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Item Hospital Price Transparency Perceptions and Observations in the United States: A Rapid Review(International Journal of Academic and Applied Research (IJAAR), 2022-07) Lieneck, Cristian H.; Darty, Kaven; Huddleston, Caitlin; Kreczmer, Jason; Lambdin, Stacy; Young, DylanBackground and Objectives: The Centers for Medicare and Medicaid (CMS) began implementing the Hospital Price Transparency Rule in 2019, requiring all participating hospitals to publish their chargemasters online (gross charges) for all services provided. Policy implementation at the organization level has been questionable, with patients and health care consumers left interpreting detailed hospital financial information available online. The research objective was to investigate price transparency perceptions and observations since the introduction of shoppable services price transparency mandates in 2021. Materials and Methods: Reviewers conducted a rapid review and identified and analyzed 20 articles and identified common themes. Results and Conclusions: Four underlying constructs surrounding hospital price transparency were identified: compliance and non-compliance with the CMS (2019) price transparency rule, pricing disparities, and accessibility/usability of public pricing information. The results of this rapid review provide insight for improving health service price transparency for the health care consumer and the potential limiting of follow-on surprise billing practices, while also helping to adapt policy on future price transparency initiatives.Item Healthcare Financial Accounting: A Guide for Leaders(Cognella, 2022-07) Lieneck, Cristian H.Recognizing that healthcare administrators must be well-versed in financial accounting principles to ensure appropriate financial management decisions for the variety of organizations which they lead, Healthcare Financial Accounting: A Guide for Leaders provides readers with a vital knowledge base. Strategically organized, the text supports a learner’s pathway towards the competent creation of valid and reliable financial statements for healthcare organizations. Utilizing both hospital and outpatient organizations as examples, chapters and their related content are organized to support readers’ cognitive processes according to Bloom’s Taxonomy while infusing a multitude of healthcare operational activities mapped to the financial accounting cycle. This application and chapter sequencing further supports healthcare administration students by preparing them for enrollment in a follow-on healthcare financial management course. The ultimate objective is for the reader to understand the intricacies of the formulation and development of the main financial statements to support their follow-on financial management fiduciary duties. Designed to help future healthcare leaders ultimately engage in sound financial management decisions, Healthcare Financial Accounting is ideal for both undergraduate and graduate courses in healthcare administration.Item Does Valved Holding Chamber Improve Aerosol Lung Deposition with a Jet Nebulizer? A Randomized Crossover Study(Multidisciplinary Digital Publishing Institute, 2022-03-04) Alcoforado, Luciana; Paiva, Dulciane Nunes; Ari, Arzu; de Melo Barcelar, Jacqueline; Brandao, Simone Cristina Soares; Fink, James B.; Dornelas de Andrade, ArmeleUsing valved holding chambers (VHC) during aerosol therapy has been reported to improve the inhaled dose with various aerosol devices, including vibrating mesh nebulizers. The aim of this study was to quantify the pulmonary deposition of a jet nebulizer (JN) with and without a VHC, and a mesh nebulizer (MN) with a VHC in a randomized cross-over trial with seven healthy consenting adults. Our hypothesis was that the use of a VHC would improve deposition with the JN. Diethylnitriaminopentacetic acid with technetium (DTPA-Tc99m), with the activity of 1 mC with 0.9% saline solution was nebulized. The radiolabeled aerosol was detected by 2D planar scintigraphy after administration. The pulmonary deposition was greater with a JN with a VHC (4.5%) than a JN alone (3.2%; p = 0.005. However, an MN with a VHC (30.0%) was six-fold greater than a JN or JN with a VHC (p < 0.001). The extrapulmonary deposition was higher in the JN group without a VHC than in the other two modalities (p < 0.001). Deposition in the device was greater with a JN + VHC than an MN+/VHC (p < 0.001). Lower residual drug at the end of the dose was detected with an MN than either JN configuration. The exhaled dose was greater with a JN alone than either an MN or JN with VHC (p < 0.001). In conclusion, the addition of the VHC did not substantially improve the efficiency of aerosol lung deposition over a JN alone.Item Facilitators and Barriers of COVID-19 Vaccine Promotion on Social Media in the United States: A Systematic Review(Multidisciplinary Digital Publishing Institute, 2022-02-08) Lieneck, Cristian H.; Heinemann, Katharine; Patel, Janki; Huynh, Hung; Leafblad, Abigail; Moreno, Emmanuel; Wingfield, ClaireBackground and Objectives: Information regarding the COVID-19 pandemic has spread internationally through a variety of platforms, including social media. While efforts have been made to help reduce the spread of misinformation on social media, many platforms are still largely unregulated. The influence of social media use on vaccination promotion is not fully understood. This systematic review aims to identify facilitators and barriers associated with vaccine promotion through social media use. Materials and Methods: Reviewers analyzed 25 articles and identified common themes. Facilitators of vaccine promotion included an increase in the efforts of social media companies to reduce misinformation, the use of social media to spread information on public health and vaccine promotion, and the positive influence towards vaccinations of family and friends. Results and Conclusions: Identified barriers to vaccine promotion included the spread of misinformation, decreased vaccine acceptance among users of social media for COVID-19 related information due to polarization, and a lack of regulation on social media platforms. The results of this review provide insight for improving public health campaign promotion on social media and can help inform policy on social media regulation and misinformation prevention.Item Accreditation and Certification: Do They Improve Hospital Financial and Quality Performance?(Multidisciplinary Digital Publishing Institute, 2021-07-14) Brooks, Matthew; Beauvais, Bradley; Kruse, Clemens S.; Fulton, Lawrence V.; Mileski, Michael; Ramamonjiarivelo, Zo; Shanmugam, Ramalingam; Lieneck, Cristian H.The relationship between healthcare organizational accreditation and their leaders’ professional certification in healthcare management is of specific interest to institutions of higher education and individuals in the healthcare management field. Since academic program accreditation is one piece of evidence of high-quality education, and since professional certification is an attestation to the knowledge, skills, and abilities of those who are certified, we expect alumni who graduated from accredited programs and obtained professional certification to have a positive impact on the organizations that they lead, compared with alumni who did not graduate from accredited programs and who did not obtain professional certification. The authors’ analysis examined the impact of hiring graduates from higher education programs that held external accreditation from the Commission on Accreditation of Healthcare Management Education (CAHME). Graduates’ affiliation with the American College of Healthcare Executives (ACHE) professional healthcare leadership organization was also assessed as an independent variable. Study outcomes focused on these graduates’ respective healthcare organization’s performance measures (cost, quality, and access) to assess the researchers’ inquiry into the perceived value of a CAHME-accredited graduate degree in healthcare administration and a professional ACHE affiliation. The results from this study found no effect of CAHME accreditation or ACHE affiliation on healthcare organization performance outcomes. The study findings support the need for future research surrounding healthcare administration professional graduate degree program characteristics and leader development affiliations, as perceived by various industry stakeholders.Item Quantifying Delivered Dose with Jet and Mesh Nebulizers during Spontaneous Breathing, Noninvasive Ventilation, and Mechanical Ventilation in a Simulated Pediatric Lung Model with Exhaled Humidity(Multidisciplinary Digital Publishing Institute, 2021-07-30) Ari, Arzu; Fink, James B.Acutely ill children may transition between spontaneous breathing (SB), noninvasive ventilation (NIV), and mechanical ventilation (MV), and commonly receive the same drug dosage with each type of ventilatory support and interface. This study aims to determine the aerosol deposition with jet (JN) and mesh nebulizers (MN) during SB, NIV, and MV using a pediatric lung model. Drug delivery with JN (Mistymax10) and MN (Aerogen Solo) was compared during SB, NIV, and MV using three different lung models set to simulate the same breathing parameters (Vt 250 mL, RR 20 bpm, I:E ratio 1:3). A heated humidifier was placed between the filter and test lung to simulate exhaled humidity (35 ± 2 °C, 100% RH) with all lung models. Albuterol sulfate (2.5 mg/3 mL) was delivered, and the drug deposited on an absolute filter was eluted and analyzed with spectrophotometry. Aerosol delivery with JN was not significantly different during MV, NIV, and SB (p = 0.075), while inhaled dose obtained with MN during MV was greater than NIV and SB (p = 0.001). The delivery efficiency of MN was up to 3-fold more than JN during MV (p = 0.008), NIV (p = 0.005), and SB (p = 0.009). Delivered dose with JN was similar during MV, NIV, and SB, although the delivery efficiency of MN differs with different modes of ventilation.Item Deep Vision for Breast Cancer Classification and Segmentation(Multidisciplinary Digital Publishing Institute, 2021-10-27) Fulton, Lawrence V.; McLeod, Alexander; Dolezel, Diane; Bastian, Nathaniel; Fulton, Christopher P.(1) Background: Female breast cancer diagnoses odds have increased from 11:1 in 1975 to 8:1 today. Mammography false positive rates (FPR) are associated with overdiagnoses and overtreatment, while false negative rates (FNR) increase morbidity and mortality. (2) Methods: Deep vision supervised learning classifies 299 × 299 pixel de-noised mammography images as negative or non-negative using models built on 55,890 pre-processed training images and applied to 15,364 unseen test images. A small image representation from the fitted training model is returned to evaluate the portion of the loss function gradient with respect to the image that maximizes the classification probability. This gradient is then re-mapped back to the original images, highlighting the areas of the original image that are most influential for classification (perhaps masses or boundary areas). (3) Results: initial classification results were 97% accurate, 99% specific, and 83% sensitive. Gradient techniques for unsupervised region of interest mapping identified areas most associated with the classification results clearly on positive mammograms and might be used to support clinician analysis. (4) Conclusions: deep vision techniques hold promise for addressing the overdiagnoses and treatment, underdiagnoses, and automated region of interest identification on mammography.Item Examining Predictors of Myocardial Infarction(Multidisciplinary Digital Publishing Institute, 2021-10-27) Dolezel, Diane; McLeod, Alexander; Fulton, Lawrence V.Cardiovascular diseases are the leading cause of death in the United States. This study analyzed predictors of myocardial infarction (MI) for those aged 35 and older based on demographic, socioeconomic, geographic, behavioral, and risk factors, as well as access to healthcare variables using the Center for Disease (CDC) Control Behavioral Risk Factor Surveillance System (BRFSS) survey for the year 2019. Multiple quasibinomial models were generated on an 80% training set hierarchically and then used to forecast the 20% test set. The final training model proved somewhat capable of prediction with a weighted F1-Score = 0.898. A complete model based on statistically significant variables using the entirety of the dataset was compared to the same model built on the training set. Models demonstrated coefficient stability. Similar to previous studies, age, gender, marital status, veteran status, income, home ownership, employment status, and education level were important demographic and socioeconomic predictors. The only geographic variable that remained in the model was associated with the West North Central Census Division (in-creased risk). Statistically important behavioral and risk factors as well as comorbidities included health status, smoking, alcohol consumption frequency, cholesterol, blood pressure, diabetes, stroke, chronic obstructive pulmonary disorder (COPD), kidney disease, and arthritis. Three access to healthcare variables proved statistically significant: lack of a primary care provider (Odds Ratio, OR = 0.853, p < 0.001), cost considerations prevented some care (OR = 1.232, p < 0.001), and lack of an annual checkup (OR = 0.807, p < 0.001). The directionality of these odds ratios is congruent with a marginal effects model and implies that those without MI are more likely not to have a primary provider or annual checkup, but those with MI are more likely to have missed care due to the cost of that care. Cost of healthcare for MI patients is associated with not receiving care after accounting for all other variables.Item Patient Throughput Initiatives in Ambulatory Care Organizations during the COVID-19 Pandemic: A Systematic Review(Multidisciplinary Digital Publishing Institute, 2021-10-30) Lieneck, Cristian H.; Ramamonjiarivelo, Zo; Cox, Jennifer; Dominguez, Jack; Gersbach, Kendal; Heredia, Edward; Khan, AfrozaBackground and objectives: Ambulatory (outpatient) health care organizations continue to respond to the COVID-19 global pandemic using an array of initiatives to provide a continuity of care for both COVID-19 and non-COVID-19 patients. The purpose of this study is to systematically identify the facilitators and barriers experienced by outpatient health care organizations in an effort to maintain effective and efficient patient throughput during the pandemic. Materials and methods: This study systematically reviewed articles focused on initiatives taken by ambulatory care organizations to maintain optimal outpatient throughput levels while balancing pandemic precautions, published during 2020. Results: Among the 30 articles that met the inclusion criteria, three initiatives healthcare organizations have taken to maintain throughput were identified: the use (and enhanced use) of telehealth, protocol development, and health care provider training. The research team also identified three barriers to patient throughput: lack of telehealth, lack of resources, and overall lack of knowledge. Conclusions: To maintain patient throughput during the COVID-19 pandemic, healthcare organizations need to develop strategies such as the use of virtual consultation and follow-up, new guidelines to move patients along the care delivery value-chain, and ongoing training of providers. Additionally, the availability of required technology for telehealth, availability of resources, and adequate knowledge are vital for continuous patient throughput to ensure continuity of care during a pandemic.Item Sustainability and CSR: The Relationship with Hofstede Cultural Dimensions(Multidisciplinary Digital Publishing Institute, 2021-11-01) Tehrani, Minoo; Rathgeber, Andreas W.; Fulton, Lawrence V.; Schmutz, BryanThis research explores the relationship between Hofstede’s femininity cultural dimension of quality of life and the masculinity cultural dimension of drive for success manifested by materialistic wealth by investigating the market value of the publicly traded firms appearing on the Dow Jones Sustainability Indices (DJSIs). The firms added to the DJSIs between the years 2010–2019 in countries with the femininity cultural dimension indicated by scores of ≤42, were selected for the first part of this study. In addition, France, with a masculinity score of 43 and Japan, with the highest masculinity score of 92, were chosen for comparison with the results from the countries with the femininity cultural dimension. The findings of this study indicate that companies in developed and emerging countries with the femininity cultural dimension show significant positive impact on their market values when added to the DJSIs. The publicly traded firms in France show a significant negative impact on their market values when added to the DJSIs. On the other hand, Japanese companies on the addition lists of DJSIs show a significant positive impact on their market values, despite Japan having the highest Hofstede masculinity score, a potential sign of cultural change in Japan.Item Protective and Non-Protective Factors of Mental Health Distress in the United States during the COVID-19 Pandemic: A Systematic Review(Multidisciplinary Digital Publishing Institute, 2021-12-17) Lieneck, Cristian H.; Bosworth, Michele; Weaver, Eric; Heinemann, Katharine; Patel, JankiBackground and objectives: Health care organizations continue to respond to the COVID-19 global pandemic and an ongoing array of related mental health concerns. These pandemic-related challenges continue to be experienced by both the U.S. population and those abroad. Materials and methods: This systematic review queried three research databases to identify applicable studies related to protective and non-protective factors of mental health distress experienced during the pandemic within the United States. Results: Three primary factors were identified as protective factors, potentially helping to moderate the incidence of mental distress during the pandemic: demographics, personal support/self-care resources, and income/financial concerns. Researchers also identified these same three constructs of non-protective factors of mental health distress, as well as two additional variables: health/social status and general knowledge/government mistrust. Conclusions: This systematic review has identified protective and non-protective factors of mental health distress experienced in the United States during the COVID-19 pandemic (to date) that can further assist medical providers in the U.S. and beyond as the pandemic and related mental health concerns continue at a global level.Item Testing Kissick’s Iron Triangle—Structural Equation Modeling Analysis of a Practical Theory(Multidisciplinary Digital Publishing Institute, 2021-12-18) Beauvais, Bradley; Kruse, Clemens S.; Fulton, Lawrence V.; Brooks, Matthew; Mileski, Michael; Lee, Kimberly; Ramamonjiarivelo, Zo; Shanmugam, RamalingamBackground/Purpose: The purpose of this research is to determine if the tradeoffs that Kissick proposed among cost containment, quality, and access remain as rigidly interconnected as originally conceived in the contemporary health care context. Although many have relied on the Kissick model to advocate for health policy decisions, to our knowledge the model has never been empirically tested. Some have called for policy makers to come to terms with the premise of the Kissick model tradeoffs, while others have questioned the model, given the proliferation of quality-enhancing initiatives, automation, and information technology in the health care industry. One wonders whether these evolutionary changes alter or disrupt the originality of the Kissick paradigms themselves. Methods: Structural equation modeling (SEM) was used to evaluate the Kissick hypothetical relationships among the unobserved constructs of cost, quality, and access in hospitals for the year 2018. Hospital data were obtained from Definitive Healthcare, a subscription site that contains Medicare data as well as non-Medicare data for networks, hospitals, and clinics (final n = 2766). Results: Reporting significant net effects as defined by our chosen study variables, we find that as quality increases, costs increase, as access increases, quality increases, and as access increases, costs increase. Policy and Practice Implications: Our findings lend continued relevance to a balanced approach to health care policy reform efforts. Simultaneously bending the health care cost curve, increasing access to care, and advancing quality of care is as challenging now as it was when the Kissick model was originally conceived.Item Enhance the Accuracy of Medication Histories for the Elderly by Using an Electronic Medication Checklist(American Health Information Management Association, 2012-09) Wang, Tiankai; Biedermann, SueMedication errors may result in serious safety issues for patients. Medication error issues are more prevalent among elderly patients, who take more medications and have prescriptions that change frequently. The challenge of obtaining accurate medication histories for the elderly at the time of hospital admission creates the potential for medication errors starting at admission.A study at a central Texas hospital was conducted to assess whether an electronic medication checklist can enhance the accuracy of medication histories for the elderly. The empirical outcome demonstrated that medication errors were significantly reduced by using an electronic medication checklist at the time of admission. The findings of this study suggest that implementing electronic health record systems with decision support for identifying inaccurate doses and frequencies of prescribed medicines will increase the accuracy of patients' medication histories.Item Adoption and Utilization of Electronic Health Record Systems by Long-Term Care Facilities in Texas(American Health Information Management Association, 2012-05) Wang, Tiankai; Biedermann, SueLong-term care (LTC) is an important sector in the healthcare industry; however, the adoption of electronic health record (EHR) systems in LTC facilities lags behind that in other sectors of healthcare. This study examines the adoption and utilization of EHRs in LTC facilities in Texas and identifies the barriers preventing implementation of EHRs. A survey instrument was mailed to all Texas LTC facilities between October 2010 and March 2011. The survey found that in Texas, 39.5 percent of LTC facilities have fully or partially implemented EHR systems and 15 percent of LTC facilities have no plans to adopt EHRs yet. There is significant variation in the use of EHR functionalities across the LTC facilities in Texas. In the LTC facilities, the administrative functions of EHRs have been more widely adopted and are more widely utilized than the clinical functions of EHRs. Among the clinical functions adopted, the resident assessment, physician orders, care management plan, and census management are the leading functions used by the LTC facilities in Texas. Lack of capital resources is still the greatest barrier to EHR adoption and implementation. Policy makers, vendors, LTC administrators, educators, and researchers should make more effort to improve EHR adoption in LTC facilities.Item The omicron variant is deepening severe staffing shortages in medical laboratories across the US(The Conversation US, Inc., 2022-01-19) Rohde, Rodney E.Medical laboratory professionals form the backbone of health care and the public health system. They conduct some 13 billion laboratory medicine tests annually in the U.S. As of January 2022, these individuals had also performed more than 860 million COVID-19 tests and counting during the pandemic. Why should anyone care? Laboratory testing is the single highest-volume medical activity affecting Americans, and it drives about two-thirds of all medical decisions made by doctors and other health care professionals. Simply put, every time you enter a hospital or health care facility for care, your life is in the hands of a medical laboratory professional.Item Provision of Palliative Care during the COVID-19 Pandemic: A Systematic Review of Ambulatory Care Organizations in the United States(Multidisciplinary Digital Publishing Institute, 2021-10-18) Lieneck, Cristian H.; Betancourt, Jose; Daemen, Cynthia; Eich, Rhiannon; Monty, Elisabeth; Petty, Mindy JoBackground and objectives: Ambulatory (outpatient) healthcare organizations continue to respond to the COVID-19 global pandemic using an array of initiatives to sustain a continuity of palliative care. Continuance of palliative care during major crises has been previously accomplished; however, the global pandemic presents new challenges to the US healthcare industry. Materials and methods: This systematic review queried four research databases to identify applicable studies related to the provision of palliative care during the pandemic in outpatient organizations within the United States. Results: There are two primary facilitators for the ongoing provision of palliative care for the outpatient segment of the United States healthcare industry: technology and advanced care planning. Researchers also identified two primary barriers in the outpatient setting impacting the continuance of palliative care: lack of resources and accessibility to care. Conclusions: This systematic review identified facilitators and barriers for palliative care initiatives in the United States that can further assist future outpatient (ambulatory care) providers at a global level as the pandemic and associated public health initiatives continueItem A Report Card on Prevention Efforts of COVID-19 Deaths in US(Multidisciplinary Digital Publishing Institute, 2021-09-07) Shanmugam, Ramalingam; Fulton, Lawrence V.; Ramamonjiarivelo, Zo; Betancourt, Jose; Beauvais, Bradley; Kruse, Clemens S.; Brooks, MatthewCOVID-19 (otherwise known as coronavirus disease 2019) is a life-threatening pandemic that has been combatted in various ways by the government, public health officials, and health care providers. These interventions have been met with varying levels of success. Ultimately, we question if the preventive efforts have reduced COVID-19 deaths in the United States. To address this question, we analyze data pertaining to COVID-19 deaths drawn from the Centers for Disease Control and Prevention (CDC). For this purpose, we employ incidence rate restricted Poisson (IRRP) as an underlying analysis methodology and evaluate all preventive efforts utilized to attempt to reduce COVID-19 deaths. Interpretations of analytic results and graphical visualizations are used to emphasize our various findings. Much needed modifications of the public health policies with respect to dealing with any future pandemics are compiled, critically assessed, and discussed.Item How to optimize aerosol drug delivery during noninvasive ventilation: What to use, how to use it, and why?(Turkish Respiratory Society, 2019-04) Ari, ArzuMuch evidence supports the use of non-invasive ventilation (NIV) in patients who have acute and chronic respiratory failure and aerosolized medications are increasingly used in this patient population. Successful application of aerosol therapy during NIV depends on the effectiveness of the drug deposition in the lungs. Previous evidence showed that many factors impact aerosol delivery to patients receiving NIV. Those factors include mode of ventilation, ventilator parameters, type of ventilator circuit, the position of the aerosol device, the location of leak port, type of exhalation valve, humidity, enhanced condensational growth, type of aerosol device, and interface as well as delivery technique. The purpose of this paper is to review the available evidence related to aerosol therapy during NIV and provide recommendations to optimize aerosol drug delivery to patients receiving NIV.Item Predicting COVID-19 cases with unknown homogeneous or heterogeneous resistance to infectivity(Public Library of Science, 2021-07-15) Shanmugam, Ramalingam; Ledlow, Gerald; Singh, Karan P.We present a restricted infection rate inverse binomial-based approach to better predict COVID-19 cases after a family gathering. The traditional inverse binomial (IB) model is inappropriate to match the reality of COVID-19, because the collected data contradicts the model’s requirement that variance should be larger than the expected value. Our version of an IB model is more appropriate, as it can accommodate all potential data scenarios in which the variance is smaller, equal, or larger than the mean. This is unlike the usual IB, which accommodates only the scenario in which the variance is more than the mean. Therefore, we propose a refined version of an IB model to be able to accommodate all potential data scenarios. The application of the approach is based on a restricted infectivity rate and methodology on COVID-19 data, which exhibit two clusters of infectivity. Cluster 1 has a smaller number of primary cases and exhibits larger variance than the expected cases with a negative correlation of 28%, implying that the number of secondary cases is lesser when the number of primary cases increases and vice versa. The traditional IB model is appropriate for Cluster 1. The probability of contracting COVID-19 is estimated to be 0.13 among the primary, but is 0.75 among the secondary in Cluster 1, with a wider gap. Cluster 2, with a larger number of primary cases, exhibits smaller variance than the expected cases with a correlation of 79%, implying that the number of primary and secondary cases do increase or decrease together. Cluster 2 disqualifies the traditional IB model and requires its refined version. The probability of contracting COVID-19 is estimated to be 0.74 among the primary, but is 0.72 among the secondary in Cluster 2, with a narrower gap. The advantages of the proposed approach include the model’s ability to estimate the community’s health system memory, as future policies might reduce COVID’s spread. In our approach, the current hazard level to be infected with COVID-19 and the odds of not contracting COVID-19 among the primary in comparison to the secondary groups are estimable and interpretable.Item Pandemic Pause: Systematic Review of Cost Variables for Ambulatory Care Organizations Participating in Accountable Care Organizations(Multidisciplinary Digital Publishing Institute, 2021-02-12) Lieneck, Cristian H.; Weaver, Eric; Maryon, ThomasAmbulatory health care provider organizations participating in Accountable Care Organizations (ACOs) organizations assume costs beyond typical practice operations that are directly associated with value-based care initiatives. Identifying these variables that influence such costs are essential to an organization’s financial viability. To enable the U.S. healthcare system to respond to the COVID-19 pandemic CMS issued blanket waivers that permit enhanced flexibility, extension, and other emergency declaration changes to ACO reporting requirements through the unforeseen future. This relaxation and even pausing of reporting requirements encouraged the researchers to conduct a systematic review and identify variables that have influenced costs incurred by ambulatory care organizations participating in ACOs prior to the emergency declaration. The research findings identified ACO-ambulatory care variables (enhanced patient care management, health information technology improvements, and organizational ownership/reimbursement models) that helped to reduce costs to the ambulatory care organization. Additional variables (social determinants of health/environmental conditions, lack of integration/standardization, and misalignment of financial incentives) were also identified in the literature as having influenced costs for ambulatory care organizations while participating in an ACO initiative with CMS. Findings can assist ambulatory care organizations to focus on new and optimized strategies as they begin to prepare for the post-pandemic resumption of ACO quality reporting requirements once the emergency declaration is eventually lifted.