title: Changes in Hospital-Physician Affiliations in U.S. Hospitals and Their Effect on Quality of Care.
abstract: BACKGROUND
  Growing evidence shows that hospitals are increasingly employing physicians.
  
  
  OBJECTIVE
  To examine changes in U.S. acute care hospitals that reported employment relationships with their physicians and to determine whether quality of care improved after the hospitals switched to this integration model.
  
  
  METHODS
  Retrospective cohort study of U.S. acute care hospitals between 2003 and 2012.
  
  
  METHODS
  U.S. nonfederal acute care hospitals.
  
  
  METHODS
  803 switching hospitals compared with 2085 nonswitching control hospitals matched for year and region.
  
  
  METHODS
  Hospitals' conversion to an employment relationship with any of their privileged physicians.
  
  
  METHODS
  Risk-adjusted hospital-level mortality rates, 30-day readmission rates, length of stay, and patient satisfaction scores for common medical conditions.
  
  
  RESULTS
  In 2003, approximately 29% of hospitals employed members of their physician workforce, a number that rose to 42% by 2012. Relative to regionally matched controls, switching hospitals were more likely to be large (11.6% vs. 7.1%) or major teaching hospitals (7.5% vs. 4.5%) and less likely to be for-profit institutions (8.8% vs. 19.9%) (all P values <0.001). Up to 2 years after conversion, no association was found between switching to an employment model and improvement in any of 4 primary composite quality metrics.
  
  
  CONCLUSIONS
  The measure of integration used depends on responses to the American Hospital Association annual questionnaire, yet this measure has been used by others to examine effects of integration. The study examined performance up to 2 years after evidence of switching to an employment model; however, beneficial effects may have taken longer to appear.
  
  
  CONCLUSIONS
  During the past decade, hospitals have increasingly become employers of physicians. The study's findings suggest that physician employment alone probably is not a sufficient tool for improving hospital care.
  
  
  BACKGROUND
  Agency for Healthcare Research and Quality and National Science Foundation Graduate Research Fellowship.
authors.affiliation: From Harvard T.H. Chan School of Public Health, Harvard Medical School, and Brigham and Women's Hospital, Boston, and Harvard University, Cambridge, Massachusetts.
authors.forename: Kirstin W
authors.initials: KW
authors.lastname: Scott
authors.affiliation: From Harvard T.H. Chan School of Public Health, Harvard Medical School, and Brigham and Women's Hospital, Boston, and Harvard University, Cambridge, Massachusetts.
authors.forename: E John
authors.initials: EJ
authors.lastname: Orav
authors.affiliation: From Harvard T.H. Chan School of Public Health, Harvard Medical School, and Brigham and Women's Hospital, Boston, and Harvard University, Cambridge, Massachusetts.
authors.forename: David M
authors.initials: DM
authors.lastname: Cutler
authors.affiliation: From Harvard T.H. Chan School of Public Health, Harvard Medical School, and Brigham and Women's Hospital, Boston, and Harvard University, Cambridge, Massachusetts.
authors.forename: Ashish K
authors.initials: AK
authors.lastname: Jha
mesh_terms: D004651:Employment / Q000639:trends; D006738:Hospices / Q000706:statistics & numerical data; D020445:Hospitalists / Q000639:trends*; D006761:Hospitals / Q000592:standards* / Q000639:trends*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D009935:Organizational Affiliation; D017060:Patient Satisfaction; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies; D014481:United States