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在高竞争和低竞争的医院市场,高风险外科手术的结果
Sherri R Thumma1,2,3, Shukri H A Dualeh2,3, Nicholas J Kunnath2,3
1Michigan State University College of Osteopathic Medicine, East Lansing.
JAMA surgery
|August 2, 2023
概括
医院市场竞争并没有持续改善高风险手术的结果. 保持竞争可能不会导致经过复杂手术的患者的手术后效果更好.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 外科手术的结果
- 卫生经济学 卫生经济学
背景情况:
- 医院竞争越来越被视为医疗保健质量的驱动力.
- 医院市场竞争与高风险手术后患者结果之间的关系尚不清楚.
研究的目的:
- 调查医院市场竞争与高风险手术后患者结果之间的关联.
- 为了确定医院之间的竞争是否与改善的外科手术结果相关.
主要方法:
- 对接受10次高风险手术 (2015-2018) 的医疗保险受益人 (65岁以上) 的回顾性分析.
- 使用赫芬达尔-希尔施曼指数将医院分为高竞争和低竞争市场.
- 对30天死亡率和再入院的风险调整分析,控制患者和医院因素.
主要成果:
- 医院市场竞争与高风险手术的改善结果之间没有发现一致的关联.
- 在竞争激烈的中心门修复和大脑动脉内关节切除的市场上观察到更高的30天死亡率.
- 在竞争激烈的市场上,在10项手术中的5项,包括开放性大动脉动脉瘤修复和膝关节置换中,发现了更高的30天复发率.
结论:
- 医院市场竞争与高风险手术后更好的结果没有可靠的联系.
- 旨在增加医院竞争的政策可能不一定会提高术后结果.
- 需要进一步的研究来了解市场动态与外科手术护理质量之间的复杂相互作用.
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