本文由小咖机器人翻译整理

期刊来源：JAMA

原文链接：https://doi.org/10.1001/jama.2023.23147

摘要内容如下：

重要性

私人股本收购美国医院对住院护理的临床质量和患者结果的影响在很大程度上仍是未知的。

目的

研究与美国医院私募股权收购相关的医院获得性不良事件和住院结果的变化。

设计、设置和参与者

2009年至2019年期间，51家私募股权收购医院的662095例住院患者的100%医疗保险A部分索赔数据与259家匹配对照医院（非私募股权收购）的4160720例住院患者的住院数据进行了比较。使用线性模型（根据患者和医院属性进行调整），采用双重差分设计的事件研究来评估私募股权收购前3年至收购后3年的住院情况。

主要结局和措施

医院获得性不良事件（与医院获得性疾病同义）；美国医疗保险和医疗补助服务中心（US Centers for Medicare&Medicaid Services）将个体情况定义为跌倒、感染和其他不良事件）、患者组合和住院结果（包括死亡率、出院处置、住院时间和再入院率）。

结果

在10091例住院患者中观察到医院获得性不良事件（或病症）。私募股权收购后，与在对照医院治疗的患者相比，在私募股权医院住院的医疗保险受益人的医院获得性疾病增加了25.4%（4.6[95%CI，2.0-7.2]每10000例住院患者的额外医院获得性疾病，P=.004）。医院获得性疾病的增加是由私募股权医院的跌倒增加27.3%（P=0.02）和中心静脉导管相关血流感染增加37.7%（P=0.04）造成的，尽管中心静脉导管减少了16.2%。尽管手术量减少了8.1%，但在私募股权医院，手术部位感染增加了一倍，从每10000例住院中的10.8例增加到21.6例；同时，尽管组间比较的统计精度受到手术住院样本量较小的限制，但这类感染在对照医院有所减少。与在对照医院接受治疗的Medicare受益人相比，在私募股权医院接受治疗的人略显年轻，不太可能同时符合Medicare和Medicaid的资格，并且更经常在住院时间较短后转到其他急症护理医院。与对照医院相比，私立医院的住院死亡率（人群中N=162652，平均为3.4%）略有下降；出院后30天死亡率无差异变化。

结论和相关性

私募股权收购与医院获得性不良事件的增加有关，包括跌倒和中心静脉导管相关的血流感染，以及手术部位感染的增加较大，但在统计学上不太精确。与对照医院相比，私募股权医院的住院死亡率略有下降，这一现象在出院30天后不再明显，原因可能是患者组合向更年轻和更少的双重资格受益人转变，以及转到其他医院的人数增加。这些发现加剧了人们对私募股权对医疗保健服务的影响的担忧。

英文原文如下：

Abstracts

Importance  The effects of private equity acquisitions of US hospitals on the clinical quality of inpatient care and patient outcomes remain largely unknown.

Objective  To examine changes in hospital-acquired adverse events and hospitalization outcomes associated with private equity acquisitions of US hospitals.

Design, Setting, and Participants  Data from 100% Medicare Part A claims for 662 095 hospitalizations at 51 private equity-acquired hospitals were compared with data for 4 160 720 hospitalizations at 259 matched control hospitals (not acquired by private equity) for hospital stays between 2009 and 2019. An event study, difference-in-differences design was used to assess hospitalizations from 3 years before to 3 years after private equity acquisition using a linear model that was adjusted for patient and hospital attributes.

Main Outcomes and Measures  Hospital-acquired adverse events (synonymous with hospital-acquired conditions; the individual conditions were defined by the US Centers for Medicare & Medicaid Services as falls, infections, and other adverse events), patient mix, and hospitalization outcomes (including mortality, discharge disposition, length of stay, and readmissions).

Results  Hospital-acquired adverse events (or conditions) were observed within 10 091 hospitalizations. After private equity acquisition, Medicare beneficiaries admitted to private equity hospitals experienced a 25.4% increase in hospital-acquired conditions compared with those treated at control hospitals (4.6 [95% CI, 2.0-7.2] additional hospital-acquired conditions per 10 000 hospitalizations, P = .004). This increase in hospital-acquired conditions was driven by a 27.3% increase in falls (P = .02) and a 37.7% increase in central line-associated bloodstream infections (P = .04) at private equity hospitals, despite placing 16.2% fewer central lines. Surgical site infections doubled from 10.8 to 21.6 per 10 000 hospitalizations at private equity hospitals despite an 8.1% reduction in surgical volume; meanwhile, such infections decreased at control hospitals, though statistical precision of the between-group comparison was limited by the smaller sample size of surgical hospitalizations. Compared with Medicare beneficiaries treated at control hospitals, those treated at private equity hospitals were modestly younger, less likely to be dually eligible for Medicare and Medicaid, and more often transferred to other acute care hospitals after shorter lengths of stay. In-hospital mortality (n = 162 652 in the population or 3.4% on average) decreased slightly at private equity hospitals compared with the control hospitals; there was no differential change in mortality by 30 days after hospital discharge.

Conclusions and Relevance  Private equity acquisition was associated with increased hospital-acquired adverse events, including falls and central line-associated bloodstream infections, along with a larger but less statistically precise increase in surgical site infections. Shifts in patient mix toward younger and fewer dually eligible beneficiaries admitted and increased transfers to other hospitals may explain the small decrease in in-hospital mortality at private equity hospitals relative to the control hospitals, which was no longer evident 30 days after discharge. These findings heighten concerns about the implications of private equity on health care delivery.

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