INAPPROPRIATENESS AND VARIATIONS IN HOSPITAL USE

医院使用的不当和变化

• 批准号: 3371671
• 负责人: JOSEPH RESTUCCIA
• 金额: $ 41.42万
• 依托单位: BOSTON UNIVERSITY MEDICAL CAMPUS
• 依托单位国家: 美国
• 财政年份: 1991
• 资助国家: 美国
• 起止时间: 1991-09-30 至 1994-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/3371671
• 关键词: Medicare /Medicaid; health care cost /financing; health care model; hospital analysis; hospital utilization; medical records; socioeconomics

We will study the relationship between small area variations in Medicare hospitalization rates and rates of inappropriate (i.e. medically unnecessary) hospitalization. The main question is whether higher rates of inappropriateness are found in areas with higher hospitalization rates, especially for clinical conditions which display much between variability. The findings will be important for cost containment programs, outcomes research, and the development of clinical practice protocols. This application is for a 30-month continuation of one-year study. In the first study we developed and applied improved methods for estimating systematic differences in hospital admission rates between small geographic areas, for estimating area-specific rates, and for forming hospital market areas, using six year of data on Massachusetts Medicare admissions by condition. Based on that work, clinical conditions have been ranked by their estimated "systematic" or underlying between-area variability. In the continuation, for each condition geographic areas will be ranked by their estimated underlying hospitalization rates. Seven diagnostic conditions will be selected, four with high and three with low variability, plus a sample of medical cases as an eighth "condition". For each condition, some discharges will be selected from areas with high hospitalization rates, some from areas with intermediate rates, and some from areas with low rates. To improve the efficiency of data collection, all discharges will be sampled from a subset of approximately 30 hospitals. Six thousand Medicare records will be reviewed. Modified, condition-specific versions of the Appropriateness Evaluation Protocol (AEP) will be used to screen sampled cases for inappropriateness. The AEP is a widely used criteria-based instrument of documented reliability and validity; two AEP modifications have already been developed and tested. PRO nurse reviewers will perform initial medical record reviews. Cases they identify as inappropriate will be evaluated further by physicians. The data will be analyzed 1) to determine whether rates of inappropriateness are related to admission rates and 2) to assess the influence of differences in population and supply characteristics on the relationship between hospitalization rates and inappropriate use of the hospital, using data bases on need, supply and demand characteristics of each area developed during the first study.

我们将研究医疗保险中的小区域变化之间的关系， 住院率和不适当的（即医疗） 不必要的）住院治疗。 主要问题是， 在住院率较高的地区， 率，特别是对于临床条件， 可变性 调查结果对控制成本很重要 计划，成果研究和临床实践的发展 协议. 此申请是一年学习的30个月延续。 在 第一项研究，我们开发并应用了改进的方法， 系统性的差异，住院率之间的小 地理区域，用于估计特定区域的比率，并用于形成 医院营销领域，使用6年马萨诸塞州医疗保险数据 按条件录取。 基于这项工作，临床条件 按其估计的“系统性”或潜在的区域间 可变性 在下一节中，将对每种条件的地理区域进行排名 根据他们估计的潜在住院率。 七诊 条件将被选择，四个高，三个低 可变性，加上医疗案例的样本作为第八个“条件”。 对于每种情况，将从具有以下条件的区域中选择一些排放 住院率高，有些来自住院率中等的地区， 有些来自低利率地区。 为了提高数据的效率 收集，所有排放物将从一个子集中取样， 近30家医院 6000份医疗保险记录将被 综述 适当性的修改后的、特定条件版本 评估方案（AEP）将用于筛选抽样病例， 不合适 AEP是一种广泛使用的基于标准的工具 有记录的可靠性和有效性;两个AEP修改 已经开发和测试。 PRO护士评审员将执行 初步医疗记录审查。 他们认为不合适的案件 将由医生进一步评估。 将对数据进行分析1）以确定 不适当的是与录取率和2）评估 人口和供应特征的差异对 住院率与不适当使用 医院，使用数据库的需要，供应和需求的特点， 每个区域都是在第一次研究中发展起来的。