对北卡罗来纳州医疗补助公司索赔数据的分析,以模拟儿科负责任护理组织的数据
Rushina Cholera1,2,3, David M Anderson1,3, Richard Chung2
1Duke Margolis Center for Health Policy, Duke University, Durham, North Carolina.
JAMA network open
|August 4, 2023
概括
一小群患有医疗复杂性的儿童在儿科负责任护理组织 (ACO) 中带来了高成本,突出了针对量身定制的基于价值的护理模式的需要. 泄漏的护理是相当大的,影响了总体成本.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 儿科健康经济学 儿科健康经济学
- 基于价值的护理模式
背景情况:
- 基于价值的支付模式在儿科中越来越受欢迎,但它们的设计往往忽视了儿童和年轻人的独特需求.
- 了解儿科的使用模式对于有效的负责任的护理组织 (ACO) 设计至关重要.
研究的目的:
- 模拟归因于假设的儿科ACO,并分析人口特征,支出和利用模式.
- 确定影响儿科人口成本和护理模式的因素.
主要方法:
- 在2017年使用北卡罗来纳州医疗补助申请数据对1至20岁的个人进行了回顾性队列研究.
- 在大型学术医疗中心 (AMC) 的初级护理基础上,归因为假设的儿科ACO.
- 分析2018年绩效年度的护理总成本和护理利用率.
主要成果:
- 在27,290名被归因的个人中,1.0%占总成本的近一半,通常与复杂的医疗条件和离AMC更远的距离有关.
- 护理总成本主要发生在家庭 (43%) 和门诊专科机构 (19%) 中.
- 超过一半的被归因的个人在ACO之外接受了护理 ("泄露的护理"),其中一些人的费用超过了护理总费用.
结论:
- 假设儿科ACO中的大多数儿童的利用率较低,但具有医疗复杂性的子组承担了高成本,并利用了广泛的家庭和专业护理.
- 在ACO以外的实质性"泄漏护理"需要针对儿科ACO进行特定的设计考虑.
- 结果为未来的儿科ACO设计提供了有关归因,高成本患者管理和减轻漏洞护理策略的信息.
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