熟练护理设施所有权的变化和短期医疗保险患者的结果
Rachel A Prusynski1, Andrew Humbert1, Tracy M Mroz1
1University of Washington Department of Rehabilitation Medicine, Seattle.
JAMA network open
|September 19, 2023
概括
熟练护理设施所有权的变化与质量指标较低的设施有关,但并不直接导致患者结果更差. 所有权的变化可能是潜在质量问题的信号,而不是造成这些问题.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 老年学是一门学科.
- 医疗保健管理的管理
背景情况:
- 熟练护理设施 (SNF) 的所有权变化正在审查对医疗保健质量和财务透明度的潜在影响.
- 人们担心,所有权转移可能会促进资金从患者护理转移,但将这些变化与患者结果联系起来的经验证据是有限的,特别是在短期逗留人口中.
研究的目的:
- 确定与所有权变更相关的SNF的特征.
- 调查SNF所有权变化是否与短期住院患者结果的差异相关,包括医院再入院,急诊室访问和社区出院率.
主要方法:
- 2016-2019年医疗保险行政数据的二次分析,包括11004个美国SNF.
- 利用多变量后勤回归和受控中断时间序列分析来评估所有权变化和患者结果之间的关联,控制设施特征.
主要成果:
- 具有历史上与较低质量相关的特征 (例如,低入住率,较大的医疗补助人口,较低的员工评级) 的设施表现出更高的所有权变更几率.
- 虽然描述性分析表明,所有权变化的设施的结果更差,但时间序列模型没有显示出与医院再入院或社区出院率的显著关联.
- 访问急诊室的适度,短期增加与所有权变化 (0.32个百分点) 有关.
结论:
- 在具有质量较低的先前指标的设施中,SNF所有权更有可能发生变化.
- 这项研究表明,所有权变化可能作为潜在质量问题的标志物,而不是导致患者结果差的直接原因.
- 调查结果强调需要监督机制,以解决推动SNF所有权变化的因素.
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