营利性医院的地位与在不同医院的再入院率：对 Medicare 数据的分析。
For-profit hospital status and rehospitalizations at different hospitals: an analysis of Medicare data.
机构信息
University of Wisconsin School of Medicine and Public Health and William S. Middleton Veterans Affairs Hospital-Geriatric Research Education and Clinical Center, Madison, Wisconsin, USA.
出版信息
Ann Intern Med. 2010 Dec 7;153(11):718-27. doi: 10.7326/0003-4819-153-11-201012070-00005.
BACKGROUND
About one quarter of rehospitalized Medicare patients are admitted to hospitals different from their original hospital. The extent to which this practice is related to for-profit hospital status and affects payments and mortality is unknown.
OBJECTIVE
To describe and examine predictors of and payments for rehospitalization at a different hospital among Medicare patients rehospitalized within 30 days at for-profit and nonprofit or public hospitals.
DESIGN
Cohort study of patients discharged and rehospitalized from January 2005 to November 2006.
SETTING
Medicare fee-for-service hospitals throughout the United States.
PARTICIPANTS
A 5% random national sample of Medicare patients with acute care rehospitalizations within 30 days of discharge (n = 74,564).
MEASUREMENTS
30-day rehospitalizations at different hospitals and total payments or mortality over the subsequent 30 days. Multivariate logistic and quantile regression models included index hospital for-profit status, discharge counts, geographic region, rural-urban commuting area, and teaching status; patient sociodemographic characteristics, disability status, and comorbid conditions; and a measure of risk adjustment.
RESULTS
16 622 patients (22%) in the sample were rehospitalized at a different hospital. Factors associated with increased risk for rehospitalization at a different hospital included index hospitalization at a for-profit, major medical school-affiliated, or low-volume hospital and having a Medicare-defined disability. Compared with patients rehospitalized at the same hospital, patients rehospitalized at different hospitals had higher adjusted 30-day total payments (median additional cost, $1308 per patient; P < 0.001) but no statistically significant differences in 30-day mortality, regardless of index hospital for-profit status.
LIMITATION
The database lacked detailed clinical information about patients and did not include information about specific provider practice motivations or the role of patient choice in hospitalization venues.
CONCLUSION
Rehospitalizations at different hospitals are common among Medicare patients, are more likely among those initially hospitalized at a for-profit hospital, and are related to increased overall payments without improved mortality.
PRIMARY FUNDING SOURCE
University of Wisconsin Hartford Center of Excellence in Geriatrics, National Institutes of Health.
背景
大约四分之一的再次住院的 Medicare 患者会被转到不同于他们最初住院的医院。这种做法与营利性医院的地位有多大关系，以及对支付和死亡率有何影响尚不清楚。
目的
描述并检查营利性医院和非营利性或公立医院在 Medicare 患者 30 天内再次住院的情况下，在不同医院再次住院的预测因素和支付情况。
设计
2005 年 1 月至 2006 年 11 月期间接受出院和再次住院的患者的队列研究。
地点
美国各地的 Medicare 按服务收费医院。
参与者
在出院后 30 天内有急性再次住院的 Medicare 患者的 5%随机全国样本（n=74564）。
测量
30 天内在不同医院的再次住院和随后 30 天的总支付或死亡率。多变量逻辑和分位数回归模型包括指数医院的营利性地位、出院次数、地理位置、城乡通勤区和教学地位；患者的社会人口统计学特征、残疾状况和合并症；以及风险调整措施。
结果
样本中 16622 名患者（22%）在其他医院再次住院。与在其他医院再次住院风险增加相关的因素包括在营利性、主要医学院附属或低容量医院的指数住院和 Medicare 定义的残疾。与在同一家医院再次住院的患者相比，在其他医院再次住院的患者的调整后 30 天总支付更高（每位患者额外费用中位数为 1308 美元；P<0.001），但无论指数医院的营利性地位如何，30 天死亡率均无统计学差异。
局限性
该数据库缺乏有关患者的详细临床信息，也不包括有关特定提供者实践动机或患者选择住院地点的作用的信息。
结论
Medicare 患者在不同医院再次住院很常见，在最初在营利性医院住院的患者中更常见，与整体支付增加有关，而与死亡率改善无关。
主要资金来源
威斯康星大学哈特福德老年病学卓越中心，美国国立卫生研究院。
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