title: Variations in inpatient mortality among hospitals in different system types, 1995 to 2000.
abstract: BACKGROUND
  Relatively few studies focused on the impact of system formation and hospital merger on quality, and these studies reported typically little or no quality effect.
  
  
  OBJECTIVE
  To study associations among 5 main types of health systems--centralized, centralized physician/insurance, moderately centralized, decentralized, and independent--and inpatient mortality from acute myocardial infarction (AMI), congestive heart failure, stroke, and pneumonia.
  
  
  METHODS
  Panel data (1995-2000) were assembled from 11 states and multiple sources: Agency for Healthcare Research and Quality State Inpatient Database, American Hospital Association Annual Surveys, Area Resource File, HMO InterStudy, and the Centers for Medicare and Medicaid Services. We applied a panel study design with fixed effects models using information on variation within hospitals.
  
  
  RESULTS
  We found that centralized health systems are associated with lower AMI, congestive heart failure, and pneumonia mortality. Independent hospital systems had better AMI quality outcomes than centralized physician/insurance and moderately centralized health systems. We found no difference in inpatient mortality among system types for the stroke outcome. Thus, for certain types of clinical service lines and patients, hospital system type matters. Research that focuses only on system membership may mask the impact of system type on the quality of care.
authors.affiliation: Division of Health Affairs, Department of Family Medicine and Rural Health, FSU College of Medicine, Tallahassee, Florida 32306-4300, USA. askar.chukmaitov@med.fsu.edu
authors.forename: Askar S
authors.initials: AS
authors.lastname: Chukmaitov
authors.forename: Gloria J
authors.initials: GJ
authors.lastname: Bazzoli
authors.forename: David W
authors.initials: DW
authors.lastname: Harless
authors.forename: Robert E
authors.initials: RE
authors.lastname: Hurley
authors.forename: Kelly J
authors.initials: KJ
authors.lastname: Devers
authors.forename: Mei
authors.initials: M
authors.lastname: Zhao
mesh_terms: D019992:Databases as Topic; D006273:Health Facility Merger; D006333:Heart Failure / Q000401:mortality; D006739:Hospital Administration / Q000145:classification*; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D009203:Myocardial Infarction / Q000401:mortality; D011014:Pneumonia / Q000401:mortality; D011787:Quality of Health Care; D020521:Stroke / Q000401:mortality; D014481:United States / Q000453:epidemiology