Hospital performance and payment: impact of integrating pay-for-performance on healthcare effectiveness in Lebanon.
Hospital performance and payment: impact of integrating pay-for-performance on healthcare effectiveness in Lebanon.
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DOI：
10.12688/wellcomeopenres.15810.2
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发表时间：
2020
影响因子：
--
通讯作者：
Ekman B
中科院分区：
文献类型：
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作者：
Khalife J;Ammar W;Emmelin M;El-Jardali F;Ekman B
背景：2014年，黎巴嫩公共卫生部将绩效工资纳入医院补偿等级，为大多数黎巴嫩人口提供住院服务。这项政策旨在通过减少不必要的住院来提高有效性，并通过在设定医院绩效评分时包括风险调整来提高公平性。方法：我们应用系统的方法来评估新政策对医院绩效的影响。主要的影响衡量标准是全国病例指数，该指数使用医疗出院和手术程序代码在2011-2016年间计算。采用Newey普通最小二乘回归估计单组间断时间序列分析模型，包括季节性调整，并按病例类型分层。代码级分析用于确定和解释因特定诊断和程序而导致的Casemix索引的变化。结果：我们的最终模型包括146家医院的1,353,025例患者，干预后滞后时间为两个月，并进行了季节性调整。在医疗病例中，干预导致每月病例指数上升0.11%(系数0.002，CI 0.001~0.003)，水平上升2.25%(系数0.022，CI 0.005~0.039)。趋势变化归因于腹泻和胃肠炎、腹痛和盆腔疼痛、原发性高血压和不明原因发热的病例减少。还发现了用于特定诊断的中短期病例的转变。水平的变化归因于编码实践的改进，特别是对乳腺癌、白血病和化疗的编码。未发现对手术病例指数的影响。结论：2014年的政策通过增加卫生部签约医院的病例指数，提高了医疗保健效率。这一增长主要是由于减少了不必要的住院，并伴随着医疗出院编码做法的改善。在医疗保健系统中整合按绩效付费可能有助于提高效率。通过对常规数据的系统收集和分析，可以实现有效的医院监管。
Background: In 2014 the Lebanese Ministry of Public Health integrated pay-for-performance into setting hospital reimbursement tiers, to provide hospitalization service coverage for the majority of the Lebanese population. This policy was intended to improve effectiveness by decreasing unnecessary hospitalizations, and improve fairness by including risk-adjustment in setting hospital performance scores. Methods: We applied a systematic approach to assess the impact of the new policy on hospital performance. The main impact measure was a national casemix index, calculated across 2011-2016 using medical discharge and surgical procedure codes. A single-group interrupted time series analysis model with Newey ordinary least squares regression was estimated, including adjustment for seasonality, and stratified by case type. Code-level analysis was used to attribute and explain changes in casemix index due to specific diagnoses and procedures. Results: Our final model included 1,353,025 cases across 146 hospitals with a post-intervention lag-time of two months and seasonality adjustment. Among medical cases the intervention resulted in a positive casemix index trend of 0.11% per month (coefficient 0.002, CI 0.001-0.003), and a level increase of 2.25% (coefficient 0.022, CI 0.005-0.039). Trend changes were attributed to decreased cases of diarrhea and gastroenteritis, abdominal and pelvic pain, essential hypertension and fever of unknown origin. A shift from medium to short-stay cases for specific diagnoses was also detected. Level changes were attributed to improved coding practices, particularly for breast cancer, leukemia and chemotherapy. No impact on surgical casemix index was found. Conclusions: The 2014 policy resulted in increased healthcare effectiveness, by increasing the casemix index of hospitals contracted by the Ministry. This increase was mainly attributed to decreased unnecessary hospitalizations and was accompanied by improved medical discharge coding practices. Integration of pay-for-performance within a healthcare system may contribute to improving effectiveness. Effective hospital regulation can be achieved through systematic collection and analysis of routine data.