診断コードの関連付けとリスク調整された短期死亡率の差異
Cyrus M Kosar1,2, Lacey Loomer1,2, Kali S Thomas1,2,3
1Department of Health Services, Policy, and Practice, Brown University, Providence, Rhode Island.
JAMA
|August 5, 2020
まとめ
クリティカル アクセス 病院 (CAH) は非CAHよりも診断数が少ないが,コーディングの違いを考慮すると死亡率は似ています. これは,併発症を調整した後に,CAHと非CAHのアウトカムが異なる可能性を示唆する.
科学分野:
- 医療サービス研究
- 田舎の健康
- 医療の質について
背景:
- 重要な病院は 田舎の保健医療へのアクセスに不可欠です
- CAH患者では非CAH患者よりも高い死亡率の可能性が懸念されています.
- メディケアの払い戻し方針は,CAHの診断コード化慣行に影響を与える可能性があります.
研究 の 目的:
- CAHと非CAHの間のリスク調整された死亡率の違いを評価する.
- 診断コードの変動が死亡率の比較に与える影響を評価する.
- 階層条件カテゴリー (HCC) のスコアがリスク調整にどのように影響するか理解する.
主な方法:
- 2007年から2017年にかけてのメディケア・フィー・フォー・サービス受給者の連続的横断研究
- 肺炎,心不全,脳卒中といった 常見の病気も含まれていました
- 死亡率は,HCCの調整と無条件で,入院および退院後30日間のデータを用いて評価された.
主要な成果:
- CAHは一貫して非CAHより少ない排出診断コードを提出し,2010年以降は格差が広がった.
- リスク調整された死亡率は,HCCを考慮すると,CAHでは高かった.
- しかし,入院併発症 (HCC) に調整されない場合,死亡率はCAHと非CAHの間ではほとんどの年に有意な違いを示さなかった.
結論:
- CAHは診断数が少ないと報告しており,これはおそらくコード化慣行によるものです.
- CAHsの短期死亡結果は,コード化の違いを考慮すると,非CAHsと比べられるように見える.
- 治療の質の違いが 観察された結果の格差を説明する可能性があることが 示唆されています
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