Burstin H R, Lipsitz S R, Udvarhelyi I S, Brennan T A
Division of General Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass. 02115.
JAMA. 1993 Aug 18;270(7):845-9.
To assess the relationship among hospital financial characteristics, patient payer mix, and the incidence of negligent medical injuries.
Retrospective medical record review linked to hospital financial reports.
Acute care hospitals in New York State in 1984.
Stratified, random sample of 30,195 medical records from 51 acute care hospitals.
Hospital rates of medical injury and substandard care were developed from reviews of 30,195 medical records at 51 acute care hospitals in New York in 1984. Hospital-level variables representing financial status, hospital staffing, and the proportion of self-pay and Medicaid hospital discharges were compiled from a variety of secondary sources.
The likelihood of negligent medical injury was highest in those hospitals with the lowest inpatient operating costs per hospital discharge (odds ratio, 2.8; 95% confidence interval, 1.5 to 5.5). The effect of low inpatient operating costs was marked among hospitals in financial distress, many of which served indigent populations.
Patients admitted to hospitals that are unable to expend sufficient resources on patient care may be at higher risk of substandard care. Further study of the effect of hospital financial status on quality of care appears to be warranted.
评估医院财务特征、患者付费组合与医疗过失伤害发生率之间的关系。
与医院财务报告相关联的回顾性病历审查。
1984年纽约州的急症护理医院。
来自51家急症护理医院的30195份病历的分层随机样本。
1984年对纽约51家急症护理医院的30195份病历进行审查，得出医院医疗伤害率和护理不达标率。代表财务状况、医院人员配备以及自费和医疗补助出院患者比例的医院层面变量，是从各种二手资料中汇编而来的。
每家出院患者住院运营成本最低的医院发生医疗过失伤害的可能性最高（优势比为2.8；95%置信区间为1.5至5.5）。住院运营成本低的影响在财务困难的医院中尤为明显，其中许多医院服务的是贫困人群。
入住无法在患者护理上投入足够资源的医院的患者，接受不达标准护理的风险可能更高。医院财务状况对护理质量的影响似乎值得进一步研究。
