Linda Dynan | Northern Kentucky University (original) (raw)
Papers by Linda Dynan
Social Science Research Network, 2022
Health Care Management Review, 2008
Wolters Kluwer Health may email you for journal alerts and information, but is committed to maint... more Wolters Kluwer Health may email you for journal alerts and information, but is committed to maintaining your privacy and will not share your personal information without your express consent. For more information, please refer to our Privacy Policy. ... Thought you might appreciate this item(s) I saw at Health Care Management Review. ... Your message has been successfully sent to your colleague. ... Some error has occurred while processing your request. Please try after some time. ... The item(s) has been successfully added to "".
International Journal of Environmental Research and Public Health
Pediatric weight management is often hampered by poor engagement and adherence. Incentives based ... more Pediatric weight management is often hampered by poor engagement and adherence. Incentives based on loss have been shown to be more effective than gain-based incentives in improving outcomes among children with health conditions other than obesity. In preparation for a clinical trial comparing loss-framed to gain-framed incentives, a survey of youth and caregiver attitudes on weight management incentives, reasons for program attendance, and an economic evaluation of a theoretical trial were conducted. Ninety of 835 (11%) surveys were completed by caregiver and child. The economic evaluation showed that loss-framed incentives had a preferable incremental cost-effectiveness ratio (a lower value is considered preferable) than gain-based incentives. Most youth and caregivers felt a gain incentive would be superior, agreed that the full incentive should go to the youth (vs. the caregiver), and identified “improving health” as a top reason for pursuing weight management.
Encyclopedia of World Poverty, 2006
Hospitalists are physicians who specialize in the care and management of hospitalized patients. I... more Hospitalists are physicians who specialize in the care and management of hospitalized patients. Increasingly hospitals are employing hospitalist models to deliver inpatient care because of the benefits they provide: reduced charges and reduced lengths of stay without compromising quality relative to more traditional models of inpatient care (Dynan, Stein, David et al., 2009). This research seeks to understand the mechanisms
Encyclopedia of World Poverty, 2006
Encyclopedia of World Poverty, 2006
The Journal of Pediatrics
Health Services Research, 2022
Journal of Pharmacy Practice, 2022
Background Nephrotoxic medication exposure is a common cause of acute kidney injury (AKI) in hosp... more Background Nephrotoxic medication exposure is a common cause of acute kidney injury (AKI) in hospitalized children and is associated with chronic kidney disease (CKD). The pharmacist-reliant NINJA program reduced nephrotoxic medication exposure and associated AKI. Objectives We assess potential healthcare cost savings from reduced CKD by preventing AKI with the NINJA program for a pediatric population through age 21. Methods We simulated a cohort of 1000 hospitalized non-critically ill children. From the published literature, 310 develop AKI, 267 survive to 6 months, and 10-70% develop CKD, and NINJA implementation reduced AKI by 23.8%. Allowing for varying CKD rates, we estimated a range of NINJA’s savings. We assumed an annual GFR decline of 1.2 (noHTN) ml/min/1.73 m2 for half the sample and 1.7 (HTN) ml/min/1.73 m2 for the other half to account for CKD progression without and with hypertension (HTN). We model attributable costs including CKD stage-related medications and outpatie...
The 1980s and 1990s witnessed a substantial wave of organizational restructuring among hospitals ... more The 1980s and 1990s witnessed a substantial wave of organizational restructuring among hospitals and physicians, as health providers rethought their organizational roles given perceived market imperatives. Mergers, acquisitions, internal restructuring, and new interorganizational relationships occurred at a record pace. Matching this was a large wave of study and discourse among health services researchers, industry experts, and consultants to understand the causes and consequences of organizational change. In many cases, this literature provides mixed signals about what was accomplished through these organizational efforts. The purpose of this review is to synthesize this diverse litera-ture. This review examines studies of horizontal consolidation and integration of hospi-tals, horizontal consolidation and integration of physician organizations, and integra-tion and relationship development between physicians and hospitals. In all, around 100 studies were examined to assess what w...
Encyclopedia of World Poverty, 2006
Medical Care, 2000
ABSTRACT Capitation holds health providers fiscally responsible for the services they deliver or ... more ABSTRACT 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. 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, in conjunction with process integration, on hospital costs. We studied a 1995 American Hospital Association (AHA) special survey that has information on 44 different physician-hospital integrative activities and on global capitation contracts held by management service organizations, physician-hospital organizations, and other similar entities. These data were combined with the AHA's Annual Survey of Hospitals, InterStudy HMO data, the area resource file, and state regulation data. Multivariate analysis was used to assess the relationship between capitation and integration and then to examine the influence of these factors and others on hospital costs. We studied 319 urban hospitals with complete data. Provider capitation was found to promote integration between hospitals and physicians in relation to administrative/practice management, physician financial risk sharing, joint ventures to create new services, computer linkages, and an overall measure of physician-hospital integration. However, anticipated effects of integration and capitation on hospital costs were not evident. Global capitation is motivating tighter integration between physicians and hospitals in a number of respects. Although capitation is currently having the intermediate effect of encouraging process integration, it is not yet having the ultimate anticipated effect of lowering hospital costs.
Medical Care Research and Review, 2004
The 1980s and 1990s witnessed a substantial wave of organizational restructuring among hospitals ... more The 1980s and 1990s witnessed a substantial wave of organizational restructuring among hospitals and physicians, as health providers rethought their organizational roles given perceived market imperatives. Mergers, acquisitions, internal restructuring, and new interorganizational relationships occurred at a record pace. Matching this was a large wave of study and discourse among health services researchers, industry experts, and consultants to understand the causes and consequences of organizational change. In many cases, this literature provides mixed signals about what was accomplished through these organizational efforts. The purpose of this review is to synthesize this diverse literature. This review examines studies of horizontal consolidation and integration of hospitals, horizontal consolidation and integration of physician organizations, and integration and relationship development between physicians and hospitals. In all, around 100 studies were examined to assess what was ...
Behavioral economics (BE) is a relatively new field within economics that incorporates insights f... more Behavioral economics (BE) is a relatively new field within economics that incorporates insights from psychology that can be harnessed to improve economic decision making with the potential to enhance good health and well-being of individuals and societies, the third of the United Nations Sustainable Development Goals. While some of the psychological principles of economic decision making were described as far back as the 1700s by Adam Smith, BE emerged as a discipline in the 1970s with the groundbreaking work of psychologists Daniel Kahneman and Amos Tversky. We describe the basic concepts of BE, heuristics (decision-making shortcuts) and their associated biases, and the BE strategies framing, incentives, and economic nudging to overcome these biases. We survey the literature to identify how BE techniques have been employed to improve individual choice (focusing on childhood obesity), health policy, and patient and healthcare provider decision making. Additionally, we discuss how th...
It is well established that health status differs across racial subpopulations within the United ... more It is well established that health status differs across racial subpopulations within the United States. Specifically, African Americans (black) live lives that are substantially shorter, on average, than those of their white neighbors. Moreover, blacks generally experience worse health outcomes than whites throughout their lifetimes.This paper examines the contributions of differences between blacks and whites in specific health-enhancing and health-deterring behaviors to the difference in self-reported health status (and a constructed health status measure) of these two groups. Micro-simulation based decomposition analysis using data from the 2005 Center for Disease Control Behavioral Risk Factor Surveillance System demonstrates that in particular, black/white differences in physical activity have relatively large impacts on the measured health status gap between the two groups, yet black/white differences in socioeconomic and demographic characteristics remain dominant sources in...
Students striving to acquire the capability of contributing to the modern global economy are neit... more Students striving to acquire the capability of contributing to the modern global economy are neither clients nor customers of an educational institution. Rather, students are creators and consumers of their own human capital, the quality of which depends in part on the investment they and their institutions are willing to make in them as they progress through their education. Just as industry integrated quality control systems into its production processes to ensure high quality before the products were made available to potential customers, educational systems can do so too. We argue that the goals of an integrated system of education are not only to demonstrate learning on the part of students, but to provide information about the need, and opportunity, for remediation prior to completion of their chosen degree program. It is thus in the interest of students and their professors to continuously improve the quality of students’ human capital to enhance the personal satisfaction of ...
Social Science Research Network, 2022
Health Care Management Review, 2008
Wolters Kluwer Health may email you for journal alerts and information, but is committed to maint... more Wolters Kluwer Health may email you for journal alerts and information, but is committed to maintaining your privacy and will not share your personal information without your express consent. For more information, please refer to our Privacy Policy. ... Thought you might appreciate this item(s) I saw at Health Care Management Review. ... Your message has been successfully sent to your colleague. ... Some error has occurred while processing your request. Please try after some time. ... The item(s) has been successfully added to "".
International Journal of Environmental Research and Public Health
Pediatric weight management is often hampered by poor engagement and adherence. Incentives based ... more Pediatric weight management is often hampered by poor engagement and adherence. Incentives based on loss have been shown to be more effective than gain-based incentives in improving outcomes among children with health conditions other than obesity. In preparation for a clinical trial comparing loss-framed to gain-framed incentives, a survey of youth and caregiver attitudes on weight management incentives, reasons for program attendance, and an economic evaluation of a theoretical trial were conducted. Ninety of 835 (11%) surveys were completed by caregiver and child. The economic evaluation showed that loss-framed incentives had a preferable incremental cost-effectiveness ratio (a lower value is considered preferable) than gain-based incentives. Most youth and caregivers felt a gain incentive would be superior, agreed that the full incentive should go to the youth (vs. the caregiver), and identified “improving health” as a top reason for pursuing weight management.
Encyclopedia of World Poverty, 2006
Hospitalists are physicians who specialize in the care and management of hospitalized patients. I... more Hospitalists are physicians who specialize in the care and management of hospitalized patients. Increasingly hospitals are employing hospitalist models to deliver inpatient care because of the benefits they provide: reduced charges and reduced lengths of stay without compromising quality relative to more traditional models of inpatient care (Dynan, Stein, David et al., 2009). This research seeks to understand the mechanisms
Encyclopedia of World Poverty, 2006
Encyclopedia of World Poverty, 2006
The Journal of Pediatrics
Health Services Research, 2022
Journal of Pharmacy Practice, 2022
Background Nephrotoxic medication exposure is a common cause of acute kidney injury (AKI) in hosp... more Background Nephrotoxic medication exposure is a common cause of acute kidney injury (AKI) in hospitalized children and is associated with chronic kidney disease (CKD). The pharmacist-reliant NINJA program reduced nephrotoxic medication exposure and associated AKI. Objectives We assess potential healthcare cost savings from reduced CKD by preventing AKI with the NINJA program for a pediatric population through age 21. Methods We simulated a cohort of 1000 hospitalized non-critically ill children. From the published literature, 310 develop AKI, 267 survive to 6 months, and 10-70% develop CKD, and NINJA implementation reduced AKI by 23.8%. Allowing for varying CKD rates, we estimated a range of NINJA’s savings. We assumed an annual GFR decline of 1.2 (noHTN) ml/min/1.73 m2 for half the sample and 1.7 (HTN) ml/min/1.73 m2 for the other half to account for CKD progression without and with hypertension (HTN). We model attributable costs including CKD stage-related medications and outpatie...
The 1980s and 1990s witnessed a substantial wave of organizational restructuring among hospitals ... more The 1980s and 1990s witnessed a substantial wave of organizational restructuring among hospitals and physicians, as health providers rethought their organizational roles given perceived market imperatives. Mergers, acquisitions, internal restructuring, and new interorganizational relationships occurred at a record pace. Matching this was a large wave of study and discourse among health services researchers, industry experts, and consultants to understand the causes and consequences of organizational change. In many cases, this literature provides mixed signals about what was accomplished through these organizational efforts. The purpose of this review is to synthesize this diverse litera-ture. This review examines studies of horizontal consolidation and integration of hospi-tals, horizontal consolidation and integration of physician organizations, and integra-tion and relationship development between physicians and hospitals. In all, around 100 studies were examined to assess what w...
Encyclopedia of World Poverty, 2006
Medical Care, 2000
ABSTRACT Capitation holds health providers fiscally responsible for the services they deliver or ... more ABSTRACT 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. 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, in conjunction with process integration, on hospital costs. We studied a 1995 American Hospital Association (AHA) special survey that has information on 44 different physician-hospital integrative activities and on global capitation contracts held by management service organizations, physician-hospital organizations, and other similar entities. These data were combined with the AHA's Annual Survey of Hospitals, InterStudy HMO data, the area resource file, and state regulation data. Multivariate analysis was used to assess the relationship between capitation and integration and then to examine the influence of these factors and others on hospital costs. We studied 319 urban hospitals with complete data. Provider capitation was found to promote integration between hospitals and physicians in relation to administrative/practice management, physician financial risk sharing, joint ventures to create new services, computer linkages, and an overall measure of physician-hospital integration. However, anticipated effects of integration and capitation on hospital costs were not evident. Global capitation is motivating tighter integration between physicians and hospitals in a number of respects. Although capitation is currently having the intermediate effect of encouraging process integration, it is not yet having the ultimate anticipated effect of lowering hospital costs.
Medical Care Research and Review, 2004
The 1980s and 1990s witnessed a substantial wave of organizational restructuring among hospitals ... more The 1980s and 1990s witnessed a substantial wave of organizational restructuring among hospitals and physicians, as health providers rethought their organizational roles given perceived market imperatives. Mergers, acquisitions, internal restructuring, and new interorganizational relationships occurred at a record pace. Matching this was a large wave of study and discourse among health services researchers, industry experts, and consultants to understand the causes and consequences of organizational change. In many cases, this literature provides mixed signals about what was accomplished through these organizational efforts. The purpose of this review is to synthesize this diverse literature. This review examines studies of horizontal consolidation and integration of hospitals, horizontal consolidation and integration of physician organizations, and integration and relationship development between physicians and hospitals. In all, around 100 studies were examined to assess what was ...
Behavioral economics (BE) is a relatively new field within economics that incorporates insights f... more Behavioral economics (BE) is a relatively new field within economics that incorporates insights from psychology that can be harnessed to improve economic decision making with the potential to enhance good health and well-being of individuals and societies, the third of the United Nations Sustainable Development Goals. While some of the psychological principles of economic decision making were described as far back as the 1700s by Adam Smith, BE emerged as a discipline in the 1970s with the groundbreaking work of psychologists Daniel Kahneman and Amos Tversky. We describe the basic concepts of BE, heuristics (decision-making shortcuts) and their associated biases, and the BE strategies framing, incentives, and economic nudging to overcome these biases. We survey the literature to identify how BE techniques have been employed to improve individual choice (focusing on childhood obesity), health policy, and patient and healthcare provider decision making. Additionally, we discuss how th...
It is well established that health status differs across racial subpopulations within the United ... more It is well established that health status differs across racial subpopulations within the United States. Specifically, African Americans (black) live lives that are substantially shorter, on average, than those of their white neighbors. Moreover, blacks generally experience worse health outcomes than whites throughout their lifetimes.This paper examines the contributions of differences between blacks and whites in specific health-enhancing and health-deterring behaviors to the difference in self-reported health status (and a constructed health status measure) of these two groups. Micro-simulation based decomposition analysis using data from the 2005 Center for Disease Control Behavioral Risk Factor Surveillance System demonstrates that in particular, black/white differences in physical activity have relatively large impacts on the measured health status gap between the two groups, yet black/white differences in socioeconomic and demographic characteristics remain dominant sources in...
Students striving to acquire the capability of contributing to the modern global economy are neit... more Students striving to acquire the capability of contributing to the modern global economy are neither clients nor customers of an educational institution. Rather, students are creators and consumers of their own human capital, the quality of which depends in part on the investment they and their institutions are willing to make in them as they progress through their education. Just as industry integrated quality control systems into its production processes to ensure high quality before the products were made available to potential customers, educational systems can do so too. We argue that the goals of an integrated system of education are not only to demonstrate learning on the part of students, but to provide information about the need, and opportunity, for remediation prior to completion of their chosen degree program. It is thus in the interest of students and their professors to continuously improve the quality of students’ human capital to enhance the personal satisfaction of ...