Lasater Karen B, Germack Hayley D, Small Dylan S, McHugh Matthew D
1 Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, PA, USA.
2 Leonard Davis Institute of Health Economics, University of Pennsylvania, PA, USA.
Policy Polit Nurs Pract. 2016 Nov;17(4):177-186. doi: 10.1177/1527154417698144. Epub 2017 Mar 17.
It is well-established that hospitals recognized for good nursing care - Magnet hospitals - are associated with better patient outcomes. Less is known about how Magnet hospitals compare to non-Magnets on quality measures linked to Medicare reimbursement. The purpose of this study was to determine how Magnet hospitals perform compared to matched non-Magnet hospitals on Hospital Value Based Purchasing (VBP) measures. A cross-sectional analysis of three linked data sources was performed. The sample included 3,021 non-federal acute care hospitals participating in the VBP program (323 Magnets; 2,698 non-Magnets). Propensity score matching was used to match Magnet and non-Magnet hospitals with similar hospital characteristics. After matching, linear and logistic regression models were used to examine the relationship between Magnet status and VBP performance. After matching and adjusting for hospital characteristics, Magnet recognition predicted higher scores on Total Performance (Regression Coefficient [RC] = 1.66, p < 0.05), Clinical Processes (RC = 3.85; p < 0.01), and Patient Experience (RC = 6.33; p < 0.001). The relationships between Magnet recognition and the Outcome and Efficiency domains were not statistically significant. Magnet hospitals known for nursing excellence perform better on Hospital VBP measures. As healthcare systems adapt to evolving incentives that reward value, attention to nurses at the front lines may be central to ensuring high-value care for patients.
众所周知，因优质护理而获得认可的医院——磁石医院——与更好的患者治疗结果相关。关于磁石医院与非磁石医院在与医疗保险报销相关的质量指标方面的比较，人们了解得较少。本研究的目的是确定磁石医院与匹配的非磁石医院在基于医院价值购买（VBP）指标上的表现如何。对三个相关数据源进行了横断面分析。样本包括3021家参与VBP项目的非联邦急症护理医院（323家磁石医院；2698家非磁石医院）。倾向得分匹配用于匹配具有相似医院特征的磁石医院和非磁石医院。匹配后，使用线性和逻辑回归模型来检验磁石状态与VBP表现之间的关系。在匹配并调整医院特征后，磁石认可预示着在总体表现（回归系数[RC]=1.66，p<0.05）、临床流程（RC=3.85；p<0.01）和患者体验（RC=6.33；p<0.001）方面得分更高。磁石认可与结果和效率领域之间的关系无统计学意义。以卓越护理闻名的磁石医院在医院VBP指标上表现更好。随着医疗保健系统适应奖励价值的不断变化的激励措施，关注一线护士可能是确保为患者提供高价值护理的核心。
