UMD Theses and Dissertations
Permanent URI for this collectionhttp://hdl.handle.net/1903/3
New submissions to the thesis/dissertation collections are added automatically as they are received from the Graduate School. Currently, the Graduate School deposits all theses and dissertations from a given semester after the official graduation date. This means that there may be up to a 4 month delay in the appearance of a given thesis/dissertation in DRUM.
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Item HOSPITAL CROSS-SECTOR PARTNERSHIPS TO PROMOTE POPULATION HEALTH(2022) Barath, Deanna; Chen, Jie; Health Services Administration; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)Health reform efforts continue to hold hospitals accountable for the care they provide by connecting hospital payments to hospital quality. With an understanding that there is no one size fits all solution and a long history of operating within the silo of the medical sector, hospitals have slowly begun to look beyond health care and invest in population health strategies. These upstream strategies usually promote health and wellbeing by addressing the social needs of patients and the social determinants of health: the conditions in which we live, work, and play. The central research question asks if hospital investments in population health strategies improve hospital quality of care. As cross-sector partnerships have long been at the center of solving large population health concerns, this dissertation seeks to assess how hospitals are engaging partners across-sectors, establish a taxonomy of hospital partnership engagement, and examine variation in hospital and community characteristics across the taxonomy in Chapter Two. This taxonomy will then be used to assess the provision of community-oriented health services in Chapter Three and readmission rates in Chapter Four. Data sources include the 2018 American Hospital Association Annual Survey Database, Area Health Resource Files, Minority Health Social Vulnerability Index, Care Compare data for unplanned readmission rates, and the Centers for Medicare and Medicaid Services’ Impact File. The analysis resulted in a four-cluster taxonomy of hospital partnership engagement (HPE) that ranged from little to no partnerships to many partnerships and often at formal levels of engagement. In general, partnership engagement increased with hospital size, teaching status, nonprofit ownership, multihospital systems, greater proportions of Medicaid discharges, urbanicity, hospital competition, median home value, household income, educational attainment, and non-white population. Partnership engagement declined with the proportion of Medicare discharges, critical access hospitals, and sole community providers shortage area designation, poverty, and elderly populations. HPE was also found to be a significant predictor of the total sum of community health services provided by hospitals, as well as each of those services, even after accounting for state-level effects. Lastly, high levels of HPE were associated with lower 30-day unplanned readmission rates. Results demonstrate an association between HPE and hospital quality, indicating that hospital investments in population health strategies can improve hospital quality.Item Interjurisdictional Competition and Urban Area Fragmentation(2005-05-26) Aylward, Stephen Richard; Oppenheimer, Joe A.; Government and Politics; Digital Repository at the University of Maryland; University of Maryland (College Park, Md.)The collective action problem in political science examines the circumstances under which groups can be successfully formed and maintained. While earlier generations of political scientists believed that groups developed in democracies because of the nature of democratic culture and procedures, Mancur Olson (The Logic of Collective Action, 1965) demonstrated that free-riding doomed many attempts at collective action unless selective benefits were granted to members--hence automobile association members receive free travel services, for example. Subsequent theories posited other reasons for successful collective action, such as communication, leadership and anticipated returns from joining. Tests of these hypotheses have taken place primarily in laboratory experiments. This study conducts a real-world natural experiment, examining interjurisdictional competition (IJC)--a government's offer of incentives for businesses to locate within its environs as opposed to the territories of others--in the setting of urbanized areas of various degrees of fragmentation (political organization as one, several or many local governments). If the free-rider hypothesis is true, IJC would increase with higher fragmentation. As the "free-rider" title suggests, IJC has been portrayed in game theory as a prisoners' dilemma. However, more detailed analysis in this study reveals several possible games, each posing a related collective action problem. Methodologically, additive indices from a nationwide survey of economic development practices measure the intensity of IJC effort. Urban area fragmentation is represented by indices using the Hirschman-Herfindahl Index method. The major hypothesis--IJC is a function of fragmentation--is analyzed using OLS regression. The regressions refute the free-rider hypothesis. The statistical analysis then examines the subsequent explanations of collective action. Anticipated returns cannot be substantiated; however, civil society-based indicators show communication and leadership to be causes of successful collective action. Finally, a case study of Hampton Roads (the Virginia Beach-Norfolk-Newport News, Virginia metropolitan area) provides a historical narrative of the efficacy of communication and leadership in successful collective action as well as a possible example of game transition from the prisoners' dilemma to an assurance game.