院际竞争已被证明会影响手术结果和支出。然而,院际竞争对神经外科的影响特征不明显。
评估院际竞争与未破裂颅内动脉瘤(UIA)的治疗策略和结果的关系。
我们确定了2002年至2011年全国住院患者样本中的所有选修UIA入院。每个医院市场的竞争强度使用经过验证的赫芬达尔-赫希曼指数(HHI)进行量化,较低的价值表示更高的竞争。然后,我们从医疗保健成本项目获得了2012年至2016年的全国HHI值。结果包括治疗方式(修剪,卷取,或非手术管理),住院死亡率,处置,并发症,停留时间(LOS)和成本。多变量回归评估了HHI与结果之间的关联,控制患者的人口统计学,严重性度量,医院特色,和治疗。
从2002年到2011年,我们研究了1435家医院的157979例择期UIA接诊,接诊率上升(13.4%到33.7%),接诊率下降(30.9%到17.6%)。平均医院HHI为0.11(范围=0.001-0.97)。从2002年到2011年,61.8%的医院的竞争下降,从2012年到2016年,68.1%的大都市地区的竞争下降。在竞争更加激烈的医院市场中,入院接受手术的几率增加(比值比[OR]=1.37,P<.001),优先于卷取而不是裁剪(OR=1.27,P<.001)。HHI与死亡率无关,处置,或LOS。然而,医院间竞争增加与更多并发症(OR=1.09,P=.001)和更高的住院费用(β系数=1.06,P<.001)相关.
对于UIA患者,在更具竞争力的地区,入院与手术干预率增加有关。卷取利用率,并发症,和住院费用。
Interhospital competition has been shown to affect surgical outcomes and expenditures. However, interhospital competition\'s impact on neurosurgery is poorly characterized.
To assess how interhospital competition is associated with treatment strategy and outcomes for unruptured intracranial aneurysms (UIAs).
We identified all elective UIA admissions in the National Inpatient Sample from 2002 to 2011. Competitive intensity of each hospital market was quantified using the validated Herfindahl-Hirschman Index (HHI), with lower values denoting higher competition. We then obtained nationwide HHI values for 2012 to 2016 from the Health Care Cost Project. Outcomes included treatment modality (clipping, coiling, or nonoperative management), inpatient mortality, disposition, complications, length of stay (LOS), and costs. Multivariate regression assessed the association between HHI and outcomes, controlling for patient demographics, severity metrics, hospital characteristics, and treatment.
We studied 157 979 elective UIA admissions at 1435 hospitals from 2002 to 2011, with an increase in coiling admissions (13.4% to 33.7%) and decrease in clipping admissions (30.9% to 17.6%). Mean hospital HHI was 0.11 (range = 0.001-0.97). Competition decreased for 61.8% of hospitals from 2002 to 2011 and 68.1% of metropolitan localities from 2012 to 2016. Admissions in more competitive hospital markets exhibited increased odds of undergoing surgery (odds ratio [OR] = 1.37, P < .001), with preference toward coiling over clipping (OR = 1.27, P < .001). HHI was not associated with mortality, disposition, or LOS. However, increased interhospital competition was associated with more complications (OR = 1.09, P = .001) and greater hospital costs (β-coefficient = 1.06, P < .001).
For UIA patients, admission to hospitals in more competitive geographies was associated with increased rates of surgical intervention, coiling utilization, complications, and hospitalization costs.