心血管支出,护理利用和参与护理改善捆绑支付的临床结果的变化 - 高级
Sukruth A Shashikumar1,2, Jie Zheng3, E John Orav4,5
1Department of Medicine (S.A.S.), Brigham and Women's Hospital, Boston, MA.
Circulation
|September 8, 2023
概括
综合支付改善护理 - 先进 (BPCI-A) 计划没有减少心血管疾病的支出或提高质量. 这项医疗保险计划在支出,利用,再入院或心脏病发作死亡率上没有显著变化.
科学领域:
- 卫生经济与政策
- 心血管医学
- 改善医疗保健的质量
背景情况:
- 综合支付改善护理 - 先进 (BPCI-A) 计划是旨在降低特定护理病例的医疗保健支出的医疗保险计划.
- 心血管疾病是医疗保险支出的主要贡献者,因此成为BPCI-A的重点领域.
- BPCI-A对心血管疾病的支出和质量的影响仍在调查中.
研究的目的:
- 评估BPCI-A倡议是否与心血管疾病的医疗支出减少有关.
- 评估BPCI-A对护理质量的影响,包括患者复杂性,利用率,再入院率和心脏病发作死亡率.
- 为了比较参与BPCI-A的医院与与之匹配的非参与对照医院的结果.
主要方法:
- 使用Medicare索赔数据进行了回顾性队列研究设计.
- 对2017年1月1日至2019年9月30日期间出院的患者进行了差异分析.
- 主要结局包括心脏病医疗和程序性发作支出的差异变化;次要结局评估了患者的复杂性,护理利用率,在家健康的日子,再入院和死亡率.
主要成果:
- 与对照组相比,BPCI-A医院的心脏病发作 (+ 16美元) 或手术发作 (+ 171美元) 的支出没有显著差异.
- 在医生护理模式,患者复杂性或护理利用方面发现了最小的差异性变化.
- 对于医疗或手术性心脏病发作,BPCI- A和对照医院之间的90天再入院率或死亡率没有统计学意义上的差异.
结论:
- 参与BPCI- A计划并没有减少针对心血管疾病的医疗支出.
- 这一举措并没有显著改善护理质量, 以利用率,再入院率或死亡率来衡量.
- 在研究期间,BPCI- A在心血管疾病或手术方面没有表现出有效性.
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