DOI QR코드

DOI QR Code

고관절 부분 치환술 시술정보 공개에 따른 재입원율, 입원일수 및 진료비의 변화

The Change in Readmission Rate, Length of Stay and Hospital Charge after Performance Reporting of Hip Hemiarthroplasty

  • 장원모 (서울대학교 의과대학 의료관리학교실) ;
  • 은상준 (계명대학교 의과대학 예방의학교실) ;
  • 사공필용 (서울대학교 의과대학 의료관리학교실) ;
  • 이채은 (서울대학교 의학연구원 의료관리학연구소) ;
  • 오무경 (서울대학교 의과대학 의료관리학교실) ;
  • 오주환 (서울대학교 의학연구원 의료관리학연구소) ;
  • 김윤 (서울대학교 의과대학 의료관리학교실)
  • Jang, Won-Mo (Department of Health Policy and Management, Seoul National University College of Medicine) ;
  • Eun, Sang-Jun (Department of Preventive Medicine, Keimyoung University College of Medicine) ;
  • SaGong, Pil-Young (Department of Health Policy and Management, Seoul National University College of Medicine) ;
  • Lee, Chae-Eun (Institute of Health Policy and Management, Medical Research Center, Seoul National University) ;
  • Oh, Moo-Kyung (Department of Health Policy and Management, Seoul National University College of Medicine) ;
  • Oh, Ju-Hwan (Institute of Health Policy and Management, Medical Research Center, Seoul National University) ;
  • Kim, Yoon (Department of Health Policy and Management, Seoul National University College of Medicine)
  • 투고 : 2010.07.26
  • 심사 : 2010.10.12
  • 발행 : 2010.11.30

초록

Objectives: We assessed impact of performance reporting information about the readmission rate, length of stay and cost of hip hemiarthroplasty. Methods: The data are from a nationwide claims database, National Quality Improvement Project database, of Health Insurance Review & Assessment Service in Korea. From January 2006 to April 2008, we received information of length of stay, readmission within 30 days, cost of 22 851 hip hemiarthroplasty episodes. Each episodes has retained the diagnoses of comorbidities and demographics. We used time-series analysis to assess the shifting of patients selections, between high volume (over 16 operations in a year) and low volume institutions, after performance reporting (December 2007). The changes of quality (readmission, length of stay) and cost were evaluated by multilevel analysis with adjustment of patient's factors and institutional factors after performance reporting. Results: As compared with the before performance reporting, the proportion of patients who choose the high volume institution, increased 3.45% and the trends continued 4 months at marginal significance (p = 0.059). After performance reporting, national average readmission rate, length of stay were decreased by 0.49 OR (95% CI=0.25 - 0.95) and 10% (${\beta}$=-0.102, p<0.01) and cost was not changed (${\beta}$=-0.01, p=0.27). The high volume institutions were more decreased than low volume in length of stay. Conclusions: After performance reporting, readmission rate, length of stay were decreased and the patient selections were marginally shifted from low volume institutions to high volume institutions.

키워드

참고문헌

  1. Naylor CD, Iron K, Handa K. Measuring Health System Performance: Problems and unities in the era of assessment and accountability. In: Smith P, editors. Measuring Up: Improving Health system Performance in OECD Countries. Paris: Organization for Economic Cooperation & Development; 2002. p. 13-31.
  2. Berwick DM, James B, Coye MJ. Connections between quality measurement and improvement. Med Care 2003; 41(Suppl 1): I30-I38.
  3. Hibbard JH, Stockard J, Tusler M. Hospital performance reports: impact on quality, market share, and reputation. Health Aff (Millwood) 2005; 24(4): 1150-1160. https://doi.org/10.1377/hlthaff.24.4.1150
  4. Pham HH, Coughlan J, O'Malley AS. The impact of quality-reporting programs on hospital operations. Health Aff (Millwood) 2006; 25(5): 1412-1422. https://doi.org/10.1377/hlthaff.25.5.1412
  5. Fung CH, Lim YW, Mattke S, Damberg C, Shekelle PG. Systematic review: the evidence that publishing patient care performance data improves quality of care. Ann Intern Med 2008; 148(2): 111-123. https://doi.org/10.7326/0003-4819-148-2-200801150-00006
  6. Marshall MN, Shekelle PG, Leatherman S, Brook RH. The public release of performance data: what do we expect to gain? A review of the evidence. JAMA 2000; 283(14): 1866-1874. https://doi.org/10.1001/jama.283.14.1866
  7. Colmers JM. Public Reporting and Transparency: Commonwealth Fund; 2007 Jan [cited 2010 Jun 3]. Available from: http://www.commonwealthfund.org/usr_doc/Colmers_pubreportingtransparency_988.pdf.
  8. Halm EA, Lee C, Chassin MR. Is volume related to outcome in health care? A systematic review and methodologic critique of the literature. Ann Intern Med 2002; 137(6): 511-520. https://doi.org/10.7326/0003-4819-137-6-200209170-00012
  9. Dudley RA, Johansen KL, Brand R, Rennie DJ, Milstein A. Selective referral to high-volume hospitals: estimating potentially avoidable deaths. JAMA 2000; 283(9): 1159-1166. https://doi.org/10.1001/jama.283.9.1159
  10. Shervin N, Rubash HE, Katz JN. Orthopaedic procedure volume and patient outcomes: a systematic literature review. Clin Orthop Relat Res 2007; 457: 35-41. https://doi.org/10.1097/BLO.0b013e3180375514
  11. Paterson JM, Williams JI, Kreder HJ, Mahomed NN, Gunraj N, Wang X, et al. Provider volumes and early outcomes of primary total joint replacement in Ontario. Can J Surg 2010; 53(3): 175-183.
  12. Report of Volume-outcome Indicators: Team for Quality Assessment. Seoul; Health Insurance Review & Assessment Service of Korea; 2009. (Korean)
  13. Benbassat J, Taragin M. Hospital readmissions as a measure of quality of health care: advantages and limitations. Arch Intern Med 2000; 160(8): 1074-1081. https://doi.org/10.1001/archinte.160.8.1074
  14. Cullen C, Johnson DS, Cook G. Re-admission rates within 28 days of total hip replacement. Ann R Coll Surg Engl 2006; 88(5): 475-478. https://doi.org/10.1308/003588406X116909
  15. Karrholm J, Garellick G, Rogmark C, Herberts P. Swedish Hip Arthroplasty Register-annual Report 2008 [cited 2010 Jun 22]. Available from: http:// www.jru.orthop.gu.se/archive/AnnualReport-2008-eng.pdf.
  16. Pulido L, Parvizi J, Macgibeny M, Sharkey PF, Purtill JJ, Rothman RH, et al. In hospital complications after total joint arthroplasty. J Arthroplasty 2008; 23(6 Suppl 1): 139-145. https://doi.org/10.1016/j.arth.2008.05.011
  17. Hahnel J, Burdekin H, Anand S. Re-admissions following hip fracture surgery. Ann R Coll Surg Engl 2009; 91(7): 591-595. https://doi.org/10.1308/003588409X432374
  18. Twisk JW. Longitudinal data analysis. A comparison between generalized estimating equations and random coefficient analysis. Eur J Epidemiol 2004; 19(8): 769-776.
  19. Kim Y, Lee SI, Kwon SM, Kang MA, Choi SE, et al. Effect Analysis & Development of Model on the Quality Improvement Project. Seoul; Health Insurance Review & Assessment Service of Korea; 2009. (Korean)
  20. Birkmeyer JD, Skinner JS, Wennberg DE. Will volumebased referral strategies reduce costs or just save lives? Health Aff (Millwood) 2002; 21(5): 234-241. https://doi.org/10.1377/hlthaff.21.5.234
  21. Baker C. Public Reporting Key to Cost/Quality Improvements in Health Care [cited 2010 Jun 25]. Available from: http://www.mass.gov/Eoaf/docs/gic/pdfs/fybsummer2009.pdf.
  22. Hibbard JH, Jewett JJ. Will quality report cards help consumers? Health Aff (Millwood) 1997; 16(3): 218-228. https://doi.org/10.1377/hlthaff.16.3.218
  23. Schneider EC, Epstein AM. Use of public performance reports: a survey of patients undergoing cardiac surgery. JAMA 1998; 279(20): 1638-1642. https://doi.org/10.1001/jama.279.20.1638
  24. Peters E, Dieckmann N, Dixon A, Hibbard JH, Mertz CK. Less is more in presenting quality information to consumers. Med Care Res Rev 2007; 64(2): 169-190. https://doi.org/10.1177/10775587070640020301
  25. Hibbard JH, Greene J, Daniel D. What is quality anyway? Performance reports that clearly communicate to consumers the meaning of quality of care. Med Care Res Rev 2010; 67(3): 275-293. https://doi.org/10.1177/1077558709356300
  26. Moser A, Korstjens I, van der Weijden T, Tange H. Themes affecting health-care consumers' choice of a hospital for elective surgery when receiving web-based comparative consumer information. Patient Educ Couns 2010; 78(3): 365-371. https://doi.org/10.1016/j.pec.2009.10.027
  27. Chassin MR. Achieving and sustaining improved quality: lessons from New York State and cardiac surgery. Health Aff (Millwood) 2002; 21(4): 40-51. https://doi.org/10.1377/hlthaff.21.4.40
  28. Jha AK, Epstein AM. The predictive accuracy of the New York State coronary artery bypass surgery report-card system. Health Aff (Millwood) 2006; 25(3): 844-855. https://doi.org/10.1377/hlthaff.25.3.844
  29. Romano PS, Zhou H. Do well-publicized risk-adjusted outcomes reports affect hospital volume? Med Care 2004; 42(4): 367-377. https://doi.org/10.1097/01.mlr.0000118872.33251.11
  30. Baker DW, Einstadter D, Thomas C, Husak S, Gordon NH, Cebul RD. The effect of publicly reporting hospital performance on market share and risk-adjusted mortality at high-mortality hospitals. Med Care 2003; 41(6): 729-740.
  31. Kim CY, Ko SK, Kim KY. Are league tables controlling epidemic of Caesarean sections in South Korea? BJOG 2005; 112(5): 607-611. https://doi.org/10.1111/j.1471-0528.2004.00481.x
  32. Khang YH, Yun SC, Jo MW, Lee MS, Lee SI. Public release of institutional Cesarean section rates in South Korea: which women were aware of the information? Health Policy 2008; 86(1): 10-16. https://doi.org/10.1016/j.healthpol.2007.09.012
  33. Lindenauer P. Public reporting and pay-for-performance programs in perioperative medicine: are they meeting their goals? Cleve Clin J Med 2009; (76 Suppl 4): S3-S8. https://doi.org/10.3949/ccjm.76.s4.01
  34. Min HJ. A Study on the Criteria for Selection of Medical Care Facilities by Outpatient [dissertation]. Nonsan: Konyang University; 2004. (Korean)
  35. Park BJ, Sung JH, Park KD, Seo SW, Kim SH. Improvemnt of Validation of National Health Insurance Claims Data Disease Code and Claim Data Utilization Strategy. Seoul: Health Insurance & Review Assessment; 2003. p. 19-30. (Korean)

피인용 문헌

  1. 정보 공개에 따른 지역별 항생제 처방률 변이에 영향을 미치는 요인 - 전국 시군구 의원을 중심으로 - vol.22, pp.3, 2010, https://doi.org/10.4332/kjhpa.2012.22.3.427