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Essays on Information Technology and Organizational Form in the Health Care Industry by Eric Jude Lammers A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy (Health Services Organization and Policy) in The University of Michigan 2012 Doctoral Committee: Professor Richard A. Hirth, Chair Professor Scott E. Masten Professor Edward C. Norton Associate Professor Kai Zheng
ii Acknowledgments I thank my dissertation committee, Rich, Kai, Scott, and Edward, for their valuable guidance of my work on this dissertation. Jack Albers provided excellent and crucial research assistance on state corporate practice of medicine laws. Many others made significant contributions. I thank Julia Adler-Milstein and Keith Kocher for important suggestions and contributions. I also thank Jeffrey McCullough for valuable suggestions and critical comments. I thank my dissertation group, Na-Eun Cho, Genna Cohen, Hyunjee Kim and Sean Huang for their valuable comments, suggestions and moral support as I produced this work. I thank other members of the faculty and staff of the department of Health Management and Policy at the University of Michigan for their help. I thank other students and faculty members who attended various presentations of my work for their helpful comments and questions. The HIMSS Foundation and John Griffith helped me to obtain valuable data used in this dissertation. The STIET doctoral training program, the Rackham Graduate School and the Health Services Organization and Policy doctoral program all provided valuable funding to support my graduate education and this dissertation. My wife, Leah, provided much love and support throughout my time in graduate school that has helped me to persevere and succeed. My sons, Nicholas, Jude, and Isaac provided the comic relief and some welcome distraction that made the time I spent in graduate school more fun. They also kept me motivated to get it done.
iii Table of Contents Acknowledgments ii List of Figures vi List of Tables vii Abstract x Chapter 1.Introduction: The Organization of Health Care Delivery and Consequences for Information Technology Adoption, Quality and Costs 1 1.1 References for Chapter 1 7 2.The Effect of Hospital-Physician Integration on Health Information Technology Adoption 8 2.1Introduction 8 2.2Conceptual Model 11 2.3Data and Methods 14 2.3.1Data Sources 14 2.3.2Empirical Model 17 2.4Results 20 2.4.1Robustness 23 2.5Discussion 25 2.6References for Chapter 28
iv 3.The Effect of Interoperable Health Information Technology on Use of Diagnostic Imaging in Emergency Departments 40 3.1Introduction and Previous Literature 40 3.2Conceptual Model 44 3.3Empirical Methods 48 3.3.1Data Construction 48 3.3.2Empirical Estimation Strategy 52 3.4Results 56 3.4.1Health Information Technology and patient revisits to the same ED 56 3.4.2Health Information Exchange and patient visits to two different EDs 57 3.4.3 Alternative specifications 59 3.5Discussion 60 3.6References for Chapter 3 64 4.