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Activity-Based Funding of Hospitals and Its Impact on Mortality, Readmission, Discharge Destination, Severity of Illness, and Volume of Care: A Systematic Review and Meta-Analysis

Resource type
Date created
2014-10-27
Authors/Contributors
Author (aut): Palmer, Karen S.
Author (aut): Agoritsas, Thomas
Author (aut): Martin, Danielle
Author (aut): Scott, Taryn
Author (aut): Mulla, Sohail M.
Author (aut): Miller, Ashley P.
Author (aut): Agarwal, Arnav
Author (aut): Bresnahan, Andrew
Author (aut): Hazzan. Afeez Abiola
Author (aut): Jeffery, Rebecca A.
Author (aut): Merglen, Arnaud
Author (aut): Negm, Ahmed
Author (aut): Siemieniuk, Reed A.
Author (aut): Bhatnagar, Neera
Author (aut): Dhalla, Irfan A.
Author (aut): Lavis, John N.
Author (aut): You, John J.
Author (aut): Duckett, Stephen J.
Author (aut): Guyatt, Gordon H.
Abstract
Background:Activity-based funding (ABF) of hospitals is a policy intervention intended to re-shape incentives across health systems through the use of diagnosis-related groups. Many countries are adopting or actively promoting ABF. We assessed the effect of ABF on key measures potentially affecting patients and health care systems: mortality (acute and post-acute care); readmission rates; discharge rate to post-acute care following hospitalization; severity of illness; volume of care. Methods:We undertook a systematic review and meta-analysis of the worldwide evidence produced since 1980. We included all studies reporting original quantitative data comparing the impact of ABF versus alternative funding systems in acute care settings, regardless of language. We searched 9 electronic databases (OVID MEDLINE, EMBASE, OVID Healthstar, CINAHL, Cochrane CENTRAL, Health Technology Assessment, NHS Economic Evaluation Database, Cochrane Database of Systematic Reviews, and Business Source), hand-searched reference lists, and consulted with experts. Paired reviewers independently screened for eligibility, abstracted data, and assessed study credibility according to a pre-defined scoring system, resolving conflicts by discussion or adjudication. Results:Of 16,565 unique citations, 50 US studies and 15 studies from 9 other countries proved eligible (i.e. Australia, Austria, England, Germany, Israel, Italy, Scotland, Sweden, Switzerland). We found consistent and robust differences between ABF and no-ABF in discharge to post-acute care, showing a 24% increase with ABF (pooled relative risk = 1.24, 95% CI 1.18–1.31). Results also suggested a possible increase in readmission with ABF, and an apparent increase in severity of illness, perhaps reflecting differences in diagnostic coding. Although we found no consistent, systematic differences in mortality rates and volume of care, results varied widely across studies, some suggesting appreciable benefits from ABF, and others suggesting deleterious consequences. Conclusions:Transitioning to ABF is associated with important policy- and clinically-relevant changes. Evidence suggests substantial increases in admissions to post-acute care following hospitalization, with implications for system capacity and equitable access to care. High variability in results of other outcomes leaves the impact in particular settings uncertain, and may not allow a jurisdiction to predict if ABF would be harmless. Decision-makers considering ABF should plan for likely increases in post-acute care admissions, and be aware of the large uncertainty around impacts on other critical outcomes.
Document
Identifier
DOI: 10.1371/journal.pone.0109975
Published as
Palmer KS, Agoritsas T, Martin D, Scott T, Mulla SM, et al. (2014) "Activity-Based Funding of Hospitals and Its Impact on Mortality, Readmission, Discharge Destination, Severity of Illness, and Volume of Care: A Systematic Review and Meta-Analysis." PLoS ONE 9(10): e109975. doi:10.1371/journal.pone.0109975
Publication title
PLoS ONE
Document title
Activity-Based Funding of Hospitals and Its Impact on Mortality, Readmission, Discharge Destination, Severity of Illness, and Volume of Care: A Systematic Review and Meta-Analysis
Date
2014
Volume
9
Issue
10
Publisher DOI
10.1371/journal.pone.0109975
Copyright statement
Copyright is held by the author(s).
Scholarly level
Peer reviewed?
Yes
Language
English
Member of collection
Download file Size
Palmer_PLoS_One_2014.pdf 682.63 KB

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