HealthDay News — According to a study published in Medical Care, vertical integration — the merging of health care providers of different levels into a single unit — is associated with a reduction in readmissions overall, although the positive effect is seen for a limited number of conditions.

Sílvia Lopes, PhD, from the Universidade NOVA de Lisboa in Portugal, and colleagues used a difference-in-differences approach to compare readmissions before and after vertical integration in six hospitals in Portugal for 2004 to 2013, relative to a control group with six similar hospitals that were not integrated. The researchers observed an overall decrease in readmissions after vertical integration (odds ratio [OR], 0.900; 95% confidence interval [CI], 0.812 to 0.997). 

In hospital analysis, there was no impact seen for two hospitals (ORs, 0.960 [95% CI, 0.848 to 1.087] and 0.944 [95% CI, 0.857 to 1.038]), while a positive effect was seen for four hospitals (greatest effect: OR, 0.811 [95% CI, 0.736 to 0.894]). 

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For a limited number of conditions there was a positive evolution, with better results for diabetes with complications (OR, 0.689 [95% CI, 0.525 to 0.904]), while no impact was seen for congestive heart failure (OR, 1.067 [95% CI, 0.827 to 1.377]).

“Merging acute and primary care providers was associated with reduced readmissions, even though improvements were not found for all institutions or condition-specific groups,” the authors write.


Lopes S, et al. “Can Vertical Integration Reduce Hospital Readmissions? A Difference-In-Differences Approach.” Medical Care. 2017;55(5): 506-513. doi: 10.1097/MLR.0000000000000704

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