School of Pharmacy, University of Southern California, Los Angeles, California, United States of America.
Sol Price School of Public Policy, University of Southern California, Los Angeles, California, United States of America.
PLoS One. 2019 Apr 19;14(4):e0215876. doi: 10.1371/journal.pone.0215876. eCollection 2019.
Health care is believed to be suffered from a "cost disease," in which a heavy reliance on labor limits opportunities for efficiencies stemming from technological improvement. Although recent evidence shows that U.S. hospitals have experienced a positive trend of productivity growth, skilled nursing facilities are relatively "low-tech" compared to hospitals, leading some to worry that productivity at skilled nursing facilities will lag behind the rest of the economy.
To assess productivity growth among skilled nursing facilities (SNFs) in the treatment of conditions which frequently involve substantial post-acute care after hospital discharge.
We constructed an analytic file with the records of Medicare beneficiaries that were discharged from acute-care hospitals to SNFs with stroke, hip fracture, or lower extremity joint replacement (LEJR) between 2006 and 2014. We populated each record for 90 days starting at the time of SNF admission, detailing for each day the treatment site and all associated costs. We used ordinary least square regression to estimate growth in SNF productivity, measured by the ratio of "high-quality SNF stays" to total treatment costs. The primary definition of a high-quality stay was a stay that ended with the return of the patient to the community within 90 days after SNF admission. We controlled for patient demographics and comorbidities in the regression analyses.
Our sample included 1,076,066 patient stays at 14,394 SNFs with LEJR, 315,546 patient stays at 14,154 SNFs with stroke, and 739,608 patient stays at 14,588 SNFs with hip fracture. SNFs improved their productivity in the treatment of patients with LEJR, stroke, and hip fracture by 1.1%, 2.2%, and 2.0% per year, respectively. That pattern was robust to a number of alternative specifications. Regressions on year dummies showed that the productivity first decreased and then increased, with a lowest point in 2011. Over the study period, quality continued to rise, but dominated by higher costs at first. Costs then started to decrease, driving productivity to grow.
There has been substantial productivity growth in recent years among SNFs in the U.S. in the treatment of post-acute-care-intensive conditions.
人们普遍认为医疗保健行业正遭受“成本病”的困扰，即对劳动力的严重依赖限制了技术进步带来的效率提升机会。尽管最近的证据表明，美国医院的生产力增长呈积极趋势，但与医院相比，护理院相对“低技术”，这使得一些人担心护理院的生产力将落后于经济的其他领域。
评估护理院（SNF）在治疗出院后需要大量康复治疗的疾病方面的生产力增长情况。
我们构建了一个分析文件，其中包含了 Medicare 受益人的记录，这些受益人在 2006 年至 2014 年间从急性护理医院出院后入住 SNF，患有中风、髋部骨折或下肢关节置换术（LEJR）。我们为每个记录填充了 90 天的信息，从 SNF 入院的时间开始，详细记录了每天的治疗地点和所有相关费用。我们使用普通最小二乘法回归来估计 SNF 生产力的增长，以“高质量 SNF 停留”与总治疗费用的比例来衡量。高质量停留的主要定义是患者在 SNF 入院后 90 天内返回社区的停留。我们在回归分析中控制了患者的人口统计学特征和合并症。
我们的样本包括 1076066 例 LEJR 患者在 14394 家 SNF 的住院治疗，315546 例中风患者在 14154 家 SNF 的住院治疗，739608 例髋部骨折患者在 14588 家 SNF 的住院治疗。SNF 在治疗 LEJR、中风和髋部骨折患者方面的生产力每年分别提高了 1.1%、2.2%和 2.0%。这种模式在许多替代规格下都是稳健的。对年度哑变量的回归表明，生产力最初下降，然后上升，最低点出现在 2011 年。在研究期间，质量持续提高，但最初主要是成本的增加。随后成本开始下降，推动生产力增长。
近年来，美国护理院在治疗需要大量康复治疗的疾病方面的生产力有了显著提高。
