Reexamining organizational configurations: An update, validation, and expansion of the taxonomy of health networks and systems
Reexamining organizational configurations: An update, validation, and expansion of the taxonomy of health networks and systems
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DOI：
10.1111/j.1475-6773.2004.00222.x
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发表时间：
2004-02-01
影响因子：
3.4
通讯作者：
Kralovec, PD
中科院分区：
文献类型：
--
作者：
Dubbs, NL;Bazzoli, GJ;Kralovec, PD
目标。(a)评估医院主导的卫生网络和系统的原始集群类别如何随时间变化；(b)确定集群配置的任何新模式；(c)演示如何使用额外的数据来改进和增强分类措施。资料来源：1994年和1998年美国医院协会（ARA）医院年度调查。研究设计。与最初的分类法一样，通过将三个战略/结构维度（差异化、整合和集中化）应用于卫生服务/产品连续体的三个组成部分（医院服务、医生安排和基于提供者的保险活动），为卫生网络和卫生系统确定了单独的集群解决方案。数据提取方法。因子分析、聚类分析和判别分析被用于分析1998年的数据。使用描述性和比较方法来分析1998年更新的分类法与1994年原始版本的分类法。主要的发现。1998年的集群类别与最初的分类法相似，但是，它们揭示了一些新的组织配置。对于卫生网络来说，产品/服务线的集中化比过去更有选择性。对于卫生系统而言，参与已在更加多样化的分散组织形式中增加和分散。对于网络和系统来说，中心化的定义随着时间的推移而改变。在其更新的形式中，分类法继续为决策者和从业者提供一个描述性和上下文框架，以评估组织计划和政策。由于美国医疗保健行业的持续发展以及该领域组织结构的随之变化，有必要不时地重新审视分类。随着新机会的出现，继续推动分类法向精化/扩展的方向发展也是有价值的。
Objectives. To (a) assess how the original cluster categories of hospital-led health networks and systems have changed over time; (b) identify any new patterns of cluster configurations; and (c) demonstrate how additional data can be used to refine and enhance the taxonomy measures.Data Sources. 1994 and 1998 American Hospital Association (ARA) Annual Survey of Hospitals.Study Design. As in the original taxonomy, separate cluster solutions are identified for health networks and health systems by applying three strategic/structural dimensions (differentiation, integration, and centralization) to three components of the health service/product continuum (hospital services, physician arrangements, and provider-based insurance activities).Data Extraction Methods. Factor, cluster, and discrimmant analyses are used to analyze the 1998 data. Descriptive and comparative methods are used to analyze the updated 1998 taxonomy relative to the original 1994 version.Principal Findings. The 1998 cluster categories are similar to the original taxonomy, however, they reveal some new organizational configurations. For the health networks, centralization of product/service lines is occurring more selectively than in the past. For the health systems, participation has grown in and dispersed across a more diverse set of decentralized organizational forms. For both networks and systems, the definition of centralization has changed over time.Conclusions. In its updated form, the taxonomy continues to provide policymakers and practitioners with a descriptive and contextual framework against which to assess organizational programs and policies. There is a need to continue to revisit the taxonomy from time to time because of the persistent evolution of the U.S. health care industry and the consequent shifting of organizational configurations in this arena. There is also value in continuing to move the taxonomy in the direction of refinement/expansion as new opportunities become available.