A Comparative Study of Quality Outcomes in Freestanding Ambulatory Surgery Centers and Hospital‐Based Outpatient Departments: 1997–2004

Chukmaitov, Askar; Menachemi, Nir; Brown, L. Steven; Saunders, Charles; Brooks, Robert G.

doi:10.1111/j.1475-6773.2007.00809.x

Cited by 38 publications

(42 citation statements)

References 33 publications

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“…Even though mortality related to the ambulatory surgical setting is rare, this indicator has been used to flag potential quality problems associated with ambulatory surgery [6,7,9,25]. Other researchers have also used mortality as an outcome for comparing quality of care provided in the outpatient setting [8,12,26,27]. We used 7-day indicators since, as a shorter measure, it can reduce the effects of extraneous factors unrelated to outpatient procedures [6].…”

Section: Outcome Variablementioning

confidence: 99%

“…Due to the significant growth in the number of ambulatory surgical procedures provided in the U.S. and associated overall costs [4], researchers have begun to examine differences in quality outcomes for procedures performed in freestanding ambulatory surgical centers (ASCs) and hospital-based outpatient departments (HOPDs) [5][6][7][8][9][10][11][12][13][14][15]. Overall, these studies have utilized varying risk-adjustment approaches and have generally produced mixed results.…”

Section: Introductionmentioning

confidence: 99%

“…Specifically, we examine the consistency of the Diagnosis Cost Groups/Hierarchical Condition Categories (DCG/ HCC) methodology as a risk-adjustment tool when using ambulatory surgical data for comparing clinical outcomes for two different types of providers, hospital-based outpatient departments (HOPD) and freestanding ambulatory surgery centers (ASC). While the DCG/HCC instrument has been validated using inpatient data [17,18], and has certain characteristics suitable for use with ambulatory data [19], this method has not been empirically tested using ambulatory surgical data, but has had a limited use in previous ambulatory research [11,15]. As part of our study, we also assess how missing secondary diagnoses fields, common in ambulatory surgery administrative data, may affect risk-adjustment and the conclusions drawn about quality performance of HOPDs and ASCs.…”

Section: Introductionmentioning

confidence: 99%

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How well does diagnosis-based risk-adjustment work for comparing ambulatory clinical outcomes?

Chukmaitov

Harless

Menachemi

et al. 2009

Health Care Manag Sci

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This paper examines the empirical consistency of the Diagnosis Cost Groups/Hierarchical Condition Categories (DCG/HCC) risk-adjustment method for comparing 7-day mortality between hospital-based outpatient departments (HOPDs) and freestanding ambulatory surgery centers (ASCs). We used patient level data for the three most common outpatient procedures provided during the 1997-2004 period in Florida. We estimated base-line logistic regression models without any diagnosis-based risk adjustment and compared them to logistic regression models with the DCG/HCC risk-adjustment, and to conditional logit models with a matched cohort risk-adjustment approach. We also evaluated models that adjusted for primary diagnoses only, and then for all available diagnoses, to assess how the frequently absent secondary diagnoses fields in ambulatory surgical data affect risk-adjustment. We found that risk-adjustment using both diagnosis-based methods resulted in similar 7-day mortality estimates for HOPD patients in comparison with ASC patients in two out of three procedures. We conclude that the DCG/HCC risk-adjustment method is relatively consistent and stable, and recommend this risk-adjustment method for health policy research and practice with ambulatory surgery data. We also recommend using risk-adjustment with all available diagnoses.

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Section: Outcome Variablementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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How well does diagnosis-based risk-adjustment work for comparing ambulatory clinical outcomes?

Chukmaitov

Harless

Menachemi

et al. 2009

Health Care Manag Sci

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“…Young, unpublished data, 2010). 20,21,22,23 Finally, recent studies of RCs have found that they also engage in cream skimming the less severely ill patients but deliver less costly care, controlling for severity. 24,25 There is some evidence regarding quality standards practiced in such clinics and comparable levels of quality of care relative to physician offices.…”

Section: Radical and Disruptive Elements That Challenge Incumbentsmentioning

confidence: 99%

Strategic Response by Providers to Specialty Hospitals, Ambulatory Surgery Centers, and Retail Clinics

Burns

David

Helmchen

2011

Population Health Management

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Strategic Response by providers to specialty hospitals, ambulatory surgery centers, and retail clinics. AbstractRadical innovation and disruptive technologies are frequently heralded as a solution to delivering higher quality, lower cost health care. According to the literature on disruption, local hospitals and physicians (incumbent providers) may be unable to competitively respond to such "creative destruction" and alter their business models for a host of reasons, thus threatening their future survival. However, strategic management theory and research suggest that, under certain conditions, incumbent providers may be able to weather the discontinuities posed by the disrupters. This article analyzes 3 disruptive innovations in service delivery: single-specialty hospitals, ambulatory surgical centers, and retail clinics. We first discuss the features of these innovations to assess how disruptive they are. We then draw on the literature on strategic adaptation to suggest how incumbents develop competitive responses to these disruptive innovations that assure their continued survival. These arguments are then evaluated in a field study of several urban markets based on interviews with both incumbents and entrants. The interviews indicate that entrants have failed to disrupt incumbent providers primarily as a result of strategies pursued by the incumbents. The findings cast doubt on the prospects for these disruptive innovations to transform health care. Radical innovation and disruptive technologies are frequently heralded as a solution to delivering higher quality, lower cost health care. According to the literature on disruption, local hospitals and physicians (incumbent providers) may be unable to competitively respond to such ''creative destruction'' and alter their business models for a host of reasons, thus threatening their future survival. However, strategic management theory and research suggest that, under certain conditions, incumbent providers may be able to weather the discontinuities posed by the disrupters. This article analyzes 3 disruptive innovations in service delivery: singlespecialty hospitals, ambulatory surgical centers, and retail clinics. We first discuss the features of these innovations to assess how disruptive they are. We then draw on the literature on strategic adaptation to suggest how incumbents develop competitive responses to these disruptive innovations that assure their continued survival. These arguments are then evaluated in a field study of several urban markets based on interviews with both incumbents and entrants. The interviews indicate that entrants have failed to disrupt incumbent providers primarily as a result of strategies pursued by the incumbents. The findings cast doubt on the prospects for these disruptive innovations to transform health care. (Population Health Management 2011;14:69-77)

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“…Previous research has compared the quality of care (Chukmaitov, Menachemi, Brown, Saunders, & Brooks, 2008) and financial performance (Chukmaitov, Tang, & Brooks, 2010) between ASCs and hospital-based outpatient departments. However, there is limited empirical work on market conditions that impact the proliferation of ASCs (Bian & Morrisey, 2006), the nature of competition between ASCs and general hospitals (Lynk & Longley, 2002), and the impact of the proliferation of ASCs on general hospitals.…”

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confidence: 99%

Ambulatory surgery center and general hospital competition

Al‐Amin

Housman

2012

Health Care Management Review

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The implications from our study differ for ASCs and hospitals. When making decisions about market entry, ASCs should choose their markets according to the following: demand for outpatient surgery, number of physicians who would practice in the surgery center, and the number of surgery centers that already exist in the market. Hospitals, on the other hand, should account for competition from ASCs while making market-entry decisions and while developing their strategic plans.

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A Comparative Study of Quality Outcomes in Freestanding Ambulatory Surgery Centers and Hospital‐Based Outpatient Departments: 1997–2004

Cited by 38 publications

References 33 publications

How well does diagnosis-based risk-adjustment work for comparing ambulatory clinical outcomes?

How well does diagnosis-based risk-adjustment work for comparing ambulatory clinical outcomes?

Strategic Response by Providers to Specialty Hospitals, Ambulatory Surgery Centers, and Retail Clinics

Ambulatory surgery center and general hospital competition

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