在医疗保险人口中对COVID-19的临床风险和门诊治疗的利用
Andrew D Wilcock1, Stephen Kissler2, Ateev Mehrotra1,3
1Harvard Medical School, Boston, Massachusetts.
JAMA health forum
|January 26, 2024
概括
门诊COVID-19治疗在高风险的医疗保险患者中未得到充分使用,低风险人群接受更多的治疗. 重定位治疗可能会挽救成千上万人的生命.
科学领域:
- 公共卫生 公共卫生
- 医疗保健服务研究 医疗服务研究
- 流行病学 流行病学
背景情况:
- 有效的门诊COVID-19疗法可以预防住院和死亡.
- 现有的研究表明,在治疗机会方面存在种族和社会经济差异.
- 推动这些差异的因素及其对公共卫生的影响需要进一步调查.
研究的目的:
- 评估美国医疗保险人口中COVID-19门诊治疗的使用情况.
- 模拟风险分层治疗分配对严重COVID-19结果的影响.
主要方法:
- 使用2022年医疗保险服务费索赔数据进行横截面研究.
- 分析门诊COVID-19治疗使用情况,COVID-19测试,门诊诊所和住院治疗情况.
- 基于综合死亡风险评分的治疗重新分配的模拟.
主要成果:
- 在2022年,只有6.0%的医疗保险受益者接受了门诊COVID-19治疗.
- 风险较高的患者,包括老年人和黑人患者,与风险较低的白人患者相比,接受的治疗少.
- 将尼尔马特雷尔维尔等治疗方法重新分配给高危人群,可以避免16503例死亡.
结论:
- 低风险的医疗保险受益人不成比例地获得了COVID-19门诊治疗.
- 这种低于最佳的利用限制了这些疗法的公共健康益处.
- 缺乏临床准入或禁忌并不能解释观察到的治疗不足.
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