Article Title

Comparison of Organizational Context Across HMORN Members

Publication Date



delivery system, organizational context


Background/Aims: Organizational context is an important element in implementation science and comparative effectiveness research (CER). Contextual factors include practice, hospital, system and environmental factors that may influence care delivery. For multisystem research networks such as the HMORN, awareness and inclusion of contextual factors can strengthen research design and interpretation of findings. Similarly, consideration of local contextual factors can enhance dissemination and implementation of interventions across systems. To our knowledge a comparative analysis of system-level contextual factors reflecting recent market and policy changes has not been performed for HMORN members. The aim of this study is to describe differences and similarities in seven system-level contextual factors across HMORN delivery systems and discuss their implications for CER and implementation research.

Methods: We performed a review of system-level contextual factors representing major policy, market or operational changes from 2004 to 2014. Contextual factors were: 1) accountable care organization (ACO) participation; 2) patient-centered medical home (PCMH) implementation; 3) CMS-CMMI program participation; 4) market consolidation (Mergers & Acquisitions); 5) systemwide adoption of Lean or continuous quality improvement (CQI) programs; 6) Beacon Community Grants; and 7) systemwide population health management program. A manual review of several data sources including HMORN member websites, CMS website, National Committee for Quality Assurance website and Office of the National Coordinator for Health Information technology website. Additional data was attained using a keyword search in industry journals. For each contextual factor we determined a system’s level of participation, start and end dates, and program or consolidation characteristics as applicable.

Results: Preliminary results indicate a wide variation across HMORN members in adoption of new models of care and market consolidation. Four members belonged to Beacon communities (health information exchanges). While most systems participated in an ACO, the funding mechanisms varied (Medicare-shared savings or Pioneer program). Systems underwent considerable consolidation, with the largest merger increasing a HMORN member size from 12 to 43 hospitals. Further results are pending.

Discussion: System-level contextual factors differ across HMORN members. Our findings draw attention to the relevance of contextual factors and may inform interpretation of results and implementation.




April 6th, 2015


April 28th, 2015