Shortell Stephen M, Wu Frances M, Lewis Valerie A, Colla Carrie H, Fisher Elliott S
School of Public Health, University of California, Berkeley, Berkeley, CA.
Health Serv Res. 2014 Dec;49(6):1883-99. doi: 10.1111/1475-6773.12234. Epub 2014 Sep 23.
To develop an exploratory taxonomy of Accountable Care Organizations (ACOs) to describe and understand early ACO development and to provide a basis for technical assistance and future evaluation of performance.
DATA SOURCES/STUDY SETTING: Data from the National Survey of Accountable Care Organizations, fielded between October 2012 and May 2013, of 173 Medicare, Medicaid, and commercial payer ACOs.
Drawing on resource dependence and institutional theory, we develop measures of eight attributes of ACOs such as size, scope of services offered, and the use of performance accountability mechanisms. Data are analyzed using a two-step cluster analysis approach that accounts for both continuous and categorical data.
We identified a reliable and internally valid three-cluster solution: larger, integrated systems that offer a broad scope of services and frequently include one or more postacute facilities; smaller, physician-led practices, centered in primary care, and that possess a relatively high degree of physician performance management; and moderately sized, joint hospital-physician and coalition-led groups that offer a moderately broad scope of services with some involvement of postacute facilities.
ACOs can be characterized into three distinct clusters. The taxonomy provides a framework for assessing performance, for targeting technical assistance, and for diagnosing potential antitrust violations.
制定一个负责医疗组织（ACO）的探索性分类法，以描述和理解早期ACO的发展，并为技术援助和未来绩效评估提供基础。
数据来源/研究背景：2012年10月至2013年5月期间对173个医疗保险、医疗补助和商业支付者ACO进行的全国负责医疗组织调查的数据。
借鉴资源依赖理论和制度理论，我们制定了ACO八个属性的衡量指标，如规模、提供的服务范围以及绩效问责机制的使用情况。使用两步聚类分析方法对数据进行分析，该方法兼顾了连续数据和分类数据。
我们确定了一个可靠且内部有效的三聚类解决方案：规模较大、提供广泛服务范围且经常包括一个或多个急性后期设施的综合系统；规模较小、以初级保健为中心、由医生主导且具备较高程度医生绩效管理的医疗机构；以及规模适中、由医院和医生联合以及联盟主导、提供适度广泛服务范围且有一些急性后期设施参与的团体。
ACO可分为三个不同的类别。该分类法为评估绩效、确定技术援助目标以及诊断潜在的反垄断违规行为提供了一个框架。
