How hospitals can improve their public quality metrics: a decision-theoretic model.

Autor: Wernz C; Department of Data Science, University of Virginia Health System, Charlottesville, VA, USA. cwernz@virginia.edu., Song Y; Department of Industrial Engineering, Clemson University, Clemson, SC, USA., Hughes DR; School of Economics, Georgia Institute of Technology, Atlanta, GA, USA.
Jazyk: angličtina
Zdroj: Health care management science [Health Care Manag Sci] 2021 Dec; Vol. 24 (4), pp. 702-715. Date of Electronic Publication: 2021 May 15.
DOI: 10.1007/s10729-021-09551-7
Abstrakt: The public reporting of hospitals' quality of care is providing additional motivation for hospitals to deliver high-quality patient care. Hospital Compare, a consumer-oriented website by the Centers for Medicare and Medicaid Services (CMS), provides patients with detailed quality of care data on most US hospitals. Given that many quality metrics are the aggregate result of physicians' individual clinical decisions, the question arises if and how hospitals could influence their physicians so that their decisions positively contribute to hospitals' quality goals. In this paper, we develop a decision-theoretic model to explore how three different hospital interventions-incentivization, training, and nudging-may affect physicians' decisions. We focus our analysis on Outpatient Measure 14 (OP-14), which is an imaging quality metric that reports the percentage of outpatients with a brain computed tomography (CT) scan, who also received a same-day sinus CT scan. In most cases, same-day brain and sinus CT scans are considered unnecessary, and high utilizing hospitals aim to reduce their OP-14 metric. Our model captures the physicians' imaging decision process accounting for medical and behavioral factors, in particular the uncertainty in clinical assessment and a physician's diagnostic ability. Our analysis shows how hospital interventions of incentivization, training, and nudging affect physician decisions and consequently OP-14. This decision-theoretic model provides a foundation to develop insights for policy makers on the multi-level effects of their policy decisions.
(© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
Databáze: MEDLINE
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