透析设施的所有权和在接受血液透析的患者中使用 epoetin 的剂量
Mae Thamer1, Yi Zhang, James Kaufman
1Medical Technology and Practice Patterns Institute, Bethesda, Md 20814, USA.
JAMA
|April 19, 2007
概括
透析设施的所有权影响了治疗贫血时的乙烯剂量. 与非营利性设施相比,营利性连锁店的剂量更高,调整更大.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 医疗保健服务研究 医疗服务研究
- 药物经济学 药物经济学
背景情况:
- 乙烯治疗是透析相关贫血的主要医疗保险药物开支.
- 透析设施的特点,包括所有权,可能会影响epoetin的处方模式和成本.
研究的目的:
- 调查透析设施所有权与处方剂量之间的关系.
- 分析利状况,连锁加盟和设施类型如何影响时的管理.
主要方法:
- 美国脏数据系统对2004年11月至12月血液透析的159522名成年末期脏病患者的数据进行分析.
- 利用回归模型来比较不同设施所有权类型 (营利性与非营利性,连锁与独立) 中的平均时剂量和剂量调整.
主要成果:
- 大型营利性透析连锁的患者比非营利性机构的患者获得明显更高的埃波剂量 (平均3306个单位/周以上).
- 营利性机构显示了更积极的剂量调整,特别是对于血红素水平较低的患者 (<33%).
- 在大型连锁设施中观察到每周的时剂量 (17,832 U 到 24,986 U) 的显著变化,即使患者病例组合相似.
结论:
- 透析设施的所有权和组织结构是美国时剂量变化的关键因素.
- 营利链表现出不同的剂量策略,包括更大的剂量调整和针对更高的血红素水平.
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