Case volume, quality of care, and care efficiency in coronary artery bypass surgery.
Case volume, quality of care, and care efficiency in coronary artery bypass surgery.
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DOI：
10.1001/archinternmed.2010.237
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发表时间：
2010-07-26
影响因子：
--
通讯作者：
Lindenauer PK
中科院分区：
文献类型：
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作者：
Auerbach AD;Hilton JF;Maselli J;Pekow PS;Rothberg MB;Lindenauer PK
当我们寻求提高医疗保健价值时，病例数量和护理质量与医院费用或住院时间的关系如何是重要的问题。针对在美国医院网络中接受冠状动脉搭桥手术的 18 岁或以上患者的观察性研究。使用我们的数据集估算病例数量。通过理想患者是否未接受推荐的药物和服务以及错过的措施总数来评估质量。我们使用多变量分层模型来估计病例数量和质量对医院费用和住院时间的影响。大多数医院 (51%) 和医生 (78%) 的提供者数量最少，只有 18% 的患者接受了所有护理质量措施。中位住院时间为 7 天（四分位数间距 [IQR] 6 至 11 天），中位费用为 25140 美元（IQR 19677 美元，33121 美元）。在根据患者和场所特征进行调整的分析中，规模最小的医院的成本高出 19.8%（95% CI 高出 3.9% 至 38%）；调整护理质量并没有消除成本差异。外科医生数量较少也与较高的成本相关，但强度较小（成本较高 3.1%，95% CI 较高 0.6% 至 5.6%）。个体质量指标与费用或住院时间的关联性不一致，但没有遗漏质量指标的患者的住院时间和费用比漏掉一项的患者要低得多。避免去医院数量最少的医院和最大限度地提高质量是通过降低冠状动脉搭桥手术成本来提高医疗保健效率的不同方法。
How case volume and quality of care relate to hospital costs or length of stay are important questions as we seek to improve the value of healthcare. Observational study of patients 18 or older who underwent coronary artery bypass grafting surgery in a network of US hospitals. Case volumes were estimated using our dataset. Quality was assessed by whether recommended medications and services were not received in ideal patients, as well as the overall number of measures missed. We used multivariable hierarchical models to estimate the effects of case volume and quality on hospital cost and length of stay. The majority of hospitals (51%) and physicians (78%) were lowest volume providers and only 18% of patients received all quality of care measures. Median length of stay was 7 days (interquartile range [IQR] 6 to 11 days), and median costs were $25140 (IQR $19677, $33121). In analyses adjusted for patient and site characteristics, lowest volume hospitals had 19.8% higher costs (95% CI 3.9% to 38% higher); adjusting for care quality did not eliminate differences in costs. Low surgeon volume was also associated with higher costs, though less strongly (3.1% higher costs, 95% CI 0.6% to 5.6% higher). Individual quality measures had inconsistent associations with costs or length of stay, but patients who had no quality measures missed had much lower length of stay and costs than those who missed even one. Avoiding lowest volume hospitals and maximizing quality are separate approaches to improving healthcare efficiency through reducing costs of coronary bypass surgery.