An exploratory qualitative study to explore why and how health systems are engaging in care delivery redesign (CDR) activities.
Health Services Research (HSR) Special Issue Publications
In a recently released issue of Health Services Research, 10 peer-reviewed journal articles examine health systems from multiple perspectives, including impacts on quality, costs, and efforts to reorganize care delivery. Collectively, the findings reveal that health care systems in their current form are not yet a cure for the problems that ail health care in the United States.
The research papers published in the volume utilize different data sources and analytic approaches to focus on various aspects of health care performance, for example:
- Trends in the formation of health systems, including the impact of systems’ formation on physician practices in markets, as well as consolidation in particular sectors, such as the home health industry.
- The degree to which "integration" is occurring, and results in better coordination of patient care across acute care, ambulatory care and specialty care services, and within the organizational and management processes of organizations.
- Variation in the governance and ownership structures across health systems, including the degree to which operational and business functions are standardized across individual units.
- The extent to which patient care management processes are being redesigned and improved, and whether specific outcomes, such as a reduction in health care disparities or reductions in health care costs are being realized.
AHRQ, the lead federal agency tasked with improving the safety and quality of the U.S. health care system, supported this research by establishing the Comparative Health System Performance (CHSP) Initiative which funded the work published in this volume. The CHSP established three research centers of excellence — the Dartmouth College Center, the RAND Center of Excellence on Health System Performance, and the NBER Center — with each taking different approaches to studying the landscape, impact and trends in health systems, including the factors that affect health systems’ use of patient-centered- outcomes research evidence.Read the News Release
Researchers in the RAND Center of Excellence on Health System Performance authored 6 of the 10 articles in this special issue. These 6 articles are listed below.
We developed manager and staff surveys to collect data on organizational, social, and clinical process integration, at four organizational levels: practice site, physician organization, health system, and outside health systems.
Health System Affiliation of Physician Organizations and Quality of Care for Medicare Beneficiaries Who Have High Needs 2020
This article tests the hypothesis that health systems provide better care to patients with high needs by comparing differences in quality between system-affiliated and nonaffiliated physician organizations.
The Importance of Understanding and Measuring Health System Structural, Functional, and Clinical Integration 2020
We explore if there are ways to characterize health systems-not already revealed by secondary data-that could provide new insights into differences in health system performance.
Racial and Ethnic Disparities in Care for Health System-Affiliated Physician Organizations and Non-Affiliated Physician Organizations 2020
This article assesses racial and ethnic disparities in care for Medicare fee-for-service beneficiaries and whether disparities differ between health system-affiliated physician organizations (POs) and nonaffiliated POs.
The objectives of this study are to understand how health systems are facilitating primary care redesign (PCR), examine the PCR initiatives taking place within systems, and identify barriers to this work.