肺炎不仅仅是肺炎:利用率和成本的差异与常见的并发病
Jessica T Lee1,2,3, Amol S Navathe2,4,5, Rachel M Werner2,5,6
1Department of Medicine, Perelman School of Medicine, Pulmonary, Allergy, and Critical Care Division, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Journal of hospital medicine
|October 10, 2023
概括
患有慢性阻塞性肺病 (COPD) 和/或心力衰竭的肺炎患者需要更高的成本和不同的护理途径. 了解这种异质性是基于价值的护理改革的关键.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 临床医学 临床医学
- 卫生经济学 卫生经济学
背景情况:
- 肺炎是住院的常见原因,也是支付改革的目标.
- 患者的异质性,特别是伴随性疾病,可以显著影响护理利用率和成本.
- 了解肺炎患者的护理变化对于有效的医疗管理至关重要.
研究的目的:
- 探索住院肺炎患者之间的异质性.
- 为了比较慢性阻塞性肺病 (COPD) 和/或心力衰竭的肺炎患者的急性后护理利用率和成本.
- 通过考虑患者特征,为基于事件的支付改革策略提供信息.
主要方法:
- 对因肺炎住院的医疗保险受益人的回顾性队列研究.
- 90天护理费用与急症后护理利用率的比较.
- 对只有肺炎的患者与肺炎和并发症 (COPD和/或心力衰竭) 的患者进行分析.
主要成果:
- 在1,926,674名出院者中,28.1%患有COPD,14.3%患有心力衰竭,14.6%患有两者.
- 只有肺炎和心力衰竭的患者最有可能被送往医院.
- 与仅患有肺炎的患者相比,COPD和/或心力衰竭患者的病例支付较高.
结论:
- 肺炎患者的异质性,定义为COPD和心力衰竭等并发症,影响护理途径和成本.
- 针对肺炎的基于情节的支付改革需要考虑患者特定的因素,而不仅仅是初级诊断.
- 干预措施必须考虑到患者的异质性,以改善基于价值的护理结果.
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