Kozhimannil Katy B, Sommerness Samantha A, Rauk Phillip, Gams Rebecca, Hirt Charles, Davis Stanley, Miller Kristi K, Landers Daniel V
Divisionof Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, USA.
Jt Comm J Qual Patient Saf. 2013 Aug;39(8):339-48. doi: 10.1016/s1553-7250(13)39048-5.
Although costs of providing care may decrease with hospital initiatives to improve obstetric and neonatal outcomes, the accompanying reduced adverse outcomes may negatively affect hospital revenues.
In 2008 a Minnesota-based hospital system (Fairview Health Services) launched the Zero Birth Injury (ZBI) initiative, which used evidence-based care bundles to guide management of obstetric services. A pre-post analysis of financial impacts of ZBI was conducted by using hospital administrative records to measure costs and revenues associated with changes in maternal and neonatal birth injuries before (2008) and after (2009-2011) the initiative.
For the Fairview Health Services hospitals, after adjusting for relevant covariates, implementation of ZBI was associated with a mean 11% decrease in the rate of maternal and neonatal adverse outcomes between 2008 and 2011 (adjusted odds ratio [AOR] = 0.89, p = .076). As a result of the adverse events avoided, the hospital system saved $284,985 in costs but earned $324,333 less revenue, which produced a net financial decrease of $39,348 (or a $305 net financial loss per adverse event avoided) in 2011, compared with 2008.
Adoption of a perinatal quality and safety initiative that reduced birth injuries had little net financial impact on the hospital. ZBI produced better clinical results at a lower cost, which represents potential savings for payers, but the hospital system offering improved quality reaped no clear financial rewards. These results highlight the important role for shared-savings collaborations (among patients, providers, government and third-party payers, and employers) to incentivize QI. Widespread adoption of perinatal safety initiatives combined with innovative payment models may contribute to better health at reduced cost.
尽管医院为改善产科和新生儿结局所采取的举措可能会降低护理成本，但随之而来的不良结局减少可能会对医院收入产生负面影响。
2008年，明尼苏达州的一家医院系统（费尔维尤健康服务公司）发起了“零出生伤害”（ZBI）倡议，该倡议使用基于证据的护理套餐来指导产科服务管理。通过利用医院行政记录来衡量该倡议实施前（2008年）和实施后（2009 - 2011年）与孕产妇和新生儿出生伤害变化相关的成本和收入，对ZBI的财务影响进行了前后分析。
对于费尔维尤健康服务公司的医院，在调整相关协变量后，2008年至2011年期间ZBI的实施与孕产妇和新生儿不良结局发生率平均降低11%相关（调整后的优势比[AOR]=0.89，p = 0.076）。由于避免了不良事件，该医院系统节省了284,985美元的成本，但收入减少了324,333美元，与2008年相比，2011年净财务减少了39,348美元（或每避免一次不良事件净财务损失305美元）。
采用一项降低出生伤害的围产期质量和安全倡议对医院的净财务影响很小。ZBI以较低成本产生了更好的临床结果，这对支付方而言意味着潜在的节省，但提供了更高质量服务的医院系统并未获得明显的经济回报。这些结果凸显了共享节约合作（在患者、提供者、政府和第三方支付方以及雇主之间）在激励质量改进方面的重要作用。围产期安全倡议与创新支付模式的广泛采用可能有助于以更低成本实现更好的健康状况。
