Effect of Hospital Referral Networks on Appropriateness of Hospitalization Decisions: A HLM Analysis

Prior studies have widely documented that referral networks encompasses important mechanisms of coordination and integration among hospitals, enabling the enhancement of a number of benefits, such as productivity, efficiency and quality of care, at the organizational level. The present paper is aimed to expand this line of research, by investigating how organizational referral networks relate to the appropriateness of decisions regarding single hospitalization events within hospitals at patient level. Data used refer to 355,546 hospitalization events in the whole population of hospital organizations located in the Abruzzo region in the Italian NHS. A multilevel analysis using hierarchical generalized linear modeling was performed to test the impact of referral networks’ structural characteristics on the appropriateness of individual-level hospitalization cases. Results demonstrate that ego-network density and hub centrality in the overall network affected the likelihood to observe appropriateness of hospi...