The relationship between competition and quality in procedural cardiac care
| Autor: | David B. Glick, Sean Apfelbaum, Joyce Woo, Benjamin Dauber, Kristen Wroblewski, Avery Tung |
|---|---|
| Rok vydání: | 2015 |
| Předmět: |
Valve surgery
media_common.quotation_subject Myocardial Infarction Perioperative Care Competition (economics) Medicine Humans Quality (business) Hospital Mortality Medical diagnosis Cardiac Surgical Procedures media_common Quality Indicators Health Care Quality of Health Care Health Facility Size Heart Valve Prosthesis Implantation Economic Competition business.industry Metropolitan statistical area Perioperative medicine.disease United States Patient volume Anesthesiology and Pain Medicine Treatment Outcome Elective Surgical Procedures Perioperative care Costs and Cost Analysis Medical emergency business |
| Zdroj: | Anesthesia and analgesia. 120(1) |
| ISSN: | 1526-7598 |
| Popis: | BACKGROUND Anesthesiologists are frequently involved in efforts to meet perioperative quality metrics. The degree to which hospitals compete on publicly reported quality measures, however, is unclear. We hypothesized that hospitals in more competitive environments would be more likely to compete on quality and thus perform better on such measures. To test our hypothesis, we studied the relationship between competition and quality in hospitals providing procedural cardiac care and participating in a national quality database. METHODS For hospitals performing heart valve surgery (HVS) and delivering acute myocardial infarction (AMI) care in the Hospital Compare database, we assessed the degree of intrahospital competition using both geographical radius and federally defined metropolitan statistical area (MSA) to determine the degree of intrahospital competition. For each hospital, we then correlated the degree of competition with quality measure performance, mortality, patient volume, and per-patient Medicare costs for both HVS and AMI. RESULTS Six hundred fifty-three hospitals met inclusion criteria for HVS and 1898 hospitals for AMI care. We found that for both definitions of competition, hospitals facing greater competition did not demonstrate better quality measure performance for either HVS or AMI. For both diagnoses, competition by number of hospitals correlated positively with cost: partial correlation coefficients = 0.40 (0.42 for MSA) (P < 0.001) for HVS and 0.52 (0.47 for MSA) (P < 0.001) for AMI. CONCLUSIONS An analysis of the Hospital Compare database found that competition among hospitals correlated overall with increased Medicare costs but did not predict better scores on publicly reported quality metrics. Our results suggest that hospitals do not compete meaningfully on publicly reported quality metrics or costs. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|