Research Question:

Coyne: Do size and ownership type make a difference in the efficiency and cost results of hospitals in Washington state? (Highlight p.164, second column, starting 15 lines from bottom to seven lines from bottom.)

Messina:

How did the research question emerge from the review of literature in the article?

Coyne: Built on an earlier study by Coyne on performance differences between multi-facility systems and independent hospitals using two cost measures. Cited studies that used a range of variables to measure differences in hospital performance, and noted that prior findings have been inconclusive in regard to hospital size, although economies of scale were found.

Messina:

Independent Variables

Type:

Coyne: Hospital size and hospital ownership structure.

Categorical

Messina:

Dependent Variables

Type:

Coyne: Efficiency measures – continuous variables.

Cost measures – continuous variables.

Messina:

Design Elements

1. Quantitative vs. Qualitative

2. Sample Size

3. Method of sample selection

4. Experimental vs. control group?

5. Reliable and valid data instruments?

Coyne:

Quantitative

96

Picked all hospitals in state, except investor owned hospitals.

No

Used data that are commonly used to measure hospital efficiency and performance with high degrees of accuracy (reliable), and data that are historically used and make sense to other hospital users (valid).

Messina:

Describe analysis.

What statistics were used?

Coyne: Two-way Analysis of Variance (ANOVA)

Messina:

Did the researchers’ conclusions make sense, did they answer the research question, and did they appear to flow from the review of the literature?

Did they explore control of extraneous variables?

Coyne: They concluded that size and ownership type make a difference in reported levels of efficiency. Not for profits seem to achieve higher performance levels, and medium and large not for profits operate more efficiently than industry average. The same results were found for cost levels, in that size and ownership type do make a difference, with medium sized hospitals reporting lower costs than large or small hospitals.

Yes, when they called for national studies that controlled for case mix, scope of services, and payer mix, all of which could have affected the results in this study in an unmeasured way.

Messina: