INAPPROPRIATENESS AND VARIATIONS IN HOSPITAL USE

医院使用的不当和变化

• 批准号: 3371673
• 负责人: JOSEPH RESTUCCIA
• 金额: $ 57.53万
• 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 1994-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/3371673
• 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小区域差异之间的关系 住院率和不合时宜(即医学上的 不必要的)住院治疗。主要问题是，更高的利率是否 在住院率较高的地区发现不适当的情况 比率，特别是在临床情况下表现出很大的 可变性。这些发现将对控制成本具有重要意义 项目、结果研究和临床实践的发展 协议。 本申请为期30个月，为期一年。在……里面 第一项研究是我们开发并应用了改进的估算方法 入院率的系统性差异很小 地理区域，用于估计区域特定速率和用于形成 医院市场区域，使用六年的马萨诸塞州医疗保险数据 按条件入场。基于这项工作，临床情况有 根据其估计的“系统性”或潜在的区域间进行排名 可变性。 接下来，将针对每种情况对地理区域进行排名 根据他们估计的潜在住院率。七项诊断 将选择条件，四个条件高，三个条件低 可变性，加上医疗病例样本，作为第八个“情况”。 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，有些来自中等住院率地区，以及 一些人来自利率较低的地区。提高数据的使用效率 集合，则将从以下子集中采样所有排放 大约30家医院。六千个医疗保险记录将是 已审阅。修改后的特定条件版本的适当性 将使用评估协议(AEP)来筛选抽样病例 不恰当。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；AEP的两个修改 已经被开发和测试。专业护士评审员将表演 最初的病历审查。他们认为不适当的案例 将由医生进行进一步的评估。 将对数据进行分析1)以确定 不恰当与录取率有关，以及2)评估 人口和供给特征的差异对农业生产的影响 住院率与不合理用药的关系 医院利用数据库，根据需求、供需特点 在第一次研究中，每个区域都得到了发展。