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Disruptive Transformations in Health Care: Technological Innovation and the Acute Care General Hospital.

机译：卫生保健领域的颠覆性变革：技术创新和急性病总医院。

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摘要

Advances in medical technology have altered the need for certain types of surgery to be performed in traditional inpatient hospital settings. Less invasive surgical procedures allow a growing number of medical treatments to take place on an outpatient basis. Hospitals face growing competition from ambulatory surgery centers (ASCs). The competitive threats posed by ASCs are important, given that inpatient surgery has been the cornerstone of hospital services for over a century. Additional research is needed to understand how surgical volume shifts between and within acute care general hospitals (ACGHs) and ASCs. This study investigates how medical technology within the hospital industry is changing medical services delivery.;The main purposes of this study are to (1) test Clayton M. Christensen's theory of disruptive innovation in health care, and (2) examine the effects of disruptive innovation on appendectomy, cholecystectomy, and bariatric surgery (ACBS) utilization. Disruptive innovation theory contends that advanced technology combined with innovative business models---located outside of traditional product markets or delivery systems---will produce simplified, quality products and services at lower costs with broader accessibility. Consequently, new markets will emerge, and conventional industry leaders will experience a loss of market share to "non-traditional" new entrants into the marketplace. The underlying assumption of this work is that ASCs (innovative business models) have adopted laparoscopy (innovative technology) and their unification has initiated disruptive innovation within the hospital industry. The disruptive effects have spawned shifts in surgical volumes from open to laparoscopic procedures, from inpatient to ambulatory settings, and from hospitals to ASCs. The research hypothesizes that: (1) there will be larger increases in the percentage of laparoscopic ACBS performed than open ACBS procedures; (2) ambulatory ACBS will experience larger percent increases than inpatient ACBS procedures; and (3) ASCs will experience larger percent increases than ACGHs.;The study tracks the utilization of open, laparoscopic, inpatient and ambulatory ACBS. The research questions that guide the inquiry are: 1. How has ACBS utilization changed over this time? 2. Do ACGHs and ASCs differ in the utilization of ACBS? 3. How do states differ in the utilization of ACBS? 4. Do study findings support disruptive innovation theory in the hospital industry?;The quantitative study employs a panel design using hospital discharge data from 2004 and 2009. The unit of analysis is the facility. The sampling frame is comprised of ACGHs and ASCs in Florida and Wisconsin. The study employs exploratory and confirmatory data analysis.;This work finds that disruptive innovation theory is an effective model for assessing the hospital industry. The model provides a useful framework for analyzing the interplay between ACGHs and ASCs. While study findings did not support the stated hypotheses, the impact of government interventions into the competitive marketplace supports the claims of disruptive innovation theory. Regulations that intervened in the hospital industry facilitated interactions between ASCs and ACGHs, reducing the number of ASCs performing ACBS and altering the trajectory of ACBS volume by shifting surgeries from ASCs to ACGHs.
机译：医疗技术的进步改变了在传统住院医院环境中进行某些类型手术的需求。侵入性较小的外科手术程序允许在门诊病人的基础上进行越来越多的医学治疗。医院面临非卧床手术中心（ASC）日益激烈的竞争。鉴于住院手术已成为一个世纪以来医院服务的基石，因此ASC构成的竞争威胁非常重要。需要更多的研究来了解外科手术量如何在急诊综合医院（ACGH）和ASC之间和之内转移。本研究调查了医院行业中的医疗技术如何改变医疗服务的提供方式;本研究的主要目的是（1）检验克莱顿·克里斯滕森（Clayton M.Christensen）在医疗保健领域的破坏性创新理论，以及（2）研究破坏性的影响阑尾切除术，胆囊切除术和减肥手术（ACBS）利用方面的创新。颠覆性创新理论认为，结合传统产品市场或交付系统之外的先进技术与创新业务模型的结合，将以较低的成本和更广泛的可及性提供简化的优质产品和服务。结果，将出现新的市场，并且传统的行业领导者将遭受市场份额的损失，从而“非传统”进入市场的新进入者。这项工作的基本假设是，ASC（创新业务模型）已采用腹腔镜（创新技术），并且它们的统一在医院行业内引发了破坏性创新。破坏性影响催生了手术量从开放到腹腔镜手术，从住院到非卧床，从医院到ASC的转变。该研究假设：（1）与开放式ACBS手术相比，腹腔镜ACBS的百分比增加更大； （2）非住院式ACBS的住院率将比住院ACBS手术的住院率高； （3）ASCs的增长将比ACGHs大。;该研究跟踪了开放式，腹腔镜，住院和门诊ACBS的使用情况。指导该研究的研究问题是：1.在这段时间内ACBS利用率如何变化？ 2. ACGH和ASC在使用ACBS方面是否有所不同？ 3.各州在使用ACBS方面有何不同？ 4.研究结果是否支持医院行业的破坏性创新理论？；定量研究采用了面板设计，该面板设计使用了2004年和2009年的医院出院数据。分析的单位是设施。抽样框架由佛罗里达州和威斯康星州的ACGH和ASC组成。该研究采用探索性和确认性数据分析。这项工作发现，破坏性创新理论是评估医院行业的有效模型。该模型为分析ACGH和ASC之间的相互作用提供了有用的框架。尽管研究结果不支持上述假设，但政府干预竞争性市场的影响支持了破坏性创新理论的主张。干预医院行业的法规促进了ASC和ACGH之间的互动，通过将手术从ASC转移到ACGH来减少执行ACBS的ASC的数量，并改变ACBS量的轨迹。

著录项

  • 作者

    Lucas, D. Pulane.;

  • 作者单位

    Virginia Commonwealth University.;

  • 授予单位 Virginia Commonwealth University.;
  • 学科 Sociology Public and Social Welfare.;Health Sciences Health Care Management.;Political Science Public Administration.
  • 学位 Ph.D.
  • 年度 2013
  • 页码 393 p.
  • 总页数 393
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

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