The Association Among Structural Quality, Operational Competence And Emergency Outpatient Visits: A Longitudinal Analysis Of US Community Hospitals

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Aber Elsaleiby


Bed Utilization, Structural Quality, Expense Per Capita, Emergency Outpatient Visits


The aim of the current study is to enhance our understanding on how hospital’s structural quality and operational competence can influence the emergency outpatient visits. We use a large database acquired from the American Hospital Association. The database has state-wide data on several health care quality parameters of interest over an extended period of 17 years starting from 1994 till 2010 for all community hospitals in the US. (4,926 community hospitals). Structural quality is captured by a measure of bed availability and usage. Operational competence is measured by the expense per capita. Finally, data on emergency outpatient visits is our outcome measure. We found that there is a significant negative association between structural quality and emergency outpatient visits. Similarly, there is a significant negative association between hospital operational performance and emergency outpatient visits. It is confirmed in this study that at high level of operational performance, increasing the structural quality will be associated with lower emergency outpatient visits. The interaction effect between structural quality and operational performance on emergency outpatient visits is also significant. As such, structural quality of hospitals can reduce emergency outpatient visits. Hospitals endeavor to improve its operational performance also reduces emergency outpatient visits. Joint emphasis on improving bed utilization and improving operational performance can further decrease emergency outpatient visits.


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