Hospital Specialization for Coronary Artery Bypass Grafting

Abstract

A distinguishing characteristic of contemporary medicine is its continued march toward greater specialization. Medical practice has increasingly become identified by its specialized practitioners, and enhanced quality of care is widely perceived to be linked to the technically advanced care they provide. Apart from the increasing number of specialized practitioners, however, there is another trend that has received somewhat less attention: greater specialization of services among hospitals. Article see p 607 But what exactly is hospital specialization, and what implications does it have for quality and efficiency in medicine? Unfortunately, there is no easily applicable definition for what it means for a hospital to be “specialized,” although recent evidence suggests that some hospitals have begun to move in this direction.1 Examples include the recent proliferation of service lines in hospitals that are focused on a few conditions, procedures, or populations—often organized under the structure of heart institutes, cancer centers, orthopedic hospitals, women's and children's hospitals, and at its most extreme, free-standing specialty hospitals that are often physician-owned. Although physician-owned specialty hospitals are the most widely contentious and discussed of these examples,2,3 the reality is that such facilities represent only a small proportion of hospitals in the United States. The rise of hospital specialization reflects recent trends by hospitals to develop and promote key services that are frequently of great interest to the public. In general, such strategies may take very different organizational approaches—from physically distinct units or buildings that house independent staff or administration to “virtual” …