The Association Between Cost and Quality in Trauma Is Greater Spending Associated With Higher-Quality Care?
The Association Between Cost and Quality in Trauma Is Greater Spending Associated With Higher-Quality Care?
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DOI：
10.1097/sla.0b013e3181e623f6
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发表时间：
2010-08-01
影响因子：
9
通讯作者：
Mukamel, Dana B.
中科院分区：
文献类型：
--
作者：
Glance, Laurent G.;Dick, Andrew W.;Mukamel, Dana B.
目的：研究创伤中心质量与费用之间的关系。背景：当前降低医疗成本和提高医疗质量的努力需要更好地了解成本与质量之间的关系。方法：利用全国住院患者样本中的数据，对73个创伤中心收治的67,124名创伤患者进行了回顾性观察研究。采用广义线性模型探讨住院费用与住院死亡率之间的关系，控制了伤害诊断、年龄、性别、受伤机制、合并症、教学状况、医院所有权、地理区域和医院工资等医院和患者因素。结果：在风险调整死亡率较低的医院接受治疗的患者的费用显著低于在中等质量医院接受治疗的患者。与普通医院相比，在高质量医院就诊的患者的相对成本为0.78(95%可信区间：0.64，0.95)。在中等死亡率和高死亡率的创伤中心治疗病人的费用是相似的。结论：在这项研究中，基于医疗成本和利用项目全国住院患者样本，在风险调整死亡率较低的医院，受伤病人的护理费用较低。风险调整死亡率较低的医院调整后的死亡率比普通医院低34%，同时支出比一般医院低近22%。
Objective: To examine the association between trauma center quality and costs.Background: Current efforts to reduce health care costs and improve health care quality require a better understanding of the relationship between cost and quality.Methods: Using data from the Healthcare Cost and Utilization Projects Nationwide Inpatient Sample, we performed a retrospective observational study of 67,124 trauma patients admitted to 73 trauma centers. Generalized linear models were used to explore the association between hospital cost and in-hospital mortality, controlling for hospital and patient factors as follows: injury diagnoses, age, gender, mechanism of injury, comorbidities, teaching status, hospital ownership, geographic region, and hospital wages.Results: Patients treated in hospitals with low risk-adjusted mortality rates had significantly lower costs than those treated in average-quality hospitals. The relative cost of patients treated in high-quality hospitals was 0.78 (95% confidence interval: 0.64, 0.95) compared with average-quality hospitals. The cost of treating patients in average- and high-mortality trauma centers was similar.Conclusion: In this study based on the Healthcare Cost and Utilization Project Nationwide Inpatient Sample, the care of injured patients is less expensive in hospitals with lower risk-adjusted mortality rates. Hospitals with low risk-adjusted mortality rates have adjusted mortality rates that are 34% lower while spending nearly 22% less compared with average-quality hospitals.