Chhatre Sumedha, Malkowicz S Bruce, Vapiwala Neha, Guzzo Thomas J, Jayadevappa Ravishankar
Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA 19104, USA.
Cancers (Basel). 2024 Dec 13;16(24):4154. doi: 10.3390/cancers16244154.
Technical efficiency evaluates a hospital's economic performance and plays an important role in variations in quality of care and outcomes. The study objective was to examine the association between hospital efficiency and quality of care among fee-for-service Medicare beneficiaries with prostate cancer and to assess if race moderates this association.
Retrospective study using Surveillance, Epidemiological, and End Results-Medicare (SEER-Medicare) data from 1998 to 2016 for prostate cancer patients aged ≥ 66. We computed hospital technical efficiency using a data envelopment analysis. Outcomes were emergency room visits, hospitalizations, cost, and mortality (all-cause and prostate cancer-specific). We used competing risk regression for survival, log-link GLM models for cost, and Poisson models for count data. The propensity score approach was used to minimize selection bias.
The cohort consisted of 323,325 patients. Compared to higher efficiency hospitals (upper quartile), low hospital efficiency (i.e., lower quartile) was associated with a higher hazard of long-term mortality (Hazard ratio (HR) = 1.06, 95% CI = 1.05, 1.08) and long-term prostate cancer-specific mortality (HR = 1.14, 95% CI = 1.11, 1.17). Compared to higher efficiency levels, lower levels were associated with impaired emergency room visits, hospitalizations, and costs. A one unit increase in the efficiency score was associated with greater benefits for cost and mortality for African American and white patients. The benefit was larger for African American patients compared to white patients.
Increasing hospital efficiency may help improve outcomes among Medicare prostate cancer patients. Policies to redirect patients to hospitals with higher efficiency can enhance the quality of care and outcomes.
技术效率评估医院的经济绩效，并且在医疗质量和治疗结果的差异中发挥重要作用。本研究的目的是检验按服务收费的医疗保险前列腺癌受益人群中医院效率与医疗质量之间的关联，并评估种族是否会调节这种关联。
一项回顾性研究，使用1998年至2016年监测、流行病学和最终结果-医疗保险（SEER-Medicare）数据，研究对象为年龄≥66岁的前列腺癌患者。我们使用数据包络分析计算医院技术效率。结果指标包括急诊就诊、住院、费用和死亡率（全因死亡率和前列腺癌特异性死亡率）。我们使用竞争风险回归分析生存情况，使用对数链接广义线性模型分析费用，使用泊松模型分析计数数据。采用倾向得分法以尽量减少选择偏倚。
该队列包括323325名患者。与高效率医院（上四分位数）相比，低医院效率（即下四分位数）与长期死亡率较高（风险比（HR）=1.06，95%置信区间（CI）=1.05，1.08）和长期前列腺癌特异性死亡率较高（HR = 1.14，95%CI = 1.11，1.17）相关。与较高效率水平相比，较低效率水平与急诊就诊、住院和费用受损相关。效率得分每增加一个单位，对非裔美国人和白人患者的费用和死亡率有更大益处。与白人患者相比，非裔美国患者的益处更大。
提高医院效率可能有助于改善医疗保险前列腺癌患者的治疗结果。将患者引导至更高效率医院的政策可以提高医疗质量和治疗结果。
