title: The Effects of Organization Design and Patient Perceptions of Care on Switching Behavior and Reliance on a Health Care System Across Time.
abstract: Sustaining ongoing relationships with patients is a strategic, clinically relevant goal of health care systems. This study develops and tests a conceptual model that aims to account for the influence of organization design, perceptions of quality of patient care, and other patient-level factors on the extent to which patients sustain reliance on a health care system. We use a longitudinal survey design and structural equation modeling to predict increases or decreases in patient reliance on the Department of Veterans Affairs health care system across a 4-year period for Veterans with Parkinson's Disease. Our findings show that specialized and integrated clinical practices have a positive association with the quality of patient care. Health care systems may be able to foster long-term relations with patients and improve service quality by allocating resources to form integrated, specialized, disease-specific centers of care designed for patients with chronic illnesses.
authors: VA Center for Healthcare Organization and Implementation Research, Boston, MA, USA Health Policy and Management Department, Boston University School of Public Health, MA, USA marian@bu.edu.
authors: Alan J
authors: AJ
authors: Labonte
authors: VA Center for Healthcare Organization and Implementation Research, Boston, MA, USA VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, TX, USA Health Policy and Management Department, Boston University School of Public Health, MA, USA.
authors: Justin K
authors: JK
authors: Benzer
authors: VA Center for Healthcare Organization and Implementation Research, Boston, MA, USA Health Policy and Management Department, Boston University School of Public Health, MA, USA.
authors: James F
authors: JF
authors: Burgess
authors: VA Center for Healthcare Organization and Implementation Research, Boston, MA, USA.
authors: Irene E
authors: IE
authors: Cramer
authors: VA Center for Healthcare Organization and Implementation Research, Boston, MA, USA Health Policy and Management Department, Boston University School of Public Health, MA, USA.
authors: Mark
authors: M
authors: Meterko
authors: VA Center for Healthcare Organization and Implementation Research, Boston, MA, USA Health Policy and Management Department, Boston University School of Public Health, MA, USA.
authors: Terri K
authors: TK
authors: Pogoda
authors: VA Center for Healthcare Organization and Implementation Research, Boston, MA, USA Health Policy and Management Department, Boston University School of Public Health, MA, USA.
authors: Martin P
authors: MP
authors: Charns
mesh_terms: D003695:Delivery of Health Care / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D008137:Longitudinal Studies; D010300:Parkinson Disease / Q000628:therapy; D017060:Patient Satisfaction; D011787:Quality of Health Care; D014481:United States; D014493:United States Department of Veterans Affairs
keywords: health care system; organization design; reliance; service quality; switching behavior