Sikka Veronica, Luke Roice D, Ozcan Yasar A
Department of Emergency Medicine, Virginia Commonwealth University Medical Center, USA.
Health Care Manage Rev. 2009 Jul-Sep;34(3):251-61. doi: 10.1097/HMR.0b013e3181a16ba7.
The rapid increase in the number of hospitals becoming members of multihospital systems in recent decades has led to the formation of local and regional clusters that have the potential to function as regional systems, a model long advocated as a policy strategy for improving health system performance.
This study addresses both cluster efficiency and the hierarchical configuration with which hospitals are grouped into clusters.
METHODOLOGY/APPROACH: This study uses 2004 data from the American Hospital Association Annual Survey multihospital system designations updated to 2005. Efficiencies are measured using data envelopment analysis.
The data envelopment analysis results show that 20 clusters or 5.8% of the sample of 343 clusters are highly efficient; the remaining 323 or 94.2% of the clusters received lesser efficiency scores, averaging 0.73 on the data envelopment analysis measure. The study found the number of beds in the primary hospitals and the percentage of hospitals in the clusters that were urban, two of three variables that reflect patterns of regional model service configurations, to be significantly correlated with cluster efficiency.
Results suggest that many hospital clusters have evolved service configurations that are consistent with historically conceptualized regional organizational forms and that the particular regional pattern of distributing service capacities across cluster members might contribute to measured performance. The study also confirms the applicability of data envelopment analysis for assessing the performance of complex, multiunit organizations.
近几十年来，加入多医院系统的医院数量迅速增加，形成了具有成为区域系统潜力的地方和区域集群，这是一种长期以来被倡导作为改善卫生系统绩效的政策策略的模式。
本研究探讨了集群效率以及医院被分组为集群的层级结构。
方法/途径：本研究使用了美国医院协会年度调查2004年的数据，并将多医院系统指定更新至2005年。效率通过数据包络分析进行衡量。
数据包络分析结果显示，20个集群或343个集群样本中的5.8%效率极高；其余323个或94.2%的集群效率得分较低，在数据包络分析衡量中平均为0.73。该研究发现，反映区域模式服务配置模式的三个变量中的两个，即基层医院的床位数和集群中城市医院的百分比，与集群效率显著相关。
结果表明，许多医院集群已经发展出与历史概念化的区域组织形式一致的服务配置，并且在集群成员之间分配服务能力的特定区域模式可能有助于衡量绩效。该研究还证实了数据包络分析在评估复杂的多单位组织绩效方面的适用性。
