Comparison of change in quality of care between safety-net and non-safety-net hospitals
Comparison of change in quality of care between safety-net and non-safety-net hospitals
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DOI：
10.1001/jama.299.18.2180
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发表时间：
2008-05-14
影响因子：
120.7
通讯作者：
Dudley, R. Adams
中科院分区：
文献类型：
--
作者：
Werner, Rachel M.;Goldman, L. Elizabeth;Dudley, R. Adams
背景 安全网医院（即主要治疗贫困和服务不足的患者的医院）的护理质量通常低于非安全网医院。虽然公开报告和按绩效付费有可能提高绩效不佳的医院的护理质量，但安全网医院可能无法投资于质量改进。因此，一些人担心这些激励措施可能会加剧医院之间现有的差距。 目的 研究医疗补助患者比例高低的医院之间护理质量差异的趋势。 设计和设置 使用公开的医院绩效数据，对 2004 年至 2006 年医院绩效与医疗补助覆盖率之间的关系进行纵向研究。使用模拟模型来估计医疗补助患者比例高和低的医院的支付情况。主要结果衡量2004年至2006年间医院绩效的变化，估计医疗补助患者比例高和低的医院之间的医院质量差异是否发生变化。结果 在4464家参与医院中，3665家（82%）纳入最终分析。医疗补助患者比例高的医院在 2004 年的表现较差，而且随着时间的推移，与医疗补助患者比例低的医院相比，其改善幅度也明显较小。医疗补助患者比例较低的医院将复合急性心肌梗死表现提高了 3.8 个百分点，而比例较高的医院则提高了 2.3 个百分点，绝对差异为 1.5 ( P=. 03)。这导致性能提升的相对差异为 39%。在医疗补助患者比例较低的医院，心力衰竭（差异 1.4 个百分点，P = 0.04）和肺炎（差异 1.3 个百分点，P）的绩效也有较大提高。
Context Safety- net hospitals ( ie, those that predominantly treat poor and under-served patients) often have lower quality of care than non - safety- net hospitals. While public reporting and pay for performance have the potential to improve quality of care at poorly performing hospitals, safety- net hospitals may be unable to invest in quality improvement. As such, some have expressed concern that these incentives have the potential to worsen existing disparities among hospitals.Objective To examine trends in disparities of quality of care between hospitals with high and low percentages of Medicaid patients.Design and Setting Longitudinal study of the relationship between hospital performance and percentage Medicaid coverage from 2004 to 2006, using publicly available data on hospital performance. A simulation model was used to estimate payments at hospitals with high and low percentages of Medicaid patients.Main Outcome Measures Changes in hospital performance between 2004 and 2006, estimating whether disparities in hospital quality between hospitals with high and low percentages of Medicaid patients have changed.Results Of the 4464 participating hospitals, 3665 ( 82%) were included in the final analysis. Hospitals with high percentages of Medicaid patients had worse performance in 2004 and had significantly smaller improvement over time than those with low percentages of Medicaid patients. Hospitals with low percentages of Medicaid patients improved composite acute myocardial infarction performance by 3.8 percentage points vs 2.3 percentage points for those with high percentages, an absolute difference of 1.5 ( P=. 03). This resulted in a relative difference in performance gains of 39%. Larger performance gains at hospitals with low percentages of Medicaid patients were also seen for heart failure ( difference of 1.4 percentage points, P= 0.04) and pneumonia ( difference of 1.3 percentage points, P