Inefficiencies of care in hub and spoke healthcare systems: A multi-state cohort study.

ABSTRACT

BACKGROUND: Complex surgical care is often centralized to one high volume (hub) hospital within a system. The benefit of this centralization in common operations is unknown. METHODS: Using the Healthcare Cost and Utilization Project's State Inpatient Databases, adult general surgical patients within hospital systems in 13 states (2016-2018) were identified. Risk-adjusted logistic regression estimated the odds of death or serious morbidity (DSM) and prolonged length of stay (LOS) at hubs relative to other system hospitals (spokes). RESULTS: We identified 122,895 patients across 43 hub-and-spoke systems. Hubs completed 83.2 â€‹% of complex and 59.6 â€‹% of common operations. For complex operations, odds of DSM were significantly lower in hubs (OR 0.80; 95 â€‹% CI [0.65, 0.98]). For common operations, odds of DSM were similar between hubs and spokes, while odds of prolonged LOS were greater at hubs (OR 1.19; 95 â€‹% CI [1.16,1.24]). CONCLUSIONS: While hub hospitals had lower odds of DSM for complex operation, they had higher odds of prolonged length of stay for common operations. This finding shows an opportunity for improved system efficiency.