Smith Richard B, Cheung Robyn, Owens Pamela, Wilson R Mark, Simpson Lisa
College of Business, University of South Florida St. Petersburg, 140 Seventh Avenue South, COB 348, St. Petersburg, FL 33701, USA.
Health Serv Res. 2007 Oct;42(5):1981-98. doi: 10.1111/j.1475-6773.2007.00698.x.
To examine the association of Medicaid market characteristics to potentially preventable adverse medical events for hospitalized children, controlling for patient- and hospital-level factors.
DATA SOURCES/STUDY SETTING: Two carefully selected Agency for Healthcare Research and Quality (AHRQ) pediatric patient safety indicators (decubitus ulcers and laceration) are analyzed using the new pediatric-specific, risk-adjusting, patient safety algorithm from the AHRQ. All pediatric hospital discharges for patients age 0-17 in Florida, New York, and Wisconsin, and at risk of any of these two patient safety events, are examined for the years 1999-2001 (N=859,922).
Logistic regression on the relevant pool of discharges estimates the probability an individual patient experiences one of the two PSI events.
Pediatric discharges from the 1999 to 2001 State Inpatient Databases (SIDs) from the AHRQ Healthcare Cost and Utilization Project, merged with hospital-level data from the American Hospital Association's Annual Survey, Medicaid data obtained from the Centers for Medicare and Medicaid Services and state Medicaid offices, and private and Medicaid managed care enrollment data obtained from InterStudy, are used in the estimations.
At the market level, patients in markets in which Medicaid payers face relatively little competition are more likely to experience a patient safety event (odds ratio [OR]=1.602), while patients in markets in which hospitals face relatively little competition are less likely to experience an adverse event (OR=0.686). At the patient-discharge and hospital levels, Medicaid characteristics are not significantly associated with the incidence of a pediatric patient safety event.
Our analysis offers additional insights to previous work and suggests a new factor--the Medicaid-payer market--as relevant to the issue of pediatric patient safety.
探讨医疗补助市场特征与住院儿童潜在可预防的不良医疗事件之间的关联，并对患者和医院层面的因素进行控制。
数据来源/研究背景：使用美国医疗保健研究与质量局（AHRQ）新的针对儿科的、风险调整的患者安全算法，分析两个精心挑选的AHRQ儿科患者安全指标（褥疮和撕裂伤）。对1999 - 2001年佛罗里达州、纽约州和威斯康星州0至17岁有这两种患者安全事件风险的儿科住院患者出院情况进行检查（N = 859,922）。
对相关出院病例库进行逻辑回归分析，以估计个体患者发生两种患者安全指标事件之一的概率。
估计中使用了AHRQ医疗保健成本与利用项目1999年至2001年的州住院数据库（SID）中的儿科出院数据，与美国医院协会年度调查的医院层面数据、从医疗保险和医疗补助服务中心及州医疗补助办公室获得的医疗补助数据，以及从InterStudy获得的私人和医疗补助管理式医疗注册数据合并。
在市场层面，医疗补助支付方面临竞争相对较少的市场中的患者更有可能发生患者安全事件（优势比[OR]=1.602），而医院面临竞争相对较少的市场中的患者发生不良事件的可能性较小（OR = 0.686）。在患者出院和医院层面，医疗补助特征与儿科患者安全事件的发生率无显著关联。
我们的分析为先前的研究提供了更多见解，并提出了一个与儿科患者安全问题相关的新因素——医疗补助支付方市场。
