Carlin Caroline S, Dowd Bryan, Feldman Roger
Medica Research Institute, Minneapolis, MN.
Division of Health Policy and Management, University of Minnesota, Minneapolis, MN.
Health Serv Res. 2015 Aug;50(4):1043-68. doi: 10.1111/1475-6773.12274. Epub 2014 Dec 22.
To fill an empirical gap in the literature by examining changes in quality of care measures occurring when multispecialty clinic systems were acquired by hospital-owned, vertically integrated health care delivery systems in the Twin Cities area.
DATA SOURCES/STUDY SETTING: Administrative data for health plan enrollees attributed to treatment and control clinic systems, merged with U.S. Census data.
We compared changes in quality measures for health plan enrollees in the acquired clinics to enrollees in nine control groups using a differences-in-differences model. Our dataset spans 2 years prior to and 4 years after the acquisitions. We estimated probit models with errors clustered within enrollees.
DATA COLLECTION/EXTRACTION METHODS: Data were assembled by the health plan's informatics team.
Vertical integration is associated with increased rates of colorectal and cervical cancer screening and more appropriate emergency department use. The probability of ambulatory care-sensitive admissions increased when the acquisition caused disruption in admitting patterns.
Moving a clinic system into a vertically integrated delivery system resulted in limited increases in quality of care indicators. Caution is warranted when the acquisition causes disruption in referral patterns.
通过研究明尼阿波利斯地区由医院拥有的垂直整合医疗服务系统收购多专科诊所系统时护理质量指标的变化，填补文献中的实证空白。
数据来源/研究背景：归因于治疗和对照诊所系统的健康计划参保人的行政数据，与美国人口普查数据合并。
我们使用差异中的差异模型，将被收购诊所中健康计划参保人的质量指标变化与九个对照组中的参保人进行比较。我们的数据集涵盖收购前2年和收购后4年。我们估计了参保人内部误差聚类的概率模型。
数据收集/提取方法：数据由健康计划的信息学团队收集。
垂直整合与结直肠癌和宫颈癌筛查率的提高以及更合理地使用急诊科有关。当收购导致入院模式中断时，门诊护理敏感型入院的概率增加。
将诊所系统纳入垂直整合的医疗服务系统导致护理质量指标的有限提高。当收购导致转诊模式中断时，需要谨慎。
