Health Care Research Methods, Analysis, and Utilization

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HLT-540: Health Care Research Methods, Analysis, and Utilization


This paper will contrast and compare the research studies of Coyne et al. (2009) and Messina et al. (2009). A series questions will be utilized to investigate, validate and summarize the research finding of Coyne et al. (2009) Hospital Cost and Efficiency: Do Hospital Size and Ownership Type Really Matter?” and Messina et al. (2009) “The Relationship Between Patient Satisfaction and Inpatient Admissions Across Teaching and Nonteaching Hospitals.”  What made them different? What type of population sample did each have? How did they ensure their work was valid? Did Coyne’s team do this in a more scientific way than Messina’s team? This paper will examine Coyne et al.’s (2009) and Messina et al.’s (2009) articles against other literature to support all results and finding.

The article studies written by Messina et al. (2009) & Coyne et al. (2009) over time have helped to redefine customer and organizational performance in health care delivery in relation to patient satisfaction with a strong emphasis on the financial implications. The first focused more on the human aspect of cost by determining the relationship, if any, that exists between satisfaction of patients, and in patient admissions in acute care health care facilities as well as the difference between the patient satisfaction and inpatient admission in acute care health care facility in both teaching and non teaching health care facilities. The second focused more on the aesthetics and managerial composition of the hospital by trying to determine whether the ownership type and size of the hospital have any bearing on the cost of service delivery and efficiency. Either way, the bottom line remains patient satisfaction, hence the attempt for further research to determine the factors that could help explain the grey areas for enhanced productivity and output.

Type of statistics.

Two major studies in healthcare were conducted using different statistical methods to determine the impatient volume data and patient satisfaction. The Coyne et al. (2009) adopted the SPSS 15.0 statistical method to test for the variance (ANOVA) while using Scheffe’s method for testing the means distribution of d subject matter to arrive at a definite but very significant conclusion using a reasonable sample size. The probability value of <0.05 was determined to be statistically substantial in the research of Messina et al. (2009). Whereas, Messina et al. (2009) using a smaller sample size, employed descriptive statistics in the form of mean, median, frequencies, and standard deviation to acquire a data distribution, which was interpreted using statistical measures of skewness. However, the result was inconclusive based on the insignificant sample size. Hence, a non parametric statistical testing was used for further analysis.

Study Sample. Further studies coordinated by Coyne et al. (2009) & Messina et al. (2009), on customer and organizational presentation with emphasis on patient satisfaction, revealed that the former differed from the later based on the sample size and approach adopted. Whereas it categorized all the state hospitals into small, medium and large and utilized 98% of the referred hospitals to arrive at a valid conclusion, the later utilized only the teaching and non-teaching hospitals in the ratio of 50:50, while adopting observation period over five years to also arrive at a valid conclusion The small health care facilitiy included 1-40 beds, the medium 41-150 beds and the bigger health care center possess greater than 151 (Messina et al., 2009) Messina et al. (2009) study method was considered very comprehensive because of the use of a scientifically couched questionnaire with relevant details of the participants. However, the two studies integrate measures to guarantee validity and reliability of the research results. This included the use of questionnaires where the content was modified over time to conform to prevailing circumstances. Several kinds of literature on customer satisfaction were reviewed by patient focus groups, financial instruments which were proven to be psychometrically stable were reliably used to measure revenues, cost, profitability and utilization of available data, coupled with the observation period of five years.The research findings have aided the optimization of customer satisfaction in health care delivery.

Further in the research efforts and submissions made by Messina et al. (2009) & Coyne et al. (2009) they documented how to improve the health care system. One can deduce the similarities and differences in both studies. For instance, while Coyne et al. (2009) adopted quantitative data as a tool, used state hospitals as sample set and adopted abtract style in reporting, they were able to establish that ownership type of the hospital and sample size, made a significant impact on the cost and efficiency of the hospitals. However, the study failed to offer suggestions as to what other medical centers could do to produce such an impact in the health care system.

Messina et al. (2009) is viewed to be more focused in proffering solutions by using descriptive data, teaching and non-teaching hospitals as sample sets, adopting executive summary style in reporting the findings that patient satisfaction does definitely correlates with the increased patient admission volumes (patient attendance volumes). In teaching hospitals more than in non teaching hospitals and unlike Coyne et al, (2009) went further to offer suggestions on the type of hospital administration that is utilized to increase inpatient admissions with respect to patient satisfaction. However, despite the differences in both studies, the similarities are both studies were conducted to improve the conditions and quality of the healthcare system.

The use of the psychometrically considered a reliable instrument to facilitate the appropriate results showing reliability and consistence. According to Cronbach’s alpha score, Messina et al. (2009) research reliability score was 0.94.

Pink et al. (2006) created a financial indicator report, declaring the research study of Coyne et al. (2009) reliable and valid. A specific report was created for the critical access hospitals (CAH), which accounted for eighty-four percent of beds in the small hospital category. The reports consist of 20 financial to be considered to an essential and viable instrument for health administrators. The reports show that the instruments were be reliable for the calculating cost, utilization, revenues, and profitability.


In conclusion, the research article written by Coyne et al. (2009) establishes that many of the research questions have been confirmed and show definitive support for findings. There are clear and concise findings on both articles of Coyne et al. (2009) and Messina et al. (2009). A concluding analysis was given, and there were ten measures that were used. It was noted that two of the studies made a substantial impact on the efficiency and cost of the hospitals (Coyne et al., 2009). Apparently, when referring to the variables of hospital size and ownership, the articles does not offer recommendations based on the research findings as to how other health care systems could do to make an impact and to implement this procedure.

In Messina et al. (2009), the study conclusion was based on the patient’s satisfaction that correlates with the admission volumes in teaching hospitals. However, the study determined there were no significant relationships between the non-teaching hospitals and the increase volumes in admission. The finding of the study showed that teaching hospitals are in the best position to increase the patient admission rate. Messina et al. (2009) suggest the accomplishment of the study was to emphasize the patients’ satisfaction. Coyne et al. (2009) and Messina et al. (2009) offers several more proposals about the hospital administration that can be used to increase inpatient admissions parallel with efforts to increase satisfaction in customer service. Messina et al. (2009), was highly focused on finding resolutions comparing to Coyne et al. (2009).

The two studies displayed many details aiming towards reliable research studies. However, each article presented with has own strengths and weaknesses. Even though, Messina et al. (2009), used an executive summary, Coyne et al. (2009), also used an executive summary as open introductions. This paper has examined Coyne et al.’s (2009) and Messina et al.’s (2009) research against other literature to support all results and findings.


Coyne, J. S., Richards, M. T.Shultz, K.Singh, S. G. et al. (2009). Hospital Cost and Efficiency: Do Hospital Size and Ownership Type Really Matter? Journal of Healthcare Management54.3: 163-74; discussion 175-6.

Griffith, J. R., Pattullo, A., Alexander, J. A., Jelinek, R. C.&Foster, D. A. (2006). “Is Anybody Managing the Store? National Trends in Hospital Performance.” Journal of Healthcare Management. 51(6). 392-406. Press Ganey Associates, Inc. (2002). Inpatient Survey Psychometrics Report, pp. 1-7. South Bend, IN: Press Ganey Associates.

Messina, J., Scotti, D. J., Driscoll, A. E., Ganey, R. & Zipp, G. P. (2009). The Relationship between Patient Satisfaction and Inpatient Admissions Across Teaching and Nonteaching Hospitals. Journal of Healthcare Management. 54:3. 177-189

Pink, G. H., G. M. Holmes, C. D’Alpe, L. A. Strunk, P. McGee, and R. T. Slifkin. (2006). “Financial Indicators for Critical Access Hospitals.” Journal of Rural Health. 22(3). 229-236.


Coyne and Messina Articles Analysis

As an example guideline, review the study components in the left-side column of the table below. Read the study by Messina et al., and build the data in the right-side column with the key components in that study.

Research Question: Coyne: Do size and ownership type make a difference in the efficiency and cost results of hospitals in Washington state? (Highlight p.164, second column, starting 15 lines from bottom to seven lines from bottom.)Messina: What is the nature of the relationship between patient satisfaction and inpatient admission in acute care hospital? Does the relationship between patient satisfaction and inpatient admission differ between teaching hospitals and non-teaching hospitals? (Highlight p 178, the second column, starting line 17 from the bottom to 8 from the bottom.)
How did the research question emerge from the review of literature in the article? Coyne: Built on an earlier study by Coyne on performance differences between multi-facility systems and independent hospitals using two cost measures. Cited studies that used a range of variables to measure differences in hospital performance, and noted that prior findings have been inconclusive in regard to hospital size, although economies of scale were found. Messina: This research was conducted by Messina et al. (2009) to facilitate better understanding for health care administration the importance of the relationship between patient satisfaction and admission volume, the rising patient expectation and declining reimbursement.
Independent VariablesType: Coyne: Hospital size and hospital ownership structure.CategoricalMessina: Patient satisfaction and inpatient admissionPatient satisfaction and teaching hospitals and non-teaching hospitals
Dependent VariablesType: Coyne: Efficiency measures – continuous variables.Cost measures – continuous variables.Messina: customer satisfaction- continuous variable admissions- continuous variable
Design Elements1. Quantitative vs. Qualitative2. Sample Size3. Method of sample selection4. Experimental vs. control group?5. Reliable and valid data instruments? Coyne: Quantitative96Picked all hospitals in state, except investor owned hospitals.NoUsed data that are commonly used to measure hospital efficiency and performance with high degrees of accuracy (reliable), and data that are historically used and make sense to other hospital users (valid).Messina: Qualitative7 teaching hospitals and 7 non-teaching hospitalsNoData was collected through discharge surveys (reliable).The surveys instruments (reliable and validity).
Describe analysis.What statistics were used? Coyne: Two-way Analysis of Variance (ANOVA)Messina: Mann-Whitney U-test.
Did the researchers’ conclusions make sense, did they answer the research question, and did they appear to flow from the review of the literature?Did they explore control of extraneous variables? Coyne: They concluded that size and ownership type make a difference in reported levels of efficiency. Not for profits seem to achieve higher performance levels, and medium and large not for profits operate more efficiently than industry average. The same results were found for cost levels, in that size and ownership type do make a difference, with medium sized hospitals reporting lower costs than large or small hospitals.Yes, when they called for national studies that controlled for case mix, scope of services, and payer mix, all of which could have affected the results in this study in an unmeasured way.Messina: The conclusion, patient satisfaction may influence the increase volumes in teaching hospitals. Non-teaching, patient satisfaction did not influence the volume growth.Yes, the support needed for further research with a larger group. Percentile score should be done instead of mean data.

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