Centre for Health Economics, University of York, York, YO10 5DD, UK.
Department of Economics and Related Studies, University of York, York, YO10 5DD, UK.
Soc Sci Med. 2020 Nov;265:113500. doi: 10.1016/j.socscimed.2020.113500. Epub 2020 Nov 4.
We investigate the extent to which small hospitals are associated with lower quality. We first take a patient perspective, and test if, controlling for casemix, patients admitted to small hospitals receive lower quality than those admitted to larger hospitals. We then investigate if differences in quality between large and small hospitals can be explained by hospital characteristics such as hospital type and staffing. We use a range of quality measures including hospital mortality rates (overall and for specific conditions), hospital acquired infection rates, waiting times for emergency patients, and patient perceptions of the care they receive. We find that small hospitals, with fewer than 400 beds, are generally not associated with lower quality before or after controlling for hospital characteristics. The only exception is heart attack mortality, which is generally higher in small hospitals.
我们研究了小医院的质量与哪些因素有关。我们首先从患者的角度出发，在控制病例组合的情况下，检验患者入住小医院是否比入住大医院的质量更低。然后，我们调查了大医院和小医院之间的质量差异是否可以用医院特征（如医院类型和人员配备）来解释。我们使用了一系列质量指标，包括医院死亡率（总体和特定情况下）、医院获得性感染率、急诊患者的等待时间以及患者对所接受护理的感知。我们发现，床位少于 400 张的小医院，在控制医院特征之前或之后，通常与较低的质量无关。唯一的例外是心脏病发作死亡率，通常在小医院更高。
