Separate and concentrate: accounting for patient complexity in general hospitals
Institute for Operations Research and the Management Sciences
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Kuntz, L., Scholtes, S., & Suelz, S. (2019). Separate and concentrate: accounting for patient complexity in general hospitals. Management Science, 65 (6), 2445-2945. https://doi.org/10.1287/mnsc.2018.3064
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.
External DOI: https://doi.org/10.1287/mnsc.2018.3064
This record's URL: https://www.repository.cam.ac.uk/handle/1810/288626