Physician-owned specialized facilities: focused factories or destructive competition?: a systematic review.

Multiple studies have investigated the business case of physician-owned specialized facilities (specialized hospitals and ambulatory surgery centers). However literature lacks integration. Building on the theoretical insights of disruptive innovation, a systematic review was conducted to assess the evidence base of these innovative delivery models. The Institute of Medicine’s quality framework (safe, effective, equitable, efficient, patient-centered and accessible care) was applied in order to evaluate the performance of such facilities. In addition the corresponding impact on full-service general hospitals was assessed. Database searches yielded 6,108 candidate articles of which 47 studies fulfilled the inclusion criteria. Overall the quality of the included studies was satisfactory. Our results show that little evidence exists in support of competitive advantages in favor of specialized facilities. Moreover even if competitive advantages exist, it is equally important to reflect on the corresponding impact on full service-general hospitals. The development of specialized facilities should therefore be monitored carefully