美国波士顿哈佛医学院J. Michael McWilliams小组最新研究分析了医院并购后医疗质量的变化。2020年1月2日，国际知名学术期刊《新英格兰医学杂志》发表了这一成果。

医院行业在过去20年中得到了实质性的巩固，并从2010年起加速发展。多项研究表明，医院合并导致商业保险患者的就医价格上涨，但对医疗质量影响的研究仍很有限。

研究组采用医疗保险索赔和医院2007-2016年间四项医疗质量指标的绩效比较数据，以及2009-2013年间医院并购的数据，进行了详细的差异分析。

研究样本包括246家收购医院和1986家对照医院。医院被收购后，患者体验调查的表现略有下降，但30天再住院率和30天死亡率均无明显变化。被收购医院临床过程调查的表现有明显改善，但这不能完全归因于所有权的变化，因为在被收购前，该表现就已改善。

总之，当一家医院被另一家医院或医疗系统并购之后，患者的体验变得稍差，但再住院率和死亡率均无显著变化。

附：英文原文

Title: Changes in Quality of Care after Hospital Mergers and Acquisitions

Author: Nancy D. Beaulieu, Ph.D.,, Leemore S. Dafny, Ph.D.,, Bruce E. Landon, M.D., M.B.A.,, Jesse B. Dalton, M.A.,, Ifedayo Kuye, M.D., M.B.A.,, and J. Michael McWilliams, M.D., Ph.D.

Issue&Volume: 2020-01-01

Abstract: 

BACKGROUND
The hospital industry has consolidated substantially during the past two decades and at an accelerated pace since 2010. Multiple studies have shown that hospital mergers have led to higher prices for commercially insured patients, but research about effects on quality of care is limited.

METHODS
Using Medicare claims and Hospital Compare data from 2007 through 2016 on performance on four measures of quality of care (a composite of clinical-process measures, a composite of patient-experience measures, mortality, and the rate of readmission after discharge) and data on hospital mergers and acquisitions occurring from 2009 through 2013, we conducted difference-in-differences analyses comparing changes in the performance of acquired hospitals from the time before acquisition to the time after acquisition with concurrent changes for control hospitals that did not have a change in ownership.

RESULTS
The study sample included 246 acquired hospitals and 1986 control hospitals. Being acquired was associated with a modest differential decline in performance on the patient-experience measure (adjusted differential change, −0.17 SD; 95% confidence interval [CI], −0.26 to −0.07; P=0.002; the change was analogous to a fall from the 50th to the 41st percentile) and no significant differential change in 30-day readmission rates (−0.10 percentage points; 95% CI, −0.53 to 0.34; P=0.72) or in 30-day mortality (−0.03 percentage points; 95% CI, −0.20 to 0.14; P=0.72). Acquired hospitals had a significant differential improvement in performance on the clinical-process measure (0.22 SD; 95% CI, 0.05 to 0.38; P=0.03), but this could not be attributed conclusively to a change in ownership because differential improvement occurred before acquisition.

CONCLUSIONS
Hospital acquisition by another hospital or hospital system was associated with modestly worse patient experiences and no significant changes in readmission or mortality rates. Effects on process measures of quality were inconclusive.

DOI: 10.1056/NEJMsa1901383

Source: https://www.nejm.org/doi/full/10.1056/NEJMsa1901383