介護改善のためのパッケージ支払いの参加に関連する心血管支出,介護利用,臨床結果の変化 - アドバンスド
Sukruth A Shashikumar1,2, Jie Zheng3, E John Orav4,5
1Department of Medicine (S.A.S.), Brigham and Women's Hospital, Boston, MA.
Circulation
|September 8, 2023
まとめ
BPCI-Aイニシアチブは,心臓血管疾患の支出を削減したり,品質を向上させなかった. このメディケアプログラムは 支出,利用,再入院,心臓発作による死亡率に 重要な変化を示さなかった.
科学分野:
- 医療経済と政策
- 心血管医学
- 医療の質の向上
背景:
- BPCI-A (バンドルド・ペイメント・フォー・ケア・イベリメント・アドバンスド) は,医療の特定のエピソードに対する医療費削減を目的としたメディケアプログラムです.
- 心血管疾患はメディケアの支出に大きく寄与しており,BPCI-Aの重点分野となっています.
- 心血管疾患の支出と品質に対するBPCI-Aの影響はまだ調査中です.
研究 の 目的:
- BPCI-Aイニシアチブが心血管疾患に対する医療費削減に結びついているかどうかを評価する.
- 患者の複雑性,利用,再入院,心臓発作による死亡率を含む,BPCI-Aの治療品質への影響を評価する.
- BPCI-Aに参加した病院と,参加していない対照病院の結果を比較する.
主な方法:
- メディケアの請求データを用いて遡及的なコホート研究が実施された.
- 2017年1月1日から2019年9月30日の間に退院した患者の差異分析が行われました.
- 主要なアウトカムには,心臓病の医療および処置に関する支出の差異的変化が含まれていました.次要なアウトカムは,患者の複雑さ,ケア利用,自宅での健康の日,再入院,および死亡率を評価しました.
主要な成果:
- BPCI-A病院での心臓病エピソード (+16ドル) や処置エピソード (+171ドル) に関する支出の有意な差異は観察されなかった.
- 医師のケアパターン,患者の複雑さ,またはケア利用の最小限の差異的な変化が見つかりました.
- BPCI-Aと対照病院の間で,医学的または手順的な心臓発作に関して,90日間の再入院率や死亡率に統計的に有意な差はなかった.
結論:
- BPCI-Aプログラムへの参加は,対象となる心血管疾患に対する医療費の削減と関連しませんでした.
- このイニシアチブは,利用率,再入院率,または死亡率で測定された医療の質の有意な改善をもたらしませんでした.
- BPCI- Aは,研究期間中に心血管疾患または手術における目標の達成に効果を示さなかった.
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