Universität zu Köln

Kuntz, Ludwig, Scholtes, Stefan and Sulz, Sandra (2019). Separate and Concentrate: Accounting for Patient Complexity in General Hospitals. Manage. Sci., 65 (6). S. 2482 - 2502. CATONSVILLE: INFORMS. ISSN 1526-5501

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Abstract

Scholars have recently suggested the reorganization of general hospitals into organizationally separate divisions for routine and non-routine services to overcome operational misalignments between the two types of services. We provide empirical evidence for this proposal from a quality perspective, using over 250,000 patient discharge records from 60 German hospitals across 39 high-mortality disease segments, and focusing on in-hospital mortality as outcome. Disentangling the effects of high, absolute, and relative hospital volumes in a disease group, our analysis suggests that routine and complex patients would benefit from a hospital organization with a multi-specialty hub for emergency and non-routine elective services at its core, complemented by organizationally separate disease-focused hospitals-within-hospitals for routine services. We also provide evidence that the hub hospital can further improve service quality for complex patients by adopting a disease-based rather than medical specialty-based departmental routing strategy for newly arriving patients. A counterfactual analysis, based on a simultaneous equations probit model that simultaneously controls for endogeneity of volume, focus, and routing strategy, suggests that the proposed reorganization could have reduced mortality in the sample by 13.43% (95% CI [6.87%; 18.95%]) for routine patients and by 11.67% (95% CI [6.13%; 16.86%]) for the most complex patients.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Kuntz, Ludwig UNSPECIFIED UNSPECIFIED UNSPECIFIED Scholtes, Stefan UNSPECIFIED UNSPECIFIED UNSPECIFIED Sulz, Sandra UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-146825
DOI:	10.1287/mnsc.2018.3064
Journal or Publication Title:	Manage. Sci.
Volume:	65
Number:	6
Page Range:	S. 2482 - 2502
Date:	2019
Publisher:	INFORMS
Place of Publication:	CATONSVILLE
ISSN:	1526-5501
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language INPUT UNCERTAINTY; PROBIT MODELS; COORDINATION; VOLUME; PERFORMANCE; MORTALITY; FOCUS; COMORBIDITY; EXPERIENCE; CUSTOMER Multiple languages Management; Operations Research & Management Science Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/14682