Project Description
Summary:
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The National Survey
of Healthcare Organizations and Systems (NSHOS) was developed by researchers
at Dartmouth College in collaboration with Harvard University; University of California, Berkeley; Mayo Clinic and the High Value Healthcare Collaborative. The NSHOS was fielded from June 2017-August
2018 with funding from the Agency for Healthcare Research and Quality's Comparative Health System Performance Initiative. This suite of nationally representative surveys aimed to characterize the structure, ownership, leadership, and care delivery capabilities of health care systems, primary and multispecialty care physician practices, and hospitals. The surveys assess ownership, mental and behavioral health, information collection for quality improvement, and ACO participation, among other topics.
Practice managers and physicians at practices and C-suite leaders at hospitals were contacted with up to four mailings with invitations to complete the survey on paper or electronically. Email and telephone outreach were conducted when possible. Most respondents completed the survey on paper. Up to three individuals in each practice were contacted for practices that had not already completed the survey.
These public versions of the practice and hospital surveys include a subset of survey questions and scales to prevent identification of respondents.
Funding Sources:
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United States Department of Health and Human Services. Agency for Healthcare Research and Quality (U19 HS024075-05 (PI: Meara))
Scope of Project
Subject Terms:
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physician practice;
primary care;
primary care practice;
survey;
hospitals;
healthcare organizations;
health systems;
integration
Time Period(s):
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7/2017 – 8/2018 (The sample frame was formed from practices and hospitals existing in a midyear 2015 IQVIA OneKey database. The survey was fielded from June 2017- August 17, 2018.)
Universe:
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Single-location primary and multispecialty
care physician practices operating in the U.S. between 2015 and 2018 with at
least three primary care physicians. Primary care physicians included family
medicine, geriatrics, internal medicine, or preventive medicine specialties.
Short-term acute care and critical access
hospitals operating in the U.S. between 2015 and 2018. Specialty hospitals were
excluded.
Methodology
Response Rate:
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We
sampled 4,976 practices and obtained 2,333 responses. The response rate for the
practice survey is 46.9%. 143 responses were later excluded because they could
not be confirmed as in our sample frame. Removing those practices, the adjusted
response rate is 44.0%.
We
sampled 1,628 hospitals and obtained 757 responses for a 46.5% response rate. 18
responses were later excluded because they could not be confirmed as in our
sample frame for an adjusted response rate of 45.4% for the hospital survey.
Sampling:
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We
used a stratified-cluster sampling design to select healthcare systems,
physician practices, and hospitals using the approach described in “O'Malley AJ, Park S. A Novel
Cluster Sampling Design that Couples Multiple Surveys to Support Multiple
Inferential Objectives. Health Serv Outcomes Res Methodol. 2020 Sep;20(2-3):85-110.
doi: 10.1007/s10742-020-00210-y. Epub 2020 Jun 9. PMID: 33613088; PMCID:
PMC7888270.” When a healthcare system was sampled, we then surveyed physician
practices and hospitals owned by those systems. We stratified our sample based
on ownership and composition structures, including samples of both system-owned
and independent physician practices and hospitals.
Data Source:
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The
National Survey of Healthcare Organizations and Systems is a primary data
collection using survey methodology.
Weights:
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Survey weights are adjusted for non-response
and are designed to allow results for our sample to be extended to the entire
sampling frame, not all physician practices or hospitals nationally. The weight
weight_r is the marginal probability of sampling a practice or hospital. In these files for public use, we use a single survey weight to avoid identifying individual respondent organizations, while the full survey accounted for the nested structure of practices and hospitals within health systems.
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