Mitchell S; Academy for Health Services Research and Health Policy. Meeting.

Abstr Acad Health Serv Res Health Policy Meet. 2002; 19: 9.

Health Policy Administration, Yale University, 240 East 86th Street #15H, New York, NY 10028; Tel: (212) 419-3532; E-mail: shannon.mitchell@yale.edu

RESEARCH OBJECTIVE: To determine the effects of network and system organizational structure on risk-adjusted in-hospital mortality quality indicators. STUDY DESIGN: Cross-sectional analysis of the Health Care Utilization Project's State Inpatient Database Risk-Adjusted Quality Indicators among hospitals affiliated with health networks and health systems. Outcome measures include: in-hospital mortality for AMI, CHF, Stroke and Pneumonia. Nework and system organizational structure is categorized according to the Taxonomy of Health Networks and Health Systems (Bazzoli et al., 1999). POPULATION STUDIED: National sample of 1500 short-term general hospitals affiliated with a network or system in 1997 and reported data to the HCUP State Inpatient Database. PRINCIPAL FINDINGS: Centralized networks and systems displayed less in-hospital mortality across conditions examined than decentralized networks and systems. Non-profit networks and systems displayed less in-hospital mortality than investor-owned networks and systems. Managed care penetration is assoicated with greater in-hospital mortality. CONCLUSIONS: The organizational structure of networks and systems has an impact on the quality of care provided in member hospitals. More centralized structure seems to promote quality of care, possibly through greater coordination, standardization, and homogeneteity of policy and practice. These findings support IOM recent recommendations regarding quality improvement and error reduction. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: As large health networks and systems continue to grow and evolve, more centralized structures should be pursued over decentralized structures. Policies aimed at improving quality of care in hospitals should take into account the structure of the network or system in which a hospital is embedded. PRIMARY FUNDING SOURCE: AHRQ

Publication Types:

• Meeting Abstracts

Keywords:

• Cross-Sectional Studies
• Hospital Mortality
• Hospitals
• Managed Care Programs
• Outcome Assessment (Health Care)
• Quality Indicators, Health Care
• economics
• hsrmtgs

Other ID:

• GWHSR0002486

UI: 102274162

From Meeting Abstracts