Hospital spending and inpatient mortality: evidence from California: an observational study.
Hospital spending and inpatient mortality: evidence from California: an observational study.
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DOI：
10.7326/0003-4819-154-3-201102010-00005
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发表时间：
2011-02-01
影响因子：
39.2
通讯作者：
Goldman DP
中科院分区：
文献类型：
--
作者：
Romley JA;Jena AB;Goldman DP
有证据表明，高医疗保险支出与区域一级更好的健康结果无关，医院的高支出与更好的流程质量无关。但是医院开支和住院病人死亡率之间的关系还不太清楚。确定医院支出与风险调整住院病人死亡率之间的关系。回顾性队列研究。达特茅斯医疗保健地图集中包括的加利福尼亚208家医院1999-2008年出院记录数据库，1999-2008年期间有2,545,352名患有六种主要疾病之一的患者住院。不同临终医院支出水平住院病人的住院死亡率。对于六种入院诊断中的每一种——急性心肌梗死、充血性心力衰竭、急性中风、胃肠道出血、髋部骨折和肺炎——患者入住高费用医院与较低的经风险调整的住院死亡率相关。例如，1999-2003年期间，在加州医院支出最高的五分位数医院收治的急性心肌梗死患者的住院死亡率低于医院支出最低的五分位数医院收治的患者（死亡率优势比0.862,95%可信区间0.742-0.983）。如果所有入院的急性心肌梗死患者都在支出最低的五分之一而不是最高的五分之一的医院接受治疗，预计住院患者死亡人数将增加1831人。医院支出与住院死亡率之间的关系不因地理区域或医院规模而异。未观察到的死亡率预测因素造成了住院费用增加是否导致住院死亡率降低的不确定性。在生命末期花费更多的医院，各种主要住院医疗条件的住院死亡率较低。国家老龄化研究所，兰德·宾健康经济中心
Evidence shows that high Medicare spending is not associated with better health outcomes at a regional level, and that high spending in hospitals is not associated with better process quality. But the relationship between hospital spending and inpatient mortality is less well understood. To determine the association between hospital spending and risk-adjusted inpatient mortality. Retrospective cohort study. Database of discharge records from 1999–2008 for 208 California hospitals included in the Dartmouth Atlas of Health Care 2,545,352 patients hospitalized during 1999–2008 with one of six major medical conditions. Inpatient mortality rates among patients admitted to hospitals with varying levels of end-of-life hospital spending. For each of six admitting diagnoses – acute myocardial infarction, congestive heart failure, acute stroke, gastrointestinal hemorrhage, hip fracture, and pneumonia – patient admission to higher-spending hospitals was associated with lower risk-adjusted inpatient mortality. During 1999–2003, for example, patients admitted with acute myocardial infarction to California hospitals in the highest quintile of hospital spending had lower inpatient mortality than those admitted to hospitals in the lowest quintile (odds ratio of mortality 0.862, 95% confidence interval 0.742–0.983). Predicted inpatient deaths would increase by 1,831 if all patients admitted with acute myocardial infarction were cared for in hospitals in the lowest quintile of spending rather than the highest. The association between hospital spending and inpatient mortality did not vary by geographic region or hospital size. Unobserved predictors of mortality create uncertainty about whether greater inpatient hospital spending leads to lower inpatient mortality. Hospitals that spend more at the end of life have lower inpatient mortality for a variety of major admitting medical conditions. National Institute on Aging, RAND Bing Center for Health Economics
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DOI：
10.1161/circoutcomes.108.825612
发表时间：
2009-11
期刊：
Circulation. Cardiovascular quality and outcomes
影响因子：
--
作者：
Ong MK;Mangione CM;Romano PS;Zhou Q;Auerbach AD;Chun A;Davidson B;Ganiats TG;Greenfield S;Gropper MA;Malik S;Rosenthal JT;Escarce JJ
通讯作者：
Escarce JJ
影响因子：
8.2
作者：
Chandra, Amitabh;Staiger, Douglas O.
通讯作者：
Staiger, Douglas O.
影响因子：
158.5
作者：
Zuckerman, Stephen;Waidmann, Timothy;Hadley, Jack
通讯作者：
Hadley, Jack
影响因子：
39.2
作者：
Fisher, ES;Wennberg, DE;Pinder, EL
通讯作者：
Pinder, EL
影响因子：
9.7
作者：
Landrum, Mary Beth;Meara, Ellen R.;Keating, Nancy L.
通讯作者：
Keating, Nancy L.