Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
Harvard Medical School Division of Cardiac Surgery and Corrigan Minehan Heart Center at Massachusetts General Hospital, Boston, Massachusetts.
J Healthc Manag. 2022;67(5):367-379. doi: 10.1097/JHM-D-21-00262.
For decades, hospitals performing cardiac surgery have carried the cost of implementing quality improvement activities and reporting quality outcomes. However, the financial return of such investments is unclear, which weakens the incentive for hospitals to invest in quality improvement activities. This study explored the relationship between a hospital's measured quality and its financial performance.
Using data from the American Hospital Association and Hospital Compare from 2014 to 2018, we performed an observational study of hospitals performing cardiac surgery. We used mixed-effects regression models with fixed-year effects and random intercepts to explore associations between measured quality and hospital financial performance. Our dependent variables were margins (profit divided by revenue) and financial distress; our independent variables included Patient Safety Indicator 90 (PSI-90) and hospital characteristics.
Our sample included 4,927 hospital-years from 1,209 unique hospitals. Hospitals in the worst-performing PSI-90 score quartile experienced a lower operating margin (-1.26%, 95% CI [-2.10 to -0.41], p = .004), a lower total margin (-0.92%, 95% CI [-1.66 to -0.17], p = .016), and an increased odds of financial distress in the next year (OR: 2.12, 95% CI [1.36-3.30], p = .001) when compared with the best-performing hospitals.
Our exploration into financial distress provides managers with a better understanding of the relationship between a hospital's measured quality and its financial position. In reflecting on our findings, hospital leaders may consider viewing patient safety as a modifiable factor that can improve their organization's overall financial health. Our findings suggest that excellent safety performance may be both financially and clinically beneficial to hospitals.
几十年来，进行心脏手术的医院一直在承担实施质量改进活动和报告质量结果的成本。然而，这种投资的财务回报尚不清楚，这削弱了医院投资质量改进活动的积极性。本研究探讨了医院测量质量与其财务绩效之间的关系。
使用 2014 年至 2018 年美国医院协会和医院比较的数据，我们对进行心脏手术的医院进行了一项观察性研究。我们使用具有固定年度效应和随机截距的混合效应回归模型来探讨测量质量与医院财务绩效之间的关系。我们的因变量是利润率（利润除以收入）和财务困境；我们的自变量包括患者安全指标 90（PSI-90）和医院特征。
我们的样本包括来自 1209 家不同医院的 4927 个医院年。PSI-90 得分最差的四分之一的医院的运营利润率较低（-1.26%，95%CI[-2.10 至-0.41]，p=.004），总利润率较低（-0.92%，95%CI[-1.66 至-0.17]，p=.016），且下一年发生财务困境的几率更高（OR：2.12，95%CI[1.36-3.30]，p=.001）与表现最好的医院相比。
我们对财务困境的探索使管理人员更好地理解了医院测量质量与其财务状况之间的关系。在反思我们的发现时，医院领导可能会考虑将患者安全视为可改善其组织整体财务健康状况的可修改因素。我们的研究结果表明，出色的安全绩效对医院在财务和临床方面都可能是有益的。
