Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA.
Boston University School of Public Health, Boston, MA.
Health Serv Res. 2018 Oct;53(5):3881-3897. doi: 10.1111/1475-6773.12975. Epub 2018 May 18.
To examine the relationship between cost and quality in Veterans Health Administration (VA) nursing homes (called Community Living Centers, CLCs) using longitudinal data.
DATA SOURCES/STUDY SETTING: One hundred and thirty CLCs over 13 quarters (from FY2009 to FY2012) were studied. Costs, resident days, and resident severity (RUGs score) were obtained from the VA Managerial Cost Accounting System. Clinical quality measures were obtained from the Minimum Data Set, and resident-centered care (RCC) was measured using the Artifacts of Culture Change Tool.
We used a generalized estimating equation model with facilities included as fixed effects to examine the relationship between total cost and quality after controlling for resident days and severity. The model included linear and squared terms for all independent variables and interactions with resident days.
With the exception of RCC, all other variables had a statistically significant relationship with total costs. For most poorer performing smaller facilities (lower size quartile), improvements in quality were associated with higher costs. For most larger facilities, improvements in quality were associated with lower costs.
The relationship between cost and quality depends on facility size and current level of performance.
利用纵向数据研究退伍军人健康管理局（VA）养老院（称为社区生活中心，CLC）的成本与质量之间的关系。
数据来源/研究设置：在 13 个季度（从 2009 财年到 2012 财年）中研究了 130 个 CLC。成本、居民天数和居民严重程度（RUGs 评分）从 VA 管理成本核算系统中获得。临床质量指标从最低数据集获得，居民为中心的护理（RCC）使用文化变革工具的人工制品进行测量。
我们使用广义估计方程模型，将设施作为固定效应纳入其中，在控制居民天数和严重程度后，研究总成本与质量之间的关系。该模型包括所有自变量的线性和平方项以及与居民天数的交互项。
除了 RCC 之外，所有其他变量与总成本都有统计学上的显著关系。对于大多数表现较差的较小设施（较低的四分位规模），质量的提高与成本的增加有关。对于大多数较大的设施，质量的提高与成本的降低有关。
成本与质量之间的关系取决于设施规模和当前的绩效水平。
