کد مقاله کد نشریه سال انتشار مقاله انگلیسی نسخه تمام متن
5723407 1411448 2017 11 صفحه PDF دانلود رایگان
عنوان انگلیسی مقاله ISI
Hospital quality variation matters - A time-trend and cross-section analysis of outcomes in German hospitals from 2006 to 2014
ترجمه فارسی عنوان
تغییرات کیفی بیمارستان مهم است - یک روند زمانی و تجزیه و تحلیل مقطعی از نتایج در بیمارستان های آلمان از سال 2006 تا 2014
موضوعات مرتبط
علوم پزشکی و سلامت پزشکی و دندانپزشکی سیاست های بهداشت و سلامت عمومی
چکیده انگلیسی


- We examine risk-adjusted and unadjusted outcome rates in German hospitals.
- Six treatment areas and 16 quality indicators for 2006-2014 are included.
- Risk-adjusted outcomes varying by factor 3-12 between the 2nd-5th quintile of hospitals.
- Choosing the right hospital can substantially lower mortality and re-intervention risks.
- Substantial efforts to lower the outcome variation between hospitals are necessary.

Awareness of care variation and associated differences in outcome quality is important for patients to recognize and leverage the benefits of hospital choice and for policy makers, providers, and suppliers to adapt initiatives to improve hospital quality of care. We examine panel data on outcome quality in German hospitals between 2006 and 2014 for cholecystectomy, pacemaker implantation, hip replacement, percutaneous coronary intervention (PCI), stroke, and acute myocardial infarction (AMI). We use risk-adjusted and unadjusted outcomes based on 16 indicators. Median outcome and outcome variation trends are examined via box plots, simple linear regressions and quintile differences. Outcome trends differ across treatment areas and indicators. We found positive quality trends for hip replacement surgery, stroke and AMI 30-day mortality, and negative quality trends for 90-day stroke and AMI readmissions and PCI inpatient mortality. Variation of risk-adjusted outcomes ranges by a factor of 3-12 between the 2nd and 5th quintile of hospitals, both at the national and regional level. Our results show that simply measuring and reporting hospital outcomes without clear incentives or regulation - “carrots and sticks” - to improve performance and to centralize care in high performing hospitals has not led to broad quality improvements. More substantial efforts must be undertaken to narrow the outcome spread between high- and low-quality hospitals.

ناشر
Database: Elsevier - ScienceDirect (ساینس دایرکت)
Journal: Health Policy - Volume 121, Issue 8, August 2017, Pages 842-852
نویسندگان
, , ,