Separate and Concentrate: Accounting for Patient Complexity in General Hospitals

• 成果类型: Article
• 署名作者: Kuntz, Ludwig; Scholtes, Stefan; Sulz, Sandra
• 署名单位: University of Cologne; University of Cambridge; Erasmus University Rotterdam; Erasmus University Rotterdam - Excl Erasmus MC
• 刊物名称: MANAGEMENT SCIENCE
• ISSN/ISSBN: 0025-1909
• DOI: 10.1287/mnsc.2018.3064
• 发表日期: 2019
• 页码: 2482-2501
• 关键词: healthcare management; hospital; patient complexity; volume; focus; Routing; solution shop; value-adding process; service quality; mortality

摘要

Scholars have recently suggested the reorganization of general hospitals into organizationally separate divisions for routine and non-routine services to overcome operational misalignments between the two types of services. We provide empirical evidence for this proposal from a quality perspective, using over 250,000 patient discharge records from 60 German hospitals across 39 high-mortality disease segments, and focusing on in-hospital mortality as outcome. Disentangling the effects of high, absolute, and relative hospital volumes in a disease group, our analysis suggests that routine and complex patients would benefit from a hospital organization with a multi-specialty hub for emergency and non-routine elective services at its core, complemented by organizationally separate disease-focused hospitals-within-hospitals for routine services. We also provide evidence that the hub hospital can further improve service quality for complex patients by adopting a disease-based rather than medical specialty-based departmental routing strategy for newly arriving patients. A counterfactual analysis, based on a simultaneous equations probit model that simultaneously controls for endogeneity of volume, focus, and routing strategy, suggests that the proposed reorganization could have reduced mortality in the sample by 13.43% (95% CI [6.87%; 18.95%]) for routine patients and by 11.67% (95% CI [6.13%; 16.86%]) for the most complex patients.