Jullet Davis - Academia.edu (original) (raw)

Papers by Jullet Davis

The Balanced Budget Act (BBA) of 1997 created an opportunity for improving long-term care for the... more The Balanced Budget Act (BBA) of 1997 created an opportunity for improving long-term care for the rural frail elderly by granting permanent provider status to the Program of All-Inclusive Care for Elders (PACE) under Medicare. PACE is a unique managed care model that provides comprehensive, integrated acute and long-term services for frail elders and program providers assume full financial risk. However, all existing PACE sites are currently located in urban settings. This article reviews the PACE provisions in the BBA legislation and describes the current PACE model. Two possible adaptations of the model are discussed for expanding PACE into rural areas.

Journal of healthcare management / American College of Healthcare Executives

As the nation's foreign-born population continues to increase, the importance of understandin... more As the nation's foreign-born population continues to increase, the importance of understanding cultural, ethnic, and religious differences to combat racial/ethnic disparities in access to and utilization of healthcare services intensifies. In Alabama, specifically, the shifting migration patterns and the growth of the foreign-born population have altered the state's demographics, introducing new cultures and languages to this traditionally biracial state. Because Alabama general hospitals are not immune to the widespread cost, access, and quality paradox that plagues every healthcare organization, they too must consider the value of cultural and linguistic competence in providing high-quality, cost-effective care. This exploratory study examined the awareness of and preparedness for the diversifying patient population of general medical and surgical hospitals in Alabama. Questionnaires were mailed to the chief executive officers of 101 general medical and surgical hospitals....

Nonprofit and Voluntary Sector Quarterly

The Journal of health administration education, 2008

As our nation's population continues to diversify, the need to provide culturally and linguis... more As our nation's population continues to diversify, the need to provide culturally and linguistically appropriate services will intensify. In the healthcare industry, specifically, it is imperative that the services provided are congruent with patients' beliefs and practices in order to avoid fatal and costly errors. Much attention has been given to the role of clinicians in providing appropriate services to racially and ethnically diverse groups to eliminate disparities and lessen barriers to access. The need for cultural and linguistic competence, however, extends beyond clinicians. This paper discusses the need to add cultural and linguistic competencies to the healthcare management curriculum and presents a set of core competencies for healthcare management majors. A core competency model is presented along with discussion suggestions and student activities designed to make the learning process intellectually stimulating and improve student receptivity.

Advances in Health Care Management, 2001

Abstract: This study tests the contingency theory proposition that a nursing facility&amp... more Abstract: This study tests the contingency theory proposition that a nursing facility&amp;#x27;s strategy moderated by its management structure improves performance. Strategy is modeled in terms of degree of innovation; while structure is modeled as organic versus mechanistic. Payor ...

International Journal of Organizational Analysis, 2006

Social Science & Medicine, 2014

We hypothesized that for-profit/chain affiliated nursing homes, those in states with higher Medic... more We hypothesized that for-profit/chain affiliated nursing homes, those in states with higher Medicaid reimbursement, and those in more competitive markets would have greater resident racial/ethnic diversity than nursing homes not meeting these criteria. Using 2004 Online Survey, Certification and Reporting data, Minimum Data Set, Lewis Mumford Center for Comparative Urban and Regional Research data, and the Area Resource File, we included U.S. Medicare/Medicaid certified nursing homes (N ¼ 8950) located in 310 Metropolitan Statistical Areas. The dependent variable quantified facility-level multiracial diversity. Ordinary least squares regression showed support for the hypothesized relationships: for-profit/chain affiliated nursing homes were more diverse than nursing homes in all other ownership/chain member categories, while higher Medicaid per-diem rates, greater residential diversity, and stronger market competition were also positively associated with nursing home racial/ethnic composition. Results suggest there is room for policy changes to achieve equitable access to all levels of nursing home services for minority elders.

Nursing Outlook, 2009

As the patient population continues to diversify, the need to provide care that is culturally and... more As the patient population continues to diversify, the need to provide care that is culturally and linguistically appropriate is intensifying. This study describes the perceptions of registered nurses (RNs) in Alabama hospitals regarding the training and resources available for providing culturally and linguistically appropriate care. The population consists of all RNs working in Alabama hospitals. A sample of 1976 RNs was obtained using an online survey. The findings indicate that although some resources and training are currently provided to nurses, the majority of respondents still lack sufficient resources and training to provide culturally and linguistically appropriate care. The lack of uniformity in resources and training makes it difficult to ensure that all healthcare providers are receiving the same information. However, hospitals do have the flexibility to tailor training to areas that are specific to their population needs.

Nonprofit and Voluntary Sector Quarterly, 2011

Journal of Health Care for the Poor and Underserved, 2004

Journal of Community Health, 2010

The number of English-as-as second-language (ESL) students in public schools across the country i... more The number of English-as-as second-language (ESL) students in public schools across the country is rising creating unique challenges for school health services with the introduction of new cultures and languages. This study describes the perceptions of school nurses in Alabama schools regarding the challenges they face when communicating with ESL students and their parents. The population consists of school nurses in Alabama public schools. The obtained sample of 1,429 responses is presented and discussed. Urban school nurses were more likely to have access to an interpreter, yet they were more likely to rely on an ESL student to act as a translator when speaking to his/her parents. Kindergarten through elementary school nurses were more likely to witness an increase in ESL students and encounter difficulty communicating with these students and their parents. School nurses have a unique opportunity to engage parents of ESL students in the health of their child, thus it is vital that they be provided with cultural facts and encouraged to use interpreter services to lessen language barriers.

International Journal of Pharmaceutical and Healthcare Marketing, 2007

Purpose – This study aims to examine the extent to which certain organizational characteristics o... more Purpose – This study aims to examine the extent to which certain organizational characteristics of a nursing home impact its decision to target the community-based seniors' (CBS) market by offering nursing home services to non-residents. The study aims to hypothesize that service provision would be greater in not-for-profit, innovative nursing homes, those with organizational slack, and those that are chain-affiliated. Design/methodology/approach – Data came from the 1999 National Nursing Home Survey. There are 1,075 nursing homes in the sample population. The data were analyzed using logistic regression. Findings – The results show that for-profit nursing homes were predisposed to offer these services. However, innovative nursing homes were less likely to offer these services. Finally, homes with slack in the form of physical therapists offered these services, but homes with nurse's aide slack were less likely to offer these services. Research limitations/implications – T...

The Health Care Manager, 2013

Niche hospitals represent a growing segment in the health care industry. Niche facilities are pri... more Niche hospitals represent a growing segment in the health care industry. Niche facilities are primarily engaged in the treatment of cardiac or orthopedic conditions. The effectiveness of this strategy is of interest because niche hospitals focus on only the most profitable services. The purpose of this research was to assess the financial effectiveness of the niche strategy. We theorize that firm and market-level factors concomitantly with the strategy of the hospital-niche versus traditional-are associated with financial performance. This research used 2 data sources, the 2003 Medicare Cost Report and the 2003 Area Resource File. The sample was limited to only for-profit, urban, nongovernmental hospitals (n = 995). The data were analyzed using hierarchical least squares regression. Financial performance was operationalized using the hospital&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s return on assets. The principal finding of this project is that niche hospitals had significantly higher performance than traditional facilities. From the organizational perspective, the niche strategy leads to better financial performance. From a societal perspective, the niche strategy provides increased focus and efficiencies through repetition. Despite the limited focus of this strategy, patients who can access these providers may experience better outcomes than patients in more traditional hospitals.

Health Care Management Review, 2009

Purpose: The use of information systems (ISs) in nursing homes is gradually increasing, yet littl... more Purpose: The use of information systems (ISs) in nursing homes is gradually increasing, yet little is known about the factors that promote the use of these systems. Using resource dependency theory as the conceptual framework, this study examines how chain membership, ownership status, and innovativeness are associated with ISs use in nursing homes. Design and Methods: We analyzed the results of the 2004 National Nursing Home Survey. The sampling process consisted of a stratified probability design. A total of 1,174 nursing homes participated in the survey. Results: The results of the regression analysis revealed that facilities that were members of a chain were significantly more likely to use all types of ISs and ISs for administrative tasks than were nonchain facilities. In addition, nonprofit nursing homes were significantly more likely to use administrative systems. Implications: The demand for nursing home services is expected to increase substantially with the aging baby boomers. The use of ISs may assist nursing homes to improve service delivery by collecting and analyzing service, finance, and administrative data that are necessary to achieve operational efficiencies. Membership in a multifacility chain may both increase the need for network-wide communication and provide resources promoting use.

The Gerontologist, 2002

Purpose: This article examines factors that distinguish nursing facilities with very high and ver... more Purpose: This article examines factors that distinguish nursing facilities with very high and very low nursing assistant turnover rates from a middle referent group, exploring the possibility that high and low turnover are discrete phenomena with different antecedents. Design and Methods: Data from a stratified sample of facilities in eight states, with directors of nursing as respondents ( N ϭ 288), were merged with facility-level indicators from the On-Line Survey Certification of Automated Records and county-level data from the Area Resource File. Multinominal logistic regression was used to identify factors associated with low (less than 6.6% in 6 months) and high (more than 64% in 6 months) turnover rates. Results: With the exception of registered nurse turnover rate, low turnover and high turnover were not associated with the same factors. Implications: Future studies of facility turnover should avoid modeling turnover as a linear function of a single set of predictors in order to provide clearer recommendations for practice.

The Gerontologist, 2006

The association between certified nurse aide, licensed practical nurse, and registered nurse turn... more The association between certified nurse aide, licensed practical nurse, and registered nurse turnover and the organizational characteristics of nursing homes are examined. Hypotheses for eight organizational characteristics are examined (staffing levels, top management turnover, resident case mix, facility quality, ownership, chain membership, size, and Medicaid census), using Online Survey, Certification, and Reporting (known as OSCAR) data. Turnover information came from primary data collected from 854 facilities in six states (Missouri, Texas, Connecticut, New York, Pennsylvania, and New Jersey). The 1-year turnover rates were 56.4%, 39.7%, and 35.8% for certified nurse aides, licensed practical nurses, and registered nurses, respectively. The results consistently show that, for all caregivers, lower staffing levels, lower quality, for-profit ownership, and higher bed size are associated with higher turnover. Some differences also are found for different levels of turnover, but there are few differences among types of nursing staff. Given that turnover rates are problematic, this study gives us a better understanding of the phenomenon and at the same time helps us further understand the wide variation that is known to exist between nursing homes, based on their organizational characteristics.

Health Services Research, 2003

Objective. To examine skilled nursing facilities (SNFs) ''make-or-buy'' decisions with respect to... more Objective. To examine skilled nursing facilities (SNFs) ''make-or-buy'' decisions with respect to rehabilitation therapy service provision in the 1990s, both before and after implementation of Medicare's Prospective Payment System (PPS) for SNFs. Data Sources. Longitudinal On-line Survey Certification and Reporting (OSCAR) data (1992-2001) on a sample of 10,241 freestanding urban SNFs. Study Design. We estimated a longitudinal multinomial logistic regression model derived from transaction cost economic theory to predict the probability of the outcome in each of four service provision categories (all employed staff, all contract, mixed, and no services provided). Principal Findings. Transaction frequency, uncertainty, and complexity result in greater control over therapy services through employment as opposed to outside contracting. For-profit status and chain affiliation were associated with greater control over therapy services. Following PPS, nursing homes acted to limit transaction costs by either exiting the rehabilitation market or exerting greater control over therapy services by managing rehabilitation services in-house. Conclusions. The financial incentives associated with changes in reimbursement methodology have implications that extend beyond the boundaries of the health care industry segment directly affected. Unintended quality and access consequences need to be carefully monitored by the Medicare program.