Impact of Specialty Hospitals on Procedure Utilization

专科医院对手术利用的影响

• 批准号: 7032164
• 负责人: BRAHMAJEE K NALLAMOTHU
• 金额: $ 21.02万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-09-30 至 2007-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7032164
• 关键词: arthroplasty; clinical research; coronary bypass; health care service utilization; health economics; health services research tag; heart surgery; hip surgery; hospitals; human data; knee; longitudinal human study

DESCRIPTION: Specialty hospitals, which provide care limited to specific conditions or procedures, are opening at a rapid pace across the United States. Chief among the concerns about the rise in specialty hospitals is their potential deleterious effect on local, full-service general hospitals. Specialty hospitals tend to focus on the most lucrative services such as cardiovascular and orthopedic procedures. As they siphon away the most "profitable" services, many worry about the financial viability of competing general hospitals and ultimately their ability to provide unprofitable but essential services such as emergency care. A second concern is that the growth of specialty hospitals could increase overall utilization of health care services. Because specialty hospitals are usually owned in part by the physicians who work there, particularly strong financial incentives could further fuel "supplier-induced" demand and the use of selected procedures. Although both concerns have face validity, neither has been examined empirically. For these reasons, we propose to study two related issues: 1) What impact does a specialty hospital's opening have on procedural volumes at competing general hospitals?; and 2) How do specialty hospitals effect overall utilization of procedures across a population? We will use of national Medicare data (1994-2002) to identify specialty hospitals and those general hospitals providing similar services in the same hospital referral regions (HRRs). Focusing on 4 procedures (coronary artery bypass grafting, percutaneous coronary intervention, total hip arthroplasty, and total knee arthroplasty), our Specific Aim 1 will first examine procedural volumes at general hospitals before and after the introduction of specialty hospitals. Our Specific Aim 2 will then assess the impact of specialty hospitals on population-based rates for the four procedures at the HRR-level. Our findings will help policy-makers better understand the relationship between specialty hospitals and procedural utilization, especially as Congress struggles with the question of whether to make a recent moratorium on new specialty hospital construction permanent.

描述：专科医院在全美范围内正在迅速开业，它们提供的护理仅限于特定的条件或程序。对专科医院增加的担忧中，首要的是它们对当地提供全方位服务的综合医院的潜在有害影响。专科医院往往专注于最有利可图的服务，如心血管和整形外科手术。随着它们抽走最“有利可图”的服务，许多人担心与之竞争的综合医院的财务可行性，以及最终它们提供无利可图但必不可少的服务(如急救)的能力。第二个令人担忧的问题是，专科医院的增长可能会提高医疗保健服务的整体利用率。由于专科医院通常部分由在那里工作的医生所有，特别是强有力的财政激励措施可能会进一步刺激“供应商诱导”的需求和对选定程序的使用。尽管这两种担忧都有表面上的正确性，但都没有经过实证检验。基于这些原因，我们建议研究两个相关的问题：1)专科医院的开设对与之竞争的综合医院的程序量有什么影响？2)专科医院如何影响整个人群对程序的总体利用？我们将使用国家医疗保险数据(1994-2002)来识别专科医院和在同一医院转诊区域(HRR)提供类似服务的综合医院。我们的具体目标1将聚焦于4种手术(冠状动脉搭桥术、经皮冠状动脉介入治疗、全髋关节置换术和全膝关节置换术)，首先检查综合医院引入专科医院之前和之后的程序量。然后，我们的具体目标2将评估专科医院对四种程序在人力资源水平上基于人群的比率的影响。我们的发现将帮助政策制定者更好地理解专科医院和程序性利用之间的关系，特别是在国会正在为是否永久暂停新的专科医院建设的问题而苦苦挣扎的时候。