The Association Between Hospital Financial Performance and the Quality of Care – A Scoping Literature Review

Document Type : Review Article

Authors

1 Health Economics and Social Security Department, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland

2 Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland

3 Harvard T.H. Chan School of Public Health, Boston, MA, USA

4 Department of Health Care Management, Technische Universität Berlin, Berlin, Germany

5 European Observatory on Health Systems and Policies, WHO European Centre for Health Policy Eurostation (Office 07C020), Brussels, Belgium

Abstract

Background 
Improving the quality of hospital care is an important policy objective. Hospitals operate under pressure to contain costs and might face challenges related to financial deficits. The objective of this paper was to identify and map the available evidence on the association between hospital financial performance (FP) and quality of care (Q).

Methods 
A scoping review was performed. Searches were conducted in 7 databases: Medline via PubMed, EMBASE, Web of Science, Scopus, EconLit, ABI/INFORM, and Business Source Complete. The search strategy combined multiple terms from 3 topics: hospital AND FP AND Q. The collected data were analysed using both quantitative and qualitative methods.

Results 
10 503 records were screened and 151 full text papers analysed. A total of 69 papers were included (60 empirical, 2 theoretical, 5 literature reviews, and 2 dissertations). The majority of identified studies were published within the last decade (2010-2021). Most empirical studies had been conducted in the United States (55/60), used cross-sectional approaches (32/60) and applied diverse regression models with FP measures as dependent variables, thus measuring the impact of Q on hospitals FP (34/60). The comparability of the studies’ results is limited due to differences in applied methods and settings. Yet, the general overview shows that in almost half of the cases the association between hospital FP and Q was positive, while no study showed a clear negative association.

Conclusion 
This scoping review provides an overview of the available literature on the association between hospital FP and Q. The results highlight numerous research gaps: (1) systematic reviews and meta-analyses of existing studies with similar measures of FP and Q are unavailable, (2) further methodological/conceptual work is needed on the metrics measuring hospital FP and Q, and (3) more empirical studies should analyse the association between FP and Q in non-US healthcare settings.

Keywords


  1. Silow-Carroll S, Alteras T, Meyer JA. Hospital Quality Improvement: Strategies and Lessons from U.S. Hospitals. New York: The Commonwealth Fund; 2007. https://www.commonwealthfund.org/publications/fund-reports/2007/apr/hospital-quality-improvement-strategies-and-lessons-us-hospitals. Updated April 1, 2007. Accessed August 19, 2021.
  2. Conry MC, Humphries N, Morgan K, et al. A 10 year (2000-2010) systematic review of interventions to improve quality of care in hospitals. BMC Health Serv Res. 2012;12:275. doi:1186/1472-6963-12-275
  3. Busse R, Klazinga N, Panteli D, Quentin W. Improving Healthcare Quality in Europe: Characteristics, Effectiveness and Implementation of Different Strategies. Copenhagen: The European Observatory on Health Systems and Policies, OECD; 2019.
  4. World Health Organization (WHO). What Are the Best Strategies for Ensuring Quality in Hospitals? WHO; 2003. https://www.euro.who.int/__data/assets/pdf_file/0006/74706/E82995.pdf. Accessed August 19, 2021.
  5. Groene O, Kringos D, Sunol R. Seven Ways to Improve Quality and Safety in Hospitals. An Evidence Based Guide. Duque Collaboration; 2014. http://www.duque.eu/uploads/DUQuE_Seven_Ways_To_Improve_Quality_And_Safety_2014.pdf. Updated January, 2014. Accessed August 19, 2021.
  6. Mathes T, Pieper D, Morche J, Polus S, Jaschinski T, Eikermann M. Pay for performance for hospitals. Cochrane Database Syst Rev. 2019;7(7):CD011156. doi:1002/14651858.CD011156.pub2
  7. Schwierz C. Cost-Containment Policies in Hospital Expenditure in the European Union (No. 037). European Commission; 2016. https://ec.europa.eu/info/sites/default/files/dp037_en.pdf. Accessed August 19, 2021.
  8. Tikkanen R, Osborn R, Mossialos E, Djordjevic A, Wharton G. International Profiles of Health Care Systems. The Commonwealth Fund; 2020. https://www.commonwealthfund.org/sites/default/files/2020-12/International_Profiles_of_Health_Care_Systems_Dec2020.pdf. Accessed August 19, 2021.
  9. Kocsis V, Koning P, Mot E. General Hospitals in Financial Distress. Reconsidering Government Intervention. CPB Background Document. Den Haag: Netherlands Bureau for Economic Policy Analysis; 2011. https://www.cpb.nl/sites/default/files/publicaties/download/cpb-background-document-general-hospitals-financial-distress-july2011_0.pdf. Accessed August 19, 2021.
  10. Dubas-Jakóbczyk K, Albreht T, Behmane D, et al. Hospital reforms in 11 Central and Eastern European countries between 2008 and 2019: a comparative analysis. Health Policy. 2020;124(4):368-379. doi:1016/j.healthpol.2020.02.003
  11. Williams D Jr, Reiter KL, Pink GH, Holmes GM, Song PH. Rural hospital mergers increased between 2005 and 2016-what did those hospitals look like? Inquiry. 2020;57:46958020935666. doi:1177/0046958020935666
  12. Schreyögg J, Stargardt T. The trade-off between costs and outcomes: the case of acute myocardial infarction. Health Serv Res. 2010;45(6 Pt 1):1585-1601. doi:1111/j.1475-6773.2010.01161.x
  13. McLoughlin V, Leatherman S. Quality or financing: what drives design of the health care system? Qual Saf Health Care. 2003;12(2):136-142. doi:1136/qhc.12.2.136
  14. Jamalabadi S, Winter V, Schreyögg J. A systematic review of the association between hospital cost/price and the quality of care. Appl Health Econ Health Policy. 2020;18(5):625-639. doi:1007/s40258-020-00577-6
  15. Barnes M, Oner N, Ray MN, Zengul FD. Exploring the association between quality and financial performance in U.S. hospitals: a systematic review. J Health Care Finance. 2017;44(2):1-32.
  16. Beauvais B, Wells R. Does money really matter? A review of the literature on the relationships between healthcare organization finances and quality. Hosp Top. 2006;84(2):20-28. doi:3200/htps.84.2.20-29
  17. Faber M, Bosch M, Wollersheim H, Leatherman S, Grol R. Public reporting in health care: how do consumers use quality-of-care information? A systematic review. Med Care. 2009;47(1):1-8. doi:1097/MLR.0b013e3181808bb5
  18. Victoor A, Delnoij DM, Friele RD, Rademakers JJ. Determinants of patient choice of healthcare providers: a scoping review. BMC Health Serv Res. 2012;12:272. doi:1186/1472-6963-12-272
  19. Pope DG. Reacting to rankings: evidence from "America's Best Hospitals". J Health Econ. 2009;28(6):1154-1165. doi:1016/j.jhealeco.2009.08.006
  20. Cashin C, Chi YL, Smith PC, Borowitz M, Thomson S. Paying for performance in health care. In: Implications for Health System Performance and Accountability. New York: Open University Press; 2014.
  21. Milstein R, Schreyoegg J. Pay for performance in the inpatient sector: a review of 34 P4P programs in 14 OECD countries. Health Policy. 2016;120(10):1125-1140. doi:1016/j.healthpol.2016.08.009
  22. Arksey H, O'Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005;8(1):19-32. doi:1080/1364557032000119616
  23. Levac D, Colquhoun H, O'Brien KK. Scoping studies: advancing the methodology. Implement Sci. 2010;5:69. doi:1186/1748-5908-5-69
  24. Tricco AC, Lillie E, Zarin W, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018;169(7):467-473. doi:7326/m18-0850
  25. Open Science Framework project registration. https://osf.io/9hn7u. Accessed August 19, 2021.
  26. Dubas-Jakóbczyk K, Kocot E, Tambor M, Quentin W. The association between hospital financial performance and the quality of care-a scoping review protocol. Syst Rev. 2021;10(1):221. doi:1186/s13643-021-01778-3
  27. Gapenski LC, Pink GH. Understanding Healthcare Financial Management. Chicago: Health Administration Press; 2015.
  28. Donabedian A. The quality of care. How can it be assessed? JAMA. 1988;260(12):1743-1748. doi:1001/jama.260.12.1743
  29. Dubas-Jakóbczyk K, Kocot E, Tambor M, Kostrzewska O, Szetela P, Quentin W. Hospital financial performance and quality of care–a scoping review of empirical studies. Eur J Public Health. 2021;31(Suppl 3):ckab165.332. doi:1093/eurpub/ckab165.332
  30. Chakraborty S. Healthcare quality and hospital financial performance: a multilevel framework. Operations and Supply Chain Management: An International Journal. 2020;13(3):233-243. doi:31387/oscm0420265
  31. Fleming ST, Boles KE. Financial and clinical performance: bridging the gap. Health Care Manage Rev. 1994;19(1):11-17.
  32. Holt HD, Clark J, DelliFraine J, Brannon D. Organizing for performance: what does the empirical literature reveal about the influence of organizational factors on hospital financial performance? Adv Health Care Manag. 2011;11:21-62. doi:1108/s1474-8231(2011)0000011006
  33. Zengul FD, Weech-Maldonado R, Savage GT. Technological innovations and hospital performance: a systematic review of the literature. Innov Entrep Health. 2014;1:13-26. doi:2147/ieh.s63131
  34. Oner N, Zengul FD, Ozaydin B, Pallotta RA, Weech-Maldonado R. Organizational and environmental factors associated with hospital financial performance: a systematic review. J Health Care Finance. 2016;43(2):13-37.
  35. Cusack S. The Impact of Quality on Financial Performance of Acute Care Hospitals [dissertation]. Philadelphia: University of the Sciences in Philadelphia; 2012.
  36. Glover G. Relationships Between Nursing Resources, Uncompensated Care, Hospital Profitability, and Quality of Care [dissertation]. Minneapolis: Walden University; 2019.
  37. Alexander JA, Weiner BJ, Griffith J. Quality improvement and hospital financial performance. J Organ Behav. 2006;27(7):1003-1029. doi:1002/job.401
  38. Ammori JB, Pelletier SJ, Lynch R, et al. Incremental costs of post-liver transplantation complications. J Am Coll Surg. 2008;206(1):89-95. doi:1016/j.jamcollsurg.2007.06.292
  39. Ammori JB, Pelletier SJ, Mathur A, et al. Financial implications of surgical complications in pediatric liver transplantation. Pediatr Transplant. 2008;12(2):174-179. doi:1111/j.1399-3046.2007.00783.x
  40. Asagbra OE, Zengul FD, Burke D. Patient engagement functionalities in U.S. hospitals: is early adoption associated with financial performance? J Healthc Manag. 2019;64(6):381-396. doi:1097/jhm-d-18-00095
  41. Beauvais B, Richter JP, Kim FS. Doing well by doing good: Evaluating the influence of patient safety performance on hospital financial outcomes. Health Care Manage Rev. 2019;44(1):2-9. doi:1097/hmr.0000000000000163
  42. Brooks M, Beauvais BM, Kruse CS, et al. Accreditation and certification: do they improve hospital financial and quality performance? Healthcare (Basel). 2021;9(7):887. doi:3390/healthcare9070887
  43. Clement RC, Kheir MM, Derman PB, et al. What are the economic consequences of unplanned readmissions after TKA? Clin Orthop Relat Res. 2014;472(10):3134-3141. doi:1007/s11999-014-3795-3
  44. Dimick JB, Weeks WB, Karia RJ, Das S, Campbell DA Jr. Who pays for poor surgical quality? Building a business case for quality improvement. J Am Coll Surg. 2006;202(6):933-937. doi:1016/j.jamcollsurg.2006.02.015
  45. Eappen S, Lane BH, Rosenberg B, et al. Relationship between occurrence of surgical complications and hospital finances. JAMA. 2013;309(15):1599-1606. doi:1001/jama.2013.2773
  46. Englesbe MJ, Dimick J, Mathur A, et al. Who pays for biliary complications following liver transplant? A business case for quality improvement. Am J Transplant. 2006;6(12):2978-2982. doi:1111/j.1600-6143.2006.01575.x
  47. Everhart D, Neff D, Al-Amin M, Nogle J, Weech-Maldonado R. The effects of nurse staffing on hospital financial performance: competitive versus less competitive markets. Health Care Manage Rev. 2013;38(2):146-155. doi:1097/HMR.0b013e318257292b
  48. Flynn DN, Speck RM, Mahmoud NN, David G, Fleisher LA. The impact of complications following open colectomy on hospital finances: a retrospective cohort study. Perioper Med (Lond). 2014;3(1):1. doi:1186/2047-0525-3-1
  49. Harkey J, Vraciu R. Quality of health care and financial performance: is there a link? Health Care Manage Rev. 1992;17(4):55-63.
  50. Healy MA, Mullard AJ, Campbell DA Jr, Dimick JB. Hospital and payer costs associated with surgical complications. JAMA Surg. 2016;151(9):823-830. doi:1001/jamasurg.2016.0773
  51. Hegji CE, Self DR, Findley CS. The link between hospital quality and services profitability. Int J Pharm Healthc Mark. 2007;1(4):290-303. doi:1108/17506120710840143
  52. Hegji CE, Self DR. The impact of hospital quality on profits, volume, and length of stay. Health Mark Q. 2009;26(3):209-223. doi:1080/07359680903263615
  53. Hegji CE. Correlates of hospital quality: a preliminary study. Econ Bull. 2006;9(4):1-13.
  54. Ho D, Lynch RJ, Ranney DN, Magar A, Kubus J, Englesbe MJ. Financial impact of surgical site infection after kidney transplantation: implications for quality improvement initiative design. J Am Coll Surg. 2010;211(1):99-104. doi:1016/j.jamcollsurg.2010.02.055
  55. Irwin JG, Hoffman JJ, Lamont BT. The effect of the acquisition of technological innovations on organizational performance: a resource-based view. J Eng Technol Manage. 1998;15(1):25-54. doi:1016/s0923-4748(97)00028-3
  56. Kodera T, Yoneda K. Hospital accreditation and financial conditions of public hospitals: Evidence from hospitals in Chubu. J Econ Econ Educ Res. 2015;16(3):97-106.
  57. Li LX, Collier DA. The role of technology and quality on hospital financial performance. Int J Serv Ind Manag. 2000;11(3):202-224. doi:1108/09564230010340715
  58. Lim JS, Lim KS, Heinrichs JH, Al-Aali K, Aamir A, Qureshi MI. The role of hospital service quality in developing the satisfaction of the patients and hospital performance. Manag Sci Lett. 2018;8(12):1353-1362. doi:5267/j.msl.2018.9.004
  59. Maiga AS, Jacobs FA. Leadership, nonfinancial, and financial outcomes: the case of community hospitals. Account Public Interest. 2009;9(1):166-190. doi:2308/api.2009.9.1.166
  60. McCue M, Mark BA, Harless DW. Nurse staffing, quality, and financial performance. J Health Care Finance. 2003;29(4):54-76.
  61. Nelson EC, Rust RT, Zahorik A, Rose RL, Batalden P, Siemanski BA. Do patient perceptions of quality relate to hospital financial performance? J Health Care Mark. 1992;12(4):6-13.
  62. Nevola A, Pace C, Karim SA, Morris ME. Revisiting ‘the determinants of hospital profitability’ in Florida. J Health Care Finance. 2016;43(2):38-60.
  63. Parente ST, Dunbar JL. Is health information technology investment related to the financial performance of U.S. hospitals? An exploratory analysis. Int J Healthc Technol Manag. 2001;3(1):48-58. doi:1504/ijhtm.2001.001104
  64. Reiter KL, Harless DW, Pink GH, Mark BA. Minimum nurse staffing legislation and the financial performance of California hospitals. Health Serv Res. 2012;47(3 Pt 1):1030-1050. doi:1111/j.1475-6773.2011.01356.x
  65. Richter JP, Muhlestein DB. Patient experience and hospital profitability: Is there a link? Health Care Manage Rev. 2017;42(3):247-257. doi:1097/hmr.0000000000000105
  66. Self DR, Hegji CE, Self RM. Alternative quality measures and profitability of hospital inpatient services offered. J Hosp Mark Public Relations. 2010;20(1):2-13. doi:1080/15390940903450917
  67. Upadhyay S, Stephenson AL, Smith DG. Readmission rates and their impact on hospital financial performance: a study of Washington hospitals. Inquiry. 2019;56:46958019860386. doi:1177/0046958019860386
  68. Wang T, Wang Y, McLeod A. Do health information technology investments impact hospital financial performance and productivity? Int J Account Inf Syst. 2018;28:1-13. doi:1016/j.accinf.2017.12.002
  69. Wright JD, Tergas AI, Hou JY, et al. Effect of regional hospital competition and hospital financial status on the use of robotic-assisted surgery. JAMA Surg. 2016;151(7):612-620. doi:1001/jamasurg.2015.5508
  70. Zhao M, Hamadi H, Rob Haley D, White-Williams C, Liu X, Spaulding A. The relationship between health information technology laboratory tracking systems and hospital financial performance and quality. Hosp Top. 2019;97(3):99-106. doi:1080/00185868.2019.1623735
  71. Dong GN. Performing well in financial management and quality of care: evidence from hospital process measures for treatment of cardiovascular disease. BMC Health Serv Res. 2015;15:45. doi:1186/s12913-015-0690-x
  72. Encinosa WE, Bernard DM. Hospital finances and patient safety outcomes. Inquiry. 2005;42(1):60-72. doi:5034/inquiryjrnl_42.1.60
  73. Ginn GO, Shen JJ, Moseley CB. Hospital financial position and the adoption of electronic health records. J Healthc Manag. 2011;56(5):337-350. doi:1097/00115514-201109000-00009
  74. Kazley AS, Ozcan YA. Organizational and environmental determinants of hospital EMR adoption: a national study. J Med Syst. 2007;31(5):375-384. doi:1007/s10916-007-9079-7
  75. Lindrooth RC, Konetzka RT, Navathe AS, Zhu J, Chen W, Volpp K. The impact of profitability of hospital admissions on mortality. Health Serv Res. 2013;48(2 Pt 2):792-809. doi:1111/1475-6773.12026
  76. Ly DP, Jha AK, Epstein AM. The association between hospital margins, quality of care, and closure or other change in operating status. J Gen Intern Med. 2011;26(11):1291-1296. doi:1007/s11606-011-1815-5
  77. Menachemi N, Burkhardt J, Shewchuk R, Burke D, Brooks RG. Hospital information technology and positive financial performance: a different approach to finding an ROI. J Healthc Manag. 2006;51(1):40-58. doi:1097/00115514-200601000-00008
  78. Nagendran M, Kiew G, Raine R, Atun R, Maruthappu M. Financial performance of English NHS trusts and variation in clinical outcomes: a longitudinal observational study. BMJ Open. 2019;9(1):e021854. doi:1136/bmjopen-2018-021854
  79. Navathe AS, Volpp KG, Konetzka RT, et al. A longitudinal analysis of the impact of hospital service line profitability on the likelihood of readmission. Med Care Res Rev. 2012;69(4):414-431. doi:1177/1077558712441085
  80. Shen JJ, Ginn GO. Financial position and adoption of electronic health records: a retrospective longitudinal study. J Health Care Finance. 2012;38(3):61-77.
  81. Zhao M, Bazzoli GJ, Clement JP, Lindrooth RC, Nolin JM, Chukmaitov AS. Hospital staffing decisions: does financial performance matter? Inquiry. 2008;45(3):293-307. doi:5034/inquiryjrnl_45.03.293
  82. Bazzoli GJ, Clement JP, Lindrooth RC, et al. Hospital financial condition and operational decisions related to the quality of hospital care. Med Care Res Rev. 2007;64(2):148-168. doi:1177/1077558706298289
  83. Nguyen OK, Halm EA, Makam AN. Relationship between hospital financial performance and publicly reported outcomes. J Hosp Med. 2016;11(7):481-488. doi:1002/jhm.2570
  84. Turner JS, Broom KD, Counte MA. Is there a relationship between value-based purchasing and hospital profitability? An exploratory study of Missouri hospitals. Health Serv Res Manag Epidemiol. 2015;2:2333392815606096. doi:1177/2333392815606096
  85. Akinleye DD, McNutt LA, Lazariu V, McLaughlin CC. Correlation between hospital finances and quality and safety of patient care. PLoS One. 2019;14(8):e0219124. doi:1371/journal.pone.0219124
  86. Bazzoli GJ, Chen HF, Zhao M, Lindrooth RC. Hospital financial condition and the quality of patient care. Health Econ. 2008;17(8):977-995. doi:1002/hec.1311
  87. Cleverley WO, Harvey RK. Is there a link between hospital profit and quality? Healthc Financ Manage. 1992;46(9):40-42.
  88. Collum TH, Menachemi N, Sen B. Does electronic health record use improve hospital financial performance? Evidence from panel data. Health Care Manage Rev. 2016;41(3):267-274. doi:1097/hmr.0000000000000068
  89. Cowan MJ, Shapiro M, Hays RD, et al. The effect of a multidisciplinary hospitalist/physician and advanced practice nurse collaboration on hospital costs. J Nurs Adm. 2006;36(2):79-85. doi:1097/00005110-200602000-00006
  90. Crowe D, Garman AN, Li CC, Helton J, Anderson MM, Butler P. Leadership development practices and hospital financial outcomes. Health Serv Manage Res. 2017;30(3):140-147. doi:1177/0951484817702564
  91. Dauser B, Hartig N, Vedadinejad M, Kirchner E, Trummer F, Herbst F. Robotic-assisted repair of complex ventral hernia: can it pay off? J Robot Surg. 2021;15(1):45-52. doi:1007/s11701-020-01078-3
  92. Hsia DC, Ahern CA. Good quality care increases hospital profits under prospective payment. Health Care Financ Rev. 1992;13(3):17-26.
  93. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014;86(1):24-33. doi:1016/j.jhin.2013.09.012
  94. Karim SA, Pink GH, Reiter KL, Holmes GM, Jones CB, Woodard EK. The effect of the magnet recognition signal on hospital financial performance. J Healthc Manag. 2018;63(6):e131-e146. doi:1097/jhm-d-17-00215
  95. Langland-Orban B, Gapenski LC, Vogel WB. Differences in characteristics of hospitals with sustained high and sustained low profitability. Hosp Health Serv Adm. 1996;41(3):385-399.
  96. Pirson M, Leclercq P, Jackson T, Leclercq M, Garrino M, Sion C. Financial consequences of hospital-acquired bacteraemia in three Belgian hospitals in 2003 and 2004. J Hosp Infect. 2008;68(1):9-16. doi:1016/j.jhin.2007.10.006
  97. Newhouse JP. Toward a theory of nonprofit institutions: an economic model of a hospital. Am Econ Rev. 1970;60(1):64-74.
  98. Hoerger TJ. 'Profit' variability in for-profit and not-for-profit hospitals. J Health Econ. 1991;10(3):259-289. doi:1016/0167-6296(91)90030-q
  99. Barney J. Firm resources and sustained competitive advantage. J Manage. 1991;17(1):99-120. doi:1177/014920639101700108
  100. Pfeffer J, Salancik C. The External Control of Organizations: A Resource Dependence Perspective. New York: Harper& Row; 1978.
  101. Zinoviev R, Krumholz HM, Ciccarone R, Antle R, Forman HP. Multicentre methodological study to create a publicly available score of hospital financial standing in the USA. BMJ Open. 2021;11(7):e046500. doi:1136/bmjopen-2020-046500
  102. Landry AY, Landry RJ 3rd. Factors associated with hospital bankruptcies: a political and economic framework. J Healthc Manag. 2009;54(4):252-271. doi:1097/00115514-200907000-00007
  103. Liu LL, Jervis KJ, Younis MZ, Forgione DA. Hospital financial distress, recovery and closure: managerial incentives and political costs. J Public Budg Account Financ Manag. 2011;23(1):31-68. doi:1108/jpbafm-23-01-2011-b002
  104. COVID-19 in 2021: The Potential Effect on Hospital Revenues. https://www.aha.org/system/files/media/file/2021/02/KH-2021-COVID-Impact-Report_FINAL.pdf. Published February, 2021. Accessed August 19, 2021.
  105. Healthcare Cost Report Information System. https://www.cms.gov/Research-Statistics-Data-and-Systems/Downloadable-Public-Use-Files/Cost-Reports. Updated October 22, 2021. Accessed August 19, 2021.
  106. American Hospital Association (AHA). Data & Statistics (2021). https://www.ahadata.com/topics/statistics. Accessed August 19, 2021.
  107. Centers for Medicare and Medicaid Services (CMS). https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HospitalQualityInits/HospitalCompare. Updated September 17, 2019. Accessed August 19, 2021.
  108. Statewide Planning and Research Cooperative System (SPARCS) for the state of New York. https://www.health.ny.gov/statistics/sparcs/. Updated September, 2019. Accessed August 19, 2021.
  109. Cacace M, Geraedts M, Berger E. Public reporting as a quality strategy. In: Busse R, Klazinga N, Panteli D, Quentin W, eds. Improving Healthcare Quality in Europe: Characteristics, Effectiveness and Implementation of Different Strategies. The European Observatory on Health Systems and Policies, OECD; 2019. p. 331-356.
  110. Dubas-Jakóbczyk K, Kocot E, Kozieł A. Financial performance of public hospitals: a cross-sectional study among Polish providers. Int J Environ Res Public Health. 2020;17(7):2188. doi:3390/ijerph17072188
  111. Peters MD, Godfrey CM, Khalil H, McInerney P, Parker D, Soares CB. Guidance for conducting systematic scoping reviews. Int J Evid Based Healthc. 2015;13(3):141-146. doi:1097/xeb.0000000000000050
  112. Berg RC, Nanavati J. Realist review: current practice and future prospects. J Res Pract. 2016;12(1):1-28.
  113. Pawson R, Greenhalgh T, Harvey G, Walshe K. Realist review--a new method of systematic review designed for complex policy interventions. J Health Serv Res Policy. 2005;10 Suppl 1:21-34. doi:1258/1355819054308530