Department of Health Policy and Administration, Pennsylvania State University, University Park, PA 16802, USA.
Med Care Res Rev. 2012 Feb;69(1):83-102. doi: 10.1177/1077558711418520. Epub 2011 Aug 17.
Some scholars advocate for health care organizations designed around the principles of volume and focus, while others suggest that the complexity of patient care renders this approach to organizing care inefficient (and ineffective). This article attempts to reconcile these views, drawing on the idea of organizational capabilities as knowledge integration to motivate an empirical examination of the extent to which the efficiency benefits of hospital volume and focus depend on the degree of patient comorbidity. In doing so, the article has two aims: (a) to shed light on both the benefits and limitations of volume and focus as organizing principles and (b) to contribute to our understanding of the implications of comorbidity for the organization of health care delivery. Using data on U.S. hospitals, the author finds evidence that the efficiency benefits of volume and focus are diminishing in the level of patient comorbidity.
一些学者主张以数量和重点为原则来设计医疗保健组织，而另一些学者则认为患者护理的复杂性使得这种组织护理的方法效率低下（和无效）。本文试图调和这些观点，借鉴组织能力作为知识整合的理念，激励对医院数量和重点的效率效益在多大程度上取决于患者合并症程度的实证检验。为此，本文有两个目的：（a）阐明数量和重点作为组织原则的优势和局限性；（b）增进我们对合并症对医疗保健提供组织的影响的理解。利用美国医院的数据，作者发现证据表明，患者合并症程度的增加降低了数量和重点的效率效益。
