title: Identifying Natural Alignments Between Ambulatory Surgery Centers and Local Health Systems: Building Broader Communities of Surgical Care.
abstract: OBJECTIVE
  To develop and compare methods for identifying natural alignments between ambulatory surgery centers (ASCs) and hospitals that anchor local health systems.
  
  
  METHODS
  Using all-payer data from Florida's State Ambulatory Surgery and Inpatient Databases (2005-2009), we developed 3 methods for identifying alignments between ASCS and hospitals. The first, a geographic proximity approach, used spatial data to assign an ASC to its nearest hospital neighbor. The second, a predominant affiliation approach, assigned an ASC to the hospital with which it shared a plurality of surgeons. The third, a network community approach, linked an ASC with a larger group of hospitals held together by naturally occurring physician networks. We compared each method in terms of its ability to capture meaningful and stable affiliations and its administrative simplicity.
  
  
  RESULTS
  Although the proximity approach was simplest to implement and produced the most durable alignments, ASC surgeon's loyalty to the assigned hospital was low with this method. The predominant affiliation and network community approaches performed better and nearly equivalently on these metrics, capturing more meaningful affiliations between ASCs and hospitals. However, the latter's alignments were least durable, and it was complex to administer.
  
  
  CONCLUSIONS
  We describe 3 methods for identifying natural alignments between ASCs and hospitals, each with strengths and weaknesses. These methods will help health system managers identify ASCs with which to partner. Moreover, health services researchers and policy analysts can use them to study broader communities of surgical care.
authors: *Department of Sociology, University of Michigan College of Literature, Science, and the Arts ‡Center for Healthcare Outcomes and Policy, University of Michigan Medical School §Department of Urology, Dow Division of Health Services Research, University of Michigan Medical School, Ann Arbor, MI †Department of Health Care Policy, Harvard Medical School, Boston, MA.
authors: Russell J
authors: RJ
authors: Funk
authors: Jason
authors: J
authors: Owen-Smith
authors: Bruce E
authors: BE
authors: Landon
authors: John D
authors: JD
authors: Birkmeyer
authors: John M
authors: JM
authors: Hollingsworth
mesh_terms: D003153:Community Health Services / Q000458:organization & administration*; D005431:Florida; D006739:Hospital Administration; D006801:Humans; D007373:Interinstitutional Relations; D013531:Surgicenters / Q000458:organization & administration*; D014481:United States