Department of Surgery, Division of Plastic, Maxillofacial, and Oral Surgery, Duke University, Durham, NC, United States of America.
Allegheny Singer Research Institute, Allegheny Health Network, Pittsburgh, PA, United States of America.
PLoS One. 2024 Aug 6;19(8):e0308331. doi: 10.1371/journal.pone.0308331. eCollection 2024.
As a result of the success of Maryland's full risk capitated payment model experiment (Global Budget Revenue) in constraining healthcare costs, there is momentum for expanding the reach of such models. However, as these models are implemented, studies analyzing their long-term effects suggest unintended spillover effects that may ultimately influence patient experiences. The aim of this study was to determine whether implementation of the GBR was associated with changes in patient experience.
Cross-sectional study using a difference-in-difference analysis to examine changes in patient experiences according to the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) domains before and after implementation of the GBR model. Acute care hospitals from 2010-2016 with completed HCAHPS surveys were included. Hospitals identified for inclusion were then matched, based on county location, to area level characteristics using the Area Health Resource File.
A total of 844 hospitals were included. Compared to hospitals in non-GBR states, hospitals in GBR states experienced significant declines in the following HCAHPS domains: "would definitely recommend the hospital to others" [Average treatment effect (ATT) = -1.19, 95% CI = -1.97, -0.41)] and 9-10 rating of the hospital (ATT = -0.93, 95% CI = -1.71, -0.15). Results also showed significant increases in the HCAHPS domains: "if patient's rooms and bathroom were always kept clean" (ATT = 1.10, 95% CI = 0.20, 2.00). There were no significant differences in changes for the other domains, including no improvements in: nursing communication, doctor communication, help from hospital staff, pain control, communication on medicines, discharge information, and quietness of the patient environment.
These findings suggest there should be efforts made to ascertain and mitigate potential adverse effects of care transformation initiatives on patient experience. Patients are stakeholders and their inputs should be sought and incorporated in care transformation efforts to ensure that these models align with improved patient experiences.
由于马里兰州全面风险总额支付模式实验（全球预算收入）成功地控制了医疗保健成本，因此扩大这些模式的应用范围具有强大动力。然而，随着这些模式的实施，分析其长期影响的研究表明，可能会出现意外的溢出效应，最终影响患者体验。本研究旨在确定实施 GBR 是否与患者体验的变化有关。
使用差异中的差异分析，对 2010 年至 2016 年期间完成 HCAHPS 调查的急性护理医院，根据 HCAHPS 领域，在实施 GBR 模型前后，检查患者体验的变化。纳入的医院根据县所在地，使用区域卫生资源文件与区域水平特征相匹配。
共纳入 844 家医院。与非 GBR 州的医院相比，GBR 州的医院在以下 HCAHPS 领域的体验显著下降：“肯定会向他人推荐医院”[平均治疗效果（ATT）=-1.19，95%置信区间（CI）=-1.97，-0.41)]和对医院的 9-10 评分（ATT=-0.93，95%CI=-1.71，-0.15）。结果还显示 HCAHPS 领域的显著增加：“如果患者的房间和浴室始终保持清洁”（ATT=1.10，95%CI=0.20，2.00）。其他领域没有显著的变化，包括在护理沟通、医生沟通、医院工作人员帮助、疼痛控制、药物沟通、出院信息和患者环境安静方面没有改善。
这些发现表明，应该努力确定和减轻医疗保健转型计划对患者体验的潜在不利影响。患者是利益相关者，应该征求他们的意见并将其纳入医疗保健转型努力中，以确保这些模式与改善患者体验相一致。
