Carter Mary W, Porell Frank W
Division of Health Sevices Research and Policy, School of Public Health University of Minnesota, Minneapolis, USA.
Gerontologist. 2003 Apr;43(2):175-91. doi: 10.1093/geront/43.2.175.
This study examined the contribution of facility-level and area market-level attributes to variations in hospitalization rates among nursing home residents.
Three years (1991-1994) of state quarterly Medicaid case-mix reimbursement data from 527 nursing homes (NH) in Massachusetts were linked with Medicare Provider Analysis and Review hospital claims and nursing facility attribute data to produce a longitudinal, analytical file containing 72,319 person-quarter observations. Logistic regression models were used to estimate the influence of facility-level and market-level factors on hospital use, after controlling for individual-level resident attributes, including: NH diagnoses, resident-level quality of care indicators, and diagnostic cost grouping classification from previous hospital stays.
Multivariate findings suggest that resident heterogeneity alone does not account for the wide variations in hospitalization rates across nursing homes. Instead, facility characteristics such as profit status, nurse staffing patterns, NH size, chain affiliation, and percentage of Medicaid and Medicare reimbursed days significantly influence NH residents' risk of hospitalization. Broader area market factors also appear to contribute to variations in hospitalization rates.
Variations in hospitalization rates may reflect underutilization, as well as overutilization. Continued efforts toward identifying medically necessary hospitalizations are needed.
本研究探讨了机构层面和地区市场层面的属性对疗养院居民住院率差异的影响。
将马萨诸塞州527家疗养院（NH）三年（1991 - 1994年）的州季度医疗补助病例组合报销数据与医疗保险提供者分析与审查医院索赔数据及护理机构属性数据相链接，以生成一个包含72319人次季度观察数据的纵向分析文件。在控制了个体层面居民属性后，使用逻辑回归模型估计机构层面和市场层面因素对住院使用情况的影响，这些个体层面居民属性包括：NH诊断、居民层面的护理质量指标以及既往住院的诊断成本分组分类。
多变量研究结果表明，仅居民异质性并不能解释各疗养院住院率的广泛差异。相反，诸如盈利状况、护士人员配置模式、NH规模、连锁关系以及医疗补助和医疗保险报销天数的百分比等机构特征，会显著影响NH居民的住院风险。更广泛的地区市场因素似乎也对住院率差异有影响。
住院率差异可能反映了利用不足以及过度利用的情况。需要持续努力确定必要的住院治疗。
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