute of Medicine: communication, community-based participatory research, cultural competence, ethics, genomics, global health, informatics, and law/policy. Findings…
The Role of Perceived Team Effectiveness in Improving Chronic Illness Care
BACKGROUND/OBJECTIVES: The importance of teams for improving quality of care has received increased attention. We examine both the correlates of self-assessed or perceived team effectiveness and its consequences for actually making changes to improve care for people with chronic illness. STUDY SETTING AND METHODS: Data were obtained from 40 teams participating in the national evaluation of the Improving Chronic Illness Care Program. Based on curr…
Support for Smoking Cessation Interventions in Physician Organizations
OBJECTIVES: To document the extent to which physician organizations, defined as medical groups and independent practice associations, are providing support for smoking cessation interventions and to identify external incentives and organizational characteristics associated with this support. METHODS: This research uses data from the National Study of Physician Organizations and the Management of Chronic Illness, conducted by the University of Cal…
The Relationships Among Dimensions of Health Services in Two Provider Systems
Stephen M. Shortell, William C. Richardson, James P. LoGerfo, Paula Diehr, Barbara Weaver, The Relationships Among Dimensions of Health Services in Two Provider Systems: A Causal Model Approach, Journal of Health and Social Behavior, Vol. 18, No. 2 (Jun., 1977), pp. 139-159
Development of a Core Competency Model for the Master of Public Health Degree
Core competencies have been used to redefine curricula across the major health professions in recent decades. In 2006, the Association of Schools of Public Health identified core competencies for the master of public health degree in graduate schools and programs of public health. We provide an overview of the model development process and a listing of 12 core domains and 119 competencies that can serve as a resource for faculty and students for …
Integrating network theory into the study of integrated healthcare
The Role of Environment in a Configurational Theory of Organizations
This paper refines existing conceptualizations of organizational task environments by distinguishing among environmental complexity, diversity, instability, uncertainty, dependence, and hostility. Based on these concepts, a typology is presented that suggests that certain combinations of environmental dimensions are important for classifying organizations. Further, the various combinations of environmental dimensions are used to specify a configu…
Occupational prestige differences within the medical and allied health professions
Patterns of Referral Among Internists in Private Practice
Patterns of referral among internists in private practice are examined in terms of the rewards and costs perceived by physicians occupying different levels of professional status in the medical community. Referral patterns are highly related to professional status networks. High status internists showed the most cohesive patterns of referral and low status the least. Findings pertaining to the institutionalization of reciprocity, as well as the i…
From the doctor's workshop to the iron cage? Evolving modes of physician control in US health systems
Implementing the Institute of Medicine’s Recommended Curriculum Content in Schools of Public Health
In September 2003, the Association of Schools of Public Health administered an online survey to representatives of all 33 accredited US schools of public health. The survey assessed the extent to which the schools were offering curriculum content in the 8 areas recommended by the Institute of Medicine: communication, community-based participatory research, cultural competence, ethics, genomics, global health, informatics, and law/policy. Findings…
Patient Engagement in ACO Practices and Patient-reported Outcomes Among Adults With Co-occurring Chronic Disease and Mental Health Conditions
BACKGROUND: Accountable care organizations (ACOs) have increased their use of patient activation and engagement strategies, but it is unknown whether they achieve better outcomes for patients with comorbid chronic physical and mental health conditions. OBJECTIVES: To assess the extent to which practices with patient-centered cultures, greater shared decision-making strategies, and better coordination among team members have better patient-reporte…
Effects of Competition, Regulation, and Corporatization on Hospital-Physician Relationships
Jeffrey A. Alexander, Michael A. Morrisey, Stephen M. Shortell, Effects of Competition, Regulation, and Corporatization on Hospital-Physician Relationships, Journal of Health and Social Behavior, Vol. 27, No. 3 (Sep., 1986), pp. 220-235
The new frontier of strategic alliances in health care
The Use of Enhanced Appointment Access Strategies by Medical Practices
BACKGROUND: Strategies to enhance appointment access are being adopted by medical practices as part of patient-centered medical home (PCMH) implementation, but little is known about the use of these strategies nationally. OBJECTIVES: We examine practice use of open access scheduling and after-hours care. RESEARCH DESIGN: Data were analyzed from the Third National Study of Physician Organizations (NSPO3) to examine which enhanced appointment acces…
An Empirical Test of the Configurational Theory of Organizations
The configurational theory of organizations was used to analyze the relationships among organization environment, structure, and performance in proprietary nursing homes. This theory extends previous contingency theory research and conceptualization by including performance as the main focus behind organization design activities. Thirty proprietary nursing homes in the state of Washington responded to comprehensive interviews and survey questionn…
Health Insurance in Practice
Patterns of Referral Among Internists in Private Practice
Patterns of referral among internists in private practice are examined in terms of the rewards and costs perceived by physicians occupying different levels of professional status in the medical community. Referral patterns are highly related to professional status networks. High status internists showed the most cohesive patterns of referral and low status the least. Findings pertaining to the institutionalization of reciprocity, as well as the i…
A Model of Physician Referral Behavior
Occupational prestige differences within the medical and allied health professions
Referral Relationships Between Internists and Psychiatrists in Fee-For-Service Practice
Increased demand for mental health services has focused increased attention on the nature of referral relationships between primary care physicians and psychiatrists in the delivery of psychiatric care. Using data collected from a population of internists in fee-for-service practice in the northern suburbs of Chicago, this paper focuses on issues involving the extent to which internists see psychiatric conditions in their practice; the extent of …
Determinants of Physician Referral Rates
The physician's important decision-making role in the allocation of medical resources is well recognized. An important part of this role is one physician's decision to refer a patient to another physician for care. Existing research, largely descriptive in nature, has been limited by lack of a clear theoretical and conceptual framework for analysis. The current paper develops and tests a model of physician referral behavior based on exchange theo…
Continuity of Medical Care
Continuity of medical care is conceived as the extent to which services are received as part of a coordinated and uninterrupted succession of events consistent with the medical care needs of patients. Two operational measures are proposed, based on the Gini and CON indices of concentration. Examples of their application are provided using the 1970 CHAS-NORC national study of health services utilization. The validity of the proposed measures is as…
Hospital Bureaucracy
The Role of Environment in a Configurational Theory of Organizations
This paper refines existing conceptualizations of organizational task environments by distinguishing among environmental complexity, diversity, instability, uncertainty, dependence, and hostility. Based on these concepts, a typology is presented that suggests that certain combinations of environmental dimensions are important for classifying organizations. Further, the various combinations of environmental dimensions are used to specify a configu…
The Relationships Among Dimensions of Health Services in Two Provider Systems
Stephen M. Shortell, William C. Richardson, James P. LoGerfo, Paula Diehr, Barbara Weaver, The Relationships Among Dimensions of Health Services in Two Provider Systems: A Causal Model Approach, Journal of Health and Social Behavior, Vol. 18, No. 2 (Jun., 1977), pp. 139-159
The Growth of Bureaucratic Medicine
A Causal Model of Health Services for Diabetic Patients
A causal model of health services which includes patient and provider variables, perceived access to care, utilization of services, continuity of care, technical quality of the care process, technical quality of the care outcome, and patient satisfaction is applied to a group of diabetic patients enrolled in the Seattle Prepaid Health Care Project. The enrollees received comprehensive health services at zero out-of-pocket cost from either a prepa…
An Empirical Test of the Configurational Theory of Organizations
The configurational theory of organizations was used to analyze the relationships among organization environment, structure, and performance in proprietary nursing homes. This theory extends previous contingency theory research and conceptualization by including performance as the main focus behind organization design activities. Thirty proprietary nursing homes in the state of Washington responded to comprehensive interviews and survey questionn…
Increased Access to Medical Care
Many federally financed programs have been launched to improve the access of the poor to medical care, under the assumption that this will improve their health. The effectiveness of these programs, however, has generally been measured by increased utilization rather than by improved health. The few studies which have considered health status have shown small or negative effects. Here, data are presented from a project which provided fully prepaid…
The Relationship Between Utilization of Mental Health and Somatic Health Services Among Low Income Enrollees in Two Provider Plans
Mental health services were included in comprehensive benefits available with no out-of-pocket expenses to enrollees in the Seattle Prepaid Health Care Project. This study was designed to examine the characteristics of users as compared to nonusers of mental health services and to examine the possibility of lower use of somatic health services attributable to the availability of mental health services. Two enrollee groups were studied: one group …
The Law of Hospital and Health Care Administration
Health Program Evaluation
The Structural Configuration of U.S. Hospital Medical Staffs
Using data from the 1973 American Hospital Association national survey of hospital medical staff organization, six factors of medical staff organization structure are examined in relation to each other and to hospital ownership, size, teaching status, geographic region and size of Standard Metropolitan Statistical Area (SMSA). The six factors include 1) Resource Capability; 2) Generalist Physician Contractual Orientation; 3) Communication and Con…
Hospital Medical Staff Organization and Quality of Care
This article examines the relationships among hospital structural characteristics, individual physician characteristics, medical staff organization characteristics and quality of care for two conditions: acute myocardial infarction and appendicitis. Using data obtained from the Commission on Professional and Hospital Activities (CPHA), approximately 50,000 acute myocardial infarction cases and 8,183 appendectomy cases collected from 96 hospitals …
Health Status as a Measure of Need for Medical Care
At the national level there has been a desire to assure that individuals have access to effective personal medical care services. Accordingly, there has been an interest in linking policies on access to care to the health needs of diverse population groups. This article critiques three measures of access linked to health status: the Use-Disability Ratio, the Symptoms-Response Ratio, and the Episode of Illness Analysis. Their utility in determinin…
The Criteria and Standards of Quality
Managing Strategic Change
Effects of Competition, Regulation, and Corporatization on Hospital-Physician Relationships
Jeffrey A. Alexander, Michael A. Morrisey, Stephen M. Shortell, Effects of Competition, Regulation, and Corporatization on Hospital-Physician Relationships, Journal of Health and Social Behavior, Vol. 27, No. 3 (Sep., 1986), pp. 220-235
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…
Organizational Assessment in Intensive Care Units (ICUs)
Health Services Research has a growing need for reliable and valid measures of managerial practices and organizational processes. A national study of 42 intensive care units involving over 1,700 respondents provides evidence for the reliability and validity of a comprehensive set of measures related to leadership, organizational culture, communication, coordination, problem solving-conflict management and team cohesiveness. The data also support …
Health Insurance in Practice
Medicine (47 obras) · Health care (31 obras) · Family medicine (30 obras) · Healthcare Policy and Management (28 obras) · Primary Care and Health Outcomes (28 obras) · Political science (27 obras) · Nursing (24 obras) · Psychology (23 obras) · Business (21 obras) · Computer Science (14 obras)