Spaulding Aaron, Tafili Aurora, Dunn Ajani, Hamadi Hanadi
Division of Health Care Delivery Research, Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, Florida, USA.
Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, Alabama, USA.
J Hosp Med. 2022 Jul;17(7):517-526. doi: 10.1002/jhm.12892. Epub 2022 Jun 21.
As healthcare organizations examine the associated benefits of employing a larger hospitalist workforce, there is a need to better understand the association with patients' quality, experience, and efficiency. However, there is a lack of information regarding how hospital use of hospitalists over time influences hospital scoring on quality programs, such as the Center for Medicare and Medicaid Services (CMS) Hospital Inpatient Value-Based Purchasing (HVBP) Program. This study examines the association between hospitalist staffing between 2014 and 2019 and HVBP scores.
We used a cross-sectional panel study design. Total Performance Score (TPS) and its domains were obtained from CMS from 2014 to 2019 and merged with the American Hospital Association Annual Survey Database. We utilized random-effects multivariable panel regression models and zero-inflated negative binomial regression to examine the association between the hospitalist-staffing ratio and the HVBP Program. All models were adjusted for hospital characteristics.
A total of 2126 hospitals were included in the study. The average ratio of hospitalists per staffed bed was 0.06, with a standard deviation of 0.15. This study suggests that hospitals that employ a higher percentage of hospitalists see improvement in their overall TPS (β = 5.40; p < .001), Patient Experience (β = 2.49; p <.05), and Efficiency (incidence-rate ratio= 1.41; p < .001) domain. However, the Clinical Care domain was no different in organizations employing more hospitalists.
There are benefits associated with TPS, Patient Experience, and Efficiency from employing hospitalists. Managers should seek opportunities to leverage hospitalists' expertise in providing care, particularly in improving care processes.
随着医疗机构审视雇佣更多住院医师所带来的相关益处，有必要更好地理解其与患者质量、体验和效率之间的关联。然而，关于医院长期使用住院医师如何影响医院在质量项目中的评分，比如医疗保险和医疗补助服务中心（CMS）的医院住院患者价值导向型采购（HVBP）项目，目前缺乏相关信息。本研究考察了2014年至2019年间住院医师配备情况与HVBP评分之间的关联。
我们采用了横断面面板研究设计。从2014年至2019年从CMS获取总绩效得分（TPS）及其领域数据，并与美国医院协会年度调查数据库合并。我们利用随机效应多变量面板回归模型和零膨胀负二项回归来考察住院医师配备比例与HVBP项目之间的关联。所有模型都对医院特征进行了调整。
本研究共纳入2126家医院。每张配备床位的住院医师平均比例为0.06，标准差为0.15。本研究表明，雇佣更高比例住院医师的医院在总体TPS（β = 5.40；p <.001）、患者体验（β = 2.49；p <.05）和效率（发病率比 = 1.41；p <.001）领域有所改善。然而，在雇佣更多住院医师的机构中，临床护理领域并无差异。
雇佣住院医师与TPS、患者体验和效率方面存在益处。管理者应寻求机会利用住院医师在提供护理方面的专业知识，特别是在改善护理流程方面。
