Department of Surgery, University of Michigan Medical School, Ann Arbor, MI.
Center for Healthcare Outcomes and Policy, Ann Arbor, MI.
Ann Surg. 2019 Aug;270(2):288-294. doi: 10.1097/SLA.0000000000002791.
The aim of this study was to evaluate whether hospital network participation is associated with improvement in surgical outcomes and spending compared to control hospitals not participating in a network.
Hospitals face significant financial and organizational pressures to integrate into networks. It remains unclear whether these business arrangements impact clinical quality or healthcare expenditures.
We conducted a longitudinal, quasi-experimental study of 1,981,095 national Medicare beneficiaries (2007-2014) undergoing general, vascular, cardiac, or orthopedic surgery at a network (n = 1868) or non-network (n = 2734) hospital. We tested whether joining a network was associated with improvement in the study outcomes after accounting for overall trends toward better outcomes. We used hierarchical multivariable logistical and linear regression to adjust for patient factors, procedural characteristics, type of admission, and hospital factors.
After accounting for patient factors and existing trends toward better outcomes, there was no association between network participation and surgical outcomes. For example, the rates of serious complications were similar between network [11.4%, 95% confidence interval (CI) 11.1%-11.5%] and non-network hospitals (11.2%; 95% CI 11.0%-11.3%; odds ratio 1.00, 95% CI 0.97-1.03, P = 0.92). There was no association between time-in-network and improvement in rates of serious complications during the 8-year study period. For example, after 7 years of network participation, the rate of serious complications in 2014 was 9.6% (95% CI 8.8%-10.4%) in network hospitals versus 9.2% (95% CI 8.5%-9.9%, P = 0.11) in non-network hospitals.
Hospital network participation was not associated with improvements in patient outcomes or lower episode payments among Medicare beneficiaries undergoing inpatient surgery.
本研究旨在评估与未参与网络的对照医院相比，医院网络参与是否与手术结果和支出的改善相关。
医院面临着巨大的财务和组织压力，需要整合到网络中。目前尚不清楚这些业务安排是否会影响临床质量或医疗保健支出。
我们对 1981095 名接受普通、血管、心脏或骨科手术的国家医疗保险受益人（2007-2014 年）进行了一项纵向、准实验研究，这些患者在网络（n=1868）或非网络（n=2734）医院接受治疗。我们测试了在考虑到整体结果改善趋势的情况下，加入网络是否与研究结果的改善相关。我们使用分层多变量逻辑和线性回归来调整患者因素、手术特征、入院类型和医院因素。
在考虑患者因素和现有改善结果的趋势后，网络参与与手术结果之间没有关联。例如，严重并发症的发生率在网络[11.4%，95%置信区间（CI）11.1%-11.5%]和非网络医院之间相似（11.2%；95% CI 11.0%-11.3%；比值比 1.00，95% CI 0.97-1.03，P=0.92）。在 8 年的研究期间，网络参与时间与严重并发症发生率的改善之间没有关联。例如，在网络参与 7 年后，2014 年网络医院严重并发症的发生率为 9.6%（95% CI 8.8%-10.4%），而非网络医院为 9.2%（95% CI 8.5%-9.9%，P=0.11）。
在接受住院手术的医疗保险受益人中，医院网络参与与患者结果的改善或住院费用的降低无关。
