Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, 3201 1st Ave N, Birmingham, AL 35222. Email:
Am J Manag Care. 2019 Aug;25(8):397-404.
To examine the relationship between participation in value-based programs and care coordination activities.
Cross-sectional, observational study of 1648 US hospitals using the American Hospital Association (AHA)'s 2013 Survey of Care Systems. Value-based program participation included participation in either an accountable care organization (ACO) or a bundled payment program. We assessed adoption (whether a hospital was using any of a set of 12 care coordination activities in the AHA survey) and spread (in each hospital adopting care coordination activities, how extensively those activities were implemented throughout the hospital).
Ordinary least squares regression assessed associations between participation in an ACO or bundled payment program and the adoption and spread of 12 care coordination activities.
Hospitals adopted nearly two-thirds of the possible care coordination activities (mean [SD] = 7.9 [4.4] of 12). Among those hospitals adopting care coordination activities, there was a relatively moderate spread of these activities (mean = 2.5; range, 1 [minimally used] to 4 [used hospitalwide]). Hospital participation in an ACO was associated with the adoption of 3.07 more care coordination activities (P <.001), on average, and 0.16 more points on the scale of spread of care coordination activities (P <.001) compared with hospitals that were not participating in an ACO. Hospital participation in a bundled payment program was associated with the adoption of 1.84 more care coordination activities (b = 1.84; P <.001) but not greater spread (b = -0.04; P = .54).
Value-based programs such as ACOs appear to encourage the adoption and spread of care coordination activities by hospitals.
考察参与基于价值的计划与护理协调活动之间的关系。
使用美国医院协会（AHA）2013 年护理系统调查对 1648 家美国医院进行的横断面观察性研究。基于价值的项目参与包括参与一个责任医疗组织（ACO）或一个捆绑支付计划。我们评估了采用（医院是否在 AHA 调查中使用了 12 项护理协调活动中的任何一项）和推广（在采用护理协调活动的每家医院中，这些活动在医院内的广泛实施程度）。
普通最小二乘法回归评估了参与 ACO 或捆绑支付计划与采用和推广 12 项护理协调活动之间的关联。
医院采用了近三分之二的可能护理协调活动（平均值[标准差]为 12 项中的 7.9[4.4]）。在采用护理协调活动的这些医院中，这些活动的推广程度相对适中（平均值为 2.5；范围为 1[最小使用]至 4[全院使用]）。与未参与 ACO 的医院相比，医院参与 ACO 平均与采用 3.07 项以上的护理协调活动相关（P<.001），在护理协调活动推广程度的量表上平均增加 0.16 分（P<.001）。医院参与捆绑支付计划与采用 1.84 项以上的护理协调活动相关（b=1.84；P<.001），但推广程度没有更大的提高（b=-0.04；P=.54）。
诸如 ACO 等基于价值的计划似乎鼓励医院采用和推广护理协调活动。
