A Cost-Effectiveness Framework for Profiling the Value of Hospital Care
A Cost-Effectiveness Framework for Profiling the Value of Hospital Care
复制标题
分析医院护理价值的成本效益框架
作者：
J. Timbie;J. Newhouse;M. Rosenthal;S. Normand
近年来，提供者分析和基于绩效的激励计划有所扩大，但需要一个理论框架来衡量和比较医疗提供者之间临床护理的“价值”。成本效益分析提供了这样一个框架，但很少用于治疗选择范围之外。作者提出了一个基于成本效益方法的分析框架，并使用2003财政年度马萨诸塞州医院样本的住院生存率和心脏病发作护理成本数据来说明他们的方法。他们使用分层模型对每个结果进行建模，该模型允许医院之间的性能根据潜在质量效应和病例组合效应而变化。他们还通过对每家医院的一对随机效应进行调节来估计增量结果，使用间接标准化来估计“预期”结果，然后计算它们的差异。增量成本和效益结果使用增量净货币效益合并。使用成本效益方法来描述医院的“价值”，可以比较服务的效益与使用现有社会权重的成本。
Provider profiling and performance-based incentive programs have expanded in recent years but need a theoretical framework for measuring and comparing the ``value'' of clinical care across medical providers. Cost-effectiveness analysis provides such a framework but has rarely been used outside of the treatment choice context. The authors present a profiling framework based on cost-effectiveness methods and illustrate their approach using data on in-hospital survival and the cost of care for a heart attack from a sample of Massachusetts hospitals during fiscal year 2003. They model each outcome using hierarchical models that allow performance to vary across hospitals as a function of a latent quality effect and an effect of case mix. They also estimate incremental outcomes by conditioning on each hospital's pair of random effects, using indirect standardization to estimate ``expected'' outcomes, and then taking their difference. Incremental cost and effectiveness outcomes are combined using incremental net monetary benefits. Using cost-effectiveness methods to profile hospital ``value'' permits the comparison of the benefit of a service relative to the cost using existing societal weights.
影响因子：
9.7
作者：
Fisher, ES;Wennberg, DE;Gottlleb, DJ
通讯作者：
Gottlleb, DJ