For-profit hospital status and rehospitalizations at different hospitals: an analysis of Medicare data.
For-profit hospital status and rehospitalizations at different hospitals: an analysis of Medicare data.
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DOI：
10.7326/0003-4819-153-11-201012070-00005
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发表时间：
2010-12-07
影响因子：
39.2
通讯作者：
Smith M
中科院分区：
文献类型：
--
作者：
Kind AJ;Bartels C;Mell MW;Mullahy J;Smith M
大约四分之一的再住院医疗保险患者被送往与原来不同的医院。这种做法在多大程度上与营利性医院的地位有关，并影响付款和死亡率，目前尚不清楚。描述和检查营利性和非营利性/公立医院的医疗保险受益人在30天内再次住院到不同医院的预测因素和支付。回顾性队列研究。美国各地的医疗保险收费医院。随机抽取2005-2006年出院后30天内接受急诊再住院治疗的5%国家医疗保险受益人样本（N= 74，564）。30-每天再住院到不同的医院;随后30天的总付款/死亡率。多变量logistic和分位数回归模型包括指标医院盈利状况、出院人数、地理区域、城乡通勤区域和教学状况;以及患者社会人口统计学、残疾状况、合并症和风险调整措施。22%（16，622）的样本再次住院到不同的医院。与再住院到不同医院的风险增加相关的因素包括在营利性医院、主要医学院附属医院或低容量指数医院住院，以及有Medicare定义的残疾。与那些再次住院到同一家医院的患者相比，再次住院到不同医院的患者有显著更高的调整后30天总支付（中位数额外1，308美元/患者，p值<0.001），但30天死亡率无显著差异，无论指标医院是否为营利性医院。该分析缺乏详细的临床数据，也没有评估具体的提供者实践动机或患者选择的作用。在医疗保险受益人中，重新住院到不同医院是很常见的，更有可能是那些最初在营利性医院住院的人，这与总体支付增加而死亡率没有改善有关。
About one-quarter of rehospitalized Medicare patients are admitted to hospitals different from their original. The extent to which this practice is related to for-profit hospital status, and impacts payments and mortality, is unknown. To describe and examine predictors of and payments for rehospitalization to a different hospital within 30 days among Medicare beneficiaries in for-profit and in not-for-profit/public hospitals. Retrospective cohort study. Medicare fee-for-service hospitals throughout the United States. Random 5% national sample of Medicare beneficiaries with acute-care rehospitalizations within 30-days of discharge, 2005–2006 (N=74,564). 30-day rehospitalizations to different hospitals; total payments/mortality over subsequent 30-days. Multivariate logistic and quantile regression models included index hospital for-profit status, discharge counts, geographic region, rural-urban commuting area, and teaching status; and patient sociodemographics, disabled status, comorbidities, and a measure of risk-adjustment. 22% (16,622) of the sample was rehospitalized to a different hospital. Factors associated with increased risk for rehospitalization to a different hospital included being hospitalized within a for-profit, major medical school-affiliated, or low volume index hospital, and having a Medicare-defined disability. When compared to those rehospitalized to the same hospital, patients rehospitalized to different hospitals had significantly higher adjusted 30-day total payments (median additional $1,308/patient, p-value<0.001), but no significant differences in 30-day mortality, regardless of index hospital for-profit status. The analysis lacked detailed clinical data, and did not assess specific provider practice motivations or the role of patient choice. Rehospitalizations to different hospitals are common among Medicare beneficiaries, more likely among those initially hospitalized at a for-profit hospital, and related to increased overall payments without improved mortality.
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DOI：
10.1046/j.1532-5415.2003.51185.x
发表时间：
2003-04-01
影响因子：
6.3
作者：
Coleman, EA
通讯作者：
Coleman, EA
影响因子：
7.2
作者：
Localio, A. Russell;Margolis, David J.;Berlin, Jesse A.
通讯作者：
Berlin, Jesse A.
影响因子：
9.7
作者：
Fisher, Elliott S.;McClellan, Mark B.;Skinner, Jonathan S.
通讯作者：
Skinner, Jonathan S.
影响因子：
9.7
作者：
Elixhauser, A;Steiner, C;Fraser, I
通讯作者：
Fraser, I
影响因子：
3
作者：
Elixhauser, A;Steiner, C;Coffey, RN
通讯作者：
Coffey, RN