透析设施支付人协会与获得脏移植的机会进行混合
David C Cron1,2, Thomas C Tsai2,3, Rachel E Patzer4,5
1Department of Surgery, Massachusetts General Hospital, Boston.
JAMA network open
|July 11, 2023
概括
患者级商业保险增加了脏移植等待名单,但透析设施的商业付款人组合并没有独立影响等待名单的访问. 进一步监测保险对移植机会的影响至关重要.
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
- 移植免疫学 移植免疫学
背景情况:
- 对末期病 (ESKD) 患者的保险覆盖越来越多地是商业化的.
- 透析设施支付者组合对脏移植获取的影响尚不清楚.
研究的目的:
- 检查透析设施商业付款人组合和脏移植1年的等待列表之间的关联.
- 区分患者层面与机构层面的商业保险对移植等待名单的影响.
主要方法:
- 使用美国脏数据系统数据 (2013-2018) 的回顾性队列研究.
- 包括233,003名开始慢性透析的患者 (年龄18-75岁).
- 多变量考克斯回归调整为患者和设施因素.
主要成果:
- 患者级商业保险与更高的等待名单率有关 (aHR,1.86).
- 更高的便利商业付款人组合显示在调整之前等待列表增加.
- 在对患者保险状况进行调整后,设施级商业付款人组合与等待名单没有显著的关联 (aHR,1.02).
结论:
- 虽然个人商业保险增加了移植等待名单,但设施一级的付款人组合并不独立地影响它.
- 不断变化的保险环境对移植机会的影响需要持续观察.
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