Spaulding Aaron, Hamadi Hanadi, Martinez Luis, Martin Timothy, Purnell Justin M, Zhao Mei
J Healthc Qual. 2019 Jan/Feb;41(1):39-48. doi: 10.1097/JHQ.0000000000000147.
Hospital Value-Based Purchasing (HVBP) is an initiative that rewards acute-care hospitals with incentive payments for the quality of care they provide. A hospital's trauma certification has the potential to influence HVBP scores as attaining the certification provides indication of the service quality offered by the hospital. As such, this study focuses on hospitals' level of trauma certification attainment through the American College of Surgeons and whether this certification is associated with greater HVBP.
A retrospective review of the 2015 HVBP database, 2015 Area Health Resources Files (AHRF) database, and the 2015 American Hospital Association (AHA) database is utilized, and propensity score matching was employed to determine the association between level of trauma certification and scores on HVBP dimensions.
Results reveal trauma certification is associated with lower HVBP domain scores when compared to hospitals without trauma certification. In addition, hospitals with a greater degree of trauma specialization were associated with lower total performance score and efficiency domain scores.
Although payers attempt to connect hospital reimbursements with quality and outcomes, unintended consequences may occur. In response to these results, HVBP risk adjustment and scoring methods should receive further scrutiny.
医院基于价值的采购（HVBP）是一项倡议，根据急性护理医院提供的护理质量给予激励性付款。医院的创伤认证有可能影响HVBP得分，因为获得该认证表明了医院提供的服务质量。因此，本研究关注医院通过美国外科医师学会获得创伤认证的水平，以及该认证是否与更高的HVBP相关。
利用对2015年HVBP数据库、2015年地区卫生资源文件（AHRF）数据库和2015年美国医院协会（AHA）数据库的回顾性分析，并采用倾向得分匹配法来确定创伤认证水平与HVBP维度得分之间的关联。
结果显示，与没有创伤认证的医院相比，创伤认证与较低的HVBP领域得分相关。此外，创伤专业化程度较高的医院与较低的总体绩效得分和效率领域得分相关。
尽管支付方试图将医院报销与质量和结果挂钩，但可能会产生意想不到的后果。针对这些结果，HVBP风险调整和评分方法应接受进一步审查。
