Jie Chen, PhD, is Associate Professor, Health Services Administration, School of Public Health, University of Maryland at College Park. E-mail:
Health Care Manage Rev. 2020 Oct/Dec;45(4):332-341. doi: 10.1097/HMR.0000000000000232.
Hospital investments in care coordination services and innovative delivery models represent an important source for improving care efficiency and population health.
The aim of this study was to explore variation of hospital-initiated care coordination services and participation in Accountable Care Organizations (ACOs) by community characteristics within an organizational theory framework.
Our main data sets included the 2015 American Hospital Association Annual Survey, Survey of Care Systems and Payment, American Community Survey, and Area Health Resource File. Two main outcomes were (a) hospital-reported initiation of care coordination practices (such as chronic disease management, post-hospital discharge continuity of care, and predictive analytics) and (b) participation in ACO models. State fixed-effects models were used to test the association between the adoption of care coordination practices and hospital characteristics, community-level sociodemographic characteristics, and health policies.
Hospitals with large bed size, located in urban areas, and/or with high volume of operations were more likely to adopt care coordination practices and participate in the ACO models. Hospitals serving communities with high uninsurance rates and/or poverty rates were significantly less likely to provide care coordination practices. More stringent Community Benefit Laws (CBLs) were positively associated with the implementation of care coordination practices suggesting strong normative impacts of CBLs.
Greater hospital-initiated care coordination practices and innovative ACO models were available in well-resourced areas. Policymakers may consider increasing resources for care coordination practices in rural, underserved, and high-poverty-high-uninsured areas to ensure that vulnerable populations can benefit from these services.
医院在护理协调服务和创新交付模式上的投资是提高护理效率和改善人口健康的重要来源。
本研究旨在从组织理论框架的角度，探讨社区特征对医院发起的护理协调服务和参与问责制医疗组织（ACO）的差异。
我们的主要数据来源包括 2015 年美国医院协会年度调查、护理系统和支付调查、美国社区调查和区域卫生资源档案。主要结果有（a）医院报告的护理协调实践的启动情况（如慢性病管理、出院后连续性护理和预测分析）和（b）参与 ACO 模式的情况。采用州固定效应模型检验了护理协调实践的采用与医院特征、社区层面的社会人口特征和卫生政策之间的关系。
床位数较大、位于城市地区且/或手术量较大的医院更有可能采用护理协调实践并参与 ACO 模式。为高未保险率和/或高贫困率社区服务的医院提供护理协调服务的可能性显著较低。更严格的社区福利法规（CBL）与护理协调实践的实施呈正相关，这表明 CBL 具有较强的规范性影响。
在资源充足的地区，医院发起的护理协调实践和创新的 ACO 模式更为常见。政策制定者可能需要考虑为农村、服务不足和高贫困高未保险地区的护理协调实践提供更多资源，以确保弱势群体能够从这些服务中受益。
