Public‐private partnerships in non‐profit hospitals: Case study of China

The gap between supply and demand for health care services is expanding rapidly in China. In order to resolve this problem, the government has implemented supply‐side reforms in the health care sector by inviting private capital to increase supply quantity and improve quality. However, health care institutions have high complexity and particular needs, while non‐profit hospitals have very strong public interests. This gives rise to complications in the implementation of public‐private partnerships (PPPs) for health care services. In this paper, the authors have selected one case each from three different models of non‐profit hospital PPP projects in the national PPP project database, operated by the Ministry of Finance, and compared how these projects were operated to identify the differences among them. A content analysis of the vital project documents is the primary analysis technique used for this comparison. Key issues investigated include reasons for model selection, requirements for private sectors and market competition level in different models, risk identification and sharing, design of payment mechanism, operation supervision, and performance appraisal of the project. Based on the comparison, some key lessons and recommendations are discussed to act as a useful reference for future non‐profit hospital PPP projects in China.     

医保总额控制下大型公立医院经营策略探讨

为解决医疗费用过快上涨、医保对供方行为约束不足、基金运行风险加剧等问题,人力资源和社会保障部等要求在统筹地区开展以总额控制为主的医保支付方式改革.总额控制对城市大型公立医院的经营管理产生了较大的影响.按照总额控制政策,提出3个层面的转型策略.在发展战略方面,转变增长方式,发挥医联体作用,增强辐射能力;在业务管理方面,确保医疗质量和安全,落实临床路径,优化服务流程;在行政管理方面,强化成本控制,加强信息化建设,转变管理职能.     

河南省5所公立医院住院患者就医体验调查

目的 了解河南省公立医院住院患者就医体验状况及其影响因素.方法 使用自行设计的住院患者体验量表(IPEQ),采用随机抽样的方法,对河南省5所公立三级甲等医院的500名住院患者进行现场调查.结果 患者就医体验的总体满意度为8.48分,其中技术水平满意度最高(4.19分)、情感支持的满意度最低(3.31分).相关性分析显示,医生技术水平与患者体验相关程度最高(0.652).结论 河南省公立医院住院患者总体体验满意度较高,但医院在人文关怀和服务流程等方面需进一步改善.     

医院内外感染葡萄球菌的耐药性分析

目的分析医院内与院外感染葡萄球菌的耐药性,为临床用药提供依据。方法收集2011年1月至2013年12月黄石市中心医院门诊(院外)、住院(院内)患者各种标本中分离的454株葡萄球菌,用VITEK-32专用卡GPI及血浆凝固酶试验进行鉴定,药敏试验按K-B琼脂扩散法进行,根据美国临床和实验室标准化协会2006对头孢西丁的耐药情况进行分类分析,数据分析用WHONET 5.5药敏分析软件。结果在379株金黄色葡萄球菌(SA)中,耐甲氧西林金黄色葡萄球菌(MRSA)检出率为41.2%,医院内、外标本MRSA检出率分别为44.1%和19.6%,差异有统计学意义(P0.05);共检出凝固酶阴性葡萄球菌75株,医院内、外标本耐甲氧西林凝固酶阴性葡萄球菌(MRCNS)检出率分别为61.1%和38.1%,差异有统计学意义(P0.05)。未检出万古霉素、替考拉宁耐药菌株。结论耐甲氧西林葡萄球菌具有多重耐药性;院外SA感染者首选药物为庆大霉素、苯唑西林;若为院内SA和对于MRCNS引起的不论是院内或院外感染,均推荐首选万古霉素或替考拉宁。     

Challenges and remediation for Patient Safety Indicators in the transition to ICD-10-CM

Reporting of hospital adverse events relies on Patient Safety Indicators (PSIs) using International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) codes. The US transition to ICD-10-CM in 2015 could result in erroneous comparisons of PSIs. Using the General Equivalent Mappings (GEMs), we compared the accuracy of ICD-9-CM coded PSIs against recommended ICD-10-CM codes from the Centers for Medicaid/Medicare Services (CMS). We further predict their impact in a cohort of 38 644 patients (1 446 581 visits and 399 hospitals). We compared the predicted results to the published PSI related ICD-10-CM diagnosis codes. We provide the first report of substantial hospital safety reporting errors with five direct comparisons from the 23 types of PSIs (transfusion and anesthesia related PSIs). One PSI was excluded from the comparison between code sets due to reorganization, while 15 additional PSIs were inaccurate to a lesser degree due to the complexity of the coding translation. The ICD-10-CM translations proposed by CMS pose impending risks for (1) comparing safety incidents, (2) inflating the number of PSIs, and (3) increasing the variability of calculations attributable to the abundance of coding system translations. Ethical organizations addressing ‘data-, process-, and system-focused’ improvements could be penalized using the new ICD-10-CM Agency for Healthcare Research and Quality PSIs because of apparent increases in PSIs bearing the same PSI identifier and label, yet calculated differently. Here we investigate which PSIs would reliably transition between ICD-9-CM and ICD-10-CM, and those at risk of under-reporting and over-reporting adverse events while the frequency of these adverse events remain unchanged.     

The Early Effects of Medicare's Mandatory Hospital Pay‐for‐Performance Program

Objective

To evaluate the impact of hospital value-based purchasing (HVBP) on clinical quality and patient experience during its initial implementation period (July 2011–March 2012).

Data Sources

Hospital-level clinical quality and patient experience data from Hospital Compare from up to 5 years before and three quarters after HVBP was initiated.

Study Design

Acute care hospitals were exposed to HVBP by mandate while critical access hospitals and hospitals located in Maryland were not exposed. We performed a difference-in-differences analysis, comparing performance on 12 incentivized clinical process and 8 incentivized patient experience measures between hospitals exposed to the program and a matched comparison group of nonexposed hospitals. We also evaluated whether hospitals that were ultimately exposed to HVBP may have anticipated the program by improving quality in advance of its introduction.

Principal Findings

Difference-in-differences estimates indicated that hospitals that were exposed to HVBP did not show greater improvement for either the clinical process or patient experience measures during the program''s first implementation period. Estimates from our preferred specification showed that HVBP was associated with a 0.51 percentage point reduction in composite quality for the clinical process measures (p > .10, 95 percent CI: −1.37, 0.34) and a 0.30 percentage point reduction in composite quality for the patient experience measures (p > .10, 95 percent CI: −0.79, 0.19). We found some evidence that hospitals improved performance on clinical process measures prior to the start of HVBP, but no evidence of this phenomenon for the patient experience measures.

Conclusions

The timing of the financial incentives in HVBP was not associated with improved quality of care. It is unclear whether improvement for the clinical process measures prior to the start of HVBP was driven by the expectation of the program or was the result of other factors.     

EHR Adoption and Hospital Performance: Time‐Related Effects

Objective

To assess whether, 5 years into the HITECH programs, national data reflect a consistent relationship between EHR adoption and hospital outcomes across three important dimensions of hospital performance.

Data Sources/Study Setting

Secondary data from the American Hospital Association and CMS (Hospital Compare and EHR Incentive Programs) for nonfederal, acute‐care hospitals (2009–2012).

Study Design

We examined the relationship between EHR adoption and three hospital outcomes (process adherence, patient satisfaction, efficiency) using ordinary least squares models with hospital fixed effects. Time‐related effects were assessed through comparing the impact of EHR adoption pre (2008/2009) versus post (2010/2011) meaningful use and by meaningful use attestation cohort (2011, 2012, 2013, Never). We used a continuous measure of hospital EHR adoption based on the proportion of electronic functions implemented.

Data Collection/Extraction Methods

We created a panel dataset with hospital‐year observations.

Principal Findings

Higher levels of EHR adoption were associated with better performance on process adherence (0.147; p < .001) and patient satisfaction (0.118; p < .001), but not efficiency (0.01; p = .78). For all three outcomes, there was a stronger, positive relationship between EHR adoption and performance in 2010/2011 compared to 2008/2009. We found mixed results based on meaningful use attestation cohort.

Conclusions

Performance gains associated with EHR adoption are apparent in more recent years. The large national investment in EHRs appears to be delivering more consistent benefits than indicated by earlier national studies.