INAPPROPRIATENESS AND VARIATIONS IN HOSPITAL USE

医院使用的不当和变化

• 批准号: 3371672
• 负责人: Michael Shwartz
• 金额: $ 2.03万
• 依托单位: BOSTON UNIVERSITY MEDICAL CAMPUS
• 依托单位国家: 美国
• 财政年份: 1988
• 资助国家: 美国
• 起止时间: 1988-09-30 至 1990-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/3371672
• 关键词: Medicare /Medicaid; health care cost /financing; hospital analysis; hospital length of stay; hospital organization /administration; hospital utilization; mathematical model; socioeconomics

This study will analyze the relationship between small area variations in Medicare hospitalization rates and rates of inappropriate (i.e., medically unnecessary) hospitalization. The main question addressed is whether higher rates of inappropriateness are important in explaining why some areas have higher hospitalization rates for some conditions. The study will be based on analysis of Medicare hospitalization rates by condition for small areas in Massachusetts over a five year period. The longitudinal nature of the data will permit the use of improved methodological approaches to identify how much of the observed variability between areas is due to systematic differences in rates between areas. Conditions will be ranked in terms of their between-area variability and, for each condition, areas ranked in terms of their hospitalization rates. Up to 6 diagnostic conditions will be selected, 3 with high, 2 with moderate and 1 with low variability, plus a sample of medicine and surgery cases irrespective of specific condition. For each condition, some areas will be selected with high hospitalization rates, some with intermediate rates and some with low rates. A sample of Medicare hospital admissions from each area will be identified for medical record review based on the proportion of the area's admissions that go to a particular hospital. A modified version of the Appropriateness Evaluation Protocol (AEP) will then be used to screen sampled cases for inappropriateness. The AEP is a widely used criteria-based instrument whose reliability and validity have been documented. PRO nurse reviewers will perform initial medical record reviews. Cases identified as inappropriate by the AEP reviews will be evaluated by physicians. Information will also be collected on selected socio-economic and demographic characteristics of the population in each small area (e.g., mortality rates, income, education) and health system supply characteristics (e.g., hospital beds, nursing home beds, physicians). Multiple regression models will be used to analyze how area hospitalization rates are related to inappropriateness rates both before and after differences in population and supply characteristics are taken into account. This study should help clarify the extent to which higher hospitalization rates are associated with inappropriate use of the hospital.

这项研究将分析小区域之间的关系 医疗保险住院率和 不适当的(即，医学上不必要的)住院治疗。这个 解决的主要问题是，更高的 不恰当在解释为什么某些领域有 某些情况下的住院率较高。 这项研究将基于对医疗保险住院情况的分析 马萨诸塞州5岁以上小区域按条件收费 一年期间。数据的纵向性质将允许 使用改进的方法来确定有多少 观察到的地区之间的差异是由于系统性的 不同地区之间的税率差异。条件将在 它们的区域间变异性的术语，以及对于每种情况， 根据住院率排名的地区。最多6个 将选择诊断条件，3个为高，2个为 中度和1个低变异性，外加一个药物和 手术病例，不分具体情况。对于每个 情况，将选择部分住院率较高的地区 利率，有些是中等利率，有些是低利率。一个 每个地区的联邦医疗保险入院人数样本如下 根据以下比例确定要进行病历审查 去特定医院的地区的入院人数。经过修改的A 适当性评估协议(AEP)的版本随后将 用于筛选抽样病例的不适当之处。AEP是 一种广泛使用的基于标准的仪器，其可靠性和 有效性已被记录在案。专业护士评审员将表演 最初的病历审查。被认定为不适当的个案 AEP的审查将由医生进行评估。 还将收集关于选定的社会经济和社会问题的信息。 各小区域的人口统计特征 (例如，死亡率、收入、教育)和卫生系统供应 特征(例如，医院床位、疗养院床位、 医生)。将使用多个回归模型来分析 区域住院率与不适当的关系 人口和供给差异前后的比率 考虑到了这些特点。这项研究应该会有所帮助 澄清住院率较高的程度 与医院的不当使用有关。