Opening Ambulatory Surgery Centers and Stone Surgery Rates in Health Care Markets

被引:18
作者
Hollingsworth, John M. [2 ,3 ,7 ]
Krein, Sarah L. [4 ,7 ]
Birkmeyer, John D. [5 ,8 ]
Ye, Zaojun [3 ]
Kim, Hyungjin Myra [6 ,7 ]
Zhang, Yun [3 ]
Hollenbeck, Brent K. [1 ,3 ,8 ]
机构
[1] Univ Michigan, Dept Urol, Div Oncol, Ann Arbor, MI 48105 USA
[2] Univ Michigan, Robert Wood Johnson Fdn, Clin Scholars Program, Ann Arbor, MI 48105 USA
[3] Univ Michigan, Div Hlth Serv Res, Ann Arbor, MI 48105 USA
[4] Univ Michigan, Div Gen Med, Dept Internal Med, Ann Arbor, MI 48105 USA
[5] Univ Michigan, Div Minimally Invas Surg, Dept Gen Surg, Ann Arbor, MI 48105 USA
[6] Univ Michigan, Ctr Stat Consultat & Res, Ann Arbor, MI 48105 USA
[7] Ann Arbor Vet Affairs Healthcare Syst, Hlth Serv Res & Dev Ctr Excellence, Ann Arbor, MI USA
[8] Michigan Surg Collaborat Outcomes Res & Evaluat, Ann Arbor, MI USA
关键词
urinary calculi; urologic surgical procedures; ambulatory surgical procedures; ambulatory care facilities; hospitals; SHOCK-WAVE LITHOTRIPSY; URETERAL CALCULI;
D O I
10.1016/j.juro.2010.05.036
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Purpose: Ambulatory surgery centers deliver surgical care more efficiently than hospitals but may increase overall procedure use and adversely affect competing hospitals. Motivated by these concerns we evaluated how opening of an ambulatory surgery center impacts stone surgery use in a health care market and assessed the effect of its opening on the patient mix at nearby hospitals. Materials and Methods: In a 100% sample of outpatient surgery from Florida we measured annual stone surgery use between 1998 and 2006. We used multiple regression to determine if the rate of change in use differed between markets, defined by the hospital service area, without and with a recently opened ambulatory surgery center. Results: Stone surgery use increased an average of 11 procedures per 100,000 individuals per year (95% CI 1-20, p <0.001) after an ambulatory surgery center opened in a hospital service area. Four years after opening the relative increase in the stone surgery rate was approximately 64% higher (95% CI 27 to 102) in hospital service areas where a center opened vs hospital service areas without a center. These market level increases in surgery were not associated with decreased surgical volume at competing hospitals and the absolute change in patient disease severity treated at nearby hospitals was small. Conclusions: While opening of an ambulatory surgery center did not appear to have an overly detrimental effect on competing hospitals, it led to a significant increase in the population based rate of stone surgery in the hospital service area. Possible explanations are the role of physician financial incentives and unmet surgical demand.
引用
收藏
页码:967 / 971
页数:5
相关论文
共 22 条
[1]  
*AG HEALTHC RES QU, STAT AMB SURG DAT 20
[2]  
[Anonymous], 1996, The Dartmouth Atlas of Health Care in the United States: The Center for the Evaluative Clinical Sciences
[3]  
Bierkens AF, 1998, BRIT J UROL, V81, P31
[4]  
Campbell D. T., 1963, Experimental and Quasi-Experimental Designs for Research
[5]   Focused factories? Physician-owned specialty facilities [J].
Casalino, LP ;
Devers, KJ ;
Brewster, LR .
HEALTH AFFAIRS, 2003, 22 (06) :56-67
[6]  
CHOUDHRY S, 2005, HLTH AFF MILLWOOD S, pW5
[7]  
CONOVER CJ, EVALUATION CERTIFICA, V2
[8]  
DAVIS JE, 1987, SURG CLIN N AM, V67, P671
[9]   Changes in hospital competitive strategy: A new medical arms race? [J].
Devers, KJ ;
Brewster, LR ;
Casalino, LP .
HEALTH SERVICES RESEARCH, 2003, 38 (01) :447-469
[10]   ADAPTING A CLINICAL COMORBIDITY INDEX FOR USE WITH ICD-9-CM ADMINISTRATIVE DATABASES [J].
DEYO, RA ;
CHERKIN, DC ;
CIOL, MA .
JOURNAL OF CLINICAL EPIDEMIOLOGY, 1992, 45 (06) :613-619