Patrick D. Shay, PhD, MS, Assistant Professor, Trinity University, San Antonio, Texas.
Health Care Manage Rev. 2021;46(4):319-331. doi: 10.1097/HMR.0000000000000275.
Local multihospital systems (LMSs) commonly struggle to effectively coordinate across system members. Although a recent taxonomy of LMSs found the majority of systems to display lower levels of differentiation, integration, and coordination, some categories of LMS forms exhibited higher levels of integration and coordination.
This study examines organizational and environmental factors associated with LMS forms displaying higher levels of integration and coordination.
METHODOLOGY/APPROACH: Applying a multitheoretical framework and drawing from sources including the American Hospital Association Annual Survey, Intellimed databases, and primary data collected from LMS communications, descriptive and multinomial logistic regression analyses were conducted to examine the association between LMS forms and varied organizational and environmental characteristics among LMSs in Florida, Maryland, Nevada, Texas, Virginia, and Washington.
The results of analysis of variance, Games-Howell, and Fisher's exact tests identified significant relationships between each of the five LMS categories and varying market, competitive, organizational, and operational factors. A multinomial logistic regression analysis also distinguished the three most common LMS forms according to organizational and environmental factors.
Recognizing the varied degrees of integration and coordination across LMSs today, the results point to several factors that may explain such variation, including market size and resources, local competitors and their forms, organizational size and ownership, patient complexity, and regulatory restrictions.
With the continued promotion and development of innovative health care reform models and with the progressing expansion of care into outpatient sites and diverse settings, LMSs will continue to face greater pressure to integrate and coordinate services throughout the continuum of care across system components and service locations. Navigating the challenges of effective coordination requires administrators and policymakers to be cognizant of the organizational and environmental factors that may hinder or fuel coordination efforts across system components in local markets.
地方多医院系统（LMS）通常难以在系统成员之间有效协调。尽管最近的 LMS 分类法发现大多数系统表现出较低水平的分化、整合和协调，但一些 LMS 形式的类别表现出更高水平的整合和协调。
本研究考察了与表现出更高水平整合和协调的 LMS 形式相关的组织和环境因素。
方法/方法：本研究应用多理论框架，并借鉴美国医院协会年度调查、Intellimed 数据库以及从 LMS 通信中收集的主要数据，进行描述性和多项逻辑回归分析，以考察佛罗里达州、马里兰州、内华达州、德克萨斯州、弗吉尼亚州和华盛顿州的 LMS 中 LMS 形式与各种组织和环境特征之间的关联。
方差分析、Games-Howell 和 Fisher 精确检验的结果表明，五种 LMS 类别中的每一种与不同的市场、竞争、组织和运营因素之间存在显著关系。一项多项逻辑回归分析还根据组织和环境因素区分了三种最常见的 LMS 形式。
鉴于当今 LMS 之间存在不同程度的整合和协调，研究结果指出了一些可能解释这种差异的因素，包括市场规模和资源、当地竞争对手及其形式、组织规模和所有权、患者复杂性以及监管限制。
随着创新型医疗改革模式的持续推广和发展，以及护理向门诊和各种场所的不断扩展，LMS 将继续面临更大的压力，需要在整个系统组件和服务地点的护理连续体中整合和协调服务。要应对有效协调的挑战，管理人员和政策制定者需要意识到可能阻碍或推动当地市场系统组件之间协调努力的组织和环境因素。
