Decentralization, technology changing the role of hospitals in the care delivery landscape

Hospital entance
The increasing mobility of healthcare services has begun to move the center of gravity for care delivery out of its traditional large-hospital setting. (Getty/monkeybusinessimages)

Technological advances and a push for higher-value care are changing the healthcare industry in unexpected ways. Even the hospital’s traditional role as the center of gravity for patient care is shifting.

In a blog post on NEJM Catalyst, Richard D. Zane, M.D., and Jennifer L. Wiler, M.D., both of the UCHealth System and University of Colorado, along with Nir J. Harish, M.D., of Tufts University Medical School, lay out the case for healthcare delivery’s decentralized future.

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To be sure, hospitals aren’t going away any time in the foreseeable future, they write. Their role as a centralized “hub” of care, however, has already begun to change.

The spread of EHR systems and initiatives aimed at standardizing patient data laid the groundwork for more geographically dispersed care coordination.

Other technological advances and industry trends have further driven the decentralization of care, pushing it from hospital settings into primary care offices, outpatient clinics and patients' homes, the authors write. For example:

  • A marked rise in smaller hospitals with a narrower focus on critical and acute care.
  • Telehealth technology that allows for virtual consults allows these facilities to operate with smaller on-campus staffs.
  • Remote patient monitoring, increased portability of diagnostic devices and increased availability of wearables. 
  • A focus on value-driven, quality care has put a premium on preventive care and improving overall population health while penalizing hospitals for readmissions.

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These changes have shifted the mix of hospital admissions to the point where the vast majority come from the hospital’s own emergency department. That's begun to cause a disruption in its own right, as hospitals reinvent their EDs to cope more efficiently with their role as the hospital’s expanded front door, according to the post.

In a way, the authors note that the ongoing changes could wind up effectively causing hospitals to come full circle to a role they embraced in the past, when hospitals were "a last resort for those who could not afford to receive care at home,” the authors write.