The Impact of Demographic and Labor Force Participation Changes on the Social Security Disability Insurance and Medicare Programs

William G. Johnson, Ph.D., Principal Investigator, and Tricia J. Johnson, funded by the Disability Research Institute at the University of Illinois at Urbana-Champaign under subcontract to the Social Security Administration

This study explores the effects of the changing demographic characteristics and labor market experiences for women in the labor force on SSDI and Medicare, and examines the extent to which differences exist among men and women in the baby boom generation. A base estimation model will be developed, using labor market conditions and demographic characteristics of individuals age 40 to 64 in 1997, to estimate the absolute growth in participation and total benefit payments for the SSDI and Medicare programs. A simulation model will then be constructed to characterize an individual's likelihood of receiving SSDI benefits, conditional upon meeting the SSDI work requirements. Simulations will explore how changes in the rates and types of medical conditions, composition of the labor force, labor market conditions and other factors will impact the SSDI program and Medicare. Special attention is given to the more general effects of the very large increase in the absolute number of women with disabilities who may have sufficient employment histories, but do not meet the definition of impairment and are not poor, so would not qualify for Supplemental Security Income. The Survey of Income and Program Participation for 1997 will be used to estimate the number of individuals meeting DI program requirements and receiving benefits. Health care utilization and expenditures for disabled persons receiving Medicare benefits will be estimated using the Cost and Use File of the Medicare Current Beneficiary Survey (1996 to 1999).

Changes in Nurse Satisfaction After Conducting Educational Interventions to Improve MD-RN Collaboration

Erin Jakubek, Jane Grady, Ph.D., Chair, Diane D. Homan, M.D., Sanford Stein, Shawn Tyrrell, R.N.

The relationship between a nurse and physician represents a classic in society. Once identified as a “game,” this relationship has significantly evolved from its historical background. Today, physicians and nurses represent a collegial, collaborative team working together for patient care issues. Effective physician-nurse (MD-RN) collaboration can significantly influence healthcare outcomes, quality of patient care, hospital costs, and employee and patient satisfaction. Specifically, employee satisfaction results at a 150 bed, suburban community hospital indicated the need for higher quality MD-RN collaboration. There is substantial research on educational interventions with the goal of improving MD-RN collaboration. There is little evidence, however, focusing on the success of multifaceted educational approaches. The current nursing shortage warrants closely examining the influence of MD-RN collaboration on nurse satisfaction.

This study is a quasi-experimental design evaluating the change in nurse satisfaction after implementing a variety of educational interventions designed to improve MD-RN collaboration at this community medical center. The variables examined include RN characteristics and RN educational interventions. To analyze this data, Chi-Square tests were performed to measure the association of overall survey scores and individual questions from the pretest to posttest to determine whether educational interventions are significant factors affecting nurse satisfaction in terms of collaboration. Kruskal-Wallis tests were also performed to compare mean satisfaction scores for RN characteristics during both the pretest and posttest survey periods.

RN survey respondents included in this sample totaled 121. There was a significant association found between the timing of the survey and overall nurse satisfaction (p=.003). There was a significant association between the timing of the survey and physicians' attitudes regarding nurse input and collaboration (p=.007). In addition, there was a significant correlation found between the timing of the survey and support for resolving conflict between nurses and physicians (p=.001). There were no significant differences in means, however, between nurse satisfaction during pretest and posttest survey periods and nurse characteristics including specialty/unit, shift, years in practice, and years at the organization.

This study yields important management implications such as identifying a complete model of educational tools and the most influential aspects of the MD-RN relationship as perceived by nurses such as conflict resolution and professional respect. While this study significantly supported the main research question, future studies may be needed to examine changes in nurse satisfaction after conducting educational interventions at a variety of institutions and geographic locations for the most applicable results. A continual quality improvement initiative focused on MD-RN collaboration would be the most beneficial for healthcare organizations in order to address the nursing shortage and maintain a positive working environment.

The Effectiveness of a Multifaceted Intervention to Improve Physician Laboratory Ordering Patterns in the Diagnosis of Acute Pancreatitis

Jennifer Gingrass, Richard Odwazny, Chair, Richard Abrams, M.D., Andy Garman, Psy.D., Robert McNutt, M.D.

As the health care system has become more technologically advanced and complex, laboratory test ordering by physicians has increased. Often, ineffective and unnecessary lab tests are ordered by force of habit or via strict adherence to established protocols. Hospitals fail to remove obsolete lab tests from physician order entry systems, and thus physicians continue to use them without discrimination. The major effects of superfluous laboratory testing include increased cost to the health care system along with patient safety concerns.

Acute pancreatitis (AP) is a common reason for hospital admission. Amylase and lipase are two commonly used tests for the diagnosis of AP. Current literature concludes that lipase is more diagnostically accurate, yet the use of amylase persists. Further, the utilization of either of these tests to monitor the progress or assess the severity of the disease is contraindicated. The goal of this study is to reduce the use of amylase in the diagnosis of AP at a large Midwestern academic medical center through a variety of educational interventions and measure the effectiveness of those interventions.

A plethora of literature exists on changing physician behavior, especially in relation to lab-ordering behavior. Various strategies have been used, including administrative interventions, financial incentives, and audit and feedback. Education is probably the most widely used and the most debated in terms of its reported effectiveness. While some studies surmise that education alone is effective in creating sustainable behavior change, other studies have concluded that education must be combined with other types of interventions to be effective in the long-term.

At the institution under study, education has been used successfully in the past to invoke physician behavior change. For that reason, a multifaceted educational intervention, including a pre-test survey, an e-mail alert, and an education session, was targeted at residents in internal medicine to reduce the use of amylase in the diagnosis and management of acute pancreatitis. Additionally, surveys were collected after each intervention to measure any changes in knowledge that might have accompanied the potential behavior change.

The results revealed that while the pre-test survey did not alter behavior with respect to the ordering of amylase, the e-mail alert and education session were effective in cumulatively reducing amylase orders by almost 12 tests per day. This translates to a reduction of about 4300 tests per year. Further, the study showed that residents actually had a significant change in knowledge after the interventions. This change in knowledge provides evidence that long-term behavior change may be sustained.

As health care costs continue to grow exponentially, and the emphasis on patient safety becomes further pronounced, managers and administrators will be continually asked to facilitate processes in which current lab ordering behavior of physicians is altered through various interventions. This study concludes that simple educational interventions can be effective in changing physician behavior and reducing unnecessary lab orders. This finding is significant because it ultimately translates to higher quality, more cost-effective, and safer patient care.

As health care costs continue to grow exponentially, and the emphasis on patient safety becomes further pronounced, managers and administrators will be continually asked to facilitate processes in which current lab-ordering behavior of physicians is altered through various interventions. This study concludes that simple educational interventions can be effective in changing physician behavior and reducing unnecessary lab orders. This finding is significant because it ultimately translates to higher quality, more cost-effective, and safer patient care.

A Study of the Effect of Educational and Administrative Interventions on Physician Behavior: Reducing Demerol Use

Jack Bailey, Bruce Elegant, Chair, Michael Silver, M.D., Terry Stonich, Pharm.D., Karen Terlicher, Tricia Johnson, Ph.D.

Physicians have been prescribing meperidine for pain relief since it was synthesized in 1939. Commonly known as Demerol ®, this drug grew in popularity from reports proclaiming its safety, efficacy, and ease of administration. Recent attention, however, has focused on meperidine's harmful side effects and inferiority as an analgesic compared to other opioids such as morphine and hydromorphone. Nationally published clinical guidelines that advocate restricting meperidine use have prompted many hospitals in the United States to reduce or eliminate prescribing the drug. Eliminating meperidine use after a half century of widespread prescription, however, requires significant behavior changes for many physicians. Research on changing physician behavior continues to try to find effective behavior change methods, as well as explanations for how physicians make clinical decisions. The efforts of one Midwestern community hospital at implementing interventions to reduce physicians' meperidine use are examined here. Through a combination of two administrative and three educational interventions over a twenty month period, the hospital was able to reduce meperidine use by 33%. Educational interventions proved more effective than administrative interventions. Further investigation revealed that while personal characteristics such as age, number of years in practice, and attending foreign medical school were correlated with meperidine use, they were too weak to form any hard conclusions about physician behavior and personal characteristics.

This study provides evidence of the effectiveness of both educational interventions and a combination of interventions at changing physician behavior. Physicians' personal characteristics affect clinical decisionmaking, but conclusions cannot be made based on personal characteristics alone. Understanding trends among characteristic groups is important, but individuality must be considered.