*Department of Urology, University of Michigan Medical School, Ann Arbor, MI †Center for Healthcare Outcomes and Policy, University of Michigan Medical School, Ann Arbor, MI ‡Department of Sociology, University of Michigan College of Literature, Science and the Arts, Ann Arbor, MI §Department of Health Care Policy, Harvard Medical School, Boston, MA ¶Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA.
Ann Surg. 2015 Mar;261(3):468-72. doi: 10.1097/SLA.0000000000000880.
To assess the proportion of outpatient surgery currently delivered in ambulatory surgery centers (ASCs) unconnected to nearby hospitals.
The ASC as a site for outpatient surgery represents one of the fastest growing sectors in health care. Because most are freestanding, ASCs may have little connection to local health systems, possibly placing them outside health reform's reach.
Using all-payer data from Florida (2005-2009), we identified all ASCs and hospitals active in the state. Using the tools of social network analysis, we then measured each ASC's strength of connection to nearby hospitals on the basis of the number of surgeons shared between facilities. Finally, we determined the proportion of all procedures and charges accounted for by (1) ASCs that are strongly connected to their local health system, (2) those that are weakly connected, and (3) those that are unconnected.
Of the 1.4 million procedures performed in Florida ASCs each year, fewer than 250,000 occur at unconnected and weakly connected ASCs. Put differently, 83% of the $4.3 billion in charges for ASC-based care originate from facilities that have substantial integration with their local health system. Although weakly and strongly connected ASCs are similar from an organizational perspective, unconnected ones tend to focus on a single specialty (P = 0.026) and are staffed by fewer physicians (P = 0.013). Furthermore, there is a trend toward fewer unconnected ASCs over time (P = 0.080).
Most ASCs are strongly connected to their local health system. Thus, efforts to constrain spending should target population-based rates of surgery, not unconnected ASCs.
评估目前在与附近医院没有关联的门诊手术中心（ASC）进行的门诊手术比例。
ASC 作为门诊手术的场所是医疗保健领域发展最快的领域之一。由于大多数 ASC 是独立的，它们可能与当地的卫生系统联系甚少，这可能使它们处于卫生改革的范围之外。
利用来自佛罗里达州的所有付款人的数据（2005-2009 年），我们确定了该州活跃的所有 ASC 和医院。然后，我们使用社交网络分析工具，根据设施之间共享的外科医生数量，衡量每个 ASC 与附近医院的连接强度。最后，我们确定了以下三种情况所占的全部手术和费用的比例：（1）与当地卫生系统紧密相连的 ASC；（2）与当地卫生系统关联较弱的 ASC；（3）与当地卫生系统没有关联的 ASC。
在佛罗里达州每年进行的 140 万例 ASC 手术中，不到 25 万例手术发生在无关联和关联较弱的 ASC。换句话说，ASC 基础护理费用的 43 亿美元中，有 83%来自与当地卫生系统有实质性整合的机构。虽然从组织角度来看，弱关联和强关联的 ASC 相似，但无关联的 ASC 往往专注于单一专业（P = 0.026），并且医生人数较少（P = 0.013）。此外，无关联的 ASC 数量呈下降趋势（P = 0.080）。
大多数 ASC 与当地卫生系统紧密相连。因此，控制支出的努力应针对基于人群的手术率，而不是针对无关联的 ASC。
