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2 Strategies to Limit Variation in Hospital Networks

By Christopher Cheney  
   March 14, 2019

Exporting best practices from high-performing hospitals and establishing regional referral centers can level variation in hospital networks' clinical outcomes.

There are two primary strategies for health systems to limit variation in their hospital networks, researchers say in an article published this week in JAMA Surgery.

The number of hospitals joining networks has doubled over the past decade. The motivations for network formation include strategic allocation of resources, improved administrative efficiency, and opportunities to create centers of excellence.

The JAMA Surgery researchers investigated whether networks of hospitals affiliated with U.S. News & World Report honor roll hospitals delivered a consistent level of care in three service lines.

"It remains unclear whether these multihospital networks are able to deliver a uniform standard of care. While some networks may provide consistent outcomes, others may offer disparate levels of quality across affiliated hospitals despite sharing the same mission or brand," the researchers wrote.

The researchers analyzed data for colectomy, coronary artery bypass graft, and hip replacement at 87 hospitals in 16 networks. Surgical outcomes at affiliated hospitals varied widely. For example, mortality rates varied from 1.1-fold to 4.1-fold.

The research team highlighted two strategies to limit clinical outcome variation in hospital networks.

1. Exporting quality

To limit variation, hospital networks can export delivery models that achieve high quality at top-performing hospitals to all affiliates. Sharing best practices across the entire network can potentially generate better clinical outcomes at all network hospitals.

2. Referral centers

Networks can try to achieve better collective outcomes by centralizing care at referral centers that treat rare conditions, high-risk patients, and volume-sensitive procedures.

"In this scenario, higher or more variable adverse event rates would manifest in networks that fail to restrict complex services to hospitals with limited experience managing complications or to those that lack specific resources, such as 24-hour intensivist staffing," the researchers wrote.

Executing corrective strategies

Gauging the performance of hospitals in a network is essential to limiting variation in clinical outcomes, the researchers wrote. "Networks should monitor variations in outcomes to characterize and improve the extent to which a uniform standard of care is being delivered."

Focusing on service lines is imperative. "Networks that fail to critically evaluate their service lines to align expertise and resources appropriately will demonstrate more variability in quality across their affiliates," the researchers wrote.

Engaging clinicians is another key element in limiting variation, they wrote. "Beyond service-line reorganization, it will be increasingly important for networks to determine how to integrate clinicians into these multihospital quality improvement efforts. Clinician input is critical to all aspects of delivery system redesign but may be particularly relevant to quality improvement."

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.


Motivations for hospital network formation include strategic allocation of resources and improved administrative efficiency.

Recent research found wide levels of variation in clinical outcomes in hospital networks.

Monitoring hospital performance is the foundation of efforts to limit clinical outcome variation in hospital networks.

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