Weech-Maldonado Robert, Shea Dennis, Mor Vincent
Department of Health Services Research, Management, and Policy, University of Florida, PO Box 100195, Gainesville, FL 32610-0195, USA.
Am J Med Qual. 2006 Jan-Feb;21(1):40-8. doi: 10.1177/1062860605280643.
The purpose of this study was to evaluate the impact of quality of care on costs in nursing homes. The sample consisted of 749 nursing homes in 5 states in 1996. Nursing home cost functions were estimated using weighted 2-stage least-squares regression analysis. Costs are measured as the facility's total patient care costs. Two outcome measures are used as quality indicators: pressure ulcers worsening and mood decline. Nonmonotonic relationships are observed between quality and costs for nursing homes in the sample. However, the pattern of the relationship is different depending on the quality indicator. For pressure ulcers, the authors observe an inverted U-shaped curve with increasing costs at the lower range of quality but decreasing costs associated with higher quality after a threshold. The opposite pattern is observed for mood decline, with a relatively flat curve at the lower range of quality but increasing costs after a threshold.
本研究的目的是评估护理质量对养老院成本的影响。样本包括1996年5个州的749家养老院。使用加权两阶段最小二乘法回归分析来估计养老院成本函数。成本以机构的患者护理总成本来衡量。使用两个结果指标作为质量指标：压疮恶化和情绪低落。样本中的养老院质量与成本之间呈现非单调关系。然而，根据质量指标的不同，这种关系的模式也有所不同。对于压疮，作者观察到一条倒U形曲线，在质量较低的范围内成本增加，但在达到某个阈值后，高质量会带来成本降低。对于情绪低落，观察到的模式则相反，在质量较低的范围内曲线相对平缓，但在达到阈值后成本增加。
