M.C. Baker is senior research analyst, Health Care Affairs, Association of American Medical Colleges, Washington, DC. C.J. Koopman is policy analyst, Healthcare Finance Policy, Healthcare Financial Management Association, Washington, DC. J.H. Landman is former director, Healthcare Finance Policy, Perspectives & Analysis, Healthcare Financial Management Association, Washington, DC. C.R. Alsdurf is director, Healthcare Finance Policy, Operational Initiatives, Healthcare Financial Management Association, Washington, DC. R.L. Gundling is senior vice president, Healthcare Financial Practices, Healthcare Financial Management Association, Washington, DC. M. Haberman is senior director, Health Systems Economics, Data & Analysis, Association of American Medical Colleges, Washington, DC. K.A. Horvath is senior director, Clinical Transformation, Association of American Medical Colleges, Washington, DC. J.M. Orlowski is chief health care officer, Association of American Medical Colleges, Washington, DC.
Acad Med. 2020 Jan;95(1):83-88. doi: 10.1097/ACM.0000000000002855.
The authors examined the "hub-and-spoke" health care system in the United States for patients transferred from one hospital ("spoke") to a major teaching hospital ("hub") and assessed the financial and clinical impact of this system on major teaching hospitals.
The authors surveyed Council of Teaching Hospitals and Health Systems members to collect detailed financial and clinical data from fiscal year 2015 for transfer cases and nontransfer cases (cases directly admitted to the teaching hospital). Data included computed margins (the difference between revenue received and direct and indirect facility costs as estimated by the hospitals) as well as case severity, average length of stay (ALOS), time of admission, surgical or medical status, and other situational variables for All Patient Refined Diagnosis Related Groups (APR-DRGs). The authors used an ordinary least-squares regression model with fixed effects to analyze the data.
Twenty-six hospitals provided data. The average difference between transfer and nontransfer cases was a 2.18 day longer ALOS and a $1,716 lower computed margin, for a case in the same APR-DRG and hospital (P < .001 for both outcomes). Transfer cases had a 19% higher case severity of illness rating and were disproportionately represented among complex APR-DRGs. Transfer patients were 14% more likely to be Medicaid beneficiaries.
Compared with nontransfer cases, transfer cases at major teaching hospitals were more complex and resulted in greater resource utilization, affecting the financial margins on which teaching hospitals rely to support their multipart mission.
作者研究了美国的“枢纽-辐条”医疗保健系统，该系统涉及从一家医院（“辐条”）转至一家主要教学医院（“枢纽”）的患者，并评估了该系统对主要教学医院的财务和临床影响。
作者对教学医院协会和健康系统成员进行了调查，以收集 2015 财年转院病例和非转院病例（直接入住教学医院的病例）的详细财务和临床数据。数据包括计算边际（收入与医院估计的直接和间接设施成本之间的差额）以及病例严重程度、平均住院时间（ALOS）、入院时间、手术或医疗状况以及其他一般患者精细诊断相关组（APR-DRGs）的情况变量。作者使用具有固定效应的普通最小二乘法回归模型分析数据。
26 家医院提供了数据。转院病例和非转院病例的平均差异为 ALOS 延长 2.18 天，计算边际减少 1716 美元，而在相同的 APR-DRG 和医院中（两种结果均 P <.001）。转院病例的疾病严重程度评分高 19%，并且在复杂的 APR-DRGs 中比例过高。转院患者中有 14%是医疗补助受益人。
与非转院病例相比，主要教学医院的转院病例更为复杂，导致资源利用增加，影响了教学医院赖以支持其多任务的财务边际。
