Do hospitals provide lower quality care on weekends?
Do hospitals provide lower quality care on weekends?
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DOI：
10.1111/j.1475-6773.2006.00663.x
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发表时间：
2007-08-01
影响因子：
3.4
通讯作者：
Becker, David J.
中科院分区：
文献类型：
--
作者：
Becker, David J.
目标。探讨周末住院治疗对急性心肌梗死（AMI）住院患者强化心脏手术时机和发生率的影响，以及对后续支出、死亡率和再入院率的影响。数据源。主要数据是1989年至1998年期间因急性心肌梗死住院的922,074名老年人、非农村、按服务收费的医疗保险受益人的纵向行政索赔。年度患者级队列提供了有关先前健康状况、程序使用、支出和健康结果的信息。研究设计。病人是分析的主要单位。我使用普通最小二乘回归来估计周末住院对心导管插入术、血管成形术和搭桥手术（在初次住院后的不同时间段）、AMI入院后不同时期的1年支出和不良健康结果率的影响。主要的发现。周末AMI患者接受立即强化心脏手术的可能性明显较低，不良健康结果的发生率明显较高。周末入院导致第1天插管率降低3.47个百分点，血管成形术降低1.52个百分点，旁路手术降低0.35个百分点
Objective. To examine the effect of a weekend hospitalization on the timing and incidence of intensive cardiac procedures, and on subsequent expenditures, mortality and readmission rates for Medicare patients hospitalized with acute myocardial infarction (AMI).Data Sources. The primary data are longitudinal, administrative claims for 922,074 elderly, nonrural, fee-for-service Medicare beneficiaries hospitalized with AMI from 1989 to 1998. Annual patient-level cohorts provide information on ex ante health status, procedure use, expenditures, and health outcomes.Study Design. The patient is the primary unit of analysis. I use ordinary least squares regression to estimate the effect of weekend hospitalization on rates of cardiac catheterization, angioplasty, and bypass surgery (in various time periods subsequent to the initial hospitalization), 1-year expenditures and rates of adverse health outcomes in various periods following the AMI admission.Principal Findings. Weekend AMI patients are significantly less likely to receive immediate intensive cardiac procedures, and experience significantly higher rates of adverse health outcomes. Weekend admission leads to a 3.47 percentage point reduction in catheterization at 1 day, a 1.52 point reduction in angioplasty, and a 0.35 point reduction in by-pass surgery (p