Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA.
Health Care Management, The Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Health Serv Res. 2022 Apr;57(2):248-258. doi: 10.1111/1475-6773.13876. Epub 2021 Sep 28.
To examine the effects of hospital membership in affiliation networks-franchise-like networks sponsored by high-quality health systems in which affiliate hospitals pay an annual fee for access to sponsor's operational and clinical resources-on clinical quality, patient experience ratings, and financial performance of affiliates and their competitors.
Network membership data from press releases and websites of four sponsors (Mayo Clinic, Cleveland Clinic, MD Anderson, Memorial Sloan Kettering), American Hospital Association's Annual Survey, Centers for Medicare & Medicaid Services' Hospital Compare, and Healthcare Cost Report Information System, all for 2005-2016.
We used a quasi-experimental design and estimated hospital-level regressions with hospital-fixed effects. Dependent variables were measures of clinical quality, patient experience, and financial performance. Independent variables included an indicator for affiliate versus nonaffiliate and fixed effects for hospital characteristics and year. To analyze effects on competitors, we repeated analyses by comparing hospitals in the same county as an affiliate to nonaffiliated, noncompetitor hospitals.
Membership was obtained through press releases and network websites then linked across datasets by name and Medicare's identification number.
Across networks, affiliates (N = 199) experienced insignificant clinical quality changes but increased net income by $38,500 and operating margin by 6.6% (p values = 0.01-0.08) compared to nonaffiliates. Multispecialty affiliates improved on no measures. Cancer-specific affiliates improved their net income ($96,900) and operating margin (3.6%; p-values < 0.05). Affiliates' competitors experienced mixed changes in clinical measures relative to hospitals without affiliates in market (p-value < 0.05) but no financial effects. Affiliation was not associated with patient experience ratings for affiliates nor competitors.
Despite quality-focused missions, affiliation networks are not guaranteed to improve public measures of quality in affiliated hospitals, although hospitals in these communities improve financially. Future research should assess the conditions and mechanisms by which affiliation improves quality consistently and which forms of quality.
研究医院在附属网络中的成员资格（由高质量医疗系统赞助的特许经营网络，附属医院需缴纳年费以获取赞助机构的运营和临床资源）对附属医院及其竞争对手的临床质量、患者体验评分和财务绩效的影响。
2005 年至 2016 年，来自四个赞助商（梅奥诊所、克利夫兰诊所、MD 安德森癌症中心、纪念斯隆凯特琳癌症中心）的新闻稿和网站、美国医院协会年度调查、医疗保险和医疗补助服务中心的医院比较以及医疗保健成本报告信息系统的网络成员数据。
我们使用准实验设计和医院固定效应的医院水平回归进行估计。因变量是临床质量、患者体验和财务绩效的衡量标准。自变量包括附属与非附属的指标，以及医院特征和年份的固定效应。为了分析对竞争对手的影响，我们通过将附属医院与同一县的非附属、非竞争对手医院进行比较，重复了分析。
成员资格通过新闻稿和网络网站获得，然后通过名称和医疗保险的识别号码在多个数据集之间进行链接。
在各个网络中，附属医院（N=199）的临床质量变化不显著，但与非附属医院相比，净利润增加了 38500 美元，运营利润率提高了 6.6%（p 值=0.01-0.08）。多专科附属医院在没有任何措施上有所改善。癌症专科医院提高了净利润（96900 美元）和运营利润率（3.6%；p 值<0.05）。附属医院的竞争对手与市场上没有附属医院的医院相比，临床指标变化混合（p 值<0.05），但没有财务影响。附属关系与附属医院和竞争对手的患者体验评分均无关。
尽管附属网络以质量为重点，但不能保证其能够改善附属医院公共质量指标，尽管这些社区的医院在财务上有所改善。未来的研究应该评估附属关系通过何种条件和机制持续改善质量，以及改善何种形式的质量。
