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The European Journal of Health Economics
Published in: The European Journal of Health Economics 3/2018

Open Access 01-04-2018 | Original Paper

Hospital heterogeneity: what drives the quality of health care

Authors: Manhal Ali, Reza Salehnejad, Mohaimen Mansur

Published in: The European Journal of Health Economics | Issue 3/2018

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Abstract

A major feature of health care systems is substantial variation in health care quality across hospitals. The quality of stroke care widely varies across NHS hospitals. We investigate factors that may explain variations in health care quality using measures of quality of stroke care. We combine NHS trust data from the National Sentinel Stroke Audit with other data sets from the Office for National Statistics, NHS and census data to capture hospitals’ human and physical assets and organisational characteristics. We employ a class of non-parametric methods to explore the complex structure of the data and a set of correlated random effects models to identify key determinants of the quality of stroke care. The organisational quality of the process of stroke care appears as a fundamental driver of clinical quality of stroke care. There are rich complementarities amongst drivers of quality of stroke care. The findings strengthen previous research on managerial and organisational determinants of health care quality.
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Literature
1.
Aragon, M.J.A., Castelli, A., Gaughan, J.: Hospital trusts productivity in the english nhs: uncovering possible drivers of productivity variations. CHE University of York Research Paper 117 (2015)
2.
Athey, S., Stern, S.: An empirical framework for testing theories about complimentarity in organizational design. NBER Working Paper, National Bureau of Economic Research (1998)
3.
4.
Bijlsma, M.J., Koning, P.W., Shestalova, V.: The effect of competition on process and outcome quality of hospital care in the Netherlands. De Econ. 161(2), 121–155 (2013)
5.
Birkmeyer, J.D., Dimick, J.B.: Understanding and reducing variation in surgical mortality. Annu. Rev. Med. 60, 405–415 (2009)CrossRefPubMed
6.
Bloom, N., Lemos, R., Sadun, R., Scur, D., Reenen, J.V.: The new empirical economics of management. CEP Occasional Papers 41, Centre for Economic Performance, LSE (2014)
7.
Bloom, N., Propper, C., Seiler, S., Van Reenen, J.: The impact of competition on management quality: evidence from public hospitals. Rev. Econ. Stud. 82(2), 457–489 (2015)CrossRef
8.
Bloom, N., Sadun, R., Van Reenen, J.: Does management matter in healthcare? Stanford Mimeo (2014)
9.
Bloom, N., Van Reenen, J.: Measuring and explaining management practices across firms and countries. Q. J. Econ. 122(4), 1351–1408 (2007)CrossRef
10.
Bradley, E.H., Curry, L.A., Spatz, E.S., Herrin, J., Cherlin, E.J., Curtis, J.P., Thompson, J.W., Ting, H.H., Wang, Y., Krumholz, H.M.: Hospital strategies for reducing risk-standardized mortality rates in acute myocardial infarction. Ann. Intern. Med. 156(9), 618–626 (2012)CrossRefPubMedPubMedCentral
11.
Bradley, E.H., Herrin, J., Curry, L., Cherlin, E.J., Wang, Y., Webster, T.R., Drye, E.E., Normand, S.-L.T., Krumholz, H.M.: Variation in hospital mortality rates for patients with acute myocardial infarction. Am. J. Cardiol. 106(8), 1108–1112 (2010)CrossRefPubMed
12.
Bray, B.D., Ayis, S., Campbell, J., Hoffman, A., Roughton, M., Tyrrell, P.J., Wolfe, C.D., Rudd, A.G.: Associations between the organisation of stroke services, process of care, and mortality in England: prospective cohort study. BMJ 346, f2827 (2013)CrossRefPubMedPubMedCentral
13.
Breiman, L., Friedman, J., Stone, C.J., Olshen, R.A.: Classification and Regression Trees. CRC Press, Boca Raton (1984)
14.
Brynjolfsson, E., Milgrom, P.: Complementarity in organization. In: Gibbons, R., Roberts, J. (eds.) The Handbook of Organizational Economics. Princeton University Press, Princeton (2013)
15.
Burnham, K.P., Anderson, D.R.: Model Selection and Multimodel Inference: A Practical Information-theoretic Approach. Springer, Berlin (2002)
16.
Candelise, L., Gattinoni, M., Bersano, A., Micieli, G., Sterzi, R., Morabito, A., the PROSIT Study Group, et al.: Lancet stroke-unit care for acute stroke patients: an observational follow-up study. 369(9558), 299–305 (2007)
17.
18.
Chandra, A., Finkelstein, A., Sacarny, A., Syverson, C.: Productivity dispersion in medicine and manufacturing. Am. Econ. Rev. 106(5), 99–103 (2016)CrossRef
19.
Chen, L.M., Nallamothu, B.K., Krumholz, H.M., Spertus, J.A., Tang, F., Chan, P.S.: Association between a hospital’s quality performance for in-hospital cardiac arrest and common medical conditions. Circ. Cardiovasc. Qual. Outcomes 6(6), 700–707 (2013)CrossRefPubMedPubMedCentral
20.
Cho, S.-H., Yun, S.-C.: Bed-to-nurse ratios, provision of basic nursing care, and in-hospital and 30-day mortality among acute stroke patients admitted to an intensive care unit: cross-sectional analysis of survey and administrative data. Int. J. Nurs. Stud. 46(8), 1092–1101 (2009)CrossRefPubMed
21.
22.
Crombie, I., Davies, H.: Beyond health outcomes: the advantages of measuring process. J. Eval. Clin. Pract. 4(1), 31–38 (1998)CrossRefPubMed
23.
Farrar, S., Yi, D., Sutton, M., Chalkley, M., Sussex, J., Scott, A.: Has payment by results affected the way that English Hospitals provide care? Difference–in–differences analysis. BMJ 339, b3047 (2013)CrossRef
24.
Fine, J.M., Fine, M.J., Galusha, D., Petrillo, M., Meehan, T.P.: Patient and hospital characteristics associated with recommended processes of care for elderly patients hospitalized with pneumonia: results from the medicare quality indicator system pneumonia module. Arch. Intern. Med. 162(7), 827–833 (2002)CrossRefPubMed
25.
Flood, A.B.: The impact of organizational and managerial factors on the quality of care in health care organizations. Med. Care Res. Rev. 51(4), 381–428 (1994)CrossRef
26.
Friedman, M.: Essays in positive economics. University of Chicago Press (1953)
27.
Fu, W., Simonoff, J.S.: Unbiased regression trees for longitudinal and clustered data. Comput. Stat. Data Anal. 88, 53–74 (2015)CrossRef
28.
Garicano, L., Rayo, L.: Why organizations fail: models and cases. J. Econ. Lit. 54(1), 137–192 (2016)CrossRef
29.
Gaynor, M., Laudicella, M., Propper, C.: Can governments do it better? Merger mania and hospital outcomes in the english nhs. J. Health Econ. 31(3), 528–543 (2012)CrossRefPubMed
30.
Gaynor, M., Seider, H., Vogt, W.B.: The volume-outcome effect, scale economies, and learning-by-doing. Am. Econ. Rev. 95, 243–247 (2005)CrossRef
31.
Ghaferi, A.A., Birkmeyer, J.D., Dimick, J.B.: Variation in hospital mortality associated with inpatient surgery. New Engl. J. Med. 361(14), 1368–1375 (2009)CrossRefPubMed
32.
Gobillon, L., Milcent, C.: Spatial disparities in hospital performance. J. Econ. Geogr. 13(6), 1013–1040 (2013)CrossRef
33.
Grimaud, O., Béjot, Y., Heritage, Z., Vallée, J., Durier, J., Cadot, E., Giroud, M., Chauvin, P.: Incidence of stroke and socioeconomic neighborhood characteristics an ecological analysis of dijon stroke registry. Stroke 42(5), 1201–1206 (2011)CrossRefPubMed
34.
Hentschker, C., Mennicken, R.: The volume–outcome relationship and minimum volume standards–empirical evidence for Germany. Health Econ. (2014)
35.
Hoeks, S., Scholte op Reimer, W., Lingsma, H., van Gestel, Y., van Urk, H., Bax, J., Simoons, M., Poldermans, D.: Process of care partly explains the variation in mortality between hospitals after peripheral vascular surgery. Eur. J. Vasc. Endovasc. Surg. 40(2), 147–154 (2010)
36.
Hothorn, T., Hornik, K., Zeileis, A.: Unbiased recursive partitioning: a conditional inference framework. J. Comput. Graph. Stat. 15(3), 651–674 (2006)CrossRef
37.
Kapral, M.K., Fang, J., Chan, C., Alter, D.A., Bronskill, S.E., Hill, M.D., Manuel, D.G., Tu, J.V., Anderson, G.M.: Neighborhood income and stroke care and outcomes. Neurology 79(12), 1200–1207 (2012)CrossRefPubMedPubMedCentral
38.
Katz, M.L.: Provider competition and healthcare quality: more bang for the buck? Int. J. Indus. Organ. 31(5), 612–625 (2013)CrossRef
39.
Ketcham, J.D., Baker, L.C., MacIsaac, D.: Physician practice size and variations in treatments and outcomes: evidence from medicare patients with ami. Health Affairs 26(1), 195–205 (2007)CrossRefPubMed
40.
Kolstad, J.T., Kowalski, A.E.: The impact of health care reform on hospital and preventive care: evidence from massachusetts. J. Public Econ. 96(11), 909–929 (2012)CrossRefPubMedPubMedCentral
41.
Kuhn, M., Johnson, K.: Applied Predictive Modeling. Springer, Berlin (2013)CrossRef
42.
Kupersmith, J.: Quality of care in teaching hospitals: a literature review. Acad. Med. 80(5), 458–466 (2005)CrossRefPubMed
43.
Langhorne, P., Taylor, G., Murray, G., Dennis, M., Anderson, C., Bautz-Holter, E., Dey, P., Indredavik, B., Mayo, N., Power, M., et al.: Early supported discharge services for stroke patients: a meta-analysis of individual patients’ data. Lancet 365(9458), 501–506 (2005)CrossRefPubMed
44.
Lindenauer, P.K., Remus, D., Roman, S., Rothberg, M.B., Benjamin, E.M., Ma, A., Bratzler, D.W.: Public reporting and pay for performance in hospital quality improvement. New Engl. J. Med. 356(5), 486–496 (2007)CrossRefPubMed
45.
Manheim, L.M., Feinglass, J., Shortell, S.M., Hughes, E.F.: Regional variation in medicare hospital mortality. Inquiry 29(1), 55–66 (1992)PubMed
46.
May, K.: Technological change and aggregation. Econometrica, 15(1), 51–63 (1947)CrossRef
47.
McClellan, M.B., Staiger, D.O.: Comparing hospital quality at for-profit and not-for-profit hospitals. In: The changing hospital industry: comparing for-profit and Not-for-profit institutions, pp. 93–112. University of Chicago Press (2000)
48.
McConnell, K.J., Chang, A.M., Maddox, T.M., Wholey, D.R., Lindrooth, R.C.: An exploration of management practices in hospitals. Healthcare 2(2), 121–129 (2014)CrossRefPubMed
49.
McConnell, K.J., Lindrooth, R.C., Wholey, D.R., Maddox, T.M., Bloom, N.: Management practices and the quality of care in cardiac units. JAMA Intern. Med. 173(8), 684–692 (2013)CrossRefPubMed
50.
McNaughton, H., McPherson, K., Taylor, W., Weatherall, M.: Relationship between process and outcome in stroke care. Stroke 34(3), 713–717 (2003)CrossRefPubMed
51.
Menachemi, N., Chukmaitov, A., Saunders, C., Brooks, R.G.: Hospital quality of care: does information technology matter? The relationship between information technology adoption and quality of care. Health Care Manag. Rev. 33(1), 51–59 (2008)CrossRef
52.
Milgrom, P., Roberts, J.: Complementarities and fit strategy, structure, and organizational change in manufacturing. J. Account. Econ. 19(2), 179–208 (1995)CrossRef
53.
Mitchell, J.B., Ballard, D.J., Whisnant, J.P., Ammering, C.J., Samsa, G.P., Matchar, D.B.: What role do neurologists play in determining the costs and outcomes of stroke patients? Stroke 27(11), 1937–1943 (1996)CrossRefPubMed
54.
Mohammed, M.A., Mant, J., Bentham, L., Raftery, J.: Comparing processes of stroke care in high-and low-mortality hospitals in the West Midlands, UK. Int. J. Qual. Health Care 17(1), 31–36 (2005)CrossRefPubMed
55.
56.
Needleman, J., Buerhaus, P., Mattke, S., Stewart, M., Zelevinsky, K.: Nurse-staffing levels and the quality of care in hospitals. New Engl. J. Med. 346(22), 1715–1722 (2002)CrossRefPubMed
57.
Needleman, J., Buerhaus, P., Pankratz, V.S., Leibson, C.L., Stevens, S.R., Harris, M.: Nurse staffing and inpatient hospital mortality. New Engl. J. Med. 364(11), 1037–1045 (2011)CrossRefPubMed
58.
O’Brien, S.M., DeLong, E.R., Peterson, E.D.: Impact of case volume on hospital performance assessment. Arch. Intern. Med. 168(12), 1277–1284 (2008)CrossRefPubMed
59.
Ogbu, U.C., Slobbe, L.C., Arah, O.A., de Bruin, A., Stronks, K., Westert, G.P.: Hospital stroke volume and case-fatality revisited. Med. Care 48(2), 149–156 (2010)CrossRefPubMed
60.
Park, S., Lee, J., Ikai, H., Otsubo, T., Imanaka, Y.: Decentralization and centralization of healthcare resources: investigating the associations of hospital competition and number of cardiologists per hospital with mortality and resource utilization in japan. Health Policy 113(1), 100–109 (2013)CrossRefPubMed
61.
62.
Propper, C., Burgess, S., Green, K.: Does competition between hospitals improve the quality of care? Hospital death rates and the nhs internal market. J. Public Econ. 88(7), 1247–1272 (2004)CrossRef
63.
Quinlan, J.R.: C4.5: Programs for Machine Learning. Elsevier, Amsterdam (2014)
64.
Rafferty, A.M., Clarke, S.P., Coles, J., Ball, J., James, P., McKee, M., Aiken, L.H.: Outcomes of variation in hospital nurse staffing in english hospitals: cross-sectional analysis of survey data and discharge records. Int. J. Nurs. Stud. 44(2), 175–182 (2007)CrossRefPubMed
65.
Reeves, M.J., Gargano, J., Maier, K.S., Broderick, J.P., Frankel, M., LaBresh, K.A., Moomaw, C.J., Schwamm, L.: Patient-level and hospital-level determinants of the quality of acute stroke care a multilevel modeling approach. Stroke 41(12), 2924–2931 (2010)CrossRefPubMed
66.
67.
Ringelstein, E.B., Chamorro, A., Kaste, M., Langhorne, P., Leys, D., Lyrer, P., Thijs, V., Thomassen, L., Toni, D.: European stroke organisation recommendations to establish a stroke unit and stroke center. Stroke 44(3), 828–840 (2013)CrossRefPubMed
68.
Roland, M., Rosen, R.: English nhs embarks on controversial and risky market-style reforms in health care. New Engl. J. Med. 364(14), 1360–1366 (2011)CrossRefPubMed
69.
Rudd, A.G., Irwin, P., Rutledge, Z., Lowe, D., Wade, D., Pearson, M.: Regional variations in stroke care in England, wales and Northern Ireland: results from the national sentinel audit of stroke. Clin. Rehabil. 15(5), 562–572 (2001)CrossRefPubMed
70.
Saposnik, G., Baibergenova, A., O’Donnell, M., Hill, M., Kapral, M., Hachinski, V., et al.: Hospital volume and stroke outcome does it matter? Neurology 69(11), 1142–1151 (2007)CrossRefPubMed
71.
Schootman, M., Lian, M., Pruitt, S.L., Deshpande, A.D., Hendren, S., Mutch, M., Jeffe, D.B., Davidson, N.: Hospital and geographic variability in thirty-day all-cause mortality following colorectal cancer surgery. Health Serv. Res. 49(4), 1145–1164 (2014)CrossRefPubMedPubMedCentral
72.
Sela, R.J., Simonoff, J.S.: Re-em trees: a data mining approach for longitudinal and clustered data. Mach. Learn. 86(2), 169–207 (2012)CrossRef
73.
Svendsen, M.L., Ehlers, L.H., Frydenberg, M., Ingeman, A., Johnsen, S.P.: Quality of care and patient outcome in stroke units: is medical specialty of importance? Med. Care 49(8), 693–700 (2011)CrossRefPubMed
74.
Svendsen, M.L., Ehlers, L.H., Ingeman, A., Johnsen, S.P.: Higher stroke unit volume associated with improved quality of early stroke care and reduced length of stay. Stroke 43(11), 3041–3045 (2012)CrossRefPubMed
75.
Syverson, C.: What determines productivity? J. Econ. Literat. 49(2), 326–365 (2011)CrossRef
76.
Ukawa, N., Ikai, H., Imanaka, Y.: Trends in hospital performance in acute myocardial infarction care: a retrospective longitudinal study in japan. Int. J. Qual. Health Care 26(5), 516–523 (2014)CrossRefPubMed
77.
78.
Whisnant, J.P.: The role of the neurologist in the decline of stroke. Ann. Neurol. 14(1), 1–7 (1983)CrossRefPubMed
79.
Wooldridge, J.: Introductory Econometrics: A Modern Approach, 5th edn. Nelson Education, Toronto (2012)
80.
Xian, Y., Holloway, R.G., Chan, P.S., Noyes, K., Shah, M.N., Ting, H.H., Chappel, A.R., Peterson, E.D., Friedman, B.: Association between stroke center hospitalization for acute ischemic stroke and mortality. JAMA 305(4), 373–380 (2011)CrossRefPubMedPubMedCentral
Metadata
Title
Hospital heterogeneity: what drives the quality of health care
Authors
Manhal Ali
Reza Salehnejad
Mohaimen Mansur
Publication date
01-04-2018
Publisher
Springer Berlin Heidelberg
Published in
The European Journal of Health Economics / Issue 3/2018
Print ISSN: 1618-7598
Electronic ISSN: 1618-7601
DOI
https://doi.org/10.1007/s10198-017-0891-9

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