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Characteristics of Top-Performing Hospitals Caring for High-Need Medicare Beneficiaries

机译：高级医疗保险受益者的顶级医院的特点

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摘要

A small proportion of high-need (HN) Medicare beneficiaries account for a large share of medical expenditures in the United States. Identifying hospitals with the best outcomes for HN patients is central to identifying and spreading evidence-based practices to improve care for this population. The objective of this study was to identify and characterize top-performing hospitals for HN patients. Administrative claims data from 2013-2014 were used to identify HN beneficiaries and their treating hospital; hospitals were ranked based on their HN beneficiaries' outcomes in 2015. Hospitalization, mortality, and days spent in community were assessed, and all outcomes were risk standardized for age, sex, dual eligibility, and hospital referral region. American Hospital Association and aggregated inpatient claims data characterized hospitals. Logistic regression models estimated the odds of ranking in the top 20% on all outcomes. Of 2253 hospitals with at least 500 HN patients in the United States, 92 (4.1%) ranked in the top 20% across all outcomes. No hospital characteristics were associated with being top performing across all outcomes, but urban hospitals were significantly less likely to perform well on hospitalization and private, for-profit hospitals performed better on mortality. Small hospitals, Accountable Care Organization providers, and those providing palliative care services were more likely to rank highly on days spent in the community. Top-performing hospitals served fewer minority, dual eligible, and HN patients, suggesting that case mix may explain some of the differences in performance, and that additional work is needed to examine programs and practices at outstanding hospitals.
机译：一小部分高需求（HN）Medicare受益者占美国的大量医疗支出。为HN患者的最佳成果确定医院是识别和传播基于证据的实践的核心，以改善对该人群的照顾。本研究的目的是识别并表征患有HN患者的最佳医院。 2013 - 2014年的行政索赔数据用于识别恒生公司及其治疗医院;在2015年，医院按照他们的HN受益者成果排名。社区中度过的住院，死亡率和日期都被评估，所有结果都是规范的年龄，性别，双重资格和医院转诊区域的风险。美国医院协会和汇总住院声明数据表征了医院。 Logistic回归模型估计所有结果的排名差异为20％。在美国至少有500个患者的2253家医院，92名（4.1％）在所有结果中排名前20％。在所有结果中，没有医院特征与最重要的表现有关，但城市医院的表现不太可能对住院治疗和私人，私营医院表现良好的死亡率。小型医院，负责任的组织提供商和提供姑息治疗服务的人更有可能在社区所花费的日子里排名。最佳医院服务于少数群体，双重符合条件和HN患者，表明案例组合可以解释一些绩效的差异，并且需要额外的工作来审查优秀医院的计划和实践。

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  • 来源
    《Disease Management》 |2020年第4期|313-318|共6页
  • 作者

    Belanger Emmanuelle; McHugh John; Meyers David J.; Joyce Nina R.; Rahman Momotazur; Schwartz Margot; Baier Rosa R.; Mor Vincent;

  • 作者单位

    Brown Univ Ctr Gerontol & Healthcare Res Sch Publ Hlth 121 South Main St 6th Floor Providence RI 02903 USA|Brown Univ Sch Publ Hlth Dept Hlth Serv Policy & Practice Providence RI 02903 USA;

    Columbia Univ Mailman Sch Publ Hlth Dept Hlth Policy & Management New York NY USA;

    Brown Univ Sch Publ Hlth Dept Hlth Serv Policy & Practice Providence RI 02903 USA;

    Brown Univ Ctr Gerontol & Healthcare Res Sch Publ Hlth 121 South Main St 6th Floor Providence RI 02903 USA|Brown Univ Sch Publ Hlth Dept Hlth Serv Policy & Practice Providence RI 02903 USA|Brown Univ Dept Epidemiol Sch Publ Hlth Providence RI 02903 USA;

    Brown Univ Ctr Gerontol & Healthcare Res Sch Publ Hlth 121 South Main St 6th Floor Providence RI 02903 USA|Brown Univ Sch Publ Hlth Dept Hlth Serv Policy & Practice Providence RI 02903 USA;

    Brown Univ Sch Publ Hlth Dept Hlth Serv Policy & Practice Providence RI 02903 USA;

    Brown Univ Sch Publ Hlth Dept Hlth Serv Policy & Practice Providence RI 02903 USA|Brown Univ Ctr Long Term Qual & Innovat Sch Publ Hlth Providence RI 02903 USA;

    Brown Univ Ctr Gerontol & Healthcare Res Sch Publ Hlth 121 South Main St 6th Floor Providence RI 02903 USA|Brown Univ Sch Publ Hlth Dept Hlth Serv Policy & Practice Providence RI 02903 USA|Brown Univ Ctr Long Term Qual & Innovat Sch Publ Hlth Providence RI 02903 USA|US Dept Vet Affairs Med Ctr Providence RI USA;

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  • 正文语种 eng
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  • 关键词

    hospital performance; Medicare beneficiaries; high need;

    机译：医院性能;Medicare受益人;高需求;

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