Goldman L Elizabeth, Vittinghoff Eric, Dudley R Adams
Departments of Medicine, University of California, San Francisco, San Francisco, California 94110, USA.
Med Care. 2007 Jun;45(6):579-83. doi: 10.1097/MLR.0b013e318041f723.
Certain hospitals play a central role in ensuring Medicaid-insured patients' access to care. Their quality of care is critical to evaluate.
To determine whether hospitals for which Medicaid patients represent a high percentage of total discharges provide a different quality of care than other hospitals.
Cross-sectional analysis.
Acute care hospitals participating in the first Hospital Compare public report (released November 2004) and the 2004 American Hospital Association hospital survey.
Hospitals serving 1 standard deviation above the national mean percentage of Medicaid patients were designated high Medicaid hospitals. Performance was assessed using percent compliance with 10 processes of care for 3 conditions: myocardial infarction, congestive heart failure, and community-acquired pneumonia.
Among the 2874 nonteaching hospitals, high Medicaid hospitals had lower adherence (P < 0.01) than other nonteaching hospitals on all 10 indicators. Of particular clinical importance, high Medicaid nonteaching hospitals less frequently prescribed beta-blockers (83% vs. 90%%, P < 0.0001) and aspirin at discharge in myocardial infarction (85% vs. 91%%, P < 0.0001), and administered antibiotics on time in CAP (68% vs. 75%, P < 0.0001). Among teaching institutions, there were few differences between high Medicaid and other hospitals.
Among hospitals publicly reporting on the Hospital Compare Web site, nonteaching hospitals treating a high percentage of Medicaid patients had lower adherence to quality indicators than other nonteaching hospitals on 10 indicators. Further research is needed to determine what factors contribute to differences in reported quality.
某些医院在确保医疗补助保险患者获得医疗服务方面发挥着核心作用。对其医疗质量进行评估至关重要。
确定医疗补助患者出院人数占总出院人数比例较高的医院所提供的医疗质量是否与其他医院不同。
横断面分析。
参与首次医院比较公开报告（2004年11月发布）和2004年美国医院协会医院调查的急性护理医院。
为医疗补助患者服务且比例高于全国平均水平1个标准差的医院被指定为高医疗补助医院。使用对心肌梗死、充血性心力衰竭和社区获得性肺炎这3种病症的10项护理流程的依从率来评估绩效。
在2874家非教学医院中，高医疗补助医院在所有10项指标上的依从性均低于其他非教学医院（P<0.01）。具有特别临床重要性的是，高医疗补助非教学医院在心肌梗死患者出院时开具β受体阻滞剂（83%对90%，P<0.0001）和阿司匹林（85%对91%，P<0.0001）的频率较低，且在社区获得性肺炎患者中按时使用抗生素的比例较低（68%对75%，P<0.0001）。在教学机构中，高医疗补助医院与其他医院之间几乎没有差异。
在医院比较网站上公开报告的医院中，治疗高比例医疗补助患者的非教学医院在10项指标上对质量指标的依从性低于其他非教学医院。需要进一步研究以确定导致报告质量差异的因素。
