Fulfilling the Promise of Hospital Consolidation to Improve Clinical Quality and Costs

履行医院整合的承诺，提高临床质量和成本

• 批准号: 10518443
• 负责人: Andrew Mounir Ibrahim
• 金额: $ 37.64万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-01 至 2027-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10518443
• 关键词: Fulfilling; Promise; Hospital; Consolidation; Improve

PROJECT SUMMARY ABSTRACT The healthcare policy and financing environment since the Affordable Care Act has increased pressure on hospitals to consolidate into larger hospital systems. Annual hospital merger activity has doubled over the last decade, and over two-thirds of US hospitals are now part of a hospital system. The presumed benefits of hospital consolidation include concentrating volume and expertise, care integration, and investment in quality improvement. If done correctly, they would translate to both quality and cost improvements. The limited data on hospital system performance shows significant variation in achieving the purported benefits of consolidation. While hospital consolidation may impact a broad spectrum of service lines, changes to surgical services may be the most informative. Surgical care has known variation in well-defined outcomes and short-term costs. As such, surgical care may be a “leading indicator” to understand the effects of hospital consolidation on healthcare quality and costs. In order to better understand this phenomenon, we propose the following aims: Aim 1: To examine the relationship between hospital network optimization and outcomes. Using claims and publicly reported data on an inclusive range of surgical procedures from public and private payers, we will assess hospital systems on rationalization of site of care, including centralization of complex procedures, avoidance of low-volume surgery, and selective referral of high-risk patients to tertiary centers. Aim 2: To examine the relationship between hospital network optimization and healthcare costs. Again using claims and publicly reported data, we will empirically assess variation between and within hospital systems in risk-adjusted 30-day episode costs for the same surgical procedures. We will then analyze the relationship between care rationalization and average system costs as well as within-system cost variation. Aim 3: To understand characteristics of high-performing networks in order to identify best practices. We will use qualitative methods to identify effective system strategies not observable in claims data. Using a positive deviance approach, we will identify hospital systems that exhibit the most longitudinal improvement in outcomes and costs and perform in-depth interviews of hospital system leaders, reviews of policies and protocols, and site visits in order to define the differentiating characteristics. Our work will allow policymakers and the public to evaluate hospital system performance in care rationalization. Our work will also provide insights that will help hospital system leaders improve the performance of their organizations.

项目摘要摘要 自从《平价医疗法案》上加大压力以来，医疗保健政策和融资环境 医院巩固到更大的医院系统中。年度医院合并活动在最后一倍 十年，现在，超过三分之二的美国医院是医院系统的一部分。假定的好处 医院合并包括集中量和专业知识，护理整合以及质量投资 改进。如果正确完成，它们将转化为质量和成本提高。有限的数据 医院系统的性能显示出实现合并的益处的显着差异。 尽管医院合并可能会影响各种各样的服务线，但外科服务的变化可能 成为最有益的。手术护理已知明确定义的结果和短期成本的差异。作为 这样的手术护理可能是了解医院合并对的“领先指标” 医疗保健质量和成本。为了更好地理解这种现象，我们提出了以下目的： 目标1：检查医院网络优化和结果之间的关系。使用索赔 并公开报告了有关公共和私人付款人的包括外科手术程序范围的数据，我们将 评估医院系统的护理现场合理化，包括复杂程序的集中化， 避免小体积手术，并选择性地转介高危患者到第三中心。目标2：到 检查医院网络优化与医疗保健成本之间的关系。再次使用 索赔和公开报告的数据，我们将紧急评估医院系统之间和内部的差异 相同手术程序的风险调整后的30天发作成本。然后我们将分析关系 在护理合理化与平均系统成本以及系统内成本变化之间。目标3：到 了解高性能网络的特征，以确定最佳实践。我们将使用 确定在索赔数据中无法观察到的有效系统策略的定性方法。使用阳性 偏差方法，我们将确定医院系统表现出最大的纵向改善 结果和成本，并对医院系统领导者进行深入的访谈，政策审查和 协议和现场访问以定义不同的特征。我们的工作将允许政策制定者 公众评估医院系统的护理合理化。我们的工作也将提供 可以帮助医院系统领导者提高组织绩效的见解。