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Separate and concentrate: accounting for patient complexity in general hospitals

Accepted version
Peer-reviewed

Type

Article

Change log

Authors

Kuntz, L 
Scholtes, S 
Suelz, S 

Abstract

Scholars have recently suggested the reorganization of general hospitals into organizationally separate divisions for routine and non-routine services to overcome operational misalignments between the two types of services. We provide empirical evidence for this proposal from a quality perspective, using over 250,000 patient discharge records from 60 German hospitals across 39 high-mortality disease segments, and focusing on in-hospital mortality as outcome. Disentangling the effects of high absolute and relative hospital volumes in a disease group, our analysis suggests that both routine and complex patients would benefit from a hospital organization with a multi-specialty hub for emergency and non-routine elective services at its core, complemented by organizationally separate disease-focused hospitals-within-hospitals for routine services. We also provide evidence that the hub hospital can further improve service quality for complex patients by adopting a disease-based rather than medical specialty-based departmental routing strategy for newly arriving patients. A counterfactual analysis, based on a simultaneous equations probit model that controls simultaneously for endogeneity of volume, focus, and routing strategy, suggests that the proposed reorganization could have reduced mortality in the sample by 13.43% (95% CI [6.87%; 18.95%]) for routine patients and by 11.67% (95% CI [6.13%; 16.86%]) for the most complex patients.

Description

Keywords

healthcare management, hospital, patient complexity, volume, focus, routing, solution shop, value-adding process, service quality, mortality

Journal Title

Management Science

Conference Name

Journal ISSN

0025-1909
1526-5501

Volume Title

65

Publisher

Institute for Operations Research and the Management Sciences