检查相对价值单位和患者报告的结果之间的关系:对基于价值的护理的影响
Justin J Turcotte1, Jane C Brennan, Andrea H Johnson
1From the Luminis Health Anne Arundel Medical Center Orthopedics, Annapolis, MD.
概括
工作相对值单位 (wRVU) 在骨科中很常见,但与患者报告的身体功能改善几乎没有关联. 单独测量工作复杂性和功能结果对于基于价值的护理至关重要.
科学领域:
- 整形外科手术 整形外科手术
- 卫生经济学 卫生经济学
- 患者的治疗结果.
背景情况:
- 工作相对价值单位 (wRVU) 是骨科外科医生普遍使用的薪酬模式.
- 转向以价值为基础的支付需要将质量和结果措施,包括患者报告的结果,整合到补偿中.
研究的目的:
- 评估wRVU与患者报告结果测量信息系统-身体功能 (PROMIS-PF) 评分的变化之间的关系.
- 确定wRVU是否可以作为患者报告的身体功能改善的代理.
主要方法:
- 对2,996次整形外科手术的回顾性审查.
- 分析患者特征,外科医生发票的wRVU,手术室 (OR) 时间和PROMIS-PF得分变化.
- 应用皮尔森相关性和多变量线性回归.
主要成果:
- 在wRVU和OR时间 (r = 0.732) 之间发现了强烈的正相关性,解释了OR时间变化的54%.
- 在wRVU和PROMIS-PF得分变化之间观察到微弱的正相关性 (r = 0.058),解释不到1%的变化.
- 每增加1点的wRVU与手术持续时间增加3分钟和PROMIS-PF变化增加0.02点有关.
结论:
- 在整形外科子专业之间,在wRVU和身体功能改善方面存在显著的变化.
- wRVU与手术时间有很强的相关性,但与功能改善的关联很小.
- 基于价值的支付模式应该保持对工作复杂性和功能结果的独特措施.
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