The Impact of Hospital Support Function Centralization on Patient Outcomes: A Before-after Study

Overview

Journal Public Health Pract (Oxf)

Date 2022 Sep 14

PMID 36101612

Authors

Adrien Le Guillou

Jan Chrusciel

Stephane Sanchez

Affiliations

Soon will be listed here.

Abstract

Objectives: This study aimed to evaluate the impact of centralizing hospital support functions such as administration, quality monitoring, procurement, and insurance on patient outcomes in a French regional hospital group.

Study Design: A before-after study was conducted within a medium-sized hospital in a rural region of France including 87,373 hospital stays between 2013 and 2017.

Methods: The intervention tested was the centralization of support functions: administration, quality monitoring, procurement, and insurance. The outcomes analyzed were patient mortality, 30 day readmissions and average length of stay.

Results: The odds ratio (OR) for patient mortality after centralization was 0.99 (95%CI, 0.92 to 1.06), and 0.94 (95%CI, 0.90 to 0.96) for readmissions. The multiplicative factor for average length of stay was 0.93 (95%CI 0.92-0.94).

Conclusions: There was an increase in measured quality of care after the intervention. This study highlights the complexity of assessing the impact of hospital-level centralization on quality-of-care indicators.

Citing Articles

High quality of diabetes care in Greenland since the launch of Steno Diabetes Center Greenland 2020 - geographical disparities need attention.

Backe M, Jorgensen M, Pedersen M Int J Circumpolar Health. 2023; 82(1):2290305.

PMID: 38055761 PMC: 10997303. DOI: 10.1080/22423982.2023.2290305.

References

Donabedian A . Evaluating the quality of medical care. 1966. Milbank Q. 2005; 83(4):691-729. PMC: 2690293. DOI: 10.1111/j.1468-0009.2005.00397.x. View

Frankl S, Breeling J, Goldman L . Preventability of emergent hospital readmission. Am J Med. 1991; 90(6):667-74. View

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. 2013; 113(1-2):100-9. DOI: 10.1016/j.healthpol.2013.06.005. View

Lieberman-Cribbin W, Galsky M, Casey M, Liu B, Oh W, Flores R . Hospital Centralization Impacts High-Risk Lung and Bladder Cancer Surgical Patients. Cancer Invest. 2017; 35(10):652-661. DOI: 10.1080/07357907.2017.1406495. View

Lingsma H, Bottle A, Middleton S, Kievit J, Steyerberg E, Marang-van de Mheen P . Evaluation of hospital outcomes: the relation between length-of-stay, readmission, and mortality in a large international administrative database. BMC Health Serv Res. 2018; 18(1):116. PMC: 5813333. DOI: 10.1186/s12913-018-2916-1. View

Thomas J, Guire K, Horvat G . Is patient length of stay related to quality of care?. Hosp Health Serv Adm. 1997; 42(4):489-507. View

Librero J, Peiro S, Ordinana R . Chronic comorbidity and outcomes of hospital care: length of stay, mortality, and readmission at 30 and 365 days. J Clin Epidemiol. 1999; 52(3):171-9. DOI: 10.1016/s0895-4356(98)00160-7. View

Ohinmaa A, Zheng Y, Jeerakathil T, Klarenbach S, Hakkinen U, Nguyen T . Trends and Regional Variation in Hospital Mortality, Length of Stay and Cost in Hospital of Ischemic Stroke Patients in Alberta Accompanying the Provincial Reorganization of Stroke Care. J Stroke Cerebrovasc Dis. 2016; 25(12):2844-2850. DOI: 10.1016/j.jstrokecerebrovasdis.2016.07.046. View

Basu A, Manning W, Mullahy J . Comparing alternative models: log vs Cox proportional hazard?. Health Econ. 2004; 13(8):749-65. DOI: 10.1002/hec.852. View

10.

Halter M, Wheeler C, Drennan V, de Lusignan S, Grant R, Gabe J . Physician associates in England's hospitals: a survey of medical directors exploring current usage and factors affecting recruitment. Clin Med (Lond). 2017; 17(2):126-131. PMC: 6297628. DOI: 10.7861/clinmedicine.17-2-126. View

11.

Goodacre S, Campbell M, Carter A . What do hospital mortality rates tell us about quality of care?. Emerg Med J. 2013; 32(3):244-7. DOI: 10.1136/emermed-2013-203022. View

12.

Jimenez-Puente A, Garcia-Alegria J, Gomez-Aracena J, Hidalgo-Rojas L, Lorenzo-Nogueiras L, Perea-Milla-Lopez E . Readmission rate as an indicator of hospital performance: the case of Spain. Int J Technol Assess Health Care. 2004; 20(3):385-91. DOI: 10.1017/s0266462304001230. View

13.

Kristensen S, Bech M, Quentin W . A roadmap for comparing readmission policies with application to Denmark, England, Germany and the United States. Health Policy. 2014; 119(3):264-73. DOI: 10.1016/j.healthpol.2014.12.009. View

14.

Rosenthal G, Harper D, Quinn L, Cooper G . Severity-adjusted mortality and length of stay in teaching and nonteaching hospitals. Results of a regional study. JAMA. 1997; 278(6):485-90. View

15.

Goodney P, Stukel T, Lucas F, Finlayson E, Birkmeyer J . Hospital volume, length of stay, and readmission rates in high-risk surgery. Ann Surg. 2003; 238(2):161-7. PMC: 1422689. DOI: 10.1097/01.SLA.0000081094.66659.c3. View

16.

Anand S, Barnighausen T . Human resources and health outcomes: cross-country econometric study. Lancet. 2004; 364(9445):1603-9. DOI: 10.1016/S0140-6736(04)17313-3. View

17.

Ashton C, Kuykendall D, Johnson M, Wray N, Wu L . The association between the quality of inpatient care and early readmission. Ann Intern Med. 1995; 122(6):415-21. DOI: 10.7326/0003-4819-122-6-199503150-00003. View

18.

Faddy M, Graves N, Pettitt A . Modeling length of stay in hospital and other right skewed data: comparison of phase-type, gamma and log-normal distributions. Value Health. 2010; 12(2):309-14. DOI: 10.1111/j.1524-4733.2008.00421.x. View

19.

Charlson M, Pompei P, Ales K, MacKenzie C . A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987; 40(5):373-83. DOI: 10.1016/0021-9681(87)90171-8. View

20.

Anderson G, Steinberg E . Hospital readmissions in the Medicare population. N Engl J Med. 1984; 311(21):1349-53. DOI: 10.1056/NEJM198411223112105. View