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

项目摘要 自《平价医疗法案》颁布以来，医疗政策和融资环境加大了医疗机构的压力。 医院合并成更大的医院系统。每年的医院合并活动比去年翻了一番 十年来，超过三分之二的美国医院现在是医院系统的一部分。假定的好处 医院合并包括集中数量和专业知识、护理整合和质量投资 改进.如果做得正确，它们将转化为质量和成本的改善。的数据有限 医院系统的绩效在实现合并的预期效益方面存在显著差异。 虽然医院合并可能会影响广泛的服务项目，但手术服务的变化可能会 是最具信息性的。手术治疗在明确的结果和短期成本方面存在已知的差异。作为 因此，外科护理可能是了解医院合并对 医疗质量和成本。为了更好地理解这一现象，我们提出以下目标： 目的1：研究医院网络优化与结果之间的关系。使用索赔 以及公共和私人支付者公开报道的关于一系列外科手术的数据，我们将 评估医院系统对护理地点的合理化，包括复杂程序的集中化， 避免低容量手术，并选择性地将高危患者转诊至三级中心。目标2： 研究医院网络优化与医疗成本之间的关系。再次使用 索赔和公开报道的数据，我们将经验性地评估医院系统之间和内部的变化， 相同手术的风险调整后30天发作成本。然后我们将分析 护理合理化和平均系统成本以及系统内成本差异之间的关系。目标3： 了解高性能网络的特点，以确定最佳做法。我们将使用 定性方法，以确定有效的系统策略，而不是在索赔数据中观察。使用正 偏差的方法，我们将确定医院系统，表现出最纵向的改善， 结果和成本，并对医院系统领导人进行深入访谈，审查政策， 协议和现场访问，以定义差异化特征。我们的工作将使政策制定者 和公众评价医院系统在护理合理化方面的绩效。我们的工作还将提供 这些见解将帮助医院系统领导者提高其组织的绩效。

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.