Hospital-physician Integration and Physician Collaboration: Implications for Care Efficiency and Outcomes

Author

Hui JiaFollow

Date of Award

8-2022

Degree Type

Dissertation

Degree Name

Doctor of Philosophy

Major

Management Science

Major Professor

Bogdan Bichescu

Committee Members

Haileab Hilafu;Wenjun Zhou;Randy V. Bradley

Abstract

This thesis focuses on healthcare operations management and consists of two essays that investigate empirically how the relationship between physicians and hospitals and the relationship between peer physicians, respectively, affect clinical care outcomes and care efficiency.

In the first essay, I study hospital-physician integration as a type of organization-service provider relationship. Many prior studies have provided insights into the benefits of a tight collaboration between hospitals and physicians. However, neutral and even negative effects of this relationship on healthcare performance have been observed and discussed in the literature. This mixed evidence points to a need for further study to elucidate the implications of hospital-physician integration for healthcare performance. This essay adopts an activity-based approach to operationalization of hospital-physician integration, referred to as ABI. I utilize patient-visit level information for patients who have been treated with coronary artery bypass graft (CABG) surgery to demonstrate a U-shaped association between ABI and clinical outcomes such as patient length of stay (LOS), in-hospital mortality risk, and readmission risk. I also find that hospital teaching status and bed utilization suppress the effect of ABI on patient LOS. The results suggest that a medium level of integration could be desirable, since a strategy of high integration trades off potentially higher patient volumes and knowledge ossification for suboptimal care outcomes.

In the second essay, I study collaboration between physicians working in emergency department (ED), a horizontal relationship between peer service providers. More specifically, I use measures of physician familiarity and a physician’s level of exposure to different peer partners, referred to as partner exposure, to denote peer collaboration. Using data on patient visits to hospital emergency departments in the U.S. state of Florida, I build econometric models to evaluate empirically the relationship between peer collaboration and care efficiency, as measured by a patient’s time spent in the ED and the number of procedures received. My investigation shows that both physician familiarity and level of partner exposure help improve care efficiency, with the associated effects being stronger for patients with severe conditions. Besides the main hypotheses, we provide several post-hoc analyses which further reveal that physicians’ single-siting status complements and enhances the relationships between physician familiarity and partner exposure, respectively, and care efficiency.

Recommended Citation

Jia, Hui, "Hospital-physician Integration and Physician Collaboration: Implications for Care Efficiency and Outcomes. " PhD diss., University of Tennessee, 2022.
https://trace.tennessee.edu/utk_graddiss/7369