Variations in healthcare measures by insurance status for patients receiving ventilator support.

M A Schnitzler, D L Lambert, L M Mundy, R S Woodward
{"title":"Variations in healthcare measures by insurance status for patients receiving ventilator support.","authors":"M A Schnitzler,&nbsp;D L Lambert,&nbsp;L M Mundy,&nbsp;R S Woodward","doi":"","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To examine differences in healthcare delivery by expected health insurance status for hospitalized patients in diagnosis-related group (DRG) 475, respiratory system diagnoses requiring intubation and continuous ventilator support.</p><p><strong>Design: </strong>A survey, derived from the Healthcare Cost and Utilization Project interstate database, of the care delivered to 21,149 adult patients in DRG 475 and hospitalized in one of 718 acute-care hospitals in nine states. Multivariate analysis was performed, controlling for demographic and hospital factors.</p><p><strong>Results: </strong>Patients insured by health maintenance organizations (HMOs) had significantly lower rates of inpatient mortality (odds ratio [OR], 0.84; 95% confidence interval [CI95], 0.73-0.96), 14.3 more procedures performed (CI95, 11.5-17.2), 7.0% shorter hospitalizations (CI95, 12.5-1.6), and 5.2% higher charges (CI95, 0.4-10.0) than those with traditional private insurance. In addition, patients insured by Medicaid had 3.5% more procedures performed (CI95, 1.6-5.4), 10.4% longer lengths of hospitalization (CI95, 6.7-14.0), and 13.8% higher charges (CI95, 10.6-17.0) than those with traditional private insurance. Finally, the uninsured had significantly lower rates of inpatient mortality (OR, 0.87; CI95, 0.77-0.99), 8.5% more procedures performed (CI95, 6.0-11.1), 16.5% shorter hospitalizations (CI95, 21.5-11.6), and 13.4% lower charges (CI95, 17.8-9.0) than those with traditional private insurance.</p><p><strong>Conclusion: </strong>Variations in healthcare measures by insurance status for this DRG emphasize the importance of more careful analyses of insurance categories as a determinant of healthcare access and outcomes. Expected insurance status was an independent predictor of cost. Private insurance and HMO populations differed significantly in outcome and cannot be considered equivalent.</p>","PeriodicalId":79831,"journal":{"name":"Clinical performance and quality health care","volume":"6 1","pages":"17-22"},"PeriodicalIF":0.0000,"publicationDate":"1998-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical performance and quality health care","FirstCategoryId":"1085","ListUrlMain":"","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0

Abstract

Objective: To examine differences in healthcare delivery by expected health insurance status for hospitalized patients in diagnosis-related group (DRG) 475, respiratory system diagnoses requiring intubation and continuous ventilator support.

Design: A survey, derived from the Healthcare Cost and Utilization Project interstate database, of the care delivered to 21,149 adult patients in DRG 475 and hospitalized in one of 718 acute-care hospitals in nine states. Multivariate analysis was performed, controlling for demographic and hospital factors.

Results: Patients insured by health maintenance organizations (HMOs) had significantly lower rates of inpatient mortality (odds ratio [OR], 0.84; 95% confidence interval [CI95], 0.73-0.96), 14.3 more procedures performed (CI95, 11.5-17.2), 7.0% shorter hospitalizations (CI95, 12.5-1.6), and 5.2% higher charges (CI95, 0.4-10.0) than those with traditional private insurance. In addition, patients insured by Medicaid had 3.5% more procedures performed (CI95, 1.6-5.4), 10.4% longer lengths of hospitalization (CI95, 6.7-14.0), and 13.8% higher charges (CI95, 10.6-17.0) than those with traditional private insurance. Finally, the uninsured had significantly lower rates of inpatient mortality (OR, 0.87; CI95, 0.77-0.99), 8.5% more procedures performed (CI95, 6.0-11.1), 16.5% shorter hospitalizations (CI95, 21.5-11.6), and 13.4% lower charges (CI95, 17.8-9.0) than those with traditional private insurance.

Conclusion: Variations in healthcare measures by insurance status for this DRG emphasize the importance of more careful analyses of insurance categories as a determinant of healthcare access and outcomes. Expected insurance status was an independent predictor of cost. Private insurance and HMO populations differed significantly in outcome and cannot be considered equivalent.

分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
接受呼吸机支持的患者的保险状况在医疗保健措施方面的差异。
目的:探讨诊断相关组(DRG) 475、呼吸系统诊断需要插管和持续呼吸机支持的住院患者的预期健康保险状况对医疗服务的影响。设计:一项来自医疗保健成本和利用项目州际数据库的调查,调查了DRG 475中21,149名成年患者的护理情况,这些患者在9个州的718家急性护理医院中的一家住院。进行多因素分析,控制人口统计学和医院因素。结果:健康维护组织(HMOs)参保患者住院死亡率显著低于参保组(优势比[OR], 0.84;95%可信区间[CI95], 0.73-0.96),比传统私人保险多执行14.3次手术(CI95, 11.5-17.2),住院时间缩短7.0% (CI95, 12.5-1.6),费用高5.2% (CI95, 0.4-10.0)。此外,与传统私人保险相比,接受医疗补助的患者的手术次数多3.5% (CI95, 1.6-5.4),住院时间长10.4% (CI95, 6.7-14.0),费用高13.8% (CI95, 10.6-17.0)。最后,未参保者的住院死亡率显著低于参保者(OR, 0.87;CI95, 0.77-0.99),比传统私人保险多8.5%的程序(CI95, 6.0-11.1), 16.5%的住院时间(CI95, 21.5-11.6), 13.4%的费用(CI95, 17.8-9.0)。结论:在本DRG中,不同保险状况的医疗保健措施的差异强调了更仔细地分析保险类别作为医疗保健获取和结果的决定因素的重要性。预期保险状况是成本的独立预测因子。私人保险和HMO人群在结果上有显著差异,不能认为是等同的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 去求助
来源期刊
自引率
0.00%
发文量
0
期刊最新文献
Comparison of clinical indicators for performance measurement of health care quality: a cautionary note. An audit of psychiatric case notes in relation to antipsychotic medication and information giving. Clinical governance: its origins and its foundations. Clinical effectiveness on an acute in-patient psychiatric unit. Clinical governance and clinical documentation: still a long way to go?
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1