University of Delaware, Newark, DE, USA.
University of Pittsburgh, Pittsburgh, PA, USA.
Med Care Res Rev. 2022 Feb;79(1):46-57. doi: 10.1177/1077558720972596. Epub 2020 Nov 13.
With the growth of vertical integration among physician practices (i.e., hospital-physician integration), there have been many studies of its effects on health care treatments and spending. It is unknown if integration shapes provider configurations, especially against the backdrop of increasing employment of nurse practitioners (NPs) and physician assistants (PAs) across specialties. Using a longitudinal panel of 144,289 practices (2008-2015), we examined the association of vertical integration with NP and PA employment. We find positive associations between vertical integration and newly employing NPs and PAs within physician practices; however, the relationships differ by practice specialty type as well as timing of vertical integration. Supplementary analyses offer supporting evidence for coinciding enhancements to practice productivity, diversification, and provider task allocation. Our results suggest that vertical integration may promote interdisciplinary provider configurations, which has the potential to improve care delivery efficiency.
随着医生执业机构（即医院-医生一体化）的垂直整合的增长，已经有许多关于其对医疗保健治疗和支出影响的研究。目前尚不清楚整合是否会影响供应商的配置，尤其是在各专业领域越来越多地雇佣护士从业者（NPs）和医师助理（PAs）的背景下。本研究使用了一个纵向的 144289 个实践案例（2008-2015 年）的面板，考察了垂直整合与 NP 和 PA 就业之间的关联。我们发现，垂直整合与医生实践中雇佣新的 NP 和 PA 之间存在正相关关系；然而，这种关系因实践专业类型以及垂直整合的时间而有所不同。补充分析为实践生产力、多样化和提供者任务分配的协同增强提供了支持证据。我们的结果表明，垂直整合可能会促进跨学科的供应商配置，这有可能提高护理服务效率。
