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首页> 外文期刊>Health services research: HSR >Hospital competition, managed care, and mortality after hospitalization for medical conditions in California.
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Hospital competition, managed care, and mortality after hospitalization for medical conditions in California.

机译：加利福尼亚州的医疗竞争，住院治疗后的管理竞争和病死率。

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OBJECTIVE: To assess the effect of hospital competition and health maintenance organization (HMO) penetration on mortality after hospitalization for six medical conditions in California. DATA SOURCE: Linked hospital discharge and vital statistics data for short-term general hospitals in California in the period 1994-1999. The study sample included adult patients hospitalized for one of the following conditions: acute myocardial infarction (N=227,446), hip fracture (N=129,944), stroke (N=237,248), gastrointestinal hemorrhage (GIH, N=216,443), congestive heart failure (CHF, N=355,613), and diabetes (N=154,837). STUDY DESIGN: The outcome variable was 30-day mortality. We estimated multivariate logistic regression models for each study condition with hospital competition, HMO penetration, hospital characteristics, and patient severity measures as explanatory variables. PRINCIPAL FINDINGS: Higher hospital competition was associated with lower 30-day mortality for three to five of the six study conditions, depending on the choice of competition measure, and this finding was robust to a variety of sensitivity analyses. Higher HMO penetration was associated with lower mortality for GIH and CHF. CONCLUSIONS: Hospitals that faced more competition and hospitals in market areas with higher HMO penetration provided higher quality of care for adult patients with medical conditions in California. Studies using linked hospital discharge and vital statistics data from other states should be conducted to determine whether these findings are generalizable.
机译：目的：评估加利福尼亚州六种医疗条件下医院竞争和健康维持组织（HMO）渗透对住院后死亡率的影响。数据来源：1994-1999年间加利福尼亚州短期综合医院的出院数据和生命统计数据相关联。研究样本包括因以下情况之一住院的成年患者：急性心肌梗塞（N = 227,446），髋部骨折（N = 129,944），中风（N = 237,248），胃肠道出血（GIH，N = 216,443），充血性心脏失败（瑞士法郎，N = 355,613）和糖尿病（N = 154,837）。研究设计：结果变量为30天死亡率。我们用医院竞争，HMO渗透率，医院特征和患者严重性指标作为解释变量，为每种研究条件估计了多元逻辑回归模型。主要发现：六种研究条件中的三到五种，医院竞争水平越高，其30天死亡率越低，这取决于竞争方法的选择，这一发现对各种敏感性分析均很可靠。 HMO渗透率越高，GIH和CHF的死亡率越低。结论：面临更多竞争的医院和市场上具有较高HMO渗透率的医院为加利福尼亚州的成年患者提供了更高的医疗质量。应该使用来自其他州的相关医院出院和生命统计数据进行研究，以确定这些发现是否可推广。

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