gms | German Medical Science

Background: Specialization in the field of hospital care with the aim of achieving higher quality of care is playing an increasingly important role – also in the context of current health policy considerations. However, what is understood by specialization in this context and on which scientific consensus the efforts are based remains largely unclear.

Objective: We searched for relevant literature to examine how a hospital that focuses on a narrow range of services or emphasizes specific services in its portfolio probably provides better quality of care.

Methods: Based on a systematic literature review in accordance with PRISMA and Cochrane guidelines, we searched for relevant literature across disciplines and without time restrictions for studies that examine the effects of specialization on selected outcome indicators (mortality, readmissions, and complications) in hospitals.

Results: Overall, 20 studies met the defined inclusion criteria and were included in the systematic review. Most studies examined organizational specialization in the fields of orthopaedics and cardiology. Sixteen studies consider effects on mortality and five studies each consider effects on readmissions or complications.

Implication for research and/or (healthcare) practice: When examining the influence of organizational specialization on the quality of care, it is essential to note that only a segment of the comprehensive construct has undergone scientific scrutiny to date. Specifically, concerning orthopaedic indications, organizational specialization manifests a distinct negative correlation with outcome indicators. However, in the realm of cardiology indications, a definitive consensus remains elusive. This review indicates that the impact of specialization on outcome quality cannot be generalized and requires a more nuanced examination taking into account the specialty as well as complexity of patients.