参与基于价值的医疗保健的卫生系统的透析成本
Leslie P Wong1, Anindita Ghosh, Jianbo Li
1Intermountain Kidney Services and Nephrology, Intermountain Healthcare, 5169 S Cottonwood St, Ste 320, Murray, UT 84107.
The American journal of managed care
|August 24, 2023
概括
不规划的"冲击式"透析开始成本显著增加,并导致较高的住院费用,而不是最优的开始. 改善透析启动策略对于基于价值的护理绩效至关重要.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 卫生经济学 卫生经济学
- 医疗保健管理的管理
背景情况:
- 未计划的"突发"透析开始与患者不良结果和医疗保健支出增加有关.
- 这些事件对以价值为基础的护理 (VBC) 模式下运行的卫生系统构成重大挑战.
- 优化透析启动对于改善VBC合同性能至关重要.
研究的目的:
- 检查与无计划"突发"透析相关的支出和医疗保健利用率,从一个大型综合医疗系统开始.
- 为了比较"崩"启动的成本和利用模式与"最佳"和"次优"透析启动策略.
主要方法:
- 这是一项回顾性,单一中心研究,分析了2017年至2020年期间过渡到透析的受益人.
- 定义的"崩"始于入院血液透析 (HD) 启动,使用中央静脉导管 (CVC).
- 分类开始为"最佳" (家庭透析或门诊无CVC的HD) 和"次优" (门诊的HD有CVC或住院的HD没有CVC).
主要成果:
- 分析了495名患者:260名"崩"开始,130名"最佳"开始,105名"低于最佳"开始.
- 分析前12个月的中位成本是"崩"启动 (67,059美元) 与"最佳" (17,891美元) 和"次优" (7,633美元) (P <.001) 的最高.
- 每1000名接受过透析后住院患者的入院次数在"突发"启动 (853) 时明显高于"最佳" (291) 和"次优" (184) (P < .001).
结论:
- "突发性"透析的开始会产生最高的医疗保健费用和医院利用率,在启动后持续.
- 这些发现强调了意外启动透析的经济和临床负担.
- 实施促进最佳透析启动的战略对于提高基于价值的护理结果至关重要.
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