Shay Patrick D, Mick Stephen S Farnsworth
Department of Health Care Administration, Trinity University, One Trinity Place, #58, San Antonio, TX, 78212, USA.
Department of Health Administration, School of Allied Health Professions, Virginia Commonwealth University, P.O. Box 980203, Richmond, VA, 23298, USA.
Health Care Manag Sci. 2017 Sep;20(3):303-315. doi: 10.1007/s10729-016-9353-7. Epub 2016 Jan 16.
Despite their prevalence and power in markets throughout the United States, local multihospital systems (LMSs)-also referred to as hospital-based "clusters"-remain an understudied organizational form, with studies instead primarily focusing either upon individual hospitals or viewing hospital systems collectively without distinguishing the local "sub-systems" that comprise larger regional or national hospital chains. To better understand these organizational forms, we develop a taxonomy specifically devoted to LMSs, applying taxonomic analysis methods to a sample of LMSs in six U.S. states while accounting for LMSs' geographic arrangements and non-hospital-based service locations. Our analysis identifies five distinct LMS categories, with forms clearly distinguished according to their varying degrees of differentiation and integration. The study's results accentuate the importance of accounting for hospital systems' activities and arrangements in local markets-including their non-hospital-based sites-and highlight differences in systems' achievement of integration and coordination across services and locations, providing considerations in light of U.S. health system reform as well as international patterns of regional system formation.
尽管地方多医院系统（LMS）在美国各地的市场中普遍存在且颇具影响力，但这种组织形式仍未得到充分研究。此前的研究主要集中在个别医院，或者将医院系统作为一个整体看待，而没有区分构成更大区域或全国性医院连锁的地方“子系统”。为了更好地理解这些组织形式，我们专门为地方多医院系统开发了一种分类法，将分类分析方法应用于美国六个州的地方多医院系统样本，同时考虑到地方多医院系统的地理布局和非医院服务地点。我们的分析确定了五个不同的地方多医院系统类别，这些类别根据其不同程度的分化和整合而明显区分开来。该研究结果强调了考虑医院系统在地方市场（包括其非医院地点）的活动和布局的重要性，并突出了各系统在跨服务和地点实现整合与协调方面的差异，为美国医疗系统改革以及区域系统形成的国际模式提供了参考。
