Measuring Efficiency: The Association Of Hospital Costs And Quality Of Care

Jha, Ashish K.; Orav, E. John; Dobson, Allen; Book, Robert A.; Epstein, Arnold M.

doi:10.1377/hlthaff.28.3.897

Cited by 129 publications

(115 citation statements)

References 12 publications

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“…Both variables may be indicators of a focus on structural quality of the practice. Prior studies investigating the association between quality and costs in the healthcare sector reported conflicting results (Carey and Burgess Jr, 1999;Hvenegaard et al, 2011;Jha et al, 2009;Schreyögg and Stargardt, 2010).…”

Section: Resultsmentioning

confidence: 99%

Estimation of a physician practice cost function

Kwietniewski¹,

Heimeshoff²,

Schreyögg³

2016

Eur J Health Econ

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Standard-Nutzungsbedingungen:Die Dokumente auf EconStor dürfen zu eigenen wissenschaftlichen Zwecken und zum Privatgebrauch gespeichert und kopiert werden.Sie dürfen die Dokumente nicht für öffentliche oder kommerzielle Zwecke vervielfältigen, öffentlich ausstellen, öffentlich zugänglich machen, vertreiben oder anderweitig nutzen.Sofern die Verfasser die Dokumente unter Open-Content-Lizenzen (insbesondere CC-Lizenzen) zur Verfügung gestellt haben sollten, gelten abweichend von diesen Nutzungsbedingungen die in der dort genannten Lizenz gewährten Nutzungsrechte. This is the first study to specify a physician practice cost function with practice costs as the unit of analysis. Our study is based on the data of 3,706 physician practices for the years 2006 to 2008. We propose a model using physician practices as the unit of observation and considering the endogenous character of physician input. In doing so, we apply a translog functional form and include a comprehensive set of variables (e.g., degree of specialisation and case-mix) that have not been previously used in this context. A system of four equations using three-stage least squares is estimated. Terms of use: Documents inWe find that a higher degree of specialisation and participation in disease management programs and gatekeeper models leads to a decrease in costs, whereas quality certification increases costs. Costs increase with the number of physicians, most likely because of the existence of indivisibilities of expensive technical equipment. Smaller practices might not reach the critical mass to invest in certain technologies, which leads to differences in the type of health care services provided by different practice types.

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Section: Resultsmentioning

confidence: 99%

Estimation of a physician practice cost function

Kwietniewski¹,

Heimeshoff²,

Schreyögg³

2016

Eur J Health Econ

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“…For each hospital, we calculated a summary performance score, 16 defined as the number of times a hospital administered dexamethasone but not antibiotics to an individual child, divided by the number of children who had a tonsillectomy at the hospital, multiplied by 100.…”

Section: Evidence-based Process Measuresmentioning

confidence: 99%

Variation in Quality of Tonsillectomy Perioperative Care and Revisit Rates in Children’s Hospitals

et al. 2014

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WHAT'S KNOWN ON THIS SUBJECT: Tonsillectomy is one of the most commonly performed surgeries in children and is one of the most cumulatively expensive conditions in pediatric hospital care. Little is known about how the quality of tonsillectomy care varies across hospitals. WHAT THIS STUDY ADDS:In a large cohort of low-risk children undergoing same-day tonsillectomy, there was substantial variation in quality measures of process, dexamethasone and antibiotic use, and outcome, revisits to the hospital within the first 30 days after surgery. abstract OBJECTIVE: To describe the quality of care for routine tonsillectomy at US children' s hospitals. METHODS:We conducted a retrospective cohort study of low-risk children undergoing same-day tonsillectomy between 2004 and 2010 at 36 US children' s hospitals that submit data to the Pediatric Health Information System Database. We assessed quality of care by measuring evidence-based processes suggested by national guidelines, perioperative dexamethasone and no antibiotic use, and outcomes, 30-day tonsillectomy-related revisits to hospital. RESULTS:Of 139 715 children who underwent same-day tonsillectomy, 10 868 (7.8%) had a 30-day revisit to hospital. There was significant variability in the administration of dexamethasone (median 76.2%, range 0.3%-98.8%) and antibiotics (median 16.3%, range 2.7%-92.6%) across hospitals. The most common reasons for revisits were bleeding (3.0%) and vomiting and dehydration (2.2%). Older age (10-18 vs 1-3 years) was associated with a greater standardized risk of revisits for bleeding and a lower standardized risk of revisits for vomiting and dehydration. After standardizing for differences in patients and year of surgery, there was significant variability (P , .001) across hospitals in total revisits (median 7.8%, range 3.0%-12.6%), revisits for bleeding (median 3.0%, range 1.0%-8.8%), and revisits for vomiting and dehydration (median 1.9%, range 0.3%-4.4%).CONCLUSIONS: Substantial variation exists in the quality of care for routine tonsillectomy across US children' s hospitals as measured by perioperative dexamethasone and antibiotic use and revisits to hospital. These data on evidence-based processes and relevant patient outcomes should be useful for hospitals' tonsillectomy quality improvement efforts. Pediatrics 2014;133:280-288

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“…[15][16][17][18] Prior studies at the area level generally show no or inverse relationships between costs and quality. 4,5,19 No study that we are aware of, however, has examined the relationship between measures of the costliness of individual physicians and quality.…”

Section: Discussionmentioning

confidence: 99%

Higher Practice Intensity Is Associated with Higher Quality of Care but More Avoidable Admissions for Medicare Beneficiaries

Landon

O’Malley²,

McKellar

et al. 2014

J GEN INTERN MED

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BACKGROUND:The relationship between practice intensity and the quality and outcomes of care has not been studied. OBJECTIVE: To examine the relationship between primary care physicians' costliness both for defined episodes of care and for defined patients and the quality and outcomes of care delivered to Medicare beneficiaries. STUDY DESIGN: Cross sectional analysis of physician survey data linked to Medicare claims. Physician costliness measures were calculated by comparing the episode specific and overall costs of care for their patients with the care delivered by other physicians. MAIN MEASURES: Proportion of eligible beneficiaries receiving each of seven preventive services and rates of preventable admissions for acute and chronic conditions. KEY RESULTS: The 2,211 primary care physician respondents included 937 internists and 1,274 family or general physicians who were linked to more than 250,000 Medicare enrollees. Patients treated by more costly physicians (whether measured by the overall costliness index or the episode-level index) were more likely to receive recommended preventive services, but were also more likely to experience preventable admissions. For instance, physicians in the lowest quartile of costliness performed appropriate monitoring for hemoglobin A1C for diabetics 72.8 % of the time, as compared with 81.9 % for physicians in the highest quartile of costliness (p<0.01). In contrast, patients treated by the physicians in the lowest quartile of episode costliness were admitted at a rate of 1.8/100 for both acute and chronic Prevention Quality Indicators (PQIs), as compared with 2.9/100 for both acute and chronic PQIs for those treated by physicians in the highest quartile of costliness (p<0.001). CONCLUSIONS: Physician practice patterns are associated with the quality of preventive services delivered to Medicare patients. Ongoing efforts to influence physician practice patterns may have differential effects on different aspects of quality.KEY WORDS: quality of care/patient safety; incentives in health care; payment systems; Medicare.

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Measuring Efficiency: The Association Of Hospital Costs And Quality Of Care

Cited by 129 publications

References 12 publications

Estimation of a physician practice cost function

Estimation of a physician practice cost function

Variation in Quality of Tonsillectomy Perioperative Care and Revisit Rates in Children’s Hospitals

Higher Practice Intensity Is Associated with Higher Quality of Care but More Avoidable Admissions for Medicare Beneficiaries

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