Ford Eric W, Short Jeremy C
Rawls College of Business, Texas Tech University, Lubbock, TX, USA.
Health Care Manage Rev. 2008 Jan-Mar;33(1):13-20. doi: 10.1097/01.HMR.0000304496.89684.7f.
Research in configurations and strategic groups has a rich history of revealing performance differences for hospitals and health care systems.
To assess the relationship between hospital-led health system configurations and the adoption of patient safety practices. In particular, the adoption of computerized physician order entry (CPOE) and intensive care unit physician staffing (IPS) is analyzed.
Analysis of variance was used to detect differences in patient safety measures based on health networks and systems' initial configuration clustering, and regression was used to assess group membership, controlling for hospital-level characteristics. The 2002 American Hospital Association survey and the first 3 years of the Leapfrog Group annual survey (2003-2005) are used for the analyses.
There were significant differences in CPOE and IPS adoption and implementation levels based on health systems' configurations. Centralized physician/insurance health systems and moderately centralized health systems were the highest configurations in terms of CPOE adoption. Group membership was not positively related to the use of IPS relative to hospitals that are not classified using the taxonomy. In fact, there is a significant and negative adoption rate for both patient safety measures in facilities classified in the independent hospital systems category.
There are systematic differences in the adoption of CPOE and IPS patient safety measures based on health system configurations. The configuration with an insurance company as part of its structure was more likely than other groups to be adopting CPOE. PRACTITIONER IMPLICATIONS: Given the durability of group membership, the Leapfrog Group and other patient safety initiatives could explicitly target configurations most likely to adopt and implement patient safety programs.
对医院配置和战略群组的研究在揭示医院及医疗保健系统的绩效差异方面有着丰富的历史。
评估以医院为主导的医疗系统配置与患者安全措施采用情况之间的关系。特别分析了计算机化医师医嘱录入（CPOE）和重症监护病房医师人员配备（IPS）的采用情况。
使用方差分析来检测基于健康网络和系统初始配置聚类的患者安全措施差异，并使用回归分析来评估群组归属情况，同时控制医院层面的特征。分析采用了2002年美国医院协会调查以及“跨越组织”年度调查的前三年（2003 - 2005年）数据。
基于医疗系统的配置，CPOE和IPS的采用及实施水平存在显著差异。就CPOE采用情况而言，集中式医师/保险医疗系统和适度集中式医疗系统处于最高配置水平。相对于未使用该分类法分类的医院，群组归属与IPS的使用并无正相关关系。事实上，在独立医院系统类别中分类的机构，这两项患者安全措施的采用率均显著为负。
基于医疗系统配置，CPOE和IPS患者安全措施的采用存在系统性差异。结构中包含保险公司的配置比其他群组更有可能采用CPOE。
鉴于群组归属的持续性，“跨越组织”及其他患者安全倡议可以明确针对最有可能采用和实施患者安全计划的配置。
