Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA.
Chest. 2020 May;157(5):1241-1249. doi: 10.1016/j.chest.2019.11.003. Epub 2019 Nov 21.
Recent policy initiatives aim to improve the value of care for patients hospitalized with pneumonia. It is unclear whether higher 30-day episode spending at the hospital level is associated with any difference in patient mortality among fee-for-service Medicare beneficiaries.
This retrospective cohort study assessed the association between hospital-level spending and patient-level mortality for a 30-day episode of care. The study used data for Medicare fee-for-service beneficiaries hospitalized at an acute care hospital with a principal diagnosis of pneumonia from July 2011 to June 2014. Analysis was conducted by using Medicare payment data made publicly available by the Centers for Medicare & Medicaid Services on the Hospital Compare website combined with Medicare Part A claims data to identify patient outcomes.
A total of 1,017,353 Medicare fee-for-service beneficiaries were hospitalized for pneumonia across 3,021 US hospitals during the study period. Mean ± SD 30-day spending for an episode of pneumonia care was $14,324 ± $1,305. The observed 30-day all-cause mortality rate was 11.9%. After adjusting for patient and hospital characteristics, no association was found between higher 30-day episode spending at the hospital level and 30-day patient mortality (adjusted OR, 1.00 for every $1,000 increase in spending; 95% CI, 0.99-1.01).
Higher hospital-level spending for a 30-day episode of care for pneumonia was not associated with any difference in patient mortality.
最近的政策举措旨在提高肺炎住院患者的医疗服务价值。目前尚不清楚医院层面的 30 天治疗费用增加是否与医疗保险受益人的患者死亡率存在差异。
本回顾性队列研究评估了 30 天治疗期内医院层面的支出与患者层面的死亡率之间的关联。该研究使用了 2011 年 7 月至 2014 年 6 月期间在急性护理医院因肺炎住院的医疗保险按服务收费受益人的数据。通过使用医疗保险按服务收费数据（医疗保险和医疗补助服务中心在 Hospital Compare 网站上公开的）与医疗保险 A 部分索赔数据相结合，对患者结局进行分析。
在研究期间，共有 1,017,353 名医疗保险按服务收费受益人为肺炎住院治疗，涉及美国 3,021 家医院。每例肺炎治疗费用为 14,324 美元±1,305 美元。观察到的 30 天全因死亡率为 11.9%。在调整了患者和医院特征后，医院层面的 30 天治疗费用增加与 30 天患者死亡率之间没有关联（调整后的比值比，每增加 1000 美元为 1.00；95%CI，0.99-1.01）。
肺炎 30 天治疗期内较高的医院层面支出与患者死亡率的差异无关。
