Urban Hospital ‘Clusters’ Do Shift High-Risk Procedures To Key Facilities, But More Could Be Done

Abstract

Since the 1990s, rapid consolidation in the hospital sector has resulted in the vast majority of hospitals joining systems that already had a considerable presence within their markets. We refer to these important local and regional systems as "clusters." To determine whether hospital clusters have taken measurable steps aimed at improving the quality of care-specifically, by concentrating low-volume, high-complexity services within selected "lead" facilities-this study examined within-cluster concentrations of high-risk cases for seven surgical procedures. We found that lead hospitals on average performed fairly high percentages of the procedures per cluster, ranging from 59 percent for esophagectomy to 87 percent for aortic valve replacement. The numbers indicate that hospitals might need to work with rival facilities outside their cluster to concentrate cases for the lowest-volume procedures, such as esophagectomies, whereas coordination among cluster members might be sufficient for higher-volume procedures. The results imply that policy makers should focus on clusters' potential for restructuring care and further coordinating services across hospitals in local areas.

Clustered and distinct: a taxonomy of local multihospital systems

“…We updated a 2009 national inventory of U.S. LMSs to reflect hospitals' LMS membership as of 2012, following methods described in previous LMS studies [5,6], which referenced hospital system websites and promotional materials as well as the American Hospital Association (AHA) Annual Survey dataset.…”

“…The results revealed a reliable final solution, with high levels of agreement across many of the compared solutions. 5 Internal validation was also performed through multiple discriminant analysis using the groupings of the final cluster solution as the dependent variable and the 14 standardized classification variables as the independent variables. Applying a separate-groups covariance matrix for the classification process and defining prior probabilities according to cluster group size led to a 99.1 % correct classification rate that far exceeded the proportional chance criterion, indicating predictive accuracy of the discriminant analysis [35].…”

“…Studies have seldom explicitly examined LMSs as an organizational form, but of the exceptions, researchers point to the potential for LMSs to improve care coordination and service rationalization given their proximate spatial arrangements [4][5][6][7]. At the same time, these scholars have challenged LMSs' progress in realizing such potential, leading us to ask, to what degree do today's LMSs integrate and coordinate the delivery of care across their services and locations?…”

Geospatial analysis of Hospital Consumer Assessment of Healthcare Providers and Systems pain management experience scores in U.S. hospitals

“…One might intuit that hospitals that are closer together may be more similar than those hospitals that are further apart [33,36]. We might alternatively hypothesize that socioeconomic pressures result in dispersion of hospitals of similar characteristics, such as for Level One trauma centers and hospitals involved in high-risk procedures throughout the U.S. [7,25,26,30]. Our results suggest that at national, regional, and local levels, U.S. hospitals exhibit clustering of PEPM scores rather than dispersion.…”

Strategic Differentiation of High-Tech Services in Local Hospital Markets

“…This is particularly true for local hospital clusters in urban areas. 23-25 National systems with single hospitals in a community would not be subject to this coordination incentive.…”