Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Dec 15;5(3):9.
doi: 10.5334/egems.200.

Leveraging Diverse Data Sources to Identify and Describe U.S. Health Care Delivery Systems

Affiliations

Leveraging Diverse Data Sources to Identify and Describe U.S. Health Care Delivery Systems

Genna R Cohen et al. EGEMS (Wash DC). .

Abstract

Health care delivery systems are a growing presence in the U.S., yet research is hindered by the lack of universally agreed-upon criteria to denote formal systems. A clearer understanding of how to leverage real-world data sources to empirically identify systems is a necessary first step to such policy-relevant research. We draw from our experience in the Agency for Healthcare Research and Quality's Comparative Health System Performance (CHSP) initiative to assess available data sources to identify and describe systems, including system members (for example, hospitals and physicians) and relationships among the members (for example, hospital ownership of physician groups). We highlight five national data sources that either explicitly track system membership or detail system relationships: (1) American Hospital Association annual survey of hospitals; (2) Healthcare Relational Services Databases; (3) SK&A Healthcare Databases; (4) Provider Enrollment, Chain, and Ownership System; and (5) Internal Revenue Service 990 forms. Each data source has strengths and limitations for identifying and describing systems due to their varied content, linkages across data sources, and data collection methods. In addition, although no single national data source provides a complete picture of U.S. systems and their members, the CHSP initiative will create an early model of how such data can be combined to compensate for their individual limitations. Identifying systems in a way that can be repeated over time and linked to a host of other data sources will support analysis of how different types of organizations deliver health care and, ultimately, comparison of their performance.

Keywords: federal data; healthcare delivery systems; healthcare organizations; hospitals; physicians; survey data.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Data Needs to Study Vertically Integrated Systems.
Figure 2
Figure 2
Data Source Linkages. Data Source Acronyms, clockwise from top: Provider Enrollment, Chain, and Ownership System (PECOS); SK&A Healthcare Databases (SK&A); Healthcare Relational Services Databases (HCRS); Internal Revenue Service 990 forms (IRS); American Hospital Association annual survey of hospitals (AHA). Matching Variable Acronyms, alphabetically: American Hospital Association ID (AHA ID); CMS Certification Number (CCN); National Provider Identifier (NPI); Tax Identification Number (TIN). Notes: Data sources specified in the black boxes may be linked through the matching variables specified in the gray boxes.

References

    1. Bishop, TF, Shortell, SM, Ramsay, PP, Copeland, KR and Casalino, LP. Trends in hospital ownership of physician practices and the effect on processes to improve quality. Am J Manag Care. 2016. March; 22(3): 172–6. - PMC - PubMed
    1. Kocher, R and Sahni, NR. Hospitals’ race to employ physicians—the logic behind a money-losing proposition. N Engl J Med. 2011; 364(19): 1790–3. DOI: 10.1056/NEJMp1101959 - DOI - PubMed
    1. Kutscher, B. No hangover: Doc buying binge rolls on as systems learn from past deals. Modern Healthcare [magazine on the Internet]; 2015. June 20 [cited 2017 Nov 3]. Available from: http://www.modernhealthcare.com/article/20150620/MAGAZINE/306209979.
    1. Neprash, HT, Chernew, ME, Hicks, AL, Gibson, T and McWilliams, JM. Association of financial integration between physicians and hospitals with commercial health care prices. JAMA Intern Med. 2015; 175(12): 1932–9. DOI: 10.1001/jamainternmed.2015.4610 - DOI - PubMed
    1. Scott, KW, Orav, EJ, Cutler, DM and Jha, AK. Changes in hospital–physician affiliations in US hospitals and their effect on quality of care. Ann Intern Med. 2017; 166(1): 1–8. DOI: 10.7326/M16-0125 - DOI - PubMed

LinkOut - more resources