Hub and spoke framework for study of surgical centralization within United States health systems.
Administrative data uses
Health care organizations and systems
Integrated delivery systems
Quality of care/patient safety
Surgery
Journal
American journal of surgery
ISSN: 1879-1883
Titre abrégé: Am J Surg
Pays: United States
ID NLM: 0370473
Informations de publication
Date de publication:
10 2023
10 2023
Historique:
received:
24
02
2023
revised:
12
04
2023
accepted:
03
05
2023
pmc-release:
01
10
2024
medline:
4
9
2023
pubmed:
9
5
2023
entrez:
8
5
2023
Statut:
ppublish
Résumé
Hospital consolidation into health systems has mixed effects on surgical quality, potentially related to degree of surgical centralization at high-volume (hub) sites. We developed a novel measure of centralization and evaluated a hub and spoke framework. Surgical centralization within health systems was measured using hospital surgical volumes (American Hospital Association) and health system data (Agency for Healthcare Research and Quality). Hub and spoke hospitals were compared using mixed effects logistic regression and system characteristics associated with surgical centralization were identified using a linear model. Within 382 health systems containing 3022 hospitals, system hubs perform 63% of cases (IQR 40-84%). Hubs are larger, in metropolitan and urban areas, and more often academically affiliated. Degree of surgical centralization varies ten-fold. Larger, multistate, and investor-owned systems are less centralized. Adjusting for these factors, there is less centralization among teaching systems (p < 0.001). A hub-spoke framework applies to most health systems but centralization varies significantly. Future studies of health system surgical care should assess the contributions of surgical centralization and teaching status on differential quality.
Sections du résumé
BACKGROUND
Hospital consolidation into health systems has mixed effects on surgical quality, potentially related to degree of surgical centralization at high-volume (hub) sites. We developed a novel measure of centralization and evaluated a hub and spoke framework.
METHODS
Surgical centralization within health systems was measured using hospital surgical volumes (American Hospital Association) and health system data (Agency for Healthcare Research and Quality). Hub and spoke hospitals were compared using mixed effects logistic regression and system characteristics associated with surgical centralization were identified using a linear model.
RESULTS
Within 382 health systems containing 3022 hospitals, system hubs perform 63% of cases (IQR 40-84%). Hubs are larger, in metropolitan and urban areas, and more often academically affiliated. Degree of surgical centralization varies ten-fold. Larger, multistate, and investor-owned systems are less centralized. Adjusting for these factors, there is less centralization among teaching systems (p < 0.001).
CONCLUSIONS
A hub-spoke framework applies to most health systems but centralization varies significantly. Future studies of health system surgical care should assess the contributions of surgical centralization and teaching status on differential quality.
Identifiants
pubmed: 37156679
pii: S0002-9610(23)00192-7
doi: 10.1016/j.amjsurg.2023.05.006
pmc: PMC10524175
mid: NIHMS1900945
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
524-530Subventions
Organisme : NCI NIH HHS
ID : U01 CA213140
Pays : United States
Organisme : AHRQ HHS
ID : U18 HS027946
Pays : United States
Organisme : NIDDK NIH HHS
ID : P30 DK079626
Pays : United States
Organisme : NIA NIH HHS
ID : P30 AG031054
Pays : United States
Organisme : NCATS NIH HHS
ID : KL2 TR003097
Pays : United States
Organisme : NCI NIH HHS
ID : K08 CA237881
Pays : United States
Organisme : AHRQ HHS
ID : R01 HS025703
Pays : United States
Organisme : NHLBI NIH HHS
ID : UH2 HL130691
Pays : United States
Organisme : NCI NIH HHS
ID : U24 CA055727
Pays : United States
Organisme : NCI NIH HHS
ID : R03 CA270671
Pays : United States
Organisme : NCI NIH HHS
ID : R21 CA259808
Pays : United States
Organisme : NCI NIH HHS
ID : UG1 CA189955
Pays : United States
Organisme : NCI NIH HHS
ID : R01 CA248439
Pays : United States
Organisme : NCI NIH HHS
ID : U54 CA267746
Pays : United States
Organisme : NCI NIH HHS
ID : R35 CA220502
Pays : United States
Organisme : NIMHD NIH HHS
ID : R01 MD013858
Pays : United States
Organisme : NIDDK NIH HHS
ID : R01 DK106041
Pays : United States
Organisme : NCCIH NIH HHS
ID : R61 AT010802
Pays : United States
Organisme : NCI NIH HHS
ID : U01 CA246567
Pays : United States
Organisme : NIMHD NIH HHS
ID : K23 MD017288
Pays : United States
Organisme : NCI NIH HHS
ID : P50 CA107399
Pays : United States
Organisme : NCI NIH HHS
ID : K08 CA234225
Pays : United States
Commentaires et corrections
Type : CommentIn
Informations de copyright
Published by Elsevier Inc.
Déclaration de conflit d'intérêts
Declaration of competing interest The authors declare no conflict of interest
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