Changes in Quality of Care after Hospital Mergers and Acquisitions
Changes in Quality of Care after Hospital Mergers and Acquisitions
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DOI：
10.1056/nejmsa1901383
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发表时间：
2020-01-02
影响因子：
158.5
通讯作者：
McWilliams, J. Michael
中科院分区：
文献类型：
--
作者：
Beaulieu, Nancy D.;Dafny, Leemore S.;McWilliams, J. Michael
背景 过去 20 年来，医院行业经历了大幅整合，并且自 2010 年以来加速了步伐。多项研究表明，医院合并导致商业保险患者的价格上涨，但有关护理质量影响的研究有限。方法 使用医疗保险索赔和医院比较 2007 年至 2016 年四项护理质量指标（临床过程指标综合、患者体验指标综合、死亡率和出院后再入院率）的绩效数据和 2009 年至 2013 年发生的医院并购数据，我们进行了双重差分分析，比较了被收购医院从收购前到收购后绩效的变化以及同时发生的变化控制未发生所有权变更的医院。结果研究样本包括246家收购医院和1986家对照医院。获得性与患者体验测量表现的适度差异性下降相关（调整后差异变化，-0.17 SD；95%置信区间[CI]，-0.26至-0.07；P=0.002；变化类似于从第50个百分位数下降到第41个百分位），并且30天再入院率没有显着差异变化（-0.10个百分点；95%CI， -0.53 至 0.34；P=0.72）或 30 天死亡率（-0.03 个百分点；95% CI，-0.20 至 0.14；P=0.72）。被收购的医院在临床过程测量方面的绩效有显着的差异性改善（0.22 SD；95% CI，0.05至0.38；P=0.03），但这不能最终归因于所有权的变化，因为差异性改善发生在收购之前。结论 医院被另一家医院或医院系统收购与患者体验稍差相关，并且再入院率或死亡率没有显着变化。对质量过程测量的影响尚无定论。 （由医疗保健研究和质量机构资助。）对 2009 年至 2013 年期间被另一家医院或卫生系统收购的 246 家医院与 1986 家未被收购的对照医院之间的医疗保健质量指标进行了比较。与对照医院相比，收购医院的患者报告体验的综合衡量指标略有恶化。死亡率或再入院率没有显着变化。
Background The hospital industry has consolidated substantially during the past two decades and at an accelerated pace since 2010. Multiple studies have shown that hospital mergers have led to higher prices for commercially insured patients, but research about effects on quality of care is limited. Methods Using Medicare claims and Hospital Compare data from 2007 through 2016 on performance on four measures of quality of care (a composite of clinical-process measures, a composite of patient-experience measures, mortality, and the rate of readmission after discharge) and data on hospital mergers and acquisitions occurring from 2009 through 2013, we conducted difference-in-differences analyses comparing changes in the performance of acquired hospitals from the time before acquisition to the time after acquisition with concurrent changes for control hospitals that did not have a change in ownership. Results The study sample included 246 acquired hospitals and 1986 control hospitals. Being acquired was associated with a modest differential decline in performance on the patient-experience measure (adjusted differential change, -0.17 SD; 95% confidence interval [CI], -0.26 to -0.07; P=0.002; the change was analogous to a fall from the 50th to the 41st percentile) and no significant differential change in 30-day readmission rates (-0.10 percentage points; 95% CI, -0.53 to 0.34; P=0.72) or in 30-day mortality (-0.03 percentage points; 95% CI, -0.20 to 0.14; P=0.72). Acquired hospitals had a significant differential improvement in performance on the clinical-process measure (0.22 SD; 95% CI, 0.05 to 0.38; P=0.03), but this could not be attributed conclusively to a change in ownership because differential improvement occurred before acquisition. Conclusions Hospital acquisition by another hospital or hospital system was associated with modestly worse patient experiences and no significant changes in readmission or mortality rates. Effects on process measures of quality were inconclusive. (Funded by the Agency for Healthcare Research and Quality.)Measures of health care quality were compared between 246 hospitals that were acquired by another hospital or health system during 2009-2013 and 1986 control hospitals that were not acquired. A composite measure of patient-reported experience worsened slightly in acquired hospitals relative to control hospitals. There were no significant changes in mortality or readmission rates.