Medicaid markets and pediatric patient safety in hospitals.
Medicaid markets and pediatric patient safety in hospitals.
复制标题
医疗补助市场和医院儿科患者安全。
DOI：
10.1111/j.1475-6773.2007.00698.x
复制
发表时间：
2007
影响因子：
3.4
通讯作者：
L. Simpson
中科院分区：
文献类型：
--
作者：
Richard B. Smith;Robyn B. Cheung;P. Owens;R. M. Wilson;L. Simpson
客观化
检查医疗补助市场特征与住院儿童潜在可预防的不良医疗事件的关联，控制患者和医院水平的因素。
数据来源/研究设置
医疗研究和质量机构(AHRQ)精心挑选的两个儿科患者安全指标(卧位体溃疡和撕裂)使用AHRQ的新的儿科专用、风险调整、患者安全算法进行了分析。对佛罗里达州、纽约和威斯康星州0-17岁患者的所有儿科医院出院患者，以及这两个患者安全事件中的任何一个，都进行了1999-2001年的检查(N=859,922)。
研究设计
相关出血池的Logistic回归估计了单个患者经历两种PSI事件之一的可能性。
数据提取方法
AHRQ医疗成本和利用项目1999年至2001年国家住院患者数据库(SID)中的儿科出院人数与美国医院协会年度调查中的医院级数据、从医疗保险和医疗补助服务中心以及州医疗补助办公室获得的医疗补助数据以及从InterStudy获得的私人和医疗补助管理保健登记数据一起用于估计。
主要发现
在市场层面，在医疗补助支付者面临相对较少竞争的市场中，患者更有可能经历患者安全事件(优势比[OR]=1.602)，而在医院面临相对较少竞争的市场中，患者更不可能经历不良事件(OR=0.686)。在患者出院和医院层面，医疗补助的特点与儿科患者安全事件的发生率没有显著关联。
结论
我们的分析为以前的工作提供了更多的见解，并提出了一个新的因素--医疗补助支付者市场--与儿科患者安全问题相关。
OBJECTIVE
To examine the association of Medicaid market characteristics to potentially preventable adverse medical events for hospitalized children, controlling for patient- and hospital-level factors.
DATA SOURCES/STUDY SETTING
Two carefully selected Agency for Healthcare Research and Quality (AHRQ) pediatric patient safety indicators (decubitus ulcers and laceration) are analyzed using the new pediatric-specific, risk-adjusting, patient safety algorithm from the AHRQ. All pediatric hospital discharges for patients age 0-17 in Florida, New York, and Wisconsin, and at risk of any of these two patient safety events, are examined for the years 1999-2001 (N=859,922).
STUDY DESIGN
Logistic regression on the relevant pool of discharges estimates the probability an individual patient experiences one of the two PSI events.
DATA EXTRACTION METHODS
Pediatric discharges from the 1999 to 2001 State Inpatient Databases (SIDs) from the AHRQ Healthcare Cost and Utilization Project, merged with hospital-level data from the American Hospital Association's Annual Survey, Medicaid data obtained from the Centers for Medicare and Medicaid Services and state Medicaid offices, and private and Medicaid managed care enrollment data obtained from InterStudy, are used in the estimations.
PRINCIPAL FINDINGS
At the market level, patients in markets in which Medicaid payers face relatively little competition are more likely to experience a patient safety event (odds ratio [OR]=1.602), while patients in markets in which hospitals face relatively little competition are less likely to experience an adverse event (OR=0.686). At the patient-discharge and hospital levels, Medicaid characteristics are not significantly associated with the incidence of a pediatric patient safety event.
CONCLUSIONS
Our analysis offers additional insights to previous work and suggests a new factor--the Medicaid-payer market--as relevant to the issue of pediatric patient safety.
管理式医疗是否会导致医疗保健市场整合？
影响因子：
3.4
作者：
Dranove,David;Simon,CarolJ;White,WilliamD
通讯作者：
White,WilliamD