The effects of organization on medical utilization: an analysis of service line organization.
OBJECTIVE
To determine whether clinical service lines in primary care and mental health reduces inpatient and urgent care utilization.


METHODS
All VHA medical centers were surveyed to determine whether service lines had been established in primary care or mental health care prior to the beginning of fiscal year 1997 (FY97). Facility-level data on medical utilization from Veterans Health Affairs (VHA) administrative databases were used for descriptive and multivariate regression analyses of utilization and of changes in measures between FY97 and FY98. Nine primary care-related and 5 mental health-related variables were analyzed.


RESULTS
Primary care and mental health service lines had been established in approximately half of all facilities. Service lines varied in duration and extent of restructuring. Mere presence of a service line had no positive and several negative effects on measured outcome variables. More detailed analyses showed that some types of service lines have statistically significant and mostly negative effects on both mental health and primary care-related measures. Newly implemented service lines had significantly less improvement in measures over time than facilities with no service line.


CONCLUSIONS
Health care organizations are implementing innovative organizational structures in hopes of improving quality of care and reducing resource utilization. We found that service lines in primary care and mental health may lead to an initial period of disruption, with little evidence of a beneficial effect on performance for longer duration service lines.
Byrne
Margaret M
MM
Center for Bioethics and Health Law, and Center for Research on Health Care, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA. byrnem@pitt.edu
Charns
Martin P
MP
Parker
Victoria A
VA
Meterko
Mark M
MM
Wray
Nelda P
NP
D017598:Efficiency, Organizational; D006302:Health Services Research; D006787:Hospitals, Veterans / Q000458:organization & administration / Q000706:statistics & numerical data*; D006801:Humans; D008605:Mental Health Services / Q000458:organization & administration* / Q000706:statistics & numerical data; D009936:Organizational Innovation; D017063:Outcome Assessment, Health Care; D011320:Primary Health Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D011357:Product Line Management / Q000145:classification / Q000458:organization & administration / Q000706:statistics & numerical data*; D014481:United States; D014493:United States Department of Veterans Affairs; D014600:Utilization Review