Zemencuk Judith K, Hofer Timothy P, Hayward Rodney A, Moseley Richard H, Saint Sanjay
Health Services Research & Development Field Program, Ann Arbor VA Center for Practice Management and Outcomes Research, Ann Arbor, Michigan, USA.
BMC Health Serv Res. 2006 Apr 4;6:45. doi: 10.1186/1472-6963-6-45.
2002 marked the first time that the rate of hospital spending in the United States out-paced the overall health care spending rate of growth since 1991. As hospital spending continues to grow and as reimbursement for hospital expenses has moved towards the prospective payment system, there is still increasing pressure to reduce costs. Hospitals have a major incentive to decrease resource utilization, including hospital length of stay. We evaluated whether physician profiling affects physician satisfaction and hospital length of stay, and assessed physicians' views concerning hospital cost containment and the quality of care they provide.
To determine if physician profiling affects hospital length of stay and/or physician satisfaction, we used quasi-experimental with before-versus-after and intervention-versus-control comparisons of length of stay data collected at an intervention and six control hospitals. Intervention hospital physicians were informed their length of stay would be compared to their peers and were given a questionnaire assessing their experience.
Nearly half of attending pre-profiled physicians felt negative about the possibility of being profiled, while less than one-third of profiled physicians reported feeling negative about having been profiled. Nearly all physicians greatly enjoyed their ward month. Length of stay at the profiled site decreased by an additional 1/3 of a day in the profiling year, compared to the non-profiled sites (p < 0.001).
A relatively non-instrusive profiling intervention modestly reduced length of stay without adversely affecting physician satisfaction.
2002年标志着自1991年以来美国医院支出增长率首次超过整体医疗保健支出增长率。随着医院支出持续增长，且医院费用报销已转向预期支付系统，降低成本的压力仍在不断增加。医院有很大的动力去减少资源利用，包括缩短住院时间。我们评估了医生概况分析是否会影响医生满意度和住院时间，并评估了医生对医院成本控制及其所提供医疗质量的看法。
为了确定医生概况分析是否会影响住院时间和/或医生满意度，我们采用了准实验方法，对在一家干预医院和六家对照医院收集的住院时间数据进行前后对比以及干预组与对照组对比。干预医院的医生被告知他们的住院时间将与同行进行比较，并收到一份评估其体验的问卷。
近一半未进行概况分析前的主治医生对可能被进行概况分析持负面态度，而进行概况分析后的医生中，不到三分之一的人表示对被进行概况分析持负面态度。几乎所有医生都非常享受他们在病房的时间。与未进行概况分析的医院相比，在进行概况分析的年份，进行概况分析医院的住院时间额外缩短了三分之一天（p < 0.001）。
一种相对非侵入性的概况分析干预适度缩短了住院时间，且未对医生满意度产生不利影响。
