Assigning ambulatory patients and their physicians to hospitals: A method for obtaining population-based provider performance measurements
Assigning ambulatory patients and their physicians to hospitals: A method for obtaining population-based provider performance measurements
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DOI：
10.1111/j.1475-6773.2006.00633.x
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发表时间：
2007-02-01
影响因子：
3.4
通讯作者：
Fisher, Elliott
中科院分区：
文献类型：
--
作者：
Bynum, Julie P. W.;Bernal-Delgado, Enrique;Fisher, Elliott
Objective.制定一种方法，用于将医疗保险参保者和为他们服务的医生分配到各个医院，并具有足够的有效性，以允许基于人口的评估提供者的特定成本和护理质量。数据来源/研究设置。研究人群包括1998年至2000年期间20%的医疗保险收费服务登记者和所有提交医疗保险服务索赔的医生。数据来自医疗保险索赔和登记文件，医疗保险的MPIER文件，以及美国医院协会年度调查。对医院的特点、其扩展医疗人员（EMS）及其分配的医疗保险登记者的利用模式进行横断面分析。医疗保险登记者被分配给他们的主要门诊医生，然后分配给该医生提供住院服务的医院，或者该医生的多个患者小组有医疗入院的医院。每个受益人都与一名医生和一家医院联系在一起，无论患者是否住院，都建立了门诊提供者特定队列（APSC）。在1998年有索引医生访问的符合条件的医疗保险登记者中，有96%被分配给特定的提供者。在两年期间，三分之二的医疗入院发生在指定的医院，三分之二的评价和管理服务由指定医院的EMS计费。经验得出的EMS医院有合理的面子和判别效度的数量和类型的医生在不同规模和类型的医院执业。第一年各医生组的风险调整成本估计值对随后一年的成本具有高度预测性（r = 0.87，p <0.0001，加权kappa = 0.65，p <0.001）。
Objective. To develop a method for assigning Medicare enrollees and the physicians who serve them to individual hospitals with adequate validity to allow population-based assessments of provider specific costs and quality of care.Data Sources/Study Setting. The study populations consist of a 20 percent sample of Medicare fee-for-service enrollees and all physicians submitting claims for Medicare services from 1998 to 2000. Data were obtained from Medicare claims and enrollment files, Medicare's MPIER file, and from the American Hospital Association Annual Survey.Study Design. Cross-sectional analysis of the characteristics of hospitals, their extended medical staffs (EMSs) and the utilization patterns of their assigned Medicare enrollees.Data Collection Methods. Medicare enrollees were assigned to their predominant ambulatory physician and then to the hospital where that physician provided inpatient services or where a plurality of that physician's patient panel had medical admissions. Each beneficiary was linked to a physician and a hospital regardless of whether the patient was hospitalized creating Ambulatory Provider Specific Cohorts (APSCs).Principal Findings. Ninety-six percent of eligible Medicare enrollees who had an index physician visit in 1998 were assigned to a specific provider. Two-thirds of the medical admissions during a 2-year period occurred at the assigned hospital and two-thirds of evaluation and management services were billed by the assigned hospital's EMS. The empirically derived EMS for hospitals had reasonable face and discriminant validity in terms of number and type of physicians practicing at different sized and type hospitals. Estimates of risk-adjusted costs across physician groups in year one are highly predictive of costs in a subsequent year ( r = 0.87, p < .0001 and weighted kappa = 0.65, p