Costs and Quality of Hospitals in Different Health Care Systems: A Multilevel Approach with Propensity Score Matching
Costs and Quality of Hospitals in Different Health Care Systems: A Multilevel Approach with Propensity Score Matching
复制标题
不同医疗保健系统中医院的成本和质量：倾向得分匹配的多层次方法
作者：
J. Schreyögg;T. Stargardt;O. Tiemann
医院之间的成本和质量的跨国比较通常是在宏观层面上进行的。这项研究的目的是探索比较不同医疗保健系统中医院微观数据的方法。为此，我们为德国和美国退伍军人健康管理局医院接受急性心肌梗死治疗的患者开发了一个与倾向评分匹配技术相结合的多层次框架，使用了类似的结构数据。我们的案例研究显示了基于匹配样本和不匹配样本的多水平回归结果的重要差异。我们的结论是，倾向得分匹配技术是处理来自不同国家的样本之间常见的基线不平衡的适当方法。在比较不同医院和医疗保健系统的患者水平数据时，建议使用多水平模型来考虑数据的聚集性结构。这些结果为探索进行卫生系统比较的新方法提供了重要的理由。
Cross-country comparisons of costs and quality between hospitals are often made at the macro level. The goal of this study was to explore methods to compare micro-level data from hospitals in different health care systems. To do so, we developed a multi-level framework in combination with a propensity score matching technique using similarly structured data for patients receiving treatment for acute myocardial infarction in German and US Veterans Health Administration hospitals. Our case study shows important differences in results between multi-level regressions based on matched and unmatched samples. We conclude that propensity score matching techniques are an appropriate way to deal with the usual baseline imbalances across the samples from different countries. Multi-level models are recommendable to consider the clustered structure of the data when patient-level data from different hospitals and health care systems are compared. The results provide an important justification for exploring new ways in performing health system comparisons.
影响因子：
7.2
作者：
Normand, SLT;Landrum, NB;McNeil, BJ
通讯作者：
McNeil, BJ