Systematic review and meta-analysis on the effect of hospital competition on quality of care: Implications for senior care |
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| Affiliation: | 1. Department of Health Business Administration, Hungkuang University Taichung, Taiwan;2. Department of Health, Policy and Management, Johns Hopkins University, Baltimore, United States;3. Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan;4. Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan;1. Kafkas University Medical Faculty, Department of Cardiology, Kars, Turkey;2. Kars Harakani State Hospital, Department of Cardiology, Kars, Turkey;3. Health Science University, Sultan Abdulhamid Han Training and Research Hospital, Department of Cardiology, Istanbul, Turkey;4. Ankara Diskapi Yildirim Beyazit Training and Research Hospital, Department of Cardiology, Ankara, Turkey;5. Ataturk University Medical Faculty, Department of Cardiology, Erzurum, Turkey;1. Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway;2. Faculty of Health Sciences, University of Stavanger, Stavanger, Norway;3. Semillero de Neurociencias y Envejecimiento, Ageing Institute, Medical School, Pontificia Universidad Javeriana, Bogotá, Colombia;4. Geriatrics Unit, Hospital Universitario San Ignacio, Bogotá, Colombia;5. Department of Internal Medicine, Division of Geriatric and Palliative Medicine, University of Texas Health Science Center at Houston, Houston, USA;6. Geriatric Epidemiology Research Department, Instituto Nacional De Geriatría, México City, Mexico;7. Geriatric Medicine Research Unit, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada;1. Department of Geriatric Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan;2. Aging and Health Research Center, National Yang-Ming University, Taipei, Taiwan;3. Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan;4. Health Data Research Center, National Taiwan University, Taipei, Taiwan;5. Graduate Institute of Clinical Pharmacy, National Taiwan University, Taipei, Taiwan;6. Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan;7. National Health Insurance Administration, Taipei, Taiwan;8. School of Pharmacy, National Taiwan University, Taipei, Taiwan |
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| Abstract: | BackgroundEmpirical studies examined the associations between hospital competition and quality of care by using different methodology, measures, patient groups and geographic locations; however, results remained inconclusive. This study aimed to apply meta-analysis to evaluate the effect of hospital competition on quality of care and to explore the potential implications to care for senior patients.MethodsA systematic review and meta-analysis combining results from various studies to obtain an overall outcome was performed. Measure of effect size, I2 test, meta-regression to find sources of heterogeneity, tests for publication bias, sensitivity analysis and cumulative analysis were performed. The mean effect size is estimated by coefficient and standard error with P values less than 0.05 which was considered statistically significant.ResultsBased on the selection criteria, only 11 studies were eligible for this meta-analysis. The pooled effect of hospital competition on quality of care was reported by all of the 11 included studies. Results of the meta-analysis suggested that hospital competition reduced quality of care, but the overall effect was relatively insignificant from a statistical perspective (Point estimate = 0.008, 95% CI = -0.004 ˜ 0.020, P > 0.05).ConclusionsHospital competition slightly increased mortality rates of acute myocardial infarction, but not statistically significant. The negative impact may be lessened over time as medical technology, practices, and techniques improve. Older patients with complex care needs may be at risk for poorer quality of care related to hospital competition. |
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| Keywords: | Hospital competition Quality of care Elderly Acute myocardial infarction Meta-analysis |
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