assistant professor, Mayo Clinic Florida, Jacksonville, Florida associate team director, Seasons Hospice & Palliative Care, Orange, California assistant professor, Department of Health Administration, Brooks College of Health, University of North Florida, Jacksonville, Florida professor and chair, Department of Health Administration, Brooks College of Health, Jacksonville, Florida.
J Healthc Manag. 2018 Jul-Aug;63(4):e43-e58. doi: 10.1097/JHM-D-16-00035.
As part of the provisions of the 2010 Affordable Care Act, the Centers for Medicare & Medicaid Services adjusts payments made to hospitals through its Hospital Value-Based Purchasing (HVBP) program. In light of the increasing aim to improve efficiency, healthcare organizations are exploring innovative strategies for care delivery, including the use of hospitalists. Supporters of the hospitalist model suggest use of these specialists offers several advantages over the traditional model of physician care in the inpatient setting, including improved coordination, reduced costs, and improved quality indicator scores. This study explores the effect of hospitalists on hospitals' scores in the four domains of the fiscal year 2016 HVBP program: clinical process of care, patient experience of care (PEOC), outcome, and efficiency. Data from the 2015 HVBP database, the 2015 Medicare Final Rule Standardizing File, and the 2015 American Hospital Association database were used for the analysis. The study used multivariate regression analysis in Stata 12. Results from this study suggest that hospitals employing a higher percentage of hospitalists see related improvement in their overall total performance score. In light of improvements within the PEOC, outcome, and efficiency scores, it would appear that hospitalists are primarily providing linking services, which helps provide better coordination of care that is otherwise lacking in more traditionally fragmented approaches to care.
根据 2010 年平价医疗法案的规定，医疗保险和医疗补助服务中心通过其医院价值为基础的采购（HVBP）计划调整支付给医院的款项。鉴于提高效率的目标越来越高，医疗机构正在探索创新的护理提供策略，包括使用医院医师。该医院医师模式的支持者认为，与传统的住院医师护理模式相比，这些专家的使用具有几个优势，包括改善协调、降低成本和提高质量指标评分。本研究探讨了医院医师对 2016 财年 HVBP 计划四个领域（临床护理过程、患者护理体验（PEOC）、结果和效率）医院评分的影响。该分析使用了 2015 年 HVBP 数据库、2015 年医疗保险最终规则标准化文件和 2015 年美国医院协会数据库中的数据。该研究使用 Stata 12 中的多元回归分析。本研究的结果表明，雇用更多医院医师的医院整体总绩效评分有所提高。鉴于 PEOC、结果和效率评分的提高，似乎医院医师主要提供链接服务，这有助于提供更好的护理协调，否则在更传统的分散护理方法中会缺乏这种协调。
