Bradbury R C, Golec J H, Steen P M
Master of Health Administration Program, Clark University, Worcester, MA 01610.
Inquiry. 1994 Spring;31(1):56-65.
This study addresses the question of whether hospitals with better health outcomes for their patients spend more or less to accomplish these results. Adult medical service admissions to 43 Pennsylvania hospitals are analyzed. Health outcomes and resource expenditures are adjusted for admission severity of illness and other patient variables. The results demonstrate a positive correlation between adjusted mortality (logit regression) and adjusted total charges, ancillary charges, and length of stay (ordinary least squares regression), but only the mortality/length-of-stay relationship is statistically significant (p < .05). For patients staying at least four days, however, there is a statistically significant, positive relationship between adjusted mortality and all three adjusted measures of resource expenditures. The relationship between the adjusted morbidity and each of these three adjusted resource measures is positive and statistically significant. The positive relationship is largely unrelated to such readily observable hospital characteristics as size, staffing, teaching status, and location in urban areas.
本研究探讨了为患者提供更好健康结果的医院在实现这些结果时花费更多还是更少的问题。对宾夕法尼亚州43家医院的成人医疗服务入院情况进行了分析。针对疾病严重程度和其他患者变量对健康结果和资源支出进行了调整。结果表明，调整后的死亡率（逻辑回归）与调整后的总费用、辅助费用以及住院时间（普通最小二乘法回归）之间存在正相关，但只有死亡率/住院时间的关系具有统计学意义（p <.05）。然而，对于住院至少四天的患者，调整后的死亡率与所有三项调整后的资源支出指标之间存在统计学上显著的正相关关系。调整后的发病率与这三项调整后的资源指标中的每一项之间的关系都是正的且具有统计学意义。这种正相关关系在很大程度上与医院规模、人员配备、教学状况和城市地区位置等易于观察到的医院特征无关。
