Is there a relationship between service integration and differentiation and patient outcomes?

OBJECTIVE: To examine the level of service integration within Maryland hospitals and service differentiation across the hospital system or network and its affect on heart failure patient clinical and economic outcomes. DATA SOURCES/STUDY SETTING: Maryland Health Services Cost Review Commission Inpatient Data for 1997 and 1998 were used for secondary data analysis. STUDY DESIGN: Retrospective cross sectional. Independent variables were the level of service integration and differentiation created from the 1998 American Hospital Association Annual Survey based on the work of Bazzoli et al. [1]. The primary dependent variables were readmission, in-hospital mortality, length of stay and costs. DATA COLLECTION/EXTRACTION METHODS: Patients discharged from Maryland hospitals with a diagnosis that grouped to DRG 127 (heart failure) were extracted. Multivariate linear and logistic models clustered by hospital were used to analyse results at the patient level. PRINCIPAL FINDINGS: A higher likelihood of readmission was found as the level of Community Differentiation increased. Although costs were higher as Total Differentiation increased in 1998, these results were not validated by 1997 data. No significant relationship was found between integration of services and outcomes. CONCLUSIONS: Similar outcomes were achieved regardless of the level of service integration or differentiation. Community hospitals produce similar patient outcomes at the same cost for this diagnosis.