医疗补助负责任的护理组织和儿童喘护理的差异
Kimberley H Geissler1, Meng-Shiou Shieh1, Arlene S Ash2
1Department of Healthcare Delivery and Population Sciences, University of Massachusetts Chan Medical School-Baystate, Springfield.
JAMA pediatrics
|September 30, 2024
概括
马萨诸塞州的医疗补助负责任照顾组织 (ACO) 没有改善儿童的常规喘诊所. 虽然Medicaid患者的适当喘药物比率有所改善,但急诊室的使用量增加,导致喘儿童的差异加剧.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 儿科喘护理 儿科喘护理
- 健康差异 在健康上的差异
背景情况:
- 数以百万计的美国儿童患有喘,许多人依赖医疗补助.
- 国家医疗补助计划正在采用负责任的护理组织 (ACO),但它们对儿科喘护理差异的影响尚不清楚.
研究的目的:
- 评估马萨诸塞州Medicaid ACO实施对儿童喘护理质量和利用的影响.
- 在ACO采用后,检查儿童喘护理中的基于保险的差异变化.
主要方法:
- 利用马萨诸塞州所有付款人索赔数据库 (2014-2020年) 针对2至17岁的患有喘的儿童.
- 雇佣差异分析 (DiD) 分析,以比较医疗补助和私人保险儿童在2018年3月ACO实施前后的结果.
- 根据人口,社区和健康状况因素进行调整.
主要成果:
- 在ACO实施后,医疗补助和私人保险儿童之间的常规喘访问率没有显著变化.
- 医疗补助保险儿童的适当喘药物比率 (AMR>0.5) 增加,但绝对率总体下降.
- 与ACO实施后私人保险儿童相比,医疗补助保险儿童使用急诊室或医院的增加.
结论:
- 马萨诸塞州医疗补助局的ACO并没有消除常规喘诊所的差异.
- 由于私人保险群体的下降,适当的喘药物治疗比例的差异缩小了.
- ACO的实施与喘儿童紧急护理利用率的差异加剧有关.
- 需要进一步研究医疗补助资金和医疗补助系统改革对儿科喘护理的影响.
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