Pross Christoph, Busse Reinhard, Geissler Alexander
Berlin University of Technology, Department of Health Care Management, Germany.
Berlin University of Technology, Department of Health Care Management, Germany; European Observatory on Health Systems and Policies, Berlin Centre of Health Economics Research, Germany.
Health Policy. 2017 Aug;121(8):842-852. doi: 10.1016/j.healthpol.2017.06.009. Epub 2017 Jul 8.
Awareness of care variation and associated differences in outcome quality is important for patients to recognize and leverage the benefits of hospital choice and for policy makers, providers, and suppliers to adapt initiatives to improve hospital quality of care. We examine panel data on outcome quality in German hospitals between 2006 and 2014 for cholecystectomy, pacemaker implantation, hip replacement, percutaneous coronary intervention (PCI), stroke, and acute myocardial infarction (AMI). We use risk-adjusted and unadjusted outcomes based on 16 indicators. Median outcome and outcome variation trends are examined via box plots, simple linear regressions and quintile differences. Outcome trends differ across treatment areas and indicators. We found positive quality trends for hip replacement surgery, stroke and AMI 30-day mortality, and negative quality trends for 90-day stroke and AMI readmissions and PCI inpatient mortality. Variation of risk-adjusted outcomes ranges by a factor of 3-12 between the 2nd and 5th quintile of hospitals, both at the national and regional level. Our results show that simply measuring and reporting hospital outcomes without clear incentives or regulation - "carrots and sticks" - to improve performance and to centralize care in high performing hospitals has not led to broad quality improvements. More substantial efforts must be undertaken to narrow the outcome spread between high- and low-quality hospitals.
了解医疗差异以及与之相关的医疗质量结果差异，对于患者认识并利用选择医院的益处而言至关重要，对于政策制定者、医疗服务提供者和供应商调整举措以提高医院医疗质量也很重要。我们研究了2006年至2014年德国医院胆囊切除术、起搏器植入术、髋关节置换术、经皮冠状动脉介入治疗（PCI）、中风和急性心肌梗死（AMI）的医疗质量结果面板数据。我们使用基于16项指标的风险调整和未调整结果。通过箱线图、简单线性回归和五分位数差异来研究结果中位数和结果差异趋势。不同治疗领域和指标的结果趋势有所不同。我们发现髋关节置换手术、中风和AMI 30天死亡率呈现积极的质量趋势，而90天中风和AMI再入院率以及PCI住院死亡率呈现消极的质量趋势。在全国和地区层面，处于第二和第五五分位数的医院之间，风险调整后结果的差异幅度在3至12倍之间。我们的结果表明，在没有明确激励措施或监管——“胡萝卜加大棒”——来提高绩效并将医疗集中于表现出色的医院的情况下，仅仅衡量和报告医院结果并未带来广泛的质量提升。必须做出更大的努力来缩小高质量和低质量医院之间的结果差距。
