医疗实践整合与医师共享患者网络的规模、强度和稳定性。

Medical Practice Consolidation and Physician Shared Patient Network Size, Strength, and Stability.

机构信息

Veterans Affairs Health Services Research & Development Center for the Study of Healthcare Innovation, Implementation, & Policy and RAND Corporation.

RAND Corporation, University of California-Berkeley, Santa Monica.

出版信息

Med Care. 2019 Sep;57(9):680-687. doi: 10.1097/MLR.0000000000001168.

DOI:10.1097/MLR.0000000000001168

PMID:31295166

Abstract

BACKGROUND

Properties of social networks and shared patient networks of physicians are associated with important outcomes, including costs, quality, information exchange, and organizational effectiveness.

OBJECTIVES

To determine whether practice consolidation affects size, strength, and stability of US practice-based physician shared patient networks.

RESEARCH DESIGN

We used a dynamic difference-in-differences (event study) design to determine how 2 types of vertical consolidation (hospital and health system practice acquisition) and 2 types of horizontal consolidation (medical group membership and practice-practice mergers) affect individual shared patient network characteristics, controlling for physician fixed effects and geographic market (metropolitan statistical area).

SUBJECTS

Practice-based US physicians whose practices consolidated 2009-2014 are identified via health system, hospital, and medical group affiliation information and appearance/disappearance of listed practice affiliations in the SK&A Physician Database.

MEASURES

Outcomes measured were network size (number of individual physicians with whom a physician shares patients within 30 d), strength (average number of shared patients within those relationships), and stability (percent of shared patient relationships that persist in the current and prior year), all generated from Medicare Shared Patient Patterns (30-d) data.

RESULTS

Shared patient network stability increases significantly after acquisition of practices by horizontal practice-practice mergers [βt=1=0.041 (P<0.001), βt=2=0.047 (P<0.001), βt=3=0.041 (P<0.001), βt=4=0.031 (P<0.05), where t is the number of years after the consolidation event]. These effects were robust to sensitivity analyses. Shared patient network size and strength are not observably associated with practice consolidation events.

CONCLUSIONS

Practice consolidation can increase the stability of physician networks, which may have positive implications for organizational effectiveness.

摘要

背景

医生的社交网络和共享患者网络的属性与重要结果相关，包括成本、质量、信息交换和组织效率。

目的

确定实践整合是否会影响美国基于实践的医生共享患者网络的规模、强度和稳定性。

研究设计

我们使用动态差异（事件研究）设计来确定 2 种垂直整合（医院和医疗系统实践收购）和 2 种水平整合（医疗集团成员资格和实践-实践合并）如何影响个体共享患者网络特征，控制医生固定效应和地理市场（大都市统计区）。

受试者

通过医疗系统、医院和医疗集团的隶属关系信息以及 SK&A 医生数据库中列出的实践隶属关系的出现/消失，确定 2009-2014 年实践整合的美国基于实践的医生。

测量

测量的结果是网络规模（在 30 天内与医生共享患者的个体医生数量）、强度（这些关系中平均共享患者数量）和稳定性（在当前和前一年持续的共享患者关系百分比），所有这些都是从 Medicare Shared Patient Patterns（30 天）数据中生成的。

结果

通过水平实践-实践合并收购实践后，共享患者网络的稳定性显著增加[βt=1=0.041（P<0.001），βt=2=0.047（P<0.001），βt=3=0.041（P<0.001），βt=4=0.031（P<0.05），其中 t 是整合事件后的年数]。这些影响在敏感性分析中是稳健的。共享患者网络的规模和强度与实践整合事件没有明显关联。