Global Health Sciences, University of California, San Francisco, CA 94105, USA.
Med Care. 2010 Jan;48(1):25-30. doi: 10.1097/MLR.0b013e3181bd47b2.
Improving the quality of inpatient hospital care is increasingly attainable in a variety of settings. However, the relationship between rising quality and costs is unclear; similarly the relationship between varying levels of quality and a patient's satisfaction remains poorly defined.
We use data from the Quality Improvement Demonstration Study (QIDS) based in 30 district hospitals in the Philippines. There were 974 children in the study; these children were cared for by 43 physicians. To measure quality of care, the physicians completed vignettes, a valid and inexpensive measure. Patient exit surveys were given to parents of children on the day of discharge, collecting information on services and hospital charges for the inpatient stay, payment sources for the hospitalization, and the Patient Satisfaction Survey (PSQ-18).
We found a nonlinear relationship between quality and hospital charges: at low levels of quality improvements are linked to lower hospital charges. However, as quality improves further, these changes lead to higher charges. Higher quality also demonstrated a similar nonlinear relationship with patient satisfaction.
The U-shaped association between quality and hospital charges suggests that targeting the lowest quality providers may decrease costs. The similar relationship between patient-reported satisfaction and quality improvement suggests that investments in quality will raise satisfaction, perhaps even when charges are increased.
在各种环境下，提高住院医院护理质量的目标越来越容易实现。然而，质量提高与成本之间的关系尚不清楚；同样，不同质量水平与患者满意度之间的关系也没有得到很好的定义。
我们使用了菲律宾 30 家地区医院开展的质量改进示范研究（QIDS）的数据。研究中有 974 名儿童，由 43 名医生负责治疗。为了衡量护理质量，医生们完成了病例记录，这是一种有效且廉价的衡量方法。在患儿出院当天，家长们会接受患者出院调查，调查内容包括住院期间的服务和住院费用、住院费用的支付来源以及患者满意度调查（PSQ-18）。
我们发现质量和医院费用之间存在非线性关系：在质量改善的较低水平，与医院费用的降低有关。然而，随着质量的进一步提高，这些变化导致了更高的费用。更高的质量也与患者满意度表现出类似的非线性关系。
质量与医院费用之间的 U 形关联表明，针对质量最低的提供者可能会降低成本。患者报告的满意度与质量改进之间的相似关系表明，即使在费用增加的情况下，对质量的投资也会提高满意度。
