增加利用管理风险的因素:一个概念验证
Jason Shafrin1, Jacob Fajnor, Shurui Zhang
1Center for Healthcare Economics and Policy, FTI Consulting, 350 S Grand Ave, Ste 3000, Los Angeles, CA 90071.
一个新的指标,即基于数据的利用管理风险指标 (BURDEN) 评分,量化了利用管理政策对患者的风险. 付费者对高风险治疗表现出一些敏感性,但决策并不完全以患者为中心.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 制药政策 制药政策
- 患者的治疗结果.
背景情况:
- 付款人的利用管理 (UM) 政策显著影响患者获得治疗的机会.
- 量化与UM政策相关的患者风险对于评估医疗保健准入至关重要.
- 现有的指标没有充分捕捉到UM实施的以患者为中心的风险.
研究的目的:
- 开发一种定量指标,即基于数据的利用管理风险指标 (BURDEN) 评分,以评估来自UM政策的患者风险.
- 评估BURDEN评分和医疗保健支付人的现实世界UM实践之间的关联.
主要方法:
- 使用有针对性的文献审查和专家诱导来制定BURDEN评分,结合了9个以患者结果为重点的UM因素.
- 根据6个利益相关者的投入,BURDEN评分被加权.
- 现实世界的数据分析,包括普通最小平方回归,检查了BURDEN分数和付款人覆盖政策之间的关系.
主要成果:
- 布尔登评分确定了UM政策的肌痛性骨髓灰质炎,多发性骨髓瘤和性炎为构成最高的患者风险.
- 拥有较高BURDEN分数的治疗与任何UM限制的可能性降低了22.0%,付款人修改步骤的可能性降低了36.2%.
- 对这些关联观察到的统计学意义 (P=.041和P=.039,分别).
结论:
- 该研究成功开发了BURDEN评分,这是一个与UM政策相关的患者风险的新型定量衡量标准.
- 付款人对BURDEN评分认定为高风险的治疗反应适度.
- 覆盖决策并不总是以患者为中心,正如一些高BURDEN治疗的UM使用增加所证明的那样.
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