{"title":"康复中心患者的社会经济地位对效率和绩效的影响。","authors":"Carine Milcent","doi":"10.23736/S1973-9087.24.08046-8","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Patients' socioeconomic status on hospitals' efficiency in controlling for clinical component characteristics may have a role that has few been studied in rehabilitation centers.</p><p><strong>Design: </strong>Because of the national health insurance system, rehabilitation centers are free of charge. To answer whether a patient's socioeconomic status (SES) is associated with efficiency and performance, we use a counterfactual analysis to get the patient's SES effect \"as if\" the patient's case was identical to whatever hospital. We restrained the data to patients from public acute care units where the decision on rehabilitation sector admission is based on availability, limiting bias by confounding factors. Besides, an analysis of six pathologies led to the same results.</p><p><strong>Setting: </strong>An exhaustive, detailed administrative database on rehabilitation center stays in France. To define the patients' socioeconomic status, we use two sources of data: the information collected at the time of the patient's entry into rehabilitation care and the information collected during the patient's stay in acute care. This double information avoids possible loss of socio-economic details between the two admissions.</p><p><strong>Population: </strong>Patients recruited were exhaustively admitted over the year 2018 for stroke, chronic obstructive pulmonary disease, heart failure, or total hip replacement in France in the acute care unit and then in a rehab center. Mainly the elderly population. Information on patients' demography, comorbidities, and SES are coded due to the reimbursement system. Different dimensions controlling for factors (hospital ownership, patient clinical characteristics, rehabilitation care specificities, medical staff detailed information, and patients' socioeconomic status), were progressively added to control for any differences in baseline data between the two groups.</p><p><strong>Methods: </strong>We assess rehabilitation centers' efficiency by combining selected outcome quality indicators (Physical score improvement, Cognitive score improvement, Mortality, Return-to-home). The specific Providers' Activity Index is used to get the performance index.</p><p><strong>Conclusions: </strong>The performance of healthcare institutions is correlated not only to the case mix of their patients but also to the socioeconomic status of the patients admitted. The performance needs to be seen in light of patients' socioeconomic status.</p><p><strong>Clinical rehabilitation impacts: </strong>The data reveals that patients' socioeconomic status affects rehabilitation care efficiency and performance. In controlling patients' socioeconomic status, for-profit rehabilitation hospitals seemed more efficient than public ones.</p>","PeriodicalId":12044,"journal":{"name":"European journal of physical and rehabilitation medicine","volume":" ","pages":"919-928"},"PeriodicalIF":3.3000,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"The effect of patients' socioeconomic status in rehabilitation centers on the efficiency and performance.\",\"authors\":\"Carine Milcent\",\"doi\":\"10.23736/S1973-9087.24.08046-8\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Patients' socioeconomic status on hospitals' efficiency in controlling for clinical component characteristics may have a role that has few been studied in rehabilitation centers.</p><p><strong>Design: </strong>Because of the national health insurance system, rehabilitation centers are free of charge. To answer whether a patient's socioeconomic status (SES) is associated with efficiency and performance, we use a counterfactual analysis to get the patient's SES effect \\\"as if\\\" the patient's case was identical to whatever hospital. We restrained the data to patients from public acute care units where the decision on rehabilitation sector admission is based on availability, limiting bias by confounding factors. Besides, an analysis of six pathologies led to the same results.</p><p><strong>Setting: </strong>An exhaustive, detailed administrative database on rehabilitation center stays in France. To define the patients' socioeconomic status, we use two sources of data: the information collected at the time of the patient's entry into rehabilitation care and the information collected during the patient's stay in acute care. This double information avoids possible loss of socio-economic details between the two admissions.</p><p><strong>Population: </strong>Patients recruited were exhaustively admitted over the year 2018 for stroke, chronic obstructive pulmonary disease, heart failure, or total hip replacement in France in the acute care unit and then in a rehab center. Mainly the elderly population. Information on patients' demography, comorbidities, and SES are coded due to the reimbursement system. Different dimensions controlling for factors (hospital ownership, patient clinical characteristics, rehabilitation care specificities, medical staff detailed information, and patients' socioeconomic status), were progressively added to control for any differences in baseline data between the two groups.</p><p><strong>Methods: </strong>We assess rehabilitation centers' efficiency by combining selected outcome quality indicators (Physical score improvement, Cognitive score improvement, Mortality, Return-to-home). The specific Providers' Activity Index is used to get the performance index.</p><p><strong>Conclusions: </strong>The performance of healthcare institutions is correlated not only to the case mix of their patients but also to the socioeconomic status of the patients admitted. The performance needs to be seen in light of patients' socioeconomic status.</p><p><strong>Clinical rehabilitation impacts: </strong>The data reveals that patients' socioeconomic status affects rehabilitation care efficiency and performance. In controlling patients' socioeconomic status, for-profit rehabilitation hospitals seemed more efficient than public ones.</p>\",\"PeriodicalId\":12044,\"journal\":{\"name\":\"European journal of physical and rehabilitation medicine\",\"volume\":\" \",\"pages\":\"919-928\"},\"PeriodicalIF\":3.3000,\"publicationDate\":\"2024-12-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"European journal of physical and rehabilitation medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.23736/S1973-9087.24.08046-8\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/10/24 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"REHABILITATION\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"European journal of physical and rehabilitation medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.23736/S1973-9087.24.08046-8","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/10/24 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"REHABILITATION","Score":null,"Total":0}
引用次数: 0
摘要
背景:病人的社会经济地位对医院效率的影响,在控制临床部分特征方面可能有作用,但在康复中心却鲜有研究:设计:由于国家医疗保险制度,康复中心是免费的。为了回答患者的社会经济地位(SES)是否与效率和绩效相关,我们采用了反事实分析法,"假设 "患者的病例与任何医院的病例相同,从而得出患者的 SES 影响。我们将数据限制在公立急症监护病房的病人身上,因为这些病房是根据病人的情况来决定是否收治康复部门的病人,从而限制了混杂因素造成的偏差。此外,对六种病症的分析也得出了相同的结果:背景:法国康复中心的详尽行政数据库。为了确定患者的社会经济状况,我们使用了两个数据来源:患者进入康复护理中心时收集的信息和患者在急症护理中心住院期间收集的信息。这种双重信息可避免两次入院之间社会经济细节的丢失:所招募的患者均为2018年期间在法国因中风、慢性阻塞性肺病、心力衰竭或全髋关节置换术在急症监护室和康复中心入院的患者。主要是老年人群。由于报销制度的原因,患者的人口统计学、合并症和社会经济地位等信息都被编码。为了控制两组患者基线数据的差异,我们逐步增加了不同的控制因素(医院所有权、患者临床特征、康复护理特殊性、医务人员详细信息和患者社会经济地位):方法:我们结合选定的结果质量指标(身体评分改善、认知评分改善、死亡率、重返家庭)来评估康复中心的效率。结论:医疗机构的绩效与医疗服务的质量并不相关:结论:医疗机构的绩效不仅与病人的病例组合有关,还与收治病人的社会经济状况有关。临床康复的影响:数据显示,病人的社会经济状况影响康复护理的效率和绩效。在控制患者的社会经济地位方面,营利性康复医院似乎比公立康复医院更有效率。
The effect of patients' socioeconomic status in rehabilitation centers on the efficiency and performance.
Background: Patients' socioeconomic status on hospitals' efficiency in controlling for clinical component characteristics may have a role that has few been studied in rehabilitation centers.
Design: Because of the national health insurance system, rehabilitation centers are free of charge. To answer whether a patient's socioeconomic status (SES) is associated with efficiency and performance, we use a counterfactual analysis to get the patient's SES effect "as if" the patient's case was identical to whatever hospital. We restrained the data to patients from public acute care units where the decision on rehabilitation sector admission is based on availability, limiting bias by confounding factors. Besides, an analysis of six pathologies led to the same results.
Setting: An exhaustive, detailed administrative database on rehabilitation center stays in France. To define the patients' socioeconomic status, we use two sources of data: the information collected at the time of the patient's entry into rehabilitation care and the information collected during the patient's stay in acute care. This double information avoids possible loss of socio-economic details between the two admissions.
Population: Patients recruited were exhaustively admitted over the year 2018 for stroke, chronic obstructive pulmonary disease, heart failure, or total hip replacement in France in the acute care unit and then in a rehab center. Mainly the elderly population. Information on patients' demography, comorbidities, and SES are coded due to the reimbursement system. Different dimensions controlling for factors (hospital ownership, patient clinical characteristics, rehabilitation care specificities, medical staff detailed information, and patients' socioeconomic status), were progressively added to control for any differences in baseline data between the two groups.
Methods: We assess rehabilitation centers' efficiency by combining selected outcome quality indicators (Physical score improvement, Cognitive score improvement, Mortality, Return-to-home). The specific Providers' Activity Index is used to get the performance index.
Conclusions: The performance of healthcare institutions is correlated not only to the case mix of their patients but also to the socioeconomic status of the patients admitted. The performance needs to be seen in light of patients' socioeconomic status.
Clinical rehabilitation impacts: The data reveals that patients' socioeconomic status affects rehabilitation care efficiency and performance. In controlling patients' socioeconomic status, for-profit rehabilitation hospitals seemed more efficient than public ones.