下肢関節置換エピソードの量とケースミックスによるメディケア・バンドル・ペイメント・プログラムにおける病院参加の関連
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PubMedで要約を見る
まとめ
この要約は機械生成です。下肢関節置換 (LEJR) の医療改善のためのメディケア・バンドル・ペイメント (BPCI) は,患者総数や症例の組み合わせを有意に変化させなかった. これは,BPCIが意図しないLEJRの手続きの増加や低リスクの患者へのシフトにつながらないことを示唆しています.
科学分野
- 健康経済学
- 医療政策
- 整形外科
背景
- メディケアの"ケア改善のためのバンドル・ペイメント (BPCI) "イニシアチブは,下肢置換手術 (LEJR) のコストを削減し,品質を向上させることを目的としています.
- 予期せぬ結果として,処置の量が増え,症例の組み合わせが低リスクの患者に移行される可能性があります.
研究 の 目的
- LEJRのための病院のBPCI参加と全体的な処置量の変化の関連性を評価する.
- BPCIへの参加が,LEJRを受けた患者のケースミックスに影響を与えたかどうかを評価する.
主な方法
- メディケアの請求データを用いた観察研究が行われた.
- BPCIに参加した病院と参加しなかった病院の市場を,差異の差異法で,イニシアチブの開始前と後に比較した.
- BPCI参加者と非参加者を比較して,病院レベルの症例ミックスを分析した.
主要な成果
- BPCIの参加は,市場レベルのLEJR総量の変化と有意に関連していなかった.
- BPCI市場では,BPCI以外の市場と比較して,以前熟練した看護施設の使用が減少したとの小さな,統計的に有意な関連性が見つかった.
- 他の人口統計的,社会経済的,臨床的,または利用上の要因については,ケースミックスにおいて有意な関連は観察されなかった.
結論
- LEJRのBPCIへの病院参加は,処置量の増加と関連していなかった.
- BPCIの参加は,患者のケースミックスにわずかな影響を及ぼし,以前は熟練した看護施設の使用がわずかに減少しました.
- これらの発見は,LEJRのためのバンドル支払いの潜在的な意図しない結果に関する懸念を軽減する可能性があります.
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