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An Empirical Investigation of "Physician Congestion" in U.S. University Hospitals.

ABSTRACT: We add a new angle to the debate on whether greater healthcare spending is associated with better outcomes, by focusing on the link between the size of the physician workforce at the ward level and healthcare results. Drawing on standard organization theories, we proposed that due to organizational limitations, the relationship between physician workforce size and medical performance is hump-shaped. Using a sample of 150 U.S. university departments across three specialties that record measures of clinical scores, as well as a rich set of covariates, we found that the relationship was indeed hump-shaped. At the two extremes, departments with an insufficient (excessive) number of physicians may gain a substantial increase in healthcare quality by the addition (dismissal) of a single physician. The marginal elasticity of healthcare quality with respect to the number of physicians, although positive and significant, was much smaller than the marginal contribution of other factors. Moreover, research quality conducted at the ward level was shown to be an important moderator. Our results suggest that studying the relationship between the number of physicians per bed and the quality of healthcare at an aggregate level may lead to bias. Framing the problem at the ward-level may facilitate a better allocation of physicians.

SUBMITTER: Manes E

PROVIDER: S-EPMC6427243 | biostudies-literature | 2019 Mar

REPOSITORIES: biostudies-literature

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An Empirical Investigation of "Physician Congestion" in U.S. University Hospitals.

Manes Eran E Tchetchik Anat A Tobol Yosef Y Durst Ronen R Chodick Gabriel G

International journal of environmental research and public health 20190302 5

We add a new angle to the debate on whether greater healthcare spending is associated with better outcomes, by focusing on the link between the size of the physician workforce at the ward level and healthcare results. Drawing on standard organization theories, we proposed that due to organizational limitations, the relationship between physician workforce size and medical performance is hump-shaped. Using a sample of 150 U.S. university departments across three specialties that record measures o ...[more]

PMID: 30832384

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Project description:ObjectivesTo determine the total numbers of privileged and full-time equivalent intensivists in acute care hospitals with intensivists and compare the characteristics of hospitals with and without intensivists.DesignRetrospective analysis of the American Hospital Association Annual Survey Database (Fiscal Year 2015).SettingTwo-thousand eight-hundred fourteen acute care hospitals with ICU beds.PatientsNone.InterventionsNone.Measurements and main resultsOf the 2,814 acute care hospitals studied, 1,469 (52%) had intensivists and 1,345 (48%) had no intensivists. There were 28,808 privileged and 19,996 full-time equivalent intensivists in the 1,469 hospitals with intensivists. In these hospitals, the median (25-75th percentile) numbers of privileged and full-time equivalent intensivists were 11 (5-24) and 7 (2-17), respectively. Compared with hospitals without intensivists, hospitals with privileged intensivists were primarily located in metropolitan areas (91% vs 50%; p < 0.001) and at the aggregate level had nearly thrice the number of hospital beds (403,522 [75%] vs 137,146 [25%]), 3.6 times the number of ICU beds (74,222 [78%] vs 20,615 [22%]), and almost twice as many ICUs (3,383 [65%] vs 1,846 [35%]). At the hospital level, hospitals with privileged intensivists had significantly more hospital beds (median, 213 vs 68; p < 0.0001), ICU beds (median, 32 vs 8; p < 0.0001), a higher ratio of ICU to hospital beds (15.6% vs 12.6%; p < 0.0001), and a higher number of ICUs per hospital (2 vs 1; p < 0.0001) than hospitals without intensivists.ConclusionsAnalyzing the intensivist section of the American Hospital Association Annual Survey database is a novel approach to estimating the numbers of privileged and full-time equivalent intensivists in acute care hospitals with ICU beds in the United States. This methodology opens the door to an enhanced understanding of the current supply and distribution of intensivists as well as future research into the intensivist workforce.

Project description:INTRODUCTION:Literature on healthcare reforms highlights the importance of physician engagement, suggesting that it is a critical factor for lowering costs while improving efficiency, quality of care, patient safety, physician satisfaction and retention. As a result, many hospitals have adopted physician engagement as a top strategic priority, but little is known about the actual evidence, making it difficult for hospital leadership to identify relationships between true physician 'work engagement' and work outcomes. The aim of this scoping review is to identify factors associated with, and tools used to measure, physician engagement. METHODS AND ANALYSIS:This scoping review will be conducted as per Arksey and O'Malley (2005). The electronic databases that will be searched from inception onwards include MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials. Grey literature will be searched via websites of relevant agencies such as Agency for Healthcare Research and Quality. Conferences and abstracts will be viewed and full paper requests made as required. Supplementary articles may be obtained by contacting field experts and searching references of relevant articles. All quantitative and qualitative study designs will be eligible that describe factors associated with, and tools used to measure, hospital physician engagement. After a small calibration exercise, screening and abstraction will be completed separately by two individuals, with discrepancies resolved by a third. Quantitative (frequencies) and qualitative analyses (generation of descriptives) will be conducted. Thematic analysis will be used to evaluate and categorise study findings. IMPLICATIONS AND DISSEMINATION:This project is part of the Ontario Hospital Association's (OHA) initiative to improve its understanding of physician engagement. The review findings will be shared with all Ontario hospitals. Dissemination will occur through peer-reviewed publications and to the OHA membership through the OHA Learning and Engagement team.

Dataset Information

An Empirical Investigation of "Physician Congestion" in U.S. University Hospitals.

Publications

An Empirical Investigation of "Physician Congestion" in U.S. University Hospitals.

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