Scanlon Dennis P, Lindrooth Richard C, Christianson Jon B
The Pennsylvania State University, University Park, PA, USA.
Health Serv Res. 2008 Oct;43(5 Pt 2):1849-68. doi: 10.1111/j.1475-6773.2008.00889.x. Epub 2008 Aug 29.
To determine if a tiered hospital benefit and safety incentive shifted the distribution of admissions toward safer hospitals.
DATA SOURCES/STUDY SETTING: A large manufacturing company instituted the hospital safety incentive (HSI) for union employees. The HSI gave union patients a financial incentive to choose hospitals that met the Leapfrog Group's three patient safety "leaps." The analysis merges data from four sources: claims and enrollment data from the company, the American Hospital Association, the AHRQ HCUP-SID, and a state Office of the Insurance Commissioner.
Changes in hospital admissions' patterns for union and nonunion employees using a difference-in-difference design. We estimate the probability of choosing a specific hospital from a set of available alternatives using conditional logistic regression.
Patients affiliated with the engineers' union and admitted for a medical diagnosis were 2.92 times more likely to select a hospital designated as safer in the postperiod than in the preperiod, while salaried nonunion (SNU) patients (not subject to the financial incentive) were 0.64 times as likely to choose a compliant hospital in the post- versus preperiod. The difference-in-difference estimate, which is based on the predictions of the conditional logit model, is 0.20. However, the machinists' union was also exposed to the incentive and they were no more likely to choose a safer hospital than the SNU patients. The incentive did not have an effect on patients admitted for a surgical diagnosis, regardless of union status. All patients were averse to travel time, but those union patients selecting an incentive hospital were less averse to travel time.
Patient price incentives and quality/safety information may influence hospital selection decisions, particularly for medical admissions, though the optimal incentive level for financial return to the plan sponsor is not clear.
确定分级医院福利与安全激励措施是否使住院分布向更安全的医院转移。
数据来源/研究背景：一家大型制造公司为工会员工设立了医院安全激励（HSI）措施。HSI为工会患者提供经济激励，促使他们选择符合“跨越组织”三项患者安全“跨越”标准的医院。该分析合并了来自四个来源的数据：公司的理赔和注册数据、美国医院协会、医疗保健研究与质量局的医疗成本和利用项目州 inpatient 数据库（AHRQ HCUP-SID）以及州保险专员办公室的数据。
采用双重差分设计，分析工会和非工会员工住院模式的变化。我们使用条件逻辑回归估计从一组可用替代方案中选择特定医院的概率。
工程师工会附属且因医疗诊断入院的患者在后期选择指定为更安全医院的可能性是前期的2.92倍，而受薪非工会（SNU）患者（不受经济激励影响）在后期选择合规医院的可能性是前期的0.64倍。基于条件逻辑模型预测的双重差分估计值为0.20。然而，机械师工会也受到了激励，他们选择更安全医院的可能性并不比SNU患者高。无论工会身份如何，该激励措施对因手术诊断入院的患者均无影响。所有患者都厌恶出行时间，但选择激励医院的工会患者对出行时间的厌恶程度较低。
患者价格激励和质量/安全信息可能会影响医院选择决策，特别是对于医疗住院情况，尽管对于计划赞助商的财务回报而言，最佳激励水平尚不清楚。
