Updated Variable‐Radius Measures of Hospital Competition

Gresenz, Carole Roan; Rogowski, Jeannette; Escarce, José J.

doi:10.1111/j.1475-6773.2004.00235.x

Cited by 60 publications

(59 citation statements)

References 4 publications

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“…However, we note that other research has found that 75% of discharges among acute care urban hospitals took place within a 10-mile radius. 12 Because hospital utilization data were not available by patient address, we aggregated population and hospital *Reports and statistics for individual cities and suburban areas are available at www.downstate.edu/ healthdata. This report series was the successor to an earlier grant from Robert Wood Johnson Foundation to examine health and socio-economic trends of the nation_s 100 largest cities, from 1980 to 1990. resource and utilization data across all cities and across all suburbs.…”

Section: Methodsmentioning

confidence: 99%

The Changing Landscape of Hospital Capacity in Large Cities and Suburbs: Implications for the Safety Net in Metropolitan America

Andrulis

Duchon²

2007

J Urban Health

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An analysis of trends in hospital use and capacity by ownership status and community poverty levels for large urban and suburban areas was undertaken to examine changes that may have important implications for the future of the hospital safety net in large metropolitan areas. Using data on general acute care hospitals located in the 100 largest cities and their suburbs for the years 1996, 1999, and 2002, we examined a number of measures of use and capacity, including staffed beds, admissions, outpatient and emergency department visits, trauma centers, and positron emission tomography scanners. Over the 6-year period, the number of for-profit, nonprofit, and public hospitals declined in both cities and suburbs, with public hospitals showing the largest percentage of decreases. By 2002, for-profit hospitals were responsible for more Medicaid admissions than public hospitals for the 100 largest cities combined. Public hospitals, however, maintained the longest Medicaid average length of stay. The proportion of urban hospital resources located in high poverty cities was slightly higher than the proportion of urban population living in high poverty cities. However, the results demonstrate for the first time, a highly disproportionate share of hospital resources and use among suburbs with a low poverty rate compared to suburbs with a high poverty rate. High poverty communities represented the greatest proportion of suburban population in 2000 but had the smallest proportion of hospital use and specialty care capacity, whereas the opposite was true of low poverty suburbs. The results raise questions about the effects of the expanding role of private hospitals as safety net providers, and have implications for poor residents in high poverty suburban areas, and for urban safety net hospitals that care for poor suburban residents in surrounding communities.

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Section: Methodsmentioning

confidence: 99%

The Changing Landscape of Hospital Capacity in Large Cities and Suburbs: Implications for the Safety Net in Metropolitan America

Andrulis

Duchon²

2007

J Urban Health

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“…We included four categories of covariates expected to relate to QI scope, hospital quality indicators, or both: market characteristics, hospital characteristics, accreditation and quality standards, and length of QI experience. In terms of market characteristics, we included three competition variables: a variable-radius Herfindal index of market concentration, defined as the sum of the squared market shares of the hospitals within a radius capturing 75 percent of a hospital's patient admissions in 1997 (Gresenz, Rogowski, and Escarce 2004); the self-reported number of other hospitals with which the hospital directly competes for patients on either an inpatient or outpatient basis; and the self-reported intensity of competition for patients among hospitals in the market, measured on a seven-point scale that ranged from (1) ''not at all intense'' to (7) ''highly intense''. We also included two managed care variables: managed care penetration, defined as the percentage of the total insured population in a county enrolled in a private risk, Medicare risk, or Medicaid risk insurance product in 1997; and self-reported percentage of patients for which hospital is paid on a capitated, negotiated per case rate, or discounted basis (excluding Medicare and Medicaid).…”

Section: Methodsmentioning

confidence: 99%

Quality Improvement Implementation and Hospital Performance on Quality Indicators

Weiner

Alexander

Shortell

et al. 2005

Health Services Research

142

106

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Objective. To examine the association between the scope of quality improvement (QI) implementation in hospitals and hospital performance on selected indicators of clinical quality. Data Sources. Secondary data from 1997 mailed survey of hospital QI practices, Medicare Inpatient Database, American Hospital Association's Annual Survey of Hospitals, the Bureau of Health Professions' Area Resource File, and two proprietary data sets compiled by Solucient Inc. containing data on managed care penetration and hospital financial performance. Study Design. Cross-sectional study of 1,784 community hospitals to assess relationship between QI implementation approach and six hospital-level quality indicators. Data Collection/Abstraction Methods. Moreover, as much as one-third of some hospital procedures expose patients to risks without improving their health; one-third of drugs prescribed are not indicated; and one-third of laboratory tests showing abnormal results do not get followed up by clinicians (Dubois and Brook 1988;Brook et al. 1990;Leape 1994; Institute of Medicine 2000).Many believe that quality improvement (QI) represents a promising strategy for improving hospital quality of care. QI is a systemic approach to planning and implementing continuous improvement in performance. QI emphasizes continuous examination and improvement of work processes by teams of organizational members trained in basic statistical techniques and problem solving tools and empowered to make decisions based on their analysis of the data. The systemic focus of QI complements a growing recognition in the field that the quality of the care delivered by clinicians depends substantially on the performance capability of the organizational systems in which they work. While individual clinician competence remains important, many increasingly see the capability of organizational systems to prevent errors, coordinate care among settings and practitioners, and ensure that relevant, accurate information is available when needed as critical elements in providing high quality care (Institute of Medicine 2000). Reflecting the growing emphasis on organizational systems of care, the Joint Commission on Accreditation of Healthcare Organizations, the National Committee for Quality Assurance, and the Peer Review Organizations of the Centers for Medicare and Medicaid have all encouraged hospitals to use QI methods.Although QI holds promise for improving quality of care, hospitals that adopt QI often struggle with its implementation (Shortell, Bennett, and Byck 1998). By implementation, we refer to the transition period, following a decision to adopt a new idea or practice, when intended users put that new idea or practice into use--for example, when clinical and nonclinical staff begin applying QI principles and practices to improve clinical care processes ( et al. 2004). In addition, the systemic nature of many quality problems implies that the effectiveness of a QI initiative may depend on its implementation across many conditions, disciplines, and departme...

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“…In estimating the impact of hospital competition on cost, we found that estimates from MSA based measures were consistently smaller in absolute value than county and HSA based measures, which in turn were smaller in absolute value than fix radius, variable radius, and patient flow based measures. MSA and county based measures are relatively easy for researchers to obtain, and updated variable radius measures are available to researchers from Gresenz et al (2004). Using these three measures would give researchers a sense of the range into which the point estimates they wish to obtain would fall.…”

Section: Discussionmentioning

confidence: 99%

“…This may be due, in part, to the complexity of these approaches and the significant resources to obtain and to process the data. 21 Research continues to be published in renown general economics, health economics, and policy-oriented journals using the traditional approaches: Burdorf et al (2004), Gresenz et al (2004), Bamezai et al (2003), Carey (2003), Cuellar and Gertler (2003), Dranove and Lindrooth (2003), Sloan et al (2003), Duggan (2002), Gaskin et al (2002), Gift et al (2002), Greenberg and Goldberg (2002), Meltzer et al (2002), Sari (2002), and Santerre and Adams (2002).…”

Section: Hospital Competition Measuresmentioning

confidence: 97%

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Do Different Measures of Hospital Competition Matter in Empirical Investigations of Hospital Behavior

2005

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Considerable controversy exists about the appropriate way hospital competition should be measured and whether findings are accurate if certain methods are employed. Data from the Healthcare Cost and Utilization Project (HCUP), the American Hospital Association (AHA), and other supplemental data sources are used to create and evaluate hospital competition measures. Correlation coefficients of these measures are assessed. Moreover, each measure is independently included as an explanatory variable in otherwise identical hospital cost function regressions. Their corresponding parameter estimates are then compared. Most measures are highly correlated. Inferences about the effect of competition on hospital cost remain the same when alternative hospital competition measures are employed. We caution researchers against using this finding to arbitrarily select a competition measure when the magnitude of the estimates is important. Copyright Springer 2004hospital competition measures, hospital markets,

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Updated Variable‐Radius Measures of Hospital Competition

Cited by 60 publications

References 4 publications

The Changing Landscape of Hospital Capacity in Large Cities and Suburbs: Implications for the Safety Net in Metropolitan America

The Changing Landscape of Hospital Capacity in Large Cities and Suburbs: Implications for the Safety Net in Metropolitan America

Quality Improvement Implementation and Hospital Performance on Quality Indicators

Do Different Measures of Hospital Competition Matter in Empirical Investigations of Hospital Behavior

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