Shah N, Smith MA; Academy for Health Services Research and Health Policy. Meeting.
Abstr Acad Health Serv Res Health Policy Meet. 2002; 19: 37.
University of Wisconsin-Madison, WARF building, 610 Walnut Street Rm. 667, Madison, WI 53706; Tel: (608) 265-3688; E-mail: nd.shah@hosp.wisc.edu
RESEARCH OBJECTIVE: Appropriate distribution of hospital services across regions may improve the efficiency and quality of heath care delivery. However, little is known about the organizational characteristics of hospitals within referral regions and the association between these characteristics and utilization patterns. The goal of this study is to 1) characterize hospital organizational characteristics (i.e. specialization, centralization, and integration), 2) to describe the average organizational characteristics of hospitals within referral regions, and 3) to relate these organizational characteristics to the rates of six common surgical procedures within these regions. STUDY DESIGN: Hospital level data were obtained from the 1999 American Hospital Association (AHA) Annual Survey. Three scales reflecting the extent of hospital specialization, centralization, and integration were created based on a modified version of Bazzoli, et. al., scales for health systems and networks (Health Services Research 1999;33:1683-1717). Data on hospital referral regions (HRRs) and the rates of six common surgical procedures in non-HMO Medicare enrollees were obtained from the Dartmouth Atlas. The mean hospital specialization, centralization, and integration were calculated for all hospitals within each HRR. The rates of these inpatient surgical procedures for HRRs were regressed on specialization, centralization, and integration. The unit of analysis was the HRR. POPULATION STUDIED: 4184 general medical and surgical hospitals that completed the 1999 AHA Annual Survey, and 306 HRRs included in the Dartmouth Atlas. PRINCIPAL FINDINGS: The average specialization, centralization, and integration across hospital referral regions were 38.2% (s.d.=7.7%), 5.0% (s.d.=5.1%), and 3.2% (s.d.=3.0%), respectively. Increased specialization was associated with lower rates of cholecystectomy, back surgery, and radical prostatectomy, but a higher rate of colectomy. Increased centralization was associated with a higher rate of lower extremity bypass and a lower rate of cholecystectomy. Increased integration was associated with higher rates of colectomy, hip replacement, and radical prostatectomy, but a lower rate of back surgery. The extent of variation for the six surgical procedures was calculated using the ratio of highest to lowest procedure rates by HRRs. There were no consistent trends in the relationship of organizational characteristics to procedure rates from low variation to high variation procedures. CONCLUSIONS: Hospital organization characteristics across hospital referral regions were associated with surgical procedure rates. In general, average regional specialization was associated with lower procedure rates and the average regional integration was associated with higher procedure rates. There was no obvious trend in association between average regional centralization and procedure rates. Optimal organizational characteristics of hospitals across regions remain to be determined. Because we assess the ecologic association between mean hospital organizational characteristics in a region and rates of surgical procedures, future analyses should evaluate these relationships more fully at the level of individual hospitals. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: Regional hospital organizational characteristics, surgical procedure rates, small area variation. PRIMARY FUNDING SOURCE: NIA, Agency for Healthcare Quality and Research
Publication Types:
Keywords:
- American Hospital Association
- Health Services Research
- Hospitals
- Male
- Medicare
- Organizational Objectives
- Quality of Health Care
- Referral and Consultation
- Small-Area Analysis
- economics
- surgery
- hsrmtgs
Other ID:
UI: 102274123
From Meeting Abstracts