BACKGROUND:Whether safety-net hospitals (SNHs) provide patient-centered care has important implications both for patient outcomes and for how these hospitals will fare under value-based purchasing (VBP). We sought to determine performance and improvement on measures of patient-reported hospital experience among SNHs compared with non-SNHs. METHODS:Our sample consisted of 3096 US hospitals. We defined safety-net hospitals as those hospitals in the highest quartile of the Disproportionate Share Hospital (DSH) index, and we used national data on patient experience from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey in 2007 and 2010 to examine overall hospital performance and improvement over time. RESULTS:Safety-net hospitals had lower performance than non-SNHs on nearly all measures of patient experience. The greatest differences were in overall hospital rating, where patients in SNHs were less likely to rate the hospital a 9 or 10 on a 10-point scale compared with patients in non-SNHs (63.9% vs 69.5%; P < .001). Gaps were also sizeable for the proportion of patients who reported receiving discharge information (2.6 percentage point difference; P < .001) and who thought they always communicated well with physicians (2.2 percentage point difference; P < .001). Although both groups of hospitals improved from 2007 through 2010, the gap between SNHs and non-SNHs increased (3.8% in 2007 vs 5.6% in 2010; P = .08). Finally, SNHs had a 60% lower odds of meeting VBP performance benchmarks for hospital payments (odds ratio, 0.4; 95% CI, 0.3-0.5; P < .001) compared with non-SNHs. CONCLUSIONS:Safety-net hospitals have lower performance than non-SNHs on metrics of patient-reported experience, improved somewhat more slowly under public reporting, and are likely to fare poorly under VBP.

译文

背景:安全网医院(SNHs)是否提供以患者为中心的护理,对患者的结局以及这些医院在基于价值的购买(VBP)下的收费方式都具有重要意义。我们试图确定与非SNH相比,SNH中患者报告的医院经验指标的性能和改进情况。
方法:我们的样本包括3096家美国医院。我们将安全网医院定义为在不成比例共享医院(DSH)指数中排名最高的四分之一的医院,并且我们使用了2007年和2010年《医院医疗保健提供者和系统消费者评估》(HCAHPS)调查中有关患者经验的国家数据,检查医院的整体绩效并随着时间的推移进行改进。
结果:在几乎所有患者体验指标上,安全网医院的绩效均低于非SNH。最大的差异在于医院的整体评分,与非SNH的患者相比,SNH的患者在10分制上对医院的评分为9分或10分的可能性较小(63.9%对69.5%; P <.001)。对于报告接受出院信息的患者比例(2.6个百分点差异; P <.001),并认为他们与医生的沟通始终很好(2.2个百分点差异; P <.001),这部分患者的差距也很大。尽管从2007年到2010年两组医院都有所改善,但SNH与非SNH之间的差距有所增加(2007年为3.8%,2010年为5.6%; P = 0.08)。最后,与非SNH相比,SNH满足医院付款的VBP绩效基准的几率要低60%(赔率,0.4; 95%CI,0.3-0.5; P <.001)。
结论:就患者报告的经验而言,安全网医院的绩效要比非SNH医院低,在公共报告中的改善速度较慢,在VBP的情况下收费可能很差。

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