Indiana University-Purdue University Indianapolis (IUPUI) / Hospital costs are the largest contributor to US health expenditures, making them
a common target for cost containment policies. Policies that reduce fragmentation in
health care and related systems could increase the value of these expenditures while
improving outcomes. Efforts to address fragmentation of health care services, such as
Accountable Care Organizations, have typically been enacted at the scale of health
systems. However, coordination within health care facilities should also be explored.
In three essays, I analyze the role of coordination in several forms. First, I
examine the introduction of interdisciplinary care teams within a hospital. This analysis
features care coordination within a health care facility with the potential to reduce
resource utilization through improved communication between team members and
between patients and their care providers. I find that care coordination reduced length of
stay for some patients while maintaining care quality. This combination results in higher
value care for patients and hospitals.
Second, I explore whether these interdisciplinary care teams impact resource
utilization and patient flow throughout the hospital. The primary outcome is reduction in
patient transfers to the ICU. Here, care coordination includes interdisciplinary teams as
well as coordination between interdisciplinary teams and intensivists in ICUs. Findings
from this analysis suggest that ICU transfers were unaffected by care coordination. Finally, I examine coordination on a larger scale. I leverage data from a national
database of trauma patients to compare mortality among adolescent patients with isolated
traumatic brain injury between adult trauma centers and pediatric trauma centers.
Previous work has shown that younger pediatric patients with this injury benefit from
treatment at pediatric trauma centers. However, it is unclear whether this benefit extends
to older pediatric patients on the cusp of adulthood. I find that, after adjusting for
differences in injury severity, adolescent patients have no difference in mortality risk
when treated at adult or pediatric trauma centers. This finding supports the current
regionalized model of trauma care where severely injured patients are taken to the nearest
trauma center, regardless of designation as pediatric or adult. / 2023-07-01
| Identifer | oai:union.ndltd.org:IUPUI/oai:scholarworks.iupui.edu:1805/29509 |
| Date | 06 1900 |
| Creators | Sheff, Zachary Thompson |
| Contributors | Ottoni-Wilhelm, Mark, Royalty, Anne, Tennekoon, Vidhura, Morrison, Gwendolyn, Dixon, Brian E. |
| Source Sets | Indiana University-Purdue University Indianapolis |
| Language | en_US |
| Detected Language | English |
| Type | Dissertation |
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