主要付款人身份与冠状动脉旁路移植的死亡率和资源利用率有关
Damien J LaPar1, George J Stukenborg, Richard A Guyer
1Department of Surgery, University of Virginia Health System, Charlottesville, VA, USA.
Circulation
|September 12, 2012
概括
医疗补助或没有保险的患者在冠状动脉旁路移植 (CABG) 后面临更高的住院死亡率. 医疗补助计划的患者也经历了更长的住院时间和更高的成本,这表明在护理方面存在差异.
科学领域:
- 心血管外科心血管外科
- 医疗保健服务研究 医疗服务研究
- 卫生经济学 卫生经济学
背景情况:
- 医疗补助和没有保险的人口是医疗改革的关键考虑因素.
- 冠状动脉绕道移植 (CABG) 的结果可能受到主要付款人身份的影响.
研究的目的:
- 调查首要付款人身份和冠状动脉旁路移植 (CABG) 后的结果之间的关联.
- 确定付款人身份是否影响住院死亡率,住院时间和CABG后的总成本.
主要方法:
- 从全国住院患者样本 (NIS) 数据库 (2003-2007) 中分析了1,250,619个孤立的CABG操作.
- 根据主要支付者的患者分层:医疗保险,医疗补助,无保险人和私人保险.
- 应用层次的多重回归模型来评估付款人身份对结果的影响,控制风险因素.
主要成果:
- 与私人保险患者相比,医疗补助和无保险患者的住院死亡率调整后的几率更高.
- 医疗补助支付人身份与最长的调整住宿时间和最高的调整总成本有关.
- 在医疗保险,医疗补助和未保险人群中,未调整的死亡率高于私人保险.
结论:
- 医疗补助和无保险身份是CABG后医院死亡率调整后增加的独立风险因素.
- 医疗补助患者的住院时间更长,调整后的总成本更高.
- 在获得护理或健康维护方面的差异可能解释了观察到的结果差异.
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