TABLE 2

Mechanisms Through Which Regionalization of Care Improves Outcomes

MechanismAdvantagesDisadvantages
High-acuity patients receive care at facilities with necessary resourcesResources at medical centers in which patients receive care match the needs of patientsDiminished volume-outcome relationship if increased numbers of specialty hospitals are built
Increased fixed costs and resources to develop such capability
Longer travel time and costs to patients and families
Economic inefficiency if supply does not meet demand
Improved systems of care
    Increased coordination of care and educationBetter coordination of care during the acute phase of hospitalizationRequires cooperation between multiple centers beyond transferral of patients
Improved standardization of care within network of non–specialty hospitalsTypically requires state or regulatory intervention into health care system
Poor coordination of postdischarge follow-up care
    Off-site consultation and assistance in the management of patientsImproved provision of scarce services to non–specialty hospitalsLimited number of conditions amenable to method
Allow patients to remain at nearby hospitals, which reduces travel time and costsLimited evidence base
Requires cooperation and collaboration between specialty and non–specialty hospital