养老院全面质量管理采用中的资源依赖与制度因素
Resource dependence and institutional elements in nursing home TQM adoption.
作者信息
Zinn J S, Weech R J, Brannon D
机构信息
Department of Health Administration, School of Business and Management, Temple University, Philadelphia, PA 19122, USA.
出版信息
Health Serv Res. 1998 Jun;33(2 Pt 1):261-73.
OBJECTIVE
To examine the contextual attributes that influence nursing home TQM adoption, as informed by resource dependence and institutional theories.
DATA SOURCES
A survey of licensed nursing home administrators in the Commonwealth of Pennsylvania during 1994-1995, the Medicare and Medicaid Annual Certification Survey (MMACS) data file, and the Area Resource File (ARF).
STUDY DESIGN
Because the dependent variable (TQM adoption vs. non-adoption) is dichotomous, the model was estimated using logistic regression.
DATA COLLECTION
Of the 615 facilities that were mailed surveys, 241 (39.2%) returned completed questionnaires. No significant differences were observed between respondents and nonrespondents in size, for-profit status, system membership, registered nurse staffing, cited licensure deficiencies, Medicare census, or Medicaid census.
PRINCIPAL FINDINGS
Perceived competition, Medicare's share of total hospital discharges in the market, and facility Medicare census were significant predictors of TQM adoption.
CONCLUSIONS
Our results provide limited support for the association between some rational adaptive and institutional factors and TQM adoption in nursing homes. Perceived competition and the influence of the Medicare program both at the facility and the market level are associated with TQM adoption. However, other factors associated with TQM adoption in other industries, such as size, are not associated with TQM adoption in the nursing homes in this study.
目的
依据资源依赖理论和制度理论，研究影响养老院采用全面质量管理（TQM）的背景因素。
数据来源
1994 - 1995年对宾夕法尼亚州持牌养老院管理人员的一项调查、医疗保险和医疗补助年度认证调查（MMACS）数据文件以及区域资源文件（ARF）。
研究设计
由于因变量（采用TQM与否）是二分变量，故使用逻辑回归对模型进行估计。
数据收集
在邮寄调查问卷的615家机构中，241家（39.2%）返回了完整问卷。在规模、营利状况、系统成员资格、注册护士配备、被引用的执照缺陷、医疗保险人口普查或医疗补助人口普查方面，未观察到受访者与未受访者之间存在显著差异。
主要发现
感知到的竞争、医疗保险在市场总出院人数中的占比以及机构医疗保险人口普查是采用TQM的显著预测因素。
结论
我们的结果为一些合理适应因素和制度因素与养老院采用TQM之间的关联提供了有限支持。感知到的竞争以及医疗保险计划在机构和市场层面的影响都与采用TQM相关。然而，在本研究中，其他行业与采用TQM相关的因素，如规模，与养老院采用TQM并无关联。
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