Mukamel Dana B, Cai Shubing, Temkin-Greener Helena
University of California, Irvine, Center for Health Policy Research, Irvine, CA, USA.
Health Serv Res. 2009 Aug;44(4):1309-25. doi: 10.1111/j.1475-6773.2009.00980.x. Epub 2009 May 26.
To estimate the costs associated with formal and self-managed daily practice teams in nursing homes.
DATA SOURCES/STUDY SETTING: Medicaid cost reports for 135 nursing homes in New York State in 2006 and survey data for 6,137 direct care workers.
A retrospective statistical analysis: We estimated hybrid cost functions that include team penetration variables. Inference was based on robust standard errors.
Formal and self-managed team penetration (i.e., percent of staff working in a team) were calculated from survey responses. Annual variable costs, beds, case mix-adjusted days, admissions, home care visits, outpatient clinic visits, day care days, wages, and ownership were calculated from the cost reports.
Formal team penetration was significantly associated with costs, while self-managed teams penetration was not. Costs declined with increasing penetration up to 13 percent of formal teams, and increased above this level. Formal teams in nursing homes in the upward sloping range of the curve were more diverse, with a larger number of participating disciplines and more likely to include physicians.
Organization of workforce in formal teams may offer nursing homes a cost-saving strategy. More research is required to understand the relationship between team composition and costs.
评估与养老院中正式和自我管理的日常护理团队相关的成本。
数据来源/研究背景：2006年纽约州135家养老院的医疗补助成本报告以及6137名直接护理人员的调查数据。
一项回顾性统计分析：我们估计了包含团队渗透变量的混合成本函数。推断基于稳健标准误差。
根据调查回复计算正式和自我管理团队的渗透率（即团队工作人员的百分比）。从成本报告中计算年度可变成本、床位、病例组合调整天数、入院人数、家庭护理访视、门诊就诊、日托天数、工资和所有权。
正式团队渗透率与成本显著相关，而自我管理团队渗透率则不然。成本随着正式团队渗透率上升至13%而下降，超过该水平则上升。处于曲线上升区间的养老院中的正式团队更加多样化，参与的学科数量更多，并且更有可能包括医生。
正式团队中的劳动力组织可能为养老院提供一种节省成本的策略。需要更多研究来理解团队构成与成本之间的关系。
