Background: Technical efficiency evaluates a hospital’s economic performance and plays an important role in variations in quality of care and outcomes. The study objective was to examine the association between hospital efficiency and quality of care among fee-for-service Medicare beneficiaries with prostate cancer and to assess if race moderates this association. Design: Retrospective study using Surveillance, Epidemiological, and End Results—Medicare (SEER-Medicare) data from 1998 to 2016 for prostate cancer patients aged ≥ 66. We computed hospital technical efficiency using a data envelopment analysis. Outcomes were emergency room visits, hospitalizations, cost, and mortality (all-cause and prostate cancer-specific). We used competing risk regression for survival, log-link GLM models for cost, and Poisson models for count data. The propensity score approach was used to minimize selection bias. Results: The cohort consisted of 323,325 patients. Compared to higher efficiency hospitals (upper quartile), low hospital efficiency (i.e., lower quartile) was associated with a higher hazard of long-term mortality (Hazard ratio (HR) = 1.06, 95% CI = 1.05, 1.08) and long-term prostate cancer-specific mortality (HR = 1.14, 95% CI = 1.11, 1.17). Compared to higher efficiency levels, lower levels were associated with impaired emergency room visits, hospitalizations, and costs. A one unit increase in the efficiency score was associated with greater benefits for cost and mortality for African American and white patients. The benefit was larger for African American patients compared to white patients. Conclusions: Increasing hospital efficiency may help improve outcomes among Medicare prostate cancer patients. Policies to redirect patients to hospitals with higher efficiency can enhance the quality of care and outcomes.
背景：技术效率评估医院的经济绩效，并在医疗质量与治疗结果的差异中扮演重要角色。本研究旨在探讨按服务收费的医疗保险前列腺癌患者中，医院效率与医疗质量之间的关联，并评估种族因素是否调节这一关联。设计：本研究采用回顾性分析，利用1998年至2016年监测、流行病学和最终结果—医疗保险（SEER-Medicare）数据库中年龄≥66岁的前列腺癌患者数据。通过数据包络分析计算医院技术效率。研究结果包括急诊就诊、住院情况、医疗费用及死亡率（全因死亡率和前列腺癌特异性死亡率）。生存分析采用竞争风险回归模型，费用分析采用对数连接广义线性模型，计数数据采用泊松模型。使用倾向评分方法以最小化选择偏倚。结果：研究队列包含323,325名患者。与高效率医院（上四分位数）相比，低效率医院（即下四分位数）与长期死亡率（风险比（HR）= 1.06，95%置信区间（CI）= 1.05, 1.08）和长期前列腺癌特异性死亡率（HR = 1.14，95% CI = 1.11, 1.17）的较高风险相关。与高效率水平相比，低效率水平与急诊就诊、住院情况和医疗费用的不良结果相关。效率评分每增加一个单位，非裔美国患者和白人患者在医疗费用和死亡率方面均获得更大益处，且非裔美国患者的获益程度高于白人患者。结论：提高医院效率可能有助于改善医疗保险前列腺癌患者的治疗结果。通过政策引导患者选择高效率医院，可提升医疗质量和治疗结果。
肿瘤(癌症)患者之家