Evidence map›Paper›PMID 33728678›Full record

ArticleHealth services research2021

The association of vertically integrated care with health care use and outcomes.

Peter J Huckfeldt, Jing Gu, José J Escarce, Pinar Karaca-Mandic, Neeraj Sood

Abstract read
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Article in Health services research, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

Peter J HuckfeldtDivision of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA.ORCID 0000-0003-1593-4167
Jing GuRegeneron Pharmaceuticals, Inc., Tarrytown, New York, USA.
José J EscarceDavid Geffen School of Medicine at UCLA, Los Angeles, California, USA.
Pinar Karaca-MandicCarlson School of Management, University of Minnesota, Minneapolis, Minnesota, USA.ORCID 0000-0002-6682-1982
Neeraj SoodSchaeffer Center for Health Policy and Economics, Sol Price School of Public Policy, University of Southern California, Los Angeles, California, USA.ORCID 0000-0001-9805-213X

Funding

Vertical Integration and Care Coordination in Post-Acute Care MarketsR01AG046838 · NIA · UNIVERSITY OF SOUTHERN CALIFORNIA · PI SOOD, NEERAJ · 2014 to 2017
$2.8M
NIA NIH HHS R01 AG046838
6 · The paper itself

Abstract

objectiveTo determine whether vertically integrated hospital and skilled nursing facility (SNF) care is associated with more efficient use of postdischarge care and better outcomes. DATA SOURCES: Medicare provider, beneficiary, and claims data from 2012 to 2014. STUDY

designWe compared facility characteristics, quality of care, and health care use for hospital-based SNFs and "virtually integrated" SNFs (defined as freestanding SNFs with close referral relationships with a single hospital) relative to nonintegrated freestanding SNFs. Among patients admitted to integrated SNFs, we estimated differences in health care use and outcomes for patients originating from the parent hospital (ie, receiving vertically integrated care) versus other hospitals using linear regressions that included SNF fixed effects. We estimated bounds for our main estimates that incorporated potential omitted variables bias. DATA EXTRACTION

methodsWe identified hospital-based SNFs based on provider data. We defined virtually integrated SNFs based on patient flows between hospitals and SNFs. We identified SNF episodes, preceding hospital stays, patient characteristics, health care use, and patient outcomes using Medicare data. PRINCIPAL

findingsConsistent with prior research, integrated SNFs performed better on quality measures and health care use relative to nonintegrated SNFs (eg, hospital-based SNFs had 11-day shorter stays compared with nonintegrated SNFs adjusting for patient characteristics, P < .001). Stroke patients admitted to hospital-based SNFs from the parent hospital had shorter preceding hospital stays (adjusted difference: -1.2 days, P = .001) and shorter initial SNF stays (adjusted difference: -2.7 days, P = .049); estimates were attenuated but still robust accounting for potential omitted variables bias. For stroke patients, associations between vertically integrated care and other outcomes were either statistically insignificant or not robust to accounting for potential omitted variables bias.

conclusionsVertically integrated hospital and SNF care was associated with shorter hospital and SNF stays. However, there were few beneficial associations with other outcomes, suggesting limited coordination benefits from vertical integration.

Indexed as

AgedAged, 80 and overDelivery of Health Care, IntegratedFemaleHealth ServicesHealth StatusHumansInsurance Claim ReviewLength of StayMaleMedicareOutcome Assessment, Health CarePatient Acceptance of Health CarePatient DischargePatient ReadmissionQuality of Health Carehealth care costshealth economicsMedicarereferrals and referral networksrehabilitation services

Identifiers

PMID33728678
PMCPMC8522559

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.