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1.
N Z Med J ; 134(1544): 81-88, 2021 10 22.
Artigo em Inglês | MEDLINE | ID: mdl-34695095

RESUMO

BACKGROUND: A minor operations clinic has been providing a "one-stop shop" at our regional New Zealand hospital for the past decade to service management of skin lesions. This study aims to assess demographics, service characteristics, clinical standards and cost-savings from this setup, and to identify areas for improvement and potentially provide a model for other health units. METHODS: All patients seen between May 2009 and June 2019 were prospectively included. Data includes demographics, waitlist period, referral sources, follow-up destinations, histology including involvement of margins and cost. RESULTS: A total of 4,926 patients were included, with 6,442 procedures overall. Median age was 72 years old. The main source of referrals was primary care. The majority of patients were returned directly to primary care. Median wait-time was 66 days, and this remained static over the decade. 56.6% of excised lesions yielded malignant histology and 90.1% achieved clear margins. There was a calculated saving of NZ$607.00 per patient with our one-stop shop compared to our previous traditional model. A further calculated saving of NZ$452,028.50 was achieved by diverting complex procedures from requiring operating theatre environments. CONCLUSIONS: Our model provides successful, streamlined and cost-effective treatment of skin lesions for our community. This model (or aspects of) may be similarly effective in other regional centres.


Assuntos
Instituições de Assistência Ambulatorial/economia , Dermatopatias/economia , Idoso , Redução de Custos , Análise Custo-Benefício , Economia Hospitalar , Feminino , Humanos , Masculino , Nova Zelândia , Estudos Prospectivos , Encaminhamento e Consulta , Dermatopatias/terapia
2.
Dig Dis Sci ; 66(11): 3635-3658, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34518939

RESUMO

AIM: To report revolutionary reorganization of academic gastroenterology division from COVID-19 pandemic surge at metropolitan Detroit epicenter from 0 infected patients on March 9, 2020, to > 300 infected patients in hospital census in April 2020 and > 200 infected patients in April 2021. SETTING: GI Division, William Beaumont Hospital, Royal Oak, has 36 GI clinical faculty; performs > 23,000 endoscopies annually; fully accredited GI fellowship since 1973; employs > 400 house staff annually since 1995; tertiary academic hospital; predominantly voluntary attendings; and primary teaching hospital, Oakland-University-Medical-School. METHODS: This was a prospective study. Expert opinion. Personal experience includes Hospital GI chief > 14 years until 2020; GI fellowship program director, several hospitals > 20 years; author of > 300 publications in peer-reviewed GI journals; committee-member, Food-and-Drug-Administration-GI-Advisory Committee > 5 years; and key hospital/medical school committee memberships. Computerized PubMed literature review was performed on hospital changes and pandemic. Study was exempted/approved by Hospital IRB, April 14, 2020. RESULTS: Division reorganized patient care to add clinical capacity and minimize risks to staff of contracting COVID-19 infection. Affiliated medical school changes included: changing "live" to virtual lectures; canceling medical student GI electives; exempting medical students from treating COVID-19-infected patients; and graduating medical students on time despite partly missing clinical electives. Division was reorganized by changing "live" GI lectures to virtual lectures; four GI fellows temporarily reassigned as medical attendings supervising COVID-19-infected patients; temporarily mandated intubation of COVID-19-infected patients for esophagogastroduodenoscopy; postponing elective GI endoscopies; and reducing average number of endoscopies from 100 to 4 per weekday during pandemic peak! GI clinic visits reduced by half (postponing non-urgent visits), and physical visits replaced by virtual visits. Economic pandemic impact included temporary, hospital deficit subsequently relieved by federal grants; hospital employee terminations/furloughs; and severe temporary decline in GI practitioner's income during surge. Hospital temporarily enhanced security and gradually ameliorated facemask shortage. GI program director contacted GI fellows twice weekly to ameliorate pandemic-induced stress. Divisional parties held virtually. GI fellowship applicants interviewed virtually. Graduate medical education changes included weekly committee meetings to monitor pandemic-induced changes; program managers working from home; canceling ACGME annual fellowship survey, changing ACGME physical to virtual site visits; and changing national conventions from physical to virtual. CONCLUSION: Reports profound and pervasive GI divisional changes to maximize clinical resources devoted to COVID-19-infected patients and minimize risks of transmitting infection.


Assuntos
COVID-19/economia , COVID-19/epidemiologia , Economia Hospitalar/organização & administração , Gastroenterologia/educação , Administração Hospitalar/métodos , SARS-CoV-2 , Cidades/economia , Cidades/epidemiologia , Educação de Pós-Graduação em Medicina/organização & administração , Gastroenterologia/economia , Administração Hospitalar/economia , Humanos , Internato e Residência , Michigan/epidemiologia , Afiliação Institucional/economia , Afiliação Institucional/organização & administração , Estudos Prospectivos , Faculdades de Medicina/organização & administração
3.
Ann Intern Med ; 174(10): 1447-1449, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34487452

RESUMO

The steady growth of corporate interest and influence in the health care sector over the past few decades has created a more business-oriented health care system in the United States, helping to spur for-profit and private equity investment. Proponents say that this trend makes the health care system more efficient, encourages innovation, and provides financial stability to ensure access and improve care. Critics counter that such moves favor profit over care and erode the patient-physician relationship. American College of Physicians (ACP) underscores that physicians are permitted to earn a reasonable income as long as they are fulfilling their fiduciary responsibility to provide high-quality, appropriate care within the guardrails of medical professionalism and ethics. In this position paper, ACP considers the effect of mergers, integration, private equity investment, nonprofit hospital requirements, and conversions from nonprofit to for-profit status on patients, physicians, and the health care system.


Assuntos
Atenção à Saúde/economia , Administração Financeira , Política Organizacional , Sociedades Médicas , Atenção à Saúde/ética , Atenção à Saúde/organização & administração , Atenção à Saúde/normas , Economia Hospitalar/ética , Economia Hospitalar/organização & administração , Economia Hospitalar/normas , Administração Financeira/ética , Administração Financeira/normas , Instituições Privadas de Saúde/economia , Instituições Privadas de Saúde/ética , Instituições Privadas de Saúde/normas , Humanos , Relações Médico-Paciente/ética , Médicos/economia , Médicos/ética , Médicos/normas , Qualidade da Assistência à Saúde/economia , Qualidade da Assistência à Saúde/organização & administração , Qualidade da Assistência à Saúde/normas , Sociedades Médicas/normas , Estados Unidos
4.
N Engl J Med ; 385(7): 618-627, 2021 08 12.
Artigo em Inglês | MEDLINE | ID: mdl-34379923

RESUMO

BACKGROUND: The Center for Medicare and Medicaid Innovation launched the Medicare Bundled Payments for Care Improvement-Advanced (BPCI-A) program for hospitals in October 2018. Information is needed about the effects of the program on health care utilization and Medicare payments. METHODS: We conducted a modified segmented regression analysis using Medicare claims and including patients with discharge dates from January 2017 through September 2019 to assess differences between BPCI-A participants and two control groups: hospitals that never joined the BPCI-A program (nonjoining hospitals) and hospitals that joined the BPCI-A program in January 2020, after the conclusion of the intervention period (late-joining hospitals). The primary outcomes were the differences in changes in quarterly trends in 90-day per-episode Medicare payments and the percentage of patients with readmission within 90 days after discharge. Secondary outcomes were mortality, volume, and case mix. RESULTS: A total of 826 BPCI-A participant hospitals were compared with 2016 nonjoining hospitals and 334 late-joining hospitals. Among BPCI-A hospitals, the mean baseline 90-day per-episode Medicare payment was $27,315; the change in the quarterly trends in the intervention period as compared with baseline was -$78 per quarter. Among nonjoining hospitals, the mean baseline 90-day per-episode Medicare payment was $25,994; the change in quarterly trends as compared with baseline was -$26 per quarter (difference between nonjoining hospitals and BPCI-A hospitals, $52 [95% confidence interval {CI}, 34 to 70] per quarter; P<0.001; 0.2% of the baseline payment). Among late-joining hospitals, the mean baseline 90-day per-episode Medicare payment was $26,807; the change in the quarterly trends as compared with baseline was $4 per quarter (difference between late-joining hospitals and BPCI-A hospitals, $82 [95% CI, 41 to 122] per quarter; P<0.001; 0.3% of the baseline payment). There were no meaningful differences in the changes with regard to readmission, mortality, volume, or case mix. CONCLUSIONS: The BPCI-A program was associated with small reductions in Medicare payments among participating hospitals as compared with control hospitals. (Funded by the National Heart, Lung, and Blood Institute.).


Assuntos
Economia Hospitalar , Medicare/economia , Pacotes de Assistência ao Paciente/economia , Melhoria de Qualidade/economia , Mecanismo de Reembolso , Idoso , Idoso de 80 Anos ou mais , Grupos Diagnósticos Relacionados , Cuidado Periódico , Feminino , Insuficiência Cardíaca/terapia , Hospitais/normas , Hospitais/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade , Readmissão do Paciente/estatística & dados numéricos , Análise de Regressão , Estados Unidos
5.
Heart Lung Circ ; 30(12): 1863-1869, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34083151

RESUMO

BACKGROUND: Elderly patients with acute coronary syndromes (ACS) are at higher risk for complications and health care resources expenditure. No previous study has assessed the specific contribution of frailty and other geriatric syndromes to the in-hospital economic cost in this setting. METHOD: Unselected patients with ACS aged ≥75 years were prospectively included. A comprehensive geriatric assessment was performed during hospitalisation. Hospitalisation-related cost per patient was calculated with an analytical accountability method, including hospital stay-related expenditures, interventions, and consumption of devices. Expenditure was expressed in Euros (2019). The contribution of geriatric syndromes and clinical factors to the economic cost was assessed with a linear regression method. RESULTS: A total of 194 patients (mean age 82.6 years) were included. Mean length of hospital stay was 11.3 days. The admission-related economic cost was €6,892.15 per patient. Most of this cost was attributable to hospital length of stay (77%). The performance of an invasive strategy during the admission was associated with economic cost (p=0.008). Of all the ageing-related variables, comorbidity showed the most significant association with economic cost (p=0.009). Comorbidity, disability, nutritional risk, and frailty were associated with the hospital length of stay-related component of the economic cost. The final predictive model of economic cost included age, previous heart failure, systolic blood pressure, Killip class at admission, left main disease, and Charlson index. CONCLUSIONS: Management of ACS in elderly patients is associated with a significant economic cost, mostly due to hospital length of stay. Comorbidity mostly contributes to in-hospital resources expenditure, as well as the severity of the coronary event.


Assuntos
Síndrome Coronariana Aguda , Fragilidade , Síndrome Coronariana Aguda/epidemiologia , Síndrome Coronariana Aguda/terapia , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Economia Hospitalar , Fragilidade/epidemiologia , Avaliação Geriátrica , Humanos , Tempo de Internação , Estudos Prospectivos
6.
Int J Health Serv ; 51(4): 559-569, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34029171

RESUMO

Health care-based negative production externalities, such as greenhouse gas emissions, underscore the need for hospitals to implement sustainable practices. Eco-certification has been adopted by a number of providers in an attempt, for instance, to curb energy consumption. While these strategies have been evaluated with respect to cost savings, their implications pertaining to hospitals' financial viability remain unknown. We specify a fixed-effects model to estimate the correlation between Energy Star certification and 3 different hospitals' financial performance measures (net patient revenue, operating expenses, and operating margin) in the United States between 2000 and 2016. The Energy Star participation indicators' parameters imply that this type of eco-certification is associated with lower net patient revenue and lower operating expenses. However, the estimated negative relationship between eco-certification and operating margin suggests that the savings in operating expenses are not enough for a hospital to achieve higher margins. These findings may indicate that undertaking sustainable practices is partially related to intangible benefits such as community reputation and highlight the importance of government policies to financially support hospitals' investments in green practices.


Assuntos
Economia Hospitalar , Hospitais , Certificação , Humanos , Renda , Estudos Longitudinais , Estados Unidos
12.
Gac. sanit. (Barc., Ed. impr.) ; 35(1): 21-27, ene.-feb. 2021. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-202091

RESUMO

OBJETIVO: El objetivo de este trabajo es demostrar que es posible monetizar el valor social que genera un hospital y que con su análisis podemos establecer una perspectiva diferente para analizar la eficiencia del gasto público. MÉTODO: Utilizando el método del caso se ha seleccionado un hospital público en España. Es idóneo por dos razones: primero, porque su actividad es pequeña y esto facilita el diálogo con los stakeholders; y segundo, como es un hospital de carácter residencial, permite realizar una experiencia de aproximación de la contabilidad social en hospitales sencilla, modificable y que es posible testar. RESULTADOS: Se establece la traducción monetaria de la actividad de un hospital, incluyendo la parte social de las transacciones económicas (mercado), las variables que no han supuesto transacción económica, pero han sido percibidas y valoradas por los stakeholders (no mercado), y la satisfacción de los stakeholders (emocional). Este valor socioemocional asciende a aproximadamente 60 millones de euros anuales para el periodo de 2013 a 2017. CONCLUSIONES: El valor social generado para los stakeholders, y su monetización, permiten gestionar de forma más eficiente las decisiones hacia el propósito social de los hospitales públicos. En concreto, el índice de valor social añadido puede ser una herramienta para la eficiencia social del hospital, ya que se establece cuánto valor social genera a partir de la financiación pública que le han asignado. Así, la disminución de este valor en los últimos años denota un problema que, sin este análisis con perspectiva social y desde los stakeholders, no podría haberse detectado


OBJECTIVE: The objective of this paper is to demonstrate that it is possible to monetize the social value generated by a hospital and use it to establish a different perspective to analyze the efficiency of public spending. METHOD: A public hospital in Spain was selected using the case method. It is suitable for two reasons; first, the hospital activity is small and therefore dialogue with stakeholders is easy; and second, as it is a hospital of a residential nature, it allows an easy, modifiable and testable approximation of social accounting in hospitals. RESULTS: It establishes the monetary translation of the activity of a hospital, including the social part of the economic transactions (market), the variables that have not been created based on economic transaction, but have been perceived and valued by the stakeholders (not market), and the satisfaction of the stakeholders (emotional). This socio-emotional value amounts to approximately 60 million Euros per year from 2013 to 2017. CONCLUSIONS: The social value generated for the stakeholders, and its monetization, allows more efficient management of decisions towards the social purpose of public hospitals. In particular, the social value added index can be a tool for the social-efficiency of hospitals, as it establishes how much social value it generates from the public funding allocated to it. Thus, the decline in this value in recent years denotes a problem that, without this analysis with a social perspective and from the stakeholders, could not have been detected


Assuntos
Humanos , Valores Sociais , Eficiência Organizacional , Economia Hospitalar , Despesas Públicas , Participação dos Interessados , Hospitais Públicos/economia , Proposta de Concorrência/economia , Contabilidade/economia
14.
Med Care ; 59(3): 213-219, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33427797

RESUMO

BACKGROUND: In anticipation of a demand surge for hospital beds attributed to the coronavirus pandemic (COVID-19) many US states have mandated that hospitals postpone elective admissions. OBJECTIVES: To estimate excess demand for hospital beds due to COVID-19, the net financial impact of eliminating elective admissions in order to meet demand, and to explore the scenario when demand remains below capacity. RESEARCH DESIGN: An economic simulation to estimate the net financial impact of halting elective admissions, combining epidemiological reports, the US Census, American Hospital Association Annual Survey, and the National Inpatient Sample. Deterministic sensitivity analyses explored the results while varying assumptions for demand and capacity. SUBJECTS: Inputs regarding disease prevalence and inpatient utilization were representative of the US population. Our base case relied on a hospital admission rate reported by the Center for Disease Control and Prevention of 137.6 per 100,000, with the highest rates in people aged 65 years and older (378.8 per 100,000) and 50-64 years (207.4 per 100,000). On average, elective admissions accounted for 20% of total hospital admissions, and the average rate of unoccupied beds across hospitals was 30%. MEASURES: Net financial impact of halting elective admissions. RESULTS: On average, hospitals COVID-19 demand for hospital bed-days fell well short of hospital capacity, resulting in a substantial financial loss. The net financial impact of a 90-day COVID surge on a hospital was only favorable under a narrow circumstance when capacity was filled by a high proportion of COVID-19 cases among hospitals with low rates of elective admissions. CONCLUSIONS: Hospitals that restricted elective care took on a substantial financial risk, potentially threatening viability. A sustainable public policy should therefore consider support to hospitals that responsibly served their communities through the crisis.


Assuntos
COVID-19/epidemiologia , Economia Hospitalar/estatística & dados numéricos , Procedimentos Cirúrgicos Eletivos/economia , Adulto , Idoso , Ocupação de Leitos/economia , Ocupação de Leitos/estatística & dados numéricos , Feminino , Número de Leitos em Hospital/estatística & dados numéricos , Humanos , Reembolso de Seguro de Saúde/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Método de Monte Carlo , Pandemias , SARS-CoV-2 , Estados Unidos/epidemiologia
15.
Health Aff (Millwood) ; 40(1): 82-90, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33400570

RESUMO

States' decisions to expand Medicaid may have important implications for their hospitals' financial ability to weather the coronavirus disease 2019 (COVID-19) pandemic. This study estimated the effects of the Affordable Care Act (ACA) Medicaid expansion on hospital finances in 2017 to update earlier findings. The analysis also explored how the ACA Medicaid expansion affects different types of hospitals by size, ownership, rurality, and safety-net status. We found that the early positive financial impact of Medicaid expansion was sustained in fiscal years 2016 and 2017 as hospitals in expansion states continued to experience decreased uncompensated care costs and increased Medicaid revenue and financial margins. The magnitude of these impacts varied by hospital type. As COVID-19 has brought hospitals to a time of great need, findings from this study provide important information on what hospitals in states that have yet to expand Medicaid could gain through expansion and what is at risk should any reversal of Medicaid expansions occur.


Assuntos
COVID-19/epidemiologia , Economia Hospitalar , Acesso aos Serviços de Saúde/estatística & dados numéricos , Hospitais , Medicaid , Pessoas sem Cobertura de Seguro de Saúde , Humanos , Medicaid/economia , Medicaid/estatística & dados numéricos , Patient Protection and Affordable Care Act/legislação & jurisprudência , SARS-CoV-2 , Governo Estadual , Estados Unidos
16.
Am J Emerg Med ; 45: 578-589, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33402309

RESUMO

BACKGROUND: Emergency department (ED) care coordination plays an important role in facilitating care transitions across settings. We studied ED care coordination processes and their perceived effectiveness in Maryland (MD) hospitals, which face strong incentives to reduce hospital-based care through global budgets. METHODS: We conducted a qualitative study using semi-structured interviews to examine ED care coordination processes and perceptions of effectiveness. Interviews were conducted from January through October 2019 across MD hospital-based EDs. Results were reviewed to assign analytic domains and identify emerging themes. Descriptive statistics of ED care coordination staffing and processes were also calculated. RESULTS: A total of 25 in-depth interviews across 18 different EDs were conducted with ED physician leadership (n = 14) and care coordination staff (CCS) (n = 11). Across all EDs, there was significant variation in the hours and types of CCS coverage and the number of initiatives implemented to improve care coordination. Participants perceived ED care coordination as effective in facilitating safer discharges and addressing social determinants of health; however, adequate access to outpatient providers was a significant barrier. The majority of ED physician leaders perceived MD's policy reform as having a mixed impact, with improved care transitions and overall patient care as benefits, but increased physician workloads and worsened ED throughput as negative effects. CONCLUSIONS: EDs have responded to the value-based care incentives of MD's global budgeting program with investments to enhance care coordination staffing and a variety of initiatives targeting specific patient populations. Although the observed care coordination initiatives were broadly perceived to produce positive results, MD's global budgeting policies were also perceived to produce barriers to optimizing ED care. Further research is needed to determine the association of the various strategies to improve ED care coordination with patient outcomes to inform practice leaders and policymakers on the efficacy of the various approaches.


Assuntos
Economia Hospitalar/tendências , Serviço Hospitalar de Emergência/organização & administração , Reforma dos Serviços de Saúde/economia , Avaliação de Processos em Cuidados de Saúde , Humanos , Entrevistas como Assunto , Maryland , Admissão e Escalonamento de Pessoal , Pesquisa Qualitativa
19.
Ann Intern Med ; 174(1): 86-92, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33045180

RESUMO

The Hospital Readmissions Reduction Program (HRRP) has penalized hospitals with higher 30-day readmission rates more than $3 billion to date. Clinicians and policy experts have raised concerns that the 30-day readmission measure used in this program provides an incomplete picture of performance because it does not capture all hospital encounters that may occur after discharge. In contrast, the excess days in acute care (EDAC) measure, which currently is not used in the HRRP, captures the full spectrum of hospital encounters (emergency department, observation stay, inpatient readmission) and their associated lengths of stay within 30 days of discharge. This study of 3173 hospitals that participated in the HRRP in fiscal year 2019 compared performance on the readmission and EDAC measures and evaluated whether using the EDAC measure would change hospitals' penalty status for 3 conditions targeted by the HRRP. Overall, only moderate agreement was found on hospital performance rankings by using the readmission and EDAC measures (weighted κ statistic: heart failure, 0.45 [95% CI, 0.42 to 0.47]; acute myocardial infarction [AMI], 0.37 [CI, 0.35 to 0.40]; and pneumonia, 0.50 [CI, 0.47 to 0.52]). Under the HRRP, the penalty status of 769 (27.0%) of 2845 hospitals for heart failure, 581 (28.3%) of 2055 for AMI, and 724 (24.9%) of 2911 for pneumonia would change if the EDAC measure were used instead of the readmission measure to evaluate performance. Fewer small and rural hospitals would receive penalties. The Centers for Medicare & Medicaid Services should consider using the EDAC measure, which provides a more comprehensive picture of postdischarge hospital use, rather than the 30-day readmission measure to evaluate health care system performance under federal quality, reporting, and value-based programs.


Assuntos
Economia Hospitalar , Hospitais/estatística & dados numéricos , Readmissão do Paciente/tendências , Idoso , Feminino , Humanos , Masculino , Alta do Paciente/tendências , Estados Unidos
20.
Health Serv Res ; 56(1): 36-48, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-32844435

RESUMO

OBJECTIVE: The California Delivery System Reform Incentive Payment Program (DSRIP) provided incentive payments to Designated Public Hospitals (DPHs) to improve quality of care. We assessed the program's impact on reductions in sepsis mortality, central line-associated bloodstream infections (CLABSIs), venous thromboembolisms (VTEs), and hospital-acquired pressure ulcers (HAPUs). DATA SOURCES: We used 2009-2014 discharge data from California hospitals. STUDY DESIGN: We used a pre-post study design with a comparison group. We constructed propensity scores and used them to assign inverse probability weights according to their similarity to DPH discharges. Interaction term coefficients of time trends and treatment group provided significance testing. DATA EXTRACTION: We used Patient Safety Indicators for CLABSI, HAPU, and VTE, and constructed a sepsis mortality measure. PRINCIPAL FINDINGS: Discharges from DPHs and non-DPHs both saw decreases in the four outcomes over the DSRIP period (2010-2014). The difference-in-difference estimator (DD) for sepsis was only significant during two time periods, comparing 2010 with 2012 (DD: -2.90 percent, 95% CI: -5.08, -0.72 percent) and 2010 with 2014 (DD: -5.74, 95% CI: -8.76 percent, -2.72 percent); the DD estimator was not significant comparing 2010 with 2012 (DD: -1.30, 95% CI: -3.18 percent, 0.58 percent) or comparing 2010 with 2013 (DD: -3.05 percent, 95% CI: -6.50 percent, 0.40 percent). For CLABSI, we did not find any meaningful differences between DPHs and non-DPHs across the four time periods. For HAPU and VTE, the only significant DD estimator compared 2014 with 2010. CONCLUSIONS: We did not find that DPHs participating in DSRIP outperformed non-DPHs during the DSRIP program. Our results were robust to multiple sensitivity analyses. Given multiple concurrent inpatient safety initiatives, it was challenging to assign improvements over time periods to DSRIP.


Assuntos
Fortalecimento Institucional/economia , Economia Hospitalar/organização & administração , Hospitais Públicos/economia , Reembolso de Incentivo/organização & administração , Planos Governamentais de Saúde/organização & administração , California , Humanos , Avaliação de Resultados em Cuidados de Saúde , Melhoria de Qualidade/normas , Estados Unidos
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