Quality of Care and Interhospital Collaboration

A Study of Patient Transfers in Italy

Datos Bibliográficos

ID9102684
AutoresA Lomi (0000-0002-2858-0022, Università della Svizzera italiana, autor de correspondencia), Daniele Mascia (0000-0002-9255-3520, Università Cattolica del Sacro Cuore), Duy Vu (0000-0002-5699-2737, The University of Melbourne), Duy Quang Vu, Francesca Pallotti (0000-0002-1045-4722, University of Greenwich), Guido Conaldi (0000-0003-3552-7307, University of Greenwich), Theodore J Iwashyna (0000-0002-4226-9310, University of Michigan)
Año2014
Volumen52
Número5
Páginas407-414
Fecha de publicación2014-05-01
Peer ReviewedSí
Open AccessNo
TipoARTICLE
RevistaMedical Care (JOURNAL)
Identificadores de la revistaISSN: 0025-7079 • E-ISSN: 1537-1948
EditorialOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/mlr.0000000000000107
PMID24714579
PMCIDPMC4036796
OpenAlexW2148351912
IdiomaEN
Citas recibidas24
Referencias citadas13

OBJECTIVES: We examine the dynamics of patient-sharing relations within an Italian regional community of 35 hospitals serving approximately 1,300,000 people. We test whether interorganizational relations provide individual patients access to higher quality providers of care. RESEARCH DESIGN AND METHODS: We reconstruct the complete temporal sequence of the 3461 consecutive interhospital patient-sharing events observed between each pair of hospitals in the community during 2005-2008. We distinguish between transfers occurring between and within different medical specialties. We estimate newly derived models for relational event sequences that allow us to control for the most common forms of network-like dependencies that are known to characterize collaborative relations between hospitals. We use 45-day risk-adjusted readmission rate as a proxy for hospital quality. RESULTS: After controls (eg, geographical distance, size, and the existence of prior collaborative relations), we find that patients flow from less to more capable hospitals. We show that this result holds for patient being shared both between as well as within medical specialties. Nonetheless there are strong and persistent other organizational and relational effects driving transfers. CONCLUSIONS: Decentralized patient-sharing decisions taken by the 35 hospitals give rise to a system of collaborative interorganizational arrangements that allow the patient to access hospitals delivering a higher quality of care. This result is relevant for health care policy because it suggests that collaborative relations between hospitals may produce desirable outcomes both for individual patients, and for regional health care systems

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