处方阿片类药物剂量,支付者类型和密歇根州外科手术后的自我报告结果,2018-2020年
Christopher J Breuler1, Christina Shabet2, Lia D Delaney3
1Department of Surgery, Michigan Medicine, Ann Arbor.
JAMA network open
|July 10, 2023
概括
协作质量改善倡议减少了所有保险类型 (包括医疗保险和医疗补助) 的术后阿片类药物处方. 这些努力随着时间的推移缩小了处方大小的差异,使更广泛的患者群体受益.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 改善外科手术的质量
- 疼痛管理和阿片类药物管理
背景情况:
- 协作质量改进 (CQI) 模型,通常由私人付款人支持,旨在通过医院网络加强医疗保健服务.
- 最近的CQI努力集中在阿片类药物管理上,但在不同保险类型中统一减少手术后阿片类药物处方仍然不清楚.
研究的目的:
- 评估保险支付人类型 (私人,医疗保险,医疗补助) 和术后阿片类药物处方大小之间的关联.
- 评估保险类型对患者报告结果的影响,包括阿片类药物消费和补充率.
主要方法:
- 这是一项回顾性队列研究,使用了密歇根外科质量协作临床注册表 (2018-2020) 中70家医院的数据.
- 包括接受一般性,结肠直肠,血管或妇科手术的成年患者.
- 分析了阿片类药物处方大小 (mg OME),患者报告的消费,补充率,满意度,疼痛,生活质量和遗憾.
主要成果:
- 在研究期间,所有保险组 (私人,医疗保险,医疗补助) 的术后阿片类药物处方量都下降了.
- 在医疗补助患者中,阿片类药物的消费量最高,但随着时间的推移而增长最少.
- 与私人保险相比,医疗补助患者的补充率随着时间的推移显著下降,调整后的费率在研究结束时趋同.
结论:
- 在全州CQI模型中,所有保险类型的术后阿片类药物处方大小都下降了,缩小了群体间的差异.
- 尽管私人纳税人提供资金,但CQI模型对医疗保险和医疗补助病人的好处是显著的,这表明了更广泛的积极影响.
- 研究结果支持CQI在促进不同患者群体和保险计划的阿片类药物管理方面的有效性.
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