Center for Healthcare Studies, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.
Ann Emerg Med. 2013 Jun;61(6):616-623.e2. doi: 10.1016/j.annemergmed.2013.01.012. Epub 2013 Mar 13.
Medicare's new, mandatory Hospital Inpatient Value-Based Purchasing Program introduces financial rewards or penalties to hospitals according to achievement or improvement on several publicly reported quality measures. Our objective was to describe hospital reporting on the 4 emergency department (ED)-related program measures, variation in performance on the ED measures across hospital characteristics, and the characteristics of hospitals that were more likely to receive performance scores based on improvement versus achievement.
This was an exploratory, descriptive analysis. We merged 2008 to 2010 performance data from Hospital Compare with the 2009 American Hospital Association Annual Survey. We calculated a composite score for the 4 ED measures and used Kruskal-Wallis tests to examine differences in performance across hospital characteristics. We also examined differences in the percentage of scores that were awarded according to improvement versus achievement.
There were 2,927 hospitals that qualified for the value-based purchasing program and were included in the analysis. For-profit hospitals received the highest scores; public hospitals and hospitals lacking The Joint Commission (TJC) accreditation received the lowest scores. Public hospitals had the largest share of scores awarded according to improvement (39.8%); for-profit hospitals had the lowest (27.8%).
We found variation in performance by hospital characteristics on the ED-related program measures. Although public and non-TJC-accredited hospitals trailed in performance, they showed strong signs of improvement, signaling that performance gaps by ownership and accreditation may decrease. Considering the increasing scope of the value-based purchasing program, ED leaders should monitor both achievement and improvement on the 4 ED-related program measures.
医疗保险新的强制性住院患者基于价值的购买计划根据几项公开报告的质量措施的实现或改进，向医院提供财务奖励或惩罚。我们的目的是描述医院在 4 项急诊（ED）相关计划措施上的报告情况，医院在 ED 措施上的表现差异，以及更有可能根据改进而非成就获得绩效评分的医院的特征。
这是一项探索性、描述性分析。我们将 2008 年至 2010 年的 Hospital Compare 绩效数据与 2009 年美国医院协会年度调查合并。我们为 4 项 ED 措施计算了一个综合评分，并使用 Kruskal-Wallis 检验来检查医院特征对绩效的差异。我们还检查了根据改进与成就获得评分的比例的差异。
有 2927 家符合基于价值的购买计划条件的医院纳入了分析。营利性医院得分最高；公立医院和没有联合委员会（TJC）认证的医院得分最低。公立医院获得的分数中，根据改进获得的分数比例最大（39.8%）；营利性医院的比例最低（27.8%）。
我们发现，在 ED 相关计划措施方面，医院特征的表现存在差异。尽管公立和非 TJC 认证的医院表现落后，但它们显示出了很大的改进迹象，这表明所有权和认证方面的绩效差距可能会缩小。考虑到基于价值的购买计划的范围不断扩大，ED 领导者应监测 4 项 ED 相关计划措施的成就和改进。
