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

项目总结摘要 自《平价医疗法案》以来的医疗政策和融资环境增加了对 医院合并成更大的医院系统。一年一度的医院合并活动比过去翻了一番 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。推定的好处 医院整合包括集中数量和专业知识、护理整合和质量投资 进步。如果做得正确，它们将转化为质量和成本的改善。上的有限数据 医院系统绩效在实现整合所声称的好处方面表现出显著的差异。 虽然医院合并可能会影响广泛的服务线，但外科服务的变化可能 成为信息量最大的。众所周知，外科治疗在明确的结果和短期成本方面存在差异。AS 这样，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，我们提出了以下目标： 目的1：检验医院网络优化与结果的关系。使用索赔 和公开报道的公共和私人付款人提供的一系列手术程序的数据，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； 避免小手术，并选择性地将高危患者转诊到三级中心。目标2：实现 检查医院网络优化和医疗成本之间的关系。再次使用 声明和公开报告的数据，我们将经验性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30天的插曲成本。然后我们将分析这一关系 保健合理化与平均系统费用以及系统内费用差异之间的关系。目标3：实现 了解高性能网络的特征，以确定最佳实践。我们将使用 确定索赔数据中无法观察到的有效系统策略的定性方法。使用正数 偏差方法，我们将确定在以下方面表现出最大纵向改进的医院系统 结果和成本，并对医院系统领导人进行深入访谈，审查政策和 协议和现场访问，以确定区别特征。我们的工作将使政策制定者 以及公众对医院系统在护理合理化方面的表现进行评价。我们的工作还将提供 有助于医院系统领导者改进其组织绩效的见解。

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.