Akintoye Emmanuel, Briasoulis Alexandros, Egbe Alexander, Orhurhu Vwaire, Ibrahim Walid, Kumar Kartik, Alliu Samson, Nas Hala, Levine Diane, Weinberger Jarrett
Department of Internal Medicine, Wayne State University/Detroit Medical Center, Detroit, Michigan.
Division of Cardiology, Mayo Clinic, Rochester, Minnesota.
Am J Cardiol. 2017 Sep 1;120(5):831-837. doi: 10.1016/j.amjcard.2017.06.009. Epub 2017 Jun 15.
This study aimed to evaluate the impact of hospital ownership on heart failure (HF) hospitalization outcomes in the United States using data from the National Inpatient Sample of the Agency for Healthcare Research and Quality. Hospital ownership was classified into three, namely, nonfederal government, not-for-profit, and for-profit hospitals. Participants were adults hospitalized with a primary diagnosis of HF (2013 to 2014). End points included inpatient mortality, length-of-stay, cost and charge of hospitalization, and disposition at discharge. Of the estimated 1.9 million HF hospitalizations in the United States between 2013 and 2014, 73% were in not-for-profit hospitals, 15% were in for-profit hospitals, and 12% were in nonfederal government hospitals. Overall, mortality rate was 3%, mean length of stay was 5.3 days, median cost of hospitalization was USD 7,248, and median charge was USD 25,229, and among those who survived to hospital discharge, 51% had routine home discharge. There was no significant difference in inpatient mortality between hospital ownership among male patients, but there was a significant difference for female patients. Compared with government hospitals, mortality in female patients was lower in not-for-profit (odds ratio: 0.85 [95% confidence interval: 0.77 to 0.94]) and for-profit hospitals (odds ratio: 0.77 [0.68 to 0.87]). In addition, mean length of stay was highest in not-for-profit hospitals (5.4 days) and lowest in for-profit hospitals (5 days). Although cost of hospitalization was highest in not-for-profit hospitals (USD 7462) and lowest in for-profit hospitals (USD 6,290), total charge billed was highest in for-profit hospitals (USD 35,576) and lowest in government hospitals (USD 19,652). The average charge-to-cost ratio was 3:1 for government hospitals, 3.5:1 for not-for-profit hospitals, and 5.9:1 for for-profit hospitals. In conclusion, there exist significant disparities in HF hospitalization outcomes between hospital ownerships. Outcomes were generally better in for-profit hospitals than other tiers of hospital and, notably, there was a significant difference in inpatient mortality for female patients (but not for male patients).
本研究旨在利用医疗保健研究与质量局国家住院样本的数据，评估美国医院所有制对心力衰竭（HF）住院结局的影响。医院所有制分为三类，即非联邦政府医院、非营利性医院和营利性医院。研究对象为以HF为主要诊断住院的成年人（2013年至2014年）。终点指标包括住院死亡率、住院时间、住院费用和收费，以及出院时的处置情况。在2013年至2014年美国估计的190万例HF住院病例中，73%发生在非营利性医院，15%发生在营利性医院，12%发生在非联邦政府医院。总体而言，死亡率为3%，平均住院时间为5.3天，住院费用中位数为7248美元，收费中位数为25229美元，在存活至出院的患者中，51%进行了常规家庭出院。男性患者中，不同所有制医院的住院死亡率无显著差异，但女性患者存在显著差异。与政府医院相比，非营利性医院（优势比：0.85[95%置信区间：0.77至0.94]）和营利性医院（优势比：0.77[0.68至0.87]）中女性患者的死亡率较低。此外，非营利性医院的平均住院时间最长（5.4天），营利性医院最短（5天）。尽管非营利性医院的住院费用最高（7462美元），营利性医院最低（6290美元），但营利性医院的总收费最高（35576美元），政府医院最低（19652美元）。政府医院的平均收费与成本之比为3:1，非营利性医院为3.5:1，营利性医院为5.9:1。总之，不同所有制医院的HF住院结局存在显著差异。营利性医院的结局总体上优于其他层级的医院，值得注意的是，女性患者的住院死亡率存在显著差异（男性患者无差异）。
