Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, United States of America.
Department of Quality and Safety, Brigham and Women's Hospital, Boston, Massachusetts, United States of America.
PLoS One. 2022 Apr 20;17(4):e0266696. doi: 10.1371/journal.pone.0266696. eCollection 2022.
High-quality care is a clear objective for hospital leaders, but hospitals must balance investing in quality with financial stability. Poor hospital financial health can precipitate closure, limiting patients' access to care. Whether hospital quality is associated with financial health remains poorly understood. The objective of this study was to compare financial performance at high-quality and low-quality hospitals.
We performed a retrospective observational cohort study of U.S. hospitals using the American Hospital Association and Hospital Compare datasets for years 2013 to 2018. We used multilevel mixed-effects linear and logistic regression models with fixed year effects and random intercepts for hospitals to identify associations between hospitals' measured quality outcomes-30-day hospital-wide readmission rate and the patient safety indicator-90 (PSI-90)-and their financial margins and risk of financial distress in the same year and the subsequent year. Our sample included 20,919 observations from 4,331 unique hospitals.
In 2018, the median 30-day readmission rate was 15.2 (interquartile range [IQR] 14.8-15.6), the median PSI-90 score was 0.96 (IQR 0.89-1.07), the median operating margin was -1.8 (IQR -9.7-5.9), and 750 (22.7%) hospitals experienced financial distress. Hospitals in the best quintile of readmission rates experienced higher operating margins (+0.95%, 95% CI [0.51-1.39], p < .001) and lower odds of distress (odds ratio [OR] 0.56, 95% CI [0.45-0.70], p < .001) in the same year as compared to hospitals in the worst quintile. Hospitals in the best quintile of PSI-90 had higher operating margins (+0.62%, 95% CI [0.17-1.08], p = .007) and lower odds of financial distress (OR 0.70, 95% CI [0.55-0.89], p = .003) as compared to hospitals in the worst quintile. The results were qualitatively similar for the same-year and lag-year analyses.
Hospitals that deliver high-quality outcomes may experience superior financial performance compared to hospitals with poor-quality outcomes.
高质量的医疗服务是医院领导层的明确目标，但医院必须在投资质量和财务稳定之间取得平衡。较差的医院财务状况可能导致医院关闭，限制患者获得医疗服务的机会。医院的质量是否与财务状况相关仍知之甚少。本研究的目的是比较高质量和低质量医院的财务绩效。
我们使用美国医院协会和医院比较数据集，对 2013 年至 2018 年的美国医院进行了回顾性观察队列研究。我们使用具有固定年份效应和医院随机截距的多级混合效应线性和逻辑回归模型，来识别医院的测量质量结果（30 天医院范围再入院率和患者安全指标-90（PSI-90））与其当年和次年的财务利润率和财务困境风险之间的关联。我们的样本包括来自 4331 家不同医院的 20919 个观察值。
2018 年，30 天再入院率中位数为 15.2（四分位距[IQR] 14.8-15.6），PSI-90 评分中位数为 0.96（IQR 0.89-1.07），运营利润率中位数为-1.8（IQR-9.7-5.9），750 家（22.7%）医院出现财务困境。与最差五分位组相比，再入院率最佳五分位组的医院运营利润率更高（+0.95%，95%CI[0.51-1.39]，p<.001），出现财务困境的可能性更低（比值比[OR]0.56，95%CI[0.45-0.70]，p<.001）。PSI-90 最佳五分位组的医院运营利润率更高（+0.62%，95%CI[0.17-1.08]，p=0.007），出现财务困境的可能性更低（OR 0.70，95%CI[0.55-0.89]，p=0.003），与最差五分位组相比。同年和滞后年分析的结果基本相似。
与质量较差的医院相比，提供高质量治疗结果的医院可能具有更好的财务表现。
