The impact of health system membership on patient safety initiatives.
BACKGROUND
Research in configurations and strategic groups has a rich history of revealing performance differences for hospitals and health care systems.


OBJECTIVE
To assess the relationship between hospital-led health system configurations and the adoption of patient safety practices. In particular, the adoption of computerized physician order entry (CPOE) and intensive care unit physician staffing (IPS) is analyzed.


METHODS
Analysis of variance was used to detect differences in patient safety measures based on health networks and systems' initial configuration clustering, and regression was used to assess group membership, controlling for hospital-level characteristics. The 2002 American Hospital Association survey and the first 3 years of the Leapfrog Group annual survey (2003-2005) are used for the analyses.


RESULTS
There were significant differences in CPOE and IPS adoption and implementation levels based on health systems' configurations. Centralized physician/insurance health systems and moderately centralized health systems were the highest configurations in terms of CPOE adoption. Group membership was not positively related to the use of IPS relative to hospitals that are not classified using the taxonomy. In fact, there is a significant and negative adoption rate for both patient safety measures in facilities classified in the independent hospital systems category.


CONCLUSIONS
There are systematic differences in the adoption of CPOE and IPS patient safety measures based on health system configurations. The configuration with an insurance company as part of its structure was more likely than other groups to be adopting CPOE. PRACTITIONER IMPLICATIONS: Given the durability of group membership, the Leapfrog Group and other patient safety initiatives could explicitly target configurations most likely to adopt and implement patient safety programs.
Ford
Eric W
EW
Rawls College of Business, Texas Tech University, Lubbock, TX, USA. eric.ford@ttu.edu
Short
Jeremy C
JC
D000704:Analysis of Variance; D004059:Diffusion of Innovation; D019538:Health Care Surveys; D006801:Humans; D007362:Intensive Care Units; D050316:Medical Order Entry Systems / Q000706:statistics & numerical data; D008505:Medical Staff, Hospital / Q000600:supply & distribution; D009096:Multi-Institutional Systems / Q000458:organization & administration* / Q000592:standards; D017751:Safety Management / Q000379:methods*; D017749:Total Quality Management; D014481:United States; D000078329:Workforce