Looking forward, looking back: assessing variations in hospital resource use and outcomes for elderly patients with heart failure.
Looking forward, looking back: assessing variations in hospital resource use and outcomes for elderly patients with heart failure.
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DOI：
10.1161/circoutcomes.108.825612
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发表时间：
2009-11
期刊：
影响因子：
--
通讯作者：
Escarce JJ
中科院分区：
文献类型：
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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
最近的研究发现，过期的医疗保险受益人患有慢性疾病的医院资源利用率存在很大差异。通过仅分析过期患者，这些研究无法确定医院之间在死亡率等健康结果方面的差异。本研究探讨了死亡率和资源利用之间的关系，在医院一级，当所有医疗保险受益人住院治疗心力衰竭进行检查。使用多变量风险调整模型对2001年1月1日至2005年6月30日期间在加州六家教学医院住院的3，999名主要诊断为心力衰竭的患者进行了分析，包括住院总天数、医院直接总费用和死亡率首次入院后180天内（“展望”）。在研究期间死亡的1，639人的子集使用多变量风险调整模型分析了死亡前180天内的总住院天数和总医院直接费用（“回顾”）。“展望”风险调整后的住院平均死亡率为17.0%至26.0%，总住院天数为7.8至14.9天，指数化总直接成本为平均值的0.66至1.30倍。死亡率和住院天数之间的斯皮尔曼等级相关系数为-0.68，死亡率和指数化总直接成本之间的相关系数为-0.93。“回顾”风险调整后的住院平均值范围为总住院日的9.1至21.7天，指数化总直接成本平均值的0.91至1.79倍。过期和所有个人之间的资源利用网站排名的变化是由于无意义的差异。加州的教学医院使用更多的资源来照顾因心力衰竭住院的病人，死亡率较低。仅关注过期个体可能会忽视死亡率变化以及更高的资源利用率和更低的死亡率之间的关联。报告值而不确定显著差异可能导致对真实差异的错误假设。
Recent studies have found substantial variation in hospital resource utilization by expired Medicare beneficiaries with chronic illnesses. By analyzing only expired patients, these studies cannot identify differences across hospitals in health outcomes like mortality. This study examines the association between mortality and resource utilization at the hospital level, when all Medicare beneficiaries hospitalized for heart failure are examined. 3,999 individuals hospitalized with a principal diagnosis of heart failure at six California teaching hospitals between January 1, 2001 and June 30, 2005 were analyzed with multivariate risk-adjustment models for total hospital days, total hospital direct costs, and mortality within 180-days after initial admission (“Looking Forward”). A subset of 1,639 individuals who died during the study period were analyzed with multivariate risk-adjustment models for total hospital days and total hospital direct costs within 180-days prior to death (“Looking Back”). “Looking Forward” risk-adjusted hospital means ranged from 17.0% to 26.0% for mortality, 7.8 to 14.9 days for total hospital days, and 0.66 to 1.30 times the mean value for indexed total direct costs. Spearman rank correlation coefficients were −0.68 between mortality and hospital days, and −0.93 between mortality and indexed total direct costs. “Looking Back” risk-adjusted hospital means ranged from 9.1 to 21.7 days for total hospital days and 0.91 to 1.79 times the mean value for indexed total direct costs. Variation in resource utilization site ranks between expired and all individuals were due to insignificant differences. California teaching hospitals that used more resources caring for patients hospitalized for heart failure had lower mortality rates. Focusing only on expired individuals may overlook mortality variation as well as associations between greater resource utilization and lower mortality. Reporting values without identifying significant differences may result in incorrect assumption of true differences.