Background
With more hospital consolidations as an inevitable part of our future health care
ecosystem, we investigated the relationship between hospital consolidations and operative
outcomes.
Methods
Using the Health Care Cost and Utilization Project State Inpatient Database (Florida
and California), the American Hospital Association Annual Survey Database, and Medicare's
Case Mix Index data, we identified 19 hospitals that consolidated between 2007 and
2013 and propensity matched them with 19 independent hospitals, using patient and
hospital characteristics. One year before consolidation and again 1 year after, we
used difference-in-differences analysis to compare changes in the risk-adjusted complication
rate of 7 elective operations performed in the consolidated hospitals and in the matched
control group.
Results
Of the 7 procedures studied, 2 procedures saw a decrease in complication rate (lumbar
and lumbosacral fusion of the posterior column posterior technique, difference-in-differences = −0.6%,
P < .01; total hip replacement, difference-in-differences = −0.6%, P < .01); 3 procedures saw an increase in complication rate (transurethral prostatectomy,
difference-in-differences = 4.1%, P < .01; cervical fusion of the anterior column anterior technique, difference-in-differences = 1.5%,
P < .01; total knee replacement, difference-in-differences = 0.3%, P < .01); and 2 procedures saw no change in complication rate (laparoscopic cholecystectomy,
lumbar and lumbosacral fusion of the anterior column posterior technique, both P > .05) after hospital consolidation.
Conclusion
Arguments have been made that consolidated health care systems can share high-performing
clinical services and infrastructure resources, such as electronic medical records,
to improve quality. Our results indicate that hospital consolidation does not uniformly
improve postoperative complication rates.
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Article info
Publication history
Published online: July 14, 2016
Accepted:
May 19,
2016
Footnotes
Supported by the National Institutes of Health grant T32 GM08750-16.
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
