医疗机构患者报告医疗照护机构和系统调查测量结果的持续性表现：其决定因素是什么？
Sustained Hospital Performance on Hospital Consumer Assessment of Healthcare Providers and Systems Survey Measures: What Are the Determinants?
机构信息
Mona Al-Amin, PhD, interim chair and associate professor, Healthcare Administration, Suffolk University, Boston, Massachusetts; Melody K. Schiaffino, PhD, assistant professor, Division of Health Management and Policy, San Diego State University, California; Sinyoung Park, PhD, assistant professor, Department of Health Administration, University of North Florida, Jacksonville; and Jeffrey Harman, PhD, professor, Department of Behavioral Sciences & Social Medicine, College of Medicine, Florida State University, Tallahassee.
出版信息
J Healthc Manag. 2018 Jan/Feb;63(1):15-28. doi: 10.1097/JHM-D-16-00006.
This study examines hospital characteristics associated with sustained superior performance on Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) measures. We classified hospitals as sustainers if they remained in the top 25th percentile of overall patient ratings of inpatient experience from 2009 through 2013. We classified hospital characteristics as modifiable or unmodifiable. Modifiable characteristics are operational measures that hospitals can change to improve performance; these characteristics include registered nurse (RN) staffing levels, presence of hospitalists, and level of physician integration. Unmodifiable characteristics are core structural dimensions, such as hospital size and teaching status, that require substantial investment to change, as well as market-level factors such as competition and unemployment rates. Using logistic regression analysis, we found that RN staffing levels, Medicare share of inpatient days, teaching status, and market competition were significant predictors of the likelihood that a given hospital sustained high levels of patient ratings over time (i.e., the likelihood of a hospital being classified as a sustainer). Hospitals with a higher ratio of inpatient days to RN staffing and higher Medicare share of inpatient days had lower odds of being classified as sustainers.
本研究考察了与医院消费者评估医疗保健提供者和系统（HCAHPS）措施持续卓越表现相关的医院特征。如果医院在 2009 年至 2013 年期间始终保持患者对住院体验总体评分的前 25%，我们将其归类为维持者。我们将医院特征分为可修改和不可修改。可修改的特征是医院可以改变以提高绩效的运营措施；这些特征包括注册护士（RN）人员配备水平、医院医生的存在以及医生整合程度。不可修改的特征是核心结构维度，例如医院规模和教学地位，这些需要大量投资才能改变，以及市场层面的因素，如竞争和失业率。使用逻辑回归分析，我们发现 RN 人员配备水平、医疗保险住院天数份额、教学地位和市场竞争是医院维持高水平患者评分的可能性的重要预测因素（即，将医院归类为维持者的可能性）。住院天数与 RN 人员配备比例较高、医疗保险住院天数份额较高的医院被归类为维持者的可能性较低。
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