Nguyen Oanh Kieu, Halm Ethan A, Makam Anil N
Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas.
Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, Texas.
J Hosp Med. 2016 Jul;11(7):481-8. doi: 10.1002/jhm.2570. Epub 2016 Feb 29.
Hospitals that have robust financial performance may have improved publicly reported outcomes.
To assess the relationship between hospital financial performance and publicly reported outcomes of care, and to assess whether improved outcome metrics affect subsequent hospital financial performance.
Observational cohort study.
Hospital financial data from the Office of Statewide Health Planning and Development in California in 2008 and 2012 were linked to data from the Centers for Medicare and Medicaid Services Hospital Compare website.
Hospital financial performance was measured by net revenue by operations, operating margin, and total margin. Outcomes were 30-day risk-standardized mortality and readmission rates for acute myocardial infarction (AMI), congestive heart failure (CHF), and pneumonia (PNA).
Among 279 hospitals, there was no consistent relationship between measures of financial performance in 2008 and publicly reported outcomes from 2008 to 2011 for AMI and PNA. However, improved hospital financial performance (by any of the 3 measures) was associated with a modest increase in CHF mortality rates (ie, 0.26% increase in CHF mortality rate for every 10% increase in operating margin [95% confidence interval: 0.07%-0.45%]). Conversely, there were no significant associations between outcomes from 2008 to 2011 and subsequent financial performance in 2012 (P > 0.05 for all).
Robust financial performance is not associated with improved publicly reported outcomes for AMI, CHF, and PNA. Financial incentives in addition to public reporting, such as readmissions penalties, may help motivate hospitals with robust financial performance to further improve publicly reported outcomes. Reassuringly, improved mortality and readmission rates do not necessarily lead to loss of revenue. Journal of Hospital Medicine 2016;11:481-488. © 2016 Society of Hospital Medicine.
财务表现强劲的医院可能会改善公开报告的医疗结果。
评估医院财务表现与公开报告的医疗结果之间的关系，并评估改善的结果指标是否会影响随后的医院财务表现。
观察性队列研究。
2008年和2012年加利福尼亚州全州卫生规划与发展办公室的医院财务数据与医疗保险和医疗补助服务中心医院比较网站的数据相关联。
医院财务表现通过运营净收入、营业利润率和总利润率来衡量。结果指标为急性心肌梗死（AMI）、充血性心力衰竭（CHF）和肺炎（PNA）的30天风险标准化死亡率和再入院率。
在279家医院中，2008年的财务表现指标与2008年至2011年AMI和PNA公开报告的结果之间没有一致的关系。然而，医院财务表现的改善（通过三项指标中的任何一项）与CHF死亡率的适度增加相关（即营业利润率每增加10%，CHF死亡率增加0.26%[95%置信区间：0.07%-0.45%]）。相反，2008年至2011年的结果与2012年随后的财务表现之间没有显著关联（所有P>0.05）。
强劲的财务表现与AMI、CHF和PNA公开报告的结果改善无关。除了公开报告之外的财务激励措施，如再入院罚款，可能有助于激励财务表现强劲的医院进一步改善公开报告的结果。令人放心的是，死亡率和再入院率的改善不一定会导致收入损失。《医院医学杂志》2016年；11：481-488。©2016医院医学协会。
