caa a22 4500 397518897 CHVBK 20180308164627.0 cr unu---uuuuu 161202e199506 xx s 000 0 eng 10.1093/intqhc/7.2.95 doi (NATIONALLICENCE)oxford-10.1093/intqhc/7.2.95 Comparing Outcomes and Charges for Patients with Acute Myocardial Infarction in Three Community Hospitals: an Approach for Assessing "Value” [Elektronische Daten] [EUGENE C. NELSON, SHELDON GREENFIELD, RON D. HAYS, CELIA LARSON, BETH LEOPOLD] Objective: To assess the value of care (i.e. outcomes in relation to charges) for acute myo-cardial infarction (Acute MI) patients in three community hospitals after controlling for patient mix differences. Design: An observational study of a cohort of acute MI patients admitted to hospital for care were studied based on medical record review and on patient-completed questionnaires at 8 weeks post-discharge. Setting: Three community hospitals located in urban areas in the southeastern region of the United States. Patients: A consecutive sample of 133 non-transfer Acute MI patients were entered into the study based on EKG results, enzyme tests and chest pain characteristics. Hospital medical record and charge data were available on all patients and patient-reports on 86% of survivors. Main outcome measures: Data were gathered on clinical outcomes (death, angina, dyspnea), functional outcomes (physical and psychosocial), satisfaction, and resource intensity (length of stay, total hospital charges, ancillary charges). Because of patient mix differences across hospitals, outcomes were adjusted for severity of Acute MI, comorbidity and demographics. Results: There were important patient mix differences across hospitals. For example, Hospital C had more comorbidity than Hospital B (57.78% of Hospital C patients vs 15.00% of Hospital B patients were rated moderate or severe using a well tested index, p <0.0001). After adjusting for patient mix differences, Hospital C scored significantly better on four of six outcome measures (i.e. angina, dyspnea, physical functioning, psychosocial functioning). For example, Hospital C's patients' mean scores on physical functioning at 8 week follow-up averaged 75.19 (on a 0-100 scale), while Hospital A's was 63.03 and Hospital B's was 48.57 (F-ratio = 4.95; p < 0.05). However, Hospital A scored significantly lower on all three resource intensity indicators (length of stay, ancillary charges, and total charges). For example, Hospital A's ancillary charges averaged $10,752 while Hospital B's and C's averaged $11,432 and $16, 598 respectively. Between-hospital comparisons on adjusted mortality and satisfaction did not differ significantly. Conclusion: The "value” profiles (i.e. outcomes related to charges) produced by these three hospitals were substantially different. Studies that simultaneously measure outcomes, costs, patient mix and processes have potential to: (a) enable clinical teams to improve the measurable value of clinical care; and (b) enable purchasers to better evaluate which providers to select as preferred sources of care. © 1995 Elsevier Science Ltd Articles nationallicence NELSON EUGENE C. Dartmouth-Hitchcock Medical Center, One Medical Center Drive Lebanon, NH 03756, and Department of Community and Family Medicine, Dartmouth Medical School Hanover, NH 03755, USA aut GREENFIELD SHELDON The Health Institute, New England Medical Center 750 Washington Street, Box 345, Boston, MA 02111, Tufts University, and Harvard School of Public Health|Boston, Massachusetts, USA aut HAYS RON D. RAND 1700 Main Street, Santa Monica, CA 90407, USA aut LARSON CELIA Quality Resource Group, Hospital Corporation of America One Park Plaza, Nashville, TN 37202, USA aut LEOPOLD BETH Department of Health Care, Quality Improvement Education and Research, Henry Ford Health System Detroit, MI 48202, USA aut International Journal for Quality in Health Care Oxford University Press 7/2(1995-06), 95-108 1353-4505 7:2<95 1995 7 intqhc https://doi.org/10.1093/intqhc/7.2.95 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1093/intqhc/7.2.95 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- NELSON EUGENE C. Dartmouth-Hitchcock Medical Center, One Medical Center Drive Lebanon, NH 03756, and Department of Community and Family Medicine, Dartmouth Medical School Hanover, NH 03755, USA aut NATIONALLICENCE 700 1- GREENFIELD SHELDON The Health Institute, New England Medical Center 750 Washington Street, Box 345, Boston, MA 02111, Tufts University, and Harvard School of Public Health|Boston, Massachusetts, USA aut NATIONALLICENCE 700 1- HAYS RON D. RAND 1700 Main Street, Santa Monica, CA 90407, USA aut NATIONALLICENCE 700 1- LARSON CELIA Quality Resource Group, Hospital Corporation of America One Park Plaza, Nashville, TN 37202, USA aut NATIONALLICENCE 700 1- LEOPOLD BETH Department of Health Care, Quality Improvement Education and Research, Henry Ford Health System Detroit, MI 48202, USA aut NATIONALLICENCE 773 0- International Journal for Quality in Health Care Oxford University Press 7/2(1995-06), 95-108 1353-4505 7:2<95 1995 7 intqhc Metadata rights reserved CC BY-NC-4.0 http://creativecommons.org/licenses/by-nc/4.0 nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-oxford