Department of Health Services Research, Management, and Policy, University of Florida College of Public Health and Health Professions, Gainesville, FL.
Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL.
Med Care. 2020 Aug;58(8):734-743. doi: 10.1097/MLR.0000000000001354.
Under the Affordable Care Act, the Centers for Medicare and Medicaid Services has greatly expanded inpatient fee-for-value programs including the Hospital Value-based Purchasing (HVBP) program. Existing evidence from the HVBP program is mixed. There is a need for a systematic review of the HVBP program to inform discussions on how to improve the program's effectiveness.
To review and summarize studies that evaluated the HVBP program's impact on clinical processes, patient satisfaction, costs and outcomes, or assessed hospital characteristics associated with performance on the program.
We searched the MEDLINE/PubMed, Scopus, ProQuest database for literature published between January 2013 and July 2019 using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines.
Of 988 studies reviewed, 33 studies that met the selection criteria were included. A small group of studies (n=7) evaluated the impact of the HVBP program, and no impact on processes or patient outcomes was reported. None of the included studies evaluated the effect of HVBP program on health care costs. Other studies (n=28) evaluated the hospital characteristics associated with HVBP performance, suggesting that safety-net hospitals reportedly performed worse on several quality and cost measures. Other hospital characteristics' associations with performance were unclear.
Our findings suggest that the current HVBP does not lead to meaningful improvements in quality of care or patient outcomes and may negatively affect safety-net hospitals. More rigorous and comprehensive adjustment is needed for more valid hospital comparisons.
根据《平价医疗法案》，医疗保险和医疗补助服务中心大大扩大了住院按价值收费的项目，包括医院价值采购（HVBP）计划。现有 HVBP 计划的证据喜忧参半。需要对 HVBP 计划进行系统评价，以为如何提高该计划的效果提供信息。
综述和总结评估 HVBP 计划对临床流程、患者满意度、成本和结果的影响，或评估与该计划绩效相关的医院特征的研究。
我们根据系统评价和荟萃分析的首选报告项目指南，在 2013 年 1 月至 2019 年 7 月期间在 MEDLINE/PubMed、Scopus 和 ProQuest 数据库中搜索文献。
在审查的 988 项研究中，有 33 项符合选择标准的研究被纳入。一小部分研究（n=7）评估了 HVBP 计划的影响，没有报告对流程或患者结果的影响。没有纳入的研究评估 HVBP 计划对医疗成本的影响。其他研究（n=28）评估了与 HVBP 绩效相关的医院特征，表明报告称，医疗服务提供不足的医院在几个质量和成本指标上的表现较差。其他医院特征与绩效的关系尚不清楚。
我们的研究结果表明，目前的 HVBP 计划不会导致医疗质量或患者结果的显著改善，并且可能会对医疗服务提供不足的医院产生负面影响。需要更严格和全面的调整，以进行更有效的医院比较。
