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Hospital quality variation matters - A time-trend and cross-section analysis of outcomes in German hospitals from 2006 to 2014.
Journal
Health Policy
ISSN
0168-8510
Type
journal article
Date Issued
2017-08
Author(s)
Research Team
https://www.alexandria.unisg.ch/persons/8635
Abstract (De)
Awareness of care variation and associated differences in outcome quality is important for patients to recognize and leverage the benefits of hospital choice and for policy makers, providers, and suppliers to adapt initiatives to improve hospital quality of care. We examine panel data on outcome quality in German hospitals between 2006 and 2014 for cholecystectomy, pacemaker implantation, hip replacement, percutaneous coronary intervention (PCI), stroke, and acute myocardial infarction (AMI). We use risk-adjusted and unadjusted outcomes based on 16 indicators. Median outcome and outcome variation trends are examined via box plots, simple linear regressions and quintile differences. Outcome trends differ across treatment areas and indicators. We found positive quality trends for hip replacement surgery, stroke and AMI 30-day mortality, and negative quality trends for 90-day stroke and AMI readmissions and PCI inpatient mortality. Variation of risk-adjusted outcomes ranges by a factor of 3-12 between the 2nd and 5th quintile of hospitals, both at the national and regional level. Our results show that simply measuring and reporting hospital outcomes without clear incentives or regulation - "carrots and sticks" - to improve performance and to centralize care in high performing hospitals has not led to broad quality improvements. More substantial efforts must be undertaken to narrow the outcome spread between high- and low-quality hospitals.
Language
English
Keywords
Hospital quality of care
Outcome variation
Quality assessment
AMI
Stroke
PCI
Cholecystectomy
Hip replacement
Pacemaker implantation
Germany
HSG Classification
contribution to scientific community
Refereed
Yes
Volume
121
Number
8
Start page
842
End page
852
Subject(s)
Division(s)
Eprints ID
259571