The importance of understanding and measuring health system structural, functional, and clinical integration
The importance of understanding and measuring health system structural, functional, and clinical integration
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DOI：
10.1111/1475-6773.13582
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发表时间：
2020-12-01
影响因子：
3.4
通讯作者：
Vaiana, Mary E.
中科院分区：
文献类型：
--
作者：
Ridgely, M. Susan;Buttorff, Christine;Vaiana, Mary E.
目的：我们探讨是否有方法来表征卫生系统，还没有透露的二手数据，可以提供新的见解，在卫生系统的性能差异。我们试图收集丰富的定性数据，以揭示卫生系统是否以及在多大程度上在结构，功能，数据来源通过“虚拟”方式对四个州24个卫生系统的162名高管进行了采访。2017年至2019年间的现场访问。研究设计探索性研究，使用主题比较分析来描述可能导致高绩效的因素。数据收集我们使用了最大变异抽样以实现规模和性能的多样性。我们进行了，转录，编码，并分析了深入的，半结构化的采访系统管理人员，包括市场背景下，卫生系统的起源，组织结构，治理特征，卫生系统的关系，附属医院和POs.Principal调查结果卫生系统的规模和所有权类型，组织和治理安排的复杂性，并承担风险的能力等主题。结构、功能和临床整合在不同的系统中各不相同，围绕集中业务功能、与医生协调财务激励、建立企业范围的EHR以及向单一签署人合同转变开展了大量活动。高管们将临床整合描述为更难实现，但必不可少。将“卫生系统”视为二元变量的研究可能会不适当地汇总分析不同类型、不同成熟程度以及不同结构、功能和临床整合阶段的卫生系统。结果，指示性能的“信号”可能被“噪声”扭曲。“结论制定方法来解释当今卫生系统的复杂结构，可以加强未来将系统作为复杂组织进行研究的努力，评估其绩效，并更好地了解支付创新，护理重新设计和其他改革的影响。
Objective We explore if there are ways to characterize health systems-not already revealed by secondary data-that could provide new insights into differences in health system performance. We sought to collect rich qualitative data to reveal whether and to what extent health systems vary in important ways across dimensions of structural, functional, and clinical integration.Data Sources Interviews with 162 c-suite executives of 24 health systems in four states conducted through "virtual" site visits between 2017 and 2019.Study Design Exploratory study using thematic comparative analysis to describe factors that may lead to high performance.Data Collection We used maximum variation sampling to achieve diversity in size and performance. We conducted, transcribed, coded, and analyzed in-depth, semi-structured interviews with system executives, covering such topics as market context, health system origin, organizational structure, governance features, and relationship of health system to affiliated hospitals and POs.Principal Findings Health systems vary widely in size and ownership type, complexity of organization and governance arrangements, and ability to take on risk. Structural, functional, and clinical integration vary across systems, with considerable activity around centralizing business functions, aligning financial incentives with physicians, establishing enterprise-wide EHR, and moving toward single signatory contracting. Executives describe clinical integration as more difficult to achieve, but essential. Studies that treat "health system" as a binary variable may be inappropriately aggregating for analysis health systems of very different types, at different degrees of maturity, and at different stages of structural, functional, and clinical integration. As a result, a "signal" indicating performance may be distorted by the "noise."Conclusions Developing ways to account for the complex structures of today's health systems can enhance future efforts to study systems as complex organizations, to assess their performance, and to better understand the effects of payment innovation, care redesign, and other reforms.