在医疗保险受益者中诊断频率和死亡风险的地理差异
H Gilbert Welch1, Sandra M Sharp, Dan J Gottlieb
1Department of Veterans Affairs Medical Center, White River Junction, Vermont, USA. h.gilbert.welch@dartmouth.edu
JAMA
|March 17, 2011
概括
在地理区域内,慢性疾病的诊断频率较高与患者死亡率较低相关. 这项研究发现,医疗保险受益人区域诊断率和病例死亡率之间存在反向关系.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 流行病学 流行病学
- 公共卫生 公共卫生
背景情况:
- 诊断通常被视为患者的特征,影响医疗保健中的风险调整政策.
- 政策旨在奖励高效和高质量的护理,诊断起着至关重要的作用.
研究的目的:
- 调查地理区域内慢性病诊断频率与病例死亡率之间的关联.
- 分析美国的收费医疗保险受益者之间的这种关系.
主要方法:
- 2007年对5,153,877名医疗保险受益者的横截面分析.
- 在306个医院转诊区域 (HRR) 中检查了9种严重慢性疾病的平均数量.
- 根据诊断频率,HRR被分为五分之一;根据年龄/性别/种族调整的病例死亡率计算.
主要成果:
- 诊断频率在HRR之间有显著的差异,从每位受益者0.58到1.23个条件.
- 更高的诊断病症数量与死亡风险增加有关.
- 相反,区域诊断频率的增加显示,患有一种或多种慢性疾病的患者病例死亡率逐步下降.
结论:
- 慢性病诊断的区域频率与病例死亡率之间存在反向关系.
- 一个地区的更高的诊断率与患有慢性疾病的受益人死亡率较低有关.
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