Can Vertical Integration Reduce Hospital Readmissions? A Difference-in-Differences Approach.
Can Vertical Integration Reduce Hospital Readmissions? A Difference-in-Differences Approach.
复制标题
DOI：
10.1097/mlr.0000000000000704
复制
发表时间：
2017-05
期刊：
影响因子：
3
通讯作者：
Santana R
中科院分区：
文献类型：
--
作者：
Lopes S;Fernandes ÓB;Marques AP;Moita B;Sarmento J;Santana R
补充数字内容可在文本中找到。纵向一体化有望改善住院护理和出院后护理之间的沟通和协调。尽管在世界各地的卫生系统中使用，但关于其对再入院影响的证据很少且相互矛盾。评估垂直整合对医院再入院的影响。使用差异中的差异，我们比较了2004-2013年6家葡萄牙医院垂直整合前后的再入院率。使用了6家未整合的类似医院作为对照组。考虑的结局为30天计划外再入院。我们在入院水平使用逻辑回归，并使用索赔数据解释患者的风险因素。还对每家医院和选定的条件进行了分析。我们的研究结果表明，垂直整合后再入院率总体下降[比值比（OR）=0.900; 95%置信区间（CI），0.812-0.997]。医院分析表明，2家医院无影响（OR=0.960; 95%CI，0.848-1.087和OR=0.944; 95%CI，0.857-1.038），4家医院有积极影响（最大影响：OR=0.811; 95%CI，0.736-0.894）。在有限数量的疾病中观察到积极的进展，糖尿病并发症的结果更好（OR=0.689; 95%CI，0.525-0.904），但对充血性心力衰竭没有影响（OR=1.067; 95%CI，0.827-1.377）。合并急性和初级保健提供者与减少再入院有关，即使没有发现所有机构或特定条件组的改善。纵向一体化在减少30天再入院方面的成功仍有挑战需要解决。
Supplemental Digital Content is available in the text. Vertical integration is expected to improve communication and coordination between inpatient care and care after discharge. Despite being used across health systems worldwide, evidence about its impact on readmissions is sparse and contradictory. To assess the impact of vertical integration on hospital readmissions. Using difference-in-differences we compared readmissions before and after vertical integration in 6 Portuguese hospitals for years 2004–2013. A control group with 6 similar hospitals not integrated was utilized. Considered outcome was 30-day unplanned readmission. We used logistic regression at the admission level and accounted for patients’ risk factors using claims data. Analyses for each hospital and selected conditions were also run. Our results suggest that readmissions decreased overall after vertical integration [odds ratio (OR)=0.900; 95% confidence interval (CI), 0.812–0.997]. Hospital analysis indicated that there was no impact for 2 hospitals (OR=0.960; 95% CI, 0.848–1.087 and OR=0.944; 95% CI, 0.857–1.038), and a positive effect in 4 hospitals (greatest effect: OR=0.811; 95% CI, 0.736–0.894). A positive evolution was observed for a limited number of conditions, with better results for diabetes with complications (OR=0.689; 95% CI, 0.525–0.904), but no impact regarding congestive heart failure (OR=1.067; 95% CI, 0.827–1.377). Merging acute and primary care providers was associated with reduced readmissions, even though improvements were not found for all institutions or condition-specific groups. There are still challenges to be addressed regarding the success of vertical integration in reducing 30-day hospital readmissions.