Dartmouth Medical School, Hanover, NH 03766, USA.
Health Serv Res. 2010 Dec;45(6 Pt 2):1981-2006. doi: 10.1111/j.1475-6773.2010.01190.x. Epub 2010 Oct 28.
To determine the effect of competition in postacute care (PAC) markets on resource intensity and outcomes of care in inpatient rehabilitation facilities (IRFs) after prospective payment was implemented.
Medicare claims, Provider of Services file, Enrollment file, Area Resource file, Minimum Data Set.
We created an exogenous measure of competition based on patient travel distances and used instrumental variables models to estimate the effect of competition on inpatient rehabilitation costs, length of stay, and death or institutionalization.
A file was constructed linking data for Medicare patients discharged from acute care between 2002 and 2003 and admitted to an IRF with a diagnosis of hip fracture or stroke.
Competition had different effects on treatment intensity and outcomes for hip fracture and stroke patients. In the treatment of hip fracture, competition increased costs and length of stay, while increasing rates of death or institutionalization. In the treatment of stroke, competition decreased costs and length of stay and produced inferior outcomes.
The effects of competition in PAC markets may vary by condition. It is important to study the effects of competition by diagnostic condition and to study the effects across populations that vary in severity. Our finding that higher competition under prospective payment led to worse IRF outcomes raises concerns and calls for additional research.
确定急性后期护理（PAC）市场竞争对前瞻性支付实施后住院康复设施（IRF）中资源利用强度和护理结果的影响。
医疗保险索赔、服务提供者文件、注册文件、区域资源文件、最小数据集。
我们根据患者的旅行距离创建了一个外生竞争衡量标准，并使用工具变量模型来估计竞争对住院康复费用、住院时间和死亡或住院的影响。
构建了一个文件，将 2002 年至 2003 年期间从急性护理出院并因髋部骨折或中风诊断而入住 IRF 的 Medicare 患者的数据链接起来。
竞争对髋部骨折和中风患者的治疗强度和结果有不同的影响。在髋部骨折的治疗中，竞争增加了成本和住院时间，同时增加了死亡或住院的几率。在中风的治疗中，竞争降低了成本和住院时间，并产生了较差的结果。
PAC 市场的竞争效应可能因病情而异。按诊断条件研究竞争的影响并研究严重程度不同的人群的竞争效应非常重要。我们发现，前瞻性支付下的更高竞争导致 IRF 结果恶化，这引起了关注，并呼吁进行更多的研究。
