Does Physician-Hospital Integration Affect the Quality and Price of Hospital Care?

项目摘要 这个项目旨在促进我们对医生和医院之间的联系的理解 一体化和医疗保健的质量和价格。《平价医疗法案》与不断变化的经济状况 鼓励了医生和医院的整合。特别是负责任的关怀组织 (ACO)激励医疗保健提供者团队提供协调的患者护理，实现跨 时间和访问。这种协调的护理应该会在减缓成本增长的同时改善患者的结果，但 整合还可以使医院提高价格。同时检查护理的价格和质量是必要的 确定医生-医院一体化对消费者福利的影响。 到目前为止，还没有其他研究检查医生-医院一体化和 使用我们提出的广泛措施提高护理质量。几项研究已经检验了这种关系 医生-医院整合与成本或价格之间的关系，但这些研究中使用的数据仅限于 几个州、医院系统或保险公司。此外，很少有研究利用最近的数据，好坏参半 结果。我们的分析将是及时的，并在全国范围内检查数据。 我们的目标是比较不同级别的医生-医院整合，以便提供信息 关于一体化可能如何影响医疗保健的质量和价格。具体地说，我们试图回答以下问题 问题： 1.医生-医院一体化的变化如何影响护理的及时性和质量？ 2.增加医-院一体化是否改善了患者体验？ 3.医生与医院一体化程度的提高是否与较低的医疗保健价格有关？ 为了回应上述目标中提出的问题，我们想进行一次之前和之后的比较 使用美国医院协会面板数据组合进行整合的回归分析 年度调查、Medicare医院比较数据库和收集详细信息的多个州数据库 2008-2013年医院级财务报告。Medicare医院比较数据库提供了 通过特定疾病护理的及时性和有效性来检查护理质量的新机会 病情(例如，急性心肌梗死、心力衰竭和中风护理；30天再住院率)和 患者经验(例如，与医生/护士的交流)。

Project Summary This project aims to advance our understanding of the association between physician-hospital integration and the quality and price of health care. The Affordable Care Act and changing economic conditions have encouraged the integration of physicians and hospitals. In particular, Accountable Care Organizations (ACOs) incentivize a team of healthcare providers to deliver coordinated patient care, yielding continuity across time and visits. This coordinated care should improve patient outcomes while slowing cost growth, but integration could also enable hospitals to raise prices. Examining both price and quality of care is necessary to determine the implications of physician-hospital integration for consumer welfare. To date, no other study has examined the relationship between physician-hospital integration and quality of care using the wide set of measures we propose. Several studies have examined the relationship between physician-hospital integration and cost or prices, but the data used in these studies has been limited to a few states, hospital systems, or insurers. In addition, few studies have utilized recent data, with mixed results. Our analysis will be timely and examine data at a nationwide level. Our goal is to compare different levels of physician-hospital integration in order to provide information on how integration may affect the quality and price of healthcare. Specifically, we seek to answer the following questions: 1. How do changes in physician-hospital integration affect the timeliness and quality of care? 2. Does increased physician-hospital integration improve the patient experience? 3. Is increased physician-hospital integration associated with lower health care prices? To respond to the queries set forth in the above aims, we would like to conduct a before versus after regression analysis of integration using a combination of panel data from the American Hospital Association Annual Survey, Medicare Hospital Compare database, and multiple state databases that collect detailed hospital-level financial reports for the years 2008-2013. The Medicare Hospital Compare database provides a novel opportunity to examine quality of care measured by timeliness and effectiveness of care for specific conditions (e.g., acute myocardial infarction, heart failure, and stroke care; 30 day readmission rates) and patient experience (e.g. communication with doctors/nurses).