退伍军人卫生管理局医院的并发症得分和严重程度较低:一个横截面研究
Matthew P Dizon1,2, Adam Chow3, Michael K Ong4,5
1Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, 795 Willow Road (152 MPD), Menlo Park, CA, USA. Matthew.Dizon@va.gov.
BMC health services research
|May 7, 2024
概括
退伍军人卫生管理局 (VHA) 的入院显示的并发症编码低于医疗保险的入院. 这表明文档强度的差异影响风险调整.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 医疗信息学 医疗信息学
- 退伍军人健康的医疗服务
背景情况:
- 之前的研究表明,退伍军人接受退伍军人卫生管理局 (VHA) 内外护理的退伍军人共同疾病记录存在差异.
- 最近的医疗保健系统变化,包括资金调整,绩效报告的强调和临床文档改进 (CDI) 计划的扩展,可能影响了VHA编码实践.
研究的目的:
- 为了比较随着时间的推移,不同医疗机构和支付人对退伍军人入院的并发症文档和严重性编码.
- 分析Elixhauser-van Walraven评分和Medicare严重性诊断相关组 (DRG) 严重性水平在VHA和非VHA设施之间的趋势.
主要方法:
- 利用7个美国州的VHA和全付款人退休数据 (2012-2017) 的连接重复的横截面数据.
- 为了减轻选择偏差,在同一年内被录取到VHA和非VHA医院的退伍军人中比较了Elixhauser-van Walraven并发症得分和DRG严重程度.
- 采用了通用线性模型,根据患者和医院的特点进行调整.
主要成果:
- 与其他设置相比,调整后的VHA入院表明持续较低的平均并发症得分 (4.44) 和最严重的DRG (22.1%) 的可能性较低.
- 医疗保险覆盖的入院患者的平均并发病率得分较高 (5.71),并更有可能患上最严重的DRG (35.3%).
结论:
- 研究结果表明,VHA和非VHA设置之间的编码强度可能存在差异,影响了风险调整后的比较.
- 加强策略可能是必要的,以提高VHA临床文档的质量.
- 当前的风险调整方法应考虑和考虑医疗保健系统之间编码强度的变化.
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