Abstract
Health care delivery systems are a growing presence in the U.S., yet research is hindered by the lack of universally agreed-upon criteria to denote formal systems. A clearer understanding of how to leverage real-world data sources to empirically identify systems is a necessary first step to such policy-relevant research. We draw from our experience in the Agency for Healthcare Research and Quality’s Comparative Health System Performance (CHSP) initiative to assess available data sources to identify and describe systems, including system members (for example, hospitals and physicians) and relationships among the members (for example, hospital ownership of physician groups). We highlight five national data sources that either explicitly track system membership or detail system relationships: (1) American Hospital Association annual survey of hospitals; (2) Healthcare Relational Services Databases; (3) SK&A Healthcare Databases; (4) Provider Enrollment, Chain, and Ownership System; and (5) Internal Revenue Service 990 forms. Each data source has strengths and limitations for identifying and describing systems due to their varied content, linkages across data sources, and data collection methods. In addition, although no single national data source provides a complete picture of U.S. systems and their members, the CHSP initiative will create an early model of how such data can be combined to compensate for their individual limitations. Identifying systems in a way that can be repeated over time and linked to a host of other data sources will support analysis of how different types of organizations deliver health care and, ultimately, comparison of their performance.
Highlights
Health care delivery systems are a growing presence in the U.S [1,2,3,4,5] and are part of a national shift from small, independent practices to larger, consolidated organizations [6,7,8,9]
Many other provider organization relationships prominent in the U.S today would not meet the Comparative Health System Performance (CHSP) definition of a health care delivery system because they do not span primary and specialty care in both the outpatient and inpatient setting, including horizontally integrated systems such as multi-specialty group practices, multi-hospital chains or multiple physician practices contracting with payers through an Independent Practice Association
Through our work on the CHSP initiative, we find that the American Hospital Association (AHA), Healthcare Relational Services (HCRS), and SK&A data largely contain the same set of component entities; they define systems differently, which leads to a different set of systems and associations between entities and systems
Summary
Health care delivery systems are a growing presence in the U.S [1,2,3,4,5] and are part of a national shift from small, independent practices to larger, consolidated organizations [6,7,8,9]. Cohen et al: Leveraging Diverse Data Sources to Identify and Describe U.S Health Care Delivery Systems care delivery systems developed by the Agency for Healthcare Research and Quality’s (AHRQ) Comparative Health System Performance (CHSP) initiative: systems must include “at least one general acute care hospital and at least one group of physicians that provides comprehensive care (including primary and specialty care) who are connected with each other and with the hospital through common ownership or joint management [16].” We use this definition as the basis to explore the following questions: 1. We aim to stimulate dialogue among researchers about the best ways to use existing data and to map the boundaries of what current data can reveal
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