在门诊内镜和结肠镜检查期间利用麻醉服务以及2003-2009年的相关支出
Hangsheng Liu1, Daniel A Waxman, Regan Main
1RAND Corporation, Boston, MA 02116, USA.
JAMA
|March 23, 2012
概括
2003年至2009年期间,胃肠道内镜的麻醉服务显著增加,主要针对低风险患者. 使用和付款因地区而异,突出显示了不断变化的程序性镇静实践.
科学领域:
- 胃肠病学 胃肠病学
- 麻醉学 麻醉学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 在胃肠道 (GI) 内镜中使用麻醉服务,特别是在低风险个体中,没有得到充分的记录,并且仍然是争论的主题.
- 了解胃肠道手术麻醉提供趋势对于资源配置和患者护理标准至关重要.
研究的目的:
- 分析消化道手术麻醉服务的使用和报销的时间变化和地理差异.
- 为了确定患者的风险概况和与胃肠病学中麻醉使用相关的区域差异.
主要方法:
- 从2003年至2009年期间,对大量的医疗保险 (1100万) 和商业保险 (500万) 患者的索赔数据进行了回顾性分析.
- 检查了胃肠道手术 (上部内镜,结肠镜) 与麻醉索赔,相关支付的比例,以及对低风险患者 (ASA身体状况类1或2) 提供的服务的比例.
主要成果:
- 从2003年到2009年,在医疗保险和商业保险人群中,在胃肠道手术中麻醉的使用率从约14%上升到30%以上.
- 超过三分之二的麻醉服务被给予低风险患者,观察到显著的区域差异 (13%西至59%东北).
- 在研究期间,胃肠道麻醉服务的支付在医疗保险中翻了一番,在商业保险患者中增加了四倍.
结论:
- 在2003年至2009年期间,在胃肠道手术中使用麻醉服务的数量大幅增加.
- 麻醉主要用于接受胃肠道手术的低风险患者,在服务提供和支付方面存在显著的区域差异.
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