Zinn J S, Aaronson W E, Rosko M D
Department of Health Administration, Temple University, Philadelphia, PA.
Med Care. 1993 Jun;31(6):475-87. doi: 10.1097/00005650-199306000-00001.
This research study utilizes indicators from federal and state surveys to evaluate variation in outcomes in 438 Medicare certified skilled nursing care facilities in Pennsylvania. First, a standardization function adjusting for patient characteristics known to influence outcomes was developed and estimated. The relationships between organizational and environmental characteristics and the chosen outcome indicators (i.e., differences between the actual and expected rate of mortality, pressure ulcers, urethral catheterization and physical restraints) were then analyzed by weighted least squares regression. Results suggest considerable interfacility variation in rates for these outcome indicators. A portion of this variation is significantly attributable to resident characteristics (P < or = 0.05). However, variation in outcomes in Pennsylvania facilities is also associated with facility characteristics (e.g., size and for-profit status), and environmental characteristics (e.g., per capita income and bed supply). Implications for nursing home management and policy are considered.
本研究利用联邦和州调查中的指标，对宾夕法尼亚州438家获得医疗保险认证的熟练护理机构的结果差异进行评估。首先，开发并估计了一个针对已知会影响结果的患者特征进行调整的标准化函数。然后，通过加权最小二乘法回归分析组织和环境特征与所选结果指标之间的关系（即实际死亡率与预期死亡率、压疮、尿道插管和身体约束率之间的差异）。结果表明，这些结果指标的发生率在机构间存在相当大的差异。这种差异的一部分可显著归因于居民特征（P≤0.05）。然而，宾夕法尼亚州各机构的结果差异也与机构特征（如规模和营利状况）以及环境特征（如人均收入和床位供应）有关。文中还考虑了对养老院管理和政策的影响。
