Systematic review and meta-analysis on the effect of hospital competition on quality of care: Implications for senior care

被引:6
作者
Shen, Vivien Chia-Ying [1 ,2 ]
Ward, William J., Jr. [2 ]
Chen, Liang-Kung [3 ,4 ]
机构
[1] Hungkuang Univ Taichung, Dept Hlth Business Adm, Taichung, Taiwan
[2] Johns Hopkins Univ, Dept Hlth Policy & Management, Baltimore, MD 21218 USA
[3] Natl Yang Ming Univ, Aging & Hlth Res Ctr, Taipei, Taiwan
[4] Taipei Vet Gen Hosp, Ctr Geriatr & Gerontol, Taipei, Taiwan
关键词
Hospital competition; Quality of care; Elderly; Acute myocardial infarction; Meta-analysis;
D O I
10.1016/j.archger.2019.05.001
中图分类号
R592 [老年病学]; C [社会科学总论];
学科分类号
03 ; 0303 ; 100203 ;
摘要
Background: Empirical studies examined the associations between hospital competition and quality of care by using different methodology, measures, patient groups and geographic locations; however, results remained inconclusive. This study aimed to apply meta-analysis to evaluate the effect of hospital competition on quality of care and to explore the potential implications to care for senior patients. Methods: A systematic review and meta-analysis combining results from various studies to obtain an overall outcome was performed. Measure of effect size, I-2 test, meta-regression to find sources of heterogeneity, tests for publication bias, sensitivity analysis and cumulative analysis were performed. The mean effect size is estimated by coefficient and standard error with P values less than 0.05 which was considered statistically significant. Results: Based on the selection criteria, only 11 studies were eligible for this meta-analysis. The pooled effect of hospital competition on quality of care was reported by all of the 11 included studies. Results of the meta-analysis suggested that hospital competition reduced quality of care, but the overall effect was relatively insignificant from a statistical perspective (Point estimate = 0.008, 95% CI = -0.004 similar to 0.020, P > 0.05). Conclusions: Hospital competition slightly increased mortality rates of acute myocardial infarction, but not statistically significant. The negative impact may be lessened over time as medical technology, practices, and techniques improve. Older patients with complex care needs may be at risk for poorer quality of care related to hospital competition.
引用
收藏
页码:263 / 270
页数:8
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