Abstract
Objectives: We examine the dynamics of patient-sharing relations
within an Italian regional community of 35 hospitals serving approximately
1,300,000 people. We test whether interorganizational
relations provide individual patients access to higher quality providers
of care.
Research Design and Methods: We reconstruct the complete
temporal sequence of the 3461 consecutive interhospital patientsharing
events observed between each pair of hospitals in the
community during 2005–2008. We distinguish between transfers
occurring between and within different medical specialties. We
estimate newly derived models for relational event sequences that
allow us to control for the most common forms of network-like
dependencies that are known to characterize collaborative relations
between hospitals. We use 45-day risk-adjusted readmission rate as
a proxy for hospital quality.
Results: After controls (eg, geographical distance, size, and the
existence of prior collaborative relations), we find that patients flow
from less to more capable hospitals. We show that this result holds
for patient being shared both between as well as within medical
specialties. Nonetheless there are strong and persistent other
organizational and relational effects driving transfers. Conclusions: Decentralized patient-sharing decisions taken by the
35 hospitals give rise to a system of collaborative interorganizational
arrangements that allow the patient to access hospitals delivering
a higher quality of care. This result is relevant for health
care policy because it suggests that collaborative relations between
hospitals may produce desirable outcomes both for individual
patients, and for regional health care systems.
Lingua originale | English |
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pagine (da-a) | 407-414 |
Numero di pagine | 8 |
Rivista | Medical Care |
Volume | 52 |
DOI | |
Stato di pubblicazione | Pubblicato - 2014 |
Pubblicato esternamente | Sì |
Keywords
- network analysis
- quality of care