Hamadi Hanadi, Apatu Emma, Spaulding Aaron
Department of Public Health, Brooks College of Health, University of North Florida, Jacksonville, Florida, USA.
Department of Health Sciences Research, Division of Health Care Policy and Research, Mayo Clinic Robert D and Patricia E Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, Florida, USA.
Int J Health Plann Manage. 2018 Jan;33(1):e168-e180. doi: 10.1002/hpm.2442. Epub 2017 Jul 21.
Extensive evidence demonstrates that a hospital's organizational ownership structure impacts its overall performance, but little is known concerning the influence of hospital structure on the health of its community. This paper explores the association between US hospital referral region (HRR) health rankings and hospital ownership and performance. Data from the 2016 Commonwealth Fund Scorecard on Local Health System Performance, the American Hospital Association dataset, and the Hospital Value-Based Purchasing dataset are utilized to conduct a cross-sectional analysis of 36 quality measures across 306 HRRs. Multivariate regression analysis was used to estimate the association among hospital ownership, system performance measures-access and affordability, prevention and treatment, avoidable hospital use and cost, and healthy lives-and performance as measured by value-based purchasing total performance scores. We found that indicators of access and affordability, as well as prevention and treatment, were significantly associated across all 3 hospitals' organizational structures. Hospital referral regions with a greater number of not-for-profit hospitals demonstrated greater indications of access and affordability, as well as better prevention and treatment rankings than for-profit and government hospitals. Hospital referral regions with a greater number of government, nonfederal hospitals had worse scores for healthy lives. Furthermore, the greater the total performance scores score, the better the HRR score on prevention and treatment rankings. The greater the per capita income, the better the score across all 4 dimensions. As such, this inquiry supports the assertion that performance of a local health system is dependent on its community's resources of health care delivery entities and their structure.
大量证据表明，医院的组织所有权结构会影响其整体绩效，但对于医院结构对其所在社区健康的影响却知之甚少。本文探讨了美国医院转诊区域（HRR）健康排名与医院所有权及绩效之间的关联。利用2016年联邦基金地方卫生系统绩效记分卡、美国医院协会数据集以及医院基于价值的采购数据集的数据，对306个HRR的36项质量指标进行横断面分析。采用多元回归分析来估计医院所有权、系统绩效指标（可及性与可负担性、预防与治疗、可避免的医院使用与成本以及健康生活）与基于价值采购的总绩效得分所衡量的绩效之间的关联。我们发现，在所有三种医院组织结构中，可及性与可负担性指标以及预防与治疗指标均显著相关。非营利性医院数量较多的医院转诊区域，在可及性与可负担性方面表现出更明显的优势，并且在预防与治疗排名上比营利性医院和政府医院更好。政府非联邦医院数量较多的医院转诊区域在健康生活方面得分较低。此外，总绩效得分越高，HRR在预防与治疗排名上的得分就越好。人均收入越高，在所有四个维度上的得分就越好。因此，这项研究支持了这样一种观点，即地方卫生系统的绩效取决于其社区医疗保健服务实体的资源及其结构。
