This study assesses integrated delivery systems (IDS) as a strategy in response to managed care through measuring its impact on inpatient average length of stay (LOS) and hospital quality (mortality).
Data was derived through merging the 1998 Hospital Performance Review and the 1998 American Hospital Association Annual Survey. Only hospitals located in Metropolitan Statistical Areas (MSAs) were included (n=1971). LOS was used as a proxy for resource use, and hospital mortality (above or below the median rate) was used as a proxy for quality. The independent variable of interest is the level of integration that is measured by "no integration," "functional integration only," and "functional and clinical integration." Hospital characteristics were controlled.
Contrary to conventional wisdom, the integration strategy is shaped by the competition rate and population size, rather than the HMO penetration rate. Multiple regression results indicate average LOS in hospitals with functional integration only is 15% less than those hospitals with not integration strategy. A logistic regression indicates that hospitals that have integrated both functionally and clinically are 1.62 times more likely to be of good quality than hospital systems with no integration strategy; and hospitals with functional integration only are 1.55 times more likely to be of good quality.
Many projected that managed care penetration would result in integration strategies, but in fact, levels of integration appear to be associated with hospital settings including population size and level of competition. Increased levels of integration are associated with decreased utilization and improved quality.
Learning Objectives: Assessment of factors affecting integrated delivery system and Practical Effective of Integrated Delivery System
Keywords: Health Care Delivery, Health Care Utilization
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
Disclosure not received
Relationship: Not Received.