Steering patients to safer hospitals? The effect of a tiered hospital network on hospital admissions.
Steering patients to safer hospitals? The effect of a tiered hospital network on hospital admissions.
复制标题
引导患者去更安全的医院？
DOI：
10.1111/j.1475-6773.2008.00889.x
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发表时间：
2008
影响因子：
3.4
通讯作者：
Christianson,JonB
中科院分区：
文献类型：
--
作者：
Scanlon,DennisP;Lindrooth,RichardC;Christianson,JonB
目的：确定分级医院福利和安全激励措施是否将入院分布向更安全的医院转移。数据来源/研究设置。一家大型制造公司为工会员工制定了医院安全激励措施（HSI）。HSI给予工会患者经济激励，以选择符合Leapfrog Group三项患者安全“飞跃”的医院。该分析合并了来自四个来源的数据：来自该公司、美国医院协会、AHRQ HCUP‐SID和州保险专员办公室的索赔和登记数据。研究设计：使用差异中差异设计，改变工会和非工会员工的入院模式。我们估计的概率选择一个特定的医院从一组可用的替代品使用条件logistic regression.Principal Findings.Patients隶属于工程师工会和承认的医疗诊断是2.92倍更有可能选择一家医院指定为安全的后期比前期，而受薪骨不连（SNU）患者（不受经济激励的影响）在治疗后选择合规医院的可能性是治疗前的0.64倍。基于条件logit模型预测的差异中差异估计值为0.20。然而，机械师工会也受到了激励，他们不太可能选择比SNU病人更安全的医院。该激励措施对因手术诊断而入院的患者没有影响，无论工会状况如何。所有的患者都反对旅行时间，但那些工会患者选择一个激励医院不太反对travel time.Conclusions.Patient价格激励和质量/安全信息可能会影响医院选择的决定，特别是对于医疗准入，虽然最佳的激励水平的财务回报计划赞助商是不清楚的。
Objective.To determine if a tiered hospital benefit and safety incentive shifted the distribution of admissions toward safer hospitals.Data Sources/Study Setting.A large manufacturing company instituted the hospital safety incentive (HSI) for union employees. The HSI gave union patients a financial incentive to choose hospitals that met the Leapfrog Group's three patient safety “leaps.” The analysis merges data from four sources: claims and enrollment data from the company, the American Hospital Association, the AHRQ HCUP‐SID, and a state Office of the Insurance Commissioner.Study Design.Changes in hospital admissions' patterns for union and nonunion employees using a difference‐in‐difference design. We estimate the probability of choosing a specific hospital from a set of available alternatives using conditional logistic regression.Principal Findings.Patients affiliated with the engineers' union and admitted for a medical diagnosis were 2.92 times more likely to select a hospital designated as safer in the postperiod than in the preperiod, while salaried nonunion (SNU) patients (not subject to the financial incentive) were 0.64 times as likely to choose a compliant hospital in the post‐ versus preperiod. The difference‐in‐difference estimate, which is based on the predictions of the conditional logit model, is 0.20. However, the machinists' union was also exposed to the incentive and they were no more likely to choose a safer hospital than the SNU patients. The incentive did not have an effect on patients admitted for a surgical diagnosis, regardless of union status. All patients were averse to travel time, but those union patients selecting an incentive hospital were less averse to travel time.Conclusions.Patient price incentives and quality/safety information may influence hospital selection decisions, particularly for medical admissions, though the optimal incentive level for financial return to the plan sponsor is not clear.