设施医疗补助支付人的负担和慢性肢体威胁性缺血症的非选择性入院
Steven Medvedovsky1, Sherene E Sharath1,2, Panos Kougias1
1Department of Surgery, State University of New York, Downstate Health Sciences University, Brooklyn.
JAMA surgery
|January 22, 2025
概括
医疗补助患者比例较高的设施对慢性四肢威胁性缺血症 (CLTI) 有更多的非选择性入院. 这表明,在资源有限的机构管理更复杂的病例时,存在不匹配,这会影响公平的患者护理.
科学领域:
- 血管外科 血管外科
- 医疗保健服务研究 医疗服务研究
- 公共卫生 公共卫生
背景情况:
- 慢性四肢威胁性缺血 (CLTI) 是一个重大的公共卫生挑战,需要大量资源来实现最佳的患者管理.
- 了解疾病严重程度和不同能力的设施的资源需求对于有效的护理提供至关重要.
研究的目的:
- 检查医疗补助患者在医疗机构的比例与CLTI非选择性入院率之间的关系.
- 确定与设施资源能力和患者付费组合相关的护理方面的潜在差异.
主要方法:
- 从1998年到2020年,使用国家住院患者样本,对美国8,769个医院的876,026例CLTI相关住院患者的回顾性分析.
- 设施根据其医疗补助患者比例 (医疗补助负担) 被分为五分之一.
- 对CLTI的非选择性入院 (紧急/紧急) 使用ICD代码识别休息疼痛,和.
主要成果:
- 随着医疗补助负担的增加 (59.7%至66.8%,P <.001),观察到增加非选择性CLTI入院的显著趋势.
- 这种关联在所有CLTI严重程度上都存在,包括休息疼痛,下肢和.
- 医疗补助负担最高的医疗机构的非选择性CLTI入院率调整后明显更高 (aOR 1.44;P < .001).
结论:
- 服务于更高比例的医疗补助患者的设施面临非选择性,资源密集型CLTI入院的可能性更大.
- 这突显了医院资源与患者需求之间的严重不匹配,可能会影响公平护理.
- 考虑设施级患者人口统计和资源能力对于有效的医疗保健资源分配至关重要.
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