All ETDs from UAB

Advisory Committee Chair

Robert Weech-Maldonado

Advisory Committee Members

Larry R Hearld

Stephen J O'Connor

Patricia A Patrician

Grant T Savage

Document Type

Dissertation

Date of Award

2013

Degree Name by School

Doctor of Philosophy (PhD) School of Health Professions

Abstract

This dissertation examined the relationship between high-technology medical services and hospital performance by focusing on financial and quality performance dimensions. An initial systematic review disclosed the paucity of research and mixed findings about the technology-performance relationship. The review indicated the need for further analyses by emphasizing some limitations of existing studies. The resource-based view (RBV) of a firm was used as a conceptual framework in examining the relationship between high-tech medical services and hospital financial performance. It was hypothesized that large breadth (number) of high-tech services and the use of rare high-tech services would be positively associated with hospitals' financial performance. It was further hypothesized that both registered nurse (RN) staffing mix and competition would positively moderate the relationships between high-tech medical services and financial performance. A longitudinal panel design with 6 years of data for the period of 2005-2010 was analyzed by using within-group fixed effects models. The findings supported the breadth hypotheses for four of the five financial performance measures. The rareness hypotheses were supported but only for operating margin (positive) and operating expenses (negative). There was no support for the moderation effects of both RN staffing mix and competition. A combination of RBV and Donabedian's structure-process-outcome (SPO) model was used to explore the relationship between high-tech medical services and quality performance. It was hypothesized that high-tech medical services with certain attributes (i.e., large breadth, rare, and relevant) would be positively associated with quality performance, measured by 30-day mortality rates for heart attacks, heart failure, and pneumonia. The findings partially supported the hypothesized relationships between rare high-tech services and 30-day mortality rates for pneumonia. The significant finding for the relationship between condition-specific high-tech services and 30 day mortality rates for heart failure was opposite to the predicted direction. There were no other significant finding to support the rest of the hypothesized relationships between high-tech services and quality performance. Condition-specific volume was the only measure that exhibited consistently significant (negative) association with 30-day mortality rates.

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