Provider specialization is an area of interest in health care as patients, payers and policy makers are now demanding better performance and demonstrated proof of the benefits of specialization. While previously ignored in the specialization debate, now even the hospitals focusing on pediatric care (i.e. children's hospitals) are experiencing pressure to demonstrate their value. The current study attempts to answer the questions: do hospitals specializing in pediatric care provide better quality pediatric inpatient care; and do they do so for differing types of patient outcomes and across different levels of care complexity? Contingency Theory is used to develop and assess a theoretical framework to see if pediatric hospital specialization is associated with improved outcomes for pediatric inpatient care. The theory suggests that not all ways of organizing are equally effective, and that organizational performance is maximized when there is alignment between organizational structure (specialization) and external contingencies (care complexity). A sample of 1,317 U.S. hospitals was included in the study. Data from two sources - the 2003 Healthcare Cost and Utilization Project (HCUP) Kids' Inpatient Database (KID) and the American Hospital Association's (AHA) Annual Survey Database for fiscal year 2003 - was used in a factor analysis to generate a measure of hospital pediatric specialization. The results of the factor analysis were then used in regression models to examine the effect hospital pediatric specialization had on patient safety and effectiveness of care at multiple levels of care complexity. Results suggest that there are two dimensions of hospital pediatric specialization - a pediatric focused element and a complex pediatric care element - and that these dimensions appear to have opposing influences on measures of inpatient care quality. Focusing primarily on the treatment of pediatric patients seems to improve the level of care provided, but specializing in the care of complex pediatric conditions has a small but significant association with higher patient safety event rates and longer than expected lengths of stay.
","abstract_html":"<p>Provider specialization is an area of interest in health care as patients, payers and policy makers are now demanding better performance and demonstrated proof of the benefits of specialization. While previously ignored in the specialization debate, now even the hospitals focusing on pediatric care (i.e. children's hospitals) are experiencing pressure to demonstrate their value. The current study attempts to answer the questions: do hospitals specializing in pediatric care provide better quality pediatric inpatient care; and do they do so for differing types of patient outcomes and across different levels of care complexity? Contingency Theory is used to develop and assess a theoretical framework to see if pediatric hospital specialization is associated with improved outcomes for pediatric inpatient care. The theory suggests that not all ways of organizing are equally effective, and that organizational performance is maximized when there is alignment between organizational structure (specialization) and external contingencies (care complexity). A sample of 1,317 U.S. hospitals was included in the study. Data from two sources - the 2003 Healthcare Cost and Utilization Project (HCUP) Kids' Inpatient Database (KID) and the American Hospital Association's (AHA) Annual Survey Database for fiscal year 2003 - was used in a factor analysis to generate a measure of hospital pediatric specialization. The results of the factor analysis were then used in regression models to examine the effect hospital pediatric specialization had on patient safety and effectiveness of care at multiple levels of care complexity. Results suggest that there are two dimensions of hospital pediatric specialization - a pediatric focused element and a complex pediatric care element - and that these dimensions appear to have opposing influences on measures of inpatient care quality. Focusing primarily on the treatment of pediatric patients seems to improve the level of care provided, but specializing in the care of complex pediatric conditions has a small but significant association with higher patient safety event rates and longer than expected lengths of stay.</p>","abstract_has_math":false,"creators":["Harris, James Mitchell, II"],"institution":null,"degree_name":"Doctor of Philosophy","degree_level":"Dissertation","degree_discipline":"Health Administration","degree_department":null,"school":null,"contributors":["Dr. Yasar A. Ozcan"],"advisors":[],"committee_chairs":[],"committee_members":[],"year":2007,"date_issued":"2007-01-01T08:00:00Z","date_published":"2007-01-01T08:00:00Z","updated_at":"2026-07-24T05:55:14Z","subjects":["childrens hospital","organizational performance","Contingency Theory","patient safety","pediatric care","medical specialization","Health and Medical Administration","Medicine and Health Sciences"],"languages":[],"rights":["© The Author"],"rights_urls":[],"identifier_entries":[{"key":"dc:identifier","label":"Identifier","values":["https://scholarscompass.vcu.edu/etd/1347"],"render_values":[{"text":"https://scholarscompass.vcu.edu/etd/1347","href":"https://scholarscompass.vcu.edu/etd/1347","code":true}]}]},"links":{"outbound_url":"https://doi.org/10.25772/BZ9E-VN19","outbound_label":"DOI","outbound_source":"dc:identifier"},"metadata_groups":[{"id":"people","label":"People","entries":[{"key":"dc:contributor","label":"Contributor","values":["Dr. Yasar A. 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While previously ignored in the specialization debate, now even the hospitals focusing on pediatric care (i.e. children's hospitals) are experiencing pressure to demonstrate their value. The current study attempts to answer the questions: do hospitals specializing in pediatric care provide better quality pediatric inpatient care; and do they do so for differing types of patient outcomes and across different levels of care complexity? Contingency Theory is used to develop and assess a theoretical framework to see if pediatric hospital specialization is associated with improved outcomes for pediatric inpatient care. The theory suggests that not all ways of organizing are equally effective, and that organizational performance is maximized when there is alignment between organizational structure (specialization) and external contingencies (care complexity). A sample of 1,317 U.S. hospitals was included in the study. Data from two sources - the 2003 Healthcare Cost and Utilization Project (HCUP) Kids' Inpatient Database (KID) and the American Hospital Association's (AHA) Annual Survey Database for fiscal year 2003 - was used in a factor analysis to generate a measure of hospital pediatric specialization. The results of the factor analysis were then used in regression models to examine the effect hospital pediatric specialization had on patient safety and effectiveness of care at multiple levels of care complexity. Results suggest that there are two dimensions of hospital pediatric specialization - a pediatric focused element and a complex pediatric care element - and that these dimensions appear to have opposing influences on measures of inpatient care quality. Focusing primarily on the treatment of pediatric patients seems to improve the level of care provided, but specializing in the care of complex pediatric conditions has a small but significant association with higher patient safety event rates and longer than expected lengths of stay.
"]},{"key":"dc:title","label":"Title","values":["The Effect of Pediatric Hospital Specialization on Patient Safety and Effectiveness of Care"]}]}],"canonical_facts":{"dc:contributor":["Dr. Yasar A. Ozcan"],"dc:creator":["Harris, James Mitchell, II"],"dc:date.available":["2014-07-09T07:00:00Z"],"dc:description.abstract":["Provider specialization is an area of interest in health care as patients, payers and policy makers are now demanding better performance and demonstrated proof of the benefits of specialization. While previously ignored in the specialization debate, now even the hospitals focusing on pediatric care (i.e. children's hospitals) are experiencing pressure to demonstrate their value. The current study attempts to answer the questions: do hospitals specializing in pediatric care provide better quality pediatric inpatient care; and do they do so for differing types of patient outcomes and across different levels of care complexity? Contingency Theory is used to develop and assess a theoretical framework to see if pediatric hospital specialization is associated with improved outcomes for pediatric inpatient care. The theory suggests that not all ways of organizing are equally effective, and that organizational performance is maximized when there is alignment between organizational structure (specialization) and external contingencies (care complexity). A sample of 1,317 U.S. hospitals was included in the study. Data from two sources - the 2003 Healthcare Cost and Utilization Project (HCUP) Kids' Inpatient Database (KID) and the American Hospital Association's (AHA) Annual Survey Database for fiscal year 2003 - was used in a factor analysis to generate a measure of hospital pediatric specialization. The results of the factor analysis were then used in regression models to examine the effect hospital pediatric specialization had on patient safety and effectiveness of care at multiple levels of care complexity. Results suggest that there are two dimensions of hospital pediatric specialization - a pediatric focused element and a complex pediatric care element - and that these dimensions appear to have opposing influences on measures of inpatient care quality. Focusing primarily on the treatment of pediatric patients seems to improve the level of care provided, but specializing in the care of complex pediatric conditions has a small but significant association with higher patient safety event rates and longer than expected lengths of stay.
"],"dc:identifier":["https://doi.org/10.25772/BZ9E-VN19","https://scholarscompass.vcu.edu/etd/1347"],"dc:rights":["© The Author"],"dc:subject":["childrens hospital","organizational performance","Contingency Theory","patient safety","pediatric care","medical specialization","Health and Medical Administration","Medicine and Health Sciences"],"dc:title":["The Effect of Pediatric Hospital Specialization on Patient Safety and Effectiveness of Care"],"thesis:degree_discipline":["Health Administration"],"thesis:degree_level":["Dissertation"],"thesis:degree_name":["Doctor of Philosophy"]},"updated_at":"2026-07-24T05:55:14Z"}