Search

Despite the prevalence of vertical integration, data and research focused on identifying and describing health systems are sparse. Until recently, we lacked an enumeration of health systems and an understanding of how systems vary by key structural attributes. To fill this gap, the Agency for Healthcare Research and Quality developed the Compendium of U.S. Health Systems, a data resource to support research on comparative health system performance. In this article, we describe the methods used to create the Compendium and present a picture of vertical integration in the United States. We identified 626 health systems in 2016, which accounted for 70% of nonfederal general acute care hospitals. These systems varied by key structural attributes, including size, ownership, and geographic presence. The Compendium can be used to study the characteristics of the U.S. health care system and address policy issues related to provider organizations.

Performance management systems (PMSYS) aid in improving the quality and efficiency of care, but little is known about factors that influence more robust PMSYS among physician organizations. Using a nationally representative survey of U.S. medical practices, we examined the extent to which organizational capabilities and external factors were associated with more developed PMSYS. Linear regression estimated the relative impact of these factors on PMSYS. On average, practices implemented a minority (32 points out of 100) of the PMSYS processes assessed. Practices evaluated ( p < .01) or financially incentivized by external entities ( p < .01), receiving data from health plans ( p < .01), participating in an accountable care organization ( p < .01), affiliating with an independent practice association and/or physician–hospital organization ( p < .01), and using health information technology ( p < .01) and chronic disease registries ( p < .01) to greater degrees had more robust PMSYS. PMSYS of medical practices are underdeveloped, although both external incentives and organizational capabilities may support PMSYS development.

This paper measures the extent to which medical groups experience external pay-for-performance incentives based on quality and patient satisfaction and the extent to which these groups pay their primary care and specialist physicians using similar criteria. Over half (52%) of large medical groups received bonus payments from health insurance plans in the period 2006–2007 based on measures of quality and patient satisfaction. Medical groups facing external pay-for-performance incentives are more likely to pay their primary care physicians (odds ratio [OR] 4.5; p

Purpose. To document use of health risk appraisals (HRAs) by U.S. physician organizations as part of their overall approach to health promotion and to identify associated organizational characteristics. Methods. Telephone survey of 1590 physician organizations in the United States; surveys were conducted in organizations comprising 20 or more physicians and were conducted between September 2000 and September 2001 (70% response rate). Chi-square tests and logistic regression analysis were used to examine the association between organizational characteristics and routine administration of HRAs. Results. Only 22.5% of physician organizations in the United States routinely administer HRAs. External quality incentives, information technology capabilities, and status as a medical group vs. an independent practice association are associated with greater odds of the routine use of HRA. Discussion. Increased use of external quality incentives and information technology in physician organizations may be important in supporting the use of HRAs.

The performance of medical groups is receiving increased attention. Relatively little conceptual or empirical work exists that examines the various dimensions of medical group performance. Using a national database of 693 medical groups, this article develops a scorecard approach to assessing group performance and presents a theory-driven framework for differentiating between high-performing versus low-performingmedical groups. The clinical quality of care, financial performance, and organizational learning capability of medical groups are assessed in relation to environmental forces, resource acquisition and resource deployment factors, and a quality-centered culture. Findings support the utility of the performance scorecard approach and identification of a number of key factors differentiating high-performing from low-performing groups including, in particular, the importance of a quality-centered culture and the requirement of outside reporting from third party organizations. The findings hold a number of important implications for policy and practice, and the framework presented provides a foundation for future research.

There is growing consensus that the U.S. health care system is not producing value relative to the resources invested. Unwarranted variation exists in quality and outcomes of care and underutilization of both evidence-based medicine and evidence-management practices. To address these issues, this article calls for a broad-based social science approach focused on obtaining a greater understanding of change at the individual, group, organizational, and environmental levels as they influence each other. Specific examples and questions for research are suggested with regard to the redesign of care systems, enhancing learning and transferring knowledge, and creating effective financial incentives. The specific measurement, analysis, and study design issues involved in under-taking such a research agenda are discussed.

Sustainability is a key requirement for partnership success and a major challenge for such organizations. Despite the critical importance of sustainability to the success of community health partnerships and the many threats to sustainability, there is little evidence that would provide partnerships with clear guidance on long-term viability. This article attempts to (1) develop a conceptual model of sustainability in community health partnerships and (2) identify potential determinants of sustainability using comparative qualitative data from four partnerships from the Community Care Network (CCN) Demonstration Program. Based on a grounded theory examination of qualitative data from the CCNevaluation, the authors hypothesize that there are five primary attributes/ activities of partnerships leading to consequential value and eventually to sustainability of collaborative capacity. They include outcomes-based advocacy, vision-focus balance, systems orientation, infrastructure development, and community linkages. The context in which the partnership operates provides the conditions for determining the appropriateness and relative impact of each of the factors related to creating consequential value in the partnership.

Investment in voluntary partnerships raises important questions: Should we invest in collaboration in moving toward the goals of health system redesign? What makes collaborative groups effective? Given the voluntary nature of these partnerships, membership perceptions of their experiences and the partnership’s effectiveness should be important predictors of success. This article provides a preliminary analyses of perceived effectiveness of participants’ perceptions of their own partnership, particularly focusingon leadership, conflict management, decision-making dynamics, and the breadth and depth of partnership membership. Members’ perceptions that the partnership membership was “sufficiently broad to accomplish objectives” had a negative and highly significant relationship to perceived effectiveness. Members’ perceptions about leadership beingethical was positively related to perceived effectiveness while perceptions that the leadership was not effective a keeping the group focused was negatively related to perceived effectiveness.

This study proposes and develops one way to examine dynamics and performance of voluntary community health partnerships through the development of a social capital index. Selected questions from a pre-existing survey [1] were used to construct three first-order concepts: Trust, Involvement, and Reciprocity. A second-order concept, Social Capital, was then derived. Individual scores were aggregated to the partnership level, and a social capital index was constructed. For validity testing, relationships of the index and accomplishment measures were examined. The index was also related to field notes on three partnerships. The chi-square value of the model indicates the concept of social capital was well captured with survey data. The index is significantly correlated with perceived accomplishment measures. The social capital concept is a viable perspective for examining community health partnerships. Its introduction should enrich our understanding of inter-organizational dynamics and performance. More extensive modeling illustrating the dynamics and performance of partnerships can be developed based on this concept.

The configurational theory of organizations was used to analyze the relationships among organization environment, structure, and performance in proprietary nursing homes. This theory extends previous contingency theory research and conceptualization by including performance as the main focus behind organization design activities. Thirty proprietary nursing homes in the state of Washington responded to comprehensive interviews and survey questionnaires designed to measure variables specified in the configurational theory. The results of this study suggest partial support for the configurational theory; most notably in explaining differences in efficiency among nursing homes operating in low intensity environments.

This paper refines existing conceptualizations of organizational task environments by distinguishing among environmental complexity, diversity, instability, uncertainty, dependence, and hostility. Based on these concepts, a typology is presented that suggests that certain combinations of environmental dimensions are important for classifying organizations. Further, the various combinations of environmental dimensions are used to specify a configurational theory of organizations by suggesting interaction effects between the various environmental dimensions and internal organizational design. Based on the typology of environmental dimensions and three premises, twelve propositions are derived for empirical testing. The existing literature relevant to some of the propositions is reviewed, the strengths and limitations of the theory are presented, and some implications for organizational research are discussed, particularly in terms of constructing more comprehensive theories of organizations.

Recent changes in the hospital operating environment and physician-supply patterns have begun to erode the historical separation between hospital management-governance and physicians. We examine alternative mechanisms whereby physicians are integrated into the hospital's management-policNmaking structure and test a number of hxpotheses related to the conditions under which various forms of integration occur. Because regulatory intensity, physician competition, and hospital corporatization enhance managerial power vis-a-vis physicians so that there is greater balance, they are hypothesized to result in more integrated hospital-physician relationships. Results of multivariate analyses of a sample of 1, 981 general, short-term hospitals provide general support for our hypotheses regarding the effects of regulation and physician competition; however, the degree and type of hospital-physician integration are shown to varY by the ownership of the corporate organization with which the hospital is affiliated.

Patterns of referral among internists in private practice are examined in terms of the rewards and costs perceived by physicians occupying different levels of professional status in the medical community. Referral patterns are highly related to professional status networks. High status internists showed the most cohesive patterns of referral and low status the least. Findings pertaining to the institutionalization of reciprocity, as well as the influence of social friendships, distance between offices, and hospital appointments are discussed. Policy implications and areas for further research are suggested.